BACKGROUND: There is a lack of consensus and insufficient data to assess the impact of late steroid withdrawal after heart transplantation (HTx). The aim of the study was to investigate the security and feasibility of corticosteroid withdrawal at 1 year after transplantation. METHODS AND RESULTS: Steroid withdrawal was attempted after ...

BACKGROUND: Gingival enlargement (GE) is a frequent side effect associated with the administration of cyclosporine (CsA) and the calcium channel blockers (CCB). The aims of this study were to determine and compare GE prevalence and severity in 3 groups of renal transplant recipients who had been medicated with CsA versus ...

Calcineurin inhibitors (CNIs) and steroids, the cornerstone of most immunosuppressive regimens in the past 20 years, have undesirable long-term side effects. This has led to the investigation of potential new strategies with sirolimus (SRL) and mycophenolate mofetil (MMF). In the SPIESSER study, de novo CNI avoidance and early steroid withdrawal ...

OBJECTIVE: To determine if a particulate steroid which has a risk for embolic infarct would be more effective than a non-particulate steroid for transforaminal epidural steroid injection (TFESI). The purpose of this study was (1) to compare the effect of cervical TFESI using particulate (e.g., triamcinolone) and non-particulate (e.g., dexamethasone) ...

STUDY DESIGN: Prospective, double-blind, randomized, case-control study. OBJECTIVE: To evaluate the efficacy of caudal epidural injections (CEI) containing steroid versus nonsteroid preparations when treating patients suffering from low back pain (LBP) and sciatica. SUMMARY OF BACKGROUND DATA: Literature seems to be deprived of well-designed randomized, controlled studies that evaluate the ...

Increased insight into the role of B lymphocytes in the pathophysiology of graft-versus-host disease has led to a number of studies assessing the efficacy of the anti-CD20 monoclonal antibody (mAb) rituximab in treating steroid-refractory chronic graft-versus-host disease (cGVHD). Findings vary greatly among these studies, however. We conducted a systematic review ...

Advances in the past few years have helped clinicians understand some of the pathogenetic mechanisms of Graves orbitopathy (GO), particularly the role of receptors for TSH and insulin-like growth factor I in the orbit. Optimal treatment strategies have been formulated and published by the European Group on Graves' Orbitopathy, which ...

To assess the time needed to achieve sustained, medication-free remission in a cohort of patients with juvenile dermatomyositis (DM) receiving a stepwise, aggressive treatment protocol. Between 1994 and 2004, a cohort of 49 children with juvenile DM who were followed up at a single tertiary care children's hospital using disease ...

The introduction of steroid therapy by Truelove and Witts in the 1950s revolutionized the treatment of ulcerative colitis. Corticosteroids are potent inhibitors of T-cell activation and proinflammatory cytokines and still represent the mainstay of therapy of patients with ulcerative colitis. About 15% of patients are resistant to steroids, and about ...

BACKGROUND: To determine the long-term outcome of patients admitted with acute severe colitis (ASC) who avoided colectomy on the index admission, a retrospective cohort study was performed. METHODS: Patients admitted for intensive treatment of ASC in 1992-1993 previously described for a predictive index of short-term outcome in severe ulcerative colitis ...

A cyclosporine (CsA)-based immunosuppression is associated with an increased incidence of cholelithiasis after heart transplantation. It is not known if tacrolimus (Tac) has comparable biliary side effects in humans. We evaluated the incidence of gallbladder sludge and cholelithiasis under Tac-based immunosuppression by ultrasound examinations in 31 cardiac transplants (25 male, ...

We conducted a multicenter prospective trial to evaluate the efficacy, safety and pharmacokinetics of a single dose of rituximab (375 mg/m(2) body surface area) for the treatment of children with refractory steroid-dependent nephrotic syndrome (SDNS). All patients (n = 12) were able to discontinue steroids at a median of 74 ...

BACKGROUND: Studies assessing the efficacy of azathioprine in steroid-dependent patients with Crohn's disease are scarce. The aim of this study was to assess the long-term efficacy and safety of azathioprine, and factors associated with sustained response, in steroid-dependent patients with Crohn's disease. MATERIAL/METHODS: In this prospective, observational study, adult steroid-dependent ...

PURPOSE: To evaluate the control of ocular inflammation and the steroid sparing effect in patients with sarcoidosis-associated uveitis treated with mycophenolate mofetil (MMF). METHODS: Retrospective case series. All patients with a diagnosis of sarcoidosis-associated uveitis that were treated with MMF between 2005 and 2007 were identified. The dose and duration ...

STUDY DESIGN: Randomized single-blind controlled trial. OBJECTIVE: We aimed to compare the effects of epidural steroid injections and physical therapy program on pain and function in patients with lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA: LSS is one of the most common degenerative spinal disorders among elderly population. Initial ...

BACKGROUND AND OBJECTIVE: The authors evaluated the results of topical cyclosporin A 1% and injected mitomycin C 0.01% use as adjunctive therapy for prevention of primary pterygium recurrence. PATIENTS AND METHODS: Eighty eyes of 76 consecutive patients who had pterygium excision surgery in a prospective, interventional clinical trial received conjunctival ...

OBJECTIVE: To evaluate health-related quality of life (HRQoL) in patients with different low-toxicity regimens posttransplantation. METHODS: One hundred fifty-six patients were randomized to standard-dose cyclosporine A (CsA), mycophenolate mofetil, and corticosteroids or daclizumab induction, mycophenolate mofetil, and corticosteroids with a low dose of CsA, tacrolimus (Low-Tac), or sirolimus. SF-36 Health ...

To establish an appropriate steroid treatment regimen for autoimmune pancreatitis (AIP). A retrospective survey of AIP treatment was conducted in 17 centres in Japan. The main outcome measures were rate of remission and relapse. Of 563 patients with AIP, 459 (82%) received steroid treatment. The remission rate of steroid-treated AIP ...

On November 2006, a bilateral hand allotransplantation was performed for a 47-year-old female who had suffered radiocarpal amputations 28 years before. Technical aspects of the operation are detailed. Alemtuzumab induction, and triple therapy of tacrolimus, mycophenolate mofetil and prednisone were used to control rejection. The evolution of the result and ...

We evaluated the pharmacokinetics and efficacy of oral mycophenolate mofetil (MMF) for treatment of refractory GVHD. In a prospective study of acute GVHD, 9 of 19 patients (47%) had a response and 10 (53%) had no improvement. Survival at 6 and 12 months after the start of MMF was 37 ...

Mycophenolate mofetil (MMF) is effective in the treatment of patients with active systemic lupus erythematosus (SLE). We sought to evaluate its efficacy in reducing the number of disease flares in adults with SLE. For this retrospective study, all patients seen at our institution over a six year period, 1999-2005, with ...

BACKGROUND: Hemangioma is a common vascular tumor. Though it involutes spontaneously, results are unpredictable. Steroid therapy is an effective mode of its regression. We present our experience of largest series and possible recommendations for treatment. MATERIALS AND METHODS: A total of 2398 patients were treated during the study period of ...

In patients with allergic fungal sinusitis, the mainstay of treatment remains surgical removal of allergic mucin and fungal debris. But as a single modality, surgery is associated with high rates of recurrence, so a number of adjunctive medical modalities have been tried, including postoperative corticosteroid therapy. We conducted a study ...

PURPOSE: The purpose of the present study was to evaluate the effect of topical cyclosporine A (CsA) treatment on corneal thickness (CT) in patients with trachomatous dry eye. METHODS: Sixty-four patients with trachomatous dry eye with a Schirmer test showing 5 mm or less and a tear film break-up time ...

The purpose of this study is to evaluate the effectiveness and safety of mycophenolate mofetil (MMF) for inducing and/or maintaining remission of lupus nephritis (LN). This is a retrospective study of 25 LN patients consecutively treated with MMF. The primary outcome was complete renal remission (CR) defined by urine protein/creatinine ...

Long-term outcome of idiopathic steroid-resistant nephrotic syndrome was retrospectively studied in 78 children in eight centers for the past 20 years. Median age at onset was 4.4 years (1.1-15.0 years) and the gender ratio was 1.4. Median follow-up period was 7.7 years (1.0-19.7 years). The disease in 45 patients (58%) ...

We conducted a double-blind, randomized multicenter trial to determine whether the addition of mycophenolate mofetil (MMF) improves the efficacy of initial systemic treatment of chronic graft-versus-host disease (GVHD). The primary endpoint was resolution of chronic GVHD and withdrawal of all systemic treatment within 2 years, without secondary treatment. Enrollment of ...

BACKGROUND: To examine whether tacrolimus is more effective and safe than cyclosporine (CsA) in inducing remission in patients with steroid-resistant nephrotic syndrome (SRNS). STUDY DESIGN: Randomized controlled trial, nonblind, parallel group. SETTINGS & PARTICIPANTS: Tertiary-care hospital; 41 consecutive patients with idiopathic SRNS, estimated glomerular filtration rate greater than 60 mL/min/1.73 ...

OBJECTIVE: Basiliximab (BAS), an interleukin-2 monoclonal antibody, has shown promising results as induction therapy in liver and kidney transplantation. We compared the efficacy and patient tolerability of BAS and antithymocyte globulin (ATG) in lung transplantation (LTx). PATIENTS AND METHODS: The study included 37 patients in two groups (ATG and BAS, ...

BACKGROUND: Tacrolimus is a potent immunomodulator that is effective in the systemic treatment of inflammatory bowel diseases (IBD). However, potential toxicity and systemic (side) effects after oral intake limit its use. We investigated the local applicability and safety of tacrolimus for distal colitis. METHODS: Patients with refractory left-sided colitis or ...

The purpose of this prospective, randomised, multicentre study was to prove the efficacy and safety of mycophenolate mofetil (MMF) in preventing graft rejection and in improving clear graft survival following high-risk keratoplasty. In all, 98 of 140 scheduled patients were included in this study (57 MMF, 41 control). Recruitment was ...

BACKGROUND/AIMS: Glucocorticoids and classic immunosuppressive drugs can improve disease activity in primary glomerulonephritis (GN). However, these drugs have serious toxicity and patients frequently experience inadequate response or relapse, so there is a need for alternative agents. This multicenter uncontrolled study analyzed the efficacy and safety of mycophenolate mofetil (MMF) in ...

BACKGROUND: Infliximab (IFX) has proven to be an effective addition to the therapeutic arsenal for refractory, fistulizing, and steroid dependent Crohn's disease (CD), with efficacy in the induction and maintenance of clinical remission of CD. Our objective in this study is to report the nationwide, multicenter experience with IFX induction ...

Adrenal crisis is a life threatening condition which can be induced by stress during surgery in patients with adrenal insufficiency. This may be prevented by perioperative administration of high doses of steroids. There is disagreement on whether supplemental perioperative steroids are required and, when administered, on the amount and frequency ...

Osteoarthritis is the most prevalent chronic non-infective joint arthritis. In the present study, the effect of new herbal pomade (Marhame-Mafasel) on knee osteoarthritis was investigated in a randomized trial. The objective of this study was to assess efficacy of Marhame- Mafasel pomade, which was consisted of several medic herbs like ...

Allergic bronchopulmonary aspergillosis (ABPA) can cause a significant clinical deterioration in patients with cystic fibrosis. There is very little research in the current literature with regard to alternatives for treatment, apart from long courses of steroids. We conducted a retrospective review of all our patients with ABPA treated with the ...

We present the case of a 67-year-old male patient with mediastinal and retroperitoneal fibrosis. In Europe, this is a rare disease. Treatment was established to prevent complications due to strictures or compressions. Because of his diabetes, a therapy of low-dose prednisone combined with mycophenolate mofetil, known as steroid sparing agent, ...

INTRODUCTION: Autoimmune hemolytic anemia in children younger than 2 years of age is usually characterized by a severe course, with a mortality rate of approximately 10%. The prolonged immunosuppression following specific treatment may be associated with a high risk of developing severe infections. Recently, the use of monoclonal antibodies (rituximab) ...

STUDY DESIGN: Retrospective case-control study. OBJECTIVE: To compare the effectiveness between caudal and trans-foraminal epidural steroid injections for the treatment of primary lumbar radiculopathy. SUMMARY OF BACKGROUND DATA: Spinal injections with steroids play an important role in non-operative care of lumbar radiculopathy. The trans-foraminal epidural steroid injection (TESI) theoretically has ...

BACKGROUND: Idiopathic retroperitoneal fibrosis (IRPF) is an uncommon, but increasingly recognized, disease. Autoimmune mechanisms probably participate in its pathogenesis. Patients have been treated with high-dose steroids and sometimes immunosuppressive drugs, resulting in toxicity risk during prolonged treatments; thus, it would be wise to look for safer drugs. Colchicine has antifibrotic, ...

Several reports have been published regarding the use of cyclosporine (CSA) in the treatment of idiopathic thrombotic thrombocytopenic purpura (TTP). We hypothesized that prophylactic CSA therapy may prevent recurrences in patients with a history of multiple relapses of TTP. Nineteen patients with idiopathic TTP were enrolled on prospective studies at ...

BACKGROUND: The aim of this retrospective study was to compare the incidence of hypotension between different anaesthetic techniques, including general anaesthesia (GA), spinal anaesthesia single injection (SA), continuous spinal anaesthesia with 2.5 mg bolus injections as needed (CSA 2.5) or 5 mg bolus injections as needed (CSA 5) in elderly ...

OBJECTIVE: Treatment of olfactory dysfunction is very difficult and has limited modality. Treatment with steroids has been used in patients with olfactory dysfunction but the side effects of steroid need to be weighed against its potential benefits. In the present study, the effect of systemic administration of dexamethasone and EGb ...

OBJECTIVE: To learn if oral steroid treatment can alter the signs of primary progressive aphasia (PPA). Many patients with PPA have had a vasectomy and there is a possible link between vasectomy and autoimmune diseases. If PPA is, at least in part, an autoimmune disease, patients might improve with immunosuppressant ...

BACKGROUND: Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated neuropathy that responds to various immunosuppressive treatments. Oral daily prednisone therapy is effective and inexpensive, but the long-term treatment that is usually necessary leads to serious adverse effects. Consequently, intravenous immunoglobulin and plasma exchange have been widely used to treat CIDP, ...

BACKGROUND: Cyclosporine A (CsA) has been found to be the first successful therapy used in the recovery of patients with steroid-refractory ulcerative colitis (UC). However, the long-term benefits of cyclosporine remain questionable. We report our results on the use of CsA in patients with severe steroid-refractory UC. METHODS: The records ...

Necrotizing systemic vasculitides are severe diseases in which prognosis improved since steroids and cytotoxic agents have been prescribed. The outcome is now better, and remission is obtained in more than 80% of patients. In this review paper, we will cover the indications of conventional treatments and new biotherapies and other ...

BACKGROUND: Hepatotoxicity results in the withdrawal of thiopurines drugs, azathioprine (AZA) and mercaptopurine (MP), in up to 10% of patients with inflammatory bowel disease. Our group previously demonstrated that allopurinol with AZA/ciclosporin/steroid 'triple therapy' improved renal graft survival. AIM: To confirm the hypothesis that allopurinol may alleviate thiopurine hepatotoxicity by ...

PURPOSE: This study aimed to assess the effectiveness of a steroid-sparing immunosuppressive treatment (IST) protocol in the control of severe or steroid-resistant autoimmune ocular inflammatory diseases. METHODS: We carried out a prospective, non-randomized clinical study. Patients presenting with ocular inflammations that failed to respond adequately to steroids alone after monotherapy ...

BACKGROUND: Mycophenolate mofetil (MM) has been successfully used for the treatment of immune-mediated diseases, including myasthenia gravis (MG). We compare our experience treating Taiwanese myasthenic patients with MM to analogous Caucasian series. METHODS: From October 2003 to April 2008, we treated 6 myasthenic patients with MM for at least one ...