scholarly journals The Occurrence Timeline of Steroid-induced Ocular Hypertension and Cataract in Children With Systemic Autoimmune Diseases

2021 ◽  
Author(s):  
Honggai Yan ◽  
Xiaohua Tan ◽  
Jifeng Yu ◽  
Tianwei Liang ◽  
Wei Shi ◽  
...  
Keyword(s):  
Autoimmune Diseases ◽  
Ocular Hypertension ◽  
Corticosteroid Treatment ◽  
Retinal Nerve Fibre Layer ◽  
Systemic Autoimmune Diseases ◽  
Oral Corticosteroids ◽  
Nerve Fibre Layer ◽  
Peak Value

Abstract Purpose Steroid-induced ocular hypertension (SIOH) and cataract can result in visual loss. This study evaluated the timetable of SIOH and steroid-induced posterior subcapsular cataract (SI-PSC) occurrences in children with systemic autoimmune diseases (SAD) undergoing long-term systemic corticosteroid treatment.Methods Thirty-seven children with SAD treated with long-term oral corticosteroids were enrolled in this study. Intraocular pressure (IOP), SI-PSC occurrences, visual field and peripapillary retinal nerve fibre layer (pRNFL) thicknesses were recorded every 3 months for at least 6 months.Results Of the 37 children, with average age 11.0±2.9 years, 22 patients (59.5%) had SIOH, 2 progressed as glaucoma at the 18-month and 3-year follow-up respectively and 12 (32.4%) patients had SI-PSC. Among patients with SIOH, 45.5% (10/22) of them had SI-PSC occurrences and among patients with normal IOP, 13.3% (2/15) of them had SI-PSC. Seventeen patients participated in a longitudinal study with a follow-up period of at least 18 months. The incidence of SIOH started at 1 month (52%, 9/17) and gradually increased to its peak value (70.6%,12/17) at 6 months, then decreased to 35.3% (6/17). SI-PSC onset started at 6 months (17.6%, 3/17), and its occurrence increased to 35.3% (6/17) at 12 months and reached to 41.2% (7/17) at 18 months. The pRNFL was thicker in the children with SIOH than the healthy controls (p = 0.01).Conclusion SIOH and SI-PSC are common coexistent complications in children with long-term corticosteroids treatment and the occurrence time is during the first month and 6 months, respectively. Patients with SIOH have a higher probability of cataract.

scholarly journals Successful Treatment of Sudden Hepatitis Induced by Long-Term Nivolumab Administration

2017 ◽  
Vol 10 (1) ◽  
pp. 368-371 ◽  
Author(s):  
Keisuke Imafuku ◽  
Koji Yoshino ◽  
Kei Yamaguchi ◽  
Satoshi Tsuboi ◽  
Kuniaki Ohara ◽  
...  
Keyword(s):  
Malignant Melanoma ◽  
Liver Function ◽  
Immune Checkpoint ◽  
Fulminant Hepatitis ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Corticosteroid Treatment ◽  
Sudden Onset ◽  
Oral Corticosteroids

Immune checkpoint inhibitors have drastically changed in the treatment of many kinds of malignancies, especially malignant melanoma. The focus of the recent experiments has not only been on their efficacy but also immune-related adverse events (irAEs). We report a case of fulminant hepatitis due to nivolumab. In this case, the patient had undergone long-term nivolumab therapy. He did not complain of any symptoms but his liver enzyme levels were extremely elevated (grade 4). We promptly decided to start oral corticosteroids in the patient. His liver function rapidly improved. The dose of corticosteroids was gradually reduced. Our case demonstrates that sudden onset fulminant hepatitis can occur despite the safe use of long-term nivolumab therapy. The irAE can improve rapidly with proper corticosteroid treatment. This report will be useful for the physicians who always use immune checkpoint inhibitors.

scholarly journals Complications and outcomes associated with 13 cases of triceps tendon disruption in dogs and cats (2003–2014)

2017 ◽  
Vol 182 (4) ◽  
pp. 108-108 ◽  
Author(s):  
Naomi Frances Earley ◽  
Gemma Ellse ◽  
Adrian M Wallace ◽  
Kevin J Parsons ◽  
Katja Voss ◽  
...  
Keyword(s):  
Corticosteroid Treatment ◽  
Normal Function ◽  
Trauma History ◽  
Referral Hospitals ◽  
Long Term Follow Up ◽  
Owner Satisfaction ◽  
Bone Tunnels ◽  
Triceps Tendon

This study reports data from a larger number of cases of triceps tendon disruption. Records from 10 veterinary referral hospitals between 2003 and 2014 were searched for canine and feline cases diagnosed with triceps tendon disruption, based on orthopaedic examination confirmed during surgery. Long-term follow-up and owner satisfaction were assessed using a questionnaire. There were 13 cases of triceps tendon disruption diagnosed across seven hospitals (nine dogs, four cats). Trauma, history or presence of a wound, surgery in the region of tendon attachment or corticosteroid treatment preceded triceps tendon disruption. Radiographic signs or histopathology suggestive of a chronic tendinopathy was common. All cases underwent surgical repair involving a tendon suture pattern, 12 of which were secured through bone tunnels. Immobilisation was used in all cases in the form of transarticular external skeletal fixation (TAESF) (8/9 dogs) or spica splint (four cats, two dogs; in one dog a TAESF was applied after complications associated with the spica splint). Complications occurred in 11 cases (17 total complications), frequently associated with the immobilisation method. One case had traumatic tendon rerupture two years following surgery. A wound at presentation was associated with the development of multiple complications. Nine cases had long-term follow-up; five achieved normal function, four achieved acceptable function. Despite the complications, overall return to subjective normal or acceptable function, as assessed by the owners, was achieved in the majority of cases.

scholarly journals Efficacy and Safety of Nivolumab and AVD in Early-Stage Unfavorable Hodgkin Lymphoma: Extended Follow-up from the GHSG Phase II Nivahl Trial

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 6-7
Author(s):  
Paul J Bröckelmann ◽  
Helen Goergen ◽  
Ulrich Keller ◽  
Julia Meissner ◽  
Karolin Trautmann ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Research Funding ◽  
Early Stage ◽  
Corticosteroid Treatment ◽  
Primary Analysis ◽  
For Profit ◽  
Health Care Company ◽  
Support Research

Background The primary analysis of the investigator-sponsored randomized multicenter phase II GHSG NIVAHL trial showed feasibility and excellent short-term efficacy of anti-PD1 based 1st-line treatment of early-stage unfavorable classical Hodgkin lymphoma (cHL). Achieving long-term disease control without excessive treatment-related morbidity is of utmost importance when developing innovative 1st-line cHL therapies. Duration of response and development of persisting immune-related toxicities are of concern in the setting of 1st-line anti-PD1 treatment. Methods NIVAHL enrolled treatment naïve early-stage unfavorable cHL patients at 28 German centers and individuals were randomized to either receive fully concomitant 4x Nivo-AVD (group A) or sequential 4xnivolumab, followed by 2x Nivo-AVD and 2x AVD (group B). Both groups received consolidative 30Gy IS-RT and the primary endpoint was complete response (CR) rate at end of study treatment. Detailed methods, patient characteristics and the primary endpoint analysis of NIVAHL have been recently published (Bröckelmann PJ et al. JAMA Oncol 2020). Herein we present extended follow-up of the NIVAHL trial to assess efficacy in terms of 2-year progression-free (PFS) and overall survival (OS) as well as safety with regards to long-term toxicities or organ impairment documented during the first year of follow-up after treatment. Results A total of 109 patients with cHL confirmed by central pathology review were enrolled between 04/2017 - 10/2018 and followed for a median of 20 and 21 months in groups A (n=55) and B (n=54), respectively, for the present analysis. All of the 7 patients deemed in partial remission (PR) at end of study treatment (EOT) converted into an ongoing CR after end of study without additional treatment during follow-up. With no relapse and no death observed since the primary analysis, the 2-year PFS estimates are 100% and 98% (95%CI 88-100%) in groups A and B, respectively, and the 2-year OS is 100% in both groups. With a median observation time for late-toxicities of 14 months after EOT (range 6-26 months) among 103 patients, any potentially treatment-related AE during follow-up was reported in 65% of patients (A: 74%, B: 56%). The highest documented CTCAE grade of late AEs was °I in 33%, °II in 25% and °III in 7% of patients with no °IV-V AEs observed. A total of 54% had at least one late event related to AVD, 47% to nivolumab and 32% to RT, with multiple relations attributable per event. Mean FEV1 and DLCOc did not decrease from baseline (91.1% -> 96.4% and 86.2% -> 83.3%, respectively). Decreased LVEF after EOT was reported in 2/56 patients with available data (4%). After EOT, 18% of patients required medication for adverse events. Corticosteroid ≥ and < 10mg prednisolone equivalent was required in 3% and 2% of patients, respectively, for a toxicity at any time during follow-up. No patient required corticosteroid treatment at last available follow-up. Most frequent toxicities reported after EOT included fatigue (21%), hypothyroidism (17%), respiratory tract disorders (16%), leukopenia (14%) and nervous system disorders (14%). Hypothyroidism was the event most frequently solely attributed to nivolumab during follow-up. The median time to onset after EOT was 5 months and affected patients nearly exclusively female (15/16 [94%]). After median follow-up of 10 months (range 0-21), hypothyroidism remained unchanged in 10 of 16 affected patients and resolved in 3 patients. Conclusion The excellent disease control of concomitant and sequential nivolumab and AVD in early-stage unfavorable cHL is confirmed with the currently available follow-up. Treatment-related toxicities ongoing or emerging during follow-up are predominantly associated with chemo- and/or RT. The most frequent nivolumab-associated late toxicity is hypothyroidism. No patient currently requires chronic corticosteroid treatment. Disclosures Bröckelmann: Bristol Myers Squibb: Honoraria, Research Funding; Takeda: Consultancy, Honoraria, Research Funding; MSD Sharp & Dohme: Research Funding. Keller:Bristol Myers Squibb: Honoraria, Other: Travel support, Speakers Bureau. Meissner:Celgene: Other: Travel support; Bristol Myers Squibb: Other: Travel support; Takeda: Other: Travel support; Merck Sharp & Dohme: Other: Travel support; Hexal: Other: Travel support. Trautmann:Bristol Myers Squibb: Honoraria. Kerkhoff:BMS: Honoraria. Hüttmann:Celgene: Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company); Lead Discovery Center GmbH: Consultancy; Seattle Genetics: Research Funding; Gilead: Honoraria; University Hospital Essen, University of Duisburg-Essen, Essen, Germany: Current Employment; Roche: Other: Travel expenses; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company). Zimmermann:Takeda: Consultancy, Honoraria, Other: Travel Expenses; Bristol-Myers Squibb: Other: Travel Expenses; MSD: Other: Travel Expenses; Novartis: Other: Travel Expenses. Fuchs:Bristol Myers Squibb: Honoraria, Research Funding; Affimed: Honoraria; Takeda: Honoraria; Amgen: Honoraria; Celgene: Honoraria. von Tresckow:Takeda: Honoraria, Other: Travel support, Research Funding; Novartis: Other: Travel support, Research Funding; Takeda: Honoraria, Other: Travel support, Research Funding; MSD Sharp & Dohme: Honoraria, Research Funding; Roche: Honoraria; Kite/Gilead: Honoraria; Pfizer: Honoraria; Amgen: Honoraria. Borchmann:Takeda: Research Funding; Bristol Myers Squibb: Research Funding. Engert:Bristol Myers Squibb: Honoraria, Research Funding; Affimed Therapeutics: Research Funding; Takeda: Honoraria, Research Funding; MSD Sharp & Dohme: Honoraria; AstraZeneca: Honoraria; Sandoz: Honoraria. OffLabel Disclosure: Nivolumab 240mg Q2W alone or in combination with AVD for 1st-line treatment of classical Hodgkin lymphoma.

High rate of conversion from ocular hypertension to glaucoma in subjects with uveitis

2021 ◽  
pp. bjophthalmol-2021-318809
Author(s):  
Tiffany Ma ◽  
Joanne L Sims ◽  
Sonya Bennett ◽  
Shenton Chew ◽  
Rachael L Niederer
Keyword(s):  
Ocular Hypertension ◽  
Vision Loss ◽  
Glaucoma Surgery ◽  
High Rate ◽  
Rapid Progression ◽  
Central Vision ◽  
Uveitic Glaucoma ◽  
Central Vision Loss

AimsTo examine presentation, management and long-term sequelae of ocular hypertension and uveitic glaucoma.MethodsRetrospective observational study of all subjects with uveitic glaucoma or ocular hypertension seen in Auckland uveitis clinics over the last 10 years.ResultsA total of 188 eyes of 139 subjects with uveitic glaucoma or ocular hypertension were included for analysis. Total follow-up was 1854.5 eye years (mean 9.9 years). The mean age at uveitis diagnosis was 49.3 years. 52.5% of subjects were male. The most common diagnoses were idiopathic uveitis (29.3%), sarcoidosis (13.3%), herpes zoster (6.9%), HLA-B27 uveitis (6.9%), tuberculosis (5.9%) and Posner-Schlossmann or cytomegalovirus (CMV) uveitis (5.3%). Median intraocular pressure (IOP) at diagnosis was 35 mm Hg (IQR 29–45). 144 eyes (77.0%) developed glaucoma during the follow-up period, of whom 41 lost some central vision due to glaucoma. Oral acetazolamide was required for IOP control in 64.5%, 50 eyes underwent trabeculectomy, 18 eyes required a tube and 6 underwent minimally invasive glaucoma surgery.ConclusionRapid progression was observed from ocular hypertension to uveitic glaucoma. Uveitic glaucoma is aggressive, with high likelihood of requiring surgical management and high risk of central vision loss. Close collaboration between uveitis and glaucoma specialists is required to maximise outcomes for these patients.

scholarly journals Long-term outcomes of ocular adnexal lesions in IgG4-related ophthalmic disease

2019 ◽  
Vol 104 (3) ◽  
pp. 345-349 ◽  
Author(s):  
Toshinobu Kubota ◽  
Masao Katayama ◽  
Reiko Nishimura ◽  
Suzuko Moritani
Keyword(s):  
Exploratory Study ◽  
Watchful Waiting ◽  
Systemic Corticosteroid ◽  
De Novo ◽  
Corticosteroid Treatment ◽  
Consensus Guidelines ◽  
Long Term Outcomes ◽  
Ophthalmic Disease

AimsTo determine the long-term outcomes of ocular adnexal lesions in immunoglobulin G4-related ophthalmic disease (IgG4-ROD).MethodsThis retrospective, non-randomised exploratory study included 82 patients with ocular adnexal lesions. We evaluated the long-term outcomes in 71 patients during the median follow-up period of 30 months, who underwent either watchful waiting (n=20; range 12–90 months) or systemic corticosteroid treatment, delivered according to consensus guidelines (n=51; range 9– 115 months). We also analysed factors that might contribute to recalcitrance to treatment.ResultsOf 82 patients, 40 (49%) were male, and the median patient age was 60 years old. Twenty-one (26%) patients with extraocular muscle (EOM) and/or trigeminal nerve branch (CN V) enlargements had a significantly high frequency of multiple ocular adnexal lesions (p<0.0001, Fisher’s exact test). In addition, two patients developed EOM and/or CN V enlargements de novo over time. Twenty patients with solitary lacrimal gland enlargements preferred watchful waiting, due to mild symptoms. Of these, 18 (90%) lesions remained dormant throughout a median follow-up of 27 months. Among 51 patients treated with corticosteroids, 31 (61%) experienced relapses after treatment and required systemic low-dose maintenance treatment. A multivariate analysis indicated that EOM and/or CN V enlargements comprised a risk factor for relapse (HR 2.7; 95% CI 1.1 to 6.7).ConclusionsThis exploratory study showed that different types of ocular adnexal lesions in IgG4-ROD displayed distinct proliferative activities. Our results suggested that EOM and/or CN V enlargements might be secondary lesions that confer refractoriness to systemic corticosteroid treatment recommended by consensus guidelines.

Sign in / Sign up

Export Citation Format

Share Document