Jason R. Strasberg, John H. Rossmeisl, Krista L. Kelsey, Hiroto Yoshikawa, Tracy L. Gieger, Michael W. Nolan
{"title":"前瞻性评估狗脑肿瘤照射后泼尼松的简短减量。","authors":"Jason R. Strasberg, John H. Rossmeisl, Krista L. Kelsey, Hiroto Yoshikawa, Tracy L. Gieger, Michael W. Nolan","doi":"10.1111/jvim.17163","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>To ameliorate anticipated or ongoing neurological deficits, dogs undergoing brain tumor irradiation often are prescribed lengthy courses of prednisone PO during and after radiotherapy (RT). This practice can contribute to unwanted corticosteroid-associated morbidity and may be unnecessary.</p>\n </section>\n \n <section>\n \n <h3> Objective</h3>\n \n <p>Determine whether long-term corticosteroid dependency can be minimized by use of succinct prednisone tapering.</p>\n </section>\n \n <section>\n \n <h3> Animals</h3>\n \n <p>Fifty-five pet dogs undergoing brain tumor irradiation.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Nineteen dogs were treated using a “rapid-taper” protocol wherein corticosteroid dose reduction began 0 to 20 days after completing RT. Outcomes were compared with a retrospectively studied control group (“slow-taper”; N = 36 dogs) in which corticosteroids were tapered more slowly according to individual clinician recommendations.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Patient demographics were similar between groups. Mean time to lowest prednisone dose was 41 days postirradiation in the rapid-taper group and 117 days in the slow-taper group (<i>P</i> = .003). In the rapid-taper group, 15 of 19 dogs (84%) were completely tapered off prednisone, vs 18 of 36 (50%) in the slow-taper group (<i>P</i> = .04). Rates at which corticosteroids had to be reinstituted later were similar for the 2 groups (approximately 1 in 3 dogs). Adverse effect rates were similar for the 2 groups. Although no comparable questionnaire-derived data were available for the “slow-taper” group, overall and neurologic quality of life remained stable after RT in the rapid-taper group.</p>\n </section>\n \n <section>\n \n <h3> Conclusions and Clinical Importance</h3>\n \n <p>For many dogs, lengthy courses of PO prednisone are avoidable after intracranial RT. Future efforts should aim to identify which dogs benefit most from accelerated prednisone tapering.</p>\n </section>\n </div>","PeriodicalId":49958,"journal":{"name":"Journal of Veterinary Internal Medicine","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jvim.17163","citationCount":"0","resultStr":"{\"title\":\"A prospective evaluation of succinct prednisone tapering after brain tumor irradiation in dogs\",\"authors\":\"Jason R. Strasberg, John H. Rossmeisl, Krista L. Kelsey, Hiroto Yoshikawa, Tracy L. Gieger, Michael W. Nolan\",\"doi\":\"10.1111/jvim.17163\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>To ameliorate anticipated or ongoing neurological deficits, dogs undergoing brain tumor irradiation often are prescribed lengthy courses of prednisone PO during and after radiotherapy (RT). This practice can contribute to unwanted corticosteroid-associated morbidity and may be unnecessary.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Objective</h3>\\n \\n <p>Determine whether long-term corticosteroid dependency can be minimized by use of succinct prednisone tapering.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Animals</h3>\\n \\n <p>Fifty-five pet dogs undergoing brain tumor irradiation.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Nineteen dogs were treated using a “rapid-taper” protocol wherein corticosteroid dose reduction began 0 to 20 days after completing RT. Outcomes were compared with a retrospectively studied control group (“slow-taper”; N = 36 dogs) in which corticosteroids were tapered more slowly according to individual clinician recommendations.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Patient demographics were similar between groups. Mean time to lowest prednisone dose was 41 days postirradiation in the rapid-taper group and 117 days in the slow-taper group (<i>P</i> = .003). In the rapid-taper group, 15 of 19 dogs (84%) were completely tapered off prednisone, vs 18 of 36 (50%) in the slow-taper group (<i>P</i> = .04). Rates at which corticosteroids had to be reinstituted later were similar for the 2 groups (approximately 1 in 3 dogs). Adverse effect rates were similar for the 2 groups. Although no comparable questionnaire-derived data were available for the “slow-taper” group, overall and neurologic quality of life remained stable after RT in the rapid-taper group.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions and Clinical Importance</h3>\\n \\n <p>For many dogs, lengthy courses of PO prednisone are avoidable after intracranial RT. 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A prospective evaluation of succinct prednisone tapering after brain tumor irradiation in dogs
Background
To ameliorate anticipated or ongoing neurological deficits, dogs undergoing brain tumor irradiation often are prescribed lengthy courses of prednisone PO during and after radiotherapy (RT). This practice can contribute to unwanted corticosteroid-associated morbidity and may be unnecessary.
Objective
Determine whether long-term corticosteroid dependency can be minimized by use of succinct prednisone tapering.
Animals
Fifty-five pet dogs undergoing brain tumor irradiation.
Methods
Nineteen dogs were treated using a “rapid-taper” protocol wherein corticosteroid dose reduction began 0 to 20 days after completing RT. Outcomes were compared with a retrospectively studied control group (“slow-taper”; N = 36 dogs) in which corticosteroids were tapered more slowly according to individual clinician recommendations.
Results
Patient demographics were similar between groups. Mean time to lowest prednisone dose was 41 days postirradiation in the rapid-taper group and 117 days in the slow-taper group (P = .003). In the rapid-taper group, 15 of 19 dogs (84%) were completely tapered off prednisone, vs 18 of 36 (50%) in the slow-taper group (P = .04). Rates at which corticosteroids had to be reinstituted later were similar for the 2 groups (approximately 1 in 3 dogs). Adverse effect rates were similar for the 2 groups. Although no comparable questionnaire-derived data were available for the “slow-taper” group, overall and neurologic quality of life remained stable after RT in the rapid-taper group.
Conclusions and Clinical Importance
For many dogs, lengthy courses of PO prednisone are avoidable after intracranial RT. Future efforts should aim to identify which dogs benefit most from accelerated prednisone tapering.
期刊介绍:
The mission of the Journal of Veterinary Internal Medicine is to advance veterinary medical knowledge and improve the lives of animals by publication of authoritative scientific articles of animal diseases.