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Perfusion Sep 2020Methylprednisolone has been used for acute respiratory distress syndrome with variable results. Veno-venous extracorporeal membrane oxygenation use in acute respiratory...
INTRODUCTION
Methylprednisolone has been used for acute respiratory distress syndrome with variable results. Veno-venous extracorporeal membrane oxygenation use in acute respiratory distress syndrome has increased. Occasionally, both are used. We hypothesized that methylprednisolone could improve lung compliance and ease weaning from extracorporeal membrane oxygenation in acute respiratory distress syndrome patients.
METHODS
We retrospectively reviewed all patients in our veno-venous extracorporeal membrane oxygenation unit treated with methylprednisolone over a 20 month period. Methylprednisolone was initiated for inability to wean off veno-venous extracorporeal membrane oxygenation. Dynamic compliance (Cdyn) was calculated at cannulation, methylprednisolone initiation, and decannulation. Demographics, extracorporeal membrane oxygenation-specific data, and ventilator data were collected. Wilcoxon rank-sum test was used to test for differences in dynamic compliance.
RESULTS
A total of 12 veno-venous extracorporeal membrane oxygenation patients received methylprednisolone. Mean age was 50 (±15) years. Seven had influenza. Methylprednisolone was started on median Day 16 (interquartile range: 11-22) of veno-venous extracorporeal membrane oxygenation. In total, 10 patients had veno-venous extracorporeal membrane oxygenation decannulation on median Day 12 (7-22) after methylprednisolone initiation. Two patients died before decannulation. The 10 decannulated patients had initial median dynamic compliance (mL × cm HO) of 12 (7-23), then 16 (10-24) at methylprednisolone initiation, and then 44 (34-60) at decannulation. Dynamic compliance was higher at decannulation than methylprednisolone initiation (p = 0.002), and unchanged from cannulation to methylprednisolone initiation for all patients (p = 0.97). A total of 10 patients had significant infections. None had significant gastrointestinal bleed or wound healing issues.
CONCLUSION
Methylprednisolone may be associated with improved compliance in acute respiratory distress syndrome allowing for decannulation from veno-venous extracorporeal membrane oxygenation. High rates of infection are associated with methylprednisolone use in veno-venous extracorporeal membrane oxygenation. Further studies are required to identify appropriate patient selection for methylprednisolone use in patients on veno-venous extracorporeal membrane oxygenation.
Topics: Extracorporeal Membrane Oxygenation; Female; Humans; Male; Methylprednisolone; Middle Aged; Respiratory Distress Syndrome; Retrospective Studies
PubMed: 32072859
DOI: 10.1177/0267659120906044 -
The Canadian Journal of Cardiology Nov 1990Myocardial infarction is a dynamic evolutionary process which can progress over a relatively prolonged interval after its onset. The ultimate extent of damage depends on... (Clinical Trial)
Clinical Trial Review
Myocardial infarction is a dynamic evolutionary process which can progress over a relatively prolonged interval after its onset. The ultimate extent of damage depends on coronary artery anatomy, the balance between myocardial oxygen supply and demand, and metabolic modulators of myocardial injury. The possibility that methylprednisolone, a synthetic anti-inflammatory corticosteroid, may exert a beneficial effect on ischemic myocardium has been studied in both animal models and patients. However, the results of these experimental and clinical investigations have been controversial, in that some have demonstrated efficacy of the drug to limit extension of evolving myocardial infarction, while others have not. The effects of dose regimen and duration of methylprednisolone administration on preservation of myocardium and infarct size remain unclear, especially in clinical studies. The problem resides in the large interindividual variations among patients in degree and distribution of coronary disease, concomitant drugs, the accuracy of techniques for measuring and monitoring changes in myocardial infarct size, and the small numbers of patients involved in the majority of these studies. The absence of clarity will continue to cast doubts over the use of methylprednisolone until its marked beneficial effects can be significantly demonstrated.
Topics: Animals; Heart Rupture, Post-Infarction; Humans; Methylprednisolone; Myocardial Infarction
PubMed: 2276078
DOI: No ID Found -
Biomaterials May 2009Systemic administration of a high-dose of Methylprednisolone (MP) can reduce neurological deficits after acute spinal cord injury (SCI). However, the use of high-dose MP... (Review)
Review
Systemic administration of a high-dose of Methylprednisolone (MP) can reduce neurological deficits after acute spinal cord injury (SCI). However, the use of high-dose MP in treating acute SCI is controversial due to significant dose related side effects and relatively modest improvements in neurological function. Here, using a rat model of SCI, we compare the efficacy of controlled, nanoparticle-enabled local delivery of MP to the injured spinal cord with systemic delivery of MP, and a single local injection of MP without nanoparticles. Based on histological and behavioral data, we report that local, sustained delivery of MP via nanoparticles is significantly more effective than systemic delivery. Relative to systemic delivery, MP-nanoparticle therapy significantly reduced lesion volume and improved behavioral outcomes. Nanoparticle-enabled delivery of MP presents an effective method for introducing MP locally after SCI and significantly enhances therapeutic effectiveness compared to bare MP administered either systemically or locally.
Topics: Animals; Behavior, Animal; Biomarkers; Drug Delivery Systems; Male; Methylprednisolone; Microscopy, Electron, Scanning; Nanoparticles; Rats; Rats, Sprague-Dawley; Spinal Cord Injuries; Time Factors
PubMed: 19185913
DOI: 10.1016/j.biomaterials.2008.12.077 -
Journal of Controlled Release :... Aug 2023A new method of transdural delivering drugs to the spinal cord has been developed, involving the use of microneedles (MNs) and a β-cyclodextrin metal-organic framework...
A new method of transdural delivering drugs to the spinal cord has been developed, involving the use of microneedles (MNs) and a β-cyclodextrin metal-organic framework (CD-MOF). This epidural microneedle array, dubbed MNs@CD-MOF@MPSS, can be utilized to deliver methylprednisolone sodium succinate (MPSS) to the site of spinal cord injury (SCI) in a controlled manner. MNs allows to generate micropores in the dura for direct drug delivery to the spinal cord, overcoming tissue barriers and targeting damaged regions. Additionally, the CD-MOF provides a secondary extended release after separating from the MNs. In in vitro study, inward MNs increased cellular absorption of MPSS and then reduced LPS-induced M1 polarization of microglia. And animal studies have shown that this method of drug delivery results in improved BMS scores and a reduction in M1 phenotype microphage and glial scar formation. Furthermore, the downregulation of the NLRP3-positive inflammasome and related pro-inflammatory cytokines was observed. In conclusion, this new drug platform has potential for clinical application in spinal cord diseases and is a valuable composite for minimally transdural controlled drug delivery. STATEMENT OF SIGNIFICANCE: This research presents a new epidural microneedle patch made up of microneedles (MNs) and a β-cyclodextrin metal-organic framework (CD-MOF). The epidural microneedle patch boasts high drug loading capacity, the ability to penetrate the dura, and controlled release. When loaded with methylprednisolone sodium succinate (MPSS), it effectively reduces inflammation and improves neurological function after spinal cord injury. Therefore, it is a novel and promising drug platform for the treatment of spinal cord diseases in a clinical setting.
Topics: Animals; Methylprednisolone Hemisuccinate; Metal-Organic Frameworks; Cyclodextrins; Delayed-Action Preparations; Spinal Cord Injuries; Spinal Cord; beta-Cyclodextrins; Methylprednisolone
PubMed: 37355211
DOI: 10.1016/j.jconrel.2023.06.028 -
Journal of the European Academy of... Mar 2011Although emollients can be sufficient to manage mild atopic dermatitis (AD), acute flares resulting in moderate-to-severe symptoms require treatment with... (Review)
Review
Although emollients can be sufficient to manage mild atopic dermatitis (AD), acute flares resulting in moderate-to-severe symptoms require treatment with anti-inflammatory agents, such as topical corticosteroids (TCs) and topical calcineurin inhibitors (TCIs). This review examines the role of a member of the newest class of TCs, the fourth-generation compound methylprednisolone aceponate (MPA) in AD management, with reference to the chemical structure, pharmacokinetics, efficacy in AD, safety assessed in preclinical and clinical trials and dosing considerations. MPA has an optimized efficacy/safety profile with minimal local or systemic adverse effects. In addition, it offers the opportunity for once-daily dosing, which provides benefits in terms of patient compliance with treatment.
Topics: Anti-Inflammatory Agents; Dermatitis, Atopic; Dose-Response Relationship, Drug; Emollients; Humans; Methylprednisolone; Treatment Outcome
PubMed: 21294777
DOI: 10.1111/j.1468-3083.2010.03789.x -
International Journal of Molecular... Mar 2020Methylprednisolone (MP) is often used in the treatment of various kidney diseases, but overcoming the systemic side effects caused by its nonspecific distribution in the...
Methylprednisolone (MP) is often used in the treatment of various kidney diseases, but overcoming the systemic side effects caused by its nonspecific distribution in the body is a challenge. This article reports the design, synthesis, and renal targeting of methylprednisolone-lysozyme (MPS-LZM). This conjugate was obtained by covalently linking MP with the renal targeting carrier LZM through a linker containing an ester bond, which could utilize the renal targeting of LZM to deliver MP to renal proximal tubular epithelial cells and effectively release MP. The reaction conditions for the preparation of the conjugate were mild, and the quality was controllable. The number of drug payloads per LZM was 1.1. Cell-level studies have demonstrated the safety and endocytosis of the conjugate. Further pharmacokinetic experiments confirmed that, compared with that of free MP, the conjugate increased the renal exposure (AUC) of active MP from 17.59 to 242.18 h*ng/mL, and the targeting efficiency improved by approximately 14 times. Tissue and organ imaging further revealed that the conjugate could reach the kidneys quickly, and fluorescence could be detected in the kidneys for up to 12 h. This study preliminarily validates the feasibility of a renal targeting design strategy for MPS-LZM, which is expected to provide a new option for improving kidney-specific distribution of glucocorticoids.
Topics: Animals; Cells, Cultured; Drug Design; Humans; Kidney; Male; Methylprednisolone; Mice; Muramidase; Organ Specificity
PubMed: 32168938
DOI: 10.3390/ijms21061922 -
Veterinary Dermatology Aug 2021
Topics: Animals; Cat Diseases; Cats; Dermatitis; Hypersensitivity; Methylprednisolone; Methylprednisolone Acetate
PubMed: 34184779
DOI: 10.1111/vde.13000 -
Musculoskeletal Care Dec 2016The use of an intra-articular methylprednisolone acetate (MPA) injection has been shown to have benefits for symptoms of knee osteoarthritis (OA). However,... (Review)
Review
Therapeutic Review of Methylprednisolone Acetate Intra-Articular Injection in the Management of Osteoarthritis of the Knee - Part 2: Clinical and Procedural Considerations.
The use of an intra-articular methylprednisolone acetate (MPA) injection has been shown to have benefits for symptoms of knee osteoarthritis (OA). However, considerations beyond drug efficacy can influence the appropriateness, clinical effectiveness and potential harm of an injection. A review of research evidence and published literature on clinical and procedural factors influencing the effectiveness and safety of a knee injection has been undertaken. Factors include dose, frequency, contraindications, precautions, drug interactions, side-effects, and procedural and patient-related considerations. An evaluation of evidence indicated that a 40 mg dose provides clinical benefit. No strong predictors of response were evident, with the exception of pain severity. Additional benefit for outcomes from higher doses, local anaesthetic, ultrasound guidance or particular anatomical approaches is yet to be demonstrated. Evidence for dose- and duration-related detrimental effects suggests judicious use and frequency. The evaluation showed that there are a number of contraindications and precautions arising from the drug pharmacology, concurrent medications, comorbidities and adverse events which need consideration and monitoring. There was limited safety evidence concerning anticoagulation. The review found that specialist guidance and limited evidence suggests that injection safety concerning warfarin may be enhanced by ensuring that the international normalized ratio level is within therapeutic range. However, the risk-benefit evaluation concerning non vitamin K antagonist oral anticoagulants remains challenging. Although there is published guidance, a lack of clinical studies, safety evidence and reversibility advocates caution. Overall, the review indicates that injection decisions and procedures need an individualized approach and supporting evidence is limited in many areas. Evaluation and discussion of benefits and risks, peri-procedural and post-injection management, and tailoring to the context and individuals' preferences are important in optimizing the benefits and safety of a knee injection.
Topics: Anesthesia, Local; Anti-Inflammatory Agents; Anticoagulants; Contraindications; Drug Interactions; Humans; Injections, Intra-Articular; Methylprednisolone; Methylprednisolone Acetate; Osteoarthritis, Knee
PubMed: 27297723
DOI: 10.1002/msc.1145 -
Anesthesia and Analgesia May 2014Methylprednisolone acetate (MPA) has a long history of use in the treatment of sciatic pain and other neuropathic pain syndromes. In several of these syndromes, MPA is... (Review)
Review
Methylprednisolone acetate (MPA) has a long history of use in the treatment of sciatic pain and other neuropathic pain syndromes. In several of these syndromes, MPA is administered in the epidural space. On a limited basis, MPA has also been injected intrathecally in patients suffering from postherpetic neuralgia and complex regional pain syndrome. The reports on efficacy of intrathecal administration of MPA in neuropathic pain patients are contradictory, and safety is debated. In this review, we broadly consider mechanisms whereby glucocorticoids exert their action on spinal cascades relevant to the pain arising after nerve injury and inflammation. We then focus on the characteristics of the actions of MPA in pharmacokinetics, efficacy, and safety when administered in the intrathecal space.
Topics: Anti-Inflammatory Agents; Drug Resistance; Female; Gene Expression; Glucocorticoids; Humans; Inflammation; Injections, Spinal; Male; Methylprednisolone; Methylprednisolone Acetate; Neuralgia; Sex Characteristics; Transcriptional Activation
PubMed: 24781577
DOI: 10.1213/ANE.0000000000000161 -
Journal of Pediatric Hematology/oncology Dec 2007
Topics: Anemia; Dose-Response Relationship, Drug; Drug Administration Schedule; Hematologic Diseases; Humans; Methylprednisolone
PubMed: 18090943
DOI: 10.1097/MPH.0b013e318159ebcd