YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==CORTICOSTEROIDS FOR PMR AND ASTHMA== 1 AUTHOR Ayoub WT AUTHOR Franklin CM AUTHOR Torretti D TITLE Polymyalgia rheumatica: duration of therapy and long term outcome SOURCE Am. J. Med.; VOL 79 ISS Sep 1985, P309-315, (REF 17) ABSTRACT IPA COPYRIGHT: ASHP The duration of therapy and outcome of 75 patients (mean age, 67.6 yr) with polymyalgia rheumatica who received prednisone (I) initially at a mean dose of 22.8 mg/day and gradually reduced to 8.1 mg after 12 months, were studied. No significant difference could be ascertained between groups segregated on the basis of age, sex, or initial steroid. The median duration of therapy was 37.3 months. It was estimated that 40% of patients will require therapy longer than 4 yr. Corticosteroids were permanently discontinued in 31 patients after a mean of 23.7 months of therapy. Results support the concept of 2 patient populations--one with limited disease and another requiring long term therapy. Relapses were frequent, occurring in 56% of patients. Evolution of arteritis during the course of therapy was infrequent, occurring in only one patient. Steroid-related adverse effects occurred in 22.7% of patients and were more common in females. The data suggest that, although corticosteroids may be discontinued in some patients with polymyalgia rheumatica, prolonged therapy is required in a significant number. 2 AUTHOR Chuang TY AUTHOR Hunder GG AUTHOR Ilstrup DM AUTHOR Kurland LT TITLE Polymyalgia rheumatica SOURCE Ann. Intern. Med.; VOL 97 ISS Nov 1982, P672-680, (REF 41) ABSTRACT IPA COPYRIGHT: ASHP A 10 yr epidemiologic and clinical study of 96 patients with polymyalgia rheumatica was reported; of these patients 30 were given aspirin (I), 9 received other nonsteroidal anti-inflammatory (NSAI) agents, 3 received I and NSAI agents and 54 received corticosteroids. The dosage of I ranged from 8 to twenty-four 300 mg tablets/day, and the corticosteroids were given at an initial dose of 5 to 100 mg/day. Patients treated with I, either alone or with NSAI, had a significantly shorter course of treatment, a shorter course of disease, and fewer relapses than those given corticosteroids. However, the data indicate that those given the former 2 treatments had a milder disease than those who received the latter. Side effects were more common in the patients given corticosteroids, but the differences were not statistically significant. Adverse reactions to the corticosteroids included facial puffiness, easy bruising, osteoporosis, diabetes mellitus, and gastrointestinal bleeding. The latter was seen in 3 patients given I. Women had a significantly longer course of treatment and disease, regardless of the treatment regimen. 5 AUTHOR Lestico MR AUTHOR Boh LE AUTHOR Schuna AA TITLE Polymyalgia rheumatica SOURCE Clin. Pharm.; VOL 12 ISS Aug 1993, P571-580, (REF 84) ABSTRACT IPA COPYRIGHT: ASHP The epidemiology, relationship to giant cell arteritis (GCA), pathogenesis, pathology, clinical and laboratory features, differential diagnosis, and treatment of polymyalgia rheumatica (PMR) are reviewed. Nonsteroidal anti-inflammatory agents may be effective in mild cases of PMR. However, corticosteroids, usually prednisone or prednisolone, are the class of drugs most widely used to treat PMR. They are effective in relieving the pain and reversing the abnormal laboratory values in most patients; responses can be apparent in 24-48 h. Corticosteroids are effective in treating PMR. Although patients with PMR must be monitored for the development of GCA, the prognosis for these patients is excellent. 5 AUTHOR Wolkowitz OM AUTHOR Rapaport M TITLE Long lasting behavioral changes following prednisone withdrawal SOURCE JAMA; VOL 261 ISS Mar 24-31 1989, P1731-1732, (REF 6) ABSTRACT IPA COPYRIGHT: ASHP Behavioral changes attributed to tapering and withdrawal of prednisone are reported in 2 male Crohn's disease patients, aged 32 and 34 yr, who had been treated with a maximum of 60 mg/day for 8 and 3 months in one patient and 30 mg/day for 3 wk in the second. The symptoms persisted for 6-8 wk after therapy was discontinued, and finally remitted without specific treatment. The symptoms were attributed to the effects of the drug on the central nervous system. 5 AUTHOR Noonan M AUTHOR Chervinsky P AUTHOR Busse WW AUTHOR Weisberg SC AUTHOR Pinnas J AUTHOR de Boisblanc BP AUTHOR Boltansky H AUTHOR Pearlman D AUTHOR Repsher L AUTHOR Kellerman D TITLE Fluticasone propionate reduces oral prednisone use while it improves asthma control and quality of life. SOURCE Am J Respir Crit Care Med; VOL 152, ISS 5 Pt 1, 1995, P1467-73 ABSTRACT This study examined the ability of fluticasone propionate aerosol to reduce oral prednisone requirements in patients with severe asthma. Ninety-six patients dependent on oral prednisone were treated for 16 wk with placebo or fluticasone propionate aerosol (750 or 1,000 micrograms twice daily). Their dosage of oral prednisone was adjusted weekly according to predetermined criteria. A total of 69% and 88% of patients treated with fluticasone propionate 750 and 1,000 micrograms twice daily, respectively, compared with 3% of placebo-treated patients used no prednisone by the end of the study. In the fluticasone propionate groups, FEV1 and peak expiratory flow rates at the last evaluable visit/date improved and the number of night awakenings and symptomatic albuterol use declined relative to placebo values (p < 0.05). Patient-rated asthma symptoms improved in the groups receiving fluticasone propionate but not in the placebo group (p < 0.005). Fluticasone propionate aerosol was well-tolerated, and it improved some dimensions of health-related quality of life measured using a standard patient survey. Fluticasone propionate aerosol (750 or 1,000 micrograms twice daily) effectively and safely allowed most asthmatics dependent on oral corticosteroids to reduce or eliminate oral prednisone use while improving pulmonary function and quality of life. 13 AUTHOR Toogood JH AUTHOR Baskerville J AUTHOR Jennings B AUTHOR Lefcoe NM AUTHOR Johansson SA TITLE Bioequivalent doses of budesonide and prednisone in moderate and severe asthma. SOURCE J Allergy Clin Immunol; VOL 84, ISS 5 Pt 1, 1989, P688-700 ABSTRACT We determined the relative antiasthmatic and systemic glucocorticoid potencies of inhaled budesonide (BUD) versus morning-dose oral prednisone (PRED) in 34 adult patients with asthma over a dose range extending from conventional to high and potentially toxic levels, 3.2 mg of BUD or 40 mg of PRED per day. Changes in symptom frequency and severity, FEV1, and peak expiratory flow rate were measured during a double-blind, double-dummy controlled, crossover protocol. The drugs proved equally effective, provided a sufficient dosage was administered. The dose required to eliminate recurrently disabling asthma relapses in these patients was about 2.0 mg of BUD per day or greater than 40 mg of PRED per day. On the average, BUD doses greater than or equal to 1.84 mg/day/70 kg adult (26.3 micrograms/kg/day) exhibited systemic effects on the 8 AM serum cortisol level and blood eosinophil count equivalent to greater than or equal to 15 mg of PRED per day. The latter doses are known to be associated with steroid-induced complications, such as osteoporosis. However, the level of systemic glucocorticoid activity produced by any particular dose of BUD in these patients was consistently much lower than that produced by the dose of PRED needed to achieve an equivalent level of antiasthmatic response. Thus, the use of high-dose inhaled BUD appears clinically reasonable and ethically acceptable in patients with severe asthma in whom the alternative is their continuing dependency on PRED. 16 AUTHOR Anand SC TITLE Comparison of cloprednol and prednisone in the treatment of asthma SOURCE Curr. Ther. Res.; VOL 32 ISS Sep 1982, P469-475, (REF 9) ABSTRACT IPA COPYRIGHT: ASHP In a double-blind, parallel study, the efficacy of cloprednol (I), up to 12.5 mg daily, was compared to prednisone, 25 mg daily or 50 mg every other day, in 19 adults with asthma. The physician's evaluation, which included subjective and objective measurements of symptoms, favored I. Pulmonary function tests showed significantly greater improvement in the I patients. There were no side effects related to use of I. 2 AUTHOR Fryer JP AUTHOR Granger DK AUTHOR Leventhal JR AUTHOR Gillingham K AUTHOR Najarian JS AUTHOR Matas AJ TITLE Steroid-related complications in the cyclosporine era. SOURCE Clin Transplant 1994 Jun;8(3 Pt 1):224-9 ABSTRACT Steroid withdrawal has potential risks (rejection) and benefits (fewer complications). Most data on steroid-related complications predates cyclosporine (CsA). We tabulated the incidence of posttransplant complications considered to be steroid-related in 748 adult kidney transplant recipients (with at least 1 year of follow-up) on CsA and prednisone. Using logistic regression analysis, we considered the effects of pre- and postoperative variables for these complications: cataracts; new-onset post-transplant diabetes; bone/joint complications; avascular necrosis; and posttransplant hypertension. Variables included pretransplant steroid therapy; initial steroid dose; prednisone dose at 1 month and 1 year; steroid-treated rejection episodes; cumulative time on steroids; sex; age; race; pretransplant hypertension; pretransplant diabetes; donor source; nonsteroid treated rejection episodes; other immunosuppressive therapy; cumulative time on dialysis; and previous renal or extrarenal transplants. Cataracts occurred in 21.1%, new-onset posttransplant diabetes in 7.6%, bone/joint complications in 49.9%, avascular necrosis in 5.5%, and post-transplant hypertension in 74.9% of recipients. Significant variables for cataract development were prednisone dose at 1 year (odds ratio [OR] = 1.32; p < 0.05), cumulative time on steroids (OR = 1.65; p < 0.001), age > 50 years (OR = 1.85; p < 0.0001), and pretransplant diabetes (OR = 1.63; p < 0.0001). For new-onset posttransplant diabetes, age > 50 years (OR = 1.63; p < 0.05) and nonwhite race (OR = 2.12; p < 0.001) were significant. For bone/joint complications, cumulative time on steroids was significant (OR = 1.45; p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)