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BMC Oral Health May 2022To compare the reported efficacy and costs of available interventions used for the management of oral lichen planus (OLP).
OBJECTIVE
To compare the reported efficacy and costs of available interventions used for the management of oral lichen planus (OLP).
MATERIALS AND METHODS
A systematic literature search was performed from database inception until March 2021 in MEDLINE via PubMed and the Cochrane library following PRISMA guidelines. Only randomized controlled trials (RCT) comparing an active intervention with placebo or different active interventions for OLP management were considered.
RESULTS
Seventy (70) RCTs were included. The majority of evidence suggested efficacy of topical steroids (dexamethasone, clobetasol, fluocinonide, triamcinolone), topical calcineurin inhibitors (tacrolimus, pimecrolimus, cyclosporine), topical retinoids, intra-lesional triamcinolone, aloe-vera gel, photodynamic therapy, and low-level laser therapies for OLP management. Based on the estimated cost per month and evidence for efficacy and side-effects, topical steroids (fluocinonide > dexamethasone > clobetasol > triamcinolone) appear to be more cost-effective than topical calcineurin inhibitors (tacrolimus > pimecrolimus > cyclosporine) followed by intra-lesional triamcinolone.
CONCLUSION
Of common treatment regimens for OLP, topical steroids appear to be the most economical and efficacious option followed by topical calcineurin inhibitors. Large-scale multi-modality, prospective trials in which head-to-head comparisons interventions are compared are required to definitely assess the cost-effectiveness of OLP treatments.
Topics: Administration, Topical; Calcineurin Inhibitors; Clobetasol; Cyclosporins; Dexamethasone; Fluocinonide; Health Care Costs; Humans; Lichen Planus, Oral; Steroids; Tacrolimus; Treatment Outcome; Triamcinolone
PubMed: 35524296
DOI: 10.1186/s12903-022-02168-4 -
BMC Musculoskeletal Disorders Apr 2023Lumbar herniated disc (HNP) is mainly treated by conservative management. Epidural steroid injection (ESI) has been an option to treat failed cases prior to surgery.... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Lumbar herniated disc (HNP) is mainly treated by conservative management. Epidural steroid injection (ESI) has been an option to treat failed cases prior to surgery. Triamcinolone has been widely used due to its efficacy in bringing about pain reduction for up to three months. However, several reports have shown some severe adverse events. Platelet-rich plasma (PRP) is made from blood through centrifugation. Several studies supported the potential short to long-term effects, and safety of PRP injection in treating HNP. The study objective was to evaluate the efficacy of PRP in treatment of single-level lumbar HNP in comparison to triamcinolone.
METHODS
Thirty patients were treated by transforaminal epidural injections. PRP was obtained from 24 ml venous blood through standardized double-spin protocol. Participants included fifteen patients each being in triamcinolone and PRP groups. The same postoperative protocols and medications were applied. The visual analogue scale of leg (LegVAS), collected at baseline, 2, 6, 12, and 24 weeks, was the primary outcome. The BackVAS, Oswestry Disability Index (ODI), adverse event, and treatment failure were the secondary endpoints.
RESULTS
Platelet ratio of PRP in fifteen patients was 2.86 ± 0.85. Patients treated by PRP injections showed statistically and clinically significant reduction in LegVAS at 6, 12, and 24 weeks, and in ODI at 24 weeks. It demonstrated comparable results on other aspects. No adverse event occurred in either group.
CONCLUSION
Noncommercial epidural double-spin PRP yielded superior results to triamcinolone. Due to its efficacy and safety, the procedure is recommended in treating single level lumbar HNP.
TRIAL REGISTRATION
NCT, NCT05234840. Registered 1 January 2019, https://clinicaltrials.gov/ct2/show/record/NCT05234840 .
Topics: Humans; Intervertebral Disc Displacement; Treatment Outcome; Pain; Triamcinolone; Injections, Epidural; Lumbar Vertebrae
PubMed: 37118707
DOI: 10.1186/s12891-023-06429-3 -
Drug Delivery and Translational Research Jun 2023Needle-free jet injectors are used for the intralesional treatment of various dermatological indications. However, a systematic review that evaluates the efficacy and... (Review)
Review
Needle-free jet injectors are used for the intralesional treatment of various dermatological indications. However, a systematic review that evaluates the efficacy and safety of these treatments has not been published. The objectives of this study are to evaluate the efficacy and safety of needle-free jet injections for dermatological indications and to provide evidence-based treatment recommendations. An electronic literature search was conducted in April 2022. Two reviewers independently selected studies based on predefined criteria and performed a methodological quality assessment using the Cochrane Collaborations risk-of-bias 2.0 assessment tool and Newcastle-Ottawa Scale. Thirty-seven articles were included, involving 1911 participants. Dermatological indications included scars, alopecia areata, hyperhidrosis, nail diseases, non-melanoma skin cancer, common warts, local anesthesia, and aesthetic indications. Keloids and other types of scars (hypertrophic, atrophic, and burn scars) were investigated most frequently (n = 7). The included studies reported favorable efficacy and safety outcomes for intralesional jet injector-assisted treatment with triamcinolone acetonide/hexacetonide, 5-fluorouracil, bleomycin, or hyaluronic acid. Two high-quality studies showed good efficacy and tolerability of intralesional jet injections with a combination of 5-fluorouracil and triamcinolone acetonide in hypertrophic scars and with saline in boxcar and rolling acne scars. No serious adverse reactions and good tolerability were reported in the included studies. Overall, the methodological quality of the included studies was low. Limited evidence suggests that needle-free jet injector-assisted intralesional treatment is efficacious and safe for hypertrophic and atrophic acne scars. More well-powered RCTs investigating the efficacy and safety of jet injector treatment in dermatology are warranted to make further evidence-based recommendations.
Topics: Humans; Triamcinolone Acetonide; Dermatology; Keloid; Fluorouracil; Acne Vulgaris; Treatment Outcome
PubMed: 36884194
DOI: 10.1007/s13346-023-01295-x -
Ophthalmologica. Journal International... 2011to provide an update on the intravitreal use of triamcinolone acetonide. (Review)
Review
BACKGROUND
to provide an update on the intravitreal use of triamcinolone acetonide.
METHODS
Review of literature regarding triamcinolone-related research.
RESULTS
after the introduction of bevacizumab and ranibizumab into clinical practice, intravitreal triamcinolone has lost its leading position as the drug most often injected intravitreally. Due to its properties as a long-acting steroid, triamcinolone has still been used for various conditions such as diffuse diabetic macular edema, retinal vein occlusions, pseudophakic cystoid macular edema, chronic prephthisical ocular hypotony and uveitis, and in combination with bevacizumab or ranibizumab. The complications of intravitreal triamcinolone therapy include secondary ocular hypertension in about 40% of the eyes injected, cataract and postoperative infectious or noninfectious endophthalmitis.
CONCLUSIONS
due to its widespread biological effects as a steroid and due to a relatively large therapeutic window, intravitreal triamcinolone has remained in clinical use for a variety of intraocular disorders, and it may be a promising candidate for intravitreal medical combination therapies.
Topics: Glucocorticoids; Humans; Intravitreal Injections; Ocular Hypertension; Ocular Hypotension; Retinal Diseases; Triamcinolone Acetonide
PubMed: 20693817
DOI: 10.1159/000317909 -
Journal of Ayub Medical College,... 2022Osteoarthritis is the most common chronic degenerative joint disease. Definite treatment of osteoarthritis is still undiscovered. This study was designed to evaluate and...
BACKGROUND
Osteoarthritis is the most common chronic degenerative joint disease. Definite treatment of osteoarthritis is still undiscovered. This study was designed to evaluate and compare the chondroprotective efficacy of piroxicam and triamcinolone in rat model of osteoarthritis.
METHODS
This laboratory based experimental study was conducted in Pharmacology Department, Army Medical College, Rawalpindi, from April-June 2019. Osteoarthritis was induced by medial meniscectomy and anterior cruciate ligament resection in knee joints of twenty-four rats. They were divided in three groups with eight rats in each. Group I, II and III were control, piroxicam and triamcinolone groups that were treated by intra articular saline, piroxicam and triamcinolone once weekly for four weeks respectively and then gait pattern was scored. Animals were euthanized thereafter and samples were taken for histopathological analysis.
RESULTS
Comparison of gait score of control, piroxicam and triamcinolone groups exhibited a p-value of <0.01. Intergroup comparison of gait of group I and II, group I and III and group II and IV depicted pvalue of <0.001,0.013 and 0.013 respectively. Likewise histopathological comparison of control, piroxicam and triamcinolone groups showed p-value of <0.01. While Intergroup histopathological comparison of group I and II, group I and III and group II and IV showed p-value of <0.001, <0.001 and 0.008 respectively.
CONCLUSION
Comparison of control group with treatment group proved chondroprotective efficacy of piroxicam and triamcinolone. On comparison of treatment groups, it was concluded that piroxicam has better chondroprotective efficacy as compared to triamcinolone.
Topics: Animals; Humans; Injections, Intra-Articular; Knee Joint; Osteoarthritis, Knee; Piroxicam; Rats; Triamcinolone
PubMed: 35466627
DOI: 10.55519/JAMC-01-8924 -
The American Journal of Sports Medicine Jul 2023The chondrotoxic effects of methylprednisolone acetate (MP) and triamcinolone acetonide (TA) have been well described. However, the mechanical effects of these commonly...
BACKGROUND
The chondrotoxic effects of methylprednisolone acetate (MP) and triamcinolone acetonide (TA) have been well described. However, the mechanical effects of these commonly used steroids on native cartilage are largely unknown.
PURPOSE
To investigate the in vitro effects of a single 1-hour MP or TA exposure on the viability, mechanics, and biochemical content of native articular cartilage explants.
STUDY DESIGN
Controlled laboratory study.
METHODS
Articular cartilage explants (n = 6 per group) were harvested from the femoral condyles of bovine stifles. Explants were exposed to chondrogenic medium containing a clinical dose of MP or TA for 1 hour, followed by fresh medium wash and exchange. Explants in the control group underwent the same treatment with chondrogenic medium alone. At 24 hours after treatment, samples were assessed for viability (live/dead), mechanical properties (creep indentation and Instron tensile testing), biochemical (collagen and glycosaminoglycan) content, and pyridinoline crosslinking via mass spectrometry.
RESULTS
Mean cell viability was significantly decreased in native explants exposed to MP (35.5%) compared with the control (49.8%; < .001) and TA (45.7%; = .01) specimens. Significant decreases were seen in the mechanical properties of steroid-treated native explants when compared with controls, with decreases in aggregate modulus (646.3 vs 312.8 kPa [MP] and 257.0 kPa [TA]; < .001), shear modulus (370.1 vs 191.2 kPa [MP] and 157.4 kPa [TA]; < .001), and ultimate tensile strength (9.650 vs 5.648 MPa [MP; = .021] and 6.065 MPa [TA; = .0403]). No significant differences in collagen and glycosaminoglycan content were found in the steroid-treated groups. Pyridinoline crosslinking was significantly decreased in explants exposed to TA compared with controls ( = .027).
CONCLUSION
Exposure of MP to articular cartilage explants was chondrotoxic, and exposure of articular cartilage explants to MP or TA resulted in significant decreases in mechanical properties of articular cartilage explants compared with controls. Clinicians should be judicious regarding use of intra-articular steroids, particularly in patients with intact healthy articular cartilage.
Topics: Humans; Animals; Cattle; Methylprednisolone; Triamcinolone; Cartilage, Articular; Triamcinolone Acetonide; Methylprednisolone Acetate; Glycosaminoglycans
PubMed: 37183987
DOI: 10.1177/03635465231162644 -
Drugs Sep 2022Triamcinolone acetonide injectable suspension for suprachoroidal use (Xipere; SCS triamcinolone acetonide) is a corticosteroid approved in the USA for the treatment of... (Review)
Review
Triamcinolone acetonide injectable suspension for suprachoroidal use (Xipere; SCS triamcinolone acetonide) is a corticosteroid approved in the USA for the treatment of macular edema associated with uveitis. Suprachoroidal injection of SCS triamcinolone acetonide results in preferential distribution into the posterior segment, which may reduce the risk of corticosteroid-related adverse events, such as cataracts and intraocular pressure (IOP) elevation. In a multicenter phase III trial in patients with non-infectious uveitic macular edema, SCS triamcinolone acetonide significantly and rapidly improved visual acuity and reduced signs of macular edema compared with sham treatment. SCS triamcinolone acetonide was generally well tolerated, with the most common adverse event being eye pain on the day of the procedure. The risk of corticosteroid-related IOP elevation appeared to be reduced in unrescued patients in the SCS triamcinolone acetonide group compared with patients in the sham control group who received rescue therapy. SCS triamcinolone acetonide is a novel and useful treatment option for uveitic macular edema.
Topics: Humans; Choroidal Effusions; Glucocorticoids; Intraocular Pressure; Macular Edema; Multicenter Studies as Topic; Tomography, Optical Coherence; Treatment Outcome; Triamcinolone Acetonide; Uveitis
PubMed: 36018461
DOI: 10.1007/s40265-022-01763-7 -
Dermatology Online Journal Dec 2018We present a case of necrobiosis lipoidica (NL) of the right abdomen in a 75-year-old man. A skin biopsy performed showed a layered infiltrate of mono and multinucleated...
We present a case of necrobiosis lipoidica (NL) of the right abdomen in a 75-year-old man. A skin biopsy performed showed a layered infiltrate of mono and multinucleated histiocytes palisaded around degenerated collagen bundles. Laboratory workup was unremarkable. The patient was treated with topical corticosteroids with cessation of progression of his disease, although the eruption did not resolve. There are a number of treatments for NL reported in the literature, all with varying efficacy. Although NL lesions are usually asymptomatic, patients with NL must be monitored closely for signs of ulceration or malignant transformation, in which case more aggressive treatment options may be warranted.
Topics: Administration, Cutaneous; Aged; Biopsy; Glucocorticoids; Histiocytes; Humans; Male; Necrobiosis Lipoidica; Skin; Triamcinolone
PubMed: 30677798
DOI: No ID Found -
Postgraduate Medical Journal Jan 1960
Topics: Humans; Triamcinolone
PubMed: 13850669
DOI: 10.1136/pgmj.36.411.23 -
Mediators of Inflammation 2012Sterile endophthalmitis appears as an infrequent complication of intravitreal injections and seems to develop mainly in the context of the off-label use of drugs that... (Review)
Review
Sterile endophthalmitis appears as an infrequent complication of intravitreal injections and seems to develop mainly in the context of the off-label use of drugs that have not been conceived for intravitreous administration. The aetiology of sterile endophthalmitis, independently of the administered drug, remains uncertain and a multifactorial origin cannot be discarded. Sterile inflammation secondary both to intravitreal triamcinolone acetonide and to intravitreal bevacizumab share many characteristics such as the acute and painless vision loss present in the big majority of the cases. Dense vitreous opacity is a common factor, while anterior segment inflammation appears to be mild to moderate. In eyes with sterile endophthalmitis, visual acuity improves progressively as the intraocular inflammation reduces without any specific treatment. If by any chance the ophthalmologist is not convinced by the sterile origin of the inflammation, this complication must be treated as an acute endophthalmitis because of the devastating visual prognosis of this intraocular infection in the absence of therapy.
Topics: Antibodies, Monoclonal, Humanized; Bevacizumab; Endophthalmitis; Humans; Inflammation; Intravitreal Injections; Off-Label Use; Triamcinolone
PubMed: 22973075
DOI: 10.1155/2012/928123