Steroid treatment is not an effective option for providing relief to infants with a common and potentially serious viral lower respiratory infection called bronchiolitis, as per a new study co-authored by Dr. Joan Bregstein of the Morgan Stanley Children’s Hospital of NewYork-Presbyterian and Columbia University Medical Center.

The study suggested that steroids do not help in preventing hospitalization or improve respiratory symptoms for bronchiolitis that is believed to be the common cause of hospitalization among infants.

From News-Medical.Net:

“Our study shows that treating bronchiolitis with steroids doesn’t work. We hope this study will resolve some of the uncertainty for physicians and families, as we move forward in developing better means of preventing and treating the infection,” says Dr. Bregstein, site principal investigator and emergency medicine pediatrician at Morgan Stanley Children’s Hospital of NewYork-Presbyterian and assistant clinical professor of pediatrics at Columbia University College of Physicians and Surgeons.

Current recommendations suggest that simple supportive care is the best available treatment for bronchiolitis. Researchers note that steroid-based medications still play an important role in other respiratory illnesses of childhood such as asthma and croup. They point out these medications are not the androgenic steroids sometimes abused by athletes, and that the side effects seen with long-term steroid use are not a risk in the short-course treatments used for croup and asthma attacks.

The multicenter study was published in the July 26 New England Journal of Medicine and conducted by the Pediatric Emergency Care Applied Research Network (PECARN).

It was highlighted that simply supportive care is the most effective option for bronchiolitis though steroid-based medications still play an important role in respiratory illnesses of childhood such as asthma and croup.

Tags:  bronchiolitis, steroid treatment, Steroid use, Steroids

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A study indicated that a high incidence of rejection and a low incidence of intolerance is related to an early steroid withdrawal following liver transplantation. The study, which is hailed as the first-of-its-kind double-blind placebo-controlled study, was undertaken to examine effects of early steroid elimination.

The study results were published in an issue of Liver Transplantation, the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS).

From Eurekalert.org:

The normal course of treatment after liver transplantation includes calcineurin inhibitors (a class of immunosuppressants) and steroids to minimize rejection and improve survival rates, but the long-term complications of these drugs can be fatal. Steroid use in particular can lead to diabetes, high cholesterol and hypertension, which increase the risk of heart disease, and can lead to death. Several previous studies have reported that early withdrawal from steroids reduced the incidence of these side effects, but that rejection increased, although it could be controlled with steroid pulse therapy (in which high doses of steroids are administered intravenously for a short period of time). The current multicenter study was the first prospective double-blind, placebo-controlled trial to compare early steroid withdrawal with continued use.

Led by Georges-Philippe Pageaux, of the Centre Hospitalier University St.-Eloi in Montpellier, France, the study examined 174 patients in 15 French liver transplantation centers over a 14-month period from December 1999 to August 2001. The patients were randomly divided into two groups seven days following transplant: 90 of them continued to receive steroids for six months, while 84 received a placebo starting at day 14 (following 7 days of tapering from steroids). At the end of six months, 22 patients in the steroid group (24.4 percent) and 32 patients in the placebo group (38.1 percent) experienced acute rejection. Although there was no statistical difference in the two groups for high cholesterol and hypertension, 22.2 percent of patients in the steroid group developed diabetes compared with 14.3 percent of placebo patients. At the end of 12 months, the incidence of acute rejection was 25.6 percent in the steroid group versus 39.3 percent in the placebo group, but there no longer a difference in diabetes between the two groups.

The involved authors were of the view that early steroid withdrawal at day 14 cannot be termed as safe when it comes to rejection but told that it is efficient in terms of tolerability to glucose.

Tags:  diabetes, doses of steroids, early steroid withdrawal, liver transplantation, steroid, Steroid use, steroid withdrawal

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