Human T-Lymphotropic Virus
Sunit K. Singh, Daniel Růžek in Neuroviral Infections, 2013
Corticosteroid has been shown to be an efficient agent for various inflammatory and autoimmune diseases. As HAM/TSP is a chronic inflammatory disease in spinal cord showing immunopathological features, corticosteroid has been one of the most popular agents for the treatment of HAM/TSP. Although high doses of methylprednisolone are sometimes given intravenously, oral prednisolone (PSL) has been the most popular treatment for HAM/TSP. Short-term efficacy of PSL treatment for HAM/TSP has been reported (Nakagawa et al. 1996). In this study, 107 of 131 HAM/TSP patients (81.7%) showed improvement of motor functions. On the other hand, data showing nonefficient or transient benefit of PSL treatment for HAM/TSP have also been reported. In addition, the long-term efficacy of PSL treatment for HAM/TSP is unclear because of several adverse effects such as opportunistic infections, gastric ulcer, glucose intolerance, hypertension, and osteoporosis. Although the efficacy of PSL treatment for HAM/TSP seems to be limited, it has to be mentioned that HTLV-I proviral loads in PBMCs of HAM/TSP patients were significantly decreased in PSL treatment over 5 years.
Thorax
Dave Maudgil, Anthony Watkinson in The Essential Guide to the New FRCR Part 2A and Radiology Boards, 2017
Cryptogenic organising pneumonia (COP), also termed BOOP (bronchiolitis obliterans with organising pneumonia), typically occurs in the 40–70-years age group. It has a wide variety of causes including post-obstructive pneumonia, acute respiratory distress syndrome (ARDS), lung carcinoma, extrinsic allergic alveolitis (EAA), collagen vascular disease, drug toxicity, and it may be idiopathic. Granulation tissue polyps fill the alveolar ducts and respiratory bronchioles with a varying degree of infiltration of the interstitium. It occurs in a mid- and lower-zone distribution, in the subpleural and peribronchiolar regions. HRCT features include patchy airspace consolidation (80%), ground-glass change (60%), centrilobular nodules (30–50%), air bronchograms, pleural effusions and aden-opathy. Many patients improve with corticosteroid therapy.
Intraocular Sustained-Release Drug Delivery in Uveitis
Glenn J. Jaffe, Paul Ashton, P. Andrew Pearson in Intraocular Drug Delivery, 2006
Although corticosteroids are the first-line treatment for uveitis and can be delivered topically, local injection or systemically, they are associated with a number of side effects and recurrence of inflammation frequently occurs after cessation of treatment (1). Topical corticosteroids do not penetrate the posterior segment well and can cause poor wound healing, corneal toxicity, and elevated intraocular pressure (2). Local therapy given as periocular corticosteroid injection can be effective. However, multiple periocular corticosteroid injections may be necessary for disease control and each injection carries a number of risks including localized toxic drug delivery vehicle reactions, extraocular muscle fibrosis, and inadvertent globe injury (3). The side effects of chronic systemic corticosteroid administration have been well documented and include changes in appearance, hypertension, hyperglycemia, gastritis, opportunistic infections, and life-threatening psychosis (Fig. 1) (4).
Health-related quality of life in adult primary immune thrombocytopenia
Published in Expert Review of Hematology, 2018
Hanna Gran Sestøl, Sine Munch Trangbæk, James B Bussel, Henrik Frederiksen
In a web-enabled survey Brown et al. reported treatment side effects amongst 589 PDSA members of whom 78% were female, 89% Caucasian, and mean age 48 years. Participants were offered a small honorarium for participation [18]. Participants in the survey reported on side effects of treatments received since diagnosis, level of bother or distress, and the need to reduce or even stop treatment due to side-effects. The investigated treatments options included corticosteroids, intravenous immunoglobulins, Anti-D immunoglobulin, rituximab, splenectomy, and other patients’ referenced therapies; the study was conducted largely prior to the trombopoietin agents. The most frequent reported side effects were associated with corticosteroid treatment where 82.8% of patients stated weight gain or increased appetite, 77.1% experienced personality changes or changes in mood or emotions, and 75.3% sleep difficulty. Other corticosteroid side effects were reported by less than 50% of patients. Of those splenectomized, 67.4% were bothered by scarring after the procedure. Patients that underwent more than one treatment course were significantly more bothered by corticosteroids than by side effects from intravenous immunoglobulins, rituximab, and splenectomy. Amongst corticosteroid treated patients 37.8% had to reduce or stop treatment due to side effects compared to 18.0% with intravenous immunoglobulins, 20.6% with Anti-D immunoglobulin, and 16.4% with rituximab.
Long-Term Efficacy and Safety of Interferon Alpha-2a in the Treatment of Chinese Patients with Behçet’s Uveitis Not Responding to Conventional Therapy
Published in Ocular Immunology and Inflammation, 2019
Peizeng Yang, Guo Huang, Liping Du, Zi Ye, Ke Hu, Chaokui Wang, Jian Qi, Liang Liang, Lili Wu, Qingfeng Cao, Aize Kijlstra
A total of 127 patients were included in this prospective study. Of these 127 patients, 114 patients were male and 13 were female (Table 1). The mean onset age was 27 ± 8 (14–51) years. The mean age at referral to our hospital was 30 ± 9 (14–51 years). The mean interval time from first diagnosis of uveitis to visiting our department was 33 ± 34 (1–168) months. Before IFNα-2a treatment, the mean duration of BD was 74 ± 34 (26–175) months. The mean duration of previous corticosteroid treatment was 46 ± 30 (24–120 months). The mean follow-up of IFNα-2a treatment was 11 ± 6 (3–33 months) (Table 1). Bilateral involvement was observed in 115 patients (91%). The total number of affected eyes was 242 eyes. Panuveitis and posterior uveitis occurred in 78% and 22% of these patients, respectively. The abnormalities of the posterior segment included retinal vasculitis, vitritis, and retinitis, which affected 100%, 100%, and 65% of patients, respectively (Table 2). The most common extraocular manifestations were recurrent oral ulcers (100%), erythema nodosum (61%), and genital ulceration (43%) (Table 2).
Use of medications during pregnancy and breastfeeding for Crohn’s disease and ulcerative colitis
Published in Expert Opinion on Drug Safety, 2021
Robyn Laube, Sudarshan Paramsothy, Rupert W Leong
Corticosteroids can traverse the placenta where they undergo rapid metabolism via the 11-β-hydroxysteroid dehydrogenase type 2 enzyme into less active metabolites, therefore reducing fetal exposure. Shorter-acting formulations, such as prednisolone and methylprednisolone, are more rapidly and extensively metabolized than longer-acting formulations such as dexamethasone, 98% of which traverses the placenta intact to attain higher fetal levels [49]. Levels of endogenous glucocorticoids are markedly lower in the fetal circulation compared to the maternal circulation, therefore rendering the fetus more susceptible to iatrogenic corticosteroids [50]. Multiple studies have identified an increased risk of maternal and fetal complications with corticosteroid use during pregnancy. These include gestational diabetes (GDM), preterm birth, LBW and neonatal adrenal suppression [51–53]. However, given that these medications are generally reserved for patients with active disease, it is difficult to distinguish whether observed adverse effects arise secondary to active IBD or corticosteroid exposure.