The treatment of granulomas has improved dramatically in recent years, but many patients still remain ill and may need more intensive treatment, researchers say.
The study, published in The Lancet Infectious Diseases on Thursday, is based on a trial that enrolled 4,622 patients with acute granulomatous granulosis who received either corticosteroid or standard therapy.
Researchers found that a two- to four-fold increase in patients with granulospasmodic syndrome (GMS) with corticosterone treatment in the early stages of treatment, or a one-to-three-fold reduction in the treatment with standard therapy, was associated with a significantly reduced incidence of relapse.
Researchers from the University of Oxford and King’s College London said the findings were in line with other studies, and could be translated into a clinical model.
They said the study showed that corticostegrel-related relapse was much more common among patients who had a positive response to corticotropin-releasing hormone (CRH) compared with those who had no response, and that this difference was particularly evident in the late stage of treatment.
“This may be due to the fact that cortisone-induced suppression of the immune response is so important to manage granulosums,” they said.
“Our findings suggest that the initial response to the initial treatment with cortisones is to suppress the immune system, which leads to the production of pro-inflammatory cytokines and chemokines that contribute to the disease.”
Dr J. Daniel McBride, of the University College London’s Institute of Clinical Immunology, said the research showed that the CRH treatment had been shown to have “very beneficial” side effects.
“It was a pretty clear indication that cortistatin-induced corticotrophin-stimulating hormone (CPH) treatment had a very beneficial effect on the progression of the disease,” he said.
A CRH trial was not conducted in humans, however.
Researchers are now studying the safety of CRH in patients who are already taking corticopram, and if they are also treated with corticocelectron-emtricitabine, an antibiotic used in the CRP trial.
“If we do not see a reduction in CRH-associated relapse in people on CRH, it will not be surprising that corticsetron-emstric will have a role to play in treating the disease in the long term,” Dr McBride said.
Granuleosum is a common form of granular cell tumour, which has a relatively low mortality rate.
“These granuloms can be extremely painful to the patient, especially in patients in their 50s and 60s, who may have a number of underlying medical conditions,” Dr McDermott said.
He said the most effective treatment for granulomes was corticovaginal corticotropic hormone (CVH) injections, but the drugs were expensive and the effectiveness of the treatment was not clear.
“There is a big gap between the costs and the efficacy of these drugs and we are now at a stage where the cost of drugs is a very important consideration,” he added.
“That gap needs to be closed by reducing costs, and we can start looking at the drugs to reduce the costs.”
Dr McBride described the findings as a “step in the right direction”.
“The results were a bit surprising, but we are not surprised,” he told BBC News.
“A lot of people have asked if this would be a problem, so hopefully the researchers will now work on that.”