The finding was part of results from a multi-center study, which was funded by the National Institutes of Health and led by Ronald Wapner, M.D., professor of obstetrics and gynecology, Columbia University Medical Center and attending obstetrician and gynecologist at NewYork-Presbyterian Hospital/Columbia.

From Sciencedaily.com:

Up until the year 2000, obstetrician-gynecologists frequently repeated the course of steroids every week, up to 10 to 11 times, in women who remained pregnant after the first course. A NIH panel that year, concerned with the lack of safety data for this practice, suggested multiple courses should be strictly reserved for patients enrolled in clinical trials.

In one of the first such trials to examine the long-term effects of the treatment on the children, women who remained pregnant a week after the initial course of corticosteroids were randomly assigned to weekly courses of corticosteroids or placebo until their babies were born.

The study, performed by members of the NIH-sponsored Maternal-Fetal Medicine Network followed a total of 556 infants at the Morgan Stanley Children’s Hospital of NewYork-Presbyterian Hospital/Columbia and 12 other sites around the country, and found that by ages two to three, the two groups of children were physically and neurologically identical, except that six out of 248 children who received multiple courses of corticosteroids had been diagnosed with cerebral palsy, compared to only 1 out of 238 children in the placebo group. The mothers of all six children with cerebral palsy in the corticosteroid group had received four or more courses of the drug.

The research was supported by the National Institute of Child Health and Human Development of the National Institutes of Health and the study results were published in an issue of the New England Journal of Medicine.

Corticosteroid nasal sprays

The finding, which was published in the November 26 issue of the Archives of Internal Medicine, suggested that the current prescription patterns and guidelines flavoring the use of antihistamines to be the first-line treatment option for mild or moderate allergies need to be altered.

From Sciencedaily.com:

Antihistamines can block the actions of histamines if taken in advance but they have no impact on the late response. Intranasal steroids inhibit the late response and prevent priming.

“Antihistamines,” explained Naclerio, “taken once symptoms have already appeared, arrive too late to block the early response and have little effect on the late response. Corticosteroids taken when symptoms begin can prevent the late response and inhibit priming, which makes the patient more sensitive to subsequent contacts.”

“Our study,” he added, “demonstrates the greater importance of the late response compared to the immediate response.”

The authors emphasize that continuous medication use is more effective than sporadic use in response to symptoms but acknowledge that few patients comply with those instructions.

In light of their findings, they suggest revising the current guidelines so that “intranasal corticosteroids should become the first-line treatment for seasonal allergies. They should now be recommended for regular use in patients with severe disease,” said Naclerio, “and for as-needed use in patients with mild disease.”

Robert Naclerio, M.D., chief of otolaryngology-head and neck surgery at the University of Chicago and director of the study, remarked more people will be benefiting and health costs can be dramatically reduced by altering the present guidelines to match patient practice.

The study called BADGER (Best ADd-on therapy Giving Effective Responses) can help physicians in predicting which of their patients will be benefiting the most and from which of the available options.

From Sciencedaily.com:

To treat children whose asthma is not well controlled while using low-dose inhaled corticosteroids, the National Heart, Lung, and Blood Institute (NHLBI) guides physicians to try one of three additional, or step-up, treatments: doubling the dosage of the inhaled corticosteroid or adding a long-acting beta antagonist (LABA) or a leukotriene receptor antagonist (LTRA) to the inhaled corticosteroid treatment.

However, physicians often find it difficult to predict which step-up treatment might work best for a particular child. So the researchers in the five-center, NHLBI-funded Childhood Asthma Research and Education (CARE) Network used a novel triple-crossover, double-blind approach to determine if the treatments improved asthma symptoms, and if so, which treatment might work best.

Robert C. Strunk, M.D., and Leonard B. Bacharier, M.D., both Washington University pediatric asthma specialists at St. Louis Children’s Hospital, were coauthors on the study, published online March 2, 2010, by the New England Journal of Medicine and presented the same day at the American Academy of Allergy, Asthma and Immunology’s annual meeting in New Orleans.

Triamcinolone

The study was published in the December 2009 issue of the Archives of Ophthalmology and was conducted by researchers led by specialists at the Johns Hopkins Wilmer Eye Institute.

From News-Medical.Net:

According to Bressler, lead author of the study, there was some evidence that steroids could improve vision outcomes from diabetic macular edema (DME), swelling of the center of the retina, the part of the retina used for reading or driving. Study results showed that steroids were not superior to laser treatments for DME.

“The primary objective of the study was to determine if steroids were superior to laser for DME, and if so, to balance that superiority with steroids‘ side effects. A secondary objective was to determine if the steroids affected the progression of diabetic retinopathy,” adds Bressler. “Steroid treatments did reduce the risk of progression of diabetic retinopathy, but, not DME, which can also cause vision loss from proliferative diabetic retinopathy, bleeding in the middle cavity of the eye or scarring of the retina, which can detach the retina from the back wall of the eye.”

Neil M. Bressler, the James P. Gills Professor of Ophthalmology and chief of the Retina Division of the Johns Hopkins Wilmer Eye Institute, chair of the government-sponsored Diabetic Retinopathy Clinical Research Network, remarked that steroid-based treatment though effective cannot be routinely recommended due to the safety issues.

Prazosin

It was remarked by study co-author S. Paul Berger, M.D., assistant professor of psychiatry and behavioral neuroscience, OHSU School of Medicine and the PVAMC, that prazosin can prove its worth by protecting the brain from any damage due to excessive levels of corticosteroid stress hormones.

From News-Medical.Net:

“Our hypothesis is that just being afraid of being blown up all the time means you have high levels of steroids all the time,” Berger said, referring to PTSD among military personnel.

Low levels of glucocorticoids have anti-inflammatory effects in the brain, but high levels can trigger inflammatory mechanisms that damage nerve cells by activating an enzyme that causes oxidative stress. Even a single exposure to a high dose of glucocorticoids can be sufficient to damage nerve cells: A previous study showed synthetic glucocorticoid therapy to treat autoimmune disorders such as rheumatoid arthritis can induce mood disorders, including psychosis, and cognitive impairment known as “steroid dementia” in severe forms.

To determine the effects of prazosin, OHSU and PVAMC researchers, led by Altaf Darvesh, Ph.D., formerly of the OHSU Department of Psychiatry, administered a glucocorticoid called dexamethasone to rats, then measured the expression of a protein known as heat shock protein 70, or HSP70, that serves as a marker for neurotoxicity. Pretreatment with prazosin, an alpha-1 receptor antagonist, resulted in “significant” slowing of dexamethasone-induced expression in the cerebral cortex.

Berger further remarked that future research will be examining how steroids pose a threat to the brain and when prazosin should be administered to most effectively protect the brain against damage.x

Diabetic retinopathy is a complication of diabetes that can result in loss of vision and blindness.

From Sciencedaily.com:

Corticosteroids have been shown to interfere with the creation of new blood vessels, possibly by reducing the production of compounds that spur their growth, the authors note. However, steroids are also associated with other eye diseases.

“Use of this intravitreal [injected into the eye] corticosteroid preparation to reduce the likelihood of progression of retinopathy is not warranted at this time because of the increased risk of glaucoma and cataract associated with intravitreal steroid use,” the authors write. “Any treatment to be used routinely to prevent proliferative diabetic retinopathy likely needs to be relatively safe because the condition already can be treated successfully and safely with panretinal photocoagulation. Nevertheless, further investigation with regard to the role of pharmacotherapy for reduction of the incidence of progression of retinopathy appears to be warranted.”

Neil M. Bressler, M.D., of Johns Hopkins University School of Medicine, Baltimore, and colleagues in the Diabetic Retinopathy Clinical Research Network conducted the study that involved 840 eyes of 693 participants having macular edema.

The finding was presented in a report in the December issue of Archives of Ophthalmology, one of the JAMA/Archives journals.

Proliferative diabetic retinopathy is an ailment that occurs when new blood vessels are formed on the optic disc or another retina component.

From Sciencedaily.com:

Corticosteroids have been shown to interfere with the creation of new blood vessels, possibly by reducing the production of compounds that spur their growth, the authors note. However, steroids are also associated with other eye diseases.

“Use of this intravitreal [injected into the eye] corticosteroid preparation to reduce the likelihood of progression of retinopathy is not warranted at this time because of the increased risk of glaucoma and cataract associated with intravitreal steroid use,” the authors write. “Any treatment to be used routinely to prevent proliferative diabetic retinopathy likely needs to be relatively safe because the condition already can be treated successfully and safely with panretinal photocoagulation. Nevertheless, further investigation with regard to the role of pharmacotherapy for reduction of the incidence of progression of retinopathy appears to be warranted.”

This study was conducted by Neil M. Bressler, M.D., of Johns Hopkins University School of Medicine, Baltimore, and colleagues in the Diabetic Retinopathy Clinical Research Network and involved 840 eyes of 693 participants having macular edema.

It is worth noting that the use of both beta2-agonist (formoterol) and a low-dose corticosteroid (budesonide) in a single inhaler and this review evaluated the new inhaler’s effectiveness.

From News-Medical.Net:

“Encouraging people to use their preventive medication is important, as it is often the case that people with asthma default on their inhaled corticosteroids,” said lead reviewer Christopher Cates, M.D., at the Community Health Sciences of St. George’s at the University of London. “This is partly because inhaled steroids do not make an immediate difference to asthma symptoms.”

In most studies, participants had treatment with a single inhaler – one inhalation of 80/4.5 milligrams of budesonide/formoterol twice daily, and as needed. Patients in the control groups used their prescribed inhaled corticosteroid with a separate reliever inhaler. Cates and his colleague evaluated three studies that included more than 4,200 adults and adolescents with chronic asthma. One study also included 224 children.

The Cochrane reviewers found no significant reduction in the number of asthma exacerbations that required hospitalization among the patients who used single inhaler therapy.

Carlos Camargo, M.D., an associate professor of medicine at Harvard Medical School, said that this single-inhaler therapy is a new approach to chronic asthma treatment is expected to provide great relief but requires further research before it can be recommended.

The involved researchers were studying the effectiveness of both a low-dose corticosteroid (budesonide) and beta2-agonist (formoterol) in a single inhaler.

The review appeared in an issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization evaluating research in all health care aspects.

From News-Medical.Net:

“Encouraging people to use their preventive medication is important, as it is often the case that people with asthma default on their inhaled corticosteroids,” said lead reviewer Christopher Cates, M.D., at the Community Health Sciences of St. George’s at the University of London. “This is partly because inhaled steroids do not make an immediate difference to asthma symptoms.”

In most studies, participants had treatment with a single inhaler – one inhalation of 80/4.5 milligrams of budesonide/formoterol twice daily, and as needed. Patients in the control groups used their prescribed inhaled corticosteroid with a separate reliever inhaler. Cates and his colleague evaluated three studies that included more than 4,200 adults and adolescents with chronic asthma. One study also included 224 children.

The Cochrane reviewers found no significant reduction in the number of asthma exacerbations that required hospitalization among the patients who used single inhaler therapy.

It was remarked by Cates that one benefit of combined inhalers is that inhaled corticosteroids can be administered on an automatic basis with the beta-agonist when it comes to relieving symptoms.

The board of directors has accredited the formation of a committee to supervise the implementation of the Drug Testing Initiative (DTI) Task Force recommendations on quality assurance and laboratory accreditation programs for U.S. horse racing drug-testing laboratories.

Dr. Tom David of the Louisiana State Racing Commission and chairman of the ARCI Racing Regulatory Veterinarian Committee explained the examining veterinarian’s interest over current NSAID and corticosteroid policies. RMTC Scientific Advisory Committee was previously appointed with the job of reexamining all existing research on NSAIDs, particularly phenylbutazone.

The RMTC Scientific Advisory Committee has noted different options for consideration in future recommendations on the administration times and threshold concentrations for NSAIDs.

The RMTC previously announced that it was carrying out research on corticosteroids commonly used in racing and the board was updated on the status of that project. A copy of Dr. Soma’s study and Dr. David’s remarks can be found at the RMTC website.

From Harness Link:

At the board meeting, other integrity issues were also discussed in depth, including the use of non-steroidal anti-inflammatory drugs (NSAIDs) and how they may affect pre-race examinations by regulatory veterinarians. Dr. Tom David of the Louisiana State Racing Commission and chairman of the ARCI Racing Regulatory Veterinarian Committee explained the examining veterinarian’s concern over current NSAID and corticosteroid policies.

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