Latest news with #glucocorticoids
Medscape
13-06-2025
- Health
- Medscape
EULAR 2025
Updated SSc Recommendations Use 'Therapeutic Continuums' The recommendations highlighted the use of immunosuppressive agents and antifibrotics to treat skin fibrosis and lung fibrosis, as well as changes to upfront treatment of pulmonary hypertension. Medscape Medical News , Jun 26, 2024 Updated SSc Recommendations Use 'Therapeutic Continuums' New Gout Drugs Might Increase Patients at Target Urate Level New options in late stages of clinical testing for refractory gout promise to increase the chances of reaching the guideline uric acid target with relatively modest risks for adverse events. Medscape Medical News , Aug 01, 2024 New Gout Drugs Might Increase Patients at Target Urate Level Taper, Dose Down, Discontinue: Striving for Less Steroid Use Now in the 75th year since the first presentation on the clinical use of glucocorticoids, what consensus has been reached in sparing their use to avoid their many potential adverse effects? Medscape Medical News, Jul 25, 2024
Medscape
10-06-2025
- Health
- Medscape
Hair Cortisone Predicts Metabolic Syndrome in Young Adults
Long-term biological stress, measured using hair glucocorticoid levels, was strongly associated with the presence of metabolic syndrome (MetS) and its components such as waist circumference and triglycerides, with the association being particularly pronounced in younger adults for hair cortisone levels. METHODOLOGY: Researchers in the Netherlands conducted a cross-sectional study to investigate the relationship between hair glucocorticoid levels and the presence of MetS and its components in 1405 adult participants (median age, 49 years; 73.6% women) from the Netherlands Study of Depression and Anxiety cohort. Levels of hair glucocorticoids (cortisol and cortisone) were measured using liquid chromatography-tandem mass spectrometry. Outcomes were the presence of MetS and its individual components that included high-density lipoprotein cholesterol, fasting glucose, and triglyceride levels; diastolic blood pressure; and waist circumference. This study also assessed whether age (≤ 49 vs ≥ 50 years) modified the relationship between hair glucocorticoids and MetS. TAKEAWAY: Hair cortisol (odds ratio [OR], 1.27) and cortisone (OR, 1.32; P < .001 for both) levels were strongly associated with MetS, with the association between hair cortisone and MetS being significantly modified by age (OR, 0.78; P = .003). < .001 for both) levels were strongly associated with MetS, with the association between hair cortisone and MetS being significantly modified by age (OR, 0.78; = .003). The link between hair glucocorticoids and MetS was stronger in younger participants than in older ones for both hair cortisol (OR, 1.52 vs 1.20) and hair cortisone (OR, 1.95 vs 1.14). Hair cortisol and cortisone levels were positively correlated with waist circumference ( P < .001 for both) and triglyceride levels ( P < .025 for both); hair cortisol, but not cortisone, levels were also positively associated with diastolic blood pressure ( P = .034) and negatively associated with high-density lipoprotein cholesterol levels ( P = .035). IN PRACTICE: "In the future, [the study] findings can be used to identify individuals with increased cardiovascular risk," the authors wrote. SOURCE: This study was led by Susanne Kuckuck, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands. It was published online on June 03, 2025, in The Journal of Clinical Endocrinology & Metabolism . LIMITATIONS: The study population was predominantly Caucasian, which limited the generalisability of the findings to other populations and ethnic minorities. Information on diet was not collected; hence, the potential influence of nutritional factors on glucocorticoid metabolism could not be assessed. This study could not show whether elevated hair glucocorticoid levels caused MetS due to its cross-sectional design. DISCLOSURES: This study was supported by Stress in Action, a research project financially supported by the Dutch Research Council and the Dutch Ministry of Education, Culture and Science. The authors declared having no conflicts of interest.
Medscape
06-06-2025
- Health
- Medscape
‘Enormous Burden' Cataloged in Relapsing Polychondritis
A large multicenter prospective cohort study has expanded 'the understanding of the range of manifestations of disease in patients with relapsing polychondritis [RP]' — particularly involving the ear, nose, throat, and musculoskeletal systems — as well as a high prevalence of organ damage, near-universal use of glucocorticoids, and frequent use of additional nonbiologic or biologic immunomodulatory therapies. METHODOLOGY: Researchers conducted a multicenter cohort study between 2017 and 2023 to evaluate clinical manifestations, treatment approaches, and the association between them in 195 patients with RP (median age, 48 years; 85.6% women). A diagnosis of RP was confirmed using comprehensive laboratory, radiographic, and other tests; all participants tested negative for proteinase 3 and myeloperoxidase. Data on clinical manifestations, organ damage, and medication history were collected at baseline study visits using standardized case report forms. Patients were grouped by treatment: Group 1 received glucocorticoids or no drugs, group 2 received nonbiologic immunosuppressive drugs (excluding JAK inhibitors) with or without glucocorticoids, and group 3 received JAK inhibitors or biologic drugs with or without nonbiologic immunosuppressives or glucocorticoids. TAKEAWAY: All patients presented with at least three clinical manifestations of RP, with a median of 11 manifestations per patient; all showed ear, nose, or airway involvement, and 83% had musculoskeletal manifestations. A substantial portion of patients (41%) developed organ damage, including sensorineural hearing loss (25%), auricular and saddle nose deformities (12% each), and subglottic stenosis (9%); among those who underwent dynamic CT of the chest, 31% had tracheomalacia, and 20% had bronchomalacia. Treatment groups 1, 2, and 3 comprised 19%, 28%, and 53% of patients, respectively; most patients (95%) received glucocorticoids, and a substantial proportion (81%) received additional immunomodulatory treatments. Patients in treatment group 3 had the highest rate of organ damage (62% vs 22% in group 2 and 15% in group 1) and were more likely to have arthritis and stenosis, whereas those in group 1 were less likely to experience nose pain. IN PRACTICE: 'Standardized assessment of disease activity is warranted for patients with RP for early detection and timely initiation of treatment. These findings also highlight the absence of a consensus approach to treatment for patients with RP and underscore the need for clinical trials and treatment guidelines in this disease to help reduce the enormous burden of disease for patients,' the authors wrote. SOURCE: This study was led by Roger Yang, MD, University of Pennsylvania, Philadelphia, and University of Montreal, Montreal, Quebec, Canada. It was published online on May 20, 2025, in ACR Open Rheumatology . LIMITATIONS: This study did not capture data on dose and duration of immunomodulatory medications or clinical features at treatment decisions. Treatment choices were made independently by clinicians and may have been influenced by factors such as drug availability or insurance, introducing variability. Moreover, the academic referral setting may have contributed to selection bias. DISCLOSURES: Two authors reported receiving support from the Vasculitis Clinical Research Consortium, Association des médecins rhumatologues du Québec, Institute for Translational Medicine and Therapeutics, and other sources. This research was also supported by the Relapsing Polychondritis Foundation and other generous donors to the Penn Relapsing Polychondritis Program.
Medscape
14-05-2025
- Health
- Medscape
Lupus Drug Withdrawal: Immunosuppressants or Steroids First?
In patients with systemic lupus erythematosus (SLE) who had been in remission for at least 1 year, immunosuppressant withdrawal was noninferior to glucocorticoid withdrawal, with no significant differences in the proportion of patients who experienced flares or in flare severity at 1- and 2-year follow-ups. METHODOLOGY: Researchers conducted a randomized noninferiority trial at a tertiary hospital in India (between May 2021 and December 2023) to compare the outcomes of immunosuppressant withdrawal with those of glucocorticoid withdrawal in adult patients with SLE in remission. They included 117 patients with SLE who had received treatment for at least 3 years, had been in remission for at least 1 year, and were receiving glucocorticoids (≤ 7.5 mg/d of prednisolone) along with one maintenance immunosuppressant. Patients were randomly assigned to one of the two groups: One tapered off prednisolone over 3 months while continuing immunosuppressants (n = 58; median age, 35 years; 98.3% women) and the other tapered off immunosuppressants while maintaining low-dose prednisolone (n = 59; median age, 36 years; 93.2% women). All patients continued receiving hydroxychloroquine. The primary outcome was the proportion of patients who experienced a flare, as defined by the SELENA-SLEDAI Flare Index, at any time up to 52 weeks, with follow-up extending up to and beyond 104 weeks. Noninferiority of immunosuppressant over glucocorticoid withdrawal was confirmed if the upper limit of the 95% CI for the between-group difference in the proportion of patients who experienced a flare was < 10%. TAKEAWAY: At 52 weeks and at maximum follow-up, the proportion of patients who experienced a flare did not differ significantly between the immunosuppressant and glucocorticoid withdrawal groups, with the risk difference between the groups indicating the noninferiority of immunosuppressant withdrawal. At the maximum follow-up, 55.2% of patients in the glucocorticoid withdrawal group and 67.8% of those in the immunosuppressant withdrawal group did not experience a flare. Among those who did, mild to moderate flares were most common. Damage accrual did not differ significantly between the two groups at maximum follow-up. Low baseline complement C3 levels were identified as a predictor of flares at both 52 weeks (hazard ratio [HR], 3.698; P = .012) and at maximum follow-up (HR, 3.785; P = .001). IN PRACTICE: 'Our results suggest that low-dose GCs [glucocorticoids], combined with HCQ [hydroxychloroquine], may be a viable long-term maintenance option for managing SLE patients in sustained remission,' the authors wrote. 'Based on our findings, it is evident that a one-size-fits-all approach to IS [immunosuppressant] or GC withdrawal may not be ideal. Instead, a personalized tapering approach considering patient risk profile, prior damage, and steroid exposure may help mitigate adverse events while maintaining disease control,' they added. SOURCE: This study was led by Aishwarya Gopal, MD, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India. It was published online on March 24, 2025, in Rheumatology . LIMITATIONS: This study had an open-label design and lacked a control arm that continued all medications. Adrenal insufficiency upon flares was not tested in patients who underwent steroid withdrawal. Remote access to glucocorticoids could not be ruled out. DISCLOSURES: This study received funding from Jawaharlal Institute of Postgraduate Medical Education and Research. The authors declared having no conflicts of interest.
