scholarly journals Treatment with Mycophenolat Mofetil of Steroid-Dependent Asthma—One Case of Severe Asthma

2009 ◽  
Vol 2009 ◽  
pp. 1-3
Author(s):  
V. Backer ◽  
E. Hjardem ◽  
T. Karlsmark
Keyword(s):  
Adverse Events ◽  
Severe Asthma ◽  
Specific Effect ◽  
Immunosuppressive Drug ◽  
Theoretical Support ◽  
Steroid Dependent ◽  
Treatment Refractory ◽  
Refractory Asthma ◽  
Experienced Treatment ◽  
Mycophenolat Mofetil

Background. Some patients with severe nonallergic asthma can be difficult to treat with conventional therapy. Mycophenolat Mofetil (MMF) is an immunosuppressive drug with multiple mechanisms. There is theoretical support of specific effect of MMF on severe asthma, in “difficult to treat” patients. The aim of the present case was to explore whether MMF had an effect in one case of severe refractory asthma. The patient. This case deals with one patient with very severe nonallergic treatment refractory asthma who experienced treatment failure on ordinary antiasthmatic treatment and severe adverse events to conventional immunosupressive treatment. She was then treated with MMF. Results. The patient experienced a gain in FEV1 and a reduction in the need for oral glucocorticosteroids as well as seldom need of when needed bronchodilator both during daytime and night. It therefore seems very interesting to examine the use of MMF for severe refractory asthma with further clinical studies and basic cellular trials.

scholarly journals Characteristics of patients with severe asthma who experienced treatment failure with omalizumab

2021 ◽  
Vol 68 ◽  
pp. 102032
Author(s):  
Tomohiro Akaba ◽  
Mitsuko Kondo ◽  
Fumi Kobayashi ◽  
Nahoko Honda ◽  
Soshi Muramatsu ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Severe Asthma ◽  
Experienced Treatment

scholarly journals Shadow cost of oral corticosteroids-related adverse events: A pharmacoeconomic evaluation applied to real-life data from the Severe Asthma Network in Italy (SANI) registry

2019 ◽  
Vol 12 (1) ◽  
pp. 100007 ◽  
Author(s):  
Giorgio Walter Canonica ◽  
Giorgio Lorenzo Colombo ◽  
Giacomo Matteo Bruno ◽  
Sergio Di Matteo ◽  
Chiara Martinotti ◽  
...  
Keyword(s):  
Adverse Events ◽  
Severe Asthma ◽  
Real Life ◽  
Pharmacoeconomic Evaluation ◽  
Life Data ◽  
Real Life Data ◽  
Oral Corticosteroids ◽  
Shadow Cost

A Short-Term Double-Blind Trial of Aerosol Triamcinolone Acetonide in Steroid-Dependent Patients with Severe Asthma

CHEST Journal ◽  
1976 ◽  
Vol 69 (4) ◽  
pp. 455-460 ◽  
Author(s):  
Robert J. Kriz ◽  
Frank Chmelik ◽  
Guillermo doPico ◽  
Charles E. Reed
Keyword(s):  
Triamcinolone Acetonide ◽  
Severe Asthma ◽  
Double Blind Trial ◽  
Short Term ◽  
Double Blind ◽  
Blind Trial ◽  
Steroid Dependent

scholarly journals IL-5Rα expression on airway neutrophils in children with treatment-refractory asthma

2018 ◽  
Vol 141 (2) ◽  
pp. AB284
Author(s):  
Monica G. Lawrence ◽  
MarthaJoy M. Spano ◽  
Amy Hinkelman ◽  
John W. Steinke ◽  
Larry Borish ◽  
...  
Keyword(s):  
Treatment Refractory ◽  
Refractory Asthma

Single-Agent Rituximab in Treatment-Refractory or Poor Prognosis Patients with Chronic Lymphocytic Leukemia.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2380-2380
Author(s):  
Giridhar U. Adiga ◽  
Peter H. Wiernik
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Adverse Events ◽  
Poor Prognosis ◽  
Single Agent ◽  
Lymphocytic Leukemia ◽  
Weekly Dose ◽  
Mantle Cell ◽  
Binet Stage ◽  
Treatment Refractory ◽  
Cell Variant

Abstract Abstract 2380 Poster Board II-357 Background: Rituximab in combination with fludarabine and cyclophosphamide (R-FC) is the new standard therapy for patients with chronic lymphocytic leukemia (CLL). Rituximab in combination with FC or any other chemotherapy is indicated for first-line treatment of patients with CLL by the EMEA. However, the FC component of this treatment is myelosuppressive, and patients with CLL who refuse or are not candidates for myelosuppressive therapy have few treatment options. We investigated the effect of single-agent rituximab in patients with treatment-refractory or poor prognosis CLL. Method: 23 patients with progressing CLL received single-agent rituximab at an initial weekly dose of 375 mg/m2. Patients were progressively escalated to 3 g/m2 at the fourth weekly dose and remained on this dose for the remainder of their treatment cycle. Clinical responses, adverse events and treatment history were recorded and analyzed. A patient with mantle cell variant CLL was included in this series but is omitted from the group analysis. Results: 13 previously treated patients received a median of 1.5 (range 1–6) prior lines of therapy; 8 of these patients were fludarabine refractory. Nine patients had received no previous treatment for CLL. Overall response rate (ORR) and complete response (CR) rate were 90.9% and 54.5%, respectively. Even in patients who were fludarabine refractory ORR was 75% with 37.5% CR. Responses by population are summarized in table 1. As of August 2009, median progression-free survival (PFS) was 12.5 months (range 0-48), with a median response duration (DR) of 8.5 months (range 0-46) (fludarabine-refractory median PFS = 8 months). Patients with high-risk Binet stage C disease had less durable responses and shorter PFS compared with Binet stage A/B patients (DR= 8 vs. 9 months, PFS= 8 vs. 17 months). Patients ≥65 years had more durable responses and longer PFS compared with patients <65 years (DR= 11.5 vs. 5 months, PFS= 16 vs. 8 months). Four patients received rituximab as maintenance therapy (375mg/m2 weekly for 4 weeks, every 6 months). All experienced CR or partial response (PR) and had a PFS which was considerably longer than the overall population (48, 36, 34 and 33 months); all 4 patients were still in remission as of August 2009. The patient with mantle cell variant CLL achieved a CR and is still in molecular remission with a DR of 94 months and PFS of 96 months as of August 2009. No unexpected adverse events were observed. Conclusions: Single-agent rituximab was an effective treatment for treatment-refractory or poor prognosis CLL, and was well tolerated. High ORR and CR rates were seen even in patients who were fludarabine refractory. Encouraging responses were seen with rituximab maintenance and in older patients. These data suggest that there is a role for single-agent rituximab in the treatment of patients with difficult-to-treat CLL, and that the concept should be studied further. Disclosures: Off Label Use: Rituximab is a monclonal antibody licenced for the treatment of NHL as a single-agent. Rituximab is CLL currently under review by the FDA as treatment for relapsed/refractory CLL in combination with chemotherapy. Here it is used as a single-agent treatment for CLL.

Assessing the effect of immunosuppressive agents for immune-related adverse event management on tumor response.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 3066-3066
Author(s):  
Pankti Reid ◽  
Daniel Olson ◽  
Thomas Gajewski
Keyword(s):  
T Cell ◽  
Adverse Events ◽  
Tumor Response ◽  
Immunosuppressive Agents ◽  
Objective Response ◽  
Treatment Algorithm ◽  
Tumor Control ◽  
High Dose ◽  
High Grade ◽  
Steroid Dependent

3066 Background: High grade immune-related adverse events (irAEs) to cancer immune checkpoint inhibitors (ICI) require considerable immunosuppression (IS) with high-dose steroids and steroid-sparing IS (SSIS) for steroid-dependent cases. T lymphocyte-specific IS has generally been avoided or used with significant caution due to the fear that these agents may negatively impact ICI efficacy. We sought to determine whether T cell-specific IS agents, such as calcineurin inhibitors (CNIs), have an adverse effect on tumor control when compared to other immunomodulatory drugs (IMDs). Methods: We retrospectively analyzed clinical annotations of adult patients treated with ICIs for malignancy from 1/1/2000-12/31/2019, highlighting patients who were managed with SSIS, specifically those most commonly used for autoimmune disease therapy. Topical IS use was excluded. Patients were categorized as tumor responders or non-responders, and irAEs were graded according to National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE). Progression-free survival (PFS) was assessed via Kaplan-Meier curve. Results: 1331 unique individuals were prescribed ≥1 ICIs, with 526 prescribed systemic steroids (39.5%) and 90 (6.8%) patients prescribed SSIS agents, 25 patients with >1 SSIS: mycophenolate (39), methotrexate (26), leflunomide (5), azathioprine (3), rituximab (24), tocilizumab (3), infliximab (8), etanercept (1), adalimumab (1), golimumab (1) and CNIs (18): cyclosporine, tacrolimus. IMDs hydroxychloroquine (6) and sulfasalazine (5) were also prescribed. The objective response rate was 50.0% in the CNI group compared to 45.5% in the IMD cohort and 45.4% in the irAE group (CTCAE grade matched) with steroids alone without any SSIS. Median PFS were compared between CNI cohort (5.4 months, range 1.3-34 months) to IMD (1.1 months, range 0.4-6.4, p=0.02) and steroid alone (2.4 months, range 0.69-17.7, p=0.48). Multiple regression analysis identified irAE presence as an independent correlates to tumor response (p=0.02). Conclusions: T cell-specific IS should not be excluded from irAE treatment algorithm as we observed that PFS was comparable to immunomodulators and similar efficacy was observed compared to steroids alone. Rapid identification and management of irAEs can help mitigate morbidity but there are virtually no reliable clinical trials to guide irAE management with SSIS. These findings support the need for larger, prospective evaluation of immunosuppression use for high grade irAE therapy.

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