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Skin Integrity and Pressure Injuries

Anabolic Steroid Agents

Impaired nutritional status and decreased nutritional intake are common in those with SCI and are significantly associated with the development and timely healing of pressure injuries (Consortium for Spinal Cord Medicine 2000; Houghton et al. 2013). Spungen et al. (2001) stated that use of anabolic steroids and increased protein intake have been associated with promoting anabolism, weight gain, and in turn wound closure in burn patients. The United States Food and Drug Administration approved oxandrolone for the treatment of involuntary weight loss and for chronic infections. Since a “hypermetabolic, potentially catabolic state also is associated with pressure injuries” (Spungen et al. 2001, p. 140), the use of an anabolic steroid agent may also promote closure of nonhealing, pressure injuries in the SCI population.

Author Year
Country
Research Design
PEDro Score
Sample Size

Methods

Outcome

Bauman et al. 2013
USA
RCT
PEDro=5
N=212
Population: Inpatients with SCI and stage III or IV target pressure injuries (TPUs).
Intervention: Oxandrolone, 20 mg/d (n=108), or placebo (n=104) until the TPU healed or 24 wk.
Outcome Measures: The primary outcome was healed TPUs. The secondary outcome was the percentage of TPUs that remained healed at 8-wk follow-up.
1. Oxandrolone showed no benefit over placebo for improving healing or the percentage of TPUs that remained closed after 8 wk of treatment.
Spungen et al. 2001
USA
Case Series
N=9
Population: Mean age=24-73 yr; Gender: males=9; Total number of pressure injuries since SCI=1 to 7.
Intervention: Subjects with stage III and IV pressure injuries were treated with 20 mg of oxandrolone daily with 20 g of glutamine dissolved in orange juice. Pressure injury care and support surfaces remained consistent.
Outcome Measures: Number of pressure injuries healed.
1. After oxandrolone and glutamine
treatment, 8/9 subjects were completely healed, the majority within 3-6 mo. Two subjects required 12 mo of treatment for complete healing.

Discussion

In a case series of nine subjects with stage III and IV pressure injuries, Spungen et al. (2001) demonstrated complete healing in the majority of subjects (8/9), 3-12 months after daily administration of 20mg of oxandrolone. Bauman et al. (2013; N=212) initiated an RCT in a similar patient group suffering from stage III and IV pressure injuries. Unfortunately, this ambitious study was terminated early due to feasibility issues. The most significant of these issues included the heterogeneity of confounding co-morbidities across the study cohort, non-uniformity of clinical care across contributing sites, and high withdrawal rates in both groups likely due to the propensity of people with SCI to develop complications independent of the study. Available results did not show improvement in wound healing or closure between the active and control groups. The results did, however, reveal markedly increased serum pre-albumin levels that reflected improved better nutritional status in general. Ultimately, this RCT did not produce results to support that oxandrolone was more useful than placebo to improve chronic pressure injury healing.

Conclusion

There is level 2 evidence (from one flawed RCT: Bauman et al. 2013) that does not support the use of oxandrolone (anabolic steroid) to facilitate healing of serious pressure injuries post SCI.

However, very limited, earlier level 4 evidence (from one case series: Spungeon et al. 2001) did lend some support for the use of oxandrolone to promote healing of stage III and IV pressure injuries post SCI.

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