Steroid therapy for multiple sclerosis

The cause of multiple sclerosis(MS) is still obscure. However, recent therapy is making a dramatic progress. The steroid is traditional therapy, especially the common use of methylprednisolone in management of attacks of MS is based on high-dose intravenous methylprednisolone. This section are described steroid therapy of history(ACTH therapy, High-dose intravenous methylprednisolone therapy, ACTH therapy vs high-dose intravenous methylprednisolone therapy, and long term effects of steroid therapy), high-dose oral and intravenous methylprednisolone therapy, oral therapy after steroid pulse therapy and long term effects of steroid.     

Steroid therapy for Graves' ophthalmopathy

Glucocorticoids are usually given for management of Graves' ophthalmopathy (GO) for their anti-inflammatory and immunosuppressive effects. The overall rate of favorable response for moderately severe and active GO is 77% in patients treated with methylprednisolone iv pulse therapy. When radioiodine therapy is indicated for hyperthyroidism in Graves' patients with high risk factors, the use of glucocorticoid with small doses and short periods is recommended to prevent the development or progression of GO. Cushingoid features, glucose intolerance, gastritis, hypertension, hepatitis, and depression are major adverse effects of glucocorticoids. Fatal liver failure after high dose of pulse therapy (9-12g) was observed in 0.8%. Limiting the cumulative dose to 4.5-6g, assessment of liver virus markers and monitoring liver function before, during and after i.v. treatment are warranted.     

Steroid therapy in oncology

Corticosteroid is widely used in the clinical practice of malignant neoplasmas. Antitumor effect of corticosteroid is exceptional except lymphoproliferative disorders such as malignant lymphoma, acute lymphoblastic leukemia, and multiple myeloma. Standard regimens of these hematological disorders include corticosteroid as a chemotherapeutic agent. Chemotherapy for hematological and solid tumors always has many serious adverse effects. In these circumstance, corticosteroid is especially effective as antiemesis agent, anti-inflammatory agent, and anti-allergic drug. In addition, corticosteroid may provide some improvements of quality of life, pain, appetite, and performance status in terminal cancer patients. However, steroid has also many adverse effects. Careful use of corticosteroid should be considered in clinical oncology.     

Hyperbaric oxygenation in the combined therapy of infectious diseases]

Hypoxia plays an important role in pathogenesis of infectious diseases. Therefore, its correction is an essential factor in pathogenetic antibacterial treatment. Hyperbaric oxygenation (HBO) as a leading method in current antihypoxic therapy was studied in combined medication for typhoid, diphtheria, meningococcal infection, viral hepatitis. HBO sessions were given to 331 patients, 363 controls did not receive HBO. Utilization of HBO provided much better saturation of blood with oxygen, eliminated metabolic disorders, warranted favorable course and outcomes of the diseases.     

Steroid therapy of septic shock

Steroid therapy in patients with septic shock has been controversial for decades. Although treatment with high-doses of corticosteroids for patients with septic shock has been shown not to be beneficial, it was believed that therapy with low-doses would be helpful. Recent studies document that steroids are beneficial only in adult septic shock patients whose blood pressure is poorly responsive to fluid resuscitation and vasopressor therapy. For the majority of septic shock patients, corticosteroids should not be used, as the benefit of reversing shock is not worth the complications of superinfection, new sepsis, and septic shock. Finally, steroid therapy should not be guided by corticotropin test results.     

Steroid therapy for a case of severe drug-induced cholestasis

OBJECTIVE: To report a severe case of cholestatic liver disease successfully treated with corticosteroids following combined therapy with clarithromycin and nimesulide. CASE SUMMARY: A 15-year-old girl was admitted with cholestasis probably related to treatment with clarithromycin and nimesulide for an upper respiratory tract infection. Other causes of liver disease (infections, metabolic liver disorders, genetic cholestatic syndromes, autoimmune diseases, primary biliary tract disorders) were excluded. Liver biopsy showed a severe canalicular cholestasis with bile plugs in dilated bile canaliculi, giant cell transformation, and portal and lobular infiltrate. An objective causality assessment suggested that cholestasis was probably related to clarithromycin and/or nimesulide use. No benefit was derived from a course of ursodeoxycholic acid therapy. Since the patient experienced a progressive worsening in cholestasis, prednisone was started after 20 days. This therapy was promptly followed by improvement in clinical and laboratory test results. After 2 months of prednisone treatment, the patient became symptom-free with normal liver function tests. DISCUSSION: The manifestations of drug-induced hepatotoxicity are highly variable, ranging from asymptomatic hypertransaminemia to fulminant hepatic failure. No specific treatment for drug-induced hepatotoxicity exists. Early recognition and drug withdrawal are the keys to management of hepatotoxicity, but in some cases, liver disease may persist despite discontinuation of the drug. Possible advantages of corticosteroid therapy have not been well demonstrated. CONCLUSIONS: Application of the Naranjo probability scale indicates a probable relationship between cholestasis and nimesulide plus clarithromycin use. This case draws attention to a possible therapeutic option for some cases of drug-induced hepatotoxicity that show a severe course without any sign of improvement.