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Expert Review of Clinical Immunology

Anna Valerieva, Sonia Caccia, Marco Cicardi
Hereditary angioedema (HAE) due to C1 inhibitor (C1-INH) deficiency is a debilitating and potentially lethal disease. Management includes on-demand treatment of angioedema and their prophylaxis. Plasma derived C1-INH is an established treatment for both on demand and prophylaxis of HAE. Conestat alfa is a recombinant form of human C1-INH (rhC1-INH) produced in transgenic rabbits. It has granted drug's registration as treatment option for acute HAE attacks in adults and adolescents in Europe, America, and other countries...
July 19, 2018: Expert Review of Clinical Immunology
Lamia Dahdah, Vincenzo Fierro, Maurizio Mennini, Stefania Arasi, Alessandro Fiocchi
No abstract text is available yet for this article.
July 16, 2018: Expert Review of Clinical Immunology
Sebastiaan Heidt, Frans H J Claas
Highly sensitized patients awaiting a kidney transplant accrue on the transplant waiting list. The breadth of HLA antibodies in this subpopulation of patients precludes receiving a compatible organ offer through regular allocation within an acceptable time-frame. Areas covered: Several alternative options to receive a transplant exist for these patients, including additional priority in regular allocation, special programs based on allocation through acceptable antigens, kidney paired donation programs, desensitization protocols, or a combination of the latter two...
July 13, 2018: Expert Review of Clinical Immunology
Mahboobeh Mahdavinia
No abstract text is available yet for this article.
July 12, 2018: Expert Review of Clinical Immunology
Stefania Arasi, Lucia Caminiti, Giuseppe Crisafulli, Giovanni Battista Pajno
IgE-mediated food allergy (FA) has been emerging as a public health priority. It is a potentially life-threatening condition with negative impact on the quality of life of patients and their family and its prevalence is increasing in westernized countries in the recent two decades. The current standard approach to FA consists of the strict avoidance of the triggering food. However, an elimination diet may be difficult and frustrating, above all for those foods (e.g. milk and egg) that are pivotal in the common diet...
July 8, 2018: Expert Review of Clinical Immunology
Clara Malattia, Mariangela Rinaldi, Alberto Martini
The prognosis of juvenile idiopathic arthritis (JIA) has changed dramatically due to the availability of novel drugs. Prompt diagnosis and treatment are essential to prevent permanent joint damage. As a result, methods to improve JIA diagnosis and prognosis are of high priority to tailor treatment strategies and maximize their efficacy. Musculoskeletal ultrasound and MRI are more sensitive than clinical examination and radiography in the detection of joint involvement and might play a substantial role to optimize the management of JIA...
July 4, 2018: Expert Review of Clinical Immunology
Nicolò Pipitone, Carlo Salvarani
The idiopathic inflammatory myopathies (IIM) dermatomyositis (DM) and polymyositis (PM) are chronic diseases affecting the striated muscles with variable involvement of other organs. Glucocorticoids are considered the cornerstone of treatment, but some patients require adjunctive immunosuppressive agents because of insufficient response to glucocorticoids, flares upon glucocorticoid tapering, or glucocorticoid-related adverse events. Areas covered: The aim of this article was to review (PubMed search until February 2018) the evidence on established and new therapies derived from randomized controlled trials (RCTs) on adult DM and PM...
July 3, 2018: Expert Review of Clinical Immunology
Linqing Zhong, Wei Wang, Hongmei Song
OBJECTIVE: The aim of the meta-analysis was to evaluate the association between ten widely studied polymorphisms of interleukin-23 receptor gene (IL-23R) and ankylosing spondylitis (AS). METHODS: Two investigators separately searched literature about the association of IL-23R polymorphisms with AS. Eligible articles were then selected and data extraction was performed independently by these two investigators. Further meta-analysis was conducted with STATA 12.0 software (Stata Corp...
June 26, 2018: Expert Review of Clinical Immunology
Rohan Ameratunga, Yeri Ahn, Anthony Jordan, Klaus Lehnert, Shannon Brothers, See-Tarn Woon
Common variable immunodeficiency disorders (CVID) are the most frequent symptomatic primary immune defect in adults. Within the broad spectrum of CVID, a proportion of patients present with a predominant T cell phenotype associated with increased mortality. These patients are termed late-onset combined immunodeficiency (LOCID) and are currently separated from patients suffering from CVID. Areas covered: We have recently codiscovered a new CVID-like disorder caused by mutations of the NFKB1 gene. Members of this non-consanguineous New Zealand kindred have a very diverse spectrum of phenotypes in spite of carrying the identical mutation...
June 26, 2018: Expert Review of Clinical Immunology
Christoph Schwarz, Benedikt Mahr, Moritz Muckenhuber, Thomas Wekerle
The B7/CD28/CTLA4 signaling cascade is the most thoroughly studied costimulatory pathway and blockade with CTLA4Ig (abatacept) or its derivative belatacept has emerged as a valuable option for pharmacologic immune modulation. Several clinical studies have ultimately led to the approval of belatacept for immunosuppression in kidney transplant recipients. Areas covered: This review will discuss the immunological background of costimulation blockade and recent preclinical data and clinical results of CTLA4Ig/belatacept...
June 25, 2018: Expert Review of Clinical Immunology
Francesca Bartoli, Sangmee Bae, Laura Cometi, Marco Matucci Cerinic, Daniel E Furst
Interleukin-6 (IL-6) is well-known for its pro-inflammatory properties, has been proven to target a wide range of cells in the joint and has been implicated in extra-articular and articular manifestations in rheumatoid arthritis (RA). Tocilizumab (TCZ) is now widely used in patients with active RA and a number of additional agents that target the IL-6 pathways are under development, including sirukumab (SRK). Areas covered: SRK is a IgG1κ human anti-IL-6 monoclonal antibody which binds to IL-6 and prevents IL-6 mediated downstream effects...
June 21, 2018: Expert Review of Clinical Immunology
Miguel A González-Gay, Trinitario Pina, Diana Prieto-Peña, Mónica Calderon-Goercke, Ricardo Blanco, Santos Castañeda
Giant cell arteritis (GCA) is the most common large-vessel vasculitis in individuals older than 50 years from Western countries. The goal of the treatment is to achieve improvement of symptoms and clinical remission as well as decrease the risk of severe vascular complications. Areas covered: The review summarizes the main epidemiological and clinical features of GCA and discusses in depth both the classic and the new therapies used in the management of GCA. Expert commentary: Prednisone/prednisolone of 40-60 mg/day is the mainstay in GCA therapy...
June 20, 2018: Expert Review of Clinical Immunology
Maysoon Eldoma, Janet Pope
Systemic sclerosis (SSc) is a rare autoimmune connective tissue disease characterized by vascular dysfunction, fibrosis, inflammation and autoantibodies. The pathophysiology of SSc is not completely understood, and many patients acquire organ or tissue damage despite advances in treatment. Current treatments target affected organs with modest improvements. Areas covered: This review evaluates several treatment strategies for SSc based on involved organs including skin, pulmonary, cardiac, renal, musculoskeletal, and gastrointestinal...
June 20, 2018: Expert Review of Clinical Immunology
Dae Hyun Yoo, Jung-Yoon Choe, Seung Cheol Shim, Chang-Hee Suh
For successful switching of bio-originators to biosimilars, confidence in the switch is an important criterion. To promote confidence, scientific evidence is critical, but still there are insufficient data for the majority of approved biosimilars. Areas covered: Scientific evidence for switching from bio-originator DMARDs to biosimilars is derived from randomized controlled trials (RCTs) for switching, extension studies of RCTs for the approval process, and real-world observational studies. To identify candidate studies, PubMed was searched to collect appropriate studies in all approved biosimilars for the treatment of rheumatic diseases...
June 18, 2018: Expert Review of Clinical Immunology
Kerry Jobling, Wan Fai Ng
No abstract text is available yet for this article.
June 18, 2018: Expert Review of Clinical Immunology
Bart V J Cuppen, Marzia Rossato, Ruth D E Fritsch-Stork, Arno N Concepcion, Suzanne P Linn-Rasker, Johannes W J Bijlsma, Jacob M van Laar, Floris P J G Lafeber, Timothy R Radstake
BACKGROUND: Several studies have employed microarray-based profiling to predict response to tumor necrosis factor-alpha inhibitors (TNFi) in rheumatoid arthritis (RA); yet efforts to validate these targets have failed to show predictive abilities acceptable for clinical practice. METHODS: The eighty most extreme responders and nonresponders to TNFi therapy were selected from the observational BiOCURA cohort. RNA sequencing was performed on mRNA from peripheral blood mononuclear cells (PBMCs) collected before initiation of treatment...
June 6, 2018: Expert Review of Clinical Immunology
Mikhail Protopopov, Denis Poddubnyy
Non-radiographic axial spondyloarthritis (nr-axSpA) represents a subtype of axial spondyloarthritis (axSpA) with no significant structural damage in sacroiliac joints and spine. In addition, patients with nr-axSpA demonstrate a substantial burden of illness, and a considerable share of them might progress to radiographic axSpA (r-axSpA) over time. The amount and quality of published data allows crude estimation of progression rate and factors related to a higher risk of progression. Areas covered: This review discusses the available data reporting the rates and predictors of radiographic progression in the sacroiliac joints and in the spine in patients with nr-axSpA as well as predisposing factors for such a progression...
June 2018: Expert Review of Clinical Immunology
Gabriella Moroni, Claudio Ponticelli
In the last few decades, identification of predictors of pregnancy outcome and appropriate pregnancy planning have significantly reduced the maternal and fetal risks in pregnant women with lupus nephritis. Areas covered: Successful pregnancies have been reported even in women with chronic renal disease and renal insufficiency. However, refractory hypertension and severe renal or cardiac chronic dysfunction are still considered contraindications to pregnancy. Pre-term delivery and fetal growth restriction may still occur in SLE patients more frequently than in healthy women, even in pregnancies regularly planned and monitored by a team of nephrologists and gynaecologists...
June 2018: Expert Review of Clinical Immunology
Paul J Deziel, Raymund Razonable
Solid organ transplant (SOT) recipients are at high risk of opportunistic infections due to bacterial, viral, fungal, and parasitic pathogens. Anti-infective prophylaxis is a time-tested proven strategy for the prevention of these infections after SOT. Areas covered: The current recommendations for the prevention of surgical site infections, herpes simplex, cytomegalovirus, invasive fungal infections, and selected parasitic diseases are highlighted. Recent peer-reviewed publications on the prevention of infection after SOT were reviewed and their significance was discussed in the context of the current recommendations for preventing infectious complications...
June 2018: Expert Review of Clinical Immunology
Johan Noble, Thomas Jouve, Lionel Rostaing, Paolo Malvezzi
Cornerstone immunosuppressive therapy currently relies on immediate-release tacrolimus, a calcineurin inhibitor (CNI) that is potentially nephrotoxic and is more diabetogenic than cyclosporine A. Two new formulations of tacrolimus have been launched: an extended-release formulation (Advagraf®/Astagraf XL®, Astellas company) and a long-lasting formulation (Envarsus®, Veloxis company). Area covered: Herein, we assess the efficacy of an extended-release formulation of tacrolimus (Advagraf®/Astagraf XL®) used in conjunction with or without an induction therapy (i...
June 2018: Expert Review of Clinical Immunology
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