Long-term Systemic Corticosteroid Exposure: A Systematic Literature Review

Rice, J. Bradford; White, Alan G.; Scarpati, Lauren M.; Wan, George J.; Nelson, Winnie W.

doi:10.1016/j.clinthera.2017.09.011

Cited by 376 publications

(282 citation statements)

References 36 publications

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“…Like our meta-analysis, Farne et al also observed a modest improvement in quality of life and a small improvement in lung function in both mepolizumab- and reslizumab-treated patients. The clinical outcomes in our study were comparable to the outcomes investigated by Farne et al, except that we included OCS maintenance dose reduction and discontinuation as critical outcomes, because the risk of serious adverse events are substantial with such treatment regimen [36]. Importantly, the study by Farne et al, although largely including the same studies, does not provide an inter-drug comparison of efficacy and safety.…”

Section: Discussionsupporting

confidence: 52%

Efficacy, adverse events, and inter-drug comparison of mepolizumab and reslizumab anti-IL-5 treatments of severe asthma – a systematic review and meta-analysis

Henriksen

Bødtger

Sidenius³

et al. 2018

European Clinical Respiratory Journal

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Background: New, complex, and expensive therapies targeting Interleukin-5 (IL-5) to treat severe eosinophilic asthma are emerging.Objective: To assess efficacy, adverse events, and inter-drug comparison of mepolizumab and reslizumab for treating severe eosinophilic asthma.Design: A systematic review and meta-analysis on randomized, placebo-controlled, clinical trials elucidating two critical (exacerbation rate and oral corticosteroid (OCS) use) and six important clinical outcomes on the efficacy and safety of mepolizumab and reslizumab.Results: Five studies (N = 2197) contributed with data for exacerbation rate, showing a reduction of 53% (95% CI 46; 59) in favour of anti-IL-5, corresponding to –0.94 annual exacerbations (95% CI –1.08;–0.82), thus exceeding the predefined minimal clinical important difference (MCID) of 25% reduction of the estimated ≥2 annual exacerbations. Quality of evidence was considered moderate, with low heterogeneity in study findings (I2 = 0%). One study (N = 135) contributed with data on percentage of patients experiencing ≥50% reduction inoral corticosteroid treatment, showing an effect of 20% (95% CI 2.3;47) in favour of anti-IL-5 treatment (mepolizumab), thus exceeding the predefined MCID of 10%. Quality of evidence was considered low.Compared to placebo, anti-IL-5 showed significant improvements in lung function, asthma control, and asthma-related quality of life, but below the MCIDs. No differences were observed for serious adverse events and number of patients, who dropped out. No studies evaluating sickleave or head-to-head comparisons were identified. By indirect comparison, we found no significant difference between mepolizumab and reslizumab in any ofthe predefined clinical outcomes. OCS treatment reduction could not be compared due to lack of reslizumab studies investigating this outcome.Conclusions: Mepolizumab and reslizumab provide significant and clinically relevant improvements in exacerbation rate and OCS reduction. Indirect, inter-study comparisons revealed no differences between the anti-IL-5 drugs in efficacy or safety measures.

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Section: Discussionsupporting

confidence: 52%

Efficacy, adverse events, and inter-drug comparison of mepolizumab and reslizumab anti-IL-5 treatments of severe asthma – a systematic review and meta-analysis

Henriksen

Bødtger

Sidenius³

et al. 2018

European Clinical Respiratory Journal

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“…Therefore, these effects should be kept in mind while using these drugs. 6,7 Routes of Corticosteroid Administration 1) Local: Adverse effects are less frequent in local treatment than in systemic treatment. a) Topical: Applied over the skin and mucosa.…”

Section: Drugs Used In the Treatment Of Oral Mucosal Diseases 1) Cortmentioning

confidence: 99%

“…Doses should be lowered slowly. 7 The side effects of short-term glucocorticosteroid prescribed for the treatment of mucosal diseases are spontaneously reversible, but those of long-term administration are more serious. Some subjects are at greater risk of the side effects as, for example those with liver disease who do not have the capacity to adequately metabolize the drug, and those with hypoalbuminemia who will have increased levels of free serum glucocorticosteroids.…”

Section: Hydrocortisone Acetatementioning

confidence: 99%

Drugs used in the treatment of oral mucosal diseases

Karapinar¹,

Ünür²

2019

Yeditepe J Dent

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The oral mucosa and the surrounding tissues are the entrance to the body, where oral mucosa-specific lesions can be seen, and where symptoms or signs of many systemic diseases can be observed. The etiology of the lesions occurring in the oral mucosa may be trauma, infection, immunological causes or idiopathic. Drug application onto the mucosa covering the oral cavity has long been a field of pharmacology. Lesions that occur as a symptom of systemic diseases are usually seen as ulcerations. The purpose of the treatment is to apply symptomatic treatments that mainly improve the patient's comfort while solving the underlying problem. These are achieved primarily by correcting oral hygiene, regulating the diet, and prescribing medicines in the appropriate manner mentioned in the article. In this review, we aimed to review the drugs used in oral mucosal diseases by the dentists who frequently deal with them.

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“…The management of both subgroups has been largely based on immunosuppression through corticosteroids and steroid sparing agents, mycophenolate mofetil, azathioprine and cyclophosphamide . Infections, osteoporosis and metabolic derangements are frequently encountered adverse effects secondary to therapy . Numerous advances in our understanding of these diseases have allowed for treatment strategies that go beyond non‐specific immunosuppression .…”

Section: Introductionmentioning

confidence: 99%

“…26,27 Infections, osteoporosis and metabolic derangements are frequently encountered adverse effects secondary to therapy. 16,18,[28][29][30][31][32][33] Numerous advances in our understanding of these diseases have allowed for treatment strategies that go beyond non-specific immunosuppression. 34,35 The application of rituximab and intravenous immunoglobulin (IVIg) in combination has shown how different aspects of these diseases can be effectively targeted.…”

Section: Introductionmentioning

confidence: 99%

From bench to bedside: evolving therapeutic targets in autoimmune blistering disease

Kridin

Kowalski

Kneiber

et al. 2019

Acad Dermatol Venereol

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Autoimmune blistering diseases comprise a group of heterogenous conditions characterized by the loss of tolerance and subsequent development of autoantibodies targeting epidermal and subepidermal adhesion proteins. Blisters and erosions form on the skin and mucous membranes leading to significant morbidity and mortality. Traditional therapies rely on systemic immunosuppression. Advancements in our understanding of the pathophysiology of pemphigus and pemphigoid have led to the development of molecules which target specific pathways involved in induction and perpetuation of disease. In this review, we outline the novel therapeutic strategies including B‐cell depletion, T‐regulatory cell repletion, cell signalling inhibitors and small molecular inhibitors, inhibitory monoclonal antibodies, as well as complement inhibition. We additionally review their current level of clinical evidence. We lastly review therapeutics targets gleaned from the experimental epidermolysis bullosa acquisita mouse model. These emerging treatments offer an exciting progression from basic science discoveries that have the potential to transform the treatment paradigm in autoimmune blistering diseases.

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Long-term Systemic Corticosteroid Exposure: A Systematic Literature Review

Cited by 376 publications

References 36 publications

Efficacy, adverse events, and inter-drug comparison of mepolizumab and reslizumab anti-IL-5 treatments of severe asthma – a systematic review and meta-analysis

Efficacy, adverse events, and inter-drug comparison of mepolizumab and reslizumab anti-IL-5 treatments of severe asthma – a systematic review and meta-analysis

Drugs used in the treatment of oral mucosal diseases

From bench to bedside: evolving therapeutic targets in autoimmune blistering disease

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