Steroid sparing agents

Lucky, A.W., Leach, A.D., Laskarzewski, P., and Wenck, H. Use of an emollient as a steroid-sparing agent in the treatment of mild to moderate atopic dermatitis in children. Pediatr. Dermatol. 1997 14 321-4. 

Azathioprine is effective as a steroid sparing agent in maintenance therapy of Crohn s disease. Use of... 

More usually now, megadose pulses (methylprednisolone 1.0 g i.v. daily for 3 days) are used, followed by oral maintenance with prednisolone and/or a steroid-sparing agent (above). 

The use of MTX has been almost exclusively for sarcoidosis. It has been a useful steroid-sparing agent for chronic pulmonary disease (9,10) and exhibits steroidsparing effects in acute pulmonary sarcoidosis (35). While widely used to treat RA, there is no evidence to suggest that MTX prevents or treats RA-associated pulmonary fibrosis. 

Kouba DJ, Mimouni D, Rencic A, et al. Mycophenolate mofetil may serve as a steroid-sparing agent for sarcoidosis. Br J Dermatol 2003 148 147 148. 

Li J, Kelly R. Treatment of pyoderma gangrenosum with mycophenolate mofetil as a steroid-sparing agent J Am Acad Dermatol October... 

For sarcoidosis, early studies by Dr. Harold Israel demonstrated the steroid-sparing properties of various cytotoxic agents such as methotrexate (MTX),... 

However, in a dose-escalation trial, thalidomide was ineffective in a cohort of 12 patients with pulmonary symptoms (310). In a trial of pulmonary sarcoidosis, thalidomide exhibited limited steroid-sparing benefit and no improvement in pulmonary lung function (318). Thalidomide is extremely teratogenic and use of the agent requires careful monitoring in both male and female patients. Thalidomide causes somnolence, constipation, and peripheral neuropathy in a significant number of patients (310). These side effects are dose dependent and may explain why thalidomide is not as useful for extracutaneous disease (318). 

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