scholarly journals Adalimumab treatment in a patient with severe presentation of VogtKoyanagi-Harada

2021 ◽  
Author(s):  
Rebecca Vieira Teixeira ◽  
André Luiz Guimarães de Queiroz ◽  
Louis Fernando Marques de Almeida ◽  
Érico Induzzi Borges ◽  
Herval Ribeiro Soares Neto ◽  
...  
Keyword(s):  
Therapeutic Response ◽  
Hand Movement ◽  
Eye Pain ◽  
Severe Intensity ◽  
Effective Option ◽  
Adalimumab Treatment ◽  
Tnfα Inhibitor ◽  
Infectious Uveitis ◽  
Chronic Corticosteroid ◽  
Necrosis Factor

Context: Vogt-Koyanagi-Harada syndrome (VKH) is a rare, multisystemic, autoimmune disease mediated by a Th1 response against melanocytes in the eye, inner ear, central nervous system, skin and hair. In this article, we report a case of VKH with severe visual impairment and discuss the therapeutic response to corticotherapy followed by the use of Adalimumab, a tumor necrosis factor (TNFα) inhibitor. Case report: A 61-year-old black woman started bilateral frontal headache of severe intensity, associated with bilateral eye pain, hyperemia and watery eyes, progressing with visual turbidity with gradual worsening, seeing only figures after eight days. After ten days bilateral hypoacusis started, also progressive. She denied eye movement pain, diplopy, dizziness, fever, joint pain or skin injuries. On examination, visual acuity (VA) in RE: hand movement for 30 cm, LE: light perception, fundus of the eye with serous bilateral retinal detachment. CSF with 155 lymphomonocyte predominance cells, proteins: 73, negative bacterioscopy and cultures. Pulsotherapy was performed for 7 days followed by 1g of cyclophosphamide and maintenance therapy with fortnightly Adalimumab. Two months after discharge, she presented VA in RE: 20/200 and LE: counting fingers at 1 meter. Conclusions: Aggressive and early treatment with immunosuppression is key to the effective treatment of VKH. Immunotherapy can be used in patients who are unresponsive to corticosteroid doses. Biological agents that target TNFα have effective results in non-infectious uveitis. Adalimumab is a safe and effective option, which also reduces the need for chronic corticosteroid therapy. The prognosis depends on the early diagnosis and treatment.

scholarly journals Cytokines in cerebrospinal fluid of children with West syndrome

2012 ◽  
Vol 18 (2) ◽  
pp. 63-66 ◽  
Author(s):  
MA Dias de Sousa ◽  
RCF Bonatti ◽  
V Rodrigues Jr ◽  
DS Azevedo ◽  
MHA Santos ◽  
...  
Keyword(s):  
Adrenocorticotropic Hormone ◽  
Therapeutic Response ◽  
West Syndrome ◽  
Symptomatic Group ◽  
Structural Abnormalities ◽  
Neurophysiological Mechanisms ◽  
Clinical Eeg ◽  
Necrosis Factor ◽  
Pathophysiologic Mechanisms

In this study we aimed to determine the levels of tumor necrosis factor beta (TNF-b), interleukin (IL) 1-beta (IL-1b), IL-5, IL-10, and interferon gamma (IFN-g ) in CSF from children during the onset of West syndrome (WS). We observed elevated levels of IL-1b and IFN-g correlated to clinical, EEG, therapeutic response, and follow-up suggesting the involvement of immune response in WS. These results suggest that inflammatory and immunologic mediators may play a role in the pathophysiologic mechanisms of infantile spasms. Our findings may explain the perfusion and cognitive disfunctions and actions of adrenocorticotropic hormone (ACTH), corticosteroids, and intravenous immunoglobulin (IVIg) observed in WS. In conclusion, WS results from association of neurophysiological mechanisms and structural abnormalities with participation of cytokines mainly in symptomatic group.

scholarly journals The effectiveness of adalimumab treatment for non-infectious uveitis

2019 ◽  
Vol 42 (2) ◽  
pp. 79-83 ◽  
Author(s):  
Eiichi Hasegawa ◽  
Atsunobu Takeda ◽  
Nobuyo Yawata ◽  
Koh-Hei Sonoda
Keyword(s):  
Adalimumab Treatment ◽  
Infectious Uveitis

scholarly journals Adalimumab treatment leads to reduction of tissue tumor necrosis factor-alpha correlated with venous leg ulcer improvement: a pilot study

2015 ◽  
Vol 13 (5) ◽  
pp. 963-966 ◽  
Author(s):  
Joshua D Fox ◽  
Katherine L Baquerizo-Nole ◽  
Brian R Keegan ◽  
Flor Macquhae ◽  
Julia Escandon ◽  
...  
Keyword(s):  
Pilot Study ◽  
Tumor Necrosis Factor ◽  
Tumor Necrosis Factor Alpha ◽  
Tumor Necrosis ◽  
Venous Leg Ulcer ◽  
Necrosis Factor Alpha ◽  
Tissue Tumor ◽  
Adalimumab Treatment ◽  
Factor Alpha ◽  
Necrosis Factor

Etanercept, a tumour necrosis factor α receptor antagonist, and methotrexate in acute sensorineural hearing loss

2006 ◽  
Vol 120 (12) ◽  
pp. 1064-1066 ◽  
Author(s):  
I Street ◽  
P Jobanputra ◽  
D W Proops
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Tumour Necrosis Factor ◽  
Tumour Necrosis ◽  
Sensorineural Hearing ◽  
Tumour Necrosis Factor Α ◽  
Tnfα Inhibitor ◽  
High Doses ◽  
Factor Α ◽  
Necrosis Factor

Patients with autoimmune inner-ear disease (AIED) are treated with high doses of steroids in the short term when suffering an acute hearing loss. As a consequence, substances such as methotrexate have been employed in the role of steroid-sparing agents. Additionally, it is known that tumour necrosis factor α (TNFα) is an important mediator of the inflammatory process, inhibition of which may be of benefit in AIED. This case report illustrates the use of a TNFα inhibitor in combination with methotrexate, which is known to be an effective combination in rheumatoid arthritis but has yet to be described for sensorineural hearing loss. We conclude that progressive AIED may respond well to TNFα inhibition, whilst more difficult cases, such as this example, could benefit from combining such therapy with methotrexate.

scholarly journals Rituximab for non-infectious Uveitis and Scleritis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Caleb C. Ng ◽  
Aileen Sy ◽  
Emmett T. Cunningham
Keyword(s):  
Granulomatosis With Polyangiitis ◽  
Therapeutic Response ◽  
Immunosuppressive Agents ◽  
Review Of Literature ◽  
Autoimmune Retinopathy ◽  
Infectious Uveitis ◽  
Infusion Reactions ◽  
Third Line Therapy ◽  
Infectious Scleritis ◽  
Third Line

Abstract Purpose To provide a comprehensive review of rituximab use for the treatment of non-infectious uveitis and scleritis. Methods Review of literature through December 2020. Results Individual data was available for 229 patients with refractory non-infectious uveitis (n = 108) or scleritis (n = 121) who received treatment with rituximab (RTX). Rituximab was generally utilized as third-line or later treatment (uveitis: 67/90, 74.4%; scleritis: 90/96, 93.8%) at a mean of 33.5 months following the diagnosis of uveitis (range = 0 to 168.0 months; median = 24.0 months) and 39.4 months after diagnosis of scleritis (range = 1.0 to 168.0 months; median = 21.0 months). Patients with non-infectious uveitis and scleritis either received prior treatment with corticosteroids only (uveitis: 18/90, 20%; scleritis: 4/94, 4.3%), or with one (uveitis: 19/90, 21.1%; scleritis: 30/94, 31.9%), two (uveitis: 11/90, 12.2%; scleritis 27/94, 28.7%), or three or more (uveitis: 37/90, 41.1%; scleritis: 31/94, 33.0%) corticosteroid-sparing immunosuppressive agents with or without corticosteroids before initiation of RTX treatment. The rheumatologic protocol (two infusions of 1 gram of RTX separated by 14 days) was utilized most frequently (uveitis: 45/87, 51.7%; scleritis: 87/114, 76.3%), followed by the Foster protocol (eight weekly infusions of 375 mg/m2 RTX; uveitis: 18/87, 20.7%; scleritis: 10/114, 8.8%), and the oncologic protocol (four weekly infusions of 375 mg/m2 RTX; uveitis: 5/87, 5.7%; scleritis: 6/114, 5.3%). Various other off-label regimens were used infrequently (uveitis: 19/87, 21.8%; scleritis 11/114, 9.6%). Rituximab treatments resulted in a positive therapeutic response for the majority of patients with non-infectious uveitis (81/97, 83.5%). Commonly treated uveitic diagnoses included non-paraneoplastic autoimmune retinopathy (30/107, 28.0%), juvenile idiopathic arthritis (21/107, 19.6%), Vogt-Koyanagi-Harada disease (12/107, 11.2%), and Behçet disease (11/107, 10.3%). Cases of non-infectious scleritis were most commonly attributed to granulomatosis with polyangiitis (75/121, 62.0%) and rheumatoid arthritis (15/121, 12.4%), and showed an even greater rate of positive therapeutic response (112/120, 93.3%) following RTX treatment. No side effects were reported in 76.3% (74/97) of uveitis and 85.5% (71/83) scleritis cases. Of those cases associated with RTX-induced adverse events, the most common were infusion reactions of various severity (11/35, 31.4%). Conclusions Overall, RTX appeared to be both effective and well-tolerated as second or third-line therapy for patients with non-infectious uveitis and scleritis.

scholarly journals The efficacy, safety, and cost-effectiveness of conventional synthetic disease-modifying anti-rheumatic drugs triple therapy in preventing relapse in rheumatoid arthritis patients: a randomized controlled trial (ESCoRT study)

2021 ◽  
Author(s):  
Juan Zhao ◽  
Wei Zhou ◽  
Yangfeng Wu ◽  
Xiaoyan Yan ◽  
Li Yang ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Triple Therapy ◽  
Induction Therapy ◽  
Controlled Trial ◽  
Cost Effective ◽  
Effective Option ◽  
Group A ◽  
Disease Modifying ◽  
Relapse Rates ◽  
Necrosis Factor

Abstract BackgroundTumor necrosis factor inhibitors (TNFi) have been widely used in rheumatoid arthritis (RA) patients who failed to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). But how to prevent relapse after discontinuation of TNFi remains challengeable.MethodsRA patients who failed to csDMARDs received an induction therapy of MTX+TNFi for maximally 12 weeks. Those achieving LDA in 12 weeks were randomly assigned at a 1:1:1 ratio into three groups: (A) adding hydroxychloroquine and sulfasalazine for the first 12 weeks and then discontinuing TNFi for the following 48 weeks; (B) maintaining TNFi+MTX for 60 weeks; and (C) maintaining TNFi+MTX for the first 12 weeks and then discontinuing TNFi for the following 48 weeks. The primary outcome was relapse.Results117 patients were enrolled for induction therapy and 67 patients who achieved LDA within 12 weeks were randomized, with 24, 21 and 22 patients in each group. The relapse rates during 60 weeks were comparable between group A and B [10/22 (45.5%) vs 7/20 (35%), p=0.491], however, both significantly lower than that of group C [17/20 (85%), p=0.019, p=0.004, respectively]. Taken ¥100000 as the threshold of willingness to pay, compared to MTX monotherapy, both TNFi maintenance and triple csDMARDs therapies were cost-effective, but triple therapy was better.ConclusionFor RA patients achieving LDA with TNFi and MTX, csDMARDs triple therapy was a cost-effective option in favor of reducing relapse.Trial registrationRegistration number: NCT02320630.

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