scholarly journals Efficacy and Safety of Dupilumab in Moderate-to-Severe Bullous Pemphigoid

2021 ◽  
Vol 12 ◽  
Author(s):  
Yihua Zhang ◽  
Qiuyun Xu ◽  
Lihong Chen ◽  
Jiawen Chen ◽  
Jing Zhang ◽  
...  
Keyword(s):  
Median Time ◽  
Bullous Pemphigoid ◽  
The Elderly ◽  
Conventional Group ◽  
Treatment Modalities ◽  
Biologic Agent ◽  
Blister Formation ◽  
Minimal Dose ◽  
Kaplan Meier ◽  
Systemic Glucocorticoids

BackgroundBullous pemphigoid (BP) is an autoimmune blistering disorder that predominantly affects the elderly. As the main treatment for BP, systemic corticosteroids are often limited by their side effects. Safer treatment modalities are therefore needed. Dupilumab is a biologic agent used to treat BP in recent years.MethodsMedical records of patients with moderate-to-severe BP were retrospectively reviewed. Twenty-four patients were included (follow-up period: 32 weeks), eight of whom received dupilumab in combination with methylprednisolone and azathioprine (dupilumab group) while the other 16 patients received methylprednisolone and azathioprine (conventional group). Response to dupilumab was evaluated by comparison of several parameters (time to stop new blister formation, time to reduce the systemic glucocorticoids to minimal dose, and total amount of methylprednisolone).ResultsThe median age of patients in the dupilumab and conventional groups were 64.50 years (range: 22–90 years) and 64.50 years (range: 17–86 years), respectively. The median duration of disease before admission in the dupilumab group was 2 months (range: 1–240 months) and 2.5 months (range: 1–60 months) in the conventional group. The median time to stop new blister formation was 8 days (range: 1–13 days) and 12 days (range: 5–21 days) in patients of the dupilumab and conventional groups, respectively (p = 0.028 by Kaplan-Meier analysis). In addition, the median time to reduce the systemic glucocorticoids to minimal dose (methylprednisolone 0.08 mg/kg/day) was 121.5 and 148.5 days for the dupilumab and conventional therapy groups, respectively (p = 0.0053 by Kaplan-Meier analysis). The median total amount of methylprednisolone (at the time of reaching the minimal dose) used in the dupilumab group was 1,898 mg (range: 1,624–2,932 mg) while the cumulative dose of conventional group was 2,344 mg (range: 1,708–4,744 mg) (p = 0.036 by Mann-Whitney U test). The median total amount of azathioprine (at the time of reaching the minimal dose) used in dupilumab group was 8,300 mg (range: 7,100–10,400 mg) while the total dose of conventional group was 10,300 mg (range: 8,900–14,400 mg) (p = 0.0048 by Mann-Whitney U test). No adverse event related to dupilumab was recorded.ConclusionsDupilumab in addition to methylprednisolone and azathioprine seems superior to methylprednisolone/azathioprine alone in controlling disease progression and accelerating the tapering of glucocorticoids.

Risk of Venous Thromboembolism in Patients with Myelodysplatic Syndrome

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5245-5245
Author(s):  
Mohamad A. Younes ◽  
Javier Munoz ◽  
Ammar Khanshour ◽  
Jessica Schering ◽  
George Yaghmour ◽  
...  
Keyword(s):  
High Risk ◽  
Median Time ◽  
Elderly Population ◽  
Risk Group ◽  
Prognostic Significance ◽  
The Elderly ◽  
High Risk Group ◽  
Treatment Modalities ◽  
Vte Prophylaxis ◽  
The Mean

Abstract Abstract 5245 Introduction: The myelodysplastic syndromes (MDS) comprise a heterogeneous group of malignant stem cell disorders characterized by dysplastic and ineffective blood cell production and a variable risk of transformation to acute leukemia (AML). Treatment of MDS with immunomodulatory drugs and eryrthropoitin is a well known risk factor for venous thromboembolic disease (VTE) and has been cited in several reports. However, the frequency of VTE in MDS patients as an independent risk factor regardless of treatment modalities has not been characterized before. Methods: We reviewed all cases of MDS diagnosed between 2000 and 2010 in our institution and did a retrospective analysis on the incidence of VTE in these patients prior or during different modalities and also according to different MDS subtypes and prognostic scores. The study also sub-classified the VTE according to being provoked or not. Results: Between 2000 and 2010, 291 patients were diagnosed with MDS in our institution. Seventeen (5.8%) patients developed VTE. Of these patients, 4(23.5%) had unprovoked VTE compared to 13(76.5%) with provoked VTE. All patients with unprovoked VTE (100%) had their venous event prior to the MDS diagnosis with a median time of 154 days (range 5–150 days). 75% (3 patients) of these patients had an intermediate-1 IPSS group and 25% (1 patient) belonged to the low risk group. In the group of patients with provoked VTE, 6 (46.2%) patients had the venous event prior to MDS diagnosis with a median time of 434 days (range 90–943 days). 83.3% (5 patients) had an intermediate-1 IPSS group and 16.7% (1 patient) belonged to the high risk group. On the other hand, 7 (53.8%) patients had provoked VTE after the MDS diagnosis with a median time of 294 days (range 14–718 days). Treatment modalities during which these VTE occurred were as follows, 3 (42.8%) patients were on erythropoietin stimulating agents (ESA), 1 (14.2%) patient was on revlimid, 2 (28.5%) patients were on active chemotherapy, and 1 (14.2%) patient was on no treatment. The IPSS group distribution for post MDS diagnosis patients with provoked VTE was as follows: 0% in the low risk group, 28.5% belonged to intermediate-1 risk group, 28.5% belonged to intermediate-2 risk group and 43% belonged to the high risk group. In patients with unprovoked VTE, the median age was 77.7 years (range 76–81 years) with equal distribution between males and females (50% each). In patients with provoked VTE, the median age was 69.6 years (range 56–85 years) with 46.1% males and 53.9% females. Discussion: The results of this study shows an increased risk of VTE in patients with MDS (5.8%) compared to that in the general population which is reported to occur in about 1 per 1000 persons per year. It also shows that all the unprovoked VTE events occurred prior to the MDS diagnosis with a median time of around 5 months. Due to this finding, we recommend that part of the workup for unprovoked VTE in the elderly population (as the mean age for unprovoked VTE was 77.7 years) include at least a CBCD and a peripheral smear to rule out cytopenias or morphologic changes suggestive of MDS. Since 46.2% of the provoked VTE happened before MDS diagnosis, we also recommend checking a CBCD in the elderly population (as the mean age for provoked VTE was 69.6 years) due to its low cost and especially if the provoking factor for VTE was not strong enough. Since 42.8% of patients with provoked VTE were on ESA during the event, we encourage aggressive VTE prophylaxis in moderate/high risk situations for these patients. The study did not show a higher prevalence of the intermediate-2 or high IPSS risk groups among patients with unprovoked (0%) or provoked VTE (46%). However, we encourage further research to study the prognostic significance of VTE in MDS patients and its relationship to progression to AML and to overall survival. Conclusion: Our study showed that a higher risk of VTE is present in patients with MDS compared to the general population and we recommend that aggressive VTE prophylaxis be given in moderate/high risk situations especially for patients who are taking ESA. We also recommend further research to be done on the prognostic significance of VTE in patients with MDS regarding overall survival and progression to AML. Disclosures: No relevant conflicts of interest to declare.

scholarly journals BULLOUS PEMPHIGOID A RARE AUTOIMMUNE DISEASE: A CASE REPORT

2019 ◽  
Vol 4 (2) ◽  
pp. 20-23
Author(s):  
S. M. Biradar ◽  
S. Dhanavidya ◽  
P. Kavya ◽  
T. Keerthi ◽  
N. Sunanda ◽  
...  
Keyword(s):  
Case Report ◽  
Bullous Pemphigoid ◽  
Male Patient ◽  
Skin Disease ◽  
The Elderly ◽  
Skin Lesions ◽  
Treatment Modalities ◽  
Susceptibility To Infection ◽  
Electrolyte Disturbances ◽  
Upper And Lower Extremities

Background. Bullous pemphigoid (BP) is a rare autoimmune blistering skin disease in the elderly and it is manifested by cutaneous blisters on the skin lesions. The objective was to emphasize the rare case of BP. Methods. A case report of BP in a 58-year-old male patient admitted to a dermatology ward is presented. Results. A 58-year-old male patient with complaints of fluid-filled skin lesions, was examined initially over the trunk, gradually progressed involving B/L upper and lower extremities. Even though the patient was treated with the recommended therapy of corticosteroid (Dexamethasone) along with adjuvant drugs, new skin lesions continued to develop, and the patient’s condition worsened. The Prednisolone was started in place of Dexamethasone on the fifth day of treatment at its higher dose (50mg/day), the Prednisolone proved its efficacy to combat the extensive condition of BP. Conclusions. Bullous pemphigoid is a distressing blistering skin disease. Untreated disease is often fatal because of the susceptibility to infection and fluid-electrolyte disturbances. The mortality of patients with bullous pemphigoid has been significantly reduced with the advent of new therapies and treatment modalities. The treatment with systemic and topical corticosteroids forms the mainstay of treatment along with other adjuvant drugs. In the present case study, the use of Prednisolone has proven its efficacy in the extensive disease state of BP and improved the patient’s quality of life.

scholarly journals Median time to pain improvement and the impact of baseline pain severity on pain response in patients with psoriatic arthritis treated with tofacitinib

RMD Open ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. e001609
Author(s):  
Kurt de Vlam ◽  
Alexis Ogdie ◽  
Andrew G Bushmakin ◽  
Joseph C Cappelleri ◽  
Roy Fleischmann ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Median Time ◽  
Pain Severity ◽  
Visual Analogue Scale Pain ◽  
Pain Response ◽  
Link Type ◽  
Kaplan Meier ◽  
Analogue Scale Pain ◽  
The Impact ◽  
Pain Improvement

BackgroundPain is a core domain of psoriatic arthritis (PsA). This post hoc analysis evaluated time to pain improvement and the impact of baseline pain severity on pain response in patients with PsA receiving tofacitinib.MethodsData from two trials (NCT01877668; NCT01882439) in patients receiving tofacitinib 5 mg twice daily, placebo switching to tofacitinib 5 mg twice daily at month 3 (placebo-to-tofacitinib) or adalimumab (NCT01877668 only) were included. Improvement in pain (≥30%/≥50% decrease from baseline in Visual Analogue Scale pain score) was assessed; median time to initial (first post-baseline visit)/continued (first two consecutive post-baseline visits) pain improvement was estimated (Kaplan-Meier) for all treatment arms. A parametric model was used to determine the relationship between baseline pain severity and time to pain response in patients receiving tofacitinib.ResultsAt month 3, more patients experienced pain improvements with tofacitinib/adalimumab versus placebo. Median days (95% CI) to initial/continued pain improvements of ≥30% and ≥50%, respectively, were 55 (29–57)/60 (57–85) and 85 (57–92)/171 (90–not estimable (NE)) for tofacitinib, versus 106 (64–115)/126 (113–173) and 169 (120–189)/NE (247–NE) for placebo-to-tofacitinib. Pain improvements were also experienced more quickly for adalimumab versus placebo. Predicted time to ≥30%/≥50% pain improvement was shorter in patients with higher baseline pain versus lower baseline pain (tofacitinib arm only).ConclusionsIn patients with PsA, pain improvements were experienced by more patients, and more rapidly, with tofacitinib and adalimumab versus placebo. In those receiving tofacitinib, higher baseline pain was associated with faster pain improvements.

Monocytes enhance neutrophil-induced blister formation in an ex vivo model of bullous pemphigoid

Allergy ◽  
2018 ◽  
Vol 73 (5) ◽  
pp. 1119-1130 ◽  
Author(s):  
E. de Graauw ◽  
C. Sitaru ◽  
M. P. Horn ◽  
L. Borradori ◽  
S. Yousefi ◽  
...  
Keyword(s):  
Bullous Pemphigoid ◽  
Ex Vivo ◽  
Ex Vivo Model ◽  
Blister Formation

scholarly journals SARS-CoV-2 Persistence in Immunocompromised Children

2021 ◽  
Author(s):  
Susan Dolan ◽  
Jean Mulcahy Levy ◽  
Angla Moss ◽  
Kelly Pearce ◽  
Samuel Dominguez ◽  
...  
Keyword(s):  
Viral Load ◽  
Median Time ◽  
Immunosuppressive Treatment ◽  
Viral Persistence ◽  
High Viral Load ◽  
Viral Loads ◽  
Mild Disease ◽  
Kaplan Meier ◽  
Diagnostic Panel ◽  
Event Times

Introduction/Objectives: We evaluated the length of time immunocompromised children (ICC) remain positive for SARS-CoV-2, identified factors associated with viral persistence and determined cycle threshold (CT) values of children with viral persistence as a surrogate of viral load. Methods: We conducted a retrospective cohort study of ICC at a pediatric hospital from March 2020-2021. Immunocompromised status was defined as primary, secondary or acquired due to medical comorbidities/immunosuppressive treatment. The primary outcome was time to first-of-two consecutive negative SARS-CoV-2 Polymerase chain reaction (PCR) tests at least 24 hours apart. Testing of sequential clinical specimens from the same subject was conducted using the Centers for Disease Control (CDC) 2019-nCoV Real-Time RT-PCR Diagnostic Panel assay. Descriptive statistics, Kaplan-Meier curve median event times and log-rank-sum tests were used to compare outcomes between groups. Results: Ninety-one children met inclusion criteria. Median age was 15.5 years (IQR 8-18 yrs), 64% were male, 58% were white, and 43% were Hispanic/Latinx. Most (67%) were tested in outpatient settings and 58% were asymptomatic. The median time to two negative tests was 42 days (IQR 25.0,55.0), with no differences in median time by illness presentation or level of immunosuppression. Seven children had >1 sample available for repeat testing, and 5/7 (71%) children had initial CT values of <30, (moderate to high viral load); 4 children had CT values of <30 3-4 weeks later, suggesting persistent moderate to high viral loads. Conclusions: Most ICC with SARS-CoV-2 infection had mild disease, with prolonged viral persistence >6 weeks and moderate to high viral load.

scholarly journals Characterization of the skin microbiota in bullous pemphigoid patients and controls reveals novel microbial indicators of disease

2021 ◽  
Author(s):  
Meriem Belheouane ◽  
Britt M Hermes ◽  
Nina Van Beek ◽  
Sandrine Benoit ◽  
Philippe Bernard ◽  
...  
Keyword(s):  
Bullous Pemphigoid ◽  
Disease Risk ◽  
Disease Status ◽  
The Elderly ◽  
Future Research ◽  
Sampling Effort ◽  
Skin Microbiota ◽  
Important Indicator ◽  
Blistering Disease ◽  
Microbe Interactions

Bullous pemphigoid (BP) is an autoimmune skin blistering disease afflicting mostly the elderly and is associated with significantly increased mortality. Here, we conducted the most extensive sampling effort of skin microbiota in BP to date to analyze whether intra-individual, body-site-specific, and/or geographical variation contributes to the emergence of BP. We find marked differences in the skin microbiota of BP patients compared to that of control subjects, and moreover that disease status rather than skin biogeography governs the skin microbiota composition in BP. Our data reveal a discernible transitional stage between normal and diseased skin in BP characterized by a loss of protective microbiota and an increase in sequences matching Staphylococcus aureus, a known inflammation-promoting species. Notably, S. aureus is ubiquitously associated with disease status, suggesting that this taxon is an important indicator of BP. Importantly, differences in a few key indicator taxa are able to reliably discriminate between BP patients and controls, characterized by their opposing abundance patterns. This may serve as valuable information for assessing disease risk and treatment outcomes. Future research will focus on the functional analysis of host-microbe and microbe-microbe interactions and the relevance of the host genome for microbiota abundances to identify novel BP treatment approaches.

scholarly journals Baseline Quantitative Hepatitis B Core Antibody Titer Is a Predictor for Hepatitis B Virus Infection Recurrence After Orthotopic Liver Transplantation

2021 ◽  
Vol 12 ◽  
Author(s):  
Bin Lou ◽  
Guanghua Ma ◽  
Feifei LV ◽  
Quan Yuan ◽  
Fanjie Xu ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Median Time ◽  
Orthotopic Liver Transplantation ◽  
Cox Regression ◽  
Hbv Infection ◽  
Hbsag Loss ◽  
Kaplan Meier ◽  
B Virus

ObjectiveHepatitis B virus (HBV) reinfection is a serious complication that arise in patients who undergo hepatitis B virus related liver transplantation. We aimed to use biomarkers to evaluate the HBV reinfection in patients after orthotopic liver transplantation.MethodsSeventy-nine patients who underwent liver transplantation between 2009 and 2015 were enrolled, and levels of biomarkers were analyzed at different time points. Cox regression and receiver operating characteristic (ROC) curves of different markers at baseline were used to analyze sustained hepatitis B surface antigen (HBsAg) loss. The Kaplan-Meier method was used to compare the levels of the biomarkers.ResultsAmong the 79 patients, 42 sustained HBsAg loss with a median time of 65.2 months (12.0-114.5, IQR 19.5) after liver transplantation and 37 patients exhibited HBsAg recurrence with a median time of 8.8 (0.47-59.53, IQR 19.47) months. In the ROC curve analysis, at baseline, 4.25 log10 IU/mL qHBcAb and 2.82 log10 IU/mL qHBsAg showed the maximum Youden’s index values with area under the curves (AUCs) of 0.685and 0.651, respectively. The Kaplan-Meier method indicated that qHBsAg and quantitative antibody against hepatitis B core antigen (qHBcAb) levels in the two groups were significantly different (p = 0.031 and 0.006, respectively). Furthermore, the Cox regression model confirmed the predictive ability of qHBcAb at baseline (AUC = 0.685).ConclusionLower pretransplantation qHBcAb is associated with HBV infection. The baseline concentration of qHBcAb is a promising predictor for the recurrence of HBV in patients undergoing liver transplantation and can be used to guide antiviral treatment for HBV infection.

scholarly journals Migraine Headache : An Overview

2010 ◽  
Vol 23 (1) ◽  
pp. 114-119
Author(s):  
ASM Hasan ◽  
Iftekhar Mahmood ◽  
MR Islam ◽  
MSI Khan ◽  
SM Ali ◽  
...  
Keyword(s):  
Migraine Headache ◽  
Botulinum Toxin Type A ◽  
Antihypertensive Agents ◽  
Opioid Analgesics ◽  
The Elderly ◽  
Botulinum Toxin Type ◽  
The United States ◽  
Treatment Modalities ◽  
Migraine Treatment ◽  
History Of

The history of headache can be traced almost to the beginning of the history of humankind. Among the many causes of it, migraine headache is a debilitating disorder affecting millions of people in the United States and worldwide. The diagnosis of migraine can significantly affect quality of life, health care costs and daily productivity. Hundreds of trials and many guidelines have documented various approaches to migraine management, whether via acute treatment or chronic migraine prophylaxis. Acute or abortive migraine management encompasses specific and nonspecific migraine therapeutics including non-opioid and opioid analgesics, triptans and ergotamines. Prophylactic migraine management data span the pharmacological spectrum from antiepileptic and antihypertensive agents to botulinum toxin type A. Special considerations for migraine management also must be applied in various populations including children, pregnant women and the elderly. Although hundreds of clinical trials are available regarding migraine treatment modalities, this review serves as an introduction to current accepted therapeutics for migraine treatment and an overview of pharmacological prophylaxis in the modern management of migraine. TAJ 2010; 23(1): 114-119

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