Our library of drug research abstracts drawn from the medical literature is updated on a regular schedule, and you can be assured that new prednisone research articles will be listed here shortly after becoming available to us.
Related Sponsors
Medical research on prednisone
Acyclovir plus steroid vs steroid alone in the treatment of Bell's palsy.
Am J Otolaryngol. 2008 May-Jun; 29(3): 163-6
Yeo SG, Lee YC, Park DC, Cha CI
PURPOSE: The pathogenetic mechanism of Bell's palsy is thought to involve herpes simplex virus reactivation within the geniculate ganglion, followed by inflammation and entrapment of the nerve at the meatal foramen. We therefore compared the therapeutic effect of acyclovir plus steroid vs steroid alone, in combination with physical therapy, in patients with Bell's palsy. MATERIALS AND METHODS: In a double-blind, randomized, prospective trial, 91 patients were randomized to treatment with acyclovir and prednisone (44 patients) or prednisone alone (47 patients). All patients underwent physical therapy. The follow-up period was greater than 6 months or encompassed the period of complete recovery from paralysis. House-Brackmann grade was evaluated 2 and 6 months after onset, with complete and satisfactory recovery defined as House-Brackmann grades I and II, respectively. RESULTS: The overall recovery rate of patients treated with steroid and acyclovir (93.1%) was greater than that of patients treated with steroid alone (85.1%), but the difference was not statistically significant. CONCLUSION: The benefit of acyclovir in Bell's palsy has not been definitively established.
J Manag Care Pharm. 2008 Apr; 14(3): 281-90
Chitre MM, Hayes W
BACKGROUND: Accelerated bone loss is a well-known outcome of chronic treatment with glucocorticoids, making glucocorticoid-induced osteoporosis a significant cause of morbidity and a burden on health care resources. Recommendations for prevention and treatment of glucocorticoid-induced osteoporosis include therapy with a bisphosphonate or calcitonin for patients taking a prednisone equivalent of 5 mg per day or more for 3 months or more. OBJECTIVE: To evaluate the effects of a targeted member and physician educational intervention on the use of anti-osteoporotic drug therapy in patients using chronic oral glucocorticoid therapy. METHODS: Pharmacy claims were analyzed for a 4-month period in each of 3 years, for claims with dates of service from April 1 through July 30, 2003, May 1 through August 31, 2004, and February 4 through May 5, 2005, to identify all adult members of a health plan of approximately 1.3 million members who received an oral glucocorticoid (e.g., prednisone, dexamethasone) for at least 90 of 120 days (chronic use) and did not receive a medication for osteoporosis prevention (e.g., risedronate, ibandronate, etidronate, raloxifene, alendronate, calcitonin) during the same 120-day time period. The intervention involved direct-to-patient mailing of a cover letter and a 2-page educational brochure, and a physician mailing that included the same 2-page educational brochure, a 1-page table of recommended drug therapies for prevention of osteroporosis, and an invitation for physicians to request by fax-back a list of at-risk patients. Follow-up claims analyses were conducted for 120 days after each of the 3 intervention periods to determine the number and percentage of target patients who were initiated and maintained on a medication to prevent osteoporosis. RESULTS: The prevalence of health plan members at risk of glucocorticoidinduced osteoporosis was 0.28% in 2003, 0.29% in 2004, 0.29% in 2005, and 0.29% during the 3 years combined. Approximately 47.5% of patients (n = 5,140) during the 3-year period who received chronic glucocorticoids also received drug therapy for prevention or treatment of osteoporosis. Women made up 59.6% (6,450/10,822) of patients who received chronic glucocorticoid therapy during the 3 years; 50.9% (3,285/6,450) of the female patients, and 54.8% (2,397/4,372) of the male patients on chronic glucocorticoid therapy were at risk because of the absence of preventive therapy with an anti-osteoporosis medication. During the 3 years, 404 (7.1%) of the total 5,682 male and female patients at risk because of chronic glucocorticoid therapy and who were the subjects of the educational intervention were started on an osteoporosis medication following the mailings. Of these, 84.9% (343/404) continued on both the glucocorticoid therapy and an anti-osteoporosis medication in the subsequent 4-month follow-up period. During the 3 years, only 4.9% of targeted physicians (n = 196), affecting 6.8% of at-risk patients (n=387), requested a list of their patients at risk via the fax-back opportunity. CONCLUSION: A simple intervention program that screened at-risk patients and reached out to these patients and their physicians via a target-mailing intended to reduce the risk of glucorticoid-induced osteoporosis was associated with a modest increase in the proportion of at-risk patients receiving preventive drug therapy for osteoporosis.
Effects of glucocorticoids on weight change during the treatment of Wegener's granulomatosis.
Arthritis Rheum. 2008 Apr 25; 59(5): 746-753
Wung PK, Anderson T, Fontaine KR, Hoffman GS, Specks U, Merkel PA, Spiera R, Davis JC, St Clair EW, McCune WJ, Stone JH,
OBJECTIVE: Weight gain is a side effect of glucocorticoid (GC) use, but the natural history and health implications of changes in weight that occur during the treatment of inflammatory disease are not understood. METHODS: We evaluated data from the Wegener's Granulomatosis Etanercept Trial. Patients were categorized according to clinical outcome at 1 year: remission (no disease flares), single flare, or multiple flares. Risk factors for gaining >/=10 kg were examined in multivariate models. RESULTS: Weights at baseline and 1 year were available for 157 (93%) of the 168 patients analyzed. During year 1, the mean cumulative prednisone dosage in the multiple flares subgroup was 7.9 gm, compared with 6.0 gm and 3.9 gm in the single flare and remission subgroups, respectively (P < 0.001). Patients in these subgroups gained an average of 2.6 kg, 4.1 kg, and 5.8 kg, respectively (P = 0.005). Weight gain did not correlate with cumulative GC dose (R = 0.10, P = 0.25). Thirty-five patients (22.3%) gained and maintained >/=10 kg in the first year. New diagnosis of Wegener's granulomatosis at baseline was an independent predictor of gaining >/=10 kg at 1 year (odds ratio 19.7, 95% confidence interval 2.4-162.6, P = 0.006). Among the 78 patients in the remission subgroup, 40 sustained remissions through the 2-year time point. For these 40 patients, the mean weight gained at year 1 did not regress by the end of year 2, despite the absence of continued GC use. CONCLUSION: Disease control was associated with lower cumulative GC doses but greater weight gain. More than one-fifth of patients gained >10 kg in the first year of treatment. The quantity of weight gained by patients during treatment has potential future health implications.
Arthritis Rheum. 2008 Apr 25; 58(5): 1293-1298
de Vries-Bouwstra JK, Goekoop-Ruiterman YP, Verpoort KN, Schreuder GM, Ewals JA, Terwiel JP, Ronday HK, Kerstens PJ, Toes RE, de Vries RR, Breedveld FC, Dijkmans BA, Huizinga TW, Allaart CF
OBJECTIVE: To determine the association of HLA-DRB1, rheumatoid factor (RF), and anti-citrullinated protein antibody (ACPA) status with progression of joint damage in early rheumatoid arthritis (RA) treated according to different treatment strategies. METHODS: The present study was conducted using data from the BeSt study (Behandelstrategieën voor Reumatoide Artritis [treatment strategies for rheumatoid arthritis]), a randomized trial comparing 4 targeted (toward achievement of a Disease Activity Score [DAS] of
Outcomes of a Modified CALGB 19802 Regimen in Adult Acute Lymphoblastic Leukemia.
J Korean Med Sci. 2008 Apr; 23(2): 278-83
Han AR, Kim K, Jang JH, Kim WS, Ahn JS, Jung CW, Lee MH, Kang WK
We analyzed the efficacy and toxicity of a modified Cancer and Leukemia Group B (CALGB) 19802 regimen in adult acute lymphoblastic leukemia (ALL). From February 2002 to August 2005, 25 adults with untreated ALL were enrolled in the study. Compared to the original regimen, the modified CALGB 19802 regimen consisted of a 4-drug induction (cyclophosphamide, daunorubicin, vincristine, and prednisone) instead of a 5-drug induction (L-asparaginase was added to the previous regimen). This was followed by high-dose methotrexate (1,000 mg/m(2)X3 days) and cytarabine (2,000 mg/m(2)X4 days) for the consolidation cycles. High-dose systemic and intrathecal methotrexate was given for central nervous system prophylaxis. Twentythree patients (92%) achieved a complete remission (CR), and two patients (8%) had refractory disease. With a median follow-up of 21.5 months, 10 patients (40%) were alive and continued to be in CR. The 3-yr probability of an event-free survival and the overall survival were 39.0% and 47.4%, respectively. Treatment related mortality and major grade 3 to 4 neurotoxicity occurred in 1 patient and 3 patients, respectively. The modified CALGB 19802 regimen demonstrated a high remission rate and a favorable survival rate.
Central serous chorioretinopathy.
Optometry. 2008 May; 79(5): 241-51
Marcuson J, Riley T
BACKGROUND: Central serous chorioretinopathy is a condition typically affecting young adults between 25 and 50 years of age. It is predominating in type A personality trait men. Central serous chorioretinopathy is defined clinically as a detachment of the sensory retina that is commonly unilateral but can also be bilateral. Laser photocoagulation has been used widely with central serous chorioretinopathy to prevent recurrence and to speed recovery time. Photodynamic therapy is emerging as a potential treatment for chronic central serous chorioretinopathy. The prognosis for resolution and visual recovery for patients with central serous chorioretinopathy is excellent. Approximately 95% of patients with central serous chorioretinopathy will recover to a final visual acuity of 20/30. CASE REPORTS: Patient 1 was a 57-year-old man who reported to the clinic with a complaint of central scotoma involving the left eye. He also had a decrease in best-corrected visual acuity of 20/30 in the left eye. Idiopathic central serous chorioretinopathy was diagnosed, and observation was the management choice. At the 6-month follow-up, the patient's left eye visual acuity had returned to 20/20. Patient 2 was a 63-year-old man who reported to the clinic with decreased central vision of the left eye. His best-corrected visual acuity in that eye was 20/40. This was an unusual case because of the patient's age and the risk of macular degeneration. With fluorescein angiography and optical coherence tomography, the diagnosis of central serous chorioretinopathy was confirmed. At the 10-month follow-up the patient's acuity had returned to 20/20 in the left eye. Patient 3 was a 59-year-old man who reported to the clinic with decreased vision in the left eye. His best-corrected visual acuity was 20/60 in that eye. He is a kidney transplant recipient and was taking 60 mg of prednisone. The patient was found to have steroid-induced central serous chorioretinopathy. Observation was the management of choice for several months without resolution. Focal laser photocoagulation was performed at the 6-month follow-up, which did not help, and his ultimate visual acuity in the left eye was 20/400. He returned to the clinic 3 years later with the same complaint in his right eye. The patient was again found to have steroid-induced central serous chorioretinopathy but in the right eye, with a best-corrected visual acuity of 20/30. Because of the failure of photocoagulation in the left eye, observation was the chosen management option. The central serous chorioretinopathy did not resolve, and because of this it was decided that the patient's nephrologist be contacted to suggest a decrease in the patient's oral prednisone dose. The nephrologist decreased his prednisone from 60 mg daily to 5 mg daily. With this change, the patient's visual acuity stabilized at 20/25. The central serous chorioretinopathy was still present but without subjective visual complaints. CONCLUSION: Central serous chorioretinopathy is a condition that normally affects type A personality trait men. Also, patients taking any type of corticosteroids must be watched closely for the development of central serous chorioretinopathy. There is no good course for treatment, with observation being the best management choice. Photodynamic therapy may become the treatment choice for patients with chronic central serous chorioretinopathy, but more studies on the use of photodynamic therapy need to be completed.
Clin Transplant. 2008 Apr 24;
Sewgobind VD, van der Laan LJ, Klepper M, Ijzermans JN, Tilanus HW, Weimar W, Baan CC
Background: The role of CD4(+) CD25(bright) regulatory T cells (Treg) in controlling alloreactivity is established, but little is known whether antigen-specific Treg are induced in fully immunosuppressed kidney transplant patients. Methods: The frequency and function of CD25(bright) T cells of nine stable kidney transplant patients before and 0.5-2 yr after transplantation were measured. Patients received triple therapy consisting of cyclosporine, mycophenolate mofetil and prednisone. To investigate the influence of transplantation and immunosuppression on Treg function, we compared their suppressive capacities pre- and post-transplantation using mixed lymphocyte reactions and kept the CD25(-/dim) effector T-cell (Teff) population constant. Results: After transplantation, the percentage of CD4(+) CD25(bright) T cells significantly decreased from 8.5% pre-transplant to 6.9% post-transplant (median, p = 0.05). However, the lower percentage of post-transplant CD4(+) CD25(bright) T cells was not associated with reduced, but rather improved suppressor function of these cells. The proliferative response of pre-transplant Teff to donor-antigens was more profoundly suppressed by post-transplant Treg than by pre-transplant Treg (pre-transplant 18% vs. post-transplant 55% median, p = 0.03) and was comparable against third party antigens at a CD25(bright):CD25(-/dim) ratio of 1:20. Conclusions: In immunosuppressed kidney transplant patients, the donor-directed suppressive capacity of CD4(+) CD25(bright) regulatory T cells improved, which may contribute to the development of donor-specific hyporesponsiveness against the graft.
Prognostic Model for Predicting Hearing Recovery in Idiopathic Sudden Sensorineural Hearing Loss.
Otol Neurotol. 2008 Apr 18;
Cvorović L, Deric D, Probst R, Hegemann S
HYPOTHESIS:: To aid in realistic counseling of patients at the time of their first visit concerning their chances for recovery, we created a simple prognostic model for predicting hearing recovery in idiopathic sudden sensorineural hearing loss (ISSHL). BACKGROUND:: An important element of research on ISSHL is to identify prognostic factors for this disease. Many studies have described predictive indicators to identify patients with a good prognosis needing no or minimal treatment. Only a few of these studies have included a model for calculating the probability for patient recovery, which may be important for clinical work, but these prognostic tables have not achieved widespread use clinically. METHODS:: Evaluation of an electronic patient data base of 541 patients with ISSHL. The standard treatment was carbogen inhalation (95% O2 and 5% CO2 8 times per day in duration of 30 min) and prednisone orally (100 mg in 1 morning dose) for 7 days. Factors that were analyzed included the patient's age, the interval between the onset of symptoms and beginning of treatment, the presence or absence of vertigo and tinnitus, audiometric patterns, the severity of hearing loss, and hearing in the opposite ear. Hearing gain was expressed either as absolute hearing gain or as relative hearing gain. Significant recovery of hearing was defined as the final pure-tone audiometry of 30 dB or less (or the same as the pure-tone audiometry of the opposite ear). RESULTS:: The absolute hearing gain was 15.1 dB. The mean relative hearing gain was 47%. Three hundred one (57%) patients had significant recovery of hearing, and 228 (43%) did not have significant recovery of hearing. Using step-wise multiple linear regression analysis, the most important factors for prognosis included severity of hearing loss, presence of vertigo, time between onset and treatment, the hearing of the other ear, and the audiogram shape (beta coefficient was -0.216, -0.231, 0.211, 0.113, and -0.064, respectively; constant, 0.968). A recovery expectancy table was developed using the data from this study. CONCLUSION:: Based on a retrospective analysis, prognostic indicators for hearing recovery in ISSHL were found to be severity of hearing loss, presence of vertigo, time between onset and treatment, the hearing of the other ear, and the audiogram shape. We created a model for calculating the probability for hearing recovery based on the analysis of 529 patients with unilateral ISSHL.
A trial of mycophenolate mofetil with prednisone as initial immunotherapy in myasthenia gravis.
Neurology. 2008 Apr 23;
OBJECTIVE: To test the hypothesis that mycophenolate mofetil (MMF) with prednisone provides better control of myasthenic weakness than prednisone alone in the initial management of generalized myasthenia gravis (MG). METHODS: Eighty immunosuppression naïve subjects with mild to moderate generalized, acetylcholine receptor positive MG at 13 centers were randomized to 2.5 g/day MMF plus 20 mg/day prednisone (n = 41) or placebo plus 20 mg/day prednisone (n = 39) and followed in a double-blind fashion for 12 weeks. Subjects over 18 years of age were included if judged to be candidates for immunosuppression; excluded were those with thymoma or severe oropharyngeal or respiratory muscle weakness. The primary measure of efficacy was change in the quantitative MG (QMG) score from baseline to week 12. Study completers could take open-label MMF for an additional 24 weeks, while prednisone was reduced to the minimally effective dosage. RESULTS: The mean change in QMG score was similar in the treated (-4.4+/-5.1) and placebo (-3.6 +/- 5.0) groups (p = 0.71). The dosage of prednisone was reduced by a similar amount in both groups during the open-label phase. Subjects tolerated the study drug well, without unexpected adverse events. CONCLUSIONS: This study demonstrated no benefit of mycophenolate mofetil (MMF) with 20 mg/ day prednisone compared to 20 mg/day of prednisone alone after 12 weeks. This may be due to greater than predicted benefit from the prednisone dosage used, the short duration of the study, or the absence of any benefit of MMF in this population of patients with myasthenia gravis.
An international, phase III, randomized trial of mycophenolate mofetil in myasthenia gravis.
Neurology. 2008 Apr 23;
Sanders DB, Hart IK, Mantegazza R, Shukla SS, Siddiqi ZA, De Baets MH, Melms A, Nicolle MW, Solomons N, Richman DP
BACKGROUND: This prospective, randomized, double-blind, placebo-controlled, phase III trial assessed the efficacy, safety, and tolerability of mycophenolate mofetil (MMF) as a steroid-sparing agent in patients with myasthenia gravis (MG). METHODS: Patients with acetylcholine receptor antibody-positive class II-IVa MG (MG Foundation of America [MGFA] criteria) taking corticosteroids for at least 4 weeks were randomized to MMF (2 g/day) or placebo for 36 weeks. The primary endpoint was a composite measure defined as achievement of minimal manifestations or pharmacologic remission (MGFA post-intervention status), with reduction of corticosteroid dose on a set schedule. Secondary endpoints included disease severity, quality-of-life scores, and safety. RESULTS: A total of 44% of MMF-treated (n = 88) and 39% of placebo-receiving (n = 88) patients achieved the primary endpoint (p = 0.541). Improvements in mean quantitative MG, MG activities of daily living, and 36-item Short-Form health survey scores were similar in both groups. Numbers of adverse events were similar in both groups. The most commonly reported adverse events in the MMF-treated group were headache (12.5%) and worsening of MG (11.4%), and in the placebo group, worsening of MG (20.5%) and diarrhea (10.2%). CONCLUSIONS: Initiation of mycophenolate mofetil (MMF) treatment was not superior to placebo in maintaining myasthenia gravis (MG) control during a 36-week schedule of prednisone tapering. There were no significant differences in the primary or secondary endpoints between the study groups. MMF was well tolerated and adverse events were consistent with previous studies. Experience from this large, international, multicenter, phase III study employing full MG Foundation of America guidelines will aid the design of future MG studies.