-
Postepy Higieny I Medycyny... Jun 2013Methylprednisolone is a synthetic glucocorticoid with a potent and long-acting anti-inflammatory, antiallergic and immunosuppressant. Its mechanism of action of... (Review)
Review
Methylprednisolone is a synthetic glucocorticoid with a potent and long-acting anti-inflammatory, antiallergic and immunosuppressant. Its mechanism of action of methylprednisolone is the result of many cellular changes. Methylprednisolone is used in many diseases, such as rheumatic diseases, autoimmune diseases, allergic, anaphylactic shock, asthma. Methylprednisolone was also used in patients with spinal cord injury, in order to minimize neurological damage. While in the above mentioned fields of medicine is undeniable role of methylprednisolone, whereas its use in the treatment of traumatic spinal cord injury within the last few years raises a lot of controversy, and in most cases, the side effects of its use outweigh the potential benefits.
Topics: Animals; Anti-Inflammatory Agents; Glucocorticoids; Humans; Methylprednisolone; Muscular Diseases; Neuroprotective Agents; Spinal Cord Injuries
PubMed: 23800640
DOI: 10.5604/17322693.1054873 -
JAMA Network Open Oct 2021Local steroid injection is commonly used in treating patients with idiopathic carpal tunnel syndrome, but evidence regarding long-term efficacy is lacking. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Local steroid injection is commonly used in treating patients with idiopathic carpal tunnel syndrome, but evidence regarding long-term efficacy is lacking.
OBJECTIVE
To assess the long-term treatment effects of local steroid injection for carpal tunnel syndrome.
DESIGN, SETTING, AND PARTICIPANTS
This exploratory 5-year extended follow-up of a double-blind, placebo-controlled randomized clinical trial was conducted from November 2008 to March 2012 at a university hospital orthopedic department. Participants included patients aged 22 to 69 years with primary idiopathic carpal tunnel syndrome and no prior treatment with local steroid injections. Data were analyzed from May 2018 to August 2018.
INTERVENTIONS
Patients were randomized to injection of 80 mg methylprednisolone, 40 mg methylprednisolone, or saline.
MAIN OUTCOMES AND MEASURES
The coprimary outcomes were the symptom severity score and rate of subsequent carpal tunnel release surgery on the study hand at 5 years. Secondary outcomes were time from injection to surgical treatment, SF-36 bodily pain score, and score on the 11-item disabilities of the arm, shoulder, and hand scale.
RESULTS
A total of 111 participants (mean [SD] age at follow-up, 52.9 [11.6] years; 81 [73.0%] women and 30 [27.0%] men) were randomized, with 37 in the 80 mg methylprednisolone group, 37 in the 40 mg methylprednisolone group, and 37 in the saline placebo group. Complete 5-year follow-up data were obtained from all 111 participants with no dropouts (100% follow-up). At baseline, mean (SD) symptom severity scores were 2.93 (0.85) in the 80 mg methylprednisolone group, 3.13 (0.70) in the 40 mg methylprednisolone group, and 3.18 (0.75) in the placebo group, and at the 5-year follow up, mean (SD) symptom severity scores were 1.51 (0.66) in the 80 mg methylprednisolone group, 1.59 (0.63) in the 40 mg methylprednisolone group, and 1.67 (0.74) in the placebo group. Compared with placebo, there was no significant difference in mean change in symptom severity score from baseline to 5 years for the 80 mg methylprednisolone group (0.14 [95%CI, -0.17 to 0.45]) or the 40 mg methylprednisolone group (0.12 [95%CI, -0.19 to 0.43]). After injection, subsequent surgical treatment on the study hand was performed in 31 participants (83.8%) in the 80 mg methylprednisolone group, 34 participants (91.9%) in the 40 mg methylprednisolone group, and 36 participants (97.3%) in the placebo group; the number of participants who underwent surgical treatment between the 1-year and 5-year follow-ups was 4 participants (10.8%) in the 80 mg methylprednisolone group, 4 participants (10.8%) in the 40 mg methylprednisolone group, and 2 participants (5.4%) in the placebo group. All surgical procedures were conducted while participants and investigators were blinded to type of injection received. The mean (SD) time from injection to surgery was 180 (121) days in the 80 mg methylprednisolone group, 185 (125) days in the 40 mg methylprednisolone group, and 121 (88) days in the placebo group. Kaplan-Meier survival curves showed statistically significant difference in time to surgical treatment (log-rank test: 80 mg methylprednisolone vs placebo, P = .002 ; 40 mg methylprednisolone vs placebo, P = .02; methylprednisolone 80 mg vs 40 mg, P = .37).
CONCLUSIONS AND RELEVANCE
These findings suggest that in idiopathic carpal tunnel syndrome, local methylprednisolone injection resulted in statistically significant reduction in surgery rates and delay in need for surgery.
TRIAL REGISTRATION
ClinicalTrials.gov Identifiers: NCT00806871 and NCT02652390.
Topics: Adult; Aged; Anti-Inflammatory Agents; Carpal Tunnel Syndrome; Female; Follow-Up Studies; Humans; Injections; Kaplan-Meier Estimate; Male; Methylprednisolone; Middle Aged; Outcome Assessment, Health Care; Young Adult
PubMed: 34677593
DOI: 10.1001/jamanetworkopen.2021.30753 -
The Journal of Spinal Cord Medicine Nov 2022Recent studies revealed the neuroprotective effects of hyperbaric oxygen (HBO) on spinal cord injury (SCI). Meanwhile, the use of methylprednisolone (MP) is one of the...
OBJECTIVE
Recent studies revealed the neuroprotective effects of hyperbaric oxygen (HBO) on spinal cord injury (SCI). Meanwhile, the use of methylprednisolone (MP) is one of the current protocols with limited effects in SCI patients. Accordingly, the aim of the present study was to investigate the effect of combined HBO and MP treatment on SCI.
DESIGN
The present study was conducted on five groups of rats each as follows: Sham group (underwent laminectomy alone at T9 level vertebra); SCI group (underwent moderate contusive SCI); MP group (underwent SCI and received MP); HBO group (underwent SCI and received HBO); HBO + MP group (underwent SCI and simultaneously received MP and HBO). Blood serum and Spinal cord tissue samples were taken 48 h after SCI for analysis of serum ferric reducing antioxidant power (FRAP) and tissue malodialdehyde (MDA) levels as well as immunohistochemistry of caspase-3 and tumor necrosis factor-alpha (TNF-α). Neurological function was evaluated by the Basso-Beattie-Bresnehan (BBB) locomotion scores until the end of experiments. Additionally, histopathology was assessed at the end of the study.
SETTING
Mazandaran University of Medical Sciences, Sari, Iran.
RESULTS
Combination therapy with HBO and MP in the HBO + MP group significantly decreased MDA as well as increased FRAP levels compared to other treatment groups. Meanwhile, attenuated TNF-α and Caspase-3 expression could be significantly detected in the HBO + MP group. At the end of treatment, the neurological outcome was significantly improved and the extent of injured spinal tissue was also significantly reduced in the HBO + MP compared to other treatment groups.
CONCLUSION
The results suggest that combined therapy with MP and HBO has synergistic effects on SCI treatment.
Topics: Rats; Animals; Spinal Cord Injuries; Caspase 3; Neuroprotective Agents; Hyperbaric Oxygenation; Methylprednisolone; Tumor Necrosis Factor-alpha; Rats, Sprague-Dawley; Spinal Cord; Oxygen
PubMed: 33830902
DOI: 10.1080/10790268.2021.1896275 -
Archives of Biochemistry and Biophysics Oct 2023Acute kidney injury in sepsis patients has an extreme mortality rate in clinical. It obviously seems that immune cells, for example, macrophages are involved with this...
Acute kidney injury in sepsis patients has an extreme mortality rate in clinical. It obviously seems that immune cells, for example, macrophages are involved with this process. Macrophages, as highly important immune cells, play a significant role in the development of human kidney diseases. But the specific role of macrophages in this process is still unclear. Under different timeline points, we surprisingly found that macrophages had the most dynamic changes in acute kidney injury immune cells. Based on macrophages' functions, they are primarily classified into M1 macrophages (pro-inflammatory) and M2 macrophages (anti-inflammatory). The polarization of M2 macrophages is closely associated with the seriousness of sepsis-induced kidney injury, but how to modulate their polarization to alleviate sepsis-associated renal damage remains unknown. We discovered that the polarization of M2 macrophages after methylprednisolone injection can significantly alleviate acute kidney injury by reducing secreted cytokine. This study suggests that the proportion of macrophage subtypes can be regulated by methylprednisolone to alleviate acute kidney injury in sepsis to provide a new sight for a clinical to provide a promising strategy for renal injury caused.
Topics: Humans; Methylprednisolone; Kidney; Macrophages; Acute Kidney Injury; Sepsis
PubMed: 37696383
DOI: 10.1016/j.abb.2023.109738 -
Journal of Neurotrauma Mar 2016Previous meta-analyses of methylprednisolone (MPS) for patients with acute traumatic spinal cord injuries (TSCIs) have not addressed confidence in the quality of... (Meta-Analysis)
Meta-Analysis Review
Previous meta-analyses of methylprednisolone (MPS) for patients with acute traumatic spinal cord injuries (TSCIs) have not addressed confidence in the quality of evidence used for pooled effect estimates, and new primary studies have been recently published. We aimed to determine whether MPS improves motor recovery and is associated with increased risks for adverse events. We searched MEDLINE, EMBASE, and The Cochrane Library, and two reviewers independently screened articles, extracted data, and evaluated risk of bias. We pooled outcomes from randomized, controlled trials (RCTs) and controlled observational studies separately and used the Grades of Recommendation, Assessment, Development, and Evaluation approach to evaluate confidence. We included four RCTs and 17 observational studies. MPS was not associated with an increase in long-term motor score recovery (two RCTs: 335 participants; mean difference [MD], -1.11; 95% confidence interval [CI], -4.75 to 2.53; p = 0.55, low confidence; two observational studies: 528 participants; MD, 1.37; 95% CI, -3.08 to 5.83; p = 0.55, very low confidence) or improvement by at least one motor grade (three observational studies: 383 participants; risk ratio [RR], 0.84; 95% CI, 0.53-1.33; p = 0.46, very low confidence). Evidence from two RCTs demonstrated superior short-term motor score improvement if MPS was administered within 8 h of injury (two RCTs: 250 participants; MD, 4.46; 95% CI, 0.97-7.94; p = 0.01, low confidence), but risk of bias and imprecision limit confidence in these findings. Observational studies demonstrated a significantly increased risk for gastrointestinal bleeding (nine studies: 2857 participants; RR, 2.18; 95% CI, 1.13-4.19; p = 0.02, very low confidence), but RCTs did not. Pooled evidence does not demonstrate a significant long-term benefit for MPS in patients with acute TSCIs and suggests it may be associated with increased gastrointestinal bleeding. These findings support current guidelines against routine use, but strong recommendations are not warranted because confidence in the effect estimates is limited.
Topics: Acute Disease; Anti-Inflammatory Agents; Hemorrhage; Humans; Methylprednisolone; Randomized Controlled Trials as Topic; Recovery of Function; Spinal Cord Injuries; Treatment Outcome
PubMed: 26529320
DOI: 10.1089/neu.2015.4192 -
Medicina Clinica Feb 2023To compare the 30-day outcome (mortality and/or ICU admission) of patients admitted for moderate-severe SARS-CoV-2 pneumonia treated with dexamethasone after the...
OBJECTIVES
To compare the 30-day outcome (mortality and/or ICU admission) of patients admitted for moderate-severe SARS-CoV-2 pneumonia treated with dexamethasone after the Recovery study versus those treated with weight-adjusted methylprednisolone.
METHODS
Retrospective cohort study of 65 patients with moderate-severe pneumonia who received dexamethasone 6 mg/day (DXM group) versus 80 treated with weight-adjusted methylprednisolone (MTPN group).
RESULTS
Twenty-one (32.3%) patients in the DXM group died vs. 8 (10%) in the MTPN group (p-value < 0.001) and 29 (44.6%) in the DXM group required ICU admission vs. 2 (2.5%) of the MTPN group (p-value < 0.001). There were no baseline differences regarding sociodemographic characteristics with a higher mean qSOFA in the MTPN group. The hazard ratio for mortality and ICU admission adjusted for age, sex, and admission CRP was 2.189 (1.082-4.426; 95% CI) and 10.589 (2.139-48.347; 95% CI) for the DXM group, respectively, vs. MTPN group.
CONCLUSIONS
Mortality and admission to the ICU were lower in patients treated with weight-adjusted methylprednisolone compared to those treated with dexamethasone.
Topics: Humans; SARS-CoV-2; Methylprednisolone; COVID-19; Retrospective Studies; COVID-19 Drug Treatment; Dexamethasone
PubMed: 35987733
DOI: 10.1016/j.medcli.2022.06.015 -
MSystems Dec 2023The SARS-CoV-2 virus infection in humans induces significant inflammatory and systemic reactions and complications of which corticosteroids like methylprednisolone have...
The SARS-CoV-2 virus infection in humans induces significant inflammatory and systemic reactions and complications of which corticosteroids like methylprednisolone have been recommended as treatment. Our understanding of the metabolic and metabolomic pathway dysregulations while using intravenous corticosteroids in COVID-19 is limited. This study will help enlighten the metabolic and metabolomic pathway dysregulations underlying high daily doses of intravenous methylprednisolone in COVID-19 patients compared to those receiving placebo. The information on key metabolites and pathways identified in this study together with the crosstalk with the inflammation and biochemistry components may be used, in the future, to leverage the use of methylprednisolone in any future pandemics from the coronavirus family.
Topics: Humans; COVID-19; Methylprednisolone; SARS-CoV-2; Administration, Intravenous; Adrenal Cortex Hormones
PubMed: 37874139
DOI: 10.1128/msystems.00726-23 -
Journal of Ayub Medical College,... 2022Diphtheria remains an important cause of paediatric mortality in developing countries. The mortality rate is still 10% and has changed little over the past 20 years with...
BACKGROUND
Diphtheria remains an important cause of paediatric mortality in developing countries. The mortality rate is still 10% and has changed little over the past 20 years with particular reference to developed world. The objective of this study is to examine clinical spectrum of diphtheric cardiomyopathy and by using tools (serum markers, ECG, Echocardiography) to predict the cardiomyopathy and role of steroids in these predicted patients.
METHODS
For this cohort study, 67 patients having diphtheria presenting for the first time in a 3- year period were enrolled after obtaining informed verbal consent from the guardian of each child. Demographical profile, vaccination status, clinical spectrum, ECG interpretation and echocardiographic findings were recorded that predicted the occurrence of diphtheric cardiomyopathy and used intravenous methylprednisolone pulses in these predicted patients to look for their outcome regarding change in severity or the fate in the form of mortality.
RESULTS
Among the 67 enrolled children (M: F 2.3:1) with age ranging from 24 to 172 months (median 106 months), 56.7% subjects presented with diphtheria were non-vaccinated. 37.3% had a cardiac involvement in the form of diphtheria cardiomyopathy or arrhythmia.7.5% patient expired on follow up. Presence of septal paradoxes on echo had association with the cardiac involvement (OR 10.1: 95% CI 1.2-84.6; p=0.0005). IV methyl prednisolone was given in all 37.3% (n=25) patients predicted as diphtheric cardiomyopathy (Asymptomatic) and 88 %(n=22) had a favourable outcome with no morbidity and mortality. 12% (n=3) were expired and they presented with shock and VT as their first presentation (symptomatic). .
CONCLUSION
Early prediction by alone or in combination of ECG and echocardiographic markers and early use of IV methyl prednisolone in these predicted patients before symptoms, can reduce the mortality related to diphtheric cardiomyopathy and can decrease the burden of the disease in the community. Further randomized controlled trials with a larger sample size are required to unambiguously delineate the prognostic value of steroids in early predicted diphtheric cardiomyopathy.
Topics: Humans; Child; Methylprednisolone; Cohort Studies; Diphtheria; Cardiomyopathies; Echocardiography; Biomarkers
PubMed: 36414582
DOI: 10.55519/JAMC-03-S1-9613 -
The European Respiratory Journal Oct 2022Corticosteroids were the first drugs proven to reduce mortality in Covid-19. In June 2020, the RECOVERY group announced the results of their seminal trial showing...
Corticosteroids were the first drugs proven to reduce mortality in Covid-19. In June 2020, the RECOVERY group announced the results of their seminal trial showing dexamethasone 6 mg per day was able to reduce 28-day mortality in hospitalized patients with Covid needing supplemental oxygen or mechanical ventilation [1]. Meta-analysis from randomized controlled trials (RCT) in Covid-19 patients confirmed RECOVERY results [2]. In those RCTs, corticosteroid doses were low (dexamethasone 6 mg per day) or intermediate (dexamethasone up to 20mg per day).
Topics: Humans; COVID-19; Methylprednisolone; Double-Blind Method; Adrenal Cortex Hormones; SARS-CoV-2
PubMed: 35777764
DOI: 10.1183/13993003.01220-2022 -
Scientific Reports Jul 2023Methylprednisolone sodium succinate (MPSS) is a parenteral water-soluble corticosteroid ester. It gives three peaks methylprednisolone (MP), 17-methylprednisolone...
Methylprednisolone sodium succinate (MPSS) is a parenteral water-soluble corticosteroid ester. It gives three peaks methylprednisolone (MP), 17-methylprednisolone hemisuccinate (17-MPHS), and methylprednisolone hemisuccinate (MPHS) that share in the assay determination as total MP. It is used on a wide scale in prescribed anti-inflammatory drugs as a common use. The current study aimed to find a rapid RP-HPLC method of MP and its derivatives analysis with high linearity, repeatability, sensitivity, selectivity, and inexpensive to use without the need for any special chemical reagents. The use of the current method achieved a satisfactory result to detect, determine and separate the MP, 17-MPHS, and MPHS in a short time. The chromatographic system consists of RP-HPLC using the BDS column (250 mm × 4.6 mm × 5 μm). The mobile phase was prepared by mixing the WFI: glacial acetic acid: acetonitrile in a volume ratio (63:2:35) at a flow rate of 2.0 mL/min with detection wavelength at 254 nm at room temperature and injection volume 20 μL. The method manifested a satisfied linearity regression R (0.9998-0.99999) with LOD 143.97 ng/mL and 4.49 µg/mL; and LOQ 436.27 ng/mL and 13.61 µg/mL for MP and MPHS respectively. The method proved its efficiency via system suitability achievement in the robustness and ruggedness conduction according to the validation guidelines. High sensitivity according to its LOD and LOQ. So, the current method could be considered in the pharmaceutical industry. The suggested method has been successfully implemented in the Egyptian local market for the quantitative assessment of the assay of the finished product.
Topics: Methylprednisolone; Methylprednisolone Hemisuccinate; Chromatography, High Pressure Liquid; Anti-Inflammatory Agents; Egypt
PubMed: 37460790
DOI: 10.1038/s41598-023-38539-2