Single daily dose corticosteroid treatment. Effect on adrenal function and therapeutic efficacy in various diseases.

Myles, A. B.; Bacon, P A; Daly, J. R.

doi:10.1136/ard.30.2.149

Cited by 44 publications

(15 citation statements)

References 13 publications

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“…In a previous study (Myles, Bacon, and Daly, 1971) it was shown that corticosteroids administered in a single daily dose in the morning allowed the plasma cortisol of most patients to rise to normal within 24 hours, and the majority retained a normal response to exogenous ACTH as shown by the tetracosactrin test. On the other hand, the same total daily dose of corticosteroid when administered half in the morning and half in the evening usually caused suppression both of the morning plasma cortisol and of the response to tetracosactrin.…”

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confidence: 95%

“…If each episode of inhibition is profound and prolonged, so that there is no opportunity for recovery before the next dose of corticosteroid is administered, HPA suppression will eventually ensue. Suppression may be regarded as inhibition which cannot be overcome in response to stress, and which will not recover rapidly and spontaneously when the exogenous corticosteroid administration is stopped (Myles and Daly, 1974).…”

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Single daily dose corticosteroid treatment.

Myles¹,

Schiller²,

Glass³

et al. 1976

Annals of the Rheumatic Diseases

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. (1976). Annals ofthe Rheumatic Diseases, 35,[73][74][75][76]. Single daily dose corticosteroid treatment. Thirteen patients with rheumatoid or psoriatic arthritis who had not previously received corticosteroids were treated with prednisolone in a single dose each morning. Insulin-hypoglycaemia tests were performed before starting steroids in each patient, and again at the conclusion ofthe study in twelve of the thirteen (duration of steroid treatment 8-40 m). There was no difference in the mean basal or peak levels of corticosteroids, or the mean peak of growth hormone (GH) in the tests done before or during treatment, although one patient lost GH responsiveness. There was thus no evidence of hypothalamo-pituitary-adrenal (HPA) suppression in any of the twelve patients, and there was a good therapeutic response in twelve out of thirteen. One patient was dropped from the trial because treatment failed. In contrast, of seven patients who had received a similar total dose of prednisolone twice daily, three showed HPA suppression and two had lost GH responsiveness.

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Single daily dose corticosteroid treatment.

Myles¹,

Schiller²,

Glass³

et al. 1976

Annals of the Rheumatic Diseases

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“…To reduce the risk of expos ing patients to corticosteroid side effects, the test period was limited to 3 months and an alternate day regimen was employed. Depres sion of the hypothalamo-pituitary-adrenal axis may be reduced by dosage schedules which give intermittent rather than the con tinuous blood levels achieved by conven tional divided daily regimes, particularly if the high therapeutic level coincides with the physiological peak cortisol level in the morn ing [14,15], Adrenocortical response to exog enous ACTH [5] endogenous ACTH [16] and insulin-induced hypoglycaemia [17] tends to be maintained during alternate day regimes although resting blood cortisol levels may be reduced compared with normal. Many un- controlled studies, e.g.…”

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confidence: 99%

A Controlled Trial of Alternate Day Prednisolone as a Maintenance Treatment for Ulcerative Colitis in Remission

et al. 1981

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A double-blind crossover trial compared prednisolone, 40 mg given orally on alternate days, with placebo as a maintenance treatment for ulcerative colitis in remission. In each patient, the study was over two periods of 3 months. Of 24 patients who completed both periods, 11 relapsed while taking placebo but did not while taking prednisolone, and 1 relapsed on prednisolone but did not on placebo (p < 0.01). 1 patient had to stop prednisolone because of hyperglycaemia; other side effects noted were mild. Prednisolone, cautiously used in this way, could be justified for the few patients who relapse frequently despite sulphasalazine.

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“…A trial comparing the effects of oral prednisone in dosages of 20 mg, 40 mg and 60 mg per day showed that 40mg was more effective than 20mg but that there was no advantage in increasing the dosage further to 60 mg per day which caused more side-effects (14). Prednisolone, 40 mg given in one daily dose, is as effective as 10 mg four times per day (15) and is likely to cause less adrenal suppression (16). Prednisone and its active metabolite prednisolone, are probably equally effective in ulcerative colitis but prednisolone is usually preferred since liver dysfunction may occur in patients with ulcerative colitis and might make drug metabolism unpredictable.…”

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confidence: 99%

Therapeutic Progress—reviewix.

Rhodes

1983

J Clin Pharm Ther

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Ulcerative colitis is a disease of unknown aetiology in which colonic mucosal inflammation and ulceration result in rectal bleeding and diarrhoea. Most patients have relapses separated by long periods of disease inactivity, but a minority of patients have more chronic symptoms. The great majority of a t t x k s of ulcerative colitis settle with prompt medical management but in the few cases where this fails, colectomy is curative although generally leaves the patient with a permanent ileostomy. With good medical and surgical management, mortality from the disease should therefore approach zero. Acute atracksCorticosteroids are the only drugs which have been shown to have an important and unequivocal therapeutic effect in acute attacks of ulcerative colitis (1, 2,3,4). If the disease is confined to the rectum or distal colon, local steroid therapy is often sufficient to obtain a remission (2, 3, 5). It may be given in the form of suppositories, enemas or rectal foam. Suppositories are the simplest to use but are only likely to give adequate drug concentrations in the lower rectum and should therefore only be used in cases of localized distal proctitis. One might imagine that a liquid enema would reach further up the colon than rectal foam but abdominal scanning following rectal instillation of isotopically labelled steroid foam has shown convincingly that it usually passes up to the proximal sigmoid colon and sometimes well into the descending colon (6). In practice, hydrocortisone foam seems at least as effective as hydrocortisone enemas, similar in cost, and generally preferred by the patient (7). It has been shown that approximately half the steroid in enemas containing hydrocortisone or prednisolone-21-phosphate is absorbed (8, 9, 10, l l ) , although it is generally thought that some at least of the therapeutic effect results from the high levels obtained locally in the rectum (10, 11 , 12, 13). Prednisolone metasulphobenzoate sodium is probably as effective as prednisolone-2 1-phosphate when given rectally, but produces much lower free prednisolone levels in the blood (13) and would therefore be expected to cause less adrenal suppression. However, this probably is of little importance clinically if topical steroids are used for a fairly short course of a few weeks or less.

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Single daily dose corticosteroid treatment. Effect on adrenal function and therapeutic efficacy in various diseases.

Cited by 44 publications

References 13 publications

Single daily dose corticosteroid treatment.

Single daily dose corticosteroid treatment.

A Controlled Trial of Alternate Day Prednisolone as a Maintenance Treatment for Ulcerative Colitis in Remission

Therapeutic Progress—reviewix.

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