Can adverse effects of glucocorticoid therapy be prevented and treated?

Goes, Marlies C van der; Strehl, Cindy; Buttgereit, Frank; Bijlsma, J. W. J.; Jacobs, Johannes W G

doi:10.1080/14656566.2016.1232390

Cited by 11 publications

(8 citation statements)

References 53 publications

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“…Even though the relationship between doses of MTP, therapeutic effectiveness and adverse effects are scarcely reviewed, our observations are similar to data presented by other authors who have demonstrated that larger doses do not lead to better results but do cause more adverse effects, especially with regard to increasing the risk of infections. 17,25,26 This is consistent with this drug's pharmacological profile. As previously mentioned, it has not been demonstrated that larger doses of glucocorticoids are more effective, either by the genomic pathway or by the non-genomic pathway.…”

Section: Discussionsupporting

confidence: 82%

Intravenous pulses of methylprednisolone to treat flares of immune-mediated diseases: how much, how long?

Danza

Borgia

Narváez

et al. 2018

Lupus

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Introduction Glucocorticoids are widely used in the treatment of immune-mediated diseases. Despite their widespread use, details on dosing, effectiveness and adverse effects are yet to be determined. Objective To know the current use of methylprednisolone (MTP) in the management of immune-mediated conditions, evaluating the relationship among doses, therapeutic response and adverse effects. Methodology A multicenter retrospective cohort study was designed, including patients who received intravenous pulses of MTP between 1 January 2013 and 12 December 2015 in three different hospitals in Uruguay. The patients included received MTP to treat systemic autoimmune diseases (SADs), hematological, nephrological and neurologic diseases and others. The following variables were analyzed: age, gender, MTP cumulative dose, duration of treatment, clinical response (complete, partial and no response) and adverse effects. Results In total, 164 cases were identified, of which 118 (72%) were female. The median age was 48.4 (SD: 18) years. The indications for MTP included: neuroimmune-mediated 92 (56.1%), SADs 29 (17.5%), hematological 15 (9.1%), nephrological 12 (7.3%) and others 16 (9.9%). The median dose to achieve complete response was 3.2 g (SD: 1.5); the median dose to accomplish a partial response was 3.5 g (SD: 1.25); the median dose for non-responders was 3.3 g (SD 1.2) ( p > 0.05). The median dose in those patients with adverse effects was 3.4 g (SD 1.5) and the median dose for those who did not experience adverse effects was 3.3 g (SD: 1.3) ( p > 0.05). The most frequent adverse effects were infectious (22/164, 13.4%). Diabetics were found to have the highest incidence of adverse effects (13/16, 81%) in comparison to non-diabetics, p < 0.05. Discussion Our study suggests a wide range of doses and duration of treatments with MTP. No major associations were found between clinical response and the use of high MTP doses, but the latter was associated with a large proportion of severe infections. No severe infections were identified with MTP doses lower than 1.5 g. The diabetic population is known to be at risk of experiencing varied adverse effects to MTP. These observations reinforce the need for protocolized use of MTP in order to achieve a better relationship among doses, effectiveness and safety profile.

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Section: Discussionsupporting

confidence: 82%

Intravenous pulses of methylprednisolone to treat flares of immune-mediated diseases: how much, how long?

Danza

Borgia

Narváez

et al. 2018

Lupus

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“…Tal como se menciona más arriba, no se ha comprobado que dosis mayores de GC sean más efectivas, ni en el caso de la vía genómica ni en el caso de la vía no genómica. En efecto, es probable que ambas vías sean saturables, no conociéndose aún la dosis exacta de saturación (12,18,19) . En la mayoría de los pacientes se empleó Prednisona a continuación de los pulsos de MTP a dosis que actualmente se definen como altas.…”

Section: Discussionunclassified

Metilprednisolona en brotes de enfermedades inmunomediadas: relación entre dosis, efectividad y seguridad. Estudio Piloto

Galdo

2017

Rev Fac Cien Med Univ Nac Cordoba

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, Álvaro Danza 4,5 . Resumen:Introducción: Metilprednisolona (MTP) es una molécula con probada efectividad antiinflamatoria e inmunosupresora para la terapia en pulsos de brotes de enfermedades inmunomediadas (EI). Sin embargo, no se conoce con certeza la mejor relación entre dosis, efectividad y efectos adversos. OBJETIVO: Conocer los usos de MTP, dosis, respuesta terapéutica y efectos adversos. Material y métodos: Se realizó un estudio retrospectivo de pacientes que recibieron MTP en el Hospital Pasteur de Uruguay. Se incluyeron pacientes que recibieron MTP en pulsos por una enfermedad inmunomediada. Se analizaron las siguientes variables: edad, sexo, dosis acumulada de MTP, duración del tratamiento con MTP, respuesta terapéutica, efectos adversos. Resultados: Se identificaron 36 casos, 27 de sexo femenino. La media de edad fue 41,5 (DE: 15,5) años. La media de dosis en los casos de respuesta completa fue 3,6 (DE: 2) gramos; la media de dosis en los casos de respuesta parcial fue 4 (DE: 1,5) gramos; la media de dosis de no respuesta fue 2,8 (DE 1,2) gramos (p> 0,05). La media de dosis en los pacientes que presentaron efectos adversos fue 4,4 (DE: 1,8) gramos y la media de dosis de los que no presentaron efectos adversos fue 3,2 (DE: 1,6) gramos (p<0,05). Conclusión: Nuestra serie sugiere que no existe una clara relación entre dosis mayores y mejores respuestas terapéuticas. Sin embargo, existe una mayor tendencia a presentar efectos adversos con dosis más elevadas. Estos hallazgos refuerzan la necesidad de racionalizar las dosis de MTP y continuar estudiando este tema en con mayor número de pacientes. Palabras clave: metilprednisolona; efectividad; efectos colaterales y reacciones adversas relacionados con medicamentos; relación dosis-respuesta a droga. Abstract:Background: Methylprednisolone (MTP) pulses have proved effectiveness for the treatment of severe manifestations of immune-mediated diseases (ID). However, the the relationship between doses, effectiveness and safety is not well established. Objective: To know MTP indications, doses, therapeutic response and safety in the clinical setting. Methodology: A retrospective review of records was performed in Hospital Pasteur of Uruguay, from patients who had received MTP during a ID flare. Variables studied: age, sex, MTP cumulative doses, duration of treatment, therapeutic response and adverse effects. Results: Thirty six cases were identified, 26 were female. The mean age was 41,5 (SD 15,5) years. The mean dose of MTP in cases of complete response was 3,6 (SD 2) grams, the mean dose in cases of partial response was 4 (SD 1,5) grams, and in cases of no response was 2,8 (SD 1,2) grams (p> 0,05). The mean dose in patients with adverse effects was 4,4 (SD 1,8) grams, and in cases without adverse effects was 3,2 (SD 1,6) grams (p<0,05). Conclusions: Our series does not confirm a relationship between higher doses and clinical response. However, an association between higher doses of MTP and adverse effects was observed. These finding should be thoroughly investi...

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“…Prophylaxis is possible for some GC-related AEs [47]. Osteoporosis should be countered by calcium and vitamin D supplementation if ≥ 7.5 mg/day prednisone equivalent is prescribed for more than 3 months [48].…”

Section: Prophylaxis Of Glucocorticoid-associated Adverse Eventsmentioning

confidence: 99%

“…Generally, proton pump inhibitors should be administered in patients with concomitant use of non-steroidal anti-inflammatory drugs for gastroprotection. As the risk for infection is increased in patients with rheumatic diseases taking GCs, adequate immunization is advised, and patients should be instructed to seek help early in case of symptomatic infections [47].…”

Section: Prophylaxis Of Glucocorticoid-associated Adverse Eventsmentioning

confidence: 99%

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Reducing the Toxicity of Long-Term Glucocorticoid Treatment in Large Vessel Vasculitis

Palmowski

Buttgereit

2020

Curr Rheumatol Rep

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Purpose While glucocorticoids (GCs) are effective in large vessel vasculitis (LVV), they may cause serious adverse events (AEs), especially if taken for longer durations and at higher doses. Unfortunately, patients suffering from LVV often need long-term treatment with GCs; therefore, toxicity needs to be expected and countered. Recent Findings GCs remain the mainstay of therapy for both giant cell arteritis and Takayasu arteritis. In order to minimize their toxicity, the following strategies should be considered: GC tapering, administration of conventional synthetic (e.g., methotrexate) or biologic (e.g., tocilizumab) GC-sparing agents, as well as monitoring, prophylaxis, and treatment of GC-related AEs. Several drugs are currently under investigation to expand the armamentarium for the treatment of LVV. Summary GC treatment in LVV is effective but associated with toxicity. Strategies to minimize this toxicity should be applied when treating patients suffering from LVV.

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Can adverse effects of glucocorticoid therapy be prevented and treated?

Cited by 11 publications

References 53 publications

Intravenous pulses of methylprednisolone to treat flares of immune-mediated diseases: how much, how long?

Intravenous pulses of methylprednisolone to treat flares of immune-mediated diseases: how much, how long?

Metilprednisolona en brotes de enfermedades inmunomediadas: relación entre dosis, efectividad y seguridad. Estudio Piloto

Reducing the Toxicity of Long-Term Glucocorticoid Treatment in Large Vessel Vasculitis

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