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Background: A reliable alternative to steroids for treating polymyalgia rheumatica has not yet been identified. Although infliximab has been used occasionally in steroid-resistant cases, its efficacy has not been demonstrated in a controlled study. Objective: To compare the efficacy of prednisone plus infliximab with that of prednisone plus placebo in patients with newly diagnosed polymyalgia rheumatica. Design: Randomized, placebo-controlled trial. Setting: 7 rheumatology clinics in Italy. Patients: 51 patients with newly diagnosed polymyalgia rheumatica. Patients with associated giant cell arteritis and those who had been previously treated with steroids or biological or immunosuppressive agents were excluded. Intervention: Initial therapy with oral prednisone tapered from 15 mg/d to 0 mg/d over 16 weeks according to a standard protocol, plus infusions of placebo or infliximab, 3 mg/kg of body weight, at weeks 0, 2, 6, 14, and 22. Measurements: The primary efficacy end point was the proportion of patients without relapse or recurrence through week 52. Secondary outcomes were the proportion of patients no longer taking prednisone, the number of relapses and recurrences, the duration of prednisone therapy, and the cumulative prednisone dose. Results: Four patients (3 in the infliximab group and 1 in the placebo group) did not complete the trial. The proportion of patients who were free of relapse and recurrence at 52 weeks did not differ between groups (6 of 20 patients [30%] in the infliximal group vs. 10 of 27 patients [37%] in the placebo group; adjusted risk difference, -3 percentage points [95% CI, -31 to 24 percentage points]; P = 0.80). In a sensitivity analysis that included dropouts, the best-case scenario yielded a difference of 5 percentage points (CI, -21 to 31 percentage points) between the groups. The secondary outcomes at weeks 22 and 52 did not differ between the groups. Limitations: The study had a small sample and a short follow-up. A low dosage of infliximab was used, and the prednisone dosage was rapidly tapered. Conclusions: Although too small to be definitive, the trial provides evidence that adding infliximab to prednisone for treating newly diagnosed polymyalgia rheumatica is of no benefit and may be harmful. If there is benefit, it is unlikely to be large.

Rifampin is an enzymatic inducer known to increase steroid metabolism. We studied two patients with giant cell arteritis in whom rifampin caused nonresponsiveness to prednisone treatment. A prednisolone pharmacokinetics study was done. When rifampin-prednisone treatment must be used in giant cell arteritis, we propose increasing the prednisone dosage to 2 mg/kg per day.

PURPOSE: To determine the effect of prednisone dose and hydroxychloroquine dose on the coronary artery disease risk factors serum cholesterol level, mean arterial blood pressure, and weight in patients with systemic lupus erythematosus. PATIENTS AND METHODS: A longitudinal cohort study of 264 patients with systemic lupus erythematosus was conducted. For all patients in the cohort, serum cholesterol, mean arterial pressure, weight, prednisone dose, hydroxychloroquine dose, and other potential confounding variables were recorded at each visit. Regression analysis appropriate for longitudinal data was used to assess the effect of prednisone on serum cholesterol and mean arterial pressure. To assess the effect of prednisone on weight, patients' weights were compared 90 days before and after a 10-mg or 20-mg increase in prednisone. RESULTS: A total of 3,027 patient visits were analyzed. In the regression model for serum cholesterol, a change in prednisone dose of 10 mg was associated with a change in cholesterol of 7.5 [+ or -] 1.46 (SE) mg% after adjustment for the other significant variables in the model, including sex, race, hydroxychloroquine dose, and proteinuria. In the regression model for hydroxychloroquine, the 200-mg and the 400-mg dose were both associated with lower serum cholesterol (8.9 [+ or -] 3.44 SE mg%). In the regression model for mean arterial blood pressure, a 10-mg change in prednisone dose led to a change in mean arterial blood pressure of 1.1 mm Hg after adjustment for age, weight, and antihypertensive drug use. A 10-mg increase in prednisone dose was associated with a mean weight change of 5.50 [+ or -] 1.23 (SE) lb. CONCLUSIONS: Changes in prednisone dose led to definable changes in risk factors for coronary artery disease, even after adjustment for other variables known to affect these risk factors. According to longitudinal regression analysis, hydroxychloroquine therapy was associated with lower serum cholesterol.

Background. In a prospective randomized manner, this study evaluated the effect of adjuvant chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone; CHOP) in patients with Stage I non-Hodgkin lymphoma (NHL) who have achieved a complete response (CR) after radiation therapy (RT). Methods. Forty-four patients with clinical or pathologic Stage I intermediate-grade or low-grade NHL were randomized to receive regional RT alone (median dose, 40 Gy) or regional RT followed by six cycles of CHOP chemotherapy. There were no differences in clinical and pathologic characteristics between the two treatment groups. Results. The median follow-up was 7 years (range, 2-10 years). The actuarial relapse-free survival (RFS) rate for the RT plus CHOP group at 7 years was 83% compared with 47% (P < 0.03) for the RT-alone group. The overall survival (OS) for the two groups was 88% and 66%, respectively (P = 0.2). In patients with intermediate-grade NHL, the 7-year actuarial RFS for RT and CHOP was 86% compared with 20% for RT alone (P = 0.004). The corresponding actuarial survival rates were 92% and 47%, respectively (P = 0.08). In patients with low-grade histologic findings, the addition of adjuvant CHOP did not improve RFS (P = 0.6) or OS. All relapses in this study were at sides remote from the initially involved areas, and in 5 of 11 patients (45%), there were recurrences 5 years or longer after initial treatment. Conclusions. This study showed that adjuvant CHOP chemotherapy significantly improves RFS in patients with Stage I intermediate-grades NHL who achieve a CR after regional-field RT. The chemotherapeutic, regimen favorably affected their probability of survival. Cancer 1993; 71:2342-50.

The most commonly used steroids are the oral preparations prednisone and prednisolone, which treat a wide range of illnesses from autoimmune disease to allergies to eosinophilic granuloma complex, immune-mediated hemolytic [...]

Corticosteroids are used to treat a wide variety of diseases and disorders, including asthma and allergies, liver diseases, kidney diseases, adrenal gland diseases, skin diseases, blood diseases, breast cancer, and arthritis. It has been known for some time that treatment with corticosteroids can impair skeletal muscle function. Corticosteroids prevent protein from being made and at the same time they increase the catabolism (breakdown) of protein. This means that the body loses nitrogen and the skeletal muscle begins to atrophy or degenerate. This condition is called steroid myopathy, and it causes the muscles to become weak. To determine if treatment with corticosteroids affects the ribcage muscles which are used for breathing, 16 healthy patients were treated with prednisone or a placebo (a pill with no prednisone) for two weeks. The strength of the muscles that are used for inhaling and exhaling, the strength of the diaphragm muscles, and the endurance of the muscles used for inhaling were measured before and after drug treatment. There were no differences in the strength or performance of the ribcage muscles in the patients who were treated with prednisone and those who were not. It is concluded that short-term treatment with prednisone does not alter the strength or function of ribcage muscles used for breathing. (Consumer Summary produced by Reliance Medical Information, Inc.)

Human growth hormone (hGH) and prednisone cause insulin resistance and glucose intolerance. However, it is unknown whether hGH and prednisone antagonize insulin action on protein, fat, and carbohydrate metabolism by [...]

Docetaxel (Taxotere)-based chemotherapy (with prednisone) maintained long-term efficacy as a treatment for advanced (metastatic) hormone-resistant prostate cancer patients, according to the 3-year updated results of the landmark TAX 327 study. [...]

Objective: To evaluate the immunogenicity of the influenza virus vaccine in children receiving short-course (a burst) prednisone therapy for acute asthmatic exacerbations. Design: Prospective cohort study. Setting: Outpatient pediatric clinic of a military medical center. Patients: Children aged 6 months to 18 years requiring the 1996 influenza virus vaccine were eligible for the study. A total of 58 children were enrolled initially. The control group included 37 asthmatic children requiring less than 900 [micro]g/d of inhaled prednisone and their siblings. The prednisone group included 21 children vaccinated at the beginning of a course of prednisone prescribed to treat an asthma exacerbation. Thirty-one control subjects (84%) and 19 patients in the prednisone group (90%) completed the study. Dropout was due to failure to come in for the postvaccination serum sampling. Interventions: All study patients underwent immunization with the 1996-1997 trivalent subvirion influenza virus vaccine (FluShield; Wyeth Laboratories Inc, Marietta, Pa) containing 15-[micro]g hemagglutinin antigens each of A/Texas/36/91 (H1N1)(A/H1), A/Wuhan/359/95 (H3N2)(A/H3), and B/Beijing/184/93 (B). The prednisone cohort received a burst of oral prednisone therapy (2 mg/kg per day for 5 days). Main Outcome Measures: To assess the immunogenicity of the vaccine between both groups, at least a 4-fold rise in titer and end titers of at least 1:40 to each of the 3 antigens were compared. Mean changes in geometric titers to the 3 antigens were also compared. Results: Proportion of patients in each group with at least a 4-fold rise in titer to each of the influenza antigens was as follows: for A/H3N3 antigen, 15 patients (79%) in the prednisone group vs 22 controls (71%) (P = .74); for A/H1N1 antigen, 16 patients in the prednisone group (84%) vs 20 controls (64%) (P = .20); and for B antigen, 7 patients in the prednisone group (37%) vs 8 controls (26%) (P = .53). Proportion of patients in each group with an end titer of at least 1:40 to each of the antigens was as follows: for A/H3N2 antigen, 18 patients in the prednisone group (95%) vs 28 controls (90%) (P = .69); for A/H1N1 antigen, 17 patients in the prednisone group (89%) vs 26 controls (84%) (P = .99); and for B antigen, 7 patients in the prednisone group (37%) vs 13 controls (42%) (P = .99). There were also no significant differences between groups in the mean changes in geometric titers to any of the 3 antigens. Conclusions: Prednisone bursts did not diminish the response of asthmatic children to the 1996 influenza virus vaccine, compared with controls. Children can be effectively vaccinated against influenza virus while they are receiving prednisone therapy bursts for asthmatic exacerbations. Arch Pediatr Adolesc Med. 1998; 152:1191-1195, Inhaled prednisone in the treatment of acute asthma exacerbations does not appear to reduce the effectiveness of the influenza virus vaccine in children. Researchers compared the vaccine response in 19 children taking burst therapy with high-dose prednisone and 31 children taking a small maintenance dose of the drug for asthma. In 90-95% of vaccinated children, the vaccine effectively conferred immunity. The immunosuppressive drug did not alter the immunogenicity of the influenza vaccine.

A study was made on the effect of long-term low-dose prednisone therapy in postmenopausal rheumatoid arthritis (RA) patients in relation to vertebral osteoporosis. Seventy-four elderly RA patients of both sexes were treated with 10 mg/d of prednisone for at least 6 months. A control group of 44 patients were given anti-rheumatic drugs. Nonsteroidal anti-inflammatory drugs were administered to all patients as each patient underwent radiographs and bone scans. Significant differences were found between the two groups of women regarding cortical and trabecular bone mineral density and vertebral abnormalities.