Methylprednisolone-Induced Lymphocytosis in Patients with Immune-Mediated Inflammatory Disorders

Bromberg, L; Roufosse, Florence; Pradier, Olivier; Delporte, Cédric; Antwerpen, Pierre Van; Maertelaer, Viviane De; Cogan, Elie

doi:10.1016/j.amjmed.2016.02.013

Cited by 13 publications

(15 citation statements)

References 19 publications

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“…In this post hoc analysis, patients who received corticosteroids showed higher increases in lymphocytes at day 3, contrary to the expectations that corticosteroids might produce lymphopenia [10] due to apoptosis or by a redistribution of recirculating lymphocytes at an early stage. A greater response from bone marrow and redistribution from lymph nodes induced by corticosteroids may explain the increase at day 3.…”

Section: Discussioncontrasting

confidence: 85%

Effect of Corticosteroids on C-Reactive Protein in Patients with Severe Community-Acquired Pneumonia and High Inflammatory Response: The Effect of Lymphopenia

Torres

Ceccato

Ferrer

et al. 2019

JCM

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Background: Lymphopenic patients with community-acquired pneumonia (CAP) have shown high mortality rates. Corticosteroids have immunomodulatory properties and regulate cytokine storm in CAP. However, it is not known whether their modulatory effect on cytokine secretion differs in lymphopenic and non-lymphopenic patients with CAP. Therefore, we aimed to test whether the presence of lymphopenia may modify the response to corticosteroids (mainly in C reactive protein (CRP)) in patients with severe CAP and high inflammatory status). Methods: A post hoc analysis of a randomized controlled trial (NCT00908713) which evaluated the effect of corticosteroids in patients with severe CAP and high inflammatory response (CRP > 15 mg/dL). Patients were clustered according to the presence of lymphopenia (lymphocyte count below 1000 cell/mm3). Results: At day 1, 35 patients (59%) in the placebo group presented with lymphopenia, compared to 44 patients (73%) in the corticosteroid group. The adjusted mean changes from day 1 showed an increase of 1.19 natural logarithm (ln) cell/mm3 in the corticosteroid group and an increase of 0.67 ln cell/mm3 in the placebo group (LS mean difference of the changes in ln (methylprednisolone minus placebo) 0.51, 95% CI (0.02 to 1.01), p = 0.043). A significant effect was also found for the interaction (p = 0.043) between corticosteroids and lymphopenia in CRP values at day 3, with lower values in patients without lymphopenia receiving corticosteroids after adjustments for potential confounders. Conclusion: In this exploratory post hoc analysis from ramdomized controlled trial (RCT) data, the response to corticosteroids, measured by CRP, may differ according to lymphocyte count. Further larger studies are needed to confirm this data.

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Section: Discussioncontrasting

confidence: 85%

Effect of Corticosteroids on C-Reactive Protein in Patients with Severe Community-Acquired Pneumonia and High Inflammatory Response: The Effect of Lymphopenia

Torres

Ceccato

Ferrer

et al. 2019

JCM

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“…Although it may seem contradictory for megestrol to induce an increase in total lymphocytes in these healthy participants, this has been seen previously using 20 mg of prednisone for 3 consecutive days, the same length of administration as in the current study [24]. A reduction in lymphocytes in humans was shown to be rapid and transient, with populations rebounding within 48 h after administration [23], and a transient increase in lymphocytes was also seen in a majority of patients on prednisolone maintenance therapy for immune-mediated inflammatory disorders and disappeared within 24-72 h following discontinuation of CSs [25]. Thus, usage of megestrol in immunocompromised individuals may also require further clinical consideration.…”

Section: Discussionsupporting

confidence: 50%

Megestrol Acetate Induces Declarative Memory Changes and Cortisol Suppression in Healthy Volunteers

Mason¹,

Ivleva²,

Enkevort³

et al. 2018

Dement Geriatr Cogn Disord

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Background: The effects of the glucocorticoid and progesterone receptor agonist megestrol on declarative memory, and the ability of phenytoin to block these effects, were assessed. Methods: Healthy volunteers received each medication combination (placebo and megestrol, phenytoin and megestrol, and placebo and placebo) using a randomized, crossover design. The Rey Auditory Verbal Learning Test assessed declarative memory. Results: Megestrol was associated with a significant reduction in declarative memory (p = 0.0008), which was attenuated by phenytoin, and was associated with significant cortisol suppression compared to placebo (p < 0.001). Conclusion: Changes in memory and cortisol suppression were found in healthy volunteers given megestrol.

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“…which minimizes the risk of possible steroid-induced alteration of the lymphocyte counts 38. According to Bisgaard et al, CRP levels did not seem to differ between relapse and remission phase, as NLR did.…”

mentioning

confidence: 90%

Neutrophil‐to‐lymphocyte ratio and CRP as biomarkers in multiple sclerosis: A systematic review

et al. 2021

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Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system, which causes demyelination and neuroaxonal damage. Low-grade systemic inflammation has been suggested to contribute to the pathogenesis due to amplification of pathogenic immune activation. However, there is a lack of reliable biomarkers of systemic inflammation predicting disease activity and progression in MS. The neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) have been identified as biomarkers of severity and disease activity in various disorders. In September 2020, we conducted a systematic literature search on multiple databases on studies reporting NLR values or CRP levels in MS. The aim of this systematic review was to highlight the current knowledge about the potential of NLR and CRP as biomarkers in MS. A total of nineteen articles qualified for inclusion. Data on CRP were included in fourteen studies and NLR in nine studies. The results regarding CRP were inconsistent, and present literature does not support the use of CRP as a diagnostic or prognostic biomarker in MS. In contrast, NLR values were increased in MS patients compared with healthy controls in all case-control studies. Furthermore, NLR was associated with disease activity in untreated patients. Our systematic review therefore indicates that NLR might serve as a potential biomarker of disease activity.Given that the results of NLR are mainly drawn from retrospective case-control or cross-sectional studies, future prospective studies with long-term follow-up are required to accurately determine optimal timing and cutoff values that may be used in the clinical setting.

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Methylprednisolone-Induced Lymphocytosis in Patients with Immune-Mediated Inflammatory Disorders

Cited by 13 publications

References 19 publications

Effect of Corticosteroids on C-Reactive Protein in Patients with Severe Community-Acquired Pneumonia and High Inflammatory Response: The Effect of Lymphopenia

Effect of Corticosteroids on C-Reactive Protein in Patients with Severe Community-Acquired Pneumonia and High Inflammatory Response: The Effect of Lymphopenia

Megestrol Acetate Induces Declarative Memory Changes and Cortisol Suppression in Healthy Volunteers

Neutrophil‐to‐lymphocyte ratio and CRP as biomarkers in multiple sclerosis: A systematic review

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