Intervention Review

Gold as an oral corticosteroid sparing agent in stable asthma

  1. David J Evans1,*,
  2. Paul Cullinan2,
  3. Duncan M Geddes3,
  4. E. Haydn Walters4,
  5. Stephen J Milan5,
  6. Paul Jones6

Editorial Group: Cochrane Airways Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 2 SEP 2010

DOI: 10.1002/14651858.CD002985

Database Title

Additional Information

How to Cite

Evans DJ, Cullinan P, Geddes DM, Walters EH, Milan SJ, Jones P. Gold as an oral corticosteroid sparing agent in stable asthma. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD002985. DOI: 10.1002/14651858.CD002985.

Author Information

  1. 1

    Hemel Hempstead Hospital, Thoracic Medicine, Hemel Hempstead, Herts, UK

  2. 2

    Imperial College (NHLI), Department of Occupational and Environmental Medicine, London, UK

  3. 3

    Royal Brompton Hospital, Respiratory Medicine, London, UK

  4. 4

    University of Tasmania, Menzies Research Institute, Hobart, Tasmania, Australia

  5. 5

    St George's Healthcare NHS Trust, Clinical Effectiveness Department, London, UK

  6. 6

    St George's Hospital Medical School, Cardiovascular Medicine, London, UK

*David J Evans, Thoracic Medicine, Hemel Hempstead Hospital, Hillfield Road, Hemel Hempstead, Herts, HP2 4AD, UK. david.evans@whht.nhs.uk. D.Evans@rbh.nthames.nhs.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Patients with chronic severe asthma are often dependent on the long term prescription of oral corticosteroids. The use of steroids is associated with serious side effects. Physicians treating such patients continue to search for alternative therapies that reduce the need for chronic dosing with oral steroids. Gold compounds are immunosuppressive agents and have benefits in the treatment of a number of inflammatory disorders. They have therefore been identified as an potentially useful agents in the treatment of chronic severe asthma both in terms of possible efficacy and as steroid sparing agents.

Objectives

The objective of this review was to assess the effects of adding gold to oral steroids in the treatment of chronic steroid dependent asthmatics.

Search methods

The Cochrane Airways Group Specialised Register of trials and reference lists of identified articles were searched. Searches were current as of September 2010.

Selection criteria

Randomised trials looking at the addition of gold compared to placebo in adult steroid dependent asthmatics.

Data collection and analysis

Trial quality was assessed and data extraction was carried out by two reviewers independently. Study authors were contacted for missing information.

Main results

Three trials fulfilled the criteria for inclusion in the review and a total of 376 patients were recruited into these studies. Data from 311 patients could be analysed. There was a small but significant treatment effect for gold in terms of steroid dose reduction (Peto Odds Ratio 0.51, 95% confidence intervals 0.31,0.83). No meta-analysis could be done for measures of lung function although overall there were few changes suggesting a positive benefit for gold. There were trends suggestive of adverse effects but no significant changes for gold treated patients with respect to proteinuria (Peto Odds Ratio 1.4, 95% confidence intervals 0.6, 3.3) dermatitis/eczema Peto Odds Ratio 2.1, 95% confidence intervals 0.9, 4.7). Update searches carried out in September 2007 and 2010 did not yield any new studies.

Authors' conclusions

The changes seen in these trials are small and probably of limited clinical significance. Given the side effects of gold and necessity for monitoring the use of gold as a steroid sparing agent in asthma cannot be recommended.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Gold may have a small impact on asthma for people dependent on corticosteroids, but adverse effects are serious and a lot of monitoring is needed.

Some people need to rely on corticosteroid drugs to control their asthma. Corticosteroids help reduce the inflammation (swelling) of the airways (passages to the lungs) associated with asthma. Long-term use of these drugs has serious adverse effects, so other ways to try and cut down on the need for corticosteroids are sometimes tried. Gold is used by people with some other kinds of inflammatory problems (such as rheumatoid arthritis). The review of trials found that people with asthma taking gold need careful monitoring as there are harmful effects, and it may only have a very small impact on asthma symptoms.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

金(Gold)作為口服類固醇節約劑治療穩定性氣喘

慢性嚴重氣喘患者通常需要長期服用口服皮質類固醇。類固醇的使用與嚴重的副作用有關。治療此類病患的醫師不斷地在尋找替代藥物，希望可以減少口服類固醇的長期使用。金化合物是一種免疫抑制劑，對一些發炎性疾病有治療效果；因此，也被認為對慢性嚴重氣喘的治療深具潛力，一方面因為可能的療效，一方面作為口服類固醇節約劑。

目標

本回顧的目的在評估－治療類固醇依賴的慢性氣喘患者時，在口服類固醇外添加金的效果。

搜尋策略

搜尋Cochrane Airways Group Specialised Register of Trials以及找到的文章的參考資料表。目前搜尋到2007年9月。

選擇標準

隨機試驗－針對類固醇依賴的氣喘成年患者，比較添加金和安慰劑的療效。

資料收集與分析

兩位審查員各自評估試驗的品質，並擷取數據。短缺的資料則連絡研究作者。

主要結論

有三個研究符合本回顧的納入標準，這些研究共招募376位病患。分析其中311位病患的資料。在減少類固醇劑量方面，金的效果雖然不大，卻是有意義的差別(Peto危險對比值[Peto Odds Ratio] 0.51，95%信賴區間0.31，0.83)。在肺功能測量值方面，整體而言，雖然金治療組有一些改變顯示正面效益，但其結果無法進行統合分析。金治療組似乎出現較多副作用，但在蛋白尿(Peto危險對比值 1.4，95%信賴區間0.6，3.3)和皮膚炎/濕疹(Peto 危險對比值2.1，95% 信賴區間0.9，4.7)方面，則沒有明顯差異。2007年9月進行一次更新搜尋，並沒有找到任何新的研究。

作者結論

這些試驗中看到的變化都很小，臨床意義可能有限。由於金的副作用及其監測的必要性，不建議以金作為氣喘患者的類固醇節約劑。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

對皮質類固醇依賴的氣喘患者，金可能有一點點影響，但副作用嚴重，而且需要經常監測。有些人需要依賴皮質類固醇藥物控制氣喘。皮質類固醇減少與氣喘相關的呼吸道發炎(腫脹)。長期使用這類藥物有嚴重的副作用，因此偶爾嘗試其他方法，以減少對皮質類固醇的需求。金被用於治療某些發炎疾病(如：類風濕性關節炎)。本回顧發現：氣喘患者服用金時，必須小心監測，因為有害，而且對氣喘症狀可能只有極小量的影響。

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