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Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
From January 1990 to June 2008, in Leuven, Belgium, 315 patients were diagnosed with contact allergy to/allergic contact dermatitis from corticosteroids (CSs) from routine patch testing with a baseline series including tixocortol pivalate, budesonide, hydrocortisone butyrate and prednisone caproate, patch testing with patients’ own CS preparations, and testing those with proven contact allergy to a corticosteroid or strongly suspected of CS allergy later with a series of 66 CSs, including two sex hormones (progesterone and testosterone). 71% of the patients had relevant reactions, but these were not specified. In this group of 315 CS allergic patients, 15 had positive patch tests to difluprednate 0.1% alc. (2). As this corticosteroid is not used in pharmaceuticals in Belgium, these positive reactions must all be considered cross-reactions to other corticosteroids.
Local versus Systemic Therapy for Noninfectious Uveitis (NIU)
Published in Seminars in Ophthalmology, 2023
Topical steroids are the mainstay of treatment for acute anterior uveitis (AAU). In 1979 they were demonstrated to hasten recovery and improve symptoms in a clinical trial comparing betamethasone phosphate 0.1%, clobetasone butyrate 0.1%, and placebo in acute unilateral nongranulomatous uveitis.9 In recent years, prednisolone acetate 1% has been the preferred therapy for acute anterior uveitis given widespread use and generic formulation.10 Difluprednate 0.05% has been shown to have increased anti-inflammatory potency and tissue penetration than other topical steroid preparations.11 Difluprednate 0.05% four times daily dosing has been shown to be noninferior to prednisolone acetate 1% eight times daily dosing.12,13 Topical steroids have also been used in uveitic macular edema (UME). In particular, monotherapy with difluprednate has been shown to be effective in improving UME and may be considered as first-line treatment.14,15
Update on the management of uveitis in children: an overview for the clinician
Published in Expert Review of Ophthalmology, 2019
Lucas Kim, Alexa Li, Sheila Angeles-Han, Steven Yeh, Jessica Shantha
Pediatric uveitis is treated in a ‘step-ladder’ approach but may also depend on disease severity, laterality, and chronicity. The first-line treatment for anterior uveitis is often the application of topical glucocorticoids corresponding to the level of inflammation. Prednisolone acetate 1% is the most commonly used topical corticosteroid, followed by the more potent difluprednate 0.05% (Durezol) which requires less frequent dosing [61]. For intermediate, posterior, or panuveitis, periocular or intraocular injections of triamcinolone acetonide (TA) have been utilized, as topical steroids do not penetrate the posterior segment as well. Intraocular therapies of longer duration include Ozurdex, a dexamethasone implant that lasts 6 months, and Retisert, a 0.59 mg Fluocinolone acetonide implant that lasts approximately 3 years [62,63]. However, the risk of cataract development and the risk of elevated intraocular pressure needs to be considered in patients in whom corticosteroid injections are administered.
Difluprednate 0.05% versus Prednisolone Acetate 1% for Endogenous Anterior Uveitis: Pooled Efficacy Analysis of Two Phase 3 Studies
Published in Ocular Immunology and Inflammation, 2019
John D. Sheppard, C. Stephen Foster, Melissa M. Toyos, Kerry Markwardt, Robert Da Vanzo, Thomas E. Flynn, John H. Kempen
Overall, there were fewer treatment withdrawals in the difluprednate group than in the prednisolone group (log-rank p-value = 0.02), especially when the treatment withdrawal was recommended due to lack of efficacy (p-value = 0.0002). These differences are remarkable in the context of a non-inferiority study design in which treatment withdrawals were not a primary endpoint. Clinical confidence in an anti-inflammatory agent allows continued recommendation with the prescriber’s full intention to succeed in eliminating deleterious sequelae of the inflammatory process. Favorable treatment outcomes reduce morbidity, clinic visits, cumulative medication toxicity, subsequent interventions, additional rescue therapy, and visual loss. Difluprednate fulfills the clinician’s intent to treat aggressively with the most effective possible agent for the shortest period of time and the fewest doses.