scholarly journals Oral steroid-sparing effect of high-dose inhaled corticosteroids in asthma

2019 ◽  
Vol 55 (1) ◽  
pp. 1901147 ◽  
Author(s):  
Ingrid Maijers ◽  
Nethmi Kearns ◽  
James Harper ◽  
Mark Weatherall ◽  
Richard Beasley
Keyword(s):  
Dose Response ◽  
Oral Corticosteroid ◽  
Inhaled Corticosteroids ◽  
Adrenal Suppression ◽  
Oral Steroid ◽  
Systemic Effects ◽  
High Dose ◽  
Response Relationship ◽  
Dose Response Relationship ◽  
Sparing Effect

BackgroundThe proportion of the efficacy of high-dose inhaled corticosteroids (ICS) in oral corticosteroid-dependent asthma that is due to systemic effects is uncertain. This study aimed to estimate the ICS dose–response relationship for oral corticosteroid-sparing effects in oral corticosteroid-dependent asthma, and to determine the proportion of oral corticosteroid-sparing effects due to their systemic effects, based on the comparative dose–response relationship of ICS versus oral corticosteroids on adrenal suppression.MethodsSystematic review and meta-analysis of randomised controlled trials reporting oral corticosteroid-sparing effects of high-dose ICS in oral corticosteroid-dependent asthma. In addition, reports of oral corticosteroid to ICS dose-equivalence in terms of adrenal suppression were retrieved. The primary outcome was the proportion of the oral corticosteroid-sparing effect of ICS that could be attributed to systemic absorption, per 1000 µg increase of ICS, expressed as a ratio. This ratio estimates the oral corticosteroid sparing effect of ICS due to systemic effects.Results11 studies including 1283 participants reporting oral corticosteroid-sparing effects of ICS were identified. The prednisone dose decrease per 1000 µg increase in ICS varied from 2.1 mg to 4.9 mg, depending on the type of ICS. The ratio of the prednisone-sparing effect due to the systemic effects per 1000 µg of fluticasone propionate was 1.02 (95% CI 0.68–2.08) and for budesonide was 0.93 (95% CI 0.63–1.89).ConclusionIn patients with oral corticosteroid-dependent asthma, the limited available evidence suggests that the majority of the oral corticosteroid-sparing effect of high-dose ICS is likely to be due to systemic effects.

Fertility of Tall Girls Treated With High-Dose Estrogen, A Dose-Response Relationship

2013 ◽  
Vol 68 (1) ◽  
pp. 36-37
Author(s):  
A. E. J. Hendriks ◽  
S. L. S. Drop ◽  
J. S. E. Laven ◽  
A. M. Boot
Keyword(s):  
Dose Response ◽  
High Dose ◽  
Response Relationship ◽  
Dose Response Relationship ◽  
Tall Girls

scholarly journals Fertility of Tall Girls Treated with High-Dose Estrogen, a Dose-Response Relationship

2012 ◽  
Vol 97 (9) ◽  
pp. 3107-3114 ◽  
Author(s):  
A. E. J. Hendriks ◽  
S. L. S. Drop ◽  
J. S. E. Laven ◽  
A. M. Boot
Keyword(s):  
Dose Response ◽  
High Dose ◽  
Response Relationship ◽  
Dose Response Relationship ◽  
Tall Girls

Dose-response relationship for risk of non-vertebral fracture with inhaled corticosteroids

2008 ◽  
Vol 38 (9) ◽  
pp. 1451-1458 ◽  
Author(s):  
M. Weatherall ◽  
K. James ◽  
J. Clay ◽  
K. Perrin ◽  
M. Masoli ◽  
...  
Keyword(s):  
Vertebral Fracture ◽  
Dose Response ◽  
Inhaled Corticosteroids ◽  
Response Relationship ◽  
Dose Response Relationship

A Retrospective Analysis of Response to High Dose Rituximab Monotherapy in CLL/NHL Patients Who Received Prior Standard Dose Rituximab Therapy.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4722-4722
Author(s):  
Casey A. Moffa ◽  
Chandana Thatikonda ◽  
Neeta Pathe ◽  
James M. Rossetti ◽  
Richard K. Shadduck ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Dose Response ◽  
Combination Chemotherapy ◽  
Progressive Disease ◽  
Standard Dose ◽  
Absolute Lymphocyte Count ◽  
High Dose ◽  
Response Relationship ◽  
Dose Response Relationship ◽  
Final Treatment

Abstract Background: Rituximab at standard dose (375 mg/m2) in combination with chemotherapy has been used to treat CLL and NHL. We retrospectively evaluated the response and toxicity of high dose rituximab (HDR) (500 mg/m2 thrice weekly for 2 weeks, total dose 3 gm/m2) in patients with CLL or NHL, who had received prior treatment with standard rituximab as either monotherapy or in combination chemotherapy, to determine if there was a dose response relationship. Methods: Eight patients with either CLL or NHL who had received HDR therapy were evaluated. Patients received HDR because they refused conventional treatment or failed to respond to prior combination chemotherapy. Seven of the patients had prior combination therapy, whereas 1 had received standard dose rituximab alone. Response to HDR was evaluated based upon absolute lymphocyte count approximately 21 days after the final treatment in CLL patients and PET/CT scan after the final treatment for NHL. Results: Mean age at treatment: 70 yrs (range = 57–83), males (n=7) and female (n=1), CLL (n=5) and NHL (n=3). One patient with CLL had Richter’s transformation. Patients received prior treatments with rituxan alone (n=1), combination therapy for CLL with FCR, FR or PCR (n=5) or combination therapy for NHL with hyperCVAD-R, CHOP-R or RICE (n=2). Of the 5 patients with CLL treated with HDR, 3 achieved partial remission (PR) while the remaining 2 patients developed progressive disease. Complete remission, however, could not be assessed secondary to lack of a post treatment bone marrow biopsy. All 3 patients with NHL developed progressive disease. One patient developed rigors during the infusion of HDR requiring IV steroids. No infusion was stopped secondary to toxicity. Conclusions: Based upon our findings, HDR was active in patients with relapsed CLL but not in relapsed NHL. Further exploration of this dose-response relationship is warranted in patients with CLL.

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