scholarly journals Early azathioprine in acute Vogt-Koyanagi-Harada disease: a prospective 24-month follow-up study with multimodal imaging and electroretinogram

2022 ◽  
Author(s):  
Marcelo Mendes Lavezzo ◽  
Viviane Mayumi Sakata ◽  
Fernanda Maria Silveira Souto ◽  
Ruy Felippe Brito Gonçalves Missaka ◽  
Priscilla Figueiredo Campos da Nobrega ◽  
...  
Keyword(s):  
Early Treatment ◽  
Oral Prednisone ◽  
High Dose ◽  
Subclinical Inflammation ◽  
High Dose Corticosteroid ◽  
Full Field ◽  
Corrected Visual Acuity ◽  
Dose Corticosteroid

Abstract Background: First-line immunosuppressive therapy (IMT) associated with high-dose corticosteroid (CS) has been proposed for the treatment of acute Vogt-Koyanagi-Harada disease (VKHD) to prevent chronicity and to prevent long-term CS side effects. However, there are very few studies that systematically evaluated visual and inflammatory outcomes in acute VKHD with early IMT. This study aimed to evaluate the outcome of high-dose corticosteroids with early addition of azathioprine (AZA) in patients with acute Vogt-Koyanagi-Harada disease (VKHD) followed for 24-month with systematic multimodal and electroretinogram exams.Methods: Prospective interventional study. Fifteen consecutive patients (30 eyes) with acute VKHD at a tertiary uveitis referral centre were followed for 24 months with systematic multimodal and full-field electroretinogram (ffERG) exams. Patients were treated with intravenous methylprednisolone followed by oral prednisone 1mg/kg/daily (CS) with slow taper and AZA introduction within 4 months. Anterior uveitis relapse, subclinical inflammation, best-corrected visual acuity (BCVA) and ffERG parameters were analyzed.Results: Fifteen patients (14 female) with a median age of 32 years were included. In the first month, 27 eyes (90%) had BCVA ≥20/40; at M24, all eyes (100%) had BCVA ≥20/25. Uveitis resolved in 28 eyes (93.3%) and became chronic recurrent in 2 eyes (6.7%); subclinical inflammation was still present in all eyes during the 24-month follow-up. ffERG parameters initially improved in all eyes; at M24, 23 eyes (76.7%) had subnormal results and 20 eyes (66.7%) had stable parameters. Eyes with very early treatment (n=12) had lower indocyanine green angiography score than eyes with early treatment (n=18) at M1 (p=0.012), but they had similar rates of recurrence, complications and ffERG parameters. Conclusion: Early AZA associated with high-dose corticosteroid was effective in improving BCVA and in controlling clinical inflammation. Isolate subclinical inflammation persisted in all eyes with no impact on ffERG in, at least, two thirds of these eyes, indicating that isolate subclinical inflammation may not be enough to indicate treatment increment.

scholarly journals Complete Remission of Relapsed Hodgkin’s Lymphoma following Brentuximab Vedotin and Gemcitabine Combination Therapy with Severe Hypotension as Possible Treatment-Related Adverse Event: A Case Report

2020 ◽  
Vol 13 (1) ◽  
pp. 341-346 ◽  
Author(s):  
Ibnu Purwanto ◽  
Bambang P. Utomo ◽  
Ahmad Ghozali
Keyword(s):  
Adverse Event ◽  
Complete Remission ◽  
Hodgkin’S Lymphoma ◽  
Brentuximab Vedotin ◽  
Hodgkin's Lymphoma ◽  
High Dose ◽  
High Dose Corticosteroid ◽  
Severe Hypotension ◽  
Dose Corticosteroid

A 40-year-old Asian female with heavily treated relapsed Hodgkin’s lymphoma showed complete remission (CR) after receiving 8 cycles of brentuximab vedotin (BV) in combination with gemcitabine as 4th line treatment. The patient remained in CR at the 18-month post-treatment follow-up. She developed severe hypotension (50/36 mm Hg) with upper and lower limb petechiae and edema after the addition of gemcitabine on the 6th cycle of BV. This adverse event resolved after 3 days of treatment with vasopressor and high-dose corticosteroid. The addition of dexamethasone for the subsequent 2 cycles successfully prevented this adverse event from recurring.

Pseudotumor cerebri following tapered corticosteroid treatment in an 8-month-old infant

2008 ◽  
Vol 1 (1) ◽  
pp. 88-90 ◽  
Author(s):  
Wilson Z. Ray ◽  
Amy Lee ◽  
Spiros L. Blackburn ◽  
Gregg T. Lueder ◽  
Jeffrey R. Leonard
Keyword(s):  
Lumbar Puncture ◽  
High Volume ◽  
Corticosteroid Treatment ◽  
Pseudotumor Cerebri ◽  
Capillary Hemangioma ◽  
High Dose ◽  
Ophthalmological Examination ◽  
High Dose Corticosteroid ◽  
Dose Corticosteroid

✓The authors report on an 8-month-old infant with an orbital capillary hemangioma. The patient had been treated with high-dose corticosteroid therapy and had had a recent decrease in dose. The patient presented to the emergency department with increased irritability and bulging fontanelles. On lumbar puncture the opening pressure was > 55 cm H2O. Ophthalmological examination revealed interval development of papilledema. The child was treated with high-volume lumbar puncture, subsequent drainage of 10 ml of cerebrospinal fluid, resumption of the previous steroid dose, and acetazolomide therapy. The patient's symptoms resolved and follow-up ophthalmological examination revealed interval resolution of papilledema. The authors present the youngest reported case of pseudotumor development after corticosteroid tapering.

scholarly journals Outcomes of Direct Vision Internal Urethrotomy for Bulbar Urethral Strictures: Technique Modification with High Dose Triamcinolone Injection

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Rishi Modh ◽  
Peter Y. Cai ◽  
Alyssa Sheffield ◽  
Lawrence L. Yeung
Keyword(s):  
Corticosteroid Injection ◽  
Direct Vision ◽  
High Dose ◽  
Internal Urethrotomy ◽  
High Dose Corticosteroid ◽  
Urethral Strictures ◽  
Significant Difference ◽  
Triamcinolone Injection ◽  
Dose Corticosteroid

Objective. To evaluate the recurrence rate of bulbar urethral strictures managed with cold knife direct vision internal urethrotomy and high dose corticosteroid injection.Methods. 28 patients with bulbar urethral strictures underwent direct vision internal urethrotomy with high dose triamcinolone injection into the periurethral tissue and were followed up for recurrence.Results. Our cohort had a mean age of 60 years and average stricture length of 1.85 cm, and 71% underwent multiple previous urethral stricture procedures with an average of 5.7 procedures each. Our technique modification of high dose corticosteroid injection had a recurrence rate of 29% at a mean follow-up of 20 months with a low rate of urinary tract infections. In patients who failed treatment, mean time to stricture recurrence was 7 months. Patients who were successfully treated had significantly better International Prostate Symptom Scores at 6, 9, and 12 months. There was no significant difference in maximum flow velocity on Uroflowmetry at last follow-up but there was significant difference in length of follow-up (p=0.02).Conclusions. High dose corticosteroid injection at the time of direct vision internal urethrotomy is a safe and effective procedure to delay anatomical and symptomatic recurrence of bulbar urethral strictures, particularly in those who are poor candidates for urethroplasty.

scholarly journals AB0616 REDUCED BONE MINERAL DENSITY IN PATIENTS WITH IDIOPATHIC INFLAMMATORY MYOPATHIES: A LONGITUDINAL STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1603.3-1604
Author(s):  
Y. K. Tang ◽  
H. So ◽  
T. L. V. Wong ◽  
H. T. Pang ◽  
V. Lao ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Bone Health ◽  
High Dose ◽  
Idiopathic Inflammatory Myopathies ◽  
Inflammatory Myopathies ◽  
Mineral Density ◽  
High Dose Corticosteroid ◽  
Dose Corticosteroid

Background:Reduced bone mineral density (BMD) leads to fragility fracture which is associated with a significant morbidity and excess mortality [1,2]. Patients with idiopathic inflammatory myopathies (IIM) should be at a heightened risk of reduced BMD as a result of the systemic inflammation, reduced mobility and corticosteroid use [3]. A previous cross-sectional study demonstrated a high prevalence of osteoporosis (23.7%) and osteopenia (47.4%) in a cohort of IIM patients [4]. However, longitudinal data are lacking.Objectives:To assess the BMD of IIM patients longitudinally and to investigate the factors associated with accelerated bone loss.Methods:This is a single centered observational study. Existing adult Chinese patients with IIMs who had serial BMD measurements done were recruited. The diagnosis of IIMs was based on the Bohan and Peter’s criteria with definite or probable cases being included [5]. Patients with clinically amyopathic disease must have the typical Gottron’s papules or heliotrope rash as determined by rheumatologists or dermatologists, and with no symptoms or signs of muscle involvement according to Sontheimer [6]. BMD was measured by dual energy X-ray absorptiometry (DEXA). Clinical variables thought to be associated with bone health were documented.Results:All together 28 patients were studied. The mean age of the patients at disease onset was 46.1 years (S.D. 12.2). There was a female predominance (92.9%). The subgroups of IIMs were: dermatomyositis (39.3%), polymyositis (25.3%), clinically amyopathic dermatomyositis (21.4%) and immune mediated necrotising myopathy (14.3%). Only a minority of the patients smoked (7.1%) and none of them drinks regularly. About one fifth of the patients were underweight. All patients have been exposed to systemic corticosteroid, while 82.1% of them were still on it between the two scans with 32.1% even on high dose (>0.5mg prednisolone/kg/day). Three out of the 28 patients (10.7%) was found to be osteoporotic at baseline and 17 patients (60.7%) were osteopenic. Follow-up DEXAs were performed mostly 5 to 10 years after the initial scan. Despite 8 patients (28.6%) were given active anti-osteoporotic medications, the bone health deteriorated significantly. The mean baseline neck of femor BMD dropped from 0.711 to 0.657 g/cm2 (p=0.042) on follow-up, while the total lumbar BMD from 0.951 to 0.905 g/cm2 (p=0.036). The T-score in 11 patients (39.3) reached osteoporotic range at the second DEXA. Together with the patients with osteopenia, 78.6% of the IMM patients had reduced BMD at the follow-up scan. Actually, 5 patients (17.9%) already had one episode of fragility fracture. The use of high dose corticosteroid in between the 2 scans was found to be associated with a greater degree of mean BMD loss in the hip (-0.171 vs -0.007 g/cm2, p=0.007).Conclusion:Reduced BMD is prevalent in patients with IIM. Follow-up study revealed significant worsening of bone health. High dose corticosteroid use might be especially detrimental. Liberal assessment of BMD and use of anti-osteoporotic drugs in IIM patients are advisable. Prompt use of steroid-sparing agents to minimize steroid exposure may also be helpful.References:[1]Falch J, Aho H, Berglund K, et al. Hip fractures in Nordic Cities: difference in incidence. Ann Chir Gynaecol 1995;84:286-90.[2]Dennison E, Mohammed MA, Cooper C. Epidemiology of osteoporosis. Rheum Dis Clin North Am 2006;32:617-29.[3]Luigi S, Massimo V, Giuseppe G. Epidemiology of osteoporosis in rheumatic disease. Clin Exp Rheumatol 2006;32:631-58.[4]So H, Yip ML, Wong KM. Prevalence and associated factors of reduced bone mineral density in patients with idiopathic inflammatory myopathies. Int J Rheum Dis 2016;19:521-8.[5]Bohan A, Peter JB. Polymyositis and dermatomyositis. N Engl J Med 1975;292:344-7.[6]6. Sontheimer RD. Clinically myopathic dermatomyositis: what can we now tell our patients? Arch Dermatol 2010;146:76-80.Disclosure of Interests:None declared

scholarly journals Reversible blindness after erroneous prescription of closantel: A case report

2021 ◽  
Author(s):  
Hamed Cheraghmakani ◽  
Reza Jafari ◽  
Elahe Karimpour-razkenari ◽  
monireh Ghazaeian
Keyword(s):  
Case Report ◽  
Plasma Exchange ◽  
Vision Loss ◽  
Pulse Therapy ◽  
High Dose ◽  
High Dose Corticosteroid ◽  
Peripheral Nerve Fiber ◽  
Corticosteroid Pulse Therapy ◽  
Dose Corticosteroid

A 20-year-old girl referred with vision loss upon closantel use. Plasma exchange and high-dose corticosteroid pulse therapy were administered. A 2.5-year follow-up showed improved vision and increased layer thickness of the peripheral nerve fiber. Early treatment with plasma exchange and high-dose corticosteroid therapy can be beneficial to reverse closantel toxicity.

High-Dose Corticosteroid Pulse Therapy Increases the Survival Rate in COVID-19 Patients at Risk of Cytokine Storm

2020 ◽  
Author(s):  
Miguel Ángel López-Zúñiga ◽  
Aida Moreno-Moral ◽  
Ana Ocaña-Granados ◽  
Francisco Padilla-Moreno ◽  
Alba María Castillo-Fernández ◽  
...  
Keyword(s):  
At Risk ◽  
Survival Rate ◽  
Pulse Therapy ◽  
High Dose ◽  
Cytokine Storm ◽  
High Dose Corticosteroid ◽  
Patients At Risk ◽  
Corticosteroid Pulse Therapy ◽  
Dose Corticosteroid

scholarly journals POS0338 STEROID-SPARING EFFECT OF ANAKINRA IN GIANT-CELL ARTERITIS: A CASE SERIES WITH CLINICAL, BIOLOGICAL AND ICONOGRAPHIC LONG-TERM ASSESSMENTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 397.1-397
Author(s):  
S. Deshayes ◽  
K. Ly ◽  
V. Rieu ◽  
G. Maigné ◽  
N. M. Silva ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Interleukin 1 ◽  
Oral Prednisone ◽  
Large Vessel ◽  
Daily Dose ◽  
Sparing Effect ◽  
Steroid Sparing

Background:The treatment of giant cell arteritis (GCA) relies on corticosteroids but is burdened by a high rate of relapses and adverse effects. Anti-interleukin-6 treatments show a clear benefit with a significant steroid-sparing effect, but late relapses occur after treatment discontinuation. In addition to interleukin-6, interleukin-1 also appears to play a significant role in GCA pathophysiology.Objectives:We report herein the efficacy of anakinra, an interleukin-1 receptor antagonist, in 6 GCA patients exhibiting corticosteroid dependence or resistance, specifically analyzing the outcome of aortitis in 4 of them, and including the long-term follow-up of 2 previously described patients (1).Methods:This retrospective study analyzed the cases of all GCA patients treated with anakinra from the French Study Group for Large Vessel Vasculitis.Patients had to satisfy the following two criteria to be enrolled in this retrospective study. First, their diagnosis of GCA should be based on the fulfillment of at least 3 criteria of the American College of Rheumatology (ACR) for GCA or on the satisfaction of 2 of these criteria along with the demonstration of LVI on imaging. Second, patients should have received anakinra because of corticosteroid dependence or resistance.Corticosteroid dependence was defined as ≥2 relapses or the combination of 2 of the following criteria: a daily dose of oral prednisone >20 mg/day (or 0.3 mg/kg) at 6 months; a daily dose of oral prednisone >10 mg/day (or 0.2 mg/kg) at 12 months; and/or a treatment maintained >24 months because of a relapsing disease course. Corticosteroid resistance was defined as persistent increased inflammatory parameters at month 3 despite a steroid dosage over 0.5 mg/kg.Results:After a median duration of anakinra therapy of 19 [18–32] months, all 6 patients exhibited complete clinical and biological remission. Among the 4 patients with large-vessel involvement, 2 had a disappearance of aortitis under anakinra, and 2 showed a decrease in vascular uptake. After a median follow-up of 56 [48–63] months, corticosteroids were discontinued in 4 patients, and corticosteroid dosage could be decreased to 5 mg/day in 2 patients. One patient relapsed 13 months after anakinra introduction in the context of increasing the daily anakinra injection interval to every 48 hours. Three patients experienced transient injection-site reactions, and 1 patient had pneumonia.Figure 1.Steroid dosages before and after the introduction of anakinra in 6 patients with giant-cell arteritis and corticosteroid dependence or resistance. The black arrow indicates the time of anakinra introduction.Conclusion:In this short series, anakinra appears to be an efficient and safe steroid-sparing agent in refractory GCA, with a possible beneficial effect on large-vessel involvement.References:[1]Ly K-H, Stirnemann J, Liozon E, Michel M, Fain O, Fauchais A-L. Interleukin-1 blockade in refractory giant cell arteritis. Joint Bone Spine 2014;81:76–8.Disclosure of Interests:Samuel Deshayes: None declared, Kim LY: None declared, Virginie Rieu: None declared, Gwénola Maigné: None declared, Nicolas Martin Silva: None declared, Alain Manrique: None declared, Jacques Monteil: None declared, Hubert de Boysson Speakers bureau: Roche-Chugai, Grant/research support from: Roche-Chugai, Achille Aouba Grant/research support from: SOBI

scholarly journals Adalimumab Accounts for Long-Term Control of Noninfectious Uveitis Also in the Absence of Concomitant DMARD Treatment: A Multicenter Retrospective Study

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Alice Bitossi ◽  
Alessandra Bettiol ◽  
Elena Silvestri ◽  
Gerardo Di Scala ◽  
Daniela Bacherini ◽  
...  
Keyword(s):  
Retention Rate ◽  
Systemic Disease ◽  
World Population ◽  
Corrected Visual Acuity ◽  
Drug Retention ◽  
Sparing Effect ◽  
Retrospective Multicenter Study ◽  
Drug Retention Rate

Objective. This study was aimed at assessing the long-term ocular control of adalimumab (ADA) in a large real-world population with noninfectious primary or secondary uveitis, focusing on the steroid-sparing effect and on disease-modifying antirheumatic drug (DMARD) cotreatment. Methods. In this retrospective, multicenter study, the efficacy of ADA was evaluated in terms of ocular control, changes in best-corrected visual acuity (BCVA), corticosteroid-sparing effect, and drug retention rate, overall and stratified according to DMARD cotreatment. Results. 106 patients were included. 88.7% had an associated systemic disease. After 6 and 12 months, proportions of patients with effective ocular control were 83.7% and 83.3%, respectively. At last the follow-up, 94.6% of patients had satisfactory ocular control. No difference in terms of ocular control at all time points emerged among patients starting ADA for ocular vs. systemic involvements. Patients with poor baseline BCVA remained stable or improved, while those with good BCVA hardly worsened. At 6 and 12 months, the median dose of prednisone significantly reduced to 5 mg/day (0-5) and 2.5 mg/day (0-5) (p<0.001). Over a median follow-up of 36 months, 38 subjects discontinued ADA treatment. Mild to moderate side effects were reported in 7 patients (6.6%). ADA ocular control, corticosteroid-sparing effect, and drug retention rate were not influenced by the concomitant use of DMARDs. Conclusion. The long-term ocular control of ADA in noninfectious primary or secondary uveitis is confirmed, also for BCVA preservation. Concomitant use of DMARDs does not provide additional benefits to ADA alone in terms of ocular control, steroid spare, and drug retention rate.

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