scholarly journals Use of Systemic Corticosteroids for Reasons Other than Asthma in Subjects with Asthma

Respiration ◽  
2021 ◽  
pp. 1-7
Author(s):  
Keisuke Watanabe ◽  
Nobuyuki Horita ◽  
Yu Hara ◽  
Nobuaki Kobayashi ◽  
Takeshi Kaneko
Keyword(s):  
Adverse Events ◽  
Systemic Corticosteroid ◽  
Multivariable Analysis ◽  
Vascular Diseases ◽  
University Hospital ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
Collagen Vascular Diseases ◽  
Systemic Corticosteroids ◽  
Asthma Patients

<b><i>Backgrounds:</i></b> Recent studies have reported increased risks of adverse events from systemic corticosteroids even with only low-dose or short-term use. Some patients with asthma experience complications requiring systemic corticosteroids. However, few studies have examined issues associated with administration of systemic corticosteroids for reasons other than asthma among subjects with asthma. <b><i>Objectives:</i></b> We investigated patterns of systemic corticosteroid exposure for reasons other than asthma in subjects with asthma. <b><i>Method:</i></b> We retrospectively reviewed the records of adult subjects with asthma followed up for &#x3e;1 year at Yokohama City University Hospital from January 1, 2010, to December 31, 2019. We investigated patterns and reasons for systemic corticosteroid use during follow-up. In addition, factors related to systemic corticosteroid use for reasons likely other than asthma were investigated. <b><i>Results:</i></b> Among the 568 subjects with asthma analyzed, 326 (57.4%) had received systemic corticosteroids for some reason. Among those 326 patients, 120 (36.8%) had received systemic corticosteroids for reasons likely other than asthma. Multivariable analysis revealed rheumatoid arthritis, eosinophilic granulomatosis with polyangiitis, other collagen vascular diseases, chronic rhinosinusitis, and malignancy as positively associated with systemic corticosteroid exposure for reasons likely other than asthma in subjects with asthma. <b><i>Conclusions:</i></b> About 40% of systemic corticosteroid use in subjects with asthma was for reasons likely other than asthma. Clinicians should be aware of their asthma patients’ exposures to systemic corticosteroids for nonasthma reasons, to avoid missing adverse events or underestimating the severity of asthma, and to reduce systemic corticosteroid use.

Impact of trainee involvement on the outcome of ERCP procedures: results of a prospective multicenter observational trial

Endoscopy ◽  
2019 ◽  
Vol 52 (02) ◽  
pp. 115-122 ◽  
Author(s):  
Theodor Voiosu ◽  
Ivo Boskoski ◽  
Andrei M. Voiosu ◽  
Andreea Benguș ◽  
Agata Ladic ◽  
...  
Keyword(s):  
Adverse Events ◽  
Multivariable Analysis ◽  
Difficulty Level ◽  
Control Group ◽  
Technical Success ◽  
Endoscopic Techniques ◽  
Trainee Group ◽  
Standard Report ◽  
Multicenter Prospective Observational Study

Abstract Background Training in advanced endoscopic techniques such as endoscopic retrograde cholangiopancreatography (ERCP) should be driven by key performance measures and standardized competence assessment in order to provide safe and high-quality interventions. We aimed to determine whether the involvement of trainees influences the outcome of the procedure and the incidence of ERCP-related adverse events. Methods This was an international, multicenter, prospective, observational study conducted at six high- and low-volume centers across Europe between October 2016 and October 2018, and included independent operators and their trainees. Standard report forms documenting indication, trainee involvement, technical outcome, and complications over a 30-day follow-up of consecutive ERCP procedures were included in the analysis. Technical success of the procedure and procedure-related adverse events were compared between procedures in the trainee group and the control group using bivariable and multivariable analysis. Results 21 trainees and 16 control endoscopists performed 1843 ERCPs during the study period. Trainee involvement in ERCP procedures did not decrease technical success (92.4 % vs. 93.7 %; P = 0.30) or increase the risk of adverse events (14.7 % vs. 14.6 %; P > 0.99). Conversely, there were significantly more moderate or severe adverse events in the control group compared with the trainee group (6.2 % vs. 3.4 %, P = 0.01). On multivariable analysis, only increased bilirubin levels, time to cannulation, and procedure difficulty level increased the risk of any procedure-related adverse event. Conclusion Trainee involvement in ERCP interventions within a proper teaching setting is safe and does not compromise the success of the procedure.

scholarly journals Immune-Related Adverse Events, Need for Systemic Immunosuppression, and Effects on Survival and Time to Treatment Failure in Patients With Melanoma Treated With Ipilimumab at Memorial Sloan Kettering Cancer Center

2015 ◽  
Vol 33 (28) ◽  
pp. 3193-3198 ◽  
Author(s):  
Troy Z. Horvat ◽  
Nelly G. Adel ◽  
Thu-Oanh Dang ◽  
Parisa Momtaz ◽  
Michael A. Postow ◽  
...  
Keyword(s):  
Overall Survival ◽  
Adverse Events ◽  
Treatment Failure ◽  
Systemic Corticosteroid ◽  
Standard Dose ◽  
Corticosteroid Treatment ◽  
Cancer Center ◽  
Time To Treatment ◽  
Systemic Corticosteroids ◽  
Time To Treatment Failure

Purpose Ipilimumab is a standard treatment for metastatic melanoma, but immune-related adverse events (irAEs) are common and can be severe. We reviewed our large, contemporary experience with ipilimumab treatment outside of clinical trials to determine the frequency of use of systemic corticosteroid or anti-tumor necrosis factor α (anti-TNFα) therapy and the effect of these therapies on overall survival (OS) and time to treatment failure (TTF). Patients and Methods We reviewed retrospectively the medical records of patients with melanoma who had received treatment between April 2011 and July 2013 with ipilimumab at the standard dose of 3 mg/kg. We collected data on patient demographics, previous and subsequent treatments, number of ipilimumab doses, irAEs and how they were treated, and overall survival. Results Of the 298 patients, 254 (85%) experienced an irAE of any grade. Fifty-six patients (19%) discontinued therapy because of an irAE, most commonly diarrhea. Overall, 103 patients (35%) required systemic corticosteroid treatment for an irAE; 29 (10%) also required anti-TNFα therapy. Defining TTF as either starting a new treatment or death, estimated median TTF was 5.7 months. Twelve percent of patients experienced long-term disease control without receiving additional antimelanoma therapy. OS and TTF were not affected by the occurrence of irAEs or the need for systemic corticosteroids. Conclusion IrAEs are common in patients treated with ipilimumab. In our experience, approximately one-third of ipilimumab-treated patients required systemic corticosteroids, and almost one-third of those required further immune suppression with anti-TNFα therapy. Practitioners and patients should be prepared to treat irAEs and should understand that such treatment does not affect OS or TTF.

scholarly journals Long-term outcomes of antibiotic combination therapy for ulcerative colitis

2021 ◽  
Vol 12 ◽  
pp. 204062232110287
Author(s):  
Yuriko Nishikawa ◽  
Nobuhiro Sato ◽  
Shintaro Tsukinaga ◽  
Kan Uchiyama ◽  
Shigeo Koido ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Side Effects ◽  
Adverse Events ◽  
Medical Information ◽  
Compliance Rate ◽  
University Hospital ◽  
Open Label ◽  
Antibiotic Combination

Aims: An antibiotic combination of amoxicillin, tetracycline and metronidazole (ATM) is effective for ulcerative colitis (UC), but this regimen is discontinued in some cases due to adverse events. This study aimed to assess a revised combination, namely, amoxicillin, fosfomycin and metronidazole (AFM), in UC patients with the goal of reducing side effects while maintaining therapeutic efficacy. Methods: A prospective open-label trial was undertaken in 104 adult UC patients. A combination of oral amoxicillin (1500 mg), fosfomycin (3000 mg) and metronidazole (750 mg) was administered to patients daily for 2–4 weeks in addition to their conventional medication. Clinical assessment was performed using the Lichtiger index before treatment and at 0, 3, 6, 9 and 12 months and 2 and 3 years. Endoscopic evaluation was performed using the Mayo score before treatment and at 3 and 12 months. Results: The compliance rate was 99.2%. Response and remission rates were 80.8% and 63.5% at completion, 73.1% and 64.4% at 3 months, and 39.4% for both at 12 months, respectively. Of the 41 patients who were in remission at 12 months, 63.4% maintained that status until the 2-year follow-up. Similarly, 69.2% of those in remission at 2 years remained relapse free at the 3-year follow-up. Side effects were observed in 44.2% of the participants. Fever occurred in one patient (1.0%), which was lower than the rate observed with ATM therapy. Conclusion: These results indicate that AFM therapy induces remission and is appropriate for long-term maintenance of UC while producing fewer and milder adverse events than ATM therapy. Clinical trials: This study was registered in the University Hospital Medical Information Network (No. R000046546).

scholarly journals Leukocytoclastic vasculitis following coronavirus disease 2019 (COVID-19): A case report

2021 ◽  
Vol 0 ◽  
pp. 1-4
Author(s):  
T. Renuka ◽  
V. T. Sandeep ◽  
P. M. Shiny ◽  
E. R. Jyothirani
Keyword(s):  
Leukocytoclastic Vasculitis ◽  
Vascular Diseases ◽  
Case Definition ◽  
Small Vessel Vasculitis ◽  
Histopathological Changes ◽  
Internal Organs ◽  
Collagen Vascular Diseases ◽  
Systemic Corticosteroids ◽  
Definition Of ◽  
Inflammatory Syndrome

Leukocytoclastic vasculitis (LCV) refers to the histopathological changes observed in a common form of small vessel vasculitis that can affect skin and/or internal organs. LCV can be precipitated by several causes (including infections, drugs, and collagen vascular diseases) or can be idiopathic. We report a 50-year-old man who presented with fever, parotid enlargement and skin rash (discrete and confluent erythematous macules, papules, and plaques and a few purpuric lesions on the back of trunk and upper limbs), 3 weeks after being diagnosed with coronavirus disease 2019 (COVID-19). The patient showed four out of the five features required to satisfy the working case definition of multisystem inflammatory syndrome in adults (MIS-A). Histopathology of rash was consistent with LCV. Whether, COVID-19 was the cause for LCV in our patient remains unclear. The fever, parotid enlargement and rash showed complete resolution following treatment with systemic corticosteroids and enoxaparin.

scholarly journals Case Report: Acute effect of benralizumab on asthma exacerbation without concomitant corticosteroid use

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 637
Author(s):  
Santi Nolasco ◽  
Raffaele Campisi ◽  
Rossella Intravaia ◽  
Morena Porto ◽  
Corrado Pelaia ◽  
...  
Keyword(s):  
Acute Exacerbation ◽  
Systemic Corticosteroid ◽  
Therapeutic Option ◽  
Symptom Control ◽  
Caucasian Woman ◽  
Eosinophilic Asthma ◽  
Corticosteroid Administration ◽  
Systemic Corticosteroids ◽  
Refractory Asthma

Background: Monoclonal antibodies are a relatively new therapeutic option for patients with severe refractory asthma, which can be used as an add-on to maintenance therapy, reducing the need for systemic corticosteroid usage, improving asthma symptom control and reducing exacerbations. We report a case of a patient with severe refractory eosinophilic asthma, reluctant to take systemic steroids, who was successfully treated with benralizumab alone during an acute asthma attack. Case presentation: A 59-year-old Caucasian woman with a history of allergic asthma since childhood showed a progressive decline in lung function with difficult to control symptoms and an increased number of hospitalizations despite maximal maintenance treatment, and was diagnosed with severe refractory asthma. She was reluctant to take systemic corticosteroids during exacerbations due to severe urinary retention; therefore, she started omalizumab with a partial reduction of symptoms and exacerbations over time. During a follow-up visit, she showed signs of acute exacerbation and she was switched to benralizumab during her acute phase with a rapid, dramatic amelioration of respiratory symptoms and pulmonary function, without concomitant systemic corticosteroid administration. During the treatment and at follow-up after one month, good tolerance and no side effects were observed. Conclusions: The use of benralizumab seems to be feasible, rapid, and safe in treating acute exacerbation of severe eosinophilic asthma without the use of systemic corticosteroids.

Predicting Patient Participation to an ICU Follow-Up Program

2021 ◽  
Author(s):  
Danielle Prevedello ◽  
Claire Steckelmacher ◽  
Marianne Devroey ◽  
Jacques Creteur ◽  
Jean-Charles Preiser
Keyword(s):  
Intensive Care ◽  
Charlson Comorbidity Index ◽  
Multivariable Analysis ◽  
Ventilatory Support ◽  
University Hospital ◽  
Multivariable Logistic Regression Analysis ◽  
Number Of Patients ◽  
Comorbidity Index

Abstract Objective: Survivors of intensive care often present long-term sequelae, including cognitive impairment and psychological discomfort. Follow-up programs have therefore been developed to assess and manage these long-term complications. Studying the effectiveness of such programs can be limited by the number of patients lost during follow-up. The aim of this study was therefore to evaluate patient characteristics predictive of participation to an intensive care unit (ICU) follow-up program. Design: In this prospective, nested, case-control study, all patients with an ICU stay of at least five days were invited to participate in an ICU follow-up program. Having attended 2 follow-up sessions at ICU and hospital discharge, they were given an appointment for their 3-month follow up. Patients were divided into two groups (“participants and “non-participants”) according to whether or not they attended this appointment. Multivariable logistic regression analysis was used to identify independent predictors of participation.Settings: An ICU follow-up program from a mixed ICU at a university hospital.Participants: All patients selected to participate to the ICU follow-up program were included in this study. They were allocated into two groups depending on their attendance in the follow-up program. Intervention: NoneMain results: Of the 199 patients included during the study period, 80 (40.2%) were classified as “participants”. These patients had a lower Charlson Comorbidity Index, a longer ICU length of stay (LOS), more frequently received ventilatory support for at least 24 hours and more frequently received extracorporeal membrane oxygenation (ECMO) than non-participant patients. In the multivariable analysis, ICU LOS longer than 10 days was associated with a 3.3 times increased likelihood of participating in the follow-up; a lower Charlson Comorbidity Index also predicted an increased likelihood of participating to the ICU follow-up clinic.Conclusions: Fewer comorbidities and longer intensive care LOS were independent predictors of participation in ICU follow-up.

scholarly journals Case Report: Acute effect of benralizumab on asthma exacerbation without concomitant corticosteroid use

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 637
Author(s):  
Santi Nolasco ◽  
Raffaele Campisi ◽  
Rossella Intravaia ◽  
Morena Porto ◽  
Corrado Pelaia ◽  
...  
Keyword(s):  
Acute Exacerbation ◽  
Systemic Corticosteroid ◽  
Therapeutic Option ◽  
Symptom Control ◽  
Caucasian Woman ◽  
Eosinophilic Asthma ◽  
Corticosteroid Administration ◽  
Systemic Corticosteroids ◽  
Refractory Asthma

Background: Monoclonal antibodies are a relatively new therapeutic option for patients with severe refractory asthma, which can be used as an add-on to maintenance therapy, reducing the need for systemic corticosteroid usage, improving asthma symptom control and reducing exacerbations. We report a case of a patient with severe refractory eosinophilic asthma, reluctant to take systemic steroids, who was successfully treated with benralizumab alone during an acute asthma attack. Case presentation: A 59-year-old Caucasian woman with a history of allergic asthma since childhood showed a progressive decline in lung function with difficult to control symptoms and an increased number of hospitalizations despite maximal maintenance treatment, and was diagnosed with severe refractory asthma. She was reluctant to take systemic corticosteroids during exacerbations due to severe urinary retention; therefore, she started omalizumab with a partial reduction of symptoms and exacerbations over time. During a follow-up visit, she showed signs of acute exacerbation and she was switched to benralizumab during her acute phase with a rapid, dramatic amelioration of respiratory symptoms and pulmonary function, without concomitant systemic corticosteroid administration. During the treatment and at follow-up after one month, good tolerance and no side effects were observed. Conclusions: The use of benralizumab seems to be feasible, rapid, and safe in treating acute exacerbation of severe eosinophilic asthma without the use of systemic corticosteroids.

scholarly journals Ipsilateralna operacija primarnog pterigijuma, senzorne ezotropije i konjuktivalni autotransplatant u istom aktu

2003 ◽  
Vol 50 (4) ◽  
pp. 143-145
Author(s):  
Dusica Risovic ◽  
Lj. Nikolic
Keyword(s):  
Dry Eye ◽  
Ocular Surface ◽  
Vascular Diseases ◽  
Rectus Muscle ◽  
Bulbar Conjunctiva ◽  
Cytostatic Drugs ◽  
Collagen Vascular Diseases ◽  
Conjunctival Autograft ◽  
The Right

The purpose of this study was to find out whether a conjunctival autograft over the recessed bulbomotor muscle can prevent a recidive of an inflamatory internal pterygium associated with strabismus. The fast growing internal pterygium (crossing corneoscleral limbus of the right eye 3-4mm towards the centre of the cornea) in a 42 years old patient, was removed by superficial keratectomy, while strabismus was corrected by the recession of the internal rectus muscle and covered with an autograft of the upper bulbar conjunctiva. Neither collagen vascular diseases, nor dry eye were present. Horizontal deviation was lessened from +12 to +6, after surgery, and the regrowth of the inflamatory pterygium was not observed during a five years follow up. The risk of the reapperance of pterygium at the site of muscle surgery for strabismus might have been avoided by creating a smooth ocular surface over a thin conjunctival autograft without Tenon's capsule. We believe that conjunctival autograft in such eyes, carrying a higher risk for pterygium regrowth, may help in the avoidance of the use of cytostatic drugs and on their untoward effects.

scholarly journals Tolerability of Omalizumab in Asthma as a Major Compliance Factor: 10-Year Follow Up

2018 ◽  
Vol 6 (10) ◽  
pp. 1839-1844 ◽  
Author(s):  
Mona Al-Ahmad ◽  
Jasmina Nurkic ◽  
Ahmed Maher ◽  
Nermina Arifhodzic ◽  
Edin Jusufovic
Keyword(s):  
Adverse Events ◽  
Treatment Efficacy ◽  
Real Life ◽  
Drop Out ◽  
Uncontrolled Asthma ◽  
Increased Risk ◽  
Asthma Patients ◽  
Severe Adverse Events

BACKGROUND: There is a lack of data related to real life, long-term safety, tolerability and compliance of omalizumab treatment in asthma patients beyond 6 years. AIM: Study aimed to assess safety, tolerability, compliance and all reasons for treatment discontinuation during 10 years on omalizumab. SUBJECT AND METHODS: This is a retrospective, observational study of uncontrolled asthma patients receiving omalizumab for the last 10 years. All data were collected from patients’ files (demographics, adverse events, comorbidities, compliance index, reasons for discontinuation of omalizumab). Reactions to omalizumab were classified as local and systemic, and their severity as mild, moderate or severe. Reactions were either immediate (minutes to hours after drug administration) or delayed (after days). Compliance to omalizumab, defined as Compliance index (CI), was calculated by comparing milligrams of given to milligrams of prescribed dose/ per year. RESULTS: Out of 35 patients receiving omalizumab, 15 drop out at different time points mostly due to treatment efficacy or appearance of new comorbidities. Patients who continue for the next ten years had mild to moderate adverse events related to omalizumab. There was no increased risk of severe adverse events during 10 years on omalizumab. Patient’s treatment tolerability, despite mild to moderate adverse events, is in favour of compliance. CONCLUSION: Compliance with omalizumab mildly decreased over 10 years but was not affected by severe adverse events of treatment or new comorbidities. Although, omalizumab is safe medicine appearance of new comorbidities has to be closely followed up.

scholarly journals FRI0477 SYSTEMIC TREATMENT IN SARCOIDOSIS. STUDY OF 377 PATIENTS FROM A SINGLE UNIVERSITY HOSPITAL

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 835.1-836
Author(s):  
M. Calderón-Goercke ◽  
R. Fernández-Ramón ◽  
J. L. Martín-Varillas ◽  
L. Sanchez-Bilbao ◽  
D. Martínez-López ◽  
...  
Keyword(s):  
Biological Therapy ◽  
Systemic Treatment ◽  
University Hospital ◽  
Research Support ◽  
Biological Drugs ◽  
Systemic Corticosteroids ◽  
Multisystemic Disease ◽  
Granulomatous Diseases ◽  
Treatment Of Sarcoidosis

Background:Sarcoidosis is a multisystemic disease characterized by the formation of non-necrotizing granulomas. The most frequently affected organs are lungs, skin and eyes. Systemic corticosteroids are the most used drugs in the treatment of this disease. Conventional and biological immunosuppressants (IS) may also be used(1-3).Objectives:To evaluate the systemic treatment of sarcoidosis according to clinical domains.Methods:Study of all consecutive patients diagnosed with sarcoidosis between 1/1/1999 and 1/1/2019 in a tertiary university hospital. The diagnosis was established following the ATS/ERS/WASOG criteria(Eur Respir J. 1999;14(4):735-737):compatible clinical and radiological presentation, evidence of non-caseifying granulomas and exclusion of other granulomatous diseases.Results:We studied 377 patients (188 men/189 women), mean age at diagnosis of 46.0±14.8 years. After a mean follow-up of 13.0±9.3 years, 161 (42.7%) patients did not require treatment. The remaining 216 (57.3%) received oral glucocorticoids (206, 54.6%) with a maximum mean dose of 43.2±19.0 mg/day, conventional IS (60, 16.2%), biological therapy (28, 7.4%) and/or endovenous methylprednisolone (15, 4.0%). Biological therapy was indicated by pulmonary (9, 32.1%), ocular (9, 32.1%), neurological (3, 10.7%), muskuloeskeletal (3, 10.7%), cutaneous (2, 7.1%), nephrological involvement (1, 3.6%); and Heerfordt’s syndrome (1, 3.6%). Adalimumab and Infliximab were the biologics used more frequently (Table).TABLESystemic treatment of sarcoidosis according to clinical domains.Conclusion:Compared to other studies, the high percentage of patients who required systemic treatment is remarkable. It also highlights the frequency of the use of biological drugs in more severe organ involvement (ocular and neurological), which is consistent with the trend in recent years.References:[1]Riancho-Zarrabeitia L, et al. Semin Arthritis Rheum. 2015; 45:361-8.[2]Vegas-Revenga N, et al. Am J Ophthalmol. 2019; 200:85-94.[3]Calvo-Río V, et al.. Clin Exp Rheumatol. 2014;32(4 Suppl 84): S54-7.Disclosure of Interests:Monica Calderón-Goercke: None declared, Raúl Fernández-Ramón: None declared, José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Lara Sanchez-Bilbao Grant/research support from: Pfizer, David Martínez-López: None declared, Iñigo González-Mazón: None declared, Jorge Javier Gaitán-Valdizán: None declared, Rosalía Demetrio-Pablo: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

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