The Experts below are selected from a list of 321 Experts worldwide ranked by ideXlab platform
Hideo Yasunaga - One of the best experts on this subject based on the ideXlab platform.
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Association of Early Systemic Corticosteroid Therapy with Mortality in Patients with Stevens–Johnson Syndrome or Toxic Epidermal Necrolysis: A Retrospective Cohort Study Using a Nationwide Claims Database
American Journal of Clinical Dermatology, 2019Co-Authors: Kojiro Morita, Hiroki Matsui, Nobuaki Michihata, Kiyohide Fushimi, Hideo YasunagaAbstract:Background Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe dermatologic disorders with high mortality. The role of systemic Corticosteroids as an adjunctive therapy for SJS or TEN remains controversial. Objective The aim of this study was to determine whether treatment with early systemic Corticosteroids impacts the in-hospital mortality of patients hospitalized with SJS or TEN. Methods Using the Japanese Diagnosis Procedure Combination Database, a large nationwide inpatient administrative claims database, we identified inpatients aged ≥ 18 years who were admitted with SJS or TEN. Treatment with early systemic Corticosteroids was defined as starting treatment with systemic Corticosteroids within 2 days (day 0 or day 1) of admission. The primary outcome was in-hospital mortality. We examined the association between early systemic Corticosteroids and in-hospital mortality using propensity score (PS) analyses. Results We identified 1846 eligible patients with SJS or TEN, including 793 patients with early systemic Corticosteroid use at ≤ 2 mg/kg/day, 558 patients with early systemic Corticosteroid use at > 2 mg/kg/day, and 495 patients without early Corticosteroid use. PS matching created 235 pairs (> 2 mg/kg/day vs. controls) and 332 pairs (≤ 2 mg/kg/day vs. controls). Early systemic Corticosteroid use was not significantly associated with lower in-hospital mortality by PS matching (> 2 mg/kg/day vs. controls: relative risk [RR] 0.83, 95% confidence interval [CI] 0.37–1.85; ≤ 2 mg/kg/day vs. controls: RR 0.61, 95% CI 0.28–1.36) and by inverse probability of treatment weighting (> 2 mg/kg/day vs. controls: RR 0.99, 95% CI 0.45–2.19; ≤ 2 mg/kg/day vs. controls: RR 0.65, 95% CI 0.29–1.47). Conclusion Early systemic Corticosteroid therapy for patients with SJS or TEN was not associated with lower in-hospital mortality. Further studies are needed to define the effect of Corticosteroids for patients with SJS or TEN.
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association of early systemic Corticosteroid therapy with mortality in patients with stevens johnson syndrome or toxic epidermal necrolysis a retrospective cohort study using a nationwide claims database
American Journal of Clinical Dermatology, 2019Co-Authors: Kojiro Morita, Hiroki Matsui, Nobuaki Michihata, Kiyohide Fushimi, Hideo YasunagaAbstract:Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe dermatologic disorders with high mortality. The role of systemic Corticosteroids as an adjunctive therapy for SJS or TEN remains controversial. The aim of this study was to determine whether treatment with early systemic Corticosteroids impacts the in-hospital mortality of patients hospitalized with SJS or TEN. Using the Japanese Diagnosis Procedure Combination Database, a large nationwide inpatient administrative claims database, we identified inpatients aged ≥ 18 years who were admitted with SJS or TEN. Treatment with early systemic Corticosteroids was defined as starting treatment with systemic Corticosteroids within 2 days (day 0 or day 1) of admission. The primary outcome was in-hospital mortality. We examined the association between early systemic Corticosteroids and in-hospital mortality using propensity score (PS) analyses. We identified 1846 eligible patients with SJS or TEN, including 793 patients with early systemic Corticosteroid use at ≤ 2 mg/kg/day, 558 patients with early systemic Corticosteroid use at > 2 mg/kg/day, and 495 patients without early Corticosteroid use. PS matching created 235 pairs (> 2 mg/kg/day vs. controls) and 332 pairs (≤ 2 mg/kg/day vs. controls). Early systemic Corticosteroid use was not significantly associated with lower in-hospital mortality by PS matching (> 2 mg/kg/day vs. controls: relative risk [RR] 0.83, 95% confidence interval [CI] 0.37–1.85; ≤ 2 mg/kg/day vs. controls: RR 0.61, 95% CI 0.28–1.36) and by inverse probability of treatment weighting (> 2 mg/kg/day vs. controls: RR 0.99, 95% CI 0.45–2.19; ≤ 2 mg/kg/day vs. controls: RR 0.65, 95% CI 0.29–1.47). Early systemic Corticosteroid therapy for patients with SJS or TEN was not associated with lower in-hospital mortality. Further studies are needed to define the effect of Corticosteroids for patients with SJS or TEN.
Leonard Bielory - One of the best experts on this subject based on the ideXlab platform.
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Management of seasonal allergic conjunctivitis: Guide to therapy
Acta Ophthalmologica, 2012Co-Authors: Brett P. Bielory, Terrence P Oʼbrien, Leonard BieloryAbstract:Seasonal allergic conjunctivitis (SAC) is an inflammatory response of the conjunctiva triggered by exposure to seasonal allergens. Treatment options for SAC include artificial tears, antihistamines, decongestants, mast cell stabilizers, nonsteroidal anti-inflammatory drugs, dual antihistamine/mast cell stabilizers, immunotherapy and Corticosteroids. Topical, intranasal and systemic formulations of Corticosteroids have traditionally provided the most effective relief of the inflammation and signs and symptoms associated with severe, acute exacerbations of SAC. However, steroid-induced ocular and systemic side-effects have limited the prescribing of these agents. This limitation of traditional Corticosteroids led to the development of modified Corticosteroids that retain the anti-inflammatory mechanism of action of traditional Corticosteroids with a much-improved safety profile because of their rapid breakdown to inactive metabolites after exerting their activity. The development of one such novel Corticosteroid, loteprednol etabonate (LE), led to the insertion of an ester (instead of a ketone) group at the carbon-20 (C-20) position of the basic Corticosteroid structure. Clinical trials assessing this C-20 ester Corticosteroid have demonstrated similar efficacy to C-20 ketone Corticosteroids in the prevention or treatment of the signs and symptoms of SAC but with a greatly improved safety profile, as the C-20 ester Corticosteroid is less likely to elevate intraocular pressure. In addition, the ketone at the C-20 position has been implicated in the formation of cataract, while nonketolic Corticosteroids do not form Schiff base intermediates with lens proteins, which is a common first step in cataractogenesis. The clinical relevance of the C-20 ester Corticosteroid class, as modelled by LE, is that they provide both effective and safe treatment of the inflammation associated with SAC and relief of its signs and symptoms. Loteprednol etabonate offers a well-tolerated treatment option for patients with debilitating acute exacerbations as well as chronic forms of the disease.
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treatment of seasonal allergic conjunctivitis with ophthalmic Corticosteroids in search of the perfect ocular Corticosteroids in the treatment of allergic conjunctivitis
Current Opinion in Allergy and Clinical Immunology, 2010Co-Authors: Brett P. Bielory, Victor L. Perez, Leonard BieloryAbstract:PURPOSE OF REVIEW: Corticosteroids are an effective short-term treatment option for seasonal allergic conjunctivitis (SAC). Their use has been limited due to their side effects and has led to the development of modified 'soft', 'smart' ophthalmic Corticosteroid formulations that retain their anti-inflammatory mechanism of action with an improved safety profile. RECENT FINDINGS: Similar to the development of the prodrug concept for the nose and lung that led to the development of ciclesonide, a chloromethyl-ester group substitution at the carbon-20 (C-20) position of the traditional Corticosteroid has led to the development of a family of potential ophthalmic Corticosteroids including loteprednol etabonate that has demonstrated similar efficacy to the C-20 ketone Corticosteroids in the treatment of the signs and symptoms of ocular allergies, but less likely to induce elevations in intraocular pressure (IOP) or the formation of cataracts. The C-20 ester Corticosteroid, loteprednol etabonate has been designed to be rapidly converted to an inactive, nontoxic metabolite, thus minimizing adverse effects, and loteprednol etabonate (0.2%) is currently the only ophthalmic Corticosteroid specifically developed for and approved by the Food and Drug Administration for treatment of SAC. SUMMARY: The development of modified or soft, smart Corticosteroids such as loteprednol etabonate provides an avenue for expanding the treatment of the inflammation associated with signs and symptoms in patients with chronic forms or severe acute exacerbations of allergic conjunctivitis. Modified Corticosteroids are an effective and well tolerated option for the short-term treatment of the inflammation and signs and symptoms associated with SAC.
G Russell - One of the best experts on this subject based on the ideXlab platform.
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posterior subcapsular cataract and inhaled Corticosteroid therapy
Thorax, 1995Co-Authors: F Abuekteish, J N P Kirkpatrick, G RussellAbstract:BACKGROUND--Although posterior subcapsular cataract complicates both systemic and topical Corticosteroid therapy, the literature on the effects of inhaled Corticosteroids is conflicting. METHODS--One hundred and forty children and young adults on inhaled Corticosteroids were examined by slit lamp ophthalmoscopy after pupillary dilatation; 103 had received one or more short courses ( or = 4 weeks) of alternate day oral Corticosteroid therapy. RESULTS--Bilateral posterior subcapsular cataract was identified in one girl who had received several prolonged courses of oral Corticosteroids, but was not identified in any other patient. CONCLUSIONS--There is no evidence to support the contention that inhaled Corticosteroid therapy on its own, or in association with short courses of oral Corticosteroid therapy, might cause cataracts. Although children receiving long term systemic Corticosteroid therapy should be screened for cataracts, this is unnecessary in children on inhaled Corticosteroids alone.
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posterior subcapsular cataract and inhaled Corticosteroid therapy
Thorax, 1995Co-Authors: F Abuekteish, J N P Kirkpatrick, G RussellAbstract:BACKGROUND--Although posterior subcapsular cataract complicates both systemic and topical Corticosteroid therapy, the literature on the effects of inhaled Corticosteroids is conflicting. METHODS--One hundred and forty children and young adults on inhaled Corticosteroids were examined by slit lamp ophthalmoscopy after pupillary dilatation; 103 had received one or more short courses ( or = 4 weeks) of alternate day oral Corticosteroid therapy. RESULTS--Bilateral posterior subcapsular cataract was identified in one girl who had received several prolonged courses of oral Corticosteroids, but was not identified in any other patient. CONCLUSIONS--There is no evidence to support the contention that inhaled Corticosteroid therapy on its own, or in association with short courses of oral Corticosteroid therapy, might cause cataracts. Although children receiving long term systemic Corticosteroid therapy should be screened for cataracts, this is unnecessary in children on inhaled Corticosteroids alone.
Toshihiko Yamashita - One of the best experts on this subject based on the ideXlab platform.
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the proton pump inhibitor lansoprazole prevents the development of non traumatic osteonecrosis of the femoral head an experimental and prospective clinical trial
European Journal of Orthopaedic Surgery and Traumatology, 2020Co-Authors: Ima Kosukegawa, Shunichiro Okazaki, Motohisa Yamamoto, Satoshi Nagoya, Chisako Suzuki, Junya Shimizu, Hiroki Takahashi, Toshihiko YamashitaAbstract:An effective prevention strategy for osteonecrosis of the femoral head (ONFH) has yet to be established. We previously reported that the innate immune system via the toll-like receptor (TLR) response induced by Corticosteroids leads to the development of ONFH and that repression of IRF7 activity by an inhibitor could interfere with the development of ONFH while maintaining the therapeutic effect of the Corticosteroids. In the present study, we hypothesize that lansoprazole has the potential to suppress IRF7 activity and prevent Corticosteroid-induced ONFH in rats. Furthermore, we conducted a preliminary clinical trial to prevent Corticosteroid-induced ONFH in autoimmune disease patients. Male Wistar rats were randomly divided into four groups. On Day 1, each rat was injected with TLR4 ligand (LPS) or TLR7 ligand (imiquimod), followed by methylprednisolone with or without lansoprazole on Day 2. They were killed at 1 or 14 days after the last injection.We prospectively recruited 30 patients requiring primary high-dose Corticosteroid treatment for immune diseases. All patients were administered lansoprazole, starting the night before Corticosteroid treatment began. MRI was performed before Corticosteroid treatment, and at 4, 12 and 24 weeks afterward. In rats, co-treatment of lansoprazole with Corticosteroids significantly repressed both IRF7 activity and the development of ONFH. Moreover, in the human patients, the incidence of ONFH was significantly decreased from 53.4 to 13.3%. Although the present study is preliminary, the results show that co-treatment of lansoprazole with Corticosteroids prevents ONFH development. Lansoprazole may be both safe and effective in preventing osteonecrosis of the femoral head in patients needing Corticosteroid treatment.
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The proton pump inhibitor, lansoprazole, prevents the development of non-traumatic osteonecrosis of the femoral head: an experimental and prospective clinical trial
European Journal of Orthopaedic Surgery & Traumatology, 2020Co-Authors: Ima Kosukegawa, Shunichiro Okazaki, Motohisa Yamamoto, Satoshi Nagoya, Chisako Suzuki, Junya Shimizu, Hiroki Takahashi, Toshihiko YamashitaAbstract:Background An effective prevention strategy for osteonecrosis of the femoral head (ONFH) has yet to be established. We previously reported that the innate immune system via the toll-like receptor (TLR) response induced by Corticosteroids leads to the development of ONFH and that repression of IRF7 activity by an inhibitor could interfere with the development of ONFH while maintaining the therapeutic effect of the Corticosteroids. Objective In the present study, we hypothesize that lansoprazole has the potential to suppress IRF7 activity and prevent Corticosteroid-induced ONFH in rats. Furthermore, we conducted a preliminary clinical trial to prevent Corticosteroid-induced ONFH in autoimmune disease patients. Methods Male Wistar rats were randomly divided into four groups. On Day 1, each rat was injected with TLR4 ligand (LPS) or TLR7 ligand (imiquimod), followed by methylprednisolone with or without lansoprazole on Day 2. They were killed at 1 or 14 days after the last injection.We prospectively recruited 30 patients requiring primary high-dose Corticosteroid treatment for immune diseases. All patients were administered lansoprazole, starting the night before Corticosteroid treatment began. MRI was performed before Corticosteroid treatment, and at 4, 12 and 24 weeks afterward. Results In rats, co-treatment of lansoprazole with Corticosteroids significantly repressed both IRF7 activity and the development of ONFH. Moreover, in the human patients, the incidence of ONFH was significantly decreased from 53.4 to 13.3%. Conclusions Although the present study is preliminary, the results show that co-treatment of lansoprazole with Corticosteroids prevents ONFH development. Lansoprazole may be both safe and effective in preventing osteonecrosis of the femoral head in patients needing Corticosteroid treatment.
Kojiro Morita - One of the best experts on this subject based on the ideXlab platform.
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Association of Early Systemic Corticosteroid Therapy with Mortality in Patients with Stevens–Johnson Syndrome or Toxic Epidermal Necrolysis: A Retrospective Cohort Study Using a Nationwide Claims Database
American Journal of Clinical Dermatology, 2019Co-Authors: Kojiro Morita, Hiroki Matsui, Nobuaki Michihata, Kiyohide Fushimi, Hideo YasunagaAbstract:Background Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe dermatologic disorders with high mortality. The role of systemic Corticosteroids as an adjunctive therapy for SJS or TEN remains controversial. Objective The aim of this study was to determine whether treatment with early systemic Corticosteroids impacts the in-hospital mortality of patients hospitalized with SJS or TEN. Methods Using the Japanese Diagnosis Procedure Combination Database, a large nationwide inpatient administrative claims database, we identified inpatients aged ≥ 18 years who were admitted with SJS or TEN. Treatment with early systemic Corticosteroids was defined as starting treatment with systemic Corticosteroids within 2 days (day 0 or day 1) of admission. The primary outcome was in-hospital mortality. We examined the association between early systemic Corticosteroids and in-hospital mortality using propensity score (PS) analyses. Results We identified 1846 eligible patients with SJS or TEN, including 793 patients with early systemic Corticosteroid use at ≤ 2 mg/kg/day, 558 patients with early systemic Corticosteroid use at > 2 mg/kg/day, and 495 patients without early Corticosteroid use. PS matching created 235 pairs (> 2 mg/kg/day vs. controls) and 332 pairs (≤ 2 mg/kg/day vs. controls). Early systemic Corticosteroid use was not significantly associated with lower in-hospital mortality by PS matching (> 2 mg/kg/day vs. controls: relative risk [RR] 0.83, 95% confidence interval [CI] 0.37–1.85; ≤ 2 mg/kg/day vs. controls: RR 0.61, 95% CI 0.28–1.36) and by inverse probability of treatment weighting (> 2 mg/kg/day vs. controls: RR 0.99, 95% CI 0.45–2.19; ≤ 2 mg/kg/day vs. controls: RR 0.65, 95% CI 0.29–1.47). Conclusion Early systemic Corticosteroid therapy for patients with SJS or TEN was not associated with lower in-hospital mortality. Further studies are needed to define the effect of Corticosteroids for patients with SJS or TEN.
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association of early systemic Corticosteroid therapy with mortality in patients with stevens johnson syndrome or toxic epidermal necrolysis a retrospective cohort study using a nationwide claims database
American Journal of Clinical Dermatology, 2019Co-Authors: Kojiro Morita, Hiroki Matsui, Nobuaki Michihata, Kiyohide Fushimi, Hideo YasunagaAbstract:Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe dermatologic disorders with high mortality. The role of systemic Corticosteroids as an adjunctive therapy for SJS or TEN remains controversial. The aim of this study was to determine whether treatment with early systemic Corticosteroids impacts the in-hospital mortality of patients hospitalized with SJS or TEN. Using the Japanese Diagnosis Procedure Combination Database, a large nationwide inpatient administrative claims database, we identified inpatients aged ≥ 18 years who were admitted with SJS or TEN. Treatment with early systemic Corticosteroids was defined as starting treatment with systemic Corticosteroids within 2 days (day 0 or day 1) of admission. The primary outcome was in-hospital mortality. We examined the association between early systemic Corticosteroids and in-hospital mortality using propensity score (PS) analyses. We identified 1846 eligible patients with SJS or TEN, including 793 patients with early systemic Corticosteroid use at ≤ 2 mg/kg/day, 558 patients with early systemic Corticosteroid use at > 2 mg/kg/day, and 495 patients without early Corticosteroid use. PS matching created 235 pairs (> 2 mg/kg/day vs. controls) and 332 pairs (≤ 2 mg/kg/day vs. controls). Early systemic Corticosteroid use was not significantly associated with lower in-hospital mortality by PS matching (> 2 mg/kg/day vs. controls: relative risk [RR] 0.83, 95% confidence interval [CI] 0.37–1.85; ≤ 2 mg/kg/day vs. controls: RR 0.61, 95% CI 0.28–1.36) and by inverse probability of treatment weighting (> 2 mg/kg/day vs. controls: RR 0.99, 95% CI 0.45–2.19; ≤ 2 mg/kg/day vs. controls: RR 0.65, 95% CI 0.29–1.47). Early systemic Corticosteroid therapy for patients with SJS or TEN was not associated with lower in-hospital mortality. Further studies are needed to define the effect of Corticosteroids for patients with SJS or TEN.
