Corticosteroids

'getting it right first time' (GIRFT) in the management of COPD (2019)

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Type of publication:
Conference abstract

Author(s):
*Ahmad N.; *Crawford E.; *Srinivasan K.; *Moudgil H.

Citation:
Thorax; Dec 2019; vol. 74

Abstract:
Background GIRFT identifies medicine optimisation to improve efficiencies and cost savings. Reducing prescription of High dose inhaled corticosteroids (HD-ICS) in chronic obstructive pulmonary disease (COPD) helps improve patient care by reducing the incidence of pneumonia. A previous work carried out by this group showed an association between HD-ICS prescriptions and the incidence of pneumonia in COPD patients locally, at the primary care level (Ibrahim J et al,Thorax 2018;73:A114-A115). Following this work, a protected learning time event was held in October 2017 for the region's general practitioners to highlight the local COPD guidelines, role of community respiratory MDT and a protocol for weaning COPD patients from HD-ICS inhalers. Aim Primary aim was to demonstrate an achievement in cost savings from reduction in pneumonia admissions coupled with reduced HD-ICS prescriptions. Hence, we compared the incidence of pneumonia in COPD patients and HD-ICS prescriptions between April-September of 2017 (P1) and 2018 (P2) in the region of Telford and Wrekin clinical commissioning group. Method Data were obtained on all hospital admissions for pneumonia between April-September 2018 with a secondary diagnosis code J44 indicating COPD, from the information desk of the clinical commissioning group. For the purpose of comparison, we had the data from previous year for the same time period. We obtained data on HD-ICS prescriptions from openprescribing.net Results There were 97 pneumonia admissions in P2 v 123 in P1, thereby indicating an absolute reduction of 21%. The total cost of pneumonia admissions in P2 was 337,233 v 463,779 in P1, thereby achieving cost savings of 126,546 over a period of 6 months. There were 300 less HD-ICS prescriptions in the 14 general practices during P2 as compared to P1. 4 practices with the highest proportion of COPD patients, achieved most reductions in HD-ICS prescriptions (reduction by 281 prescriptions) and at the same time accounting for 32 less pneumonia admissions. Conclusion GIRFT objectives can be achieved through engagement with primary care. In this respect, it is important to achieve integration as we have done in our area. Our effort fully supports development of new care models to achieve efficiencies within the local health economy.

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Treatment of the first episode of childhood idiopathic nephrotic syndrome: A systematic review and meta-analysis (2015)

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Type of publication:
Conference abstract

Author(s):
Zolotas E., *Leontsinis I.

Citation:
Archives of Disease in Childhood, April 2015, vol./is. 100/(A208-A209)

Abstract:
Background and objective Corticosteroids induce remission in 80% of children with idiopathic nephrotic syndrome (INS). However 90% of steroid responders experience at least one relapse and 40% of them suffer from frequent relapses. The optimal treatment for the first episode of INS in terms of preventing subsequent relapses remains controversial. Methods We conducted a systematic review and meta-analysis of randomised controlled trials (RCT). We searched MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials without language restriction. We also searched proceedings from international conferences and we contacted investigators. We only included RCT which compared different regimens for the treatment of the first episode of INS in children. Results 26 RCT were included. Nine studies compared the classic two-month steroid regimen with prolonged steroid courses ranging from three to seven months. Meta-analysis of those studies showed no difference in the number of children with frequent relapses [RR: 0.79, 95% CI (0.57, 1.08)] (Figure 1) and number of relapses per patient [WMD: -0.37, 95% CI (-0.85, 0.1)]. Cumulative steroid dose was significantly higher with prolonged courses [SMD: 0.48 95% CI (0.16, 0.81)] (Figure 2). Eight studies compared three months with six months of steroid treatment. Similarly there was no difference in frequent relapses [RR: 0.63, 95% CI (0.36, 1.10)] (Figure 3) and relapses per patient [WMD: -0.32, 95% CI (-0.65, 0.00)]. Three RCT explored the potential benefit of adding cyclosporine, azithromycin or sarei-to, a Chinese herb, to steroids. Only sarei-to was showed to improve frequent relapses and number of relapses per patient. Conclusion This meta-analysis showed no sufficient evidence that prolonged steroid courses for the first episode of INS can prevent future relapses. The cumulative steroid dose was significantly higher with prolonged courses suggesting a potential for increased toxicity, even though the incidence of side effects was similar. In conclusion, the current evidence cannot support that prolongation of steroid treatment for the first episode of INS for more than two to three months is beneficial. Abbreviations RR relative risk, CI confidence intervals, WMD weighted mean difference, SMD standardised mean difference (Figure Presented).

Link to full-text: http://adc.bmj.com/content/100/Suppl_3/A208.2.full.pdf+html