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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 -
Arthritis & Rheumatology (Hoboken, N.J.) Aug 2021To evaluate the efficacy and safety of anakinra compared to triamcinolone in the treatment of gout flares. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To evaluate the efficacy and safety of anakinra compared to triamcinolone in the treatment of gout flares.
METHODS
Patients for whom nonsteroidal antiinflammatory drugs and colchicine were not suitable treatments were enrolled in this multicenter, randomized, double-blind study with follow-up for up to 2 years. The study was designed to assess superiority of anakinra (100 or 200 mg/day for 5 days) over triamcinolone (40 mg in a single injection) for the primary end point of changed patient-assessed pain intensity in the most affected joint (scored on a visual analog scale of 0-100) from baseline to 24-72 hours. Secondary outcome measures included: safety, immunogenicity, and patient- and physician-assessed global response.
RESULTS
One hundred sixty-five patients were randomized to receive anakinra (n = 110) or triamcinolone (n = 55). The median age was 55 years (range 25-83), 87% were men, the mean disease duration was 8.7 years, and the mean number of self-reported flares during the prior year was 4.5. A total of 301 flares were treated (214 with anakinra; 87 with triamcinolone). Anakinra in both doses and triamcinolone provided clinically meaningful reduction in patient-assessed pain intensity in the first and subsequent flares. For the first flare, the mean decline in pain intensity from baseline to 24-72 hours for total anakinra and triamcinolone was -41.2 and -39.4, respectively (P = 0.688). Anakinra performed better than triamcinolone for most secondary end points. There were no unexpected safety findings. The presence of antidrug antibodies was not associated with adverse events or altered pain reduction.
CONCLUSION
Anakinra was not superior to triamcinolone for the primary end point, but had comparable efficacy in pain reduction and was favored for most secondary end points. Anakinra is an effective option for gout flares when conventional therapy is unsuitable.
Topics: Adult; Aged; Aged, 80 and over; Arthralgia; Double-Blind Method; Female; Gout; Humans; Interleukin 1 Receptor Antagonist Protein; Male; Middle Aged; Pain Measurement; Patient Reported Outcome Measures; Symptom Flare Up; Treatment Outcome; Triamcinolone
PubMed: 33605029
DOI: 10.1002/art.41699 -
Nature Biomedical Engineering Oct 2022Hydrogels that provide mechanical support and sustainably release therapeutics have been used to treat tendon injuries. However, most hydrogels are insufficiently tough,...
Hydrogels that provide mechanical support and sustainably release therapeutics have been used to treat tendon injuries. However, most hydrogels are insufficiently tough, release drugs in bursts, and require cell infiltration or suturing to integrate with surrounding tissue. Here we report that a hydrogel serving as a high-capacity drug depot and combining a dissipative tough matrix on one side and a chitosan adhesive surface on the other side supports tendon gliding and strong adhesion (larger than 1,000 J m) to tendon on opposite surfaces of the hydrogel, as we show with porcine and human tendon preparations during cyclic-friction loadings. The hydrogel is biocompatible, strongly adheres to patellar, supraspinatus and Achilles tendons of live rats, boosted healing and reduced scar formation in a rat model of Achilles-tendon rupture, and sustainably released the corticosteroid triamcinolone acetonide in a rat model of patellar tendon injury, reducing inflammation, modulating chemokine secretion, recruiting tendon stem and progenitor cells, and promoting macrophage polarization to the M2 phenotype. Hydrogels with 'Janus' surfaces and sustained-drug-release functionality could be designed for a range of biomedical applications.
Topics: Rats; Humans; Swine; Animals; Hydrogels; Chitosan; Adhesives; Triamcinolone Acetonide; Tendon Injuries; Achilles Tendon; Chemokines
PubMed: 34980903
DOI: 10.1038/s41551-021-00810-0 -
BMJ (Clinical Research Ed.) Apr 2022To compare the clinical effectiveness of adding a single ultrasound guided intra-articular hip injection of corticosteroid and local anaesthetic to advice and education... (Randomized Controlled Trial)
Randomized Controlled Trial
Clinical effectiveness of one ultrasound guided intra-articular corticosteroid and local anaesthetic injection in addition to advice and education for hip osteoarthritis (HIT trial): single blind, parallel group, three arm, randomised controlled trial.
OBJECTIVE
To compare the clinical effectiveness of adding a single ultrasound guided intra-articular hip injection of corticosteroid and local anaesthetic to advice and education in adults with hip osteoarthritis.
DESIGN
Pragmatic, three arm, parallel group, single blind, randomised controlled trial.
SETTING
Two community musculoskeletal services in England.
PARTICIPANTS
199 adults aged ≥40 years with hip osteoarthritis and at least moderate pain: 67 were randomly assigned to receive advice and education (best current treatment (BCT)), 66 to BCT plus ultrasound guided injection of triamcinolone and lidocaine, and 66 to BCT plus ultrasound guided injection of lidocaine.
INTERVENTIONS
BCT alone, BCT plus ultrasound guided intra-articular hip injection of 40 mg triamcinolone acetonide and 4 mL 1% lidocaine hydrochloride, or BCT plus ultrasound guided intra-articular hip injection of 5 mL 1% lidocaine. Participants in the ultrasound guided arms were masked to the injection they received.
MAIN OUTCOME MEASURES
The primary outcome was self-reported current intensity of hip pain (0-10 Numerical Rating Scale) over six months. Outcomes were self-reported at two weeks and at two, four, and six months.
RESULTS
Mean age of the study sample was 62.8 years (standard deviation 10.0) and 113 (57%) were women. Average weighted follow-up rate across time points was 93%. Greater mean improvement in hip pain intensity over six months was reported with BCT plus ultrasound-triamcinolone-lidocaine compared with BCT: mean difference -1.43 (95% confidence interval -2.15 to -0.72), P<0.001; standardised mean difference -0.55 (-0.82 to -0.27). No difference in hip pain intensity over six months was reported between BCT plus ultrasound-triamcinolone-lidocaine compared with BCT plus ultrasound-lidocaine (-0.52 (-1.21 to 0.18)). The presence of ultrasound confirmed synovitis or effusion was associated with a significant interaction effect favouring BCT plus ultrasound-triamcinolone-lidocaine (-1.70 (-3.10 to -0.30)). One participant in the BCT plus ultrasound-triamcinolone-lidocaine group with a bioprosthetic aortic valve died from subacute bacterial endocarditis four months after the intervention, deemed possibly related to the trial treatment.
CONCLUSIONS
Ultrasound guided intra-articular hip injection of triamcinolone is a treatment option to add to BCT for people with hip osteoarthritis.
TRIAL REGISTRATION
EudraCT 2014-003412-37; ISRCTN50550256.
Topics: Adrenal Cortex Hormones; Adult; Anesthetics, Local; Arthralgia; Female; Humans; Injections, Intra-Articular; Lidocaine; Middle Aged; Osteoarthritis, Hip; Pain; Single-Blind Method; Treatment Outcome; Triamcinolone; Ultrasonography, Interventional
PubMed: 35387783
DOI: 10.1136/bmj-2021-068446 -
The Journal of Allergy and Clinical... Feb 2020Atopic dermatitis (AD) is a highly pruritic chronic inflammatory skin disorder. Ruxolitinib, a selective inhibitor of Janus kinase 1 and Janus kinase 2, potently... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Atopic dermatitis (AD) is a highly pruritic chronic inflammatory skin disorder. Ruxolitinib, a selective inhibitor of Janus kinase 1 and Janus kinase 2, potently suppresses cytokine signaling involved in AD pathogenesis.
OBJECTIVE
We sought to evaluate the efficacy and safety of ruxolitinib (RUX) cream in adults with AD.
METHODS
In this phase 2 study (NCT03011892), 307 adult patients with AD, an Investigator's Global Assessment score of 2 or 3 (mild or moderate), and 3% to 20% affected body surface area were equally randomized for 8 weeks of double-blind treatment to RUX (1.5% twice daily [BID], 1.5% once daily [QD], 0.5% QD, 0.15% QD), vehicle, or triamcinolone cream (0.1% BID for 4 weeks, then vehicle for 4 weeks). Subsequently, patients could apply 1.5% RUX BID for 4 additional weeks of open-label treatment. The primary end point was the comparison between 1.5% RUX cream BID and vehicle in mean percentage change from baseline in Eczema Area and Severity Index at week 4.
RESULTS
All RUX regimens demonstrated therapeutic benefit at week 4; 1.5% BID provided the greatest improvement in Eczema Area and Severity Index (71.6% vs 15.5%; P < .0001) and Investigator's Global Assessment responses (38.0% vs 7.7%; P < .001) versus vehicle. Rapid reductions in the itch numerical rating scale score occurred within 36 hours (1.5% BID vs vehicle, ‒1.8 vs ‒0.2; P < .0001) and were sustained through 12 weeks. Patients who transitioned to 1.5% RUX BID improved in all measures. RUX was not associated with clinically significant application-site reactions.
CONCLUSIONS
RUX cream provided rapid and sustained improvements in AD symptoms and was well tolerated.
Topics: Adult; Anti-Inflammatory Agents; Dermatitis, Atopic; Double-Blind Method; Female; Humans; Janus Kinase 1; Janus Kinase 2; Male; Middle Aged; Nitriles; Pyrazoles; Pyrimidines; Skin Cream; Triamcinolone
PubMed: 31629805
DOI: 10.1016/j.jaci.2019.08.042 -
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 -
BMJ (Clinical Research Ed.) Oct 2023To compare treatment effects between ultrasound guided lavage with corticosteroid injection and sham lavage with and without corticosteroid injection in patients with... (Randomized Controlled Trial)
Randomized Controlled Trial
Ultrasound guided lavage with corticosteroid injection versus sham lavage with and without corticosteroid injection for calcific tendinopathy of shoulder: randomised double blinded multi-arm study.
OBJECTIVE
To compare treatment effects between ultrasound guided lavage with corticosteroid injection and sham lavage with and without corticosteroid injection in patients with calcific tendinopathy of the shoulder.
DESIGN
Pragmatic, three arm, parallel group, double blinded, sham controlled, randomised, superiority trial with repeated measurements over 24 months.
SETTING
Six hospitals in Norway and Sweden.
PARTICIPANTS
220 adults with calcific tendinopathy of the shoulder, persistent for at least three months.
INTERVENTIONS
Ultrasound guided deposit lavage plus subacromial injection of 20 mg triamcinolone acetonide and 9 mL 1% lidocaine hydrochloride (lavage+steroid); sham lavage plus subacromial injection of 20 mg triamcinolone acetonide and 9 mL 1% lidocaine hydrochloride (sham lavage+steroid); or sham lavage plus subacromial injection of 10 mL 1% lidocaine hydrochloride (sham). All patients received a physiotherapeutic treatment regimen consisting of four home exercises.
MAIN OUTCOME MEASURES
The primary outcome was the result on the 48 point scale (0=worst; 48=best) of the Oxford Shoulder Score (OSS) at four month follow-up. Secondary outcomes included measurements on the short form of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) and of pain intensity up to 24 months. The influence of the size of the deposit at baseline and of the persistence or disappearance of the deposit was investigated.
RESULTS
Data from 218 (99%) participants were included in the primary analysis. Differences between groups on the OSS at four months were not significant: lavage+steroid versus sham 0.2 (95% confidence interval -2.3 to 2.8; P=1.0); sham lavage+steroid versus sham 2.0 (-0.5 to 4.6; P=0.35); lavage+steroid versus sham lavage+steroid -1.8 (-4.3 to 0.7; P=0.47). After four months, 143 patients with insufficient treatment effect received supplementary treatment. At 24 months, none of the study procedures was superior to sham. No serious adverse events were reported.
CONCLUSIONS
This study found no benefit for ultrasound guided lavage with a corticosteroid injection or for sham lavage with a corticosteroid injection compared with sham treatment in patients with calcific rotator cuff tendinopathy of the shoulder.
TRIAL REGISTRATION
NCT02419040EudraCT 2015-002343-34; Ethical committee Norway 2015-002343-34; Ethical committee Sweden 2015/79-31; Clinicaltrials.gov NCT02419040.
Topics: Adult; Humans; Shoulder; Triamcinolone Acetonide; Therapeutic Irrigation; Shoulder Pain; Ultrasonography, Interventional; Adrenal Cortex Hormones; Lidocaine; Tendinopathy; Treatment Outcome; Injections, Intra-Articular
PubMed: 37821122
DOI: 10.1136/bmj-2023-076447 -
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 -
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 -
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