Anti-cytokine biologics

2013 ◽  
pp. 636-641 ◽  
Author(s):  
Andrew J. K. Östör
Keyword(s):  
Tumour Necrosis ◽  
Signs And Symptoms ◽  
Increased Risk ◽  
Treatment Paradigm ◽  
History Of ◽  
Disease Modifying ◽  
Dramatic Shift ◽  
Disease Modifying Agents ◽  
Necrosis Factor

Following the introduction of biologic disease-modifying agents into the therapeutic armoury against rheumatoid arthritis (RA) a dramatic shift has occurred in the natural history of the condition. Improvements have been seen not only in the signs and symptoms of disease but also in radiographic progression, functionality, quality of life, and productivity. Anti-cytokine biologics have been at the forefront of this management ’revolution’ as tumour necrosis factor (TNF) antagonists were the first to be trialled in this setting, leading to a profound alteration in the treatment paradigm. In addition to the five anti-TNF biologics (infliximab, etanercept, adalimumab, certolizumab, golimumab), IL-6 blockade with tocilizumab has also been shown to be effective in RA. Antagonism of IL-1 with anakinra, however, has not been as successful. In order to optimize outcomes anti-cytokine biologics are being used earlier in the management of RA. Trial data has shown that they work as well, if not better, in early disease, to achieve disease remission. Safety remains of paramount importance, particularly the increased risk of infection, which has been seen in clinical trials and in biologic registries. The side-effect profile is favourable overall, however. A number of novel anti-cytokine biologics are currently being trialled potentially paving the way for ’individualized’ therapy.

scholarly journals Case Report of Transverse Myelitis in a Patient Receiving Etanercept for Rheumatoid Arthritis

2013 ◽  
Vol 2013 ◽  
pp. 1-2
Author(s):  
Helen Defty ◽  
Edward Sames ◽  
Teresa Doherty ◽  
Rodney Hughes
Keyword(s):  
Rheumatoid Arthritis ◽  
Tumour Necrosis ◽  
Transverse Myelitis ◽  
Neurological Complications ◽  
Tumour Necrosis Factor Alpha ◽  
Necrosis Factor Alpha ◽  
Factor Alpha ◽  
Disease Modifying ◽  
Disease Modifying Agents ◽  
Necrosis Factor

Etanercept is a monoclonal antibody targeted against Tumour Necrosis Factor-alpha (TNF-a) which is an effective treatment for rheumatoid arthritis and is in cases where conventional disease modifying agents such as methotrexate have failed. Neurological complications of treatment have been documented. We describe a case of transverse myelitis occurring in a 48 year-old lady with RA since 1994 who had been receiving etanercept for four years.

scholarly journals Estrogens and Progestogens in Triple Negative Breast Cancer: Do They Harm?

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2506
Author(s):  
Mark van Barele ◽  
Bernadette A. M. Heemskerk-Gerritsen ◽  
Yvonne V. Louwers ◽  
Mijntje B. Vastbinder ◽  
John W. M. Martens ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Triple Negative ◽  
Hormone Replacement ◽  
Breast Cancers ◽  
Younger Women ◽  
Alternative Pathways ◽  
Increased Risk ◽  
History Of ◽  
Hormone Sensitive

Triple-negative breast cancers (TNBC) occur more frequently in younger women and do not express estrogen receptor (ER) nor progesterone receptor (PR), and are therefore often considered hormone-insensitive. Treatment of premenopausal TNBC patients almost always includes chemotherapy, which may lead to premature ovarian insufficiency (POI) and can severely impact quality of life. Hormone replacement therapy (HRT) is contraindicated for patients with a history of hormone-sensitive breast cancer, but the data on safety for TNBC patients is inconclusive, with a few randomized trials showing increased risk-ratios with wide confidence intervals for recurrence after HRT. Here, we review the literature on alternative pathways from the classical ER/PR. We find that for both estrogens and progestogens, potential alternatives exist for exerting their effects on TNBC, ranging from receptor conversion, to alternative receptors capable of binding estrogens, as well as paracrine pathways, such as RANK/RANKL, which can cause progestogens to indirectly stimulate growth and metastasis of TNBC. Finally, HRT may also influence other hormones, such as androgens, and their effects on TNBCs expressing androgen receptors (AR). Concluding, the assumption that TNBC is completely hormone-insensitive is incorrect. However, the direction of the effects of the alternative pathways is not always clear, and will need to be investigated further.

Fatigue: Has It Affected Your Compassion?

2017 ◽  
Vol 36 (5) ◽  
pp. 289-293
Author(s):  
Bobbi S. Greiner ◽  
Gail A. Poskey
Keyword(s):  
Risk Factors ◽  
Compassion Fatigue ◽  
Work Productivity ◽  
Signs And Symptoms ◽  
Poor Quality ◽  
Job Dissatisfaction ◽  
Job Turnover ◽  
Additional Stress ◽  
Increased Risk

AbstractCompassion fatigue is a concept used to describe how various stressors affect individuals who work in health care and other caregiving professions. The results of compassion fatigue may include decreased work productivity, poor quality of care, safety concerns, job dissatisfaction, and job turnover. The NICU professionals are at an increased risk for experiencing compassion fatigue because of the nature of working with critically ill infants, their families, and the additional stress of the workplace. The purpose of this article is for the NICU professional to understand compassion fatigue, identify the risk factors, recognize the signs and symptoms, and offer strategies to implement within the NICU environment.

scholarly journals Risk of solid cancer in patients exposed to anti-tumour necrosis factor therapy: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

2014 ◽  
Vol 74 (6) ◽  
pp. 1087-1093 ◽  
Author(s):  
Louise K Mercer ◽  
Mark Lunt ◽  
Audrey L S Low ◽  
William G Dixon ◽  
Kath D Watson ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Tumour Necrosis Factor ◽  
Tumour Necrosis ◽  
Cancer Registries ◽  
British Society ◽  
Solid Cancer ◽  
Increased Risk ◽  
Risk Of Cancer ◽  
Necrosis Factor ◽  
Biologics Register

BackgroundPatients with rheumatoid arthritis (RA) have an increased risk of certain solid cancers, in particular lung cancer, compared to the general population. Treatment with tumour necrosis factor (TNF) inhibitors (TNFi) may further enhance this risk.ObjectivesTo compare the risk of solid cancer in patients with RA treated with TNFi to that in patients treated with non-biologic (synthetic) disease modifying antirheumatic drugs (sDMARDs).MethodsPatients with a physician diagnosis of RA enrolled in the British Society for Rheumatology Biologics Register, a national prospective cohort study established in 2001 to monitor the long-term safety of TNFi, were followed via record linkage with the national cancer registries until first solid cancer, death, for 5 years, or until 2011. Rates of solid cancers in 11 767 patients without prior cancer who received TNFi were compared to those in 3249 patients without prior cancer treated with sDMARDs.Results427 solid cancers were reported in 52 549 patient-years follow-up for the TNFi group (81 (95% CI 74 to 89) per 10 000 patient-years) and 136 cancers were reported in 11 672 patient-years in the sDMARD cohort (117 (95% CI 98 to 138) per 10 000 patient-years). After adjusting for differences in baseline characteristics there was no difference in risk of solid cancer for TNFi compared to sDMARD treated patients: HR 0.83 (95% CI 0.64 to 1.07). There was no difference in the relative risk of cancer for any of the individual TNFi drugs.ConclusionsThe addition of TNFi to sDMARD does not alter the risk of cancer in RA patients selected for TNFi in the UK.

scholarly journals Quality of life for veterans with multiple sclerosis on disease-modifying agents: Relationship to disability

2006 ◽  
Vol 43 (1) ◽  
pp. 35 ◽  
Author(s):  
Joseph B. Guarnaccia ◽  
Mihaela Aslan ◽  
Theresa Z. OConnor ◽  
MaryAnn Hope ◽  
Lewis Kazis ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Sclerosis ◽  
Disease Modifying ◽  
Disease Modifying Agents

scholarly journals Ixekizumab is efficacious when used alone or when added to conventional synthetic disease-modifying antirheumatic drugs (cDMARDs) in patients with active psoriatic arthritis and previous inadequate response or intolerance to tumour necrosis factor inhibitors

RMD Open ◽  
2018 ◽  
Vol 4 (2) ◽  
pp. e000692 ◽  
Author(s):  
Peter Nash ◽  
Frank Behrens ◽  
Ana-Maria Orbai ◽  
Suchitrita S Rathmann ◽  
David H Adams ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Tumour Necrosis Factor ◽  
Tumour Necrosis ◽  
Short Form ◽  
Joint Disease ◽  
Inadequate Response ◽  
Efficacy And Safety ◽  
Disease Modifying ◽  
Necrosis Factor

ObjectiveTo conduct subset analyses of SPIRIT-P2 (NCT02349295) to investigate the efficacy and safety of ixekizumab versus placebo in three subgroups of patients with active psoriatic arthritis (PsA) according to the concomitant conventional synthetic disease-modifying antirheumatic drug (cDMARD) received: any background cDMARDs (including methotrexate), background methotrexate only, or none.MethodsPatients were randomised to receive placebo, ixekizumab 80 mg every 4 weeks (IXEQ4W) or every 2 weeks (IXEQ2W). Efficacy and safety were assessed when patients were subdivided according to cDMARD use at baseline. Efficacy was evaluated versus placebo at week 24 by the American College of Rheumatology criteria (ACR20/50), achievement of minimal disease activity (MDA) state, Disease Activity Index for PsA (DAPSA), 28-joint Disease Activity Score using C-reactive protein (DAS28-CRP), Health Assessment Questionnaire-Disability Index and the 36-item Short-Form health survey physical functioning domain.ResultsRegardless of background cDMARD status, ACR20, ACR50 and MDA response rates were significantly higher than placebo with IXEQ4W or IXEQ2W treatment. Similarly, significant improvements were observed relative to placebo for DAS28-CRP and DAPSA across subgroups. Physical function also significantly improved relative to placebo with IXEQ4W treatment regardless of background cDMARD status and with IXEQ2W alone. Percentages of reported treatment-emergent adverse events (AEs), serious AEs (including serious infections) and discontinuations due to AEs in each subgroup were comparable to the overall SPIRIT-P2 population.ConclusionIxekizumab was efficacious in patients with active PsA and previous tumour necrosis factor inhibitor (TNFi) inadequate response or TNFi intolerance treated with ixekizumab alone or when added to cDMARDs with subgroup safety profiles that were consistent with that observed in the overall SPIRIT-P2 population.

Recurrence of First Afebrile Unprovoked Seizure and Parental Consanguinity: A Hospital-Based Study

2020 ◽  
Vol 35 (10) ◽  
pp. 643-648
Author(s):  
Miral A. Al Momani ◽  
Basima Almomani ◽  
Salar Bani Hani ◽  
Andrew Lux
Keyword(s):  
University Hospital ◽  
Unprovoked Seizure ◽  
Recurrent Attack ◽  
Parental Consanguinity ◽  
Pediatric Clinic ◽  
Increased Risk ◽  
High Incidence ◽  
History Of

Purpose: The aim of the current study was to determine the incidence, clinical characteristics, and risk factors associated with the recurrence of first unprovoked seizure in children. Methods: A retrospective, observational study was conducted at King Abdullah University Hospital in Jordan. Children aged from 1 month to 16 years old who attended the hospital between January 2013 to December 2017 were evaluated on the basis of medical records, from the first visit and for a 1-year follow-up period. Results: During the study period, a total of 290 cases with first unprovoked seizure were included. The incidence of first unprovoked seizure was 441 cases per 100 000 patient visits to the pediatric clinic. More than half of the cases developed a second attack (55.3%). Children with parental consanguinity were almost 3 times more likely to develop a second attack of seizure compared to those without parental consanguinity (odds ratio [OR] = 2.785, 95% confidence interval [CI] = 1.216-6.378, P = .015) and patients who had a history of focal type of seizure were almost twice as likely to develop seizure recurrence (OR = 1.798, 95% CI = 1.013-3.193, P = .045). Conclusions: The current results showed a high incidence of first unprovoked seizure among children in Jordan. Parental consanguinity and focal seizure were associated with the increased risk of recurrent attack. This finding highlights the need for public education regarding the outcomes of parental consanguinity to improve the patient’s quality of life.

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