Dr. Djillali Annane said at the 12th International Congress on Infectious Diseases that a consensus has emerged that corticosteroids provide major benefits in patients with severe sepsis or septic shock.

Dr. Annane of the University of Versailles, France, said these benefits only with low doses of corticosteroids administered for at least 5 days, and only in the sizable patient subsets having adrenal insufficiency or refractory septic shock.

From Internalmedicinenews.com:

Much of the lengthy controversy in this field was the result of great heterogeneity in clinical trials, particularly those done before 1992. For example, steroids for septic shock fell into disfavor all through the 1980s and 1990s because multiple trials before 1992 showed no benefit. That’s because these negative studies used short-course, high-dose corticosteroids, Dr. Annane explained. Today, with the benefit of hindsight, it can be emphatically stated that no evidence supports the use of such therapy, he said at the congress, which was sponsored by the International Society for Infectious Diseases.

Dr. Annane was first author of a 2006 Cochrane Collaboration systematic review of corticosteroids for treatment of severe sepsis and septic shock (Cochrane Library ISSN 1464-780X).

In 15 randomized trials totaling more than 2,000 children and adults included in the analysis, steroid therapy didn’t change 28-day all-cause mortality. But the results varied with dosing strategy. In nine trials of replacement-dose corticosteroids—the equivalent of hydrocortisone at 200–300 mg/day intravenously for 5 days or longer—there was a highly significant 20% reduction in the relative risk of 28-day mortality compared with placebo, along with a greater proportion of patients experiencing shock reversal by day 7. In contrast, patients on high-dose, short-course corticosteroids didn’t benefit.

The benefits, as shown in multiple randomized placebo-controlled trials, are enhanced 28-day mortality, shorter shock duration, improved hemodynamics, reduced organ dysfunction, and less systemic inflammation.

Tags: corticosteroids, hydrocortisone, steroids

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Significant reductions in mortality rate can be noticed in COPD (chronic obstructive pulmonary disease) patients when inhaled corticosteroids are used.

This finding was disclosed by a study appearing in an issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP).

From Sciencedaily.com:

Dr. Macie and colleagues found that the mortality rates in patients 65+ who received inhaled corticosteroids were 11.7 percent, compared with 13.1 percent for those who did not. Patients in the younger group showed even greater results, with a mortality rate of 3.0 percent for patients receiving inhaled corticosteroids within 90 days, compared with 6.0 percent for those who did not, providing a mortality reduction rate of 53 percent. When patients who received steroids in the year prior were removed from the analysis, mortality was reduced by 34 percent. Researchers attribute this finding to multifactorial reasons, including reductions in exacerbations of the disease and suppression of inflammation.

Researchers also found a 23 percent reduced risk of death when comparing the effects of inhaled steroids with bronchodilators in patients in the 65+ group. In all cases, the most significant results were found when inhaled corticosteroids were administered within the first 30 days following hospital discharge.

It was reported by this study that individuals making use of steroids paired with beta-agonists demonstrated a fall in cardiovascular-related death alone by 38 percent.

Tags: chronic obstructive pulmonary disease, COPD, corticosteroids, steroids, use of steroids

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According to a new review of studies, most individuals afflicted with sore throat don’t need to ask their doctors for steroids such as prednisone.

Study co-author Dr. Brian H. Rowe of the University of Alberta in Edmonton told Reuters Health that there has been “a bit of a push” for using corticosteroids to treat sore throats based on the inflammation-quelling powers of the drugs.

From in.reuters.com:

Steroids, given by mouth or by injection, are powerful drugs with short- and long-term side effects, he said, so they shouldn’t be prescribed unless there’s clear evidence that their benefits outweigh the risks.

To investigate, he and his colleagues searched the medical literature and came up with 10 “gold standard” clinical studies comparing corticosteroids — with or without antibiotics — to inactive placebo or standard treatment in patients with sore throat. The studies included nearly 1,100 patients.

The team reports in the journal Academic Emergency Medicine that corticosteroids hastened pain relief by about four and a half hours, on average. Patients taking them had less pain – about one point on a scale of 0 to ten – 24 hours later.

Rowe said that steroids work fast for known strep throat but their benefits aren’t enough to justify widespread use to treat sore throat.

Tags: corticosteroids, Prednisone, sore throat, steroids

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Being overweight or obese does not make asthma worse in patients with mild and moderate forms of the health complication, as per researchers from National Jewish Health. It was, however, noted by the researchers that it could minimize the response to medications.

Lead author E. Rand Sutherland, Associate Professor of Medicine at National Jewish Health said that the findings suggest that asthma improvement may not necessarily result from loss of weight.

From News-medical.net:

“The findings also suggest that patients and physicians should be aware that obese asthma patients may not respond well to corticosteroids, the most successful controller medication for asthma, which can affect dosing decisions and choices of possible alternatives to steroids.”

Previous studies have suggested that obesity predisposes people to developing asthma, to suffer more severe asthma symptoms, and to respond less to medications. However, the exact mechanism for these links has been unclear, and the studies have generally relied upon patients’ reports of their diagnosis and symptoms rather than using more precise tools to characterize patients.

Dr. Sutherland said the data suggest that obese and overweight people respond less well to asthma controller medications when compared to their leaner counterparts.

Tags: Asthma, corticosteroids, obesity, steroids

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The biological rationale for why large doses of corticosteroids given repeatedly over several weeks may help individuals with lupus has been uncovered by researchers at UT Southwestern Medical Center.

Lupus is a chronic inflammatory disease that affects more than 1 million people in the United States. Unlike the anabolic steroids abused by athletes for bulking up muscles, corticosteroids are routinely used to treat inflammation in lupus patients.

From News-Medical.Net:

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.

“By giving the very high dose early and frequently in the course of the disease, we could actually end up using much less steroids in the long run,” said Dr. Marilynn Punaro, professor of pediatrics at UT Southwestern and co-author of the study. “This finding suggests that by doing so, we might be able to get the disease under control more quickly and patients might experience fewer long-term side effects.”

Dr. Marilynn Punaro, professor of pediatrics at UT Southwestern and co-author of the study and director of the pediatric rheumatology division at UT Southwestern, said that steroids are probably always going to be a short-term fix because they work fast and powerfully.

Tags: anabolic steroids, corticosteroids, lupus, steroids

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According to transplantation researchers at the University of Cincinnati (UC), post-transplant patients who are not administered with corticosteroids are better placed than their counterparts on steroids.

It was reported by the researchers that post-transplant patients off steroids experienced improved graft survival rates, reduced early mortality, and fewer cardiovascular events than patients administered with steroids.

From Sciencedaily.com:

UC researchers are also reporting results of shared protocols on the bortezomib treatment for antibody-mediated rejection. After presenting their bortezomib findings at the 2009 ATC, UC researchers created the START collaborative to share standard of care treatment protocols for bortezomib therapies. Through the collaborative, transplant centers worldwide have requested this information to treat individual patients with a variety of solid organ transplant types.

“The information shared from this partnership represents an international collaborative experience of treating this unmet need in transplantation that inevitably results in graft loss,” says Alloway. “Because transplant centers may have one to five antibody-mediated cases a year, it’s difficult to assess a potential new treatment. But when you are able to share every center’s cases together in one report, it’s easier to identify trends that support definitive design of future controlled trials.”

The finding was presented by researchers with the Division of transplantation and department of internal medicine at the American Transplant Congress (ATC), the annual meeting of the American Society of Transplantation on May 1-5 in San Diego.

Tags: corticosteroids, graft survival, steroids

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According to a study appearing in an issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), mortality rate can be significantly reduced in COPD (chronic obstructive pulmonary disease) patients when inhaled corticosteroids are used.

The study reported that patients making use of steroids paired with beta-agonists experienced a fall in cardiovascular-related death alone by 38 percent.

From Sciencedaily.com:

Dr. Macie and colleagues found that the mortality rates in patients 65+ who received inhaled corticosteroids were 11.7 percent, compared with 13.1 percent for those who did not. Patients in the younger group showed even greater results, with a mortality rate of 3.0 percent for patients receiving inhaled corticosteroids within 90 days, compared with 6.0 percent for those who did not, providing a mortality reduction rate of 53 percent. When patients who received steroids in the year prior were removed from the analysis, mortality was reduced by 34 percent. Researchers attribute this finding to multifactorial reasons, including reductions in exacerbations of the disease and suppression of inflammation.

Researchers also found a 23 percent reduced risk of death when comparing the effects of inhaled steroids with bronchodilators in patients in the 65+ group. In all cases, the most significant results were found when inhaled corticosteroids were administered within the first 30 days following hospital discharge.

W. Michael Alberts, MD, FCCP, President of the ACCP, said the study findings are intriguing for clinicians and suggest the need of future research for defining the roles and mechanisms of the effect of inhaled steroids on both cardiovascular and respiratory mortality.

Tags: chronic obstructive pulmonary disease, COPD, corticosteroids, steroids, use of steroids

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During the annual meeting of the American College of Allergy, Asthma and Immunology (ACAAI) in Seattle, new findings in context to use of chronic corticosteroids were revealed.

Corticosteroids (steroids) have been believed to be wonder drugs when it comes to managing and treating severe health complications and symptoms when other medications failed to deliver any good results, as per Rebecca Green, M.D., Ph.D., Assistant Professor, Pediatric Endocrinology and Diabetes, Washington University School of Medicine in St. Louis, Mo.

From News-Medical.Net:

The side effects attributed to corticosteroids include decreased bone mineral density and reduced bone mass, and also in children, reduced growth rate. According to Dr. Green, strategies to alleviate these effects include minimizing oral doses and adding topical or inhaled steroids to provide the same anti-inflammatory benefit in the areas affected by inflammation while avoiding systemic effects. Disturbance in bone acquisition in childhood can reduce peak bone mass and therefore significantly impact the life time risk of osteoporosis.

“One of the challenges has been distinguishing the effects of the inflammatory process itself on bone mass and growth, and the effects of corticosteroids on bone growth from the effects of corticosteroids on bone mass,” she said.

“Analysis of large population databases has recently yielded extremely valuable data about corticosteroids and fractures, with some unexpected impact of lower doses. Analysis of the same database for inhaled steroid use in adults showed a small increase in fracture risk in users of inhaled steroids compared to control, but comparable risk of fracture in inhaled steroid users compared to individuals using inhaled bronchodilators. This suggests that the increased risk of fracture was secondary to the disease itself, not the inhaled steroids,” Dr. Green explained.

The use of inhaled corticosteroids can reduce bone mineral growth in male children progressing through puberty but the associated risk is more likely to be outweighed by the ability to reduce quantity of oral corticosteroids used in these children, according to Dr. Kelly, Professor Emeritus of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, N.M.

Tags: chronic corticosteroids, corticosteroids, steroid use, steroids

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Young males afflicted with MD (Duchenne muscular dystrophy), a rare but devastating condition, can find considerable relief coming their way and expect to walk longer for as much as three additional years when treated with corticosteroids.

It was remarked by Wendy King, a physical therapist in the neurology department at Ohio State University that the chances of scoliosis and the magnitude of curvature are reduced considerably with daily administration of steroids. King also remarked that calcium supplements and bone mineral density must be indicated to patients with Duchenne muscular dystrophy are recommended at intervals of six to twenty four months due to implications associated with steroids.

From Medpagetoday.com:

The reason for non-treatment with steroids was invariably parent refusal because of fear of side effects, the researchers said. The average duration of steroid use was 8.04 years.

The study found:

* Boys on steroids were able to walk independently, on average, 3.3 years longer than those who weren’t treated. The difference — from 9.21 years to 12.52 years — was significant at P<0.0001.

* The prevalence of scoliosis in the treated boys was 31%, compared with 91% among those not getting steroids, a difference that was significant at P<0.0001.

* The average scoliotic curve was 11.6 degrees in the treated boys, compared with 33.2 degrees in the untreated boys, which was also significant at P<0.0001.

* On the other hand, 32% of the treated boys had vertebral compression fractures versus none in those not getting steroids, which was significant at P<0.0012.

* The yearly long-bone fracture rate was 0.088 among the treated boys, but only 0.033 in the untreated group, difference by a factor of 2.6, which was significant at P<0.0032.

Several factors probably play a role in the increased rate of long-bone fractures, the researchers said, including prolonged independent walking and increased body weight because of the steroids.

The finding was disclosed in a study supported by the General Clinical Research Center at the Ohio State University and the National Center of Research Resources of NIH.

Tags: calcium supplements, corticosteroids, duchenne muscular dystrophy, steroids

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The chances of an asthma attack relapsing are reduced significantly when patients afflicted with asthma are given a short course of corticosteroids after they are discharged from the hospital, according to a Cochrane Systematic Review.

It was remarked by Carol Spooner, a colleague, that this review strongly supports the administration of systematic corticosteroids for treating outpatients after getting them discharged from the hospital post an asthma attack.

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.

It was concluded by the review that use of steroids could possibly minimize the need of inhalers and may even prove effective for prolonging lives by as much as three weeks.

Tags: Asthma, corticosteroids, steroids

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