Incidence of acute spinal cord injury and associated complications of methylprednisolone therapy: a national population-based study in South Korea

Choi, Sung Hoon; Sung, Chang ho; Heo, Dong Ryul; Jeong, Soo-Young; Kang, Chang Nam

doi:10.1038/s41393-019-0357-2

Cited by 41 publications

(35 citation statements)

References 26 publications

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“…For years, other medications including glucocorticoids and nonsteroidal anti-inflammatory drugs (NSAIDs) were used to manage secondary events after SCI. However, these medications showed a wide range of potential complications such as gastrointestinal ulcer/bleeding and increased risks for respiratory, urinary tract, and wound infections, hyperglycemia, steroid induced myopathy, and mortality [8,[41][42][43][44]. Ibrutinib therapy seems to act as a safe treatment with fewer side effects that could be used to lessen complications associated with the SCI.…”

Section: Discussionmentioning

confidence: 99%

Ibrutinib reduces neutrophil infiltration, preserves neural tissue and enhances locomotor recovery in mouse contusion model of spinal cord injury

et al. 2021

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Following acute spinal cord injury (SCI), excessive recruitment of neutrophils can result in inflammation, neural tissue loss and exacerbation of neurological outcomes. Ibrutinib is a bruton's tyrosine kinase inhibitor in innate immune cells such as the neutrophils that diminishes their activation and influx to the site of injury. The present study evaluated the efficacy of ibrutinib administration in the acute phase of SCI on neural tissue preservation and locomotor recovery. Ibrutinib was delivered intravenously at 3.125 mg/kg either immediately, 12 hours after, or both immediately and 12 hours after SCI induction in adult male C57BL/6 mice. Neutrophil influx into the lesion area was evaluated 24 hours following SCI using light microscopy and immunohistochemistry methods. Animals' body weight changes were recorded, and their functional motor recovery was assessed based on the Basso mouse scale during 28 days after treatment. Finally, spinal cord lesion volume was estimated by an unbiased stereological method. While animals' weight in the control group started to increase one week after injury, it stayed unchanged in treatment groups. However, the double injection of ibrutinib led to a significantly lower body weight compared to the control group at 4 weeks post-injury. Mean neutrophil counts per visual field and the lesion volume were significantly decreased in all ibrutinib-treated groups. In addition, ibrutinib significantly improved locomotor functional recovery in all treated groups, especially in immediate and double-injection groups. Neural tissue protection and locomotor functional recovery suggest ibrutinib treatment as a potent immunotherapeutic intervention for traumatic SCI that warrants clinical testing.

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Section: Discussionmentioning

confidence: 99%

Ibrutinib reduces neutrophil infiltration, preserves neural tissue and enhances locomotor recovery in mouse contusion model of spinal cord injury

et al. 2021

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“…AOSpine organization on the other hand suggested a high-dose of MPSS/MP within 8 hours of acute SCI as a treatment option in their 2017 guideline (Fehlings et al, 2017) . A retrospective population-based cohort study showed that 61.5% (rang from 40.7 to 75.7) patients in South Korea between 2007 and 2017 received high-dose MPSS/MP within 8 hours of acute spinal cord injury (Choi et al, 2020) . In our study, we used 500mg of MPSS/MP as a threshold, based on the user guide, and found that 2 084 (14.1% of 14 754) TSCI patients were treated with a MPSS/MP of ≥500 mg, with only 641 (4.3% of 14 754) patients receiving it within 8 hours.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological and Clinical Features, Treatment Status, and Economic Burden of Traumatic Spinal Cord Injury in China

Zhou

Lou

Chen

et al. 2021

Preprint

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Background China has the largest population of traumatic spinal cord injury (TSCI), but has not yet performed a national-level study on its epidemiological and clinical features, treatment status, and economic burden. Methods A total of 14 754 patients were recruited between January 2013 and December 2018 from 37 hospitals in 11 provinces and municipalities, which represented all geographical divisions of China. The percentage of TSCI in hospitalized patients and the percentage of TSCI in hospitalized patients through the orthopaedic departments were calculated. The treatment status, total and daily costs were collected. Results The percentage of TSCI in hospitalized patients and the percentage of TSCI in hospitalized patients through the orthopaedic departments did not change significantly overall (APC= -0.5%, 95% CI: -3.0 to 2.1 and -1.6%, -4.9 to 1.8, respectively). A total of 10 918 (74.0%) patients received surgery after TSCI. However, only 3.0% of patients underwent surgery received surgery less than 24 hours after injury. A total of 2 084 (14.1%) patients were treated with methylprednisolone sodium succinate/methylprednisolone (MPSS/MP) at a high dose (?500 mg) and 641 (4.3%) patients receiving it within 8 hours. The total costs for acute TSCI decreased (-4.8%, -6.2 to -3.4), while the daily costs did not change significantly (0.5%, -1.2 to 2.2). Conclusions This study revealed epidemiological and clinical features, treatment status, and economic burden of TSCI that occurred in China from 2013 to 2018. Funding National Key Research and Development Project of Stem Cell and Transformation Research (2019YFA0112100).

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“… 25 36 51) In South Korea, the prescription rate of MPSS in SCI patients for the past 11 years was 59%, and it was the highest at 76% in 2012, and then gradually decreased to 41% in 2017. 14) Most prevalent rationale for using steroids in SCI patients is because of the belief that it will work and medical litigation. 36) Compared to the North America or Europe, South Korea still has a high proportion of steroid prescriptions for SCI.…”

Section: Update Of Steroid Management For Acute Scimentioning

confidence: 99%

“… 1 3) The prevalence and incidence of SCI vary according to geopolitical and economic conditions, and about 1,000 new cord injury patients occur every year in South Korea. 14) Also, until now, the pathophysiology of SCI has been studied very deeply in terms of cellular and molecular aspects, and accordingly, there have been many studies and discussions on the management of SCI, but there are still controversies especially regarding the use of steroid. Therefore, we aim to provide updated reviews and guidelines for the use of steroids in acute SCI.…”

Section: Introductionmentioning

confidence: 99%

Review: Steroid Use in Patients With Acute Spinal Cord Injury and Guideline Update

Lee

Jeong

2022

Korean J Neurotrauma

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Acute spinal cord injury (SCI) is a devastating condition that causes enormous damage to a patient’s physical, mental, and economic situation and requires a multidisciplinary approach to treatment. Research on SCI has been performed for a long time, and the management of SCI has developed dramatically in recent decades as a mechanism of injury and the pathophysiology of SCI have been revealed from the primitive stage in the past. In the treatment of patients with acute SCI, there is a lot of debate regarding surgical treatment strategies and pharmacological management, such as steroid use. In particular, the efficacy of steroid use, such as methylprednisolone sodium succinate, has been increasing and decreasing and is still intensely debated. The practice guidelines reported so far for this are also at the “suggest” stage with weak recommendations. Therefore, this review aims to summarize the effects of steroid use on SCI. This review provides an overview of current practical guidelines and clinical studies on steroid use in patients with SCI.

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Incidence of acute spinal cord injury and associated complications of methylprednisolone therapy: a national population-based study in South Korea

Cited by 41 publications

References 26 publications

Ibrutinib reduces neutrophil infiltration, preserves neural tissue and enhances locomotor recovery in mouse contusion model of spinal cord injury

Ibrutinib reduces neutrophil infiltration, preserves neural tissue and enhances locomotor recovery in mouse contusion model of spinal cord injury

Epidemiological and Clinical Features, Treatment Status, and Economic Burden of Traumatic Spinal Cord Injury in China

Review: Steroid Use in Patients With Acute Spinal Cord Injury and Guideline Update

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