Tuberculosis & Anabolics
TUBERCULOSIS & ANABOLIC STEROIDS
(& COPD EFFECTS)
Medifit Education explains use of Anabolic steroids in Tuberculosis & Chronic Obstructive Pulmonary Disease.
EFFECT OF DECA-DURABOLIN 25 MG ON THE COURSE OF PULMONARY TUBERCULOSIS WITH STANDARD ANTI TUBERCULOSIS TREATMENT
This study was an open controlled trial where 84 cases of tuberculosis patients finished the study. The treatment period was for duration of 3 months. The patients were randomly assigned to each of the following treatment groups A or B.
Group A received Anti-tuberculosis treatment + Deca-durabolin 25 mg IM (1 ml) every 3 wk.
Group B received Anti-tuberculosis treatment (ATT) alone.
All the patients who were included had a base line sputum for AFB direct smear, complete blood picture, chest X-ray, record of weight, skin thickness and arm circumference, liver function tests, renal profile and serum proteins. All the patients were followed up with a monthly sputum smear examination, and records of weight, arm circumference and skin thickness. Liver and renal function tests were carried as and when needed. A review of Chest X-ray was done at the end of 3 months. There was a significant increase in weight gain in the study group at the end of three months. The mean increase in weight gain in study group is 3.863 plus minus 2.52 and in control group it was 1.18 plus minus 1.55. In study group, the mean increase in serum proteins at the end was 0.673 plus minus 0.445 (statistically significant) and in control group it was 0.164 plus minus 0.165. There was better sense of wellbeing at the end of 3 months in the study group. However addition of anabolic steroid may not alter the rate of bacteriological and radiological response.
ANDROGENIC ANABOLIC STEROIDS IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
The largest randomized, double-blind, placebocontrolled trial was conducted that included 217 patients (male and female). Patients were pre-stratified into a depleted group [body weight less than 90% and/or a FFM less than 67% (men)/63% (women) of ideal body weight] and a nondepleted group. Patients received nutritional therapy with placebo or nandrolone decanoate (women 25mg, men 50 mg; every 2 weeks). In the depleted patients, nandrolone decanoate did not result in a greater weight gain compared with nutritional therapy alone. However, measurements of body composition indicated a larger increase in muscle mass in the nandrolone decanoate group, whereas weight gain in the nutritional group consisted mainly of fat mass. Although weight gain was less pronounced in the nondepleted patients, similar favorable effects of AASs on body composition were seen. Also, the maximal inspiratory mouth pressure, a measure of respiratory muscle strength, improved significantly more in the nandrolone decanoate-treated patients.
Patients had moderate-to-severe COPD and involuntary weight loss of more than 10% of ideal body weight. Patients were treated with oxandrolone 10mg twice a day. In this study, body weight, body composition (as measured by bioelectric impedance analysis), spirometry, Karnofsky performance status, and 6 min walk distance were measured. Results from 82 patients at 2 months and 55 patients at 4 months showed that oxandrolone facilitated weight restoration. Bioelectric impedance analysis showed that weight gain was primarily because of an increase in lean tissue. Karnofsky performance status scores improved, 6 min walk distance showed a trend for improvement. Spirometry findings did not change significantly.
OTHER TYPES OF TUBERCULOSIS
Adjunctive corticosteroids may reduce mortality from all forms of tuberculosis by 17%, no matter which organ group was affected, according to a meta-analysis.
Julia A. Critchley, DPhil, from the Division of Population Health Sciences and Education, St. George’s, University of London, United Kingdom, and colleagues report their findings.
According to Dr. Critchley and colleagues, 8.7 million cases of tuberculosis are diagnosed each year, with nearly 1.4 million deaths. The condition is particularly lethal in some regions where health systems are fragile and high numbers of patients also have been diagnosed with HIV or are poor or elderly.
Although steroids have systemic effects, their benefits in blunting the damaging effect of the body’s inflammatory response to infection are thought to be organ-specific for patients with tuberculosis. To put that theory to the test, the research team searched for studies with patients diagnosed with any form of tuberculosis published from 1955 to 2012. They included 41 trials involving 3560 treated patients and 2982 control patients in their meta-analysis. The types of steroids prescribed varied, as did dose and duration.
“Mortality was lower in patients who were given steroids for every included tuberculosis organ system; the overall reduction in mortality with steroids was 17% (risk ratio [RR] 0.83, 95% [confidence interval] CI 0.74–0.92),” the authors write. “We noted no significant heterogeneity between trials within or between organ systems within organ systems: pulmonary 14%, meningitis 12%, pericarditis 0% could not be calculated for pleurisy, between organ systems 0%.”
In an accompanying comment, Guy E. Thwaites, PhD, from the Centre for Clinical Infection and Diagnostics Research, Guy’s and St. Thomas’ Hospitals National Health Service Foundation Trust, London, writes that the results “must be interpreted cautiously” because of weaknesses in the underlying trials. Moreover, a recently identified polymorphism in the gene that encodes leukotriene A4 hydrolase could clarify which patients are more susceptible to tuberculous meningitis. Corticosteroids reduced mortality in patients with the hyper inflammatory phenotype but were detrimental to patients with the hypo inflammatory phenotype.
These preliminary findings and the meta-analysis “should stimulate the reappraisal of adjunctive corticosteroids for pulmonary tuberculosis by new randomized controlled trials,” Dr. Thwaites writes.
Limitations include the small size of the studies, which left most underpowered, and the less stringent reporting methods at the time the trials were conducted, which in many cases predated the use of modern combination therapies. In addition, many trials occurred before the advent of HIV and the rise of drug-resistant tuberculosis. Because adverse events are poorly reported in older studies, the authors advocate for new trials that can more accurately assess the benefits and risks of adjunctive corticosteroid use.
“Our analysis suggests a benefit from steroids that seems to be consistent across organ systems,” the authors conclude. “Even in the absence of contemporary data for rifampicin-based regimens for treatment of pulmonary tuberculosis, if this result shows a true systemic effect across organ systems, it provides indirect evidence to suggest that steroids could be of benefit in pulmonary tuberculosis.”
STEROIDS MAY HELP REDUCE DEATHS FROM ALL TYPES OF TUBERCULOSIS
12 March 2013
The routine use of steroids to treat tuberculosis may help reduce deaths from all types of the disease, according to a new review of existing research.
Each year there are 8.7million cases of TB worldwide, and it causes 1.4million deaths. The most common form of the disease (pulmonary TB) affects the lungs, but there are many other forms and it can affect almost all the body’s organs.
Currently, steroids are routinely used only for certain types of TB – each of which affects a different organ system – where they have been proven effective as a secondary treatment alongside anti-TB drugs. Exactly how steroids help combat TB is not known, but they are believed to counter the tissue-damaging effect of the inflammatory response caused by the disease.
This latest research – which summarized the findings of existing studies from 1955 to 2012 on the effect of steroids on all types of TB – found that there were 17 per cent less deaths overall among patients taking steroids than those who were not. The study did not demonstrate a difference in death rates between different forms of TB.
The researchers say their findings suggest that steroids could work in a systemic way that is similar for all forms of the disease. Nevertheless, they say further studies are required before steroids should be recommended for all TB patients. Such studies should investigate if the reduced death rate is seen when looking at current TB drugs only, in studies with greater numbers of patients, and if the benefits of routinely prescribing steroids for all TB would outweigh the risk of harmful side effects. Potential side effects of steroid use include increased vulnerability to other infections.
The research was carried out by a team at St George’s, University of London, in partnership with Newcastle University, the University of Liverpool and the Liverpool School of Tropical Medicine. It has been published in The Lancet Infectious Diseases.
The researchers analysed results from 41 previous major TB trials on the efficacy of corticosteroids – drugs based on hormones found in the adrenal gland, which are used to reduce inflammation. They looked at trials involving the five common forms of TB for which steroid trials had been conducted. The types of TB were pericarditis (affecting the heart), meningitis (the brain and spinal cord), peritonitis (the abdomen) and pleurisy (the membranes surrounding the lungs). In total, they examined information on 3,560 patients who took steroids and 2,982 who did not. The types of steroids, the doses and the duration of treatment varied.
As the trials took place over 57 years, the anti-TB combination drug regimens also varied. Rifampicin – the most effective and now most widely used anti-TB drug – was not involved in any of the 19 trials held before 1983. All but one of the trials involving pulmonary TB was held pre-rifampicin. However, the researchers did not observe any difference in death rates of patients taking steroids between current and older treatments.
Lead author Professor Julia Critchley from St George’s, University of London said: “There has been debate among clinicians on whether steroids should be routinely prescribed for TB patients. At the moment they’re used in a specific way to target certain organ systems, and they have been proven effective in treating the meningitis and pericarditis forms of TB, but our findings suggest that the effects in one organ system might well apply to the others in terms of an overall reduction in deaths from the disease. There could therefore be benefit in using steroids for all tuberculosis.”
But Professor Critchley added: “The quality and amount of evidence we had for each type of TB varied, and most of the trials took place before the emergence of drugs resistant to anti-TB therapies, so we need to do further studies to build up a more comprehensive and up-to-date picture.”
Fiona Young, a research associate in public health from Newcastle University who contributed to the study, said: “The efficacy of steroid treatment for all forms of tuberculosis suggests there is an effect on death for TB of all types, although numbers were small.
“Tuberculosis presents a major public health challenge and it’s important that we determine the effects of steroids in an era where drug resistance and HIV impact upon tuberculosis treatment outcomes.”
This case suggests that patients using anabolic steroids might be susceptible to developing tuberculosis in either reactivating a latent infection or facilitating development of disease after a recent infection and that the use of nandrolone limits the diagnostic value of key parameters for the diagnosis of pleural TB, a finding not previously reported. We would like to recommend that attention should be paid to the possibility of nandrolone as a drug implicated in tuberculous eosinophilic pleurisy.
Anabolic steroids help to build up cellular tissue, especially in the muscles, by increasing their protein content and this process is referred to as anabolism. These drugs in conjunction with adquate diet, and high intensity work- outs, build muscle mass and strength besides enhancing speed, enduarance and stamina. For this reason they are very popular among athletes, body builders and weight lifters.
Anabolic steroids were first artificially synthesized in the 1930s. Recently, they have found good use in the treatment of chronic and sometimes terminal conditions such as AIDS and Cancer and in the treatment of individuals in whom the male hormone testosterone is produced in low quantities.
Anabolic steroids helps in tuberculosis to build of cellular tissue by increasing protein synthesis – anabolism.