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Glucocorticoid therapy as first-line treatment in primary hypophysitis: a systematic review and individual patient data meta-analysis

OBJECTIVES: High-dose glucocorticoids are associated with improved recovery of deficits in primary autoimmune hypophysitis (PAH), but optimal dosing, route, and duration are unclear. DESIGN: We reviewed literature for first-line glucocorticoid treatment in PAH until December 2021 and performed an in...

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Autores principales: Krishnappa, Brijesh, Shah, Ravikumar, Memon, Saba Samad, Diwaker, Chakra, Lila, Anurag R, Patil, Virendra A, Shah, Nalini S, Bandgar, Tushar R
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9874965/
https://www.ncbi.nlm.nih.gov/pubmed/36445257
http://dx.doi.org/10.1530/EC-22-0311
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author Krishnappa, Brijesh
Shah, Ravikumar
Memon, Saba Samad
Diwaker, Chakra
Lila, Anurag R
Patil, Virendra A
Shah, Nalini S
Bandgar, Tushar R
author_facet Krishnappa, Brijesh
Shah, Ravikumar
Memon, Saba Samad
Diwaker, Chakra
Lila, Anurag R
Patil, Virendra A
Shah, Nalini S
Bandgar, Tushar R
author_sort Krishnappa, Brijesh
collection PubMed
description OBJECTIVES: High-dose glucocorticoids are associated with improved recovery of deficits in primary autoimmune hypophysitis (PAH), but optimal dosing, route, and duration are unclear. DESIGN: We reviewed literature for first-line glucocorticoid treatment in PAH until December 2021 and performed an individual patient data meta-analysis to analyze clinical, hormonal, and radiological outcomes with respect to route, dose, and duration (<6.5 vs 6.5–12 vs >12 weeks) of glucocorticoid treatment according to disease severity. RESULTS: A total of 153 PAH patients from 83 publications were included. The median age at presentation was 41 (32.5–48) years with a female preponderance (70.3%). Visual field recovery was significantly better with i.v. (91.7%) as compared to oral (54.5%) route and high dose (100%) and very high dose (90.9%) as compared to medium dose (20%) of glucocorticoids. Corticotroph axis recovery was greater in i.v. (54.8% vs 28.1% oral, P = 0.033) route and increasing glucocorticoid dose group (0% vs 38.1% vs 57.1%), attaining statistical significance (P = 0.012) with very high-dose. A longer duration of treatment (>6.5 weeks) was associated with better corticotroph and thyrotroph recovery. The need for rescue therapy was lower with i.v. route (38% vs 17.5%, P = 0.012) and with increasing glucocorticoid doses (53.3% vs 34.3% vs 17.3%, P = 0.016). In severe disease, visual field and corticotroph axis recovery were significantly higher with i.v. route and very high-dose steroids. The adverse effects of glucocorticoids were independent of dose and duration of treatment. CONCLUSIONS: Very high-dose glucocorticoids by i.v. route and cumulative longer duration (>6.5 weeks) lead to better outcomes and could be considered as first-line treatment of severe PAH cases.
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spelling pubmed-98749652023-02-06 Glucocorticoid therapy as first-line treatment in primary hypophysitis: a systematic review and individual patient data meta-analysis Krishnappa, Brijesh Shah, Ravikumar Memon, Saba Samad Diwaker, Chakra Lila, Anurag R Patil, Virendra A Shah, Nalini S Bandgar, Tushar R Endocr Connect Research OBJECTIVES: High-dose glucocorticoids are associated with improved recovery of deficits in primary autoimmune hypophysitis (PAH), but optimal dosing, route, and duration are unclear. DESIGN: We reviewed literature for first-line glucocorticoid treatment in PAH until December 2021 and performed an individual patient data meta-analysis to analyze clinical, hormonal, and radiological outcomes with respect to route, dose, and duration (<6.5 vs 6.5–12 vs >12 weeks) of glucocorticoid treatment according to disease severity. RESULTS: A total of 153 PAH patients from 83 publications were included. The median age at presentation was 41 (32.5–48) years with a female preponderance (70.3%). Visual field recovery was significantly better with i.v. (91.7%) as compared to oral (54.5%) route and high dose (100%) and very high dose (90.9%) as compared to medium dose (20%) of glucocorticoids. Corticotroph axis recovery was greater in i.v. (54.8% vs 28.1% oral, P = 0.033) route and increasing glucocorticoid dose group (0% vs 38.1% vs 57.1%), attaining statistical significance (P = 0.012) with very high-dose. A longer duration of treatment (>6.5 weeks) was associated with better corticotroph and thyrotroph recovery. The need for rescue therapy was lower with i.v. route (38% vs 17.5%, P = 0.012) and with increasing glucocorticoid doses (53.3% vs 34.3% vs 17.3%, P = 0.016). In severe disease, visual field and corticotroph axis recovery were significantly higher with i.v. route and very high-dose steroids. The adverse effects of glucocorticoids were independent of dose and duration of treatment. CONCLUSIONS: Very high-dose glucocorticoids by i.v. route and cumulative longer duration (>6.5 weeks) lead to better outcomes and could be considered as first-line treatment of severe PAH cases. Bioscientifica Ltd 2022-11-25 /pmc/articles/PMC9874965/ /pubmed/36445257 http://dx.doi.org/10.1530/EC-22-0311 Text en © The authors https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Research
Krishnappa, Brijesh
Shah, Ravikumar
Memon, Saba Samad
Diwaker, Chakra
Lila, Anurag R
Patil, Virendra A
Shah, Nalini S
Bandgar, Tushar R
Glucocorticoid therapy as first-line treatment in primary hypophysitis: a systematic review and individual patient data meta-analysis
title Glucocorticoid therapy as first-line treatment in primary hypophysitis: a systematic review and individual patient data meta-analysis
title_full Glucocorticoid therapy as first-line treatment in primary hypophysitis: a systematic review and individual patient data meta-analysis
title_fullStr Glucocorticoid therapy as first-line treatment in primary hypophysitis: a systematic review and individual patient data meta-analysis
title_full_unstemmed Glucocorticoid therapy as first-line treatment in primary hypophysitis: a systematic review and individual patient data meta-analysis
title_short Glucocorticoid therapy as first-line treatment in primary hypophysitis: a systematic review and individual patient data meta-analysis
title_sort glucocorticoid therapy as first-line treatment in primary hypophysitis: a systematic review and individual patient data meta-analysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9874965/
https://www.ncbi.nlm.nih.gov/pubmed/36445257
http://dx.doi.org/10.1530/EC-22-0311
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