Randomised controlled trial of long-term maintenance #corticosteroid therapy in patients with autoimmune #pancreatitis

http://m.gut.bmj.com/content/early/2016/08/19/gutjnl-2016-312049

Conclusions Maintenance corticosteroid therapy for 3 years may decrease relapses in patients with AIP compared with those who discontinued the therapy at 26 weeks.

Committee Opinion No.677: Antenatal #Corticosteroid Therapy for #Fetal Maturation

http://mobile.journals.lww.com/greenjournal/_layouts/15/oaks.journals.mobile/articleviewer.aspx?year=2016&issue=10000&article=00062

Continued surveillance of long-term outcomes after in utero corticosteroid exposure should be supported. Quality improvement strategies to optimize appropriate and timely antenatal corticosteroid administration are encouraged.

Should recommendations about starting inhaled #corticosteroid treatment for mild #asthma be based on symptom frequency: a post-hoc efficacy analysis of the START study

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31399-X/fulltext

In mild recent-onset asthma, once daily, low-dose budesonide decreases SARE risk, reduces lung function decline, and improves symptom control similarly across all symptom subgroups. The results do not support restriction of inhaled corticosteroids to patients with symptoms on more than 2 days per week and suggest that treatment recommendations for mild asthma should consider both risk reduction and symptoms.

High Frequency of Systemic #Corticosteroid Use for Acute #Respiratory Tract Illnesses in Ambulatory Settings

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2673299?redirect=true

Clinical practice guidelines do not recommend systemic steroids in the treatment of acute respiratory tract infections (ARTIs).1 While some studies have shown earlier symptom resolution with steroids given for pharyngitis,2 clinical trials show no efficacy of systemic steroids for sinusitis3 and bronchitis.4 Adverse events can develop within 30 days of short-term steroid use, which raises concern about the safety of systemic steroids for ARTIs.5 We conducted the present study to examine the frequency of steroid use for ARTIs in Louisiana and nationally and to examine factors associated with this clinical practice

Association of #Corticosteroid Treatment With Outcomes in Adult Patients With #Sepsis
A Systematic Review and Meta-analysis

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2719197

This meta-analysis included 37 RCTs (N = 9564 patients). Eleven trials were rated as low risk of bias. Corticosteroid use was associated with reduced 28-day mortality (RR, 0.90; 95% CI, 0.82-0.98; I2 = 27%) and intensive care unit (ICU) mortality (RR, 0.85; 95% CI, 0.77-0.94; I2 = 0%) and in-hospital mortality (RR, 0.88; 95% CI, 0.79-0.99; I2 = 38%). Corticosteroids were significantly associated with increased shock reversal at day 7 (MD, 1.95; 95% CI, 0.80-3.11) and vasopressor-free days (MD, 1.95; 95% CI, 0.80-3.11) and with ICU length of stay (MD, −1.16; 95% CI, −2.12 to −0.20), the sequential organ failure assessment score at day 7 (MD, −1.38; 95% CI, −1.87 to −0.89), and time to resolution of shock (MD, −1.35; 95% CI, −1.78 to −0.91). However, corticosteroid use was associated with increased risk of hyperglycemia (RR, 1.19; 95% CI, 1.08-1.30) and hypernatremia (RR, 1.57; 95% CI, 1.24-1.99).

Conclusions and Relevance The findings suggest that administration of corticosteroids is associated with reduced 28-day mortality compared with placebo use or standard supportive care. More research is needed to associate personalized medicine with the corticosteroid treatment to select suitable patients who are more likely to show a benefit.