scholarly journals High Dose Infliximab in the Treatment of Refractory Uveitis: Does Dose Matter?

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Sukesh Sukumaran ◽  
Katherine Marzan ◽  
Bracha Shaham ◽  
Andreas Reiff
Keyword(s):  
Los Angeles ◽  
Disease Control ◽  
Dose Escalation ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
High Dose ◽  
Topical Steroids ◽  
Optimal Dosing ◽  
Control Disease ◽  
Achieve Disease Control

Background. Infliximab (INF) has been shown to be beneficial in treating refractory uveitis, however, no data exist on optimal dosing and the efficacy of higher dosing. Objectives. To compare the efficacy of low-dose (LD) (<10 mg/kg), moderate-dose (MD) (≥10–15 mg/kg), and high-dose (HD) INF (≥15–20 mg/kg) in the treatment of uveitis. Methods. Retrospective chart review children with uveitis diagnosed at Childrens Hospital Los Angeles and Millers Children’s Hospital, CA, USA. Results. Of the 34 INF-treated children, 6 patients received LD, 19 received MD, and 9 received HD. Average disease duration prior to therapy was 10.6, 24.6, and 37.1 months each group, respectively. Topical steroids were discontinued after an average of 3 months, 9.5 months, and 10.2 months in the LD, MD, and HD groups, respectively. We found that 66% of patients receiving LD, 42% of MD, and 66% receiving HD INF failed therapy and required either dose escalation or alternate medication for disease control. Conclusions. INF is beneficial in the treatment of uveitis, and dose escalation up to 4 times above the approved dose is often necessary to achieve disease control in patients with uveitis. Doses < 10 mg/kg every 4 weeks may not be sufficient to control disease.

High-dose osimertinib for CNS progression in EGFR+ non-small cell lung cancer (NSCLC): A multi-institutional experience.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 9586-9586 ◽  
Author(s):  
Andrew Piper-Vallillo ◽  
Julia K Rotow ◽  
Jacqueline V Aredo ◽  
Khvaramza Shaverdashvili ◽  
Jia Luo ◽  
...  
Keyword(s):  
Disease Control ◽  
Dose Escalation ◽  
Leptomeningeal Disease ◽  
High Dose ◽  
Treatment Intensification ◽  
Cns Disease ◽  
Kaplan Meier ◽  
Institutional Experience ◽  
Life Threatening ◽  
Parenchymal Disease

9586 Background: High-dose osimertinib 160 mg QD (osi160) has activity in osi-naïve, EGFR+ NSCLC pts with CNS or leptomeningeal disease (LMD) per the BLOOM trial, but the role of dose-escalation for CNS progression (PD) and/or LMD that develops while on 80 mg QD (osi80) is unclear. We describe here our multi-institutional experience with osi160. Methods: 105 pts from 8 institutions with advanced EGFR+ NSCLC treated with osi160 were retrospectively reviewed. To assess the CNS efficacy of dose escalation for CNS PD, we focused on pts who escalated from osi80 to osi160 for CNS PD without the addition of chemo and/or RT during dose escalation (cohort A, 24 pts). We also examined osi escalation for CNS PD while receiving chemo and/or RT (cohort B, 34 pts) and those who started on osi160 for CNS PD as the initial osi dose without overlapping therapies (cohort C, 11 pts). Radiographic responses were clinically assessed via chart review of scan reports. Kaplan-Meier analysis was used for time-to-event endpoints. We defined median duration of CNS disease control (MedDurCNSCon) on osi160 as time from the start of osi160 to CNS PD or discontinuation of osi160. Results: Among the 105 pts, 69 (26M, 43F; median age 57) EGFR+ NSCLC pts (29 del19, 31 L858R, 9 other) received osi160 for CNS PD between 10/2013 and 1/2020. Median lines of therapy pre-osi was 1 (range 0-8). While all 69 pts had CNS PD at the start of osi160, 61 (90%) had isolated CNS/LMD PD, without systemic PD. In cohort A, osi160 monotherapy had a MedDurCNSCon of 3.8 mos (95% CI, 1.7 – 5.8). Cohort A pts with isolated LMD (11) had MedDurCNSCon 5.8 mos (95% CI, 1.7 – 9) while those with parenchymal mets only (11) had MedDurCNSCon of 2 mos (95% CI, 1 - 4.9). In cohort B, osi160 in combination with RT (22) and/or chemo (14), had a MedDurCNSCon of 5.1 mos (95% CI, 3.1 – 6.5). In cohort C, osi160 monotherapy had a MedDurCNSCon of 4.2 mos (95% CI, 1.6 – NA). Pts on osi160 had no severe or life-threatening side effects. Conclusions: In this real-world cohort of EGFR+ NSCLC pts with CNS and/or LMD PD on osi80, dose escalation to 160 provided modest benefit with median 3.8 mos added CNS disease control. Dose escalation appeared more effective in pts with LMD versus parenchymal disease (MedDurCNSCon of 5.8 vs 2 mos). Treatment intensification with osi escalation plus RT and/or chemo appeared to confer about 1 month additional CNS disease control (power for comparison limited). Osi naïve pts started at 160 for CNS PD derived similar benefit. While limited by small numbers and retrospective design, this study suggests we need improved strategies to optimally manage CNS PD arising on osi80.

Effect of Intravenous Immunoglobulin on Prednisone Dose in Patients with Pemphigus Vulgaris

2006 ◽  
Vol 10 (5) ◽  
pp. 222-227 ◽  
Author(s):  
Nicole Mittmann ◽  
Brian Chan ◽  
Sandra Knowles ◽  
P. Régine Mydlarski ◽  
Lidia Cosentino ◽  
...  
Keyword(s):  
Intravenous Immunoglobulin ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Pemphigus Vulgaris ◽  
High Dose ◽  
Women's College ◽  
Prednisone Dose ◽  
Systemic Corticosteroids ◽  
The Mean ◽  
Ivig Administration

Background: Current therapeutic options for the treatment of pemphigus vulgaris (PV) are prednisone and immunosuppressants. Patients unresponsive to high-dose systemic corticosteroids and conventional immunosuppressants may respond to intravenous immunoglobulin (IVIG). Objective: The primary outcome was the change in prednisone dose at 6 months and 1 year post-IVIG administration. Methods: A retrospective chart review of PV patients treated at Sunnybrook and Women's College Health Sciences Centre between January 1999 and October 2004 was conducted. Demographic information, corticosteroid and IVIG use, dosage, and the timing of administration for all patients were obtained. Results: Eight PV patients, mean age of 50 years (± 14.7 years), were reviewed. There was a significant decrease in mean prednisone dose at 6 months (45%) and 12 months (71%) compared with the mean dose at the start of treatment ( p < .05). Limitations: Concomitant medication use may influence results. Conclusion: This study demonstrates that IVIG can lower prednisone doses in PV patients.

scholarly journals Vancomycin and DRESS: A retrospective chart review of 32 cases in Los Angeles, California

2017 ◽  
Vol 77 (5) ◽  
pp. 973-975 ◽  
Author(s):  
Barbara D. Lam ◽  
Melanie M. Miller ◽  
Adam V. Sutton ◽  
David Peng ◽  
Ashley B. Crew
Keyword(s):  
Los Angeles ◽  
Chart Review ◽  
Retrospective Chart Review

scholarly journals Treatment of Advanced Oropharyngeal Cancers with Chemotherapy and Radiation

2003 ◽  
Vol 82 (5) ◽  
pp. 367-370 ◽  
Author(s):  
Maria M. LoTempio ◽  
Marilene B. Wang ◽  
Ahmad Sadeghi
Keyword(s):  
Los Angeles ◽  
Primary Tumor ◽  
Chart Review ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Concomitant Chemotherapy ◽  
Small Series ◽  
Lost To Follow Up ◽  
Base Of The Tongue

We conducted a retrospective chart review of treatment outcomes in 17 adults who had been selected to undergo concomitant chemotherapy and radiation (chemo/XRT) for late-stage oropharyngeal cancers. All patients had been treated at the West Los Angeles VA Medical Center between March 1, 1998, and Sept. 30, 2000. Nine patients had a primary tumor at the base of the tongue, five had a primary tumor in the tonsillar area, and three had a tumor that affected both sites. Of this group, 15 patients completed one to three cycles of chemo/XRT, and the remaining two died during therapy. At the most recent follow-up, 9 of the 17 patients (52.9%) were documented to still be alive; seven patients had earlier died as a result of their primary tumor or a distant metastasis, and one patient had been lost to follow-up after completing treatment. At study's end, the duration of post-treatment survival ranged from 2 to 36 months (mean: 12.5). Based on the results of our small series, we conclude that chemo/XRT is a valid alternative to surgery with postoperative radiation and to radiation alone. Chemo/XRT yields acceptable rates of local control and allows for organ preservation with tolerable side effects.

scholarly journals Understanding and Application of Daptomycin-Susceptible Dose-Dependent Category for Enterococcus: A Mixed-Methods Study

2022 ◽  
Vol 9 (1) ◽  
Author(s):  
Jennifer L Adema ◽  
Laurel N Lake ◽  
Ryan W Stevens ◽  
Breann M Hogan ◽  
Audrey N Schuetz ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Chart Review ◽  
Susceptibility Testing ◽  
Retrospective Chart Review ◽  
Mixed Methods Study ◽  
Clinical Microbiology Laboratory ◽  
Optimal Dosing ◽  
Enterococcus Spp ◽  
Dose Dependent ◽  
Question Survey

Abstract Background In 2018, the Clinical Microbiology Laboratory at our institution adopted updated daptomycin Enterococcus–susceptible dose-dependent breakpoints. While the introduction of susceptible dose-dependent (SDD) was intended to guide practice toward optimal dosing, the understanding and application of daptomycin SDD breakpoints for enterococci were unknown. Methods This mixed-methods study combined a clinician survey with a retrospective pre–post prescribing analysis. An 8-question survey was distributed to infectious diseases (ID) and internal medicine (IM) clinicians. A retrospective chart review of hospitalized adults with infections due to Enterococcus spp. was conducted before (pre-SDD) and after (post-SDD) adoption of SDD reporting for enterococci. Results Survey response rates were 40 of 98 (41%) for IM and 22 of 34 (65%) for ID clinicians. ID clinicians scored significantly higher than IM clinicians in knowledge of SDD. Chart review of 474 patients (225 pre- vs 249 post-SDD) showed that daptomycin dosage following susceptibility testing was significantly higher post-SDD compared with pre-SDD (8.5 mg/kg vs 6.4 mg/kg; P &lt; .001) with no difference in empiric dosing (6.3 mg/kg vs 6.2 mg/kg; P = .67). Definitive daptomycin use varied between the pre- and post-SDD periods (35.1% vs 16.9%; P &lt; .001). Conclusions The survey revealed that ID clinicians placed more importance on and had more confidence in the SDD category over IM clinicians. SDD reporting was associated with a change in definitive daptomycin dosing. ID specialist involvement is recommended in the care of infections due to enterococci for which daptomycin is reported as SDD given their expertise.

scholarly journals Dose Escalation and Co-therapy Intensification Between Etanercept, Adalimumab, and Infliximab: The CADURA Study

2017 ◽  
Vol 11 (1) ◽  
pp. 123-135 ◽  
Author(s):  
Carter Thorne ◽  
Gilles Boire ◽  
Andrew Chow ◽  
Kirsten Garces ◽  
Fang Liu ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Practice ◽  
Dose Escalation ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Routine Clinical Practice ◽  
Total Drug

Objective: To compare anti-TNF dose escalation, DMARD and/or glucocorticoid intensification, switches to another biologic, and drug and drug-related costs over 12 and 18 months for rheumatoid arthritis (RA) patients initiating etanercept (ETN), adalimumab (ADA), or infliximab (IFX) in routine clinical practice across Canada. Methods: A retrospective chart review of biologic-naïve adult RA patients newly initiating ADA, ETN, or IFX between January 01, 2006 and December 31, 2012 from 11 practices across Canada. Results: There were 314 patients in the 12-month analysis and 217 in the 18-month analysis. No dose escalation occurred with ETN over 12 and 18 months versus 38% and 32% for IFX (p<0.001) and 2% and 2% for ADA (p=0.199, p=0.218). Over 18 months, dose escalation and/or DMARD and/or glucocorticoid intensification was less frequent among ETN (16%) versus IFX (44%, p=0.005) and ADA (34%, p=0.004). By 18 months, 22% of patients initiating ADA had switched to another biologic compared with 6% of ETN patients (p=0.001). Patients initiating ETN had lower total (drug and drug-related) costs over 12 and 18 months compared to IFX, and no difference compared to ADA when adjusted for potential confounders. Patients with dose escalation had higher costs compared to those with no dose escalation. Conclusion: Physicians were more likely to escalate the dose of IFX, but optimize co-therapy with ADA and ETN. ETN patients had no dose escalation and were less likely to have DMARD and/or glucocorticoid intensification than ADA patients. ETN-treated patients had lower costs compared to IFX patients.

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