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steroid withdrawal protocol

Ajit Sood, Ramit Mahajan, Garima Juyal, Vandana Midha, Charanpreet Singh Grewal, Varun Mehta, Arshdeep Singh, Mohan C Joshi, Vikram Narang, Kirandeep Kaur, Hasrat Sidhu
Background/Aims: Four high-quality randomized controlled trials have proven the efficacy of fecal microbiota transplantation (FMT) in active ulcerative colitis (UC). We assessed the efficacy of FMT in a real-world setting involving steroid-dependent patients with UC. Methods: This was a single-center prospective analysis of data from steroid-dependent patients with UC treated with FMT from September 2015 to September 2017 at the Dayanand Medical College, a tertiary care center in India...
November 20, 2018: Intestinal Research
Neeraj Narula, Amit Dhillon, Dongni Zhang, Mary E Sherlock, Melody Tondeur, Mary Zachos
BACKGROUND: Corticosteroids are often preferred over enteral nutrition (EN) as induction therapy for Crohn's disease (CD). Prior meta-analyses suggest that corticosteroids are superior to EN for induction of remission in CD. Treatment failures in EN trials are often due to poor compliance, with dropouts frequently due to poor acceptance of a nasogastric tube and unpalatable formulations. This systematic review is an update of a previously published Cochrane review. OBJECTIVES: To evaluate the effectiveness and safety of exclusive EN as primary therapy to induce remission in CD and to examine the importance of formula composition on effectiveness...
April 1, 2018: Cochrane Database of Systematic Reviews
Anne I Dipchand
Pediatric heart transplantation is standard of care for children with end-stage heart failure. The diverse age range, diagnoses, and practice variations continue to challenge the development of evidence-based practices and new technologies. Outcomes in the most recent era are excellent, especially with the more widespread use of ventricular assist devices (VADs). Waitlist mortality remains high and knowledge of risk factors for death while waiting and following transplantation contributes to decision-making around transplant candidacy and timing of listing...
January 2018: Annals of Cardiothoracic Surgery
Nemin Zhu, Neal E Rowe, Paul R Martin, Sean S Luke, Thomas B Mcgregor, Frank Myslik, Vivian C Mcalister, Alp Sener, Patrick P Luke
INTRODUCTION: We sought to determine whether protocol biopsies could be used to guide treatment and improve outcomes in simultaneous pancreas-kidney (SPK) patients. METHODS: Between 2004 and 2013, protocol biopsies were performed on SPK patients at 3-6 months and one year post-transplant. Maintenance immunosuppression consisted of a calcineurin inhibitor, anti-proliferative agent, and corticosteroid. Corticosteroid was withdrawn in negative early biopsies, maintained in subclinical/ borderline biopsies, and increased if Banff IB or greater rejection was identified...
June 2018: Canadian Urological Association Journal
Rajil Mehta, Sushma Bhusal, Parmjeet Randhawa, Puneet Sood, Aravind Cherukuri, Christine Wu, Chethan Puttarajappa, William Hoffman, Nirav Shah, Massimo Mangiola, Adriana Zeevi, Amit D Tevar, Sundaram Hariharan
The impact of subclinical inflammation (SCI) noted on early kidney allograft biopsies remains unclear. This study evaluated the outcome of SCI noted on 3-month biopsy. A total of 273/363 (75%) kidney transplant recipients with a functioning kidney underwent allograft biopsies 3-months posttransplant. Among those with stable allograft function at 3 months, 200 biopsies that did not meet the Banff criteria for acute rejection were identified. These were Group I: No Inflammation (NI, n = 71) and Group II: Subclinical Inflammation (SCI, n = 129)...
July 2018: American Journal of Transplantation
Joseph L Goulet, Eugenia Buta, Matthew Brennan, Alicia Heapy, Liana Fraenkel
BACKGROUND: Knee osteoarthritis (OA) is the most common cause of knee pain in older adults. Despite the limited data supporting their use, non-steroidal anti-inflammatory drugs (NSAID) are among the most commonly prescribed medications for knee OA. The use of NSAIDs for knee pain warrants careful examination because of toxicity associated with this class of medications. METHODS: We describe the design of a placebo-controlled, noninferiority, randomized withdrawal trial to examine discontinuation of an NSAID in patients with painful knee OA...
February 2018: Contemporary Clinical Trials
Lars Pape
Immunosuppressive protocols used in pediatric kidney transplantation have changed substantially within the last decade. Many transplant centers now focus on the use of tacrolimus and mycophenolate mofetil in combination with early steroid withdrawal, frequently combined with antibody induction therapy. However, this approach is mainly based on treatment efficacy and-compared to other immunosuppressive regimens used in this context-leads to higher rates of viral infections in patients. In this review I assess data from prospective, interventional trials of immunosuppressive therapy in pediatric kidney transplantation...
October 24, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Daniel Agustín Godoy, Pablo David Guerrero Suarez, Luis Rafael Moscote-Salazar, Mario Di Napoli
Intracranial hypertension (IH) is one of the final pathways of acute brain injury. In severe traumatic brain injury (sTBI), it independently predicts poor outcomes. Its control represents a key aspect of the management. Lack of response to conventional therapies signals a state of ''refractory IH'', with an associated mortality rate of 80-100%. In such cases, hypothermia, barbiturates at high doses (BBT), decompressive craniectomy (DC), and extreme hyperventilation are utilized. However, none of them has proven efficacy...
July 2017: Bulletin of Emergency and Trauma
Sabina Cevoli, Giulia Giannini, Valentina Favoni, Rossana Terlizzi, Elisa Sancisi, Marianna Nicodemo, Stefano Zanigni, Maria Letizia Bacchi Reggiani, Giulia Pierangeli, Pietro Cortelli
BACKGROUND: Drug withdrawal still remains the key element in the treatment of Medication Overuse Headache (MOH), but there is no consensus about the withdrawal procedure. Still debated is the role of the steroid therapy. The aim of this study was to evaluate the effectiveness of methylprednisolone or paracetamol in the treatment of withdrawal headache in MOH. METHODS: We performed a pilot, randomized, single-blinded, placebo controlled trial. MOH patients, unresponsive to a 3 months prophylaxis, underwent withdrawal therapy on an inpatient basis...
December 2017: Journal of Headache and Pain
Petra Hruba, Irena Tycova, Eva Krepsova, Eva Girmanova, Alena Sekerkova, Janka Slatinska, Ilja Striz, Eva Honsova, Ondrej Viklicky
BACKGROUND: Steroid avoidance in immunosuppression in kidney transplantation offers several metabolic advantages, however it is associated with higher early acute rejection rate. Cellular and molecular mechanisms of this phenomenon remain poorly understood. METHODS: In this single center observational study, low-risk kidney transplant recipients randomized into large multicenter prospective ADVANCE trial with steroid avoidance/early withdrawal and center standard of care treated patients were monitored for 12months...
June 2017: Transplant Immunology
Anne Tsampalieros, Greg A Knoll, Amber O Molnar, Nicholas Fergusson, Dean A Fergusson
BACKGROUND: A number of corticosteroid minimization and avoidance protocols for post-solid organ transplant have been developed. The study objective was to examine the effect of corticosteroid withdrawal/avoidance on growth and safety parameters in pediatric solid organ transplant recipients. METHODS: A systematic review using Medline and Embase was performed. All randomized controlled trials (RCT) and observational studies comparing corticosteroid withdrawal/avoidance to controls receiving corticosteroids in pediatric transplant recipients which reported growth as change in height or final height were included...
April 2017: Transplantation
Maria C Haller, Ana Royuela, Evi V Nagler, Julio Pascual, Angela C Webster
BACKGROUND: Steroid-sparing strategies have been attempted in recent decades to avoid morbidity from long-term steroid intake among kidney transplant recipients. Previous systematic reviews of steroid withdrawal after kidney transplantation have shown a significant increase in acute rejection. There are various protocols to withdraw steroids after kidney transplantation and their possible benefits or harms are subject to systematic review. This is an update of a review first published in 2009...
August 22, 2016: Cochrane Database of Systematic Reviews
E M A Macedo, W C Santos, B P Sousa, E M Lopes, C A Piauilino, F V M Cunha, D P Sousa, F A Oliveira, F R C Almeida
Pharmacological treatment of inflammatory pain is usually done by administration of non-steroidal anti-inflammatory drugs (NSAIDs). These drugs present high efficacy, although side effects are common, especially gastrointestinal lesions. One of the pharmacological strategies to minimize such effects is the combination of drugs and natural products with synergistic analgesic effect. The monoterpene terpinolene (TPL) is a chemical constituent of essential oils present in many plant species, which have pharmacological activities, such as analgesic and anti-inflammatory...
June 20, 2016: Brazilian Journal of Medical and Biological Research
T Yokoyama, O Konno, Y Kihara, Y Nakamura, H Iwamoto, S Kawachi
OBJECTIVES: ABO-incompatible kidney transplantation has increased the possibility of finding suitable living donors for patients with renal failure. However, there are inevitable immunological risks, including a high risk of early post-transplantation complications. The purpose of this study was to evaluate recipient outcomes following ABO-incompatible kidney transplantation. METHODS: Seventy-one patients who had undergone living-donor kidney transplantation (LDKT) at our center between January 2008 and December 2013 were divided into ABO-incompatible (ABOi; n = 21) and ABO-compatible (ABOc; n = 50) groups...
April 2016: Transplantation Proceedings
M Strueber, G Warnecke, J Fuge, A R Simon, R Zhang, T Welte, A Haverich, J Gottlieb
The role of mammalian target of rapamycin (mTOR) inhibitors in de novo immunosuppression after lung transplantation is not well defined. We compared Everolimus versus mycophenolate mofetil in an investigator-initiated single-center trial in Hannover, Germany. A total of 190 patients were randomly assigned 1:1 on day 28 posttransplantation to mycophenolate mofetil (MMF) or Everolimus combined with cyclosporine A (CsA) and steroids. Patients were followed up for 2 years. The primary endpoint was freedom from bronchiolitis obliterans syndrome (BOS)...
November 2016: American Journal of Transplantation
Afia Umber, Mary Killackey, Anil Paramesh, Yongjun Liu, Huaizhen Qin, Muhammad Atiq, Belinda Lee, Arnold Brent Alper, Eric Simon, Joseph Buell, Rubin Zhang
We compare the outcomes of induction therapies with either methylprednisolone (group 1, n = 58), basiliximab (group 2, n = 56) or alemtuzumab (group 3, n = 98) in primary deceased donor kidney transplants with delayed graft function (DGF). Protocol biopsies were performed. Maintenance was tacrolimus and mycophenolate with steroid (group 1 and 2) or without steroid (group 3). One-year biopsy-confirmed acute rejection (AR) rates were 27.6, 19.6 and 10.2 % in group 1, 2 and 3 (p = 0.007). AR was significantly lower in group 3 (p = 0...
April 2017: Journal of Nephrology
Lucindo J Quintans-Júnior, Adriano A S Araújo, Renan G Brito, Priscila L Santos, Jullyana S S Quintans, Paula P Menezes, Mairim R Serafini, Gabriel F Silva, Flavio M S Carvalho, Nicole K Brogden, Kathleen A Sluka
AIMS: Evaluate the anti-hyperalgesic effect of the complex containing β-caryophyllene (βCP) and β-cyclodextrin (βCD) in a non-inflammatory chronic muscle pain mice model and investigated its action on superficial dorsal horn of the lumbar spinal cord. MAIN METHODS: The βCP-βCD complex were prepared and characterized through the DSC, TG/DTG, FTIR, XRD and SEM. The model of chronic muscle pain was induced by two injections of pH4.0 saline (20μL) into left gastrocnemius 5days apart...
March 15, 2016: Life Sciences
Jacqueline G OʼLeary, Millie Samaniego, Marta Crespo Barrio, Luciano Potena, Adriana Zeevi, Arjang Djamali, Emanuele Cozzi
Production of de novo donor-specific antibodies (dnDSA) is a major risk factor for acute and chronic antibody-mediated rejection and graft loss after all solid organ transplantation. In this article, we review the data available on the risk of individual immunosuppressive agents and their ability to prevent dnDSA production. Induction therapy with rabbit antithymocyte globulin may achieve a short-term decrease in dnDSA production in moderately sensitized patients. Rituximab induction may be beneficial in sensitized patients, and in abrogating rebound antibody response in patients undergoing desensitization or treatment for antibody-mediated rejection...
January 2016: Transplantation
R Brian Stevens, Kirk W Foster, Clifford D Miles, Andre C Kalil, Diana F Florescu, John P Sandoz, Theodore H Rigley, Tamer Malik, Lucile E Wrenshall
INTRODUCTION: The two most significant impediments to renal allograft survival are rejection and the direct nephrotoxicity of the immunosuppressant drugs required to prevent it. Calcineurin inhibitors (CNI), a mainstay of most immunosuppression regimens, are particularly nephrotoxic. Until less toxic antirejection agents become available, the only option is to optimize our use of those at hand. AIM: To determine whether intensive rabbit anti-thymocyte globulin (rATG) induction followed by CNI withdrawal would individually or combined improve graft function and reduce graft chronic histopathology-surrogates for graft and, therefore, patient survival...
2015: PloS One
Tobias Deuse, Christoph Bara, Markus J Barten, Stephan W Hirt, Andreas O Doesch, Christoph Knosalla, Carola Grinninger, Jörg Stypmann, Jens Garbade, Peter Wimmer, Christoph May, Martina Porstner, Uwe Schulz
In recent years a series of trials has sought to define the optimal protocol for everolimus-based immunosuppression in heart transplantation, with the goal of minimizing exposure to calcineurin inhibitors (CNIs) and harnessing the non-immunosuppressive benefits of everolimus. Randomized studies have demonstrated that immunosuppressive potency can be maintained in heart transplant patients receiving everolimus despite marked CNI reduction, although very early CNI withdrawal may be inadvisable. A potential renal advantage has been shown for everolimus, but the optimal time for conversion and the adequate reduction in CNI exposure remain to be defined...
November 2015: Contemporary Clinical Trials
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