scholarly journals Use Of Leflunomide In Patients With Hypersensitivity Pneumonitis

2020 ◽  
Author(s):  
Sungryong Noh ◽  
Ruchi Yadav ◽  
Manshi Li ◽  
Xiaofeng Wang ◽  
Debasis Sahoo ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Lung Function ◽  
Adverse Effects ◽  
Pulmonary Function ◽  
Hypersensitivity Pneumonitis ◽  
Second Line ◽  
Significant Fibrosis ◽  
Discontinue Therapy ◽  
Sparing Effect ◽  
Steroid Sparing

Abstract Prednisone has been shown to reverse lung function declines in hypersensitivity pneumonitis patients without established fibrosis. Second line immunosuppressants like azathioprine and mycophenolate mofetil have a steroid sparing effect and improve DLCO. There is no published literature on the use of leflunomide in such patients. We reviewed our experience with leflunomide for treatment of hypersensitivity pneumonitis in 40 patients. We stratified patients according to the presence or absence of significant (>20%) fibrosis. We studied the effect of leflunomide on FVC and DLCO trajectory and reported the changes at 12 months.Treatment with leflunomide tended to improve the estimated FVC slope from 0.18±1.90% (SEM) of predicted per year to 4.62±1.65% of predicted (NS, p=0.118). It significantly improved the FVC at 12 months of treatment by 4.4% of predicted (p=0.02). DLCO continued to increase at 1.45±1.44% (SEM) of predicted per year. Non-fibrotic HP patients had the largest gain in pulmonary function. Their FVC increased by 8.3% (p=0.001) and DLCO by 4.8% (p=0.011). Patients with fibrotic HP did not improve. Leflunomide treatment was associated with significant gastrointestinal and other adverse effects leading 40% of patients to discontinue therapy. It had a significant steroid sparing effect with half the patients weaned off prednisone entirely.Leflunomide appears to be a fairly well tolerated steroid sparing immunosuppressant that improves pulmonary function in HP patients. It is most effective in patients without significant fibrosis.

scholarly journals Outcomes of immunosuppressive therapy in chronic hypersensitivity pneumonitis

2017 ◽  
Vol 3 (3) ◽  
pp. 00016-2017 ◽  
Author(s):  
Ayodeji Adegunsoye ◽  
Justin M. Oldham ◽  
Evans R. Fernández Pérez ◽  
Mark Hamblin ◽  
Nina Patel ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Lung Function ◽  
Adverse Events ◽  
Immunosuppressive Therapy ◽  
Hypersensitivity Pneumonitis ◽  
Pulmonary Function Tests ◽  
Lung Function Decline ◽  
Azathioprine Therapy ◽  
Free Survival ◽  
Chronic Hypersensitivity Pneumonitis

In chronic hypersensitivity pneumonitis (CHP), lack of improvement or declining lung function may prompt use of immunosuppressive therapy. We hypothesised that use of azathioprine or mycophenolate mofetil with prednisone reduces adverse events and lung function decline, and improves transplant-free survival.Patients with CHP were identified. Demographic features, pulmonary function tests, incidence of treatment-emergent adverse events (TEAEs) and transplant-free survival were characterised, compared and analysed between patients stratified by immunosuppressive therapy. A multicentre comparison was performed across four independent tertiary medical centres.Among 131 CHP patients at the University of Chicago medical centre (Chicago, IL, USA), 93 (71%) received immunosuppressive therapy, and had worse baseline forced vital capacity (FVC) and diffusing capacity, and increased mortality compared with those who did not. Compared to patients treated with prednisone alone, TEAEs were 54% less frequent with azathioprine therapy (p=0.04) and 66% less frequent with mycophenolate mofetil (p=0.002). FVC decline and survival were similar between treatment groups. Analyses of datasets from four external tertiary medical centres confirmed these findings.CHP patients who did not receive immunosuppressive therapy had better survival than those who did. Use of mycophenolate mofetil or azathioprine was associated with a decreased incidence of TEAEs, and no difference in lung function decline or survival when compared with prednisone alone. Early transition to mycophenolate mofetil or azathioprine may be an appropriate therapeutic approach in CHP, but more studies are needed.

scholarly journals Mycophenolate Mofetil for the Treatment of Autoimmune Hepatitis in Patients Refractory to Standard Therapy

2004 ◽  
Vol 18 (5) ◽  
pp. 321-326 ◽  
Author(s):  
Shane M Devlin ◽  
Mark G Swain ◽  
Stefan J Urbanski ◽  
Kelly W Burak
Keyword(s):  
Mycophenolate Mofetil ◽  
Autoimmune Hepatitis ◽  
Alanine Aminotransferase ◽  
Standard Therapy ◽  
Conventional Treatment ◽  
Case Series ◽  
Therapeutic Options ◽  
Sparing Effect ◽  
Histological Remission ◽  
Steroid Sparing

There are limited therapeutic options available for patients with autoimmune hepatitis in whom conventional treatment fails. A case series of five patients unresponsive to or unable to take azathioprine, 6-mercaptopurine or corticosteroids who were treated with mycophenolate mofetil (MMF) is reported. While on MMF, alanine aminotransferase normalized or remained normal in all patients. MMF had a steroid-sparing effect and histological remission was demonstrated in one patient after seven months of MMF. One patient experienced an uncomplicated episode of pyelonephritis. In conclusion, MMF can effectively induce and maintain remission in refractory autoimmune hepatitis patients.

Steroid-Sparing Effect Of Mycophenolate Mofetil In Pulmonary Sarcoidosis

2010 ◽  
Author(s):  
Preetam Jolepalem ◽  
Nevins W. Todd ◽  
Edward J. Britt ◽  
Michael Terrin ◽  
Carla Peterman ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Pulmonary Sarcoidosis ◽  
Sparing Effect ◽  
Steroid Sparing

Mycophenolate Mofetil Is Well Tolerated and May Stabilize Lung Function in Chronic Hypersensitivity Pneumonitis Patients

CHEST Journal ◽  
2015 ◽  
Vol 148 (4) ◽  
pp. 766A
Author(s):  
Lacey Robinson ◽  
Yevgeniya Gartshteyn ◽  
Niti Agarwal ◽  
Lori Shah ◽  
Matthew Baldwin ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Lung Function ◽  
Hypersensitivity Pneumonitis ◽  
Chronic Hypersensitivity Pneumonitis

scholarly journals Steroid-sparing effect of mepolizumab in children with severe eosinophilic nonallergic asthma

2021 ◽  
Vol 49 (5) ◽  
pp. 113-116
Author(s):  
Maria Angela Tosca ◽  
Donata Girosi ◽  
Oliviero Sacco ◽  
Roberto Bernardini ◽  
Giorgio Ciprandi
Keyword(s):  
Lung Function ◽  
Therapeutic Option ◽  
Clinical Findings ◽  
Peripheral Eosinophilia ◽  
Interleukin 5 ◽  
Asthma Exacerbations ◽  
Effective Therapeutic Option ◽  
Sparing Effect ◽  
Steroid Sparing

Background: Asthma is characterized by a chronic airway inflammation, usually sustained by type 2 immunity. Bronchial and peripheral eosinophilia are biomarkers for type 2 asthma. Biologicals are the most effective treatment for severe asthma at present. Mepolizumab is an antagonist of interleukin-5 (IL-5), the most relevant cytokine involved in eosinophilia.Objective: This case report evaluated the effectiveness of mepolizumab in two girls with severe eosinophilic non-allergic asthma.Materials and methods: Two female children with severe eosinophilic nonallergic asthma were treated with mepolizumab for two years. Clinical findings, lung function, peripheral eosinophils, asthma control, and bronchial endoscopy were performed.Results: Biologicals reduced the eosinophilia, asthma exacerbations, and improved lung function in both patients. The treatment was also safe and well-tolerated.Conclusion: Mepolizumab represents an effective therapeutic option in the management of severe pediatric asthma.  

Tiotropium for Adults with Inadequately Controlled Persistent Asthma

2013 ◽  
Vol 47 (1) ◽  
pp. 117-123 ◽  
Author(s):  
Katie S Adams ◽  
Denise K Lowe
Keyword(s):  
Clinical Trials ◽  
Pulmonary Function ◽  
Case Reports ◽  
Pulmonary Function Tests ◽  
Persistent Asthma ◽  
High Dose ◽  
Function Tests ◽  
Sparing Effect ◽  
Steroid Sparing

OBJECTIVE To review the literature evaluating the efficacy and steroid-sparing effect of tiotropium for inadequately controlled persistent asthma in adults. DATA SOURCES Information was obtained through a search of MEDLINE/PubMed (1966-October 2012), using the terms asthma and tiotropium. A further review of reference citations was performed to identify other relevant articles. STUDY SELECTION AND DATA EXTRACTION English-language case reports and clinical trials were reviewed. Publications evaluating the efficacy and steroid-sparing effect of tiotropium in adults with inadequately controlled persistent asthma were included in the review. One case report and 5 clinical trials met our criteria. DATA SYNTHESIS The ultimate goal for asthma management is to maintain disease control by preventing acute exacerbations while avoiding adverse medication effects. Inhaled corticosteroids (ICS) are part of all preferred maintenance regimens for persistent asthma. Unfortunately, persistent asthma remains inadequately controlled in some patients and concerns about serious adverse effects with long-term high-dose ICS treatment exist. Interest in the use of tiotropium to control asthma symptoms and reduce steroid requirements in inadequately controlled persistent asthma is emerging. Results of several trials indicate that tiotropium improves pulmonary function markers and reduces corticosteroid requirements. Moreover, the largest and longest published trial not only showed improvements in pulmonary function tests but also a reduction in corticosteroid use and an increase in the time to first exacerbation. CONCLUSIONS Although tiotropium use in treatment of persistent asthma appears to be promising, more robust clinical trials are needed to assess whether improved pulmonary function tests as well as a decrease in asthma exacerbations and corticosteroid requirements translate into improvements in quality of life. Additionally, the optimal patient population, long-term efficacy, and safety of tiotropium when delivered by various methods need to be determined before it can be recommended over current alternative asthma therapies.

Mycophenolate mofetil and myasthenia gravis

Lupus ◽  
2005 ◽  
Vol 14 (3_suppl) ◽  
pp. 46-49 ◽  
Author(s):  
E Ciafaloni
Keyword(s):  
Mycophenolate Mofetil ◽  
Side Effects ◽  
Myasthenia Gravis ◽  
Neuromuscular Transmission ◽  
Autoimmune Disorder ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Multicenter Trials ◽  
Sparing Effect ◽  
Steroid Sparing

Myasthenia gravis (MG) represents the prototypic autoimmune disorder with well characterized immunopathology. Advances in the diagnosis and treatment of this neuromuscular transmission disorder have significantly improved the management of myasthenic patients. Unfortunately the currently available immunomodulating treatments have significant side effects and some patients do not tolerate them or adequately respond to them. Therefore the possibility of a new immunosuppressant agent that is safe, effective and has steroid-sparing effect is very appealing. Mycophenolate mofetil (MMF) has shown promising effects in MG patients in preliminary studies and is currently being studied in two prospective, randomized, double-blind, placebo controlled, multicenter trials to better establish its role in the treatment of MG.

scholarly journals Steroid-sparing effect of mycophenolate mofetil in the treatment of a subepidermal blistering autoimmune disease in a dog : clinical communication

2010 ◽  
Vol 81 (4) ◽  
Author(s):  
P.J. Ginel ◽  
B. Blanco ◽  
R. Lucena ◽  
C.R. Jimenez ◽  
C. Peinado-Guitart ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Oral Prednisone ◽  
Skin Lesions ◽  
Term Treatment ◽  
Dermoepidermal Junction ◽  
Clinical Communication ◽  
Long Term Treatment ◽  
Histopathologic Evaluation ◽  
Sparing Effect ◽  
Steroid Sparing

A 7-year-old female Cocker spaniel-cross was referred with an 8-month history of mucocutaneous erosive dermatitis. On physical examination, skin lesions affected the eyelids and periocular area, lips and vulva. Lesions were symmetrical with small diffuse superficial ulcers, haemorrhagic crusts, adherent purulent exudation in haired skin, and alopecia with hyperpigmentation and scarring. Histopathologic evaluation showed multiple, non-intact dermoepidermal junction vesicles and ulceration associated with a dermal lichenoid infiltrate. Immunohistochemistry showed strong to moderate reactivity in the dermoepidermal junction for the antibodies directed against canine IgG, human IgG lambda light chains and C3, respectively. A diagnosis of autoimmune subepidermal blistering dermatosis was made. Treatment with oral prednisone at 2 mg/kg and mycophenolate mofetil (MMF) at 20 mg/kg twice daily was initiated and after 4 weeks the ulcers and erosions were cured. During the rest of treatment, MMF was maintained at 10 mg/kg twice daily and prednisone could be tapered to 0.25 mg/kg once every other day without recurrences. In conclusion, this case report shows that MMF was well tolerated and might be effective as steroid-sparing agent in the long-term treatment of this autoimmune subepidermal blistering disease.

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