Cortisone and QTc-Interval

Overview

Scientific and clinical data report about shortening of QTc-interval in patients treated with cortisone. Peal et al. analyzed chemical suppression of long QT syndrome (Type 2) in an in vivo zebrafish model. Their study revealed that flurandrenolide reproducibly suppressed the long QT phenotype via the glucocorticoid signaling pathway. In contrast to treatment with dexamethasone and testosterone, treatment with pure mineralocorticoid deoxycorticosterone acetate did not suppress long QT phenotype. Knockdown of the glucocorticoid receptor or, conversely, of the androgen receptor showed that flurandrenolide acting through the glucocorticoid receptor shortens ventricular action potentials. The mechanism is distinct from trafficking rescue of the defective zebrafish-ERG channel. The authors discuss that a drug normalizing repolarization would be a novel therapeutic tool in long QT syndrome and conclude that glucocorticoids could be expected to aid in the acute management of patients with long QT syndrome, e.g. in episodes of arrhythmic storm. In addition, corticoid induced normalization of the QT interval is reported in a patient with drug-induced prolongation of the QTc interval. Brostoff et al. report on a patient suffering from mucocutaneous leishmaniasis treated with sodium stibogluconate. During therapy, the QTc interval prolonged and returned to normal within 4 days after starting glucocorticoid therapy with prednisolone 20 mg twice daily. Interrogation of the study: – shortens cortisone the QTc-interval? – how long is the interval until shortening of QTc-interval? – is the effect prolonged? – is the effect dose dependend?

Full Title of Study: “Influence of Cortisone on QTc-interval”

Study Type

  • Study Type: Observational [Patient Registry]
  • Study Design
    • Time Perspective: Prospective
  • Study Primary Completion Date: April 25, 2020

Interventions

  • Other: Cortisone
    • Observation of QTc-interval

Arms, Groups and Cohorts

  • Neurology
    • Patients with inflammatory disease, especially multiple sclerosis, who underwent therapy with cortisone (>=40mg/d)
  • Pulmonology
    • Patients after LTX (under medication possible prologing QTc-interval), who underwent therapy with cortisone (>=40mg/d)

Clinical Trial Outcome Measures

Primary Measures

  • Duration of QTc-interval
    • Time Frame: 1 week
    • daily ECG controls and measuring QTc-interval

Participating in This Clinical Trial

Inclusion Criteria

  • patients who underwent therapy with cortisone (>=40mg/d) Exclusion Criteria:

  • patients with elevated intracranial pressure – myocardial infarction within the last 6 months – untreated stenosis of the coronary arteries – right bundle branch block – autoimmune disease

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Asklepios Neurological Clinic Bad Salzhausen
  • Collaborator
    • University of Giessen
  • Provider of Information About this Clinical Study
    • Sponsor

References

Brostoff JM, Lockwood DN. Glucocorticoids as a novel approach to the treatment of disabling side effects of sodium stibogluconate. J Clin Pharm Ther. 2012 Feb;37(1):122-3. doi: 10.1111/j.1365-2710.2011.01259.x. Epub 2011 Apr 4.

Peal DS, Mills RW, Lynch SN, Mosley JM, Lim E, Ellinor PT, January CT, Peterson RT, Milan DJ. Novel chemical suppressors of long QT syndrome identified by an in vivo functional screen. Circulation. 2011 Jan 4;123(1):23-30. doi: 10.1161/CIRCULATIONAHA.110.003731. Epub 2010 Nov 15.

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