Posts Tagged ‘corticosteroids’

Lupus, which is a chronic inflammatory disease, affecting more than 1 million people in the United States alone can be effectively treated with use of steroids.

The biological rationale as to why large doses of corticosteroids (steroids) administered over several weeks can be of great help to lupus patients was revealed by researchers at the UT Southwestern Medical Center.

From News-Medical.Net:

Unlike the anabolic steroids athletes sometimes use illegally to bulk up muscle, corticosteroids are routinely used to treat inflammation in lupus patients. The drugs, however, can cause undesirable side effects including weight gain and acne when taken over long periods of time.

In a study published in a recent issue of Nature, researchers at UT Southwestern and other institutions show in blood cells that giving very high doses of intravenous corticosteroids early and frequently in the course of the disease is more effective at killing the cells that drive lupus than giving the standard limited intravenous steroids followed by high doses of oral corticosteroids over a period of months. The cells used came from lupus patients as well as from animal models of lupus.

Dr. Marilynn Punaro, professor of pediatrics at UT Southwestern and co-author of the study, remarked that administration of high doses of steroids in the preliminary stages and on a regular basis could greatly help in high steroid doses at a later point of time.

A Cochrane Systematic Review has suggested that the risk of an asthma attack relapsing is reduced considerably when a short course of corticosteroids is administered to asthmatic patients after being discharged from the hospital post-attack.

It is was disclosed by the study that administration of steroids could be effective for reducing the use of inhalers besides revealing that such benefits can hold good for a period of three weeks.

From News-Medical.Net:

This updated finding was drawn after reviewing data in six trials that together involved 374 people.

Between 12% and 16% of people who are discharged from hospital after having an asthma attack have a relapse within two weeks. “There is considerable debate about the best way of treating people who have asthma attacks, including the dose, method of delivery and timing of delivery of corticosteroids. Our research found clear evidence that people who arrived at a hospital with acute asthma and were well enough to be discharged benefited from the addition of corticosteroid therapy,” says lead author Professor Brian Rowe, who works at the University of Alberta, in Edmonton, Canada.

Carol Spooner, the review colleague, said that the use of systematic corticosteroids for treating outpatients after getting discharged from the hospital after asthma attack is strongly endorsed by the systematic review.

The FDA-approved drug presently used for providing relief in terms of withdrawal symptoms from substance abuse, Naltrexone, can be used for providing relief to patients suffering from Crohn’s disease.

The drug is presently used for easing down drug and alcohol abuse symptoms and can prove to be an effective drug for Crohn’s disease, as per a Pilot study by Penn State College of Medicine.

From News-Medical.Net:

Typical treatment for Crohn’s involves using steroids or corticosteroids, which suppress the immune system and can have other toxic side effects. Treatment is often time-intensive and expensive, as well.

“This is a novel approach to treating a common disease, and it’s simple, it’s safe, and it costs far less than current standards of treatment,” Smith said. “We don’t yet know the exact mechanisms involved in how it works, but we’re working on that as well.”

Smith initiated the study using a Dean’s Feasibility Grant — a program designed to encourage investigators to design trials in their area of expertise and seek outside funding. The National Institutes of Health (NIH) recently awarded the College of Medicine $500,000 for the team to continue the study.

Jill P. Smith, a gastroenterology specialist and researcher at the College of Medicine and Penn State Milton S. Hershey Medical Center in Los Angeles at the National Association of Gastroenterologists annual Digestive Diseases Week conference, presented the findings.

According to a study by researchers from the UT Southwestern Medical Center, pneumonia patients can expect more benefits coming their way than what could have been attained with the use of antibiotics alone with steroids.

A combination of steroids and antibiotics could be one of the best ways to provide relief to patients suffering with pneumonia, as per the study. The combination holds good even in midst of an asthma attack (M pneumoniae infection).

From News-medical.net:

Adding corticosteroids to traditional antimicrobial therapy might help people with pneumonia recover more quickly than with antibiotics alone, UT Southwestern Medical Center scientists have found.

Unlike the anabolic steroids used to bulk up muscle, corticosteroids are often used to treat inflammation related to infectious diseases, such as bacterial meningitis. Used against other infectious diseases, however, steroid therapy has been shown to be ineffective or even harmful.

In a study available online and in a future issue of the Journal of Infectious Diseases, researchers at UT Southwestern show that mice infected with a type of severe bacterial pneumonia and subsequently treated with steroids and antibiotics recovered faster and had far less inflammation in their lungs than mice treated with antibiotics alone.

Dr. Robert Hardy, Study’s Senior Author & Associate Professor of Internal Medicine and Pediatrics, said that clinical trials will soon start for confirming findings of the study.

Patients with moderate to severe chronic obstructive pulmonary disease (COPD) can experience reductions in frequency of exacerbations by as much as 35 percent by using a macrolide antibiotic in the long term, as per a London-based study.

Results of the study suggest that there is a significant effect of low-dose macrolide therapy on the frequency of exacerbation, and severity with moderate to severe COPD, according to lead author of the paper, Terence A. R. Seemungal, Ph.D., and Jadwiga Wedzicha, M.D., principle investigator.

From News-Medical.Net:

While their findings are encouraging, Dr. Seemungal points out that they must be put in context with future findings. Furthermore, the threat of growing antibiotic resistance resulting from widespread prophylactic use of erythromycin is not a trivial concern. “In this scenario, substantial, widespread emergence of macrolide bacterial resistance is virtually foreordained, with attendant reduction in the antimicrobial usefulness of this drug class,” wrote Ken M. Kunisaki, M.D. and Denise E. Niewoehner, M.D., of the Veterans Affairs Medical Center in Minneapolis, in the accompanying editorial. “Balancing benefit against harm could pose a dilemma for which there might be no clear answers.”

Moreover, not all of the study patients were treated with guideline-recommended therapy, such as inhaled corticosteroids or inhaled long-acting bronchodilators, which have been shown to decrease exacerbation frequency. The degree of added benefit of erythromycin over and above standard therapy will require further study.

“Observations that any intervention might decrease the frequency and severity of acute exacerbations in COPD present considerable public health implications,” observed John Heffner, M.D., past president of the ATS. “Exacerbations occur about once a year among patients with moderate to severe COPD and account for more than $30 billion dollars in direct and indirect costs annually in the United States alone.”

The study results were published in the first issue for December of the American Journal of Respiratory and Critical Care Medicine, which is published by the American Thoracic Society.

Corticosteroids may prove to be of little or no use for improving the survival rates in end-stage acute respiratory distress syndrome (ARDS), as per an NIH-sponsored trial.

Steroids may lead to hasten death if given in the condition for more than 13 days, as per the Late Steroid Rescue Study, undertaken by the ARDS Clinical Research Network of the National Heart, Lung, and Blood Institute (NHLBI).

From Earthtimes.org:

The findings of the study appear in the April 20 issue of the New England Journal of Medicine. The study had 180 people with ARDS, who were followed for a week to 28 days. Researchers reported identical death rates in people who received steroids (28.6 percent) and those who did not (29.2 percent). “These findings provide important information to help us determine the safest and most effective ways to care for patients with this devastating condition,” said Elizabeth G. Nabel, MD, Director at NHLBI. “Whether and how to use steroids to treat ARDS patients have been important questions for years. We now have better evidence of the effect of this treatment to help clinicians and patients make more informed decisions.”

The researchers emphasized that future studies are needed before arriving at any conclusions.

Corticosteroids are ineffective for improving survival in patients with late-stage acute respiratory distress syndrome (ARDS), according to results from the ARDS Clinical Research Network of the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.

Acute respiratory distress syndrome is a sudden and life-threatening condition that affects approximately 150,000 people annually in the United States alone.

From News-Medical.Net:

There is no specific drug treatment for ARDS. The focus of care is to get enough oxygen into the blood until the lungs are functioning again. Patients are placed in the intensive care unit and supported with mechanical ventilators and fluids. Some patients recover and can breathe on their own within a week or so. Others might need to be on mechanical support to help with breathing for longer periods of time, but they can develop long-term complications from ventilator use or other treatments.

Because ARDS is related to inflammation in the lung, steroids are sometimes used in the hopes of helping the lungs heal. Earlier small or observational studies have suggested that moderate doses of steroids given 7 or more days after the onset of ARDS might improve lung function and increase survival. But a larger randomized clinical trial – considered the gold standard in medical research – was needed to determine whether moderate doses of steroids are beneficial for patients with late-stage ARDS.

NHLBI Director Elizabeth G. Nabel, MD said the findings provide invaluable information for determining the safest yet the most effective ways to treat patients with this devastating condition.

Low levels of vitamin D were found to be linked with minimized lung function and medication use in children with asthma, as per researchers at National Jewish Health.

This finding was revealed in a paper published online this week in the Journal of Allergy & Clinical Immunology.

From Sciencedaily.com:

“Our findings suggest two possible explanations,” said senior author Donald Leung, MD, PhD. “It could be that lower vitamin D levels contribute to increasing asthma severity, which requires more corticosteroid therapy. Or, it may be that vitamin D directly affects steroid activity, and that low levels of vitamin D make the steroids less effective, thus requiring more medication for the same effect.”

The researchers performed a series of laboratory experiments that indicated vitamin D enhances the action of corticosteroids. They cultured some immune cells with the corticosteroid dexamethasone alone and others with vitamin D first, then dexamethasone. The vitamin D significantly increased the effectiveness of dexamethasone. In one experiment vitamin D and dexamethasone together were more effective than 10 times as much dexamethasone alone.

The researchers also incubated immune-system cells for 72 hours with a staphylococcal toxin to induce corticosteroid resistance. Vitamin D restored the activity of dexamethasone.

“Our work suggests that vitamin D enhances the anti-inflammatory function of corticosteroids,’ said Dr. Leung. “If future studies confirm these findings vitamin D may help asthma patients achieve better control of their respiratory symptoms with less medication.”

Daniel Searing, MD, and his colleagues reported that ability of Vitamin D for enhancing the activity of the most effective controller medication for asthma, corticosteroids.

Corticosteroid nasal sprays are better than antihistamines when used “as needed” to treat seasonal allergies, according to researchers from the University of Chicago.

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.

According to a new study by researchers at Washington University School of Medicine and other institutions, asthmatic children who do not show much improvement with symptoms while using low-dose inhaled corticosteroids can expect benefit with doses of steroids are increased or one of two asthma drugs is added.

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.