Pharmacokinetics and Pharmacodynamics of Systemic Corticosteroids in Autoimmune and Inflammatory Diseases: A Review of Current Evidence.

Autor: Möhlmann JE; Department of Clinical Pharmacy, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands. j.e.mohlmann@umcutrecht.nl., Ezzafzafi S; Department of Clinical Pharmacy, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands., Lindemans CA; Department of Stem Cell Transplantation, Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands.; Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands., Jansen MHA; Department of Paediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands., Nierkens S; Department of Stem Cell Transplantation, Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands.; Department of Translational Immunology, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands., Huitema ADR; Department of Clinical Pharmacy, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands.; Department of Pharmacology, Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands.; Department of Pharmacy and Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands., van Luin M; Department of Clinical Pharmacy, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands.
Jazyk: angličtina
Zdroj: Clinical pharmacokinetics [Clin Pharmacokinet] 2024 Sep; Vol. 63 (9), pp. 1251-1270. Date of Electronic Publication: 2024 Sep 12.
DOI: 10.1007/s40262-024-01419-7
Abstrakt: Background and Objective: Systemic corticosteroids have a long history of use in the treatment of autoimmune and inflammatory diseases. Both efficacy and safety show large interindividual variability (IIV), suggesting that corticosteroids may have the potential for individualised dosing strategies to optimise therapy. This systematic review aims to provide an overview of current evidence on the pharmacokinetic (PK) and pharmacodynamic (PD) relationships of systemic corticosteroids in patients with autoimmune and inflammatory diseases.
Methods: A systematic literature search was conducted in PubMed and Embase for PK/PD studies of systemic corticosteroids in autoimmune and inflammatory diseases in humans published until December 2023. Studies were scored from 1 to 5 according to criteria for the levels of evidence, as inspired by the Oxford Centre for Evidence-Based Medicine.
Results: Twelve studies (1981-2016) were included. The majority of these studies had a small sample size. The corticosteroids involved were prednisone, prednisolone, methylprednisolone and budesonide. Substantial IIV of corticosteroid PK was described in all studies. Evidence for a relationship between the PK of corticosteroids and efficacy was inconclusive and limited. However, there was some evidence for a relationship between the PK of prednisolone and the severity of Cushingoid features.
Conclusion: There is insufficient evidence to draw firm conclusions on the potential associations between PK and clinical outcome of systemic corticosteroid treatment in autoimmune and inflammatory diseases. This is remarkable given the many decades that steroid drugs have been used in clinical care. Prospective research is recommended with robust and well-defined cohorts to fully quantify the PK/PD associations of corticosteroids.
(© 2024. The Author(s).)
Databáze: MEDLINE
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