Utility of azathioprine, methotrexate and cyclosporine as steroid-sparing agents in chronic alopecia areata: a retrospective study of continuation rates in 138 patients.

BACKGROUND: The management of chronic alopecia areata (CAA) is challenging. There is currently no therapy that produces consistent successful hair regrowth. Systemic therapies, including prednisolone and steroid-sparing agents (SSA), are often tried in patients with CAA. As there are no head-to-head clinical trials that compare efficacy of one SSA over another, retrospective studies of treatment in clinical practice may help guide clinical practice. OBJECTIVE: To investigate the utility of SSAs in the treatment of AA. METHODS: An electronic medical records search identified patients with AA and those prescribed azathioprine, cyclosporine or methotrexate between 2002 and 2019. Type of AA, treatment duration, reason for cessation, use of concurrent prednisolone, dose of prednisolone and duration of prednisolone use were recorded. The primary outcome was SSA continuation rate at 6 and 12 months. RESULTS: A total of 852 AA patients were identified, among whom 138 patients had been treated with azathioprine, methotrexate or cyclosporine. Of these 138 patients treated with a SSA, 92 (66.7%) continued treatment for at least 12 months: 75.3% (55/73) of azathioprine users, 50% (11/22) of methotrexate users and 60.5% (26/43) of cyclosporine users. At 12 months, 67.3% of azathioprine users required concurrent prednisolone at a mean dose of 5.6 mg daily, 63.6% of methotrexate users required prednisolone at a mean dose of 5 mg daily and 57.7% of cyclosporine users required prednisolone at a mean dose of 8.7 mg daily. The SSA was ceased due to an adverse event in 15.9% of patients and a lack of efficacy in 17.4%. CONCLUSION: The most well-utilized SSA for CAA patients at our clinic was azathioprine. This study highlights that most CAA patients who commence treatment with azathioprine, methotrexate or cyclosporine continue that treatment for at least 12 months and most require concurrent low-dose prednisolone to maintain remission or promote continued hair regrowth.

Sample preparation and storage can change arsenic speciation in human urine.

BACKGROUND: Stability of chemical speciation during sample handling and storage is a prerequisite to obtaining reliable results of trace element speciation analysis. There is no comprehensive information on the stability of common arsenic species, such as inorganic arsenite [As(III)], arsenate [As(V)], monomethylarsonic acid, dimethylarsinic acid, and arsenobetaine, in human urine. METHODS: We compared the effects of the following storage conditions on the stability of these arsenic species: temperature (25, 4, and -20 degrees C), storage time (1, 2, 4, and 8 months), and the use of additives (HCl, sodium azide, benzoic acid, benzyltrimethylammonium chloride, and cetylpyridinium chloride). HPLC with both inductively coupled plasma mass spectrometry and hydride generation atomic fluorescence detection techniques were used for the speciation of arsenic. RESULTS: We found that all five of the arsenic species were stable for up to 2 months when urine samples were stored at 4 and -20 degrees C without any additives. For longer period of storage (4 and 8 months), the stability of arsenic species was dependent on urine matrices. Whereas the arsenic speciation in some urine samples was stable for the entire 8 months at both 4 and -20 degrees C, other urine samples stored under identical conditions showed substantial changes in the concentration of As(III), As(V), monomethylarsonic acid, and dimethylarsinic acid. The use of additives did not improve the stability of arsenic speciation in urine. The addition of 0.1 mol/L HCl (final concentration) to urine samples produced relative changes in inorganic As(III) and As(V) concentrations. CONCLUSIONS: Low temperature (4 and -20 degrees C) conditions are suitable for the storage of urine samples for up to 2 months. Untreated samples maintain their concentration of arsenic species, and additives have no particular benefit. Strong acidification is not appropriate for speciation analysis.

Guar by-product improves carbohydrate tolerance in healthy human subjects.

Guar gum possesses distinct hypoglycemic properties. The other fraction of the guar bean, guar by-product (GBP), was studied to determine if it possesses any hypoglycemic properties. When 25 g GBP or wheat bran were consumed with a carbohydrate test meal by 10 healthy subjects, at 15 and 30 min after the GBP test meal significantly lower normalized plasma glucose responses were measured. Postprandial plasma insulin responses were similar after both test meals. During the first 60 min postprandially, the mean integrated plasma glucose response area was significantly lower after the GBP test meal. These data indicate that GBP, like guar gum, possesses hypoglycemic properties; because of the different chemical characteristics of these 2 guar bean fractions, it seems that their hypoglycemic properties are due probably to different mechanisms.