(9R)-9-chloro-11-17-dihydroxy-17-(2-hydroxy-1-oxoethyl)-10-13-16-trimethyl-6-7-8-11-12-14-15-16-octahydrocyclopenta[a]phenanthren-3-one and Cataract

The risk of cataracts associated with the long-term use of inhaled corticosteroids (ICS) is poorly recognized, yet may be of major public health importance. The aim of this study was to determine the dose-response relationship of ICS use and risk of cataracts in adults.. A systematic review and meta-analysis was performed of case-control studies of cataracts and ICS use, which included at least two doses of ICS and in which the number of cases and controls using each dose of ICS was reported. The primary outcome variable was risk of cataracts.. Four case-control studies were identified, with a total of 46 638 cases and 146 378 controls. There was a significant relationship between the risk of cataracts and ICS dose, with a random effects pooled odds ratio for risk of cataracts per 1000 microg increase in daily beclomethasone dipropionate dose of 1.25 (95% CI: 1.14-1.37).. The risk of cataracts was increased by approximately 25% for each 1000 microg per day increase in the dose of beclomethasone dipropionate or equivalent. These findings reinforce the importance of prescribing within the therapeutic dose-response range for ICS in asthma and the need to determine the dose-response relationship for the efficacy of ICS in COPD. Screening for the presence of cataracts could usefully be undertaken in older subjects with asthma and COPD, particularly current or ex-smokers.

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Asthma; Beclomethasone; Cataract; Dose-Response Relationship, Drug; Humans; Pulmonary Disease, Chronic Obstructive; Risk Factors

Topics: Administration, Inhalation; Adrenal Glands; Adult; Anti-Asthmatic Agents; Asthma; Beclomethasone; Budesonide; Cataract; Child; Drug Administration Schedule; Humans; Randomized Controlled Trials as Topic; Skin

Inhaled corticosteroids (ICS) are mainstay in controlling the symptoms of asthma. Previous studies have demonstrated that ICS have minimal systemic effects, at doses of up to 400 micrograms per day for children and up to 1000 micrograms per day for adults. At higher doses some systemic effects can be seen. But to date there is no convincing evidence that this gives rise to any of the well known clinical sequelae of corticosteroid excess. To determine the dosage of ICS, it is important to weigh up the potential benefits and risks in each patient. The use of spacer devices and mouth rinsing may reduce local and systemic adverse effects.

Topics: Administration, Inhalation; Adult; Anti-Inflammatory Agents; Beclomethasone; Bone Density; Cataract; Child; Child Development; Glycolipids; Humans; Hypothalamo-Hypophyseal System; Pituitary-Adrenal System; Skin Diseases

From the experience above, it may be concluded that corticosteroid therapy in allergic disease has become more effective than ever before. The expected variations in usage of new important pharmacologic agents is seen with special clarity in the use of corticosteroids. The wide acclaim for the "miracle drug of the 1950's", which followed penicillin of the 1940's, soon gave away to anguish about side-effects that threatened to abolish its use entirely in the late 1950's. The 1960's brought alternate day therapy for chronic usage and recognition that short term usage was relatively safe. The 1970's saw proliferation of topically active steroids similar to those so important to the practice of Dermatology in the previous decade. Results in treating asthma and nasal diseases have been excellent and extensive research for adverse effects has been largely unrevealing.

Topics: Administration, Intranasal; Adrenal Cortex Hormones; Asthma; Beclomethasone; Cataract; Cushing Syndrome; Humans; Hypersensitivity; Hypersensitivity, Immediate; Long-Term Care; Nasal Polyps; Osteonecrosis; Osteoporosis; Prednisone; Rhinitis; Sleep Initiation and Maintenance Disorders; Stress, Physiological

Inhaled corticosteroids (ICS) are recommended first-line therapy for the treatment of persistent asthma. However, reports from observational studies have suggested that the use of ICS may be associated with systemic adverse events, such as glaucoma and cataract (opacity of the lens) formation.. To compare two ICS over 1 year regarding the formation/progression of lenticular opacities in patients with asthma.. Adults (>or=18 years of age) with moderate-to-severe asthma were randomized to ciclesonide 640 micro g/day (n = 785) or beclomethasone dipropionate 640 micro g/day (n = 783) in a multinational, double-blind, active-controlled, parallel-group study. The primary endpoint was the occurrence of a positive Class I grading shift (increase [worsening] in Lens Opacities Classification System [LOCS] III score of >or= 0.5 for nuclear opalescence, >or= 0.8 for cortical opacification, or >or= 0.5 for posterior subcapsular opacification, or cataract surgery) in either eye at any visit over the 12-month, double-blind treatment period.. Mean changes (+/- standard error) in nuclear opalescence and cortical and posterior subcapsular opacification were small and similar between groups (ciclesonide 640 micro g/day: 0.10 +/- 0.02, 0.07 +/- 0.02 and 0.04 +/- 0.01, respectively; beclomethasone dipropionate 640 micro g/day: 0.11 +/- 0.02, 0.09 +/- 0.02 and 0.03 +/- 0.01, respectively). Class I shifts were observed in 34.3% versus 36.8% of ciclesonide-treated and beclomethasone dipropionate-treated patients, respectively. Ciclesonide 640 micro g/day was non-inferior to beclomethasone dipropionate 640 micro g/day regarding Class I shifts (risk ratio of ciclesonide to beclomethasone dipropionate, 0.940 [95% confidence interval, 0.820-1.077]); the 95% confidence interval upper bound was lower than the pre-specified non-inferiority bound of 1.333 (p < 0.0001), thereby excluding the possibility of higher risk ratio values.. Mean changes in LOCS III scores were very small in both groups. Treatment with ciclesonide 640 micro g/day or beclomethasone dipropionate 640 micro g/day for 1 year has a minimal impact on lenticular opacities development and/or progression.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Allergic Agents; Asthma; Beclomethasone; Cataract; Double-Blind Method; Female; Glucocorticoids; Humans; Lens, Crystalline; Male; Middle Aged; Pregnenediones; Young Adult

The prevalence of posterior subcapsular cataracts in young patients receiving inhaled glucocorticoids for treatment of chronic asthma is unknown. In a cross-sectional study, slit-lamp examinations were done on 95 consecutive young patients who were taking inhaled beclomethasone or budesonide. No posterior subcapsular cataracts were found. The median age of the patients was 13.8 (range 5.8-24.8). The median dose of inhaled beclomethasone or budesonide was 750 micrograms/day (range 300-2000), or 12.9 micrograms/kg per day (range 7.5-34.2). The median duration of treatment was 5 years (range 1-15). 77% of the patients had not used oral glucocorticoids in the year preceding the examination. This study suggests that routine screening for posterior subcapsular cataracts in this patient population is not warranted.

Topics: Administration, Inhalation; Adolescent; Adult; Aerosols; Asthma; Beclomethasone; Bronchodilator Agents; Budesonide; Cataract; Child; Child, Preschool; Chronic Disease; Cross-Sectional Studies; Female; Humans; Male; Manitoba; Patient Compliance; Pregnenediones

Topics: Administration, Inhalation; Adolescent; Adrenal Cortex Hormones; Adult; Beclomethasone; Cataract; France; Humans; Steroids

Prolonged exposure to inhaled corticosteroids among adults over 49 years old has been reported to increase cataract risk. Small-scale studies of inhaled steroid users suggest that no increased risk for children and young adults exists. To describe cataract risk among people with asthma who use inhaled corticosteroids relative to patients with asthma with no history of corticosteroid use, we conducted a retrospective observational cohort study of patients identified from the United Kingdom-based General Practice Database with a nested case-control analysis. Relative to patients who do not use corticosteroids, all inhaled corticosteroid users were at a marginally increased risk of cataract (RR = 1.3). Among individuals 40 years of age or older, the risk ratio increased with use of increasing numbers of inhaled corticosteroid prescriptions after controlling for diabetes mellitus, hypertension, and smoking history. This trend was not evident in those under age 40.

Topics: Administration, Inhalation; Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Androstadienes; Anti-Inflammatory Agents; Asthma; Beclomethasone; Budesonide; Cataract; Child; Child, Preschool; Cohort Studies; Drug Prescriptions; Fluticasone; Humans; Incidence; Middle Aged; Nebulizers and Vaporizers; Odds Ratio; Retrospective Studies; Risk Factors; Time Factors; United Kingdom

Oral corticosteroid users are at increased risk of cataract, but the risk among intranasal corticosteroids users is unknown.. Our purpose was to describe the risk of cataract among users of intranasal steroids.. A retrospective observational cohort study of cataract incidence was conducted among users of oral and intranasal steroids identified from the United Kingdom-based General Practice Research Database with a nested case-control analysis to control for confounding factors. The study population included 286,078 subjects aged less than 70 years old drawn from 350 general practices in England and Wales. Patients were classified as users of only intranasal corticosteroids, users of only oral corticosteroids, and nonusers of either medication. Computerized medical records were used to identify cases of cataract. Two hundred twenty-five cases were randomly selected for validation against general practitioners' held referral and hospitalization letters.. The incidence rate of cataract (1.0/1000 person-years) among users of intranasal corticosteroids was similar to the incidence rate among nonusers. However, oral corticosteroid users were at higher risk of cataract (2.2/1000 person-years). Approximately 70% of intranasal corticosteroid exposure was to beclomethasone dipropionate only; the event rate in this group was similar to that in the unexposed group. Cataract risk did not increase with the number of prior prescriptions for intranasal corticosteroids.. The use of intranasal corticosteroids was not associated with an increased risk of cataracts in this study population.

Topics: Administration, Intranasal; Administration, Oral; Adrenal Cortex Hormones; Adult; Aged; Asthma; Beclomethasone; Cataract; Cohort Studies; Female; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors

It is possible that corticosteroids administered via nasal spray might reach ocular structures in levels sufficient to provoke an ocular hypertensive response and cause posterior subcapsular cataracts (PSCs) in susceptible individuals. In the present study, 26 patients who had undergone endoscopic sinus surgery were evaluated prospectively with respect to intraocular pressure and PSC formation following the use of nasal steroids for at least three months. Eighteen patients (69%) self-administered 200 micrograms/day of budesonide nasal spray twice daily, and eight patients (31%) self-administered 200 micrograms/day of beclomethasone dipropionate nasal spray twice daily, for a period of three to 19 months (mean 8.8 +/- 3.6 months). Ophthalmologic examination, tonometry, visual field testing and biomicroscopic studies revealed no evidence of ocular hypertension or PSCs during postoperative follow-up. We conclude that intranasal corticosteroids can be used safely for prolonged periods without increasing the risk of ocular hypertension or PSCs.

Topics: Administration, Inhalation; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Beclomethasone; Budesonide; Cataract; Cataract Extraction; Female; Humans; Intraocular Pressure; Male; Middle Aged; Ocular Hypertension; Retrospective Studies; Time Factors

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Beclomethasone; Cataract; Cross-Sectional Studies; Humans; Middle Aged; Reproducibility of Results; Risk Factors

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Beclomethasone; Budesonide; Cataract; Humans; Risk Factors

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Beclomethasone; Cataract; Glucocorticoids; Humans; Risk Factors

Although posterior subcapsular cataract complicates both systemic and topical corticosteroid therapy, the literature on the effects of inhaled corticosteroids is conflicting.. One hundred and forty children and young adults on inhaled corticosteroids were examined by slit lamp ophthalmoscopy after pupillary dilatation; 103 had received one or more short courses (< or = 7 days) of oral corticosteroids in the management of acute asthmatic attacks and four had also received one or more prolonged courses (> or = 4 weeks) of alternate day oral corticosteroid therapy.. Bilateral posterior subcapsular cataract was identified in one girl who had received several prolonged courses of oral corticosteroids, but was not identified in any other patient.. There is no evidence to support the contention that inhaled corticosteroid therapy on its own, or in association with short courses of oral corticosteroid therapy, might cause cataracts. Although children receiving long term systemic corticosteroid therapy should be screened for cataracts, this is unnecessary in children on inhaled corticosteroids alone.

Topics: Administration, Inhalation; Administration, Topical; Adolescent; Adult; Age Distribution; Anti-Inflammatory Agents; Asthma; Beclomethasone; Bronchodilator Agents; Budesonide; Cataract; Child; Child, Preschool; Drug Administration Schedule; Female; Glucocorticoids; Humans; Male; Pregnenediones

Topics: Administration, Inhalation; Adult; Asthma; Beclomethasone; Cataract; Female; Humans

Topics: Administration, Inhalation; Adolescent; Adult; Aerosols; Aged; Beclomethasone; Cataract; Humans; Middle Aged

Topics: Administration, Oral; Adult; Aerosols; Asthma; Beclomethasone; Cataract; Female; Humans; Middle Aged; Prednisolone

Topics: Aerosols; Beclomethasone; Cataract; Humans; Lens Capsule, Crystalline

A distinct disturbance to the structure of the lens epithelium was observed in cataract patients receiving steroid medication. Of those cataract patients receiving steroids, 83% exhibited a reticulated pattern of intercellular clefts compared to 5% in the control group. The reticulated pattern was shown to be due to the presence of gaps between the lateral borders of the epithelial cells by electron microscopy. A significant correlation between steroid therapy and epithelial disruption was demonstrated. The significance of such epithelial disruption to cataract formation is discussed.

Topics: Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Beclomethasone; Betamethasone; Cataract; Cell Count; Dose-Response Relationship, Drug; Epithelium; Female; Humans; Lens, Crystalline; Male; Microscopy, Electron; Middle Aged; Prednisolone

A study of anterior capsules from cataractous lenses revealed that there are marked abnormalities in epithelial structure associated with cataract. In certain cases a distinctive reticulated pattern was observed in whole mounts of the anterior capsule and of these a higher number than expected were from patients receiving steroid medication. In tissue culture experiments it was found that the presence of steroids in the growth medium (10 microM prednisolone) adversely affected the growth of human lens epithelial cells. These observations are consistent with the hypothesis that steroid-induced cataracts are the result of effects on anterior lens epithelial cell function.

Topics: Adult; Aged; Aged, 80 and over; Beclomethasone; Cataract; Cell Count; Cells, Cultured; Epithelial Cells; Epithelium; Glucocorticoids; Humans; Lens Capsule, Crystalline; Lens, Crystalline; Middle Aged; Prednisolone; Time Factors

Extrapulmonary effects of alternate-day prednisone and inhaled beclomethasone dipropionate therapy were examined in 24 and 32 children with asthma, respectively. Early morning serum cortisol values were significantly lower among patients receiving alternate-day prednisone than among patients receiving inhaled beclomethasone dipropionate and control subjects at 24 hours but not at 48 hours after an alternate-day prednisone dose. Urinary-free cortisol output during the second 24 hours of the alternate-day prednisone regimen were similar to values among patients receiving inhaled beclomethasone and were significantly lower than among control subjects for both groups. Mean heights among patients before being placed on maintenance corticosteroids were at the thirty-fifth percentile and were similar for both regimens. This was significantly lower than initial measurements for control subjects who, on average, were near the fiftieth percentile for both children with asthma not requiring maintenance corticosteroids and normal healthy Iowa children. Mean heights for both corticosteroid-treated groups remained at the thirty-fifth percentile after more than a 2-year average duration of follow-up. Heights of children with chronic asthma not requiring maintenance corticosteroids were initially significantly higher (fifty-first percentile) than the patients who subsequently required maintenance corticosteroids and increased significantly to the sixty-first percentile during a mean 2.7-year follow-up. Heights of healthy Iowa children remained near the fiftieth percentile during a mean 7-year follow-up. Disproportionate weight gain, although it was not consistently present, was significantly more likely with the alternate-day prednisone. Other extrapulmonary effects of the corticosteroid regimens appeared not to be of clinical importance during the time period of the study.

Topics: Administration, Inhalation; Adolescent; Asthma; Beclomethasone; Blood Cell Count; Body Height; Body Weight; Candidiasis; Cataract; Child; Female; Growth; Hematocrit; Hemoglobins; Humans; Hydrocortisone; Immunoglobulins; Male; Prednisone

Topics: Aerosols; Asthma; Beclomethasone; Cataract; Child; Female; Humans

Slit-lamp examinations were performed on 24 children and adolescents with severe asthma, all of whom had received steroids for at least 365 days. Posterior subcapsular cataracts (PSCC) were detected in 7 (29.1%). None of the patients had been treated with beclomethasone. All 7 of the patients with PSCC were in the subgroup of 14 patients who had been on the highest doses of corticosteroid, 10 mg or more per day, for the longest period of time. The 7 children with PSCC were all below the fifth percentile for height and had fallen away from their normal growth curve. Of the 17 children in whom PSCC were not detected, only 1 was below the fifth percentile for height. It would seem from our results that the steroid-requiring asthmatic who is growth-suppressed is at an increased risk for developing PSCC. We have documented the reversal of PSCC in 2 children. Both of these children had been placed on beclomethasone, which allowed for the discontinuation of daily prednisone in one case and a reduction to less than 10 mg per day of prednisone in the other. The reversal occurred within 6 months of starting on beclomethasone.

Topics: Adolescent; Adrenal Cortex Hormones; Asthma; Beclomethasone; Body Height; Cataract; Child; Child, Preschool; Female; Humans; Male; Prednisone

Forty-two chronic asthmatic children, including 10 with associated eczema, were examined for lenticular complications. The children had received oral corticosteroids for a minimum of 3 years. Twelve were treated with beclomethasone inhalant therapy, and the children with eczema had had topical corticosteroids. Only one child was found to have cataracts commensurate with corticosteroid therapy. Possible reasons for the low incidence of cataracts in this study are discussed.

Topics: Adolescent; Adrenal Cortex Hormones; Asthma; Beclomethasone; Cataract; Child; Child, Preschool; Cromolyn Sodium; Drug Therapy, Combination; Eczema; Female; Humans; Male; Prednisone