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Alopecia areata is an autoimmune form of non-scarring hair loss. It is usually characterized by limited areas of hair loss. However, the disease may progress to complete scalp and body hair loss (alopecia totalis, alopecia universalis). In patients with alopecia areata hair loss significantly impacts the quality of life. Children and adolescents with alopecia areata often experience bullying, including physical aggression. The disease severity evaluation tools used in clinical practice are: the Severity of Alopecia Tool (SALT) score and the Alopecia Areata Scale (AAS). A SALT score equal to or greater than 20 constitutes a commonly accepted indication for systemic therapy in alopecia areata. When using the AAS, moderate to severe alopecia areata should be considered a medical indication for systemic treatment. Currently, the only two EMA-approved medications for alopecia areata are baricitinib (JAK 1/2 inhibitor) for adults and ritlecitinib (JAK 3/TEC inhibitor) for individuals aged 12 and older. Both are EMA-approved for patients with severe alopecia areata. Other systemic medications used off-label in alopecia areata include glucocorticosteroids, cyclosporine, methotrexate and azathioprine. Oral minoxidil is considered an adjuvant therapy with limited data confirming its possible efficacy. This consensus statement is to outline a systemic treatment algorithm for alopecia areata, indications for systemic treatment, available therapeutic options, their efficacy and safety, as well as the duration of the therapy.

MeSH
alopecia areata * farmakoterapie MeSH
alopecie farmakoterapie MeSH
azathioprin terapeutické užití MeSH
dítě MeSH
dospělí MeSH
inhibitory Janus kinas * terapeutické užití MeSH
kvalita života MeSH
lidé MeSH
minoxidil terapeutické užití MeSH
mladiství MeSH
Check Tag
dítě MeSH
dospělí MeSH
lidé MeSH
mladiství MeSH
Publikační typ
časopisecké články MeSH
přehledy MeSH

Článek

Prediction of thiopurine failure in pediatric Crohn's disease: pediatric IBD Porto group of ESPGHAN

Pediatric research. 2023 ; 93 (6) : 1659-1666. [pub] 20220825

Pediatr Res
ISSN 1530-0447
Medvik
Zdroj

BACKGROUND: Maintaining of remission early in the disease course of Crohn's disease (CD) is essential and has major impact on the future prognosis. This study aimed to identify baseline predictors to develop model allowing stratification of patients who will not benefit from long-term azathioprine (AZA) treatment and will require more intensive therapy. METHODS: This study was designed to develop clinical prediction rule using retrospective data analysis of pediatric CD patients included in prospective inception cohort. Clinical relapse was defined as necessity of re-induction of remission. Sequence of Cox models was fitted to predict risk of relapse. RESULTS: Out of 1190 CD patients from 13 European centers, 441 were included, 50.3% patients did not experience clinical relapse within 2 years of AZA treatment initiation. Median time to relapse was 2.11 (CI 1.59-2.46) years. Of all the tested parameters available at diagnosis, six were significant in multivariate analyses: C-reactive protein (p = 0.038), body mass index Z-score >0.8 SD (p = 0.002), abnormal sigmoid imaging (p = 0.039), abnormal esophageal endoscopy (p = 0.005), ileocolonic localization (p = 0.023), AZA dose in specific age category (p = 0.031). CONCLUSIONS: Although the possibility of predicting relapse on AZA treatment appears limited, we developed predictive model based on six baseline parameters potentially helpful in clinical decision. IMPACT: The possibility of predicting relapse on AZA treatment appears to be possible but limited. We identified six independent predictors available at diagnosis of early AZA/6-MP treatment failure in pediatric CD patients. Using combination of these factors, a model applicable to clinical practice was created. A web-based tool, allowing estimation of individual relapse risk in pediatric CD patients on a particular therapeutic regimen, has been developed.

MeSH
azathioprin terapeutické užití škodlivé účinky MeSH
Crohnova nemoc * komplikace diagnóza farmakoterapie MeSH
dítě MeSH
imunosupresiva terapeutické užití škodlivé účinky MeSH
indukce remise MeSH
lidé MeSH
prospektivní studie MeSH
recidiva MeSH
retrospektivní studie MeSH
Check Tag
dítě MeSH
lidé MeSH
Publikační typ
časopisecké články MeSH
práce podpořená grantem MeSH

Článek

Switch pacientka s Crohnovou nemocí z i. v. infliximabu na s. c. z důvodu pozitivity protilátek proti infliximabu

Lerchová, Iva
Autor Lerchová, Iva Centrum biologické terapie, Městská nemocnice Ostrava

Acta medicinae. 2023 ; 12 (1) : 81-82.

ISSN 1805-398X
Medvik
Zdroj

MeSH
alopurinol aplikace a dávkování škodlivé účinky MeSH
azathioprin aplikace a dávkování škodlivé účinky MeSH
Crohnova nemoc * farmakoterapie imunologie komplikace MeSH
dospělí MeSH
infliximab * aplikace a dávkování imunologie škodlivé účinky MeSH
kombinovaná farmakoterapie MeSH
lékové postižení jater etiologie MeSH
leukocytární L1-antigenní komplex analýza MeSH
lidé MeSH
náhrada léků MeSH
terapie neúspěšná MeSH
Check Tag
dospělí MeSH
lidé MeSH
mužské pohlaví MeSH
Publikační typ
kazuistiky MeSH

Článek

Rituximab versus azathioprine for maintenance of remission for patients with ANCA-associated vasculitis and relapsing disease: an international randomised controlled trial

Annals of the rheumatic diseases. 2023 ; 82 (7) : 937-944. [pub] 20230323

Ann Rheum Dis
ISSN 1468-2060
Medvik
Zdroj

OBJECTIVE: Following induction of remission with rituximab in anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) relapse rates are high, especially in patients with history of relapse. Relapses are associated with increased exposure to immunosuppressive medications, the accrual of damage and increased morbidity and mortality. The RITAZAREM trial compared the efficacy of repeat-dose rituximab to daily oral azathioprine for prevention of relapse in patients with relapsing AAV in whom remission was reinduced with rituximab. METHODS: RITAZAREM was an international randomised controlled, open-label, superiority trial that recruited 188 patients at the time of an AAV relapse from 29 centres in seven countries between April 2013 and November 2016. All patients received rituximab and glucocorticoids to reinduce remission. Patients achieving remission by 4 months were randomised to receive rituximab intravenously (1000 mg every 4 months, through month 20) (85 patients) or azathioprine (2 mg/kg/day, tapered after month 24) (85 patients) and followed for a minimum of 36 months. The primary outcome was time to disease relapse (either major or minor relapse). RESULTS: Rituximab was superior to azathioprine in preventing relapse: HR 0.41; 95% CI 0.27 to 0.61, p<0.001. 19/85 (22%) patients in the rituximab group and 31/85 (36%) in the azathioprine group experienced at least one serious adverse event during the treatment period. There were no differences in rates of hypogammaglobulinaemia or infection between groups. CONCLUSIONS: Following induction of remission with rituximab, fixed-interval, repeat-dose rituximab was superior to azathioprine for preventing disease relapse in patients with AAV with a prior history of relapse. TRIAL REGISTRATION NUMBER: NCT01697267; ClinicalTrials.gov identifier.

MeSH
ANCA-asociované vaskulitidy * farmakoterapie MeSH
azathioprin * terapeutické užití MeSH
cyklofosfamid terapeutické užití MeSH
imunosupresiva terapeutické užití MeSH
indukce remise MeSH
lidé MeSH
protilátky proti cytoplazmě neutrofilů MeSH
recidiva MeSH
rituximab terapeutické užití MeSH
výsledek terapie MeSH
Check Tag
lidé MeSH
Publikační typ
časopisecké články MeSH
práce podpořená grantem MeSH
randomizované kontrolované studie MeSH

Web zdroj

Effect of immunosuppressive therapy in inflammatory cardiomyopathy: data from The Czech Inflammatory Cardiomyopathy Immunosuppressive Trial

Bratislavské lekárske listy. 2022 ; 123 (1) : 37-43.

ISSN 0006-9248
Medvik
Zdroj

INTRODUCTION: The indications for specific treatment in the cases of inflammatory cardiomyopathy are based on limited data from several small clinical trials. AIM: A comparison of the effect of two dose regimens of combined immunosuppressive therapy by adding them to conventional heart failure therapy and comparing them with conventional heart failure therapy alone in patients with inflammatory cardiomyopathy. METHODS AND STUDY POPULATION: We enrolled 20 patients; mean age 46.10±7.33 years, duration of symptoms <6 months, LVEF ≤40 %, NYHA class II–IV, with biopsy‐proven myocarditis. Patients were randomly separated into groups treated with immunosuppressive therapy in addition to conventional heart failure therapy or to a group treated with conventional heart failure therapy alone. Clinical and echocardiographic parameters were evaluated. RESULTS: The baseline values of LVEF in the group of immunosuppressive therapy (LVEF 22.3±4.7 %) were similar to those in the group treated with conventional heart failure therapy (LVEF 21.7±4.7 %; p=0.757). After twelve months there was no statistically significant difference in LVEF between the two studied groups (LVEF 33.7±9.5 % for the immunosuppressive therapy group and 41.3±13.0 % for the conventional therapy group; p=0.175). CONCLUSION: In our study population, we proved no positive effect of combined immunosuppressive therapy on the left ventricular function over 12 months. The main limitation of the study is the small number of enrolled patients (Tab. 4, Fig. 1, Ref. 35).

MeSH
azathioprin aplikace a dávkování MeSH
dospělí MeSH
imunosupresivní léčba * metody škodlivé účinky MeSH
kardiomyopatie * farmakoterapie terapie MeSH
kombinovaná farmakoterapie MeSH
lidé středního věku MeSH
lidé MeSH
myokarditida farmakoterapie terapie MeSH
prednison aplikace a dávkování MeSH
prospektivní studie MeSH
tepový objem účinky léků MeSH
výsledek terapie MeSH
Check Tag
dospělí MeSH
lidé středního věku MeSH
lidé MeSH
Publikační typ
práce podpořená grantem MeSH
randomizované kontrolované studie MeSH
srovnávací studie MeSH
Geografické názvy
Česká republika MeSH

Článek

Případy bulózního pemfigoidu po očkování proti covidu-19
[Bullous Pemphigoid after COVID-19 Vaccination. Two Cases Report]

Československá dermatologie. 2022 ; 97 (3) : 127-131.

ISSN 0009-0514
Medvik
Zdroj

Bulózní pemfigoid je nejčastější autoimunitní onemocnění charakterizované tvorbou subepidermálních puchýřů na kůži a méně často na sliznicích. Vyskytuje se především u starší populace. Mezi možné vyvolávající příčiny patří trauma, ultrafialové záření a léky, vzácně se popisují případy po očkování. Autoři popisují nový vznik pemfigoidu a výrazné zhoršení dříve diagnostikovaného pemfigoidu u dvou pacientů po aplikaci druhé dávky mRNA vakcíny PFIZER a BioNTech.

Bullous pemphigoid represents the most common autoimmune subepidermal blistering disease of the skin. It usually develops in the elderly population. Several factors have been implicated in the pathogenesis, such as trauma, ultraviolet therapy and drugs. Rarely, case reports describe the association of vaccination with the onset of pemphigoid. We report new onset of bullous pemphigoid and deterioration of previously diagnosed pemphigoid in two patients after the second dose of mRNA COVID-19 vaccination.

MeSH
azathioprin aplikace a dávkování terapeutické užití MeSH
bulózní pemfigoid * diagnóza farmakoterapie MeSH
komorbidita MeSH
lidé středního věku MeSH
lidé MeSH
prednison aplikace a dávkování terapeutické užití MeSH
vakcíny proti COVID-19 škodlivé účinky MeSH
výsledek terapie MeSH
Check Tag
lidé středního věku MeSH
lidé MeSH
mužské pohlaví MeSH
Publikační typ
kazuistiky MeSH

Článek

Snášenlivost léčby nintedanibem při zavedené imunosupresivní léčbě
[Tolerability of nintedanib treatment with established immunosuppressive therapy]

Šterclová, Martina, 1979-
Autor Autorita ORCID Pneumologická klinika 1. LF UK a FTN Pneumologická klinika 2. LF a FN Motol, Praha

Farmakoterapie. 2022 ; 18 (1) : 34-41.

Farmakoterapie (Praha Print)
ISSN 1801-1209
Medvik
Zdroj

Účinnost nintedanibu na zpomalení poklesu plicních funkcí u pacientů s progredujícím fibrotizujícím (PF) fenotypem intersticiálního plicního procesu (IPP) byla ověřena klinickou studií INBUILD, jejíž výsledky byly publikovány v roce 2019. Zatímco v této studii bylo souběžné použití nintedanibu a imunosupresiv omezeno, v klinické praxi před rozhodnutím, zda nintedanibem imunosupresi nahradit, nebo jej ke stávající léčbě přidat, stojíme poměrně často. Zatím nebylo publikováno mnoho prací zabývajících se snášenlivostí kombinované imunosupresivní a antifibrotické léčby. Sdělení přináší přehled zkušeností s kombinovanou imunosupresivní a antifibrotickou léčbou u šesti nemocných, s dobrou snášenlivostí léčby.

The effectiveness of nintedanib in slowing the decline in lung function in patients with a progressive fibrotic (PF) phenotype of the interstitial lung process (IPP) was validated in the INBUILD clinical trial, published in 2019. While the concomitant use of nintedanib and immunosuppressants was limited in this study, the practice before deciding whether to replace nintedanib with immunosuppression or to add it to existing treatment is quite common. To date, many studies have been published on the tolerability of combined immunosuppressive and antifibrotic therapy. The communication provides an overview of the experience with combined immunosuppressive and antifibrotic treatment in six patients with good tolerance.

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