Triamcinolone Acetonide Therapy Research Articles

Corrigendum to "Intralesional Triamcinolone Acetonide Therapy for Inflammatory Oral Ulcers". Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 128, Issue 5, 485 - 490.

Corrigendum to "Intralesional Triamcinolone Acetonide Therapy for Inflammatory Oral Ulcers". Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 128, Issue 5, 485 - 490.

Effectiveness of intraperitoneal or intrapleural administration of triamcinolone acetonide for the control of malignant ascites and pleural effusion (Kansai Clinical Oncology Group-G1102 study).

We conducted a retrospective multi-institutional study to evaluate the efficacy and toxicity of intraperitoneal or intrapleural triamcinolone acetonide (TA), a slowly metabolized corticosteroid administration for the management of malignant ascites or pleural effusion. The medical records of patients with gynecologic cancer who were treated with paracentesis or thoracocentesis followed by administration of 400 mg of TA between 2005 and 2014 were reviewed. The median age of the 74 eligible patients was 59 years. An Eastern Cooperative Oncology Group performance status 3-4 was present in 53 patients (73%), and 52 patients (70%) had ovarian cancer. Paracentesis followed by TA administration was performed in 65 patients (88%), and 37 patients (50%) were treated in a palliative setting. Chemotherapy or surgery after TA administration was performed in 37 patients (50%) in an aggressive setting, of which 14 patients (19%) were treated at the primary phase and 23 patients (31%) were treated at recurrent phase. The time interval of serial drainage was prolonged in 15 of 19 assessable patients, resulting in a response rate of 79% (95% confidence interval [95% CI]: 54-94%). Median overall survival after TA therapy in a palliative setting was 36 days (95% CI: 19-58 days). After TA therapy in a palliative setting, one patient complained of mild abdominal pain, two patients with advanced peritonitis carcinomatosis experienced bowel perforation, and three patients died within 7 days owing to disease progression. Intraperitoneal and intrapleural TA administration were feasible and effective in symptomatic control of ascites and pleural effusion.

Efficacy and safety of postvitrectomy intravitreal triamcinolone therapy for diabetic macular edema.

After vitrectomy, diffusion and clearance rates of numerous drugs are increased, leading to a shorter intravitreal half-life. This raises doubts about the efficacy of intravitreal therapies, as retina specialists generally believe that a shorter half-life compromises the drugs' therapeutic effect. We conducted a study to evaluate the functional and anatomical effect of intravitreal triamcinolone acetonide therapy (IVTA) in previously vitrectomized eyes with diabetic macular edema (DME). In this retrospective, multicenter case series study including vitrectomized patients with DME who underwent IVTA injections, central macular thickness (CMT) measured with spectral-domain optical coherence tomography and best-corrected visual acuity (BCVA) in Early Treatment Diabetic Retinopathy Study letters were evaluated after each procedure. All relevant medical data were collected, including previous ophthalmologic treatments and comorbidities. Twenty vitrectomized eyes of 20 patients, mean age 58.1 years (range 40-72 years), were enrolled in the study. All patients presented DME and received at least one IVTA injection. Mean time between pars plana vitrectomy and IVTA was 12.9 ± 8.7 months. Mean pretreatment and posttreatment CMT was 438.8 ± 90.8 μm and 301.2 ± 76.2 μm, respectively, a difference that reached statistical significance (p<0.001). Mean gain in BCVA letter score was 7.83 ± 14.9 letters after treatment (p = 0.039). Mean intraocular pressure was significantly increased after IVTA (17.2 ± 1.9 mm Hg at baseline vs 21.2 ± 4.59 mm Hg after IVTA, p = 0.002). A positive anatomical and functional effect was observed in our cohort. Our results suggest that, despite prior vitrectomy, triamcinolone remains a valid therapeutic approach for eyes with persistent DME. Further prospective randomized studies with larger patient samples are needed to validate this conclusion.

Intraocular pressure elevation after intravitreal triamcinolone acetonide injection: a Meta-analysis.

To report on intraocular pressure (IOP) after intravitreal injections of triamcinolone acetonide. Systematic literature review of studies that investigated the effects of an injection of triamcinolone intravitreal triamcinolone acetonide on IOP was conducted according to the Cochrane Collaboration methodology and the reported effects have been analyzed with Meta-analysis. We found that the IOP follows an inverted-U shape pattern over time starting with an average value of 14.81±1.22 mm Hg before the injection, rising to a maximum of 19.48±2.15 mm Hg after one month of injection and falling down to 16.16±1.92 mm Hg after 6mo. Moreover, country of study, age, previous history of glaucoma and gender compositions matter for cross-study were different in reported IOP changes. Our findings may be helpful in determining pressure elevation risk of intravitreal triamcinolone acetonide therapy as well as comparing it with those of more recent therapies such as the anti-vascular endothelial growth factor agents.

Short-term efficacy of intravitreal triamcinolone acetonide for macular edema secondary to retinal vein occlusion that is refractory to intravitreal bevacizumab.

Aims:To evaluate the 1-month efficacy of intravitreal triamcinolone acetonide (TA) in treating macular edema secondary to retinal vein occlusion (RVO) that was refractory to intravitreal bevacizumab.Materials and Methods:This retrospective, observational study included 23 eyes from 23 patients with macular edema secondary to RVO. Macular edema that did not respond to two or more consecutive intravitreal bevacizumab injections was treated with intravitreal TA. Central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were compared before and one month after TA injection.Results:Fifteen eyes were diagnosed with central RVO, and eight eyes were diagnosed with branch RVO. All patients were previously treated with 2.4 ± 0.6 intravitreal bevacizumab injections. The TA injection was performed, on average, 5.8 ± 1.4 weeks after the last bevacizumab injection. The CFT before TA injection was 516.6 ± 112.4 μm and significantly decreased to 402.3 ± 159.7 μm after TA therapy (P < 0.001). The logarithm of the minimal angle of resolution BCVA was 0.72 ± 0.34 before TA therapy and was not significantly improved by the treatment (0.67 ± 0.35, P = 0.119), despite a decrease in CFT. However, seven eyes (30.4%) had a BCVA gain of one or more lines.Conclusions:Intravitreal TA therapy was beneficial in some patients with macular edema secondary to RVO that was refractory to intravitreal bevacizumab therapy. This study suggests that intravitreal TA should be considered as a treatment option for refractory macular edema.

Role of Concomitant Triamcinolone Acetonide Injection in Small-Gauge Vitrectomy for Idiopathic Epiretinal Membrane Peel.

The concomitant use of triamcinolone acetonide (TA) at the completion of pars plana vitrectomy for the treatment of epiretinal membrane may speed up the anatomical and functional outcomes of surgery. We report the outcome of patients undergoing small-gauge vitrectomy for idiopathic epiretinal membrane peel with or without adjuvant TA therapy. This is a retrospective, single-center case series. We included 75 eyes of 75 individual patients. Twenty-six patients (group A) had an adjuvant TA injection during surgery, whereas 49 patients (group B) were not injected. We assessed the patients for change in visual acuity (VA) and central macular thickness before and after surgery. Group A had a mean logarithm of the minimum angle of resolution VA of 0.63 ± 0.33 and 0.51 ± 0.31 preoperatively and 3 months after surgery, respectively. Group B had a mean logarithm of the minimum angle of resolution VA of 0.47 ± 0.17 and 0.36 ± 0.17 preoperatively and 3 months after surgery, respectively. No significant difference was found between the groups in change of VA. The mean central macular thickness for groups A and B patients before surgery was 474.12 ± 120 μm and 445 ± 85 μm, decreasing to 369 ± 70 μm and 386 ± 60 μm at the final visit, respectively. The difference in macular thickness reduction between the groups was statistically significant. Anatomical and functional improvement was found in both groups after surgery. Macular thickness was further reduced in the group of patients treated with adjuvant TA.

Results of intravitreal triamcinolone acetonide in patients with macular edema secondary to branch retinal vein occlusion

Macular edema is one of the most common causes of visual loss in patients with retinal vein oclusions. Intravitreal corticosteroids and intravitreal anti-vascular endothelial growth factors are modalities of treatment for macular edema secondary to branch retinal vein occlusion (BRVO). To present the results of intravitreal triamcinolone acetonide therapy in patients with macular edema secondary to BRVO. A retrospective clinical interventional study included 32 patients with macular edema secondary to BRVO. The records of 32 eyes of 32 patients who received 4 mg/0.1 mL injection of intravitreal triamcinlone for macular edema secondary to BRVO were evaluated. Patients with visual acuity <0.40 logMAR (logarithm of the minimum angle of resolution), central macular thickness (CMT) >260 μm and no neovascularization at baseline were included. Patients with diabetes mellitus, a history of intravitreal anti vascular endothelial growth factor injection, grid laser photocoagulation and ischemic BRVO were excluded. The re-injections were performed in cases with increased CMT >100 μm or vision loss of five or more letters. The mean follow-up was 12 ± 1.9 months. The visual acuity increased from 0.58 ± 0.16 at baseline to 0.25 ± 0.11 logMAR (P < 0.001). The CMT decreased from 490 ± 107 μm at baseline to 266 ± 90 μm at 12 months (P < 0.001). Both cataract and glaucoma developed in 18.75 % patients. Intravitreal triamcinolone, due to absence of systemic side effects, can be used with confidence for treatment macular edema secondary to BRVO. However the main disadvantages of intravitreal triamcinolone injection are elevation of intraocular pressure and formation of cataract.

Recurrent Dermatitis and Dermal Hypersensitivity Following a Jellyfish Sting: A Case Report and Review of Literature

Jellyfish envenomation often causes an immediate painful vesiculopapular eruption. Less commonly it can cause a type IV allergic hypersensitivity that manifests with delayed or recurrent cutaneous lesions at the primary site or distant from the primary site. These secondary reactivations may be related to high antijellyfish immunoglobulin levels, intracutaneously sequestered antigen, or cross-reacting venom. Immunomodulators such as pimecrolimus and tacrolimus and topical and intralesional corticosteroid therapy decrease this recurrent dermatitis. We report a case of a 9-year-old girl with a recurrent jellyfish dermatitis lasting more than 1 year after the initial envenomation. The dermatitis finally resolved after treatment with tacrolimus and intralesional triamcinolone acetonide therapy.

Retrospective analysis of earlobe keloids treated with the carbon dioxide laser ablation or cold steel debulking surgery

Background: Treatment of keloids is a therapeutic challenge. Objectives: To determine the outcome and the risk of recurrence after debulking cold steel surgery or carbon dioxide (CO2) laser ablation of earlobe keloids. Material and methods: The case records of 16 patients with earlobe keloids managed at Changi General Hospital, Singapore, from 2003 to 2009 were reviewed retrospectively. Results: Fourteen patients were females, and the mean age at presentation was 20 years. Eight patients underwent CO2 laser ablation, six patients underwent cold steel surgery, one patient underwent both surgery and CO2 laser ablation, and one patient received only 40 mg/ml of intralesional triamcinolone acetonide. Fourteen patients were followed up for 1–24 months post procedure, and two patients defaulted. Both modalities were equally effective in debulking the earlobe keloids. All 13 patients who had either CO2 laser ablation or cold steel surgery had recurrence of keloid growth at 2–18 weeks post procedure. The patient who received intralesional triamcinolone acetonide therapy alone had only partial response to the therapy. Conclusions: Both the CO2 laser ablation and cold steel surgery were equally useful in reducing the size of the earlobe keloids, but were not effective in preventing regrowth of the keloids, even with adjunctive intralesional steroids. Patients should be clearly counselled regarding this.

Intralesional triamcinolone acetonide injection combined with conventional interventional modalities for the management of recalcitrant benign central airway stenosis: preliminary experience

To evaluate the efficacy and security of local injection of triamcinolone acetonide (TA) combined multiple convention interventional procedures for benign central airway stenosis (BAS). Forty patients with intractable benign central airway restenosis after treated by repeatedly traditional interventional treatment in our hospital between January 2008 to December 2010 were retrospectively analyzed. Forty intractable BAS patients were selected and averagely divided into treatment group and control group. Local injection of TA was used to cover entire stenosis lesions. Two or more procedures were combined to manage complicated airway stenosis. After a 6 months follow-up, compared to before and after the treatment of airway diameter, airway stricture rate, dyspnea score, interphase of interventional treatment and clinical stabilization, fasting blood glucose, plasma cortisol, injection local mucosal and clinical symptoms, evaluated its curative effect and side effect. Twenty cases of treatment group patients with intractable benign central airway stenosis were treated. After 6 to 18 months follow-up, 16 patients remain stable after treatment, besides 4 patients appear restenosis. 16 patients, did not appear restenosis; 4 patients appear restenosis. Restenosis interphase time or Clinical stationary time was increased from (10.95 ± 5.49) days before the therapy to (98.75 ± 55.58) days after therapy of local injection of TA (P < 0.01). The long-term outcome, the control group 20 cases restenosis in a 6 months follow-up time. After 6 months the the airway diameter of treatment group is (8.70 ± 2.52) mm compared with control group (4.50 ± 1.64) mm, (P < 0.01); the airway narrow rate of treatment group is (29.17 ± 14.55)%, compared with control group (64.80 ± 13.35)%, (P < 0.01); breathlessness score of treatment group is (0.55 ± 0.76), compared with control group (2.70 ± 0.92, P < 0.01), with statistically significant difference. None of the twenty patients appear local injections related complications, observation period, cortisol levels remain normal without glucocorticoids related serious complications. Local injections of TA therapy combined with traditional interventional techniques for BAS has good curative effect and safety.

Subglottische Trachealstenosen

To assess the results of endoscopic CO(2) laser resections combined with mitomycin-C and/or triamcinolone acetonide therapy in the treatment of patients with symptomatic subglottic tracheal stenosis. Eleven patients (all female) with subglottic tracheal stenosis were divided into two groups: six patients with idiopathic subglottic tracheal stenosis and five with subglottic tracheal stenosis of known etiology (four with Wegener's disease and one with polychondritis of the trachea). Three patients showed signs of reflux. The primary outcome measure was improvement of the clinical symptoms and the secondary the postoperative reduction of airway resistance. All patients were treated with CO(2) laser resections combined with mitomycin-C and/or triamcinolone acetonide therapy. Postoperative examinations during a period of 7 to 72months demonstrated a reduction of symptoms and of airway resistance in all patients. One or more endoscopic CO(2) laser resections combined with mitomycin-C and/or triamcinolone acetonide therapy are effective in the treatment of subglottic tracheal stenoses. Long-term oral steroid and immunosuppressive therapy as well as the use of proton pump inhibitors positively influences the postoperative outcome.

Release profile and transscleral permeation of triamcinolone acetonide loaded nanostructured lipid carriers (TA-NLC): in vitro and ex vivo studies

Nanostructured lipid carriers (NLC) have been developed for sustained release of triamcinolone acetonide (TA), a corticosteroid commonly indicated for macular edema, neovascularization, and other ocular inflammatory disorders. TA-NLC were prepared by high-pressure homogenization and characterized for in vitro release by dialysis bag. Ex vivo permeation profile was assessed using rabbit sclera isolated and mounted in Franz diffusion cells. TA-NLC were placed in episcleral donor compartment and choroidal side was perfused with HEPES buffer. Tissue sections underwent drug wash-out, following analysis by validated RP-HPLC of drug content and perfused fractions collected over 24 hours. Drug release followed one-order kinetics and permeability studies confirmed that TA is able to diffuse across rabbit sclera in sustained profile, following zero-order kinetics. Strong tissue binding was observed, providing a drug depot. These findings are of potential use when designing future TA therapy strategies for ocular diseases of posterior segment. From the Clinical EditorIn this study of triamcinolone acetonide loaded nanosize lipid carriers, potential ophthalmological applications are investigated including its trans-scleral permeation and release profile. Future in vitro studies are anticipated to establish this novel lipid carrier as a future therapeutic option for ocular diseases of the posterior segment.

Drug safety evaluation of intravitreal triamcinolone acetonide

Introduction: Triamcinolone acetonide (TA) is a steroidal drug that has been widely administered intravitreally for retinal and choroidal conditions. Safety of steroidal products for intraocular use is essential because of their risk of ocular adverse events. This review comprehensively discusses the safety of intravitreal administration of TA. Areas covered: This paper analyzes the mechanisms of action and key pharmacokinetic attributes and provides a discussion of the main clinical trials investigating clinical applications of intravitreal TA. The safety of intravitreal TA is evaluated through a search of the Medline database from 1980 to 2011. The most relevant literature on the safety of intravitreal TA is also discussed. Expert opinion: The complications of intravitreal TA therapy include secondary ocular hypertension in about 20 – 40% of eyes, steroid-induced cataract in about 15 – 20% of cases and postinjection infectious endophthalmitis and pseudoendophthalmitis in less than 1%. TA is an effective drug for various retinal and choroidal diseases when delivered intravitreally. It may imply an off-label use and it may be associated with ocular adverse events. Intravitreal TA is not associated with significant systemic safety risks.

Intraperitoneal and intrapleural administrations of triamcinolone acetonide for control of malignant ascites and pleural effusion.

e15505 Background: Patients with advanced gynecologic cancer often have massive ascites and pleural effusion, requiring frequent paracentesis (PC). Triamcinolone acetonide (TA) is a slowly metabolized corticosteroid. We evaluated the efficacy of intraperitoneal and intrapleural administrations of TA for control of malignant ascites and pleural effusion. Methods: We conducted a retrospective review of 48 patients with gynecologic cancer who were treated with PC followed by 400 mg of TA at our institutions since 2005. Results: Intraperitoneal TA therapy was performed in 44 patients (38 ovarian, 3 endometrial, 3 cervical) and intrapleural therapy in 4 (2 ovarian, 1 cervical, 1 endometrial), of whom 31 (65%) had recurrent cancer. Twenty-five (52%) were treated in a palliative setting, while 23 (48%) underwent chemotherapy (n=21) or surgery (n=2) following TA therapy. The median age of all patients was 60 years (range, 36-80). ECOG performance status (PS) before TA therapy was 1 in 2, 2 in 10, 3 in 28, and 4 in 8, with 43 (90%) showing improved PS after therapy. In addition, the interval between PC treatments was prolonged in 16 of 21 (76%) assessable patients. One patient complained of abdominal pain (grade 2, NCI-CTCAE ver.3) 1 day after TA therapy, while bowel perforation occurred 7 days after TA therapy in 2 ovarian cancer patients in a palliative setting. Median overall survival after therapy in a palliative setting was 20 days (range: 5-168), while it was 137 days (range: 15-1319) in other settings. Conclusions: Intraperitoneal and intrapleural TA administrations were found to be feasible and effective for patients receiving either palliative or aggressive treatment.

Benefit of repetitive intrathecal triamcinolone acetonide therapy in predominantly spinal multiple sclerosis: prediction by upper spinal cord atrophy

Intrathecal injection of triamcinolone acetonide (TCA) has been shown to provide substantial benefit in a subset of progressive multiple sclerosis (MS) patients with predominant spinal symptoms. We examined whether atrophy of the upper spinal cord (USC) as measured by MRI can serve as a predictive marker for response to repetitive intrathecal TCA application. Repetitive administration of 40 mg TCA was performed in 31 chronic progressive MS patients up to six times within 3 weeks. Expanded Disability Status Scale (EDSS) and maximum walking distance (WD) were assessed before and after the treatment cycle. Cervical 3D T1-weighted images were acquired on a 1.5T scanner at baseline. Mean cross-sectional area of the USC was determined using a semi-automated volumetry method. Results were compared with a group of 29 healthy controls to group patients into those with and without atrophy. Results show a negative correlation between the degree of USC atrophy and treatment benefit. A higher treatment benefit in patients with little USC atrophy but short initial maximum WD was observed. Absence of USC atrophy as measured on MRI is a predictive marker for intrathecal TCA therapy outcome in progressive MS. Patients with initial poor walking abilities, but only little or no atrophy, benefited most from TCA therapy.

Comparison of Photocoagulation With Combined Intravitreal Triamcinolone for Diabetic Macular Edema

PurposeTo compare the efficacy between macular laser grid (MLG) photocoagulation and MLG plus intravitreal triamcinolone acetonide (IVTA; MLG+IVTA) therapy in diabetic macular edema (DME) patients.MethodsA prospective, randomized, clinical trial was conducted of DME patients. A total of 60 eyes (54 patients) affected by DME were observed for a minimum of 6 months. Thirty eyes of 28 patients who received MLG treatment and 30 eyes of 26 patients who received the combined MLG+IVTA treatment were included in the study. Main outcome measures were BCVA and central macular thickness (CMT) as measured by optical coherence tomography (OCT) at 1, 3, and 6 months after treatment. Additionally, the authors examined retrospectively 20 eyes of 20 patients who were treated with only IVTA and compared with the 2 groups (MLG group and MLG+IVTA group).ResultsBaseline BCVA was 0.53±0.32 and CMT was 513.9±55.1 µm in the MLG group. At 1 and 3 months after treatment, the MLG group showed no significant improvement of BCVA and CMT, although there was significant improvement after 6 months. In the MLG+IVTA group, the baseline BCVA was 0.59±0.29 and CMT was 498.2±19.8 µm. After treatment, significant improvement of BCVA and CMT was observed at all follow-up time periods. When comparing the MLG group with the MLG+IVTA group, the latter had better results after 1 and 3 months, although at 6 months, there was no significant difference of BCVA and CMT between the 2 groups. Additionally, the IVTA group showed more improvement than the MLG group at 1 and 3 months but showed no significant difference at 6 months. In addition, the IVTA group showed no significant difference with the MLG+IVTA group at all follow-up time periods.ConclusionsFor DME patients, the combined MLG+IVTA treatment had a better therapeutic effect than the MLG treatment for improving BCVA and CMT at the early follow-up time periods. IVTA treatment alone could be an additional alternative therapeutic option to combined therapy.

Linear lichen planus distributed in the lines of Blaschko developing during intramuscular triamcinolone acetonide therapy for alopecia areata multiplex

Linear lichen planus distributed in the lines of Blaschko developing during intramuscular triamcinolone acetonide therapy for alopecia areata multiplex

Efficacy and retention times of intravitreal triamcinolone acetonide for macular edema

To evaluate the retention of intravitreal triamcinolone acetonide (TA) particles and the efficacy of TA therapy for patients with cystoid macular edema in branch retinal vein occlusion (BRVO) or diabetic macular edema (DME). We monitored the TA particles until absorption from the vitreous cavity was complete. The correlation between the intravitreal retention time of TA and its efficacy was evaluated based on central macular thickness (CMT). The intravitreal TA retention time was a mean 141.8 +/- 139.6 days in BRVO patients and 114.5 +/- 59.6 days in DME patients. Patient age and retention time were negatively correlated (r = -0.46; P = 0.013). At 6 months posttreatment the mean CMT decreased from 544.1 +/- 143.7 to 322.4 +/- 131.9 mum in BRVO patients and from 454.5 +/- 119.0 to 371.2 +/- 209.4 mum in DME patients. Retention time and CMT reduction were positively correlated in BRVO patient (r = 0.56, P = 0.02) but not in DME patients (P = 0.06). Intravitreal TA reduced the CMT in BRVO and DME patients over 6 months. The retention time was longer in younger individuals. The efficacy of the therapy depended on the intravitreal TA retention time observed clinically in BRVO patients. Biomicroscopic examination of intravitreal TA is useful for evaluation of its efficacy.

Randomized trial of pimecrolimus cream versus triamcinolone acetonide paste in the treatment of oral lichen planus

Lichen planus is a common chronic inflammatory mucocutaneous disease, affecting 0.1% to 4% of the general population. There is no published randomized active control clinical trial on pimecrolimus for the treatment of oral lichen planus (OLP). The purpose of this study was to compare the efficacy and safety of pimecrolimus 1% cream with triamcinolone acetonide 0.1% paste in treating OLP. In this investigator-blinded parallel-group randomized clinical trial, 40 patients were randomly assigned in two equal groups to receive either pimecrolimus 1% cream or triamcinolone acetonide 0.1% paste 4 times daily for a total of 2 months and followed up for another 2 months. The patients were assessed for painful symptoms measured by visual analog scale, the Oral Health Impact Profile score, and objective clinical score. Nonparametric tests were used to assess the main outcomes. Intention-to-treat analysis was used. Eighteen patients in pimecrolimus group and 17 patients in triamcinolone group finished the 4-month trial course. Both pimecrolimus and triamcinolone groups showed significant improvement in all measured efficacy end points throughout the visits. There was no significant difference between changes from baseline median values of pimecrolimus and triamcinolone groups after treatment termination in terms of visual analog scale score (-9.8 +/- 11.3 vs -8.4 +/- 18.3, P = .70), Oral Health Impact Profile score (-1.5 +/- 2.6 vs -1.6 +/- 2.1, P = .38), and clinical score (-0.7 +/- 0.6 vs -0.8 +/- 0.7, P = .86), respectively. Two patients in pimecrolimus group experienced prominent but transient burning sensation whereas none of the patients in triamcinolone group had any prominent adverse event (P = .24). Blood levels in pimecrolimus group were not measured and carcinogenicity of pimecrolimus, especially in its long-term use for OLP, is yet to be determined. This study showed that patients with OLP may benefit from both topical pimecrolimus and triamcinolone acetonide therapy with minimal side effects. Further studies should be conducted to assess the maintenance effects and long-term safety of both drugs (Cochrane skin group identifier: CSG TrialNo. 22).

Comparison of the hypothalamic–pituitary–adrenal axis susceptibility upon single-dose i.m. depot versus long-acting i.v. triamcinolone acetonide therapy: a direct pharmacokinetic correlation

The effects of single injections of glucocorticoid (GC) depot suspension and of long-acting GC were studied in conscious dogs. Both the depot suspension GC triamcinolone-16,17-alpha-acetonide (TAA) and the long-acting triamcinolone acetonide-21-dihydrogen phosphate (TAA-DHP) decreased basal and ACTH-stimulated cortisol levels and in a specific time-dependent way. Before treatment, all dogs had normal basal and peak cortisol responses to ACTH challenge (13-15 and > 120 nmol/l at 1 h respectively). Intravenous TAA-DHP reduced cortisol levels for 12 h, i.m. TAA reduced cortisol levels as of 1.5 h and the effect lasted for at least 4 weeks. Both treatments blunted the peak response to ACTH. ACTH elevated cortisol levels to or above baseline values within 10 days following TAA-DHP treatment, but the TAA treatment suppressed an ACTH response for at least 4 weeks. Kinetic analysis of both the preparations demonstrated rapid absorption (tmax, 0.6-1.5 h) and low maximum plasma concentrations (peak Cmax, 2.99-5.51 nmol/l) of the steroids; indeed, the terminal half-life of TAA-DHP (13.9 +/- 1.3 h) was very much shorter than that of TAA (125.9 +/- 15.8 h). In addition, the mean residence time differed very much (11 vs 160 h for TAA-DHP and TAA respectively), in line with a delayed elimination of the depot compared with the long-acting formulation. Application of these TAA formulations needs careful evaluation for their surprisingly different effects on endocrine stress axis activity.