Steroids Blog

As per a new study conducted by researchers from the Ohio State University Medical Center, a substance created by body’s immune cells can play a critical role in progression of disease in animals, which closely mimics multiple sclerosis.

The study concluded that the molecule, known as macrophage migration inhibitory factor (MIF), can help in effectively preventing multiple sclerosis.

From News-Medical.Net:

“Our results suggest that MIF may be less important for initiating MS, but that it may be necessary for MS progression,” says principal investigator Caroline C. Whitacre, professor of molecular virology, immunology and medical genetics.

“These findings indicate that in the future we can perhaps use MIF levels to predict the onset of a relapse. But more importantly, perhaps this study will lead to drugs that can halt the course of MS by blocking the action of MIF.”

Though MIF may be regarded as not so important for the initiation of multiple sclerosis (MS), it is important for the progression of MS, as per principal investigator Caroline C. Whitacre, Professor of molecular virology, immunology and medical genetics.

These findings suggested that the MIF levels can be effectively used to predict the onset of a relapse. Moreover, this study is expected to create new paradigm for halting the course of MS by blockage of MIF activities.

Multiple myeloma occurs when the body makes an abnormally high number of cancerous plasma cells. When healthy, plasma cells help to protect the body from infection and disease by forming antibodies that attack foreign substances. But when the body makes too many plasma cells that all make the same type of antibody, this leads to multiple myeloma, causing damage to bones, overabundance of calcium in the blood, anemia, and weakening of the immune system.

Fortunately, the researchers at Cedars-Sinai Medical Center report that treatment with a steroid pill improves the overall survival of patients with multiple myeloma, a cancer of the plasma cells in bone marrow.

From Bio-medicine:

In the study, the researchers compared patients with multiple myeloma receiving prednisone in pill-form following a response to treatment with one of two chemotherapy combinations: vincristine, doxorubicin and dexamethasone with prednisone or with or without quinine, which has been found to increase the effectiveness of chemotherapy. Treatment with either of the chemotherapy combinations was repeated every 21 days for at least six months or until patients achieved at least a 25 percent reduction in tumor size. After a 53-month follow-up period, the investigators found that there was no difference in either progression-free or overall survival between the patients receiving chemotherapy with or without quinine.

To determine whether prednisone alone was effective as maintenance therapy, patients who responded to treatment with up-front chemotherapy were randomly selected to receive either 10 (the amount that the body normally makes daily) or 50 mg of prednisone every other day until their disease progressed.

The team will still conduct future studies to examine whether prednisone is effective to prolong remission for patients with other cancers such as leukemia or lymphoma. In addition, other drug combinations that include prednisone will be evaluated as maintenance therapy for patients with multiple myeloma.

In a study conducted by Dr. Fares E. Sayegh of the Aristotle University of Thessaloniki Medical School in Greece, and his colleagues showed that caudal epidural injections (CEIs) with local anesthetic, with or without steroids are both helpful to patients with low back pain and sciatica. Based on their findings, all patients who participated in the study showed improvements in the symptoms of their illnesses.

The research team analyzed data from 183 patients with severe chronic low back pain and sciatica who were randomized to receive CEIs with xylocaine, betamethasone dipropionate and betamethasone phosphate, or injections with xylocaine and water for injection (WFI).

From Modern Medicine:

Caudal epidural injections (CEIs) with local anesthetic, with or without steroids, may help patients with low back pain, but the steroids may help provide faster relief,

The researchers found that both groups showed improvements in symptoms from the first week following injection, but the rate of decrease in Oswestry Disability Index score was more rapid in the steroid group. Although both groups showed improvements in the straight leg raising test, the improvement was faster in the steroid group.

“CEIs containing local anesthetic and steroid or WFI could be effective in relieving the symptoms of patients suffering from low back pain and sciatica. The injection of steroid with local anesthetic leads to greater and faster relief during the first week after the CEI and this improvement is maintained even one-year later. The clinical symptoms of the WFI-group patients are relieved in a more progressive way and not as much and as fast as of the steroid-group’s patients, even one year after the CEI,” the authors write.

In the end of the study, Dr. Sayegh and his colleagues emphasized that caudal epidural injections with local anesthetics and steroids offer faster and better relief on low back pain and sciatica.

Steroid eye drops have been the mainstay of anti-inflammatory treatment for decades indicated for most types of ocular surgery and inflammatory conditions of the eye. Newer developments in eye drops now give us different “strengths” of steroid eye drops. New drug delivery systems will be giving us sustained release of steroids.

Recently the FDA approved a biodegradable sustained release drug delivery system called Ozurdex. This drug is injected into the vitreous cavity and releases dexamethasone for a limited time. It is indicated for the treatment of macular edema caused by vein occlusions. It is believed that the off-label use for intraocular inflammation is sure to follow for treatment of refractory uveitis and possible post-operative inflammation of the anterior segment and posterior segment (retina).

From Gerson Lehrman Group:

The gold-standard of anti-inflammatory eyedrops has been prednisolone acetate 1%. Prednisolone acetate 1% has been effective in controlling intraocular inflammation as well as inflammation of the palpebral and bulbar conjunctiva.

Durezol was recently released as a topical synthetic steroid indicated for post-surgical inflammation. The drug reportedly has no rise in intraocular pressure, yet has the same anti-inflammatory “power” as prednisolone acetate 1.

Vexol is known as a “soft” steroid. It has less anti-inflammatory properties and is indicated for treatment of inflammatory conditions of the anterior segment and surgery.

Lotemax is also a “soft” steroid, has decreased anti-inflammatory properties, does have IOP spikes and is indicated for inflammatory conditions of the palpebral and bulbar conjunctiva, cornea and anterior segment.

LASIK surgery is commonly treated with prednisolone acetate 1% 4x/day for about one week. Intravitreal injections of triamcinolone acetonide have been popular over the past several years.

Because of recent developments in pharmaceuticals and technology, we now have more choices for treating intraocular inflammation. Treatments ranging from simple eye drops to injection and laser applications are now within reach.

A surgical implant, which is sutured to the sclera, is a useful second-line therapy for patients with sympathetic ophthalmia who have recurrent inflammation or can’t tolerate systemic anti-inflammatory medications. Researchers said that the implant, an approved noninfectious uveitis treatment, releases low doses of steroid helps prevent inflammation and stabilize vision in patients with sympathetic ophthalmia.

In a retrospective study, three of the patients regained vision because of resolution of inflammation and macular edema. Vision was stabilized in the remainder of the patients, and none of them lost vision because of the device or ongoing sympathetic ophthalmia.

From Medpage today:

“Until recently, the primary treatment option for sympathetic ophthalmia was nonsurgical and involved high doses of oral steroids followed by oral immunosuppressive medication to preserve vision in a patient’s remaining eye,” said lead author Vinit Mahajan, M.D., Ph.D., also of the University of Iowa Hospitals and Clinics.

But such systemic treatment, he said in a statement, “subjects patients to life-long use of immunosuppressive drugs that have serious side effects such as osteoporosis, weight gain, potentially life-threatening infection, and liver or kidney damage.”

To evaluate the effects of the implant in cases of sympathetic ophthalmia, the researchers looked at records of eight patients who underwent surgical implantation of the device with post-operative follow-up from three months to two years.

The results support the use of the implant in sympathetic ophthalmia, the researchers said, although the “conclusions have to be tempered” because of the small number of patients and the retrospective nature of the study.

Sympathetic ophthalmia is a rare condition in which, after surgery on or trauma to one eye, the other becomes inflamed in an autoimmune response. Although the implant has found to be effective, it still needs to be replaced after two and a half years since sympathetic ophthalmia is a chronic disease.

As per a recently concluded research, an appetite-stimulating hormone has been identified that can offer the ability to treat common ailments of muscle atrophy.

Muscular Atrophy is referred to as a debilitating process, which results in an extensive loss of muscle function and mass. This condition results in worsening of the quality of life and can occur with aging, inadequate food intake, and nerve injury.

As per Andrea Graziani, PhD., study’s co-author, molecular biologist with the Department of Clinical and Experimental Medicine and the Biotechnology Center for Applied Medical Research, University of Piemonte Orientale, Novara, Italy, Des-acyl ghrelin, which is a form of ghrelin and an appetite-stimulating hormone in the body, can be used to treat patients with muscular atrophy.

From News-Medical.Net:

Currently, there are few options to treat the problem. Some of the treatments, such as anabolic steroids (testosterone) and insulin-like growth factor 1 (IFG-1), raise concerns about safety and effectiveness, said study co-author Andrea Graziani, PhD. He is a molecular biologist with the Department of Clinical and Experimental Medicine and the Biotechnology Center for Applied Medical Research, University of Piemonte Orientale, Novara, Italy.

“Because of the wide impact of muscular atrophy on public health, it is of pivotal importance to find new and better drug strategies to treat it,” Graziani said.

Graziani and his co-workers are studying des-acyl ghrelin, a form of ghrelin, the appetite-stimulating hormone found in the body. Until recently, researchers thought that des-acyl ghrelin was inactive because it does not share the main activities of ghrelin-stimulating appetite, fat and the release of growth hormone.

However, Graziani’s group recently found that des-acyl ghrelin shares some biological activities with ghrelin, such as stimulating differentiation of other cells, including-important to this study-cells that are precursors to skeletal muscle cells.

In this new study, the researchers discovered that des-acyl ghrelin has a direct anti-atrophic activity on the skeletal muscle of mice with muscular atrophy caused by either denervation (nerve injury) or fasting. Mice that were genetically altered to have increased levels of des-acyl ghrelin had less skeletal muscle loss than the untreated control mice. This held true for both causes of muscular atrophy.

The study was Graziani and his team is expected to provide new treatment avenues for treating muscular atrophy. This study was supported by Telethon, Regione Piemonte, and the Italian Ministry for University and Research.

According to a research conducted at the National Jewish Medical and Research Center, black teens are three times more likely to have steroid-resistant asthma than their white counterparts.

The research revealed that the African-American Children were more likely to develop steroid-resistant asthma than the white teens, as per Joseph Spahn, M.D., a pediatric allergist and director of the Immunopharmacology Lab at National Jewish.

Other recent epidemiological studies found that black teenagers with asthma are found to be sicker and tend to have a high mortality rate than white teenagers with asthma. It was also revealed that inhaled steroids can be one of the most effective ways in controlling asthma.

From News.Bio-Medicine.Org:

“Our results suggest that children with steroid-resistant asthma are more likely to be African-American, to have required treatment with oral steroids at an earlier age and to require larger amounts of oral steroids for only marginal control of their asthma,” said Joseph Spahn, M.D., a pediatric allergist and director of the Immunopharmacology Lab at National Jewish.

Other recent epidemiological studies have shown that blacks with asthma are sicker and have a higher mortality rate than whites with asthma. Doctors at National Jewish now are trying to determine whether blacks have a more vigorous immune response to airway inflammation–which means that higher doses of steroids must be used to control inflammation–or a poor response to steroids secondary to a genetic resistance to the drugs.

“The theory is that with ongoing airway inflammation you get worsening asthma and diminished steroid sensitivity,” Dr. Spahn said.

This study of 164 teen-agers treated at National Jewish also showed that 25 percent of the group was steroid resistant. Children with less than a 15 percent improvement in lung function following a “burst” of inhaled steroids–high doses over seven days–were considered steroid resistant.

“Twenty-five percent of the kids admitted to National Jewish have steroid-resistant asthma, which is much greater than anyone thought,” Dr. Spahn said.

Further Studies are undergoing to ascertain whether or not the black teens have a more vigorous immune response to airway inflammation.

It is believed that only 1/10 of a percent of the fifteen million asthma patients in the United States alone are resistant to steroid therapy while they are approximately five million children with asthma in the United States.

The study is the first one to examine steroid-resistant asthma in children and was published in the Journal of Allergy and Clinical Immunology.

The research team of Dr. Onur Ozcelik of the Cukurova University reported that anabolic steroids can cause gingival enlargement. This is because the gingiva is affected by sex hormones, and clinical changes in periodontal tissue have been observed during puberty, pregnancy, menopause, and with the use of oral contraceptives. This engorgement of the gums makes it easier for bacteria in plaque to accumulate, placing steroid users at risk for severe gum infection.

However, in the study, steroid users who were found to have significantly enlarged gums did not have more plaque beneath their gums compared to non steroid users. The study compared the gums of 24 body builders who had been using anabolic steroids for less than one year with 20 body builders who had never used steroids.

From medpage today:

The overgrown gums make it easier for bacteria in plaque to accumulate, placing steroid users at risk for severe gum infection, said Onur Ozcelik, D.D.S., Ph.D., and colleagues of Cukurova University here in the July issue of the Journal of Periodontology.

The current study compared the gums of 24 body builders who had been using anabolic steroids for less than one year with 20 body builders who had never used steroids. All participants were between the ages of 17 and 29.

Compared with their steroid-free counterparts, the steroid users were found to have:

• significantly thicker gums (an average score of 1 versus 0.3; P<.001).
• more gingival encroachment onto teeth (an average score of 0.9 versus 0.2; P<.001).
• more overall gingival enlargement (average score 0.9 versus 0.3; P<.001).

There are no known facts if the engorgement of the gums will regress when the use anabolic steroids is stopped. So, the researchers urge dentists and periodontists to be familiar with the potential side effects of anabolic steroids to the gingival tissues.

A group of Australian researchers proved that steroid injections are apparently of no use in tennis elbow and a wait and watch approach may be the best. The researchers tested this approach on a group of volunteers, while a second group was given a local corticosteroid injection and advised to gradually return to normal activities. The final group received eight treatments of physiotherapy of 30 minutes over six weeks and was taught home exercises and self-manipulation. Each group’s progress was measured at six weeks, and again after a year.

From Bio-Medicine:

Steroid injections are apparently of no use in tennis elbow and a wait and watch approach may be the best, a new study in the BMJ says. Australian researchers tested this approach in one group of volunteers, who were assured that their problem would be sorted out.

Initially, corticosteroid injections were the most successful treatment, with 78% of those in the group reporting improvements, followed closely by physiotherapy with a 65% success rate when compared to just 27% in the ‘wait and see’ group.

However, after 52 weeks the injection group rates of improvement were significantly worse than those of the physiotherapy group. The injection group also had the most reported recurrences, with 72% of participants’ condition deteriorating after three or six weeks – which could be due, in part, to a quicker initial recovery leading to greater use and over-taxing of the elbow.

The study findings also support the idea that tennis elbow is, in most cases, a self-limiting condition.

The study showed that the injection group also had the most reported recurrences, with 72% of participants’ condition deteriorating after three or six weeks. At the end of the study participants in both the physiotherapy and wait and see group had either much improvement or completely recovered from their condition.

Researchers have found that injectable teriparatide (Forteo) increase bone-mineral density (BMD) as much as twice when compared to oral alendronate (Fosamax) in a head-to-head comparison.

During the study, it was remarked by Kenneth Saag, M.D., of the University of Alabama at Birmingham and his colleagues that teriparatide was considered to be associated with greater increases in BMD at the hip and spine areas.

From Medpagetoday.com:

“In our study, teriparatide was associated with greater increases in [BMD] at the spine and hip and with significantly fewer new vertebral fractures,” Dr. Saag’s group wrote. But the dropout rate for adverse effects was twice as high for those taking teriparatide.

Only one out of 171 evaluable patients receiving teriparatide had radiographic evidence of a vertebral fracture, while 10 of 165 evaluable patients on alendronate had such fractures (P=0.004).

Nonvertebral fractures occurred at similar rates with the two treatments (5.6% versus 3.7%, P=0.36). BMD in the total hip increased with both drugs, though less dramatically than in the lumbar spine. Teriparatide increased hip BMD by 3.8% while it rose 2.4% in the alendronate group. The advantage for teriparatide was significant (P<0.01). Significantly more patients in the teriparatide group had at least one elevated serum calcium measurement > 10.5 mg/dL (18% versus 5.7%, P<0.001) and there was a tendency toward more patients with at least one measurement > 11 mg/dL (3.8% versus 1%, P=0.06).

Teriparatide is a recombinant peptide drug, based on a portion of the parathyroid hormone protein. Earlier studies had indicated that it leads to increased BMD.

Teriparatide is regarded to a potential first-line therapy for steroid-induced osteoporosis as per the findings of Saag and his colleagues, as per Philip N. Sambrook, M.D., of the University of Sydney.

It is noteworthy to note that teriparatide is currently approved by the FDA only for men and postmenopausal women with osteoporosis who are suffering from high risks of fractures.