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1.
Health Technol Assess ; 26(41): 1-118, 2022 10.
Article in English | MEDLINE | ID: covidwho-2099087

ABSTRACT

BACKGROUND: Corticosteroids are a mainstay of the treatment of moderately severe relapses of ulcerative colitis, yet almost 50% of patients do not respond fully to these and risk prolonged steroid use and side effects. There is a lack of clarity about the definitions of steroid resistance, the optimum choice of treatment, and patient and health-care professional treatment preferences. OBJECTIVES: The overall aim of this research was to understand how steroid-resistant ulcerative colitis is managed in adult secondary care and how current practice compares with patient and health-care professional preferences. DESIGN: A mixed-methods study, including an online survey, qualitative interviews and discrete choice experiments. SETTING: NHS inflammatory bowel disease services in the UK. PARTICIPANTS: Adults with ulcerative colitis and health-care professionals treating inflammatory bowel disease. RESULTS: We carried out a survey of health-care professionals (n = 168), qualitative interviews with health-care professionals (n = 20) and patients (n = 33), discrete choice experiments with health-care professionals (n = 116) and patients (n = 115), and a multistakeholder workshop (n = 9). The interviews with and survey of health-care professionals showed that most health-care professionals define steroid resistance as an incomplete response to 40 mg per day of prednisolone after 2 weeks. The survey also found that anti-tumour necrosis factor drugs (particularly infliximab) are the most frequently offered drugs across most steroid-resistant (and steroid-dependent) patient scenarios, but they are less frequently offered to thiopurine-naive patients. Patient interviews identified several factors influencing their treatment choices, including effectiveness of treatment, recommendations from health-care professionals, route of administration and side effects. Over time, depending on the severity and duration of symptoms and, crucially, as medical treatment options become exhausted, patients are willing to try alternative treatments and, eventually, to undergo surgery. The discrete choice experiments found that the probability of remission and of side effects strongly influences the treatment choices of both patients and health-care professionals. Patients are less likely to choose a treatment that takes longer to improve symptoms. Health-care professionals are willing to make difficult compromises by tolerating greater safety risks in exchange for therapeutic benefits. The treatments ranked most positively by patients were infliximab and tofacitinib (each preferred by 38% of patients), and the predicted probability of uptake by health-care professionals was greatest for infliximab (62%). LIMITATIONS: The survey and the discrete choice experiments with patients and health-care professionals are limited by their relatively small sample sizes. The qualitative studies are subject to selection bias. The timing of the different substudies, both before and during the COVID-19 pandemic, is a potential limitation. CONCLUSIONS: We have identified factors influencing treatment decisions for steroid-resistant ulcerative colitis and the characteristics to consider when choosing treatments to evaluate in future randomised controlled trials. The findings may be used to improve discussions between patients and health-care professionals when they review treatment options for steroid-resistant ulcerative colitis. FUTURE WORK: This research highlights the need for consensus work to establish an agreed definition of steroid resistance in ulcerative colitis and a greater understanding of the optimal use of tofacitinib and surgery for this patient group. A randomised controlled trial comparing infliximab with tofacitinib is also recommended. FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 41. See the NIHR Journals Library website for further project information.


Steroids are one of the main treatments for ulcerative colitis; however, steroids work well for only about 50% of people who take them. There are many other treatments that can be given when steroids do not work, but evidence is limited about how these treatments are best used. To carry out better research about the best treatment options and to improve clinical practice in the future, this study aimed to find out how adults with steroid-resistant ulcerative colitis are managed in hospital and why patients and health-care professionals prefer different treatments. The study combined various methods of research, including an online survey of health-care professionals (n = 168), interviews with health-care professionals (n = 20) and patients (n = 33), a survey of health-care professionals (n = 116) and patients (n = 115) to ask them about treatment preferences, and a multistakeholder workshop (n = 9). The interviews with and survey of health-care professionals found that most health-care professionals define steroid resistance as an incomplete response to 40 mg per day of prednisolone after 2 weeks. The survey also found that the most frequently offered drugs are anti-tumour necrosis factor drugs (particularly infliximab). Patient interviews found that several factors influenced treatment choices, including effectiveness of treament, guidance from health-care professionals, route of administration and side effects. Patients were willing to try alternative treatments and surgery over time. The survey found that a higher level of remission and a lower chance of side effects strongly influenced treatment choices. Patients are less likely to choose a treatment that takes longer to improve symptoms. Health-care professionals are willing to make difficult compromises by tolerating greater safety risks in exchange for therapeutic benefits. Infliximab and tofacitinib were ranked most positively by patients, and the predicted uptake by health-care professionals was greatest for infliximab. The results of this study help improve understanding of why people choose certain treatments, improve decision-making in partnership and inform the design of future research.


Subject(s)
COVID-19 , Colitis, Ulcerative , Adult , Humans , Colitis, Ulcerative/drug therapy , Colitis, Ulcerative/surgery , Infliximab/therapeutic use , Patient Preference , Pandemics , Neoplasm Recurrence, Local , Prednisolone/therapeutic use , Cost-Benefit Analysis , Randomized Controlled Trials as Topic
2.
J Korean Med Sci ; 37(41): e299, 2022 Oct 24.
Article in English | MEDLINE | ID: covidwho-2089756

ABSTRACT

Multisystem inflammatory syndrome in children and adults (MIS-C/A) was rarely reported as a complication of coronavirus disease 2019 (COVID-19) and potential adverse events following COVID-19 vaccination. Recently, the case definition of MIS-C/A was developed by the Brighton Collaboration Network. However, only a limited number of adult patients with MIS-A following immunization have been reported, and there is still little evidence for adequate treatment. A 57-year-old man presented with fever, headache, vomiting, and hypotension 24 days after receiving the second COVID-19 vaccination with the Pfizer-BioNTech vaccine. According to the Brighton Collaboration Case Definition, the patient met a definitive case of MIS-A after vaccination (level 1 of diagnostic certainty). After administration of medium-dose prednisolone (20 mg/d) with colchicine (1.2 mg/d), all symptoms and signs improved rapidly. The dose of prednisolone was gradually tapered from the third week, and the patient confirmed a full recovery without medication after 8 weeks. This is the first report showing that low-dose steroids in combination with colchicine may be an effective treatment option for MIS-A after vaccination.


Subject(s)
COVID-19 , Humans , Male , Middle Aged , Colchicine/therapeutic use , COVID-19/drug therapy , COVID-19 Vaccines/adverse effects , Prednisolone/therapeutic use , RNA, Messenger , Steroids , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/drug therapy , Systemic Inflammatory Response Syndrome/etiology , Vaccination/adverse effects
3.
RMD Open ; 8(2)2022 09.
Article in English | MEDLINE | ID: covidwho-2029523

ABSTRACT

OBJECTIVES: To investigate factors associated with severe COVID-19 in people with idiopathic inflammatory myopathy (IIM). METHODS: Demographic data, clinical characteristics and COVID-19 outcome severity of adults with IIM were obtained from the COVID-19 Global Rheumatology Alliance physician-reported registry. A 3-point ordinal COVID-19 severity scale was defined: (1) no hospitalisation, (2) hospitalisation (and no death) and (3) death. ORs were estimated using multivariable ordinal logistic regression. Sensitivity analyses were performed using a 4-point ordinal scale: (1) no hospitalisation, (2) hospitalisation with no oxygen (and no death), (3) hospitalisation with oxygen/ventilation (and no death) and 4) death. RESULTS: Of 348 patients, 48% were not hospitalised, 39% were hospitalised (and did not die) and 13% died. Older age (OR=1.59/decade, 95% CI 1.31 to 1.91), high disease activity (OR=3.50, 95% CI 1.25 to 9.83; vs remission), ≥2 comorbidities (OR=2.63, 95% CI 1.39 to 4.98; vs none), prednisolone-equivalent dose >7.5 mg/day (OR=2.40, 95% CI 1.09 to 5.28; vs no intake) and exposure to rituximab (OR=2.71, 95% CI 1.28 to 5.72; vs conventional synthetic disease-modifying antirheumatic drugs only) were independently associated with severe COVID-19. In addition to these variables, in the sensitivity analyses, male sex (OR range: 1.65-1.83; vs female) was also significantly associated with severe outcomes, while COVID-19 diagnosis after 1 October 2020 (OR range: 0.51-0.59; vs on/before 15 June 2020) was significantly associated with less severe outcomes, but these associations were not significant in the main model (OR=1.57, 95% CI 0.95 to 2.59; and OR=0.61, 95% CI 0.37 to 1.00; respectively). CONCLUSIONS: This is the first large registry data on outcomes of COVID-19 in people with IIM. Older age, male sex, higher comorbidity burden, high disease activity, prednisolone-equivalent dose >7.5 mg/day and rituximab exposure were associated with severe COVID-19. These findings will enable risk stratification and inform management decisions for patients with IIM.


Subject(s)
COVID-19 , Myositis , Physicians , Rheumatology , Adult , COVID-19/epidemiology , COVID-19 Testing , Female , Humans , Male , Myositis/epidemiology , Prednisolone/therapeutic use , Registries , Rituximab/therapeutic use
4.
J R Coll Physicians Edinb ; 52(2): 100-104, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-2005569

ABSTRACT

BACKGROUND: COVID-19 pneumonia is complicated with residual lung fibrosis, as evidenced by imaging and postmortem pathological findings. In addition to steroids, we compared the efficacy of nintedanib and pirfenidone in the management of COVID-19 lung fibrosis measured by CT severity score (CTSS). METHODS: All cases of COVID-19 pneumonia diagnosed as COVID-19 positive by RT-PCR having SpO2 ⩽ 96% and CTSS ⩾ 10 even after 15 days were included in the study. The patients were divided into three groups. All three groups received steroids at a dose of 1 mg/kg body weight of prednisolone or equivalent. The first group received steroids alone, the second group received pirfenidone with steroids and the third group received nintedanib with steroids. All patients were followed up at 6 and 12 weeks. The primary endpoint of our study was to find out any improvement in CTSS. RESULTS: Out of 90 patients, 56 patients completed the study. Among three groups, 19 (33.9%) patients received steroids (control) only, 16 (28.6%) patients received steroids with pirfenidone and 21 (37.5%) patients received steroids with nintedanib. The study population had a mean (±SD) age of 52.5 ± 10.1 years, mean (±SD) C-reactive protein of 97.1 ± 102.2 mg/L (normal <6 mg/L), mean (±SD) serum ferritin 459.4 ± 305.5 ng/mL (normal <250 ng/mL), mean (±SD) serum d-dimer level 2.1 ± 2.6 µg/mL (normal <0.5 µg/mL) and mean (±SD) CTSS of 16.9 ± 4.3. There was significant improvement in CTSS in group receiving nintedanib compared to pirfenidone at 12 weeks (3.67 ± 1.21 vs 9.07 ± 1.12) with a p-value <0.01. CONCLUSION: Along with steroids in the treatment of COVID-19 lung fibrosis, there was a significant improvement in lung CTSS with nintedanib compared to pirfenidone.


Subject(s)
COVID-19 , Idiopathic Pulmonary Fibrosis , Adult , C-Reactive Protein , COVID-19/drug therapy , Ferritins , Humans , Idiopathic Pulmonary Fibrosis/diagnosis , Idiopathic Pulmonary Fibrosis/drug therapy , Indoles , Middle Aged , Prednisolone/therapeutic use , Pyridones/therapeutic use , Treatment Outcome
5.
Medicina (Kaunas) ; 58(9)2022 Aug 24.
Article in English | MEDLINE | ID: covidwho-1997708

ABSTRACT

Here, we report two cases of patients with interstitial pneumonia (IP) on steroids who developed Pneumocystis jirovecii pneumonia (PJP) following coronavirus disease 2019 (COVID-19) infection. Case 1: A 69-year-old man on 10 mg of prednisolone (PSL) daily for IP developed new pneumonia shortly after his COVID-19 infection improved and was diagnosed with PJP based on chest computed tomography (CT) findings and elevated serum ß-D-glucan levels. Trimethoprim-sulfamethoxazole (TMP-SMZ) was administered, and the pneumonia resolved. Case 2: A 70-year-old woman taking 4 mg/day of PSL for IP and rheumatoid arthritis developed COVID-19 pneumonia, which resolved mildly, but her pneumonia flared up and was diagnosed as PJP based on CT findings, elevated ß-D-glucan levels, and positive polymerase chain reaction for P. jirovecii DNA in the sputum. The autopsy revealed diffuse alveolar damage, increased collagen fiver and fibrotic foci, mucinous component accumulation, and the presence of a P. jirovecii cyst. In conclusion, steroids and immunosuppressive medications are well-known risk factors for PJP. Patients with IP who have been taking these drugs for a long time are frequently treated with additional steroids for COVID-19; thus, PJP complications should be avoided in such cases.


Subject(s)
COVID-19 , Lung Diseases, Interstitial , Pneumocystis carinii , Pneumonia, Pneumocystis , Aged , COVID-19/complications , Female , Glucans/therapeutic use , Humans , Lung Diseases, Interstitial/complications , Lung Diseases, Interstitial/drug therapy , Male , Pneumocystis carinii/genetics , Pneumonia, Pneumocystis/complications , Pneumonia, Pneumocystis/drug therapy , Prednisolone/therapeutic use , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
6.
BMJ Open ; 12(8): e060416, 2022 08 10.
Article in English | MEDLINE | ID: covidwho-1986365

ABSTRACT

INTRODUCTION: Hyposmia and anosmia are common in COVID-19. Most patients regain normal smell within 4 weeks, but severe loss of smell persists roughly in 20% after 2 months and may last up to a year or longer. These persistent smell disorders greatly influence daily life. It is hypothesised that COVID-19 induces inflammation around the olfactory nerve and in the olfactory pathway, leading to smell disorders. Corticosteroids might reduce this local inflammatory response and improve smell. METHODS AND ANALYSIS: We will conduct a single-centre, randomised, placebo-controlled trial to determine the efficacy of a short high-dose treatment of oral prednisolone for persistent loss of smell after COVID-19 in the early phase. We will include 116 patients with persistent (>4 weeks) loss of smell within 12 weeks of COVID-19 diagnosis, based on a positive PCR/antigen test. One group receives 40 mg of prednisolone for 10 days and the other group receives matching placebo treatment. In addition, all patients will perform smell training for 12 weeks. The primary outcome is objective olfactory function measured by means of sniffin' sticks test. Secondary outcomes are objective gustatory function by means of taste strips test and subjective taste and smell ability, trigeminal sensations, quality of life and nasal symptoms, measured by three questionnaires. These outcomes will be measured at inclusion before treatment and 12 weeks later. ETHICS AND DISSEMINATION: The Institutional Review Board of the University Medical Center Utrecht approved the research protocol (21-635/G-D, October 2021). The trial results will be shared in peer-reviewed medical journals and scientific conferences. TRIAL REGISTRATION NUMBER: NL9635. EUCTR2021-004021-71-NL.


Subject(s)
COVID-19 , Olfaction Disorders , Adrenal Cortex Hormones/therapeutic use , Anosmia/drug therapy , Anosmia/etiology , COVID-19/complications , COVID-19 Testing , Cocos , Humans , Olfaction Disorders/drug therapy , Olfaction Disorders/etiology , Prednisolone/therapeutic use , Quality of Life , Randomized Controlled Trials as Topic , SARS-CoV-2 , Smell
7.
Intern Med ; 61(15): 2327-2332, 2022 Aug 01.
Article in English | MEDLINE | ID: covidwho-1968932

ABSTRACT

A 41-year-old Japanese man was admitted to our hospital with acute perimyocarditis 4 weeks after coronavirus disease 2019 (COVID-19) infection. Ten days after admission, the patient showed bilateral facial nerve palsy in the course of improvement of perimyocarditis under treatment with aspirin and colchicine. After prednisolone therapy, perimyocarditis completely improved, and the facial nerve palsy gradually improved. Acute perimyocarditis and facial nerve palsy can occur even 4 weeks after contracting COVID-19.


Subject(s)
COVID-19 , Facial Paralysis , Adult , COVID-19/complications , Facial Nerve , Facial Paralysis/etiology , Humans , Male , Prednisolone/therapeutic use
8.
BMC Ophthalmol ; 22(1): 297, 2022 Jul 07.
Article in English | MEDLINE | ID: covidwho-1923532

ABSTRACT

BACKGROUND: Punctate inner choroidopathy (PIC) is a rare idiopathic inflammatory multifocal chorioretinopathy. Although the etiology of PIC is unknown, it is proposed to be an autoimmune disease that arises in the context of polygenic susceptibility triggered by an environmental stimulus, such as infection. We reported a case of PIC immediately after COVID-19 infection. CASE PRESENTATION: A 25-year-old woman complained of blurred vision in the right eye six days after the symptoms of COVID-19 infection first appeared. The patient visited our hospital and underwent comprehensive ophthalmological examination 18 days after the initial COVID-19 symptoms. Based on the characteristic fundus features observed with multimodal imaging, retinal specialists made a diagnosis of PIC. The patient was affected with high myopia. As her general COVID-19 symptoms disappeared, the patient was prescribed oral prednisolone 30 mg/day for 14 days to treat PIC. Fundus abnormality decreased and her ocular symptoms improved. No side effects were observed, including the recurrence of general COVID-19 symptoms. CONCLUSION: We experienced an extremely rare case of PIC immediately after COVID-19 infection and showed the potential safety and effectiveness of oral prednisolone in treating PIC in the active phase after the disappearance of the general COVID-19 infection symptoms.


Subject(s)
COVID-19 , Choroid Diseases , White Dot Syndromes , Adult , COVID-19/complications , Choroid Diseases/diagnosis , Choroid Diseases/etiology , Female , Fluorescein Angiography/methods , Humans , Prednisolone/therapeutic use , Tomography, Optical Coherence/methods
9.
BMJ Case Rep ; 15(6)2022 Jun 08.
Article in English | MEDLINE | ID: covidwho-1891768

ABSTRACT

A woman in her 80s was admitted with 5 days of progressive dyspnoea and hypoxic respiratory failure, in the setting of receiving a 3-week course of low-dose to moderate-dose prednisolone for a pruritic skin rash. Her medical history was not significant for major medical comorbidities or any other clear risk factors for secondary immunosuppression apart from advanced age. CT revealed widespread small-airway and parenchymal disease with ground-glass opacities consistent with atypical respiratory infection. Sputum PCR confirmed Pneumocystis jirovecii She was diagnosed with Pneumocystis jirovecii pneumonia (PJP) in the context of her clinical presentation, radiological features and PCR result. Her HIV status was negative. The patient was treated with 4 weeks of trimethoprim-sulfamethoxazole and 3 weeks of adjunctive prednisolone. She initially required high-dependency unit support with non-invasive ventilation. In this case report, we review the literature regarding PJP in the dermatology setting.


Subject(s)
HIV Infections , Pneumocystis carinii , Pneumonia, Pneumocystis , Respiratory Insufficiency , Female , HIV Infections/complications , Humans , Pneumonia, Pneumocystis/complications , Prednisolone/therapeutic use , Respiratory Insufficiency/complications
10.
Ann Rheum Dis ; 81(7): 925-936, 2022 07.
Article in English | MEDLINE | ID: covidwho-1874520

ABSTRACT

BACKGROUND: Low-dose glucocorticoid (GC) therapy is widely used in rheumatoid arthritis (RA) but the balance of benefit and harm is still unclear. METHODS: The GLORIA (Glucocorticoid LOw-dose in RheumatoId Arthritis) pragmatic double-blind randomised trial compared 2 years of prednisolone, 5 mg/day, to placebo in patients aged 65+ with active RA. We allowed all cotreatments except long-term open label GC and minimised exclusion criteria, tailored to seniors. Benefit outcomes included disease activity (disease activity score; DAS28, coprimary) and joint damage (Sharp/van der Heijde, secondary). The other coprimary outcome was harm, expressed as the proportion of patients with ≥1 adverse event (AE) of special interest. Such events comprised serious events, GC-specific events and those causing study discontinuation. Longitudinal models analysed the data, with one-sided testing and 95% confidence limits (95% CL). RESULTS: We randomised 451 patients with established RA and mean 2.1 comorbidities, age 72, disease duration 11 years and DAS28 4.5. 79% were on disease-modifying treatment, including 14% on biologics. 63% prednisolone versus 61% placebo patients completed the trial. Discontinuations were for AE (both, 14%), active disease (3 vs 4%) and for other (including covid pandemic-related disease) reasons (19 vs 21%); mean time in study was 19 months. Disease activity was 0.37 points lower on prednisolone (95% CL 0.23, p<0.0001); joint damage progression was 1.7 points lower (95% CL 0.7, p=0.003). 60% versus 49% of patients experienced the harm outcome, adjusted relative risk 1.24 (95% CL 1.04, p=0.02), with the largest contrast in (mostly non-severe) infections. Other GC-specific events were rare. CONCLUSION: Add-on low-dose prednisolone has beneficial long-term effects in senior patients with established RA, with a trade-off of 24% increase in patients with mostly non-severe AE; this suggests a favourable balance of benefit and harm. TRIAL REGISTRATION NUMBER: NCT02585258.


Subject(s)
Arthritis, Rheumatoid , Prednisolone , Aged , Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , Double-Blind Method , Drug Therapy, Combination , Glucocorticoids/therapeutic use , Humans , Methotrexate/therapeutic use , Prednisolone/therapeutic use , Treatment Outcome
11.
JAMA Pediatr ; 176(3): 236-243, 2022 Mar 01.
Article in English | MEDLINE | ID: covidwho-1864299

ABSTRACT

IMPORTANCE: In children with corticosteroid-sensitive nephrotic syndrome, many relapses are triggered by upper respiratory tract infections. Four small studies found that administration of daily low-dose prednisolone for 5 to 7 days at the time of an upper respiratory tract infection reduced the risk of relapse, but the generalizability of their findings is limited by location of the studies and selection of study population. OBJECTIVE: To investigate the use of daily low-dose prednisolone for the treatment of upper respiratory tract infection-related relapses. DESIGN, SETTING, AND PARTICIPANTS: This double-blind, placebo-controlled randomized clinical trial (Prednisolone in Nephrotic Syndrome [PREDNOS] 2) evaluated 365 children with relapsing steroid-sensitive nephrotic syndrome with and without background immunosuppressive treatment at 122 pediatric departments in the UK from February 1, 2013, to January 31, 2020. Data from the modified intention-to-treat population were analyzed from July 1, 2020, to December 31, 2020. INTERVENTIONS: At the start of an upper respiratory tract infection, children received 6 days of prednisolone, 15 mg/m2 daily, or matching placebo preparation. Those already taking alternate-day prednisolone rounded their daily dose using trial medication to the equivalent of 15 mg/m2 daily or their alternate-day dose, whichever was greater. MAIN OUTCOMES AND MEASURES: The primary outcome was the incidence of first upper respiratory tract infection-related relapse. Secondary outcomes included overall rate of relapse, changes in background immunosuppressive treatment, cumulative dose of prednisolone, rates of serious adverse events, incidence of corticosteroid adverse effects, and quality of life. RESULTS: The modified intention-to-treat analysis population comprised 271 children (mean [SD] age, 7.6 [3.5] years; 174 [64.2%] male), with 134 in the prednisolone arm and 137 in the placebo arm. The number of patients experiencing an upper respiratory tract infection-related relapse was 56 of 131 (42.7%) in the prednisolone arm and 58 of 131 (44.3%) in the placebo arm (adjusted risk difference, -0.02; 95% CI, -0.14 to 0.10; P = .70). No evidence was found that the treatment effect differed according to background immunosuppressive treatment. No significant differences were found in secondary outcomes between the treatment arms. A post hoc subgroup analysis assessing the primary outcome in 54 children of South Asian ethnicity (risk ratio, 0.66; 95% CI, 0.40-1.10) vs 208 children of other ethnicity (risk ratio, 1.11; 95% CI, 0.81-1.54) found no difference in efficacy of intervention in those of South Asian ethnicity (test for interaction P = .09). CONCLUSIONS AND RELEVANCE: The results of PREDNOS 2 suggest that administering 6 days of daily low-dose prednisolone at the time of an upper respiratory tract infection does not reduce the risk of relapse of nephrotic syndrome in children in the UK. Further work is needed to investigate interethnic differences in treatment response. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN10900733; EudraCT 2012-003476-39.


Subject(s)
Nephrotic Syndrome , Respiratory Tract Infections , Adrenal Cortex Hormones/therapeutic use , Child , Humans , Male , Nephrotic Syndrome/complications , Nephrotic Syndrome/drug therapy , Prednisolone/therapeutic use , Quality of Life , Recurrence , Respiratory Tract Infections/drug therapy , Respiratory Tract Infections/prevention & control
12.
Intern Med ; 61(10): 1581-1585, 2022 May 15.
Article in English | MEDLINE | ID: covidwho-1847020

ABSTRACT

We herein report two cases of coronavirus disease 2019 (COVID-19) vaccine-induced immune thrombocytopenia (ITP). A 69-year-old Japanese man developed severe thrombocytopenia after COVID-19 vaccination. He had oral bleeding and hemoptysis but no thrombotic symptoms. He improved rapidly with oral prednisolone therapy. A 34-year-old Japanese woman had generalized purpura after COVID-19 vaccination. Her platelet count improved rapidly after treatment with prednisolone and eltrombopag. The occurrence of two cases of ITP after COVID-19 vaccination at a single institution suggests that there could be more such undiagnosed cases, especially cases of mild secondary ITP.


Subject(s)
COVID-19 , Purpura, Thrombocytopenic, Idiopathic , Thrombocytopenia , Adult , Aged , COVID-19 Vaccines/adverse effects , Female , Humans , Male , Prednisolone/therapeutic use , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Purpura, Thrombocytopenic, Idiopathic/etiology , Thrombocytopenia/chemically induced , Vaccination
13.
J Investig Med High Impact Case Rep ; 10: 23247096221090843, 2022.
Article in English | MEDLINE | ID: covidwho-1794049

ABSTRACT

Covid 19 positive patients requiring oxygen therapy to maintain saturations above 90% were given a trial of oral prednisolone between 15 and 30 mg until they were weaned to room air maintaining saturations >95%. This treatment resulted in the rapid resolution of worsening respiratory function of 4 Covid 19 positive patients within the High Dependency unit in a tertiary medical center. The cases are from the "first wave" in Trinidad, March 2020. The signs and symptoms of respiratory failure resolved after 72 hours of prednisolone treatment and none of these patients were escalated to non-invasive or invasive respiratory support. The patients were kept for a further 48 hours after the steroids were discontinued to monitor for relapse of symptoms, all patients were discharged home after quarantine. The initiation of a prednisolone steroid trial must be considered in Covid 19 positive patients needing supplementary oxygen therapy or developing worsening shortness of breath. Early Covid respiratory failure responds to a low dose for a short duration and prevents escalation to non-invasive/invasive respiratory support.


Subject(s)
COVID-19 , Respiratory Insufficiency , Humans , Oxygen , Prednisolone/therapeutic use , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , SARS-CoV-2
14.
Ocul Immunol Inflamm ; 30(5): 1250-1254, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1784140

ABSTRACT

PURPOSE: To report a case of Vogt-Koyanagi-Harada (VKH) disease following mRNA-1273 (Moderna) COVID-19 vaccination. METHODS: Retrospective case report. RESULTS: A 50-year-old Korean woman developed bilateral serous retinal detachment 35 days after the first dose of COVID-19 mRNA vaccination (mRNA-1273, Moderna). She experienced adverse effects such as erythema and pain at the injection site, headache, myalgia, and allergy symptoms prior to ocular manifestation. She was diagnosed with Vogt-Koyanagi-Harada (VKH) disease. After treatment with oral prednisolone, the serous retinal detachment resolved and vision improved. CONCLUSION: COVID-19 vaccination might be associated with VKH disease development, and the ingredients of the mRNA vaccine or viral peptide encoded by mRNA may have activated the immunological process and induced VKH disease.


Subject(s)
2019-nCoV Vaccine mRNA-1273 , COVID-19 , Retinal Detachment , Uveomeningoencephalitic Syndrome , Female , Humans , Middle Aged , 2019-nCoV Vaccine mRNA-1273/adverse effects , COVID-19/prevention & control , Prednisolone/therapeutic use , Retinal Detachment/chemically induced , Retinal Detachment/diagnosis , Retinal Detachment/diet therapy , Retrospective Studies , Uveomeningoencephalitic Syndrome/diagnosis , Uveomeningoencephalitic Syndrome/drug therapy , Uveomeningoencephalitic Syndrome/etiology , Vaccination/adverse effects
15.
Clin Rheumatol ; 41(8): 2449-2456, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1772929

ABSTRACT

OBJECTIVES: Patients with giant cell arteritis (GCA) represent a fragile population with an increased infection risk. In a recent study, older age, a higher number of comorbidities, higher disease activity and prednisolone ≥ 10 mg/day were associated with worse COVID-19 outcome. We aimed to evaluate the frequency and severity of COVID-19 in a well-defined GCA cohort. METHODS: We reviewed medical records of histologically and/or by imaging-proven GCA patients diagnosed between September 2011 and February 2020 at our secondary/tertiary centre and followed during the COVID-19 pandemic between March 2020 and February 2022 (24 months). Descriptive statistics were used to explore the studied population. RESULTS: Of 314 patients with GCA diagnosed for the first time during a 102-month period, 49 patients died before March 2020. Of the remaining 265 patients, 55 (20.8%) patients suffered from a total of 57 SARS-CoV-2 infections. We observed 44 (77.2%) mild and 13 (22.8%) severe COVID-19 episodes (the latter defined as needing hospitalization, death or thrombotic complication). Patients with severe COVID-19 were more likely to have arterial hypertension (12 [92.3%] vs. 25 [56.8%]; p = 0.022), cardiovascular disease (7 [53.8%] vs. 10 [22.7%]; p = 0.043) or obesity (5 [38.5%] vs. 5 [11.4%]; p = 0.038). Neither prednisolone dose 1-5 mg/day (p = 0.483) nor leflunomide use (p = 1.000) was associated with COVID-19 course. There were no significant differences in sex, age, GCA type, GCA disease duration and other comorbidities in patients with mild and severe COVID-19 in our cohort. CONCLUSION: More than a fifth of our GCA patients had severe COVID-19. Treatment with leflunomide or low doses of glucocorticoids were not associated with severe course in our cohort. Key Points • Treatment with leflunomide or low doses of glucocorticoids were not associated with worse COVID-19 outcome. • Outcomes of COVID-19 improved as the COVID-19 pandemic, prevention and treatment options evolved. • Arterial hypertension, cardiovascular disease or obesity were associated with severe COVID-19.


Subject(s)
COVID-19 , Cardiovascular Diseases , Giant Cell Arteritis , Hypertension , COVID-19/epidemiology , Cardiovascular Diseases/complications , Cardiovascular Diseases/epidemiology , Giant Cell Arteritis/complications , Giant Cell Arteritis/drug therapy , Giant Cell Arteritis/epidemiology , Glucocorticoids/therapeutic use , Humans , Hypertension/complications , Leflunomide/therapeutic use , Obesity/complications , Observational Studies as Topic , Pandemics , Prednisolone/therapeutic use , SARS-CoV-2 , Slovenia
16.
Medicine (Baltimore) ; 101(3): e28639, 2022 Jan 21.
Article in English | MEDLINE | ID: covidwho-1642427

ABSTRACT

ABSTRACT: The development of pulmonary fibrosis is a rare complication of the novel coronavirus disease 2019 (COVID-19). Limited information is available in the literature about that, and the present study aimed to address this gap.This case-control study included 64 patients with post-COVID-19 pulmonary fibrosis who were hospitalized for COVID-19.The percentage of patients aged ≥65 years (44%) who demised was higher than those who survived (25%). Male patients (62%) had higher mortality than female patients (37%). The most frequently reported clinical symptoms were shortness of breath (98%), cough (91%), and fever (70%). Most COVID-19 patients with pulmonary fibrosis (81%) were admitted to an intensive care unit (ICU), and 63% required mechanical ventilation. Bilateral lung infiltrates (94%), "ground glass" opacity (91%), "honeycomb" lung (25%), and pulmonary consolidation (9%) were commonly identified in COVID-19 patients with pulmonary fibrosis who survived. The findings for computed tomography and dyspnea scale were significantly higher in severe cases admitted to the ICU who required mechanical ventilation. A higher computerized tomography score also correlated significantly with a longer duration of stay in hospital and a higher degree of dyspnea. Half of the COVID-19 patients with pulmonary fibrosis (50%) who survived required oxygen therapy, and those with "honeycomb" lung required long-term oxygen therapy to a far greater extent than others. Cox regression revealed that smoking and asthma were significantly associated with ICU admission and the risk of mortality.Post-COVID-19 pulmonary fibrosis is a severe complication that leads to permanent lung damage or death.


Subject(s)
COVID-19/complications , Lung/diagnostic imaging , Adrenal Cortex Hormones/therapeutic use , Anticoagulants/therapeutic use , COVID-19/epidemiology , Case-Control Studies , Cough/etiology , Dyspnea/etiology , Female , Fever/etiology , Humans , Intensive Care Units , Male , Oxygen , Prednisolone/therapeutic use , Pulmonary Fibrosis/etiology , Pulmonary Fibrosis/therapy , Retrospective Studies , SARS-CoV-2 , Saudi Arabia/epidemiology , Tomography, X-Ray Computed , Vitamins/therapeutic use
17.
Dermatol Ther ; 35(3): e15279, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1583588

ABSTRACT

Leukocytoclastic vasculitis (LCV) is the vasculitis of small vessels. In this report, we describe a 38-year-old male patient who presented to our outpatient clinic with a 1-week history of rash on his lower extremities that had started 4 days after receiving the Pfizer-BioNTech SARS-CoV-2 vaccine. A diagnosis of LCV was made based on clinical and histopathological findings. The patient was treated with antihistamines and prednisolone, after which improvement was observed in the lesions. With this paper, we aim to raise awareness concerning the possibility of LCV development after COVID-19 vaccination.


Subject(s)
/adverse effects , COVID-19 , Vaccination , Vasculitis, Leukocytoclastic, Cutaneous , Adult , COVID-19/prevention & control , Histamine Antagonists/therapeutic use , Humans , Male , Prednisolone/therapeutic use , SARS-CoV-2 , Vaccination/adverse effects , Vasculitis, Leukocytoclastic, Cutaneous/chemically induced , Vasculitis, Leukocytoclastic, Cutaneous/diagnosis , Vasculitis, Leukocytoclastic, Cutaneous/drug therapy
18.
Int J Immunopathol Pharmacol ; 35: 20587384211063976, 2021.
Article in English | MEDLINE | ID: covidwho-1582484

ABSTRACT

The underlying cause of many complications associated with severe COVID-19 is attributed to the inflammatory cytokine storm that leads to acute respiratory distress syndrome (ARDS), which appears to be the leading cause of death in COVID-19. Systemic corticosteroids have anti-inflammatory activity through repression of pro-inflammatory genes and inhibition of inflammatory cytokines, which makes them a potential medical intervention to diminish the upregulated inflammatory response. Early in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the role of corticosteroids was unclear. Corticosteroid use in other indications such as ARDS and septic shock has proven benefit while its use in other respiratory viral pneumonias is associated with reduced viral clearance and increased secondary infections. This review article evaluates the benefits and harms of systemic corticosteroids in patients with COVID-19 to assist clinicians in improving patient outcomes, including patient safety. Dexamethasone up to 10 days is the preferred regimen to reduce mortality risk in COVID-19 patients requiring oxygen support, mechanical ventilation, or extracorporeal membrane oxygenation. If dexamethasone is unavailable, other corticosteroids can be substituted at equivalent doses. Higher doses of corticosteroids may be beneficial in patients who develop ARDS. Corticosteroids should be avoided early in the disease course when patients do not require oxygen support because of potential harms.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , COVID-19/drug therapy , Adrenal Cortex Hormones/adverse effects , Dexamethasone/adverse effects , Dexamethasone/therapeutic use , Humans , Hydrocortisone/adverse effects , Hydrocortisone/therapeutic use , Influenza, Human/drug therapy , Methylprednisolone/adverse effects , Methylprednisolone/therapeutic use , Prednisolone/adverse effects , Prednisolone/therapeutic use
19.
Respir Physiol Neurobiol ; 297: 103813, 2022 03.
Article in English | MEDLINE | ID: covidwho-1521498

ABSTRACT

This study was aimed to explore the precise dose of corticosteroid therapy in critical COVID-19. A total of forty-five critical COVID-19 patients were enrolled. The process of critical COVID-19 was divided into alveolitis and fibrosis stages. Most nonsurvivors died in fibrosis phase. Nonsurvivors had more dyspnea symptoms, fewer days of hospitalization, shorter duration of alveolitis and fibrosis. High-dose daily corticosteroid therapy (≥150 mg/d) was associated with shorter survival time and lower lymphocyte count in fibrosis phase. Moreover, a high cumulative dose (≥604 mg) was tied to longer duration of virus shedding, lower oxygenation index (OI), higher incidence of tracheal intubation, fewer lymphocytes and higher levels of C-reactive protein (CRP) and lactate dehydrogenase (LDH). In alveolitis phase, the low-to-moderate-dose daily corticosteroid therapy and a small cumulative dose reduced lymphocytes. In conclusion, low-to-moderate dose corticosteroids may be beneficial in the fibrosis phase. High-dose corticosteroid therapy in the fibrosis phase aggravates the severity of critical COVID-19.


Subject(s)
COVID-19/drug therapy , Glucocorticoids/administration & dosage , Lung/diagnostic imaging , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/therapeutic use , Aged , C-Reactive Protein/metabolism , COVID-19/blood , COVID-19/diagnostic imaging , COVID-19/physiopathology , Critical Illness , Female , Fibrosis , Glucocorticoids/therapeutic use , Humans , L-Lactate Dehydrogenase/metabolism , Lung/pathology , Lung/physiopathology , Lymphocyte Count , Male , Methylprednisolone/administration & dosage , Methylprednisolone/therapeutic use , Middle Aged , Prednisolone/administration & dosage , Prednisolone/therapeutic use , SARS-CoV-2 , Severity of Illness Index , Survival Rate , Tomography, X-Ray Computed , Virus Shedding
20.
Pediatr Dermatol ; 38(5): 1359-1360, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1505904

ABSTRACT

Whether affecting children or adults, SARS-CoV-2 infection (COVID-19) can have multi-organ involvement mediated by an inflammatory cascade. Immunoglobulin A (IgA) is one of the key components of the inflammatory cascade that can lead to endothelial injury and inflammation. IgA vasculitis or Henoch-Schönlein purpura (HSP) has been rarely reported in the context of COVID-19. In this report, we highlight a case of HSP occurring 2 days after diagnosis of COVID-19 in a 16-year-old boy, who presented with palpable purpura of the lower extremities and buttocks, diffuse abdominal pain, hemoptysis, and hematochezia. He was treated with oral prednisolone with rapid clinical improvement.


Subject(s)
COVID-19 , Adolescent , Child , Humans , /diagnosis , Male , Pain , Prednisolone/therapeutic use , SARS-CoV-2
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