Topical Dexamethasone Research Articles

Preclinical Testing of Dendritic Core-Multishell Nanoparticles in Inflammatory Skin Equivalents.

Human skin equivalents emerged as novel tools in preclinical dermatological research. It is being claimed that they may bridge the translational gap between preclinical and clinical research, yet only a few studies have investigated their suitability for preclinical drug testing so far. Therefore, we investigated if inflammatory skin equivalents, which emulate hallmarks of atopic dermatitis (AD), are suitable to assess the anti-inflammatory effects of dexamethasone (DXM) in a cream formulation or loaded onto dendritic core-multishell nanoparticles. Topical DXM application resulted in significantly decreased expression of the proinflammatory cytokine TSLP, increased expression of the skin barrier protein involucrin, and facilitated glucocorticoid receptor translocation in a dose-dependent manner. Further, DXM treatment inhibited gene expression of extracellular matrix components, potentially indicative of the known skin atrophy-inducing side effects of glucocorticoids. Overall, we were able to successfully assess the anti-inflammatory effects of DXM and the superiority of the nanoparticle formulation. Nevertheless the identification of robust readout parameters proved challenging and requires careful study design.

Peripheral Ulcerative Keratitis Secondary to the Inactive COVID-19 Vaccine-CoronaVac

ABSTRACT Purpose To report a case of peripheral ulcerative keratitis (PUK) secondary to the inactive Covid-19 vaccine. Methods The case of a 67-year-old man who presented with unilateral progressive vision-threatening PUK with nodular scleritis was reported. The results of clinical examinations with surgical and medical treatments were noted. Results The extended workup for autoimmune and infectious etiologies for PUK that all returned negative. The patient was treated with oral steroids, azathioprine, and topical cyclosporine with topical dexamethasone for his PUK and underlying possible immunopathology. Corneal amniotic membrane grafting was also performed 4 times and finally, the patient underwent penetrant keratoplasty for visual rehabilitation. Conclusions To our knowledge, we report the first case of PUK that is possible to secondary to an inactive vaccine for SARS-CoV-2. The inactive covid vaccine should be considered as an etiological agent in PUK cases where the standard workup is negative.

Objective measurement of adherence to topical steroid medication after penetrating keratoplasty using an electronic monitoring aid: A pilot study.

ObjectivesCorneal transplantation is the most common transplant worldwide and its success critically depends on the management of corneal graft rejection through topical steroid therapy during the first 12 months after surgery. There is currently no published data on adherence after keratoplasty. This pilot study aims to explore the adherence to topical steroid after penetrating keratoplasty using a smart electronic device.MethodsThirty patients undergoing penetrating keratoplasty were included to evaluate the adherence to topical dexamethasone medication for 12 months after surgery. Patients received the usual post-transplantation treatment (topical dexamethasone) and follow-up after surgery (day 15, months 1, 2, 3, 4, 5, 6, 9, and 12). Adherence to treatment was monitored using the KaliJAR device (Kali Care, Santa Clara, CA, USA), which recorded the number of single-dose units (SDU) discarded. At control visits, data recorded by the device were compared to the manually count of SDU. Adherence ratio and individual adherence curve were explored for all patients.ResultsData from 27 patients showed a high agreement between adherence ratio calculated based on the device data and obtained from manual counting of the discarded SDU (intraclass coefficient correlation of 0.87 [95% CI: 0.738–0.938]). Mean adherence to the treatment over the 12-month study period was 95.2 ± 4%.ConclusionsAdherence to topical dexamethasone for 12 months after corneal transplantation was high. The connected device was able to record accurately the discarded SDU. This approach would be a particular interest in the early identification and personalized follow-up of poorly adherent patients.

Intraocular Pressure Elevation Following the Use of Topical Dexamethasone Ointment After Squint Surgery.

Purpose:To describe the pattern of intraocular pressure (IOP) changes after squint surgery in eyes of black Africans at the University College Hospital, Ibadan, Nigeria.Materials and Methods:This was a retrospective review of the clinical records of patients who underwent squint surgery between 2010 and 2019. Data on demographic characteristics, preoperative and postoperative intraocular pressure values, co-existing ocular pathology, type of strabismus, surgery performed, frequency and duration of postoperative topical steroid use and treatment received for elevated intraocular pressure were collected and descriptively summarised.Results:Thirty-six (39.1%) out of 92 patients who had squint surgery during the study period met study inclusion criteria. Mean age was 20.5 ± 13.6 years. All patients were administered Maxitrol® ointment postoperatively. Baseline, peak and net change in IOP were 12.9 ± 2.6 mmHg, 21.3 ± 6.8 mmHg and 8.39 ± 7.2 mmHg respectively. Thirty-one (86.1%) patients had elevation in IOP from baseline; 21 (67.7%) of these had significant IOP elevation. Topical steroid therapy was tailed off rapidly for all patients with significant IOP elevation. Twelve patients were commenced on topical IOP lowering medications, with normalization of intraocular pressure in majority of them by three months after surgery.Conclusion:Elevated intraocular pressure with the use of topical dexamethasone ointment after squint surgery was common in this study and majority of the patients had significant elevation in intraocular pressure. Close monitoring of the intraocular pressure of black patients, especially children, on topical steroid medication after squint surgery is strongly recommended.

Scedosporium scleritis following pterygium excision with conjunctival autograft

A 67-year-old female presented 6 months following left pterygium surgery with autoconjunctival graft with presumed episcleritis. Following a trial of topical dexamethasone, she returned with pain, reduced vision, and a donor-site scleral nodule. MRI orbits demonstrated scleritis; oral prednisolone was commenced for presumed immune-mediated scleritis. Ten days later, vision reduced to light-perception with significant vitritis overlying a subretinal lesion associated with the donor site. Vitreous tap cultured Scedosporium aurantiacum. Treatment consisted of vitrectomy, scleral debridement with corneal patch graft, with both systemic and intravitreal voriconazole. Further scleral debridement was attempted but unable to be completed due to its posterior extent. As repeat MRI orbits showed persistent active scleritis in proximity to the optic nerve which posed a risk of meningitis, a decision was made for enucleation. This case highlights the difficulties in distinguishing between infectious and autoimmune scleritis, and the importance of excluding infection, particularly in eyes with prior surgery.

Treatment of oral chronic graft-versus-host disease: a retrospective cohort study.

ABSTRACTObjective The aim of this study was to evaluate patients with complete response of oral chronic graft-versus-host disease to immunosuppressive treatment.Methods A total of 29 patients submitted to allogeneic hematopoietic stem cell transplantation, with oral chronic graft-versus-host disease, were enrolled in this retrospective study, from September 2012 to February 2018. Patients were treated with combined topical dexamethasone solution and topical tacrolimus ointment, combined topical dexamethasone and topical tacrolimus, systemic immunosuppressive medication, and topical dexamethasone only.Results The mean time of complete response of lichenoid lesions, erythema, and ulcers using dexamethasone and systemic immunosuppressive medication was of 105, 42 and 42 days, respectively (p=0.013).When we associated dexamethasone, tacrolimus and systemic immunosuppressive medication, the mean time of complete response of lichenoid lesions, erythema and ulcers was of 91,84 and 77 days (p=0.011). When dexamethasone was used alone, the mean time of complete response of lichenoid lesions, erythema and ulcers was 182, 140, 21 days, respectively (p=0.042).Conclusion Our study shows that lichenoid lesions require more time to heal. Notably, lichenoid lesions tend to respond better to dexamethasone combined with tacrolimus and systemic immunosuppressive medication, whereas erythema and ulcers respond better to dexamethasone combined with systemic immunosuppressive medication and dexamethasone only, respectively.

A randomized clinical trial of topical dexamethasone vs. cyclosporine treatment for oral lichen planus.

Background Oral lichen planus (OLP) is a common, frequently symptomatic, immune-mediated disease. Various treatments have been used for symptomatic OLP, including corticosteroids and immunosuppressants administered topically or systemically. The aim of this study was to compare the effectiveness of topical dexamethasone vs. topical cyclosporine in treatment of symptomatic OLP.Material and Methods Thirty-two patients with biopsy-proven symptomatic OLP were randomly assigned to two therapeutic groups: dexamethasone 2mg/5ml or cyclosporine 100mg/ml, both administered topically in a swish and spit method three times a day for 4 weeks. The patients were followed up for a total of 6 months. Assessed parameters included clinical scoring (according to Thongprasom’s scale, 0-5), pain (VAS scale, 0-10), dysphagia and speech difficulties (none, mild or severe). Possible side effects, including fungal overgrowth, were also recorded.Results At the end of the 4-week treatment period, both dexamethasone and cyclosporine showed a statistically significant improvement in clinical scoring (p<0.025 and p=0.034, respectively), which was better with dexamethasone (p=0.001). In addition, both dexamethasone and cyclosporine induced statistical significant improvement in pain and dysphagia (and speech difficulties for dexamethasone), without significant differences between the two groups. Regarding side effects, patients in the dexamethasone group developed candidiasis more frequently compared to cyclosporine (p=0.031).At the end of the 6-month follow-up period, the difference in response between the two groups was not statistically significant. Interestingly, a trend for further improvement compared with the end of the 4-week treatment period was noticed only for patients treated with cyclosporine.Conclusions Despite the small number of enrolled patients, topical cyclosporine treatment induces a significant clinical improvement in symptomatic OLP patients, which, compared to topical dexamethasone, appears to be less pronounced during initial administration, but capable to induce further improvement after discontinuation with a satisfactory long-term remission in the absence of significant side effects. This study may contribute to a better understanding of the differences in effectiveness of OLP topical treatments and guide future larger scale clinical trials. Key words:Oral lichen planus, topical treatment, dexamethasone, cyclosporine.

Systemic and topical Ginkgo biloba leaf extract (Egb-761) ameliorated rat paw inflammation in comparison to dexamethasone

Ethnopharmacological relevanceGinkgo Biloba leaf extract (Egb-761) is used for treating various inflammatory disease conditions therefore this study was performed. Aim of the studyThe present study aimed at comparing the ameliorative effects of both systemic and topical Egb-761 versus dexamethasone on carrageenan-induced hind paw inflammation in rats. Material and methodsWistar albino rats were injected with carrageenan solution in the sub-planter region of the right hind paw. Egb-761 and dexamethasone were administered systemically to two groups while Egb-761 ointment 2% and dexamethasone sodium phosphate ointment were applied topically for another two groups. Vernier Caliper was used to assess rat paw thickness. Tissue malondialdehyde (MDA), nitric oxide (NO), and tumor necrosis factor-α (TNF-α) levels have been estimated. ResultsCarrageenan induced a significant rat paw edema and inflammation noticed 1 h post-injection as well as an increase of MDA, NO, and TNF-α in the inflamed skin tissues compared to the control group. Systemic and topical administration of Egb-761 and dexamethasone resulted in a significant reduction in carrageenan-induced rat paw edema. They reduced the tissue levels of MDA, NO, and TNF-α. Dexamethasone showed a little bit superior anti-inflammatory and antioxidant efficacy over Egb-761. ConclusionOur findings indicate the possibility of the therapeutic value of Egb-761 for alleviation of local inflammation by attenuating the increased MDA, NO and TNF-α levels.

Dexamethasone-Eluting Contact Lens for the Prevention of Postphotorefractive Keratectomy Scar in a New Zealand White Rabbit Model.

To evaluate the safety and efficacy of an experimental dexamethasone-eluting contact lens (DCL) for the prevention of postphotorefractive keratectomy (PRK) corneal haze in a New Zealand White (NZW) rabbit model. Both eyes of 29 NZW rabbits underwent PRK. The rabbits were randomized to one of the 5 study arms for 4 weeks: tarsorrhaphy only, tarsorrhaphy and bandage contact lens (BCL) replaced weekly, tarsorrhaphy and BCL for 1 week plus topical 0.1% dexamethasone ophthalmic solution (drops) for 4 weeks, tarsorrhaphy and BCL replaced weekly plus topical dexamethasone for 4 weeks, and tarsorrhaphy and DCL changed weekly for 4 weeks. Each week for 4 consecutive weeks postoperatively, the tarsorrhaphies were opened, the eyes underwent evaluation and imaging, and the tarsorrhaphies were replaced. Contact lenses were cultured on removal. Central corneal haze was assessed weekly with corneal densitometry. After 4 weeks, the animals were killed, and the eyes were enucleated for histopathologic analysis. The tarsorrhaphy only group displayed more haze with a greater change in optical densitometry from pre-op compared with the other treatment groups. There was no difference between the DCL group and the groups receiving a BCL and dexamethasone drops in densitometry or histopathology. No NZW rabbits developed clinical signs of infection, and cultures from DCLs and BCLs grew similar organisms. In the post-PRK rabbit model, DCLs worn weekly for 4 weeks were safe and as effective at preventing corneal haze as 0.1% dexamethasone drops applied 4 times a day for 4 weeks.

The Influence of Ciprofloxacin-Dexamethasone Ear Drops on Perforation Closure Rates After Endoscopic Tympanoplasty.

Topical ciprofloxacin and dexamethasone have both been shown to disrupt healing of tympanic membrane perforations in animal models. There have been no clinical studies evaluating the effect of ciprofloxacin-dexamethasone (CD) ear drops on success of tympanoplasty. We compare perforation closure rates in pediatric endoscopic tympanoplasty with and without use of postoperative CD. Retrospective comparative cohort study. Tertiary referral centre. One hundred sixty-two totally endoscopic tympanoplasties with porcine-derived collagen graft in children, mean age 12.0 years (range 2.3-17.9 yrs). Prescription of CD versus no ear drops in the immediate postoperative period. Perforation closure rate 2 months after totally endoscopic tympanoplasty. Postoperative CD was given to 65 (40%) ears and no drops given to the remainder. Overall, successful closure of tympanic membrane perforation was achieved in 140 (86%) of ears. The closure rate was not significantly different in those ears given CD postoperatively than those not given CD (54/65 [83%] vs 86/97 [89%], Fisher's p = 0.35). Multiple logistical regression revealed no confounding effect of other variables on outcome including age, revision surgery, graft position, or type of postoperative packing material. Our results reveal no harm or benefit with prescription of drops containing ciprofloxacin and dexamethasone on success of perforation closure after tympanoplasty. Allocation to treatment in this retrospective study was nonrandomized and was predominantly based on a change in practice. No other variables are known to have influenced this finding but a randomized prospective study could be justified for more reliable evidence.

Comparative analysis of the post-operative anti-inflammatory effect of topical 0.1% dexamethasone sodium eye drops, topical 1% prednisolone acetate eye drops and difluprednate 0.05% topical eye drops after small incision cataract surgery at a tertiary eye care institute in India

Background & Objectives: Comparative analysis of the post-operative anti-inflammatory effect of topical 0.1% dexamethasone sodium eye drops, topical 1% prednisolone acetate eye drops and difluprednate 0.05% topical eye drops after small incision cataract surgery at a tertiary eye care institute in India. Materials and Methods: The current study was a prospective randomised control study conducted from June 2019 to January 2021 at a tertiary eye care institute in India after taking due clearance from the institutional ethical committee. 300 eyes of 215 patients were enrolled into the study and divided into three groups consisting of 100 eyes in each group. Group A patients received topical Dexamethasone 0.1% eye drops, group B & C received Prednisolone acetate 1% and difluprednate 0.05% eye drops respectively. Level of significance was kept at p Results: Baseline IOP values between the three groups did not show any statistical significance. Significant difference in the analgesia was observed in the difluprednate 0.05% group. AC cells & flare was decreased by around the 7th day of treatment in difluprednate and prednisolone acetate eye drops treated groups. Conclusion: To conclude our study opines that, dexamethasone is non-inferior and equally efficacious to prednisolone and difluprednate in the management of post cataract surgery inflammation. Although difluprednate 0.05% provides superior analgesia and early clearance of AC cells & flare, which may further aid in early visual rehabilitation and recovery. Keywords: Difluprednate, Prednisolone, AC cells, Flare, IOP.

Evaluation of Intraocular Pressure Changes with Topical Dexamethasone 0.1%, Prednisolone 1% and Difluprednate 0.05% Postcataract Surgery- A Randomised Clinical Trial

Introduction: Topical corticosteroids are most commonly used for the control of postoperative inflammation after cataract surgery. Topical steroids may cause increase in Intraocular Pressure (IOP) which, if left untreated may lead to progressive optic nerve damage and glaucomatous field defects. Aim: To compare the ocular hypertensive response of three commonly used corticosteroids in an effort to generate evidence for managing postcataract surgery inflammation more effectively. Materials and Methods: This randomised clinical trial was carried out for a period of one year from November 2018 to October 2019, among 150 patients undergoing cataract surgery. Patients were divided into three groups. Group A-50 patients received topical dexamethasone 0.1%, Group B-50 patients received topical prednisolone 1% and Group C-50 patients received topical difluprednate 0.05% four times a day for six weeks after cataract surgery. Postoperative IOP was recorded preoperatively, on first postoperative day and at the end of first week, third week and sixth week with non contact tonometer and statistical significance was assessed with the help of repeated measures mixed model Analysis of Variance (ANOVA). Results: The mean age of the patients was 64.4±9.39 years, 48% were males and 52% patients were females. Mean IOP in the three drug groups was not statistically significant at 1st week, 3rd week and at 6th week after cataract surgery. Two patients belonging to difluprednate group at the end of 1st week and one patient at the end of 3rd week after cataract surgery developed significant rise in IOP (&gt;31 mmHg). Conclusion: It can be concluded that all three steroids were equally safe and did not cause any statistically significant rise in IOP over six-week postoperative period. However, higher values were noted in difluprednate group at the end of first and third week after cataract surgery.

Stomatitis in mTOR inhibitors treatment and other targeted cancer therapy, possibilities of influencing it, and the use of local corticotherapy

BACKGROUND Stomatitis associated with targeted oncological therapy, typically everolimus related one, belongs among the major complications affecting the quality of life of a patient and intensity of his/her oncological treatment. Corticosteroids, especially for topical application, represent a major therapeutic and possibly prophylactic intervention. PURPOSE Basic summary of clinical characteristics, incidence and overview of possibilities of influencing the incidence of stomatitis related to targeted oncological therapy. RESULTS When treated with everolimus, the overall incidence of stomatitis is about two thirds of the patients. A solution with dexamethasone sodium phosphate 0.1mg/mL (0.01%) in the SWISH study showed a significant reduction in the complication when used as prophylactic mouthwash during the treatment with everolimus, and the solution is also suggested by the Europan Society for Medical Oncology guidelines for treatment in stomatitis with ulcers. The availability of topical dexamethasone is variable with respect to the concentration, type of dexamethasone salt and the formula. CONCLUSION Solutions containing dexamethasone are an integral part of oral care during targeted oncological therapy; however, the standardization of indications and prescriptions for standard use in practice still remains an open topic.

Comparative study of efficacy of topical dexamethasone 0.1% with difluprednate 0.05% in post-operative small incision cataract surgery

Introduction: Post-operative ocular inflammation is a common occurrence following cataract surgery. Corticosteroids have been used to treat ocular inflammation; however, they carry a risk of side effects, particularly an increase in intra ocular pressure (IOP). Previous studies have proved that difluprednate is more efficacious compared to dexamethasone. Hence this study was undertaken to compare the efficacy of difluprednate ophthalmic emulsion 0.05% and dexamethasone 0.1% in postoperative management after small incision cataract surgery. Materials and Methods: A total 200 patients were selected as per inclusion criteria and equally divided between difluprednate and dexamethasone groups. Dexamethasone 0.1% or difluprednate0.05% was prescribed post operatively following small incision cataract surgery. Patients were examined on post-operative day 1, 7, 15 and 30 for anterior segment by slit-lamp examination and side effects. IOP was measured in both the groups on day 30. Results: In our observation both drugs were efficient in the reduction of anterior chamber cells and flare with difluprednate being more rapid. Corneal edema was reduced equally by both the drugs at all observation periods. There was no clinically significant IOP elevation in both difluprednate and dexamethsone group. Difluprednate was found to be more effective in controlling pain compared to dexamethasone. Conclusion: As per present study both difluprednate ophthalmic emulsion 0.05% eye drops and dexamethasone 0.1% eye drops were equally effective in reducing post cataract surgery inflammation. Hence, difluprednate emulsion 0.05% can be used in post-operative management after cataract surgery; nonetheless, further clinical trials with long follow- up period are required. Keywords: Cataract surgery, Dexamethasone, Difluprednate, Dose uniformity, Ocular inflammation, Opthalmic emulsion.

Comparison of Intravenous and Topical Dexamethasone for Total Knee Arthroplasty: A Randomized Double-Blinded Controlled Study of Effects on Dexamethasone Administration Route and Enhanced Recovery

BackgroundThe optimal route for dexamethasone (DEX) administration regimen for patients undergoing primary TKA has not been investigated. This study aims to determine whether intravenous and topical DEX provide different clinical effects in patients with TKA. MethodsIn this double-blinded, placebo-controlled trial, 90 patients undergoing primary TKA were randomized to intravenous DEX group (n = 45) or topical DEX group (n = 45, DEX applied in anesthetic cocktail for periarticular injection). The primary outcome was postoperative VAS pain score and morphine consumption. Secondary outcomes were included knee swelling, knee flexion, and extension angle, Knee Society Score (KSS), and postoperative hospital stays. Tertiary outcomes assessed the blood-related metrics, including inflammatory biomarkers and fibrinolysis parameters. Finally, nausea and vomiting and other adverse events were compared. ResultsThe topical administration of DEX provide lower pain score at 2h, 8h, 12h at rest (P < .05) and 12h, 24h with activity (P < .05), and less knee swelling in the first postoperative day (P < .05), while intravenous DEX was more effective in decreasing blood inflammatory biomarkers, including C-reactive protein (CRP) at postoperative 24h (P < .05) and interleukin-6 (IL-6) at postoperative 24h, 48h (P < .05), and reducing postoperative nausea (P < .05) for patients receiving TKA. However, there was no significant difference in knee flexion and extension angle, KSS, postoperative hospital stays, and complications occurrence (P > .05) between intravenous and topical DEX after TKA. ConclusionTopical administration of DEX provided better clinical outcomes on postoperative pain management and knee swelling early after TKA, while intravenous DEX was more effective in decreasing blood inflammatory biomarkers and preventing postoperative nausea.

Choroidal thickness after phacoemulsification: nonrandomized comparison of postoperative topical ketorolac vs dexamethasone vs combination of ketorolac-dexamethasone eyedrops.

To compare the effect of topical dexamethasone vs ketorolac vs combined dexamethasone-ketorolac after phacoemulsification on choroidal thickness (CT). Tertiary university-based hospital. Prospective nonrandomized comparative case series. Ninety-two eyes of 92 patients were assigned to the 3 groups after uneventful phacoemulsification: Group 1, dexamethasone; Group 2, ketorolac; Group 3, combined dexamethasone-ketorolac applied topically. CT at subfoveal (SFCT), nasal, and temporal as primary and central retinal thickness (CRT) as secondary outcomes were measured preoperatively and at 1 month, 3 months, and 6 months postoperatively using enhanced depth-imaging optical coherence tomography. Preoperative CT was similar between the groups (all P > .05). The groups differed in pattern of changes in nasal and temporal CT (both P < .001) although their changes of CRT (P = .13) and SFCT (P = .55) over time were similar. The mean of SFCT at 1 month, 3 months, and 6 months was significantly higher than baseline in dexamethasone (P < .001 for all follow-ups) and combined (P < .001 for both 1 month and 3 months and P = .03 for 6 months) groups, whereas it was not statistically significant in the ketorolac group (P = .07). There was an increase in the nasal and temporal CT in 3 groups, persisted at 6 months in dexamethasone (both P < .001) and ketorolac (both P < .001) groups, whereas the change was not statistically significant at 6 months in the combined group. Choroidal thickness measurements were performed in 31 eyes of 31 patients in group 1, 29 eyes of 29 patients in group 2, and 32 eyes of 32 patients in group 3. Dexamethasone and combined groups had statistically significant changes of SFCT after phacoemulsification; however, the ketorolac group did not. The pattern of SFCT changes was similar between 3 groups.

Economic evaluation of prevention of cystoid macular edema after cataract surgery in patients without diabetes: ESCRS PREMED study report 4.

To investigate the cost-effectiveness of prophylactic treatments against cystoid macular edema (CME) after cataract surgery in patients without diabetes. Seven ophthalmology clinics in the Netherlands and Belgium. Prospective cost-effectiveness analysis using data from a European multicenter randomized clinical trial (ESCRS PREMED). Patients without diabetes planned for expected uneventful cataract surgery were randomized to topical bromfenac (Yellox, n = 242), topical dexamethasone (n = 242), or a combination treatment (n = 238). All relevant resources from a healthcare perspective were included in the cost analysis within a time horizon of 12 weeks postoperatively. The main effectiveness outcome was quality-adjusted life years (QALYs). The main cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER) based on the cost per QALY. The study comprised 722 patients without diabetes. Total healthcare costs and QALYs were € 447 (US $562) and 0.174 in the bromfenac group, €421 (US $529) and 0.179 in the dexamethasone group, and €442 (US $565) and 0.182 in the combination group. Bromfenac was most costly and least effective (ie, strongly dominated). The ICER was €6544 (US $8221) per QALY for the combination group compared with the dexamethasone group. Assuming that the willingness to pay is € 20 000 (US $25 126) per QALY, the cost-effectiveness probability was 3%, 32%, and 65% in the bromfenac, dexamethasone, and combination groups, respectively. In patients without diabetes, combination treatment with topical bromfenac and dexamethasone was effective and cost-effective in preventing CME after cataract surgery compared with treatment with either drug alone.

Functionally distinct IFN-γ+ IL-17A+ Th cells in experimental autoimmune uveitis: T-cell heterogeneity, migration, and steroid response.

Immunopathogenic roles for both Th1 (CD4+ IFN-γ+ ) and Th17 (CD4+ IL-17A+ ) cells have been demonstrated in experimental autoimmune uveitis (EAU). However, the role for Th17/Th1 (CD4+ T cells co-expressing IFN-γ and IL-17A) cells in EAU is not yet understood. Using interphotoreceptor retinoid-binding protein peptide-induced EAU in mice, we found increased levels of Th17/Th1 cells in EAU retinae (mean 9.6±4.2%) and draining LNs (mean 8.4±3.9%; p=0.01) relative to controls. Topical dexamethasone treatment effectively reduced EAU severity and decreased retinal Th1 cells (p=0.01), but had no impact on retinal Th17/Th1 or Th17 cells compared to saline controls. Using in vitro migration assays with mouse CNS endothelium, we demonstrated that Th17/Th1 cells were significantly increased within the migrated population relative to controls (mean 15.6±9.5% vs. 1.9±1.5%; p=0.01). Chemokine receptor profiles of Th17/Th1 cells (CXCR3 and CCR6) did not change throughout the transendothelial migration process and were unaffected by dexamethasone treatment. These findings support a role for Th17/Th1 cells in EAU and their resistance to steroid inhibition suggests the importance of targeting both Th17 and Th17/Th1 cells for improving therapy.

Topical Corticosteroids a Viable Solution for Oral Graft Versus Host Disease? A Systematic Insight on Randomized Clinical Trials.

Background and Objectives: This research attempts to provide a clear view of the literature on randomized clinical trials (RCTs) concerning the efficacy of topical dexamethasone, clobetasol and budesonide in oral graft versus host disease (GVHD). Materials and Methods: An electronic search of the PubMed, Web of Science and Scopus databases was carried out for eligible RCTs. Studies were included if they had adult patients with oral GVHD treatment with topical corticosteroids, and if the RCT study was published in English. The Cochrane Risk of Bias tool was used to assess the quality of these studies. Overall, three RCTs were included (an Open, Randomized, Multicenter Trial; a Randomized Double-Blind Clinical Trial; and an Open-Label Phase II Randomized Trial). Results: The trials involved 76 patients, of which 44 patients received topical dexamethasone, 14 patients received topical clobetasol and 18 patients received topical budesonide. Topical agents were most frequently used when oral tissues were the sole site of involvement. It appears that the best overall response is present for budesonide with no difference between the four arms, followed by clobetasol, and then by dexamethasone. The limitation of the current study is mainly represented by the fact that overall response was derived in two of the studies from other parameters. Moreover, both budesonide and clobetasol were used in only one study each, while two assessed dexamethasone. Conclusions: Based on the clinical trials, all three agents seem to be effective in treating oral GVHD and had a satisfactory safety profile. There is still a need for assessing high quality RCTs to assess the efficacy of these therapies on a larger cohort.

PENFIGÓIDE BOLHOSO INDUZIDO POR FÁRMACO: UM RELATO DE CASO

Bullous pemphigoid is the most common autoimmune dermatosisthat can be caused by drugs. The objective of this study was followingthe evolution of a patient with pharmacodermia in use of several drugs. A female patient was treated in a hospital in the city of Presidente Prudente, presenting intact and broken blisters, require etiological investigation. Other diagnostic hypotheses such as porphyria cutanea tarda were ruled out, and the diagnosis of bullous pemphigoid of pharmacological etiology was suggested through cutaneous biopsy of a blister. We stopped using antibiotics and kept the medication in continuous use. It wasintroduced oral prednisone and topical dexamethasone, and it was possible to observe a favorable evolution of the condition, without intercurrences and reduction of the blisters until only residual lesions remained. By analyzing the variables of the case it is assumed that the quinolones were responsible for the condition, emphasizing the importance of knowing the drug reactions to guarantee an early diagnosis.