The use of medications containing steroids are of little to no use when it comes to preventing visit to the hospital or improving respiratory symptoms related to bronchiolitis, a common viral lower respiratory infection in infants. This finding was disclosed in a study published in the July 26 issue of the New England Journal of Medicine.

These findings by the Pediatric Emergency Care Applied Research Network (PECARN) are considered by many as qualified advice to treat bronchiolitis, one of the most common causes of infant hospitalization.

From News-Medical.Net:

The study compared hospitalization rates for 600 children between the ages of 2 months and 12 months who visited emergency rooms with moderate-to-severe bronchiolitis. Patients were treated with either a dose of dexamethasone (a glucocorticoid form of steroid medication) or a placebo and evaluated after one hour, and again at four hours. The hospital admission rate for both groups was identical at nearly 40 percent. Both groups improved during treatment, but the placebo group did as well as the group treated with active medication. The study was conducted in the emergency departments at 20 hospitals across the United States between November and April during a three-year period. Bronchiolitis is most common during the winter months.

“We learned that a commonly used treatment doesn’t work,” said Howard M. Corneli, M.D., professor of pediatrics at the University of Utah and the principal investigator on the study. “Now that we’ve demonstrated glucocorticoids aren’t effective in treating bronchiolitis, we can focus our efforts on finding better treatments and better preventive strategies.”

This study truly highlights the power of PECARN to provide answers to otherwise difficult-to-answer questions, as per Nathan Kuppermann, M.D., a professor of emergency medicine and pediatrics at the University of California, Davis, chair of the PECARN network’s steering committee, and the senior investigator of the study.

Tags: bronchiolitis, dexamethasone, steroid, steroids

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According to a study published in an issue of The New England Journal of Medicine, medications containing steroids are not effective for improving respiratory symptoms or preventing hospitalization among infants suffering with bronchiolitis.

Findings of the study truly highlights the power of a research network such as Pediatric Emergency Care Applied Research Network (PECARN) in providing answers to otherwise difficult-to-answer questions, according to Nathan Kuppermann, M.D., a professor of emergency medicine and pediatrics at the University of California, Davis, chair of the PECARN network’s steering committee and the senior investigator of the study.

From News-Medical.Net:

The study compared hospitalization rates for 600 children between the ages of 2 months and 12 months who visited emergency rooms with moderate-to-severe bronchiolitis. Patients were treated with either a dose of dexamethasone (a glucocorticoid form of steroid medication) or a placebo and evaluated after one hour, and again at four hours. The hospital admission rate for both groups was identical at nearly 40 percent. Both groups improved during treatment, but the placebo group did as well as the group treated with active medication. The study was conducted in the emergency departments at 20 hospitals across the United States between November and April during a three-year period. Bronchiolitis is most common during the winter months.

“We learned that a commonly used treatment doesn’t work,” said Howard M. Corneli, M.D., professor of pediatrics at the University of Utah and the principal investigator on the study. “Now that we’ve demonstrated glucocorticoids aren’t effective in treating bronchiolitis, we can focus our efforts on finding better treatments and better preventive strategies.”

These findings by PECARN offer critical implications for medical practitioners to treat bronchiolitis, one of the most common causes of infant hospitalization.

Tags: bronchiolitis, dexamethasone, steroid, steroid medications

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During a study conducted at 44 centers in the United States and Canada and involving 353 patients with myeloma, it was found that a combination of drugs lenalidomide and dexamethasone could be useful for treating patients.

It was found during the study that pairing a new derivative of thalidomide with a steroid could slow down the progress of multiple myeloma along with prolonging lives of patients who have earlier relapsed from past treatments.

From News-Medical.Net:

“These trials highlight how large-scale cooperation in a team effort by myeloma investigators can quickly confirm benefits and introduce new active agents for patients with this disease,” Weber says. “We also owe a debt to the willing patients who participated in this study.”

Multiple myeloma is caused by formation of abnormal plasma cells, a type of white blood cell, in the bone marrow. These cells multiply rapidly, crowding out normal red and white blood cells and platelets. Tumors starting in the bone marrow may cause pain, and weaken bones predisposing them to fracture. In the United States about 20,000 people are diagnosed with multiple myeloma annually, and about 11,000 succumb to the disease each year.

Thalidomide, a breakthrough drug for multiple myeloma, is produced and marketed by Celgene Corporation as Thalomid(r). The company chemically altered thalidomide to make lenalidomide, known commercially as Revlimid(r), in hopes of reducing side effects and improving efficacy against the disease. The drugs attack both the malignant cells and the cellular environment that nurtures them.

It was remarked by lead author Donna Weber, M.D., associate professor in the Department of Lymphoma and Myeloma at the University of Texas M. D. Anderson Cancer Center that these combinational drugs are effective as the disease may become immune to one therapy.

Tags: dexamethasone, lenalidomide, multiple myeloma, myeloma, steroid, thalidomide

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Glucocorticoids, the primary controller medication for asthma, are 40 percent less effective in obese and overweight asthma patients than in asthmatic patients with normal weight. This finding was disclosed by researchers at National Jewish Health.

The study, by Associate Professor of Medicine E. Rand Sutherland, MD, MPH and his colleagues at National Jewish Health, appeared in an issue of the American Journal of Respiratory and Critical Care Medicine.

From Medicalnewstoday.com:

The study at National Jewish Health sought to understand why glucocorticoids, commonly called steroids, might be less effective in overweight and obese asthma patients. Dr. Sutherland and his colleagues enrolled 45 nonsmoking adults, 33 of whom had asthma, and measured the response of cells in the blood and the lungs to the steroid dexamethasone.

Steroids interfere with inflammatory signaling pathways by raising the level of a molecule known as MAP kinase phosphatase-1 (MKP-1). When the researchers applied the steroid dexamethasone to cultures of the participants’ blood cells, they found that steroids did not increase MKP-1 as effectively in overweight and obese asthmatics when compared to lean asthmatics. Dexamethasone increased the levels of MKP-1 by 5.27 times in cultured blood cells from lean asthma patients, whereas MKP-1 levels in overweight and obese asthmatics increased by only 3.11 times, a 41 percent smaller response. The heavier a person was the less their cells were likely to respond to dexamethasone. This negative relationship between weight and response to steroids did not occur in participants who did not have asthma.

“Steroids were clearly less effective in overweight and obese asthma patients,” said Dr. Sutherland. “Previous studies have suggested a link between weight and response to steroids in patients, and this study suggests a potential mechanism by which this occurs. It also suggests that future research should be directed specifically to understanding how asthma medications work in overweight and obese asthmatics.

It was remarked that inhaled steroids are still effective in treating overweight and obese asthmatics.

Tags: Asthma, dexamethasone, glucocorticoids, steroid, steroids

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Low vitamin D levels share a relationship with lower lung function and greater medication use in children affected with asthma, as per researchers at National Jewish Health in a paper published online in the Journal of Allergy & Clinical Immunology.

It was reported by Daniel Searing, MD, and his colleagues that vitamin D has the ability to improve the activity of corticosteroids, which are considered to be the most effective of all asthma control medications.

From Sciencedaily.com:

Patients low in vitamin D generally had higher levels of IgE, a marker of allergy, and responded positively to more allergens in a skin prick test. Allergies to the specific indoor allergens, dog and house dust mite, were higher in patients with low vitamin D levels. Low vitamin D also correlated with low FEV1, the amount of air a person can exhale in one second, and lower FEV1/FVC, another measure of lung function. Use of inhaled steroids, oral steroids and long-acting beta agonists were all higher in patients low in vitamin D.

“Our findings suggest two possible explanations,” said senior author Donald Leung, MD, PhD. “It could be that lower vitamin D levels contribute to increasing asthma severity, which requires more corticosteroid therapy. Or, it may be that vitamin D directly affects steroid activity, and that low levels of vitamin D make the steroids less effective, thus requiring more medication for the same effect.”

The researchers performed a series of laboratory experiments that indicated vitamin D enhances the action of corticosteroids. They cultured some immune cells with the corticosteroid dexamethasone alone and others with vitamin D first, then dexamethasone. The vitamin D significantly increased the effectiveness of dexamethasone. In one experiment vitamin D and dexamethasone together were more effective than 10 times as much dexamethasone alone.

Dr. Leung said that the work suggested that vitamin D improves the anti-inflammatory function of corticosteroids.

Tags: Asthma, corticosteroids, dexamethasone, Inhaled steroids, Oral Steroids, steroids, Vitamin D

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Young children suffering with bronchiolitis, a common viral lower respiratory infection in infants, are not able to find any relief with medications based on steroids, as per a study published in an issue of the New England Journal of Medicine.

This finding by the Pediatric Emergency Care Applied Research Network (PECARN) resolved controversy from past research and is considered to guide during treatment for the most common cause of infant hospitalization.

From News-Medical.Net:

The study compared hospitalization rates for 600 children between the ages of 2 months and 12 months who visited emergency rooms with moderate-to-severe bronchiolitis. Patients were treated with either a dose of dexamethasone (a glucocorticoid form of steroid medication) or a placebo and evaluated after one hour, and again at four hours. The hospital admission rate for both groups was identical at nearly 40 percent. Both groups improved during treatment, but the placebo group did as well as the group treated with active medication. The study was conducted in the emergency departments at 20 hospitals across the United States between November and April during a three-year period. Bronchiolitis is most common during the winter months.

Howard M. Corneli, M.D., professor of pediatrics at the University of Utah and the principal investigator on the study, said that glucocorticoids (a form of steroids) do not prove effective for treating bronchiolitis and future efforts must be focused upon better treatments and better preventive strategies.

Tags: bronchiolitis, dexamethasone, glucocorticoid, respiratory infection, steroid, steroids

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A common steroid treatment, dexamethasone treatment, which is often prescribed to young children with bronchiolitis, does not prove useful in terms of improving symptoms or reducing hospitalization, according to DMC Children’s Hospital of Michigan.

Findings of this study appeared in an issue of New England Journal of Medicine.

From News-Medical.Net:

Prashant Mahajan, M.D., M.P.H, M.B.A, DMC Children’s Hospital vice chief of pediatric emergency medicine and associate professor of pediatrics and emergency medicine at Wayne State University School of Medicine was a lead co- investigator in this nation-wide study involving 600 infants aged two to 12 months. The research was conducted through the 21-site Pediatric Emergency Care Applied Research Network (PECARN), the first federally-funded multi- institutional network for research in pediatric emergency medicine. Funded by the Health Resources and Services Administration Emergency Medical Services for Children (EMSC) program, the study also received funding from HRSA’s research program, as well as core funding from PECARN. The PECARN network is funded with cooperative agreements with HRSA, as part of the EMSC program.

It is believed that these study finding will provide invaluable insights to medical practitioners, all over the world, for treating young children with bronchiolitis.

Tags: bronchiolitis, dexamethasone, steroid

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A recent study by DMC Children’s Hospital of Michigan has found that a treatment involving a common steroid, dexamethasone, which is often prescribed to children with bronchiolitis, is non-effective. It was disclosed that dexamethasone has no effect on improvement of symptoms or in minimizing hospitalization.

The findings of this research study appeared in an issue of the New England Journal of Medicine.

From News-Medical.Net:

Bronchiolitis is the leading cause of hospitalization for infants in the United States and accounts for more than 100,000 admissions each year. Hospital charges associated with the disease exceed $700 million annually. According to Dr. Mahajan, prescribing dexamethasone is a common practice among emergency room physicians and pediatricians to treat acute bronchiolitis. “Corticosteroids are commonly used to treat bronchiolitis although evidence of their effectiveness is limited.” The findings of this study resolve controversy from prior research and are expected to help guide treatment for the most common cause of infant hospitalization.

Given the results of this study, though there is really no best treatment for children, researchers now can concentrate on finding better treatment and better preventative strategies.

DMC Children’s Hospital of Michigan treats 500-600 patients annually for bronchiolitis. Hospital length of stay, later medical visits or admissions, and adverse events were also evaluated in the study.

The study lead investigators note that glucocorticoid medications still play an important role in other respiratory illnesses of childhood, such as asthma and croup. They point out these medications are not the androgenic steroids sometimes abused by athletes, and that the side effects seen with long-term steroid use are not a risk in the short-course treatments used for croup and asthma attacks.

Prashant Mahajan, M.D., M.P.H, M.B.A, DMC Children’s Hospital vice chief of pediatric emergency medicine and associate professor of pediatrics and emergency medicine at Wayne State University School of Medicine was a lead co- investigator in this nationwide study that involved 600 infants, aged 2-12 months.

Tags: androgenic steroids, bronchiolitis, corticosteroids, dexamethasone, steroid, steroids

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Hemangiomas, which are strawberry like birthmarks commonly seen during early infancy, are usually harmless but can lead to distortion of tissue and vision obstruction in nearly 10 percent cases.

Problematic hemangiomas have been treated with corticosteroids like dexamethasone and prednisone since the 1960s but steroids can fail at times and their action mechanism against hemangioma has remained a mystery.

From Sciencedaily.com:

Greenberger, Bischoff and colleagues worked with hemangioma stem cells isolated from patient tissue samples provided by Mulliken, and showed that:

* When human hemangioma stem cells were pretreated with dexamethasone, then implanted in mice, the tumors that formed had far fewer blood vessels.

* Dexamethasone suppressed the stem cells’ production of VEGF-A, but did not suppress VEGF-A production by endothelial cells from the same hemangioma.

* When VEGF-A production was suppressed in hemangioma stem cells using shRNA silencing, then implanted in the mice, there was an 89 percent reduction in vessel growth.

* VEGF-A was detected in actively growing hemangiomas, but not in regressing (involuting) hemangiomas.

Earlier research in Bischoff’s lab and that of Bjorn Olsen, MD, PhD, of the Harvard School of Dental Medicine, indicates that hemangiomas may result from an in utero mutation in a stem cell destined to become an endothelial cell, causing a disruption in the normally well-ordered process of blood vessel development. Under a 2008 Translational Research Program grant from Children’s, Bischoff’s lab has been using hemangioma stem cells to test a library of existing medications that might specifically inhibit the proliferation of the hemangioma stem cells, and thereby limit growth of the hemangioma tumor.

The study was funded by the National Institutes of Health, the Translational Research Program at Children’s Hospital Boston, a Harvard Skin Diseases Pilot Study Grant, Sheba Medical Center (Israel), and the John Butler Mulliken Foundation.

Tags: corticosteroids, dexamethasone, Hemangiomas, Prednisone, steroids

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Coating DNA with a topical steroid may increase the efficacy of therapeutic gene delivery, as per bioengineers at the University of Pennsylvania.

It was shown by the researchers that a common anti-inflammation steroid when wrapped around a DNA strand may prove useful for preventing the immune responses that can be commonly associated with gene-transfer techniques.

From Sciencedaily.com:

According to Diamond, the chemistry involved in manufacturing this new steroid vehicle is a fairly straightforward, one-step process that is simple compared to creating viral gene-therapy vectors. “But this is more than just ‘gene therapy on steroids,’” Diamond said. “The dexamethasone not only eased inflammation in an animal model, but, as our study showed, actually allowed the cells to use the foreign DNA more effectively.”

In addition, corticosteroids can suppress the major inflammatory cytokines created by the immune response after gene delivery. According to studies in cell culture and animal models, the steroid-coated DNA showed lower initial inflammation and greater expression of the gene over time. The results have encouraged the researchers to continue studies and to envision broader application of the technique toward diseases that might also benefit from gene-transfer therapy.

“In humans, especially in inflammatory diseases, a steroid coating would greatly enhance the chances of successful gene transfer” Diamond said. “As an alternative, I could foresee the use of this coating technique to tailor therapies by choosing drugs that would amplify the benefit of a particular therapeutic gene.”

The technique studies that were performed in animal models were presented in the Feb. 15 issue of the journal Gene Therapy, available online.

Tags: dexamethasone, DNA, gene delivery, steroid, steroids, topical steroid

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