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Immunosuppression withdrawal

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https://www.readbyqxmd.com/read/28529524/antithyroid-drug-therapy-for-graves-disease-and-implications-for-recurrence
#1
REVIEW
Jia Liu, Jing Fu, Yuan Xu, Guang Wang
Graves' disease (GD) is the most common cause of hyperthyroidism worldwide. Current therapeutic options for GD include antithyroid drugs (ATD), radioactive iodine, and thyroidectomy. ATD treatment is generally well accepted by patients and clinicians due to some advantages including normalizing thyroid function in a short time, hardly causing hypothyroidism, and ameliorating immune disorder while avoiding radiation exposure and invasive procedures. However, the relatively high recurrence rate is a major concern for ATD treatment, which is associated with multiple influencing factors like clinical characteristics, treatment strategies, and genetic and environmental factors...
2017: International Journal of Endocrinology
https://www.readbyqxmd.com/read/28521707/biologic-agents-in-systemic-dermatotherapy-cutaneous-and-systemic-side-effects
#2
George Badavanis, Efstathia Pasmatzi, Alexandra Monastirli, Dionysios Tsambaos
The recent significant breakthroughs in the understanding of the pathogenetic mechanisms of psoriasis and other immune-mediated inflammatory disorders, have led to the emergence of a wide array of biologic agents or biologics, that are especially designed to target selective intracellular or extracellular components and pathways of the dysregulated immune response. These targeted biologic agents have altered the landscape in dermatotherapy aiming to offer higher therapeutic efficacy and an alternative in patients who either failed on conventional systemic regimens or have no other therapeutic options...
May 18, 2017: Current Drug Safety
https://www.readbyqxmd.com/read/28518214/immune-monitoring-as-prerequisite-for-transplantation-tolerance-trials
#3
REVIEW
Katayoun Behnam Sani, Birgit Sawitzki
Ever since its first application in clinical medicine, scientists have urged to induce tolerance towards foreign allogeneic transplants and thus avoid rejection by the recipient's immune system. This would circumvent chronic use of immunosuppressive drugs (IS) and thus avoid development of IS-induced side effects, which are contributing to the still unsatisfactory long-term graft and patient survival after solid organ transplantation. Although manifold strategies of tolerance induction have been described in preclinical models, only three therapeutic approaches have been successfully utilized in a still small number of patients...
May 18, 2017: Clinical and Experimental Immunology
https://www.readbyqxmd.com/read/28512418/cushing-s-syndrome-cortisol-and-cognitive-competency-a-case-report
#4
Neil Oronsky, Bennett Thilagar, Carolyn M Ray, Scott Caroen, Michelle M C Lybeck, Lindsey Ferry, Ronald A Voves, Bryan Oronsky
Glucocorticoids are associated with immunosuppression and neuropsychiatric complications. We describe the case of a carcinoid patient with Cushing's syndrome (CS) and neurocognitive impairment due to ectopic ACTH production who developed sepsis and died because of his family's decision to withdraw antibiotic treatment. This report is presented to illustrate the importance of advanced-care planning in patients with CS.
January 2017: Case Reports in Oncology
https://www.readbyqxmd.com/read/28507917/systemic-meta-analysis-assessing-the-short-term-applicability-of-early-conversion-to-mammalian-target-of-rapamycin-inhibitors-in-kidney-transplant
#5
Jayant Kumar, Isabella Reccia, Tomokazu Kusano, Bridson M Julie, Ajay Sharma, Ahmed Halawa
AIM: To consolidate the present evidence of effectiveness in renal functioning and graft survival following early introduction of mammalian target of rapamycin (mTOR) inhibitors with or without calcineurin inhibitors (CNIs) in renal transplant recipients. METHODS: We analysed the current literature following PROSPERO approval describing the role of immunosuppressive agent, mTOR inhibitors as an alternative to CNI within six months of renal transplant by searching the PubMed, EMBASE, Cochrane, Crossref, and Scopus using MeSH terms...
April 24, 2017: World Journal of Transplantation
https://www.readbyqxmd.com/read/28499322/azathioprine-allows-glucocorticoid-withdrawal-post-hoc-results-of-a-prospective-study-in-patients-with-inflammatory-bowel-diseases
#6
Niels Teich, Wolfgang Mohl, Bernd Bokemeyer, Burkhard Bündgens, Jürgen Büning, Stephan Miehlke, Dietrich Hüppe, Christian Maaser, Britta Siegmund, Carsten Schmidt, Andreas Stallmach
Background Azathioprine is recommended as first-line immunosuppressant in patients with steroid-dependent inflammatory bowel diseases (IBDs). However, data on steroid withdrawal after induction therapy in IBD patients are sparse. Methods In this post-hoc analysis of a prospective multicenter study, we analyzed the proportion and clinical characteristics of 324 azathioprine-tolerant patients as to whether they could terminate the glucocorticoid therapy after initiation of treatment with azathioprine. Results Systemic steroid therapy was required in 190 patients (58...
May 2017: Zeitschrift Für Gastroenterologie
https://www.readbyqxmd.com/read/28497440/-treatment-of-relapsing-remitting-multiple-sclerosis-with-fingolimod-in-routine-clinical-practice
#7
C Alcala-Vicente, F C Perez-Miralles, F Gascon-Gimenez, I Bosca-Blasco, A Navarre-Gimeno, F Coret-Ferrer, B Casanova-Estruch
INTRODUCTION: Fingolimod is a selective immunosuppressant that targets the S1P receptor, and is indicated in the treatment of aggressive relapsing-remitting multiple sclerosis (RRMS) and following treatment failure with first-order drugs. AIM: To investigate the safety and effectiveness of fingolimod under the conditions of routine clinical practice. PATIENTS AND METHODS: We conducted an observational study with prospective follow-up of patients with RRMS who received fingolimod from January 2011 until February 2014...
May 16, 2017: Revista de Neurologia
https://www.readbyqxmd.com/read/28495642/feasibility-of-lenalidomide-therapy-for-persistent-chronic-lymphocytic-leukemia-after-allogeneic-transplantation
#8
Maria R Khouri, Elias J Jabbour, Alison M Gulbis, Francesco Turturro, Celina Ledesma, Martin Korbling, Barry I Samuels, Sairah Ahmed, Amin M Alousi, Stefan O Ciurea, David Marin, Krina K Patel, Uday R Popat, Carlos E Bueso-Ramos, Roland L Bassett, Issa F Khouri
In patients with chronic lymphocytic leukemia (CLL), persistence of disease after allogeneic stem cell transplantation (alloSCT) can result in poor outcomes. In an effort to improve these outcomes, patients with persistent CLL who were 90-100 days post alloSCT with no evidence of graft-versus-host-disease (GVHD) were randomized to receive lenalidomide or standard care (withdrawal of immunosuppression followed by donor lymphocyte infusion). Lenalidomide was initiated at 5 mg every other day and increased to 10 mg daily if tolerated in each patient...
May 8, 2017: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/28493355/consideration-of-difficulties-and-exit-strategies-in-a-case-of-face-allotransplantation-resulting-in-failure
#9
Özlenen Özkan, Ömer Özkan, Umuttan Doğan, Vural Taner Yılmaz, Hilmi Uysal, Levent Ündar, Ebru Apaydın Doğan, Ozan Salim, Anı Çinpolat, Atilla Ramazanoglu
We describe the first rescue procedure in a case of total face allotransplantation. The recipient was a 54-year-old man with severe disfigurement of the entire face following an accidental gunshot injury 5 years previously. The large defect included the maxilla, mandible, and mid-face. Full face procurement was performed from a multiorgan cadaveric donor and was allotransplanted to the recipient. The post-transplant induction immunosuppressive regimen included ATG combined with tacrolimus, mycophenolate mofetil, and prednisone, while maintenance was provided by the last three of these...
May 11, 2017: Microsurgery
https://www.readbyqxmd.com/read/28491853/infection-associated-acute-interstitial-nephritis-a-case-report
#10
Rupesh Raina, Shirisha Ale, Tushar Chaturvedi, Luke Fraley, Robert Novak, Natthavat Tanphaichitr
BACKGROUND: Acute interstitial nephritis (AIN) is a clinico-pathological syndrome associated with a variety of infections, drugs, and sometimes with unknown causes. It is a common cause of acute kidney injury (AKI) and subsequent renal impairment, which often times is under-diagnosed. Infection-associated AIN occurs as a consequence of many systemic bacterial, viral, and parasitic infec-tions; however, its incidence has decreased significantly after the advent of antimicrobials. Infection-associated AIN presents with both oliguric or non-oliguric renal insufficiency, without the classical clinical triad of AIN (fever, rash, and arthralgia)...
March 2017: Journal of Nephropathology
https://www.readbyqxmd.com/read/28481421/immunomodulatory-treatment-other-than-corticosteroids-immunoglobulin-and-plasma-exchange-for-chronic-inflammatory-demyelinating-polyradiculoneuropathy
#11
REVIEW
Mohamed Mahdi-Rogers, Ruth Brassington, Angela A Gunn, Pieter A van Doorn, Richard Ac Hughes
BACKGROUND: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a disease that causes progressive or relapsing and remitting weakness and numbness. It is probably caused by an autoimmune process. Immunosuppressive or immunomodulatory drugs would be expected to be beneficial. This review was first published in 2003 and has been updated most recently in 2016. OBJECTIVES: To assess the effects of immunomodulatory and immunosuppressive agents other than corticosteroids, immunoglobulin, and plasma exchange in CIDP...
May 8, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28479903/post-transplant-withdrawal-of-lamivudine-results-in-fatal-hepatitis-flares-in-kidney-transplant-recipients-under-immune-suppression-with-inactive-hepatitis-b-infection
#12
Bin Miao, Xiang-Ming Lao, Guo-Li Lin
OBJECTIVE: To evaluate the consequences of lamivudine withdrawal in kidney transplant recipients, under immunosuppression, with inactive hepatitis B virus (HBV) infection. INTRODUCTION: HBV infection is more frequent in kidney transplant recipients than in the general population mainly due to the high risk of acquisition during dialysis, before kidney transplantation. METHODS: The records of hepatitis B surface antigen (HBsAg)-positive, immunosuppressed kidney transplant recipients, where lamivudine was withdrawn after transplantation along with reduction in immunosuppressant dose, admitted to our hospital between 2005 and 2012, were retrospectively evaluated...
December 2016: African Health Sciences
https://www.readbyqxmd.com/read/28479445/atrium-advanta-v12-large-diameter-stent-graft-applications-in-infra-renal-abdominal-aortic-pseudo-aneurysms-due-to-behcet-disease-safety-and-efficacy
#13
Çetin Murat Altay, Ayhan Alpar, Osman Melih Topcuoglu, Murat Bulent Kucukay, Dondu Uskudar Cansu, Tuncer Temel, Nilgun Isiksalan Ozbulbul, Fahrettin Kucukay
PURPOSE: To determine the safety and effectiveness of Atrium Advanta V12 large diameter stent-graft applications for infra-renal abdominal aortic pseudoaneurysms (due to Behcet disease). METHOD: Data of Advanta V12™ (Atrium Europe B.V, Mijdrecht, the Netherlands) applied 12 female patients (mean age 30.5 ± 6.3, range 26-44), with infra-renal abdominal aortic pseudoaneurysms were analyzed retrospectively. All Advanta V12 large diameter stent-grafts were implemented from right or left sided 12F femoral sheaths...
May 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28473916/progressive-multifocal-leukoencephalopathy-after-heart-transplantation-4-years-of-clinically-stable-infection-on-low-dose-immunosuppressive-therapy
#14
Per Sundbom, Laila Hubbert, Lena Serrander
Progressive multifocal leukoencephalopathy (PML), caused by reactivation of JC-virus is a relatively rare complication seen in patients with compromised immune system. There are no evidence-based treatment available and prognosis is poor. Withdrawal of immunosuppressant can result in further neurological deterioration and for patients with solid organ transplantations, fatal graft rejection. We report a 52-year-old women that presented with seizures within 1 month after heart transplantation. Initial diagnosis was vascular disease...
February 2017: Oxford Medical Case Reports
https://www.readbyqxmd.com/read/28468254/natalizumab-in-multiple-sclerosis-long-term-management
#15
REVIEW
Marinella Clerico, Carlo Alberto Artusi, Alessandra Di Liberto, Simona Rolla, Valentina Bardina, Pierangelo Barbero, Stefania Federica De Mercanti, Luca Durelli
Natalizumab is a monoclonal antibody highly effective in the treatment of relapsing remitting multiple sclerosis (RRMS) patients. Despite its effectiveness, there are growing concerns regarding the risk of progressive multifocal leukoencephalopathy (PML), a brain infection caused by John Cunningham virus (JCV), particularly after 24 doses and in patients who previously received immunosuppressive drugs. Long-term natalizumab treated, immunosuppressive-pretreated, and JCV antibody-positive patients are asked to rediscuss natalizumab continuation or withdrawal after 24 doses...
April 29, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28448002/measurement-of-t-cell-alloreactivity-using-imaging-flow-cytometry
#16
Stephen C Juvet, Sajad Moshkelgosha, Sharon Sanderson, Joanna Hester, Kathryn J Wood, Andrew Bushell
The measurement of immunological reactivity to donor antigens in transplant recipients is likely to be crucial for the successful reduction or withdrawal of immunosuppression. The mixed leukocyte reaction (MLR), limiting dilution assays, and trans-vivo delayed-type hypersensitivity (DTH) assay have all been applied to this question, but these methods have limited predictive ability and/or significant practical limitations that reduce their usefulness. Imaging flow cytometry is a technique that combines the multiparametric quantitative powers of flow cytometry with the imaging capabilities of fluorescent microscopy...
April 19, 2017: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/28444729/benefits-of-rituximab-as-a-second-line-treatment-for-autoimmune-haemolytic-anaemia-in-children-a-prospective-french-cohort-study
#17
Stéphane Ducassou, Guy Leverger, Helder Fernandes, Hervé Chambost, Yves Bertrand, Corinne Armari-Alla, Brigitte Nelken, Fabrice Monpoux, Corinne Guitton, Thierry Leblanc, Alain Fisher, Odile Lejars, Eric Jeziorski, Fanny Fouissac, Patrick Lutz, Marlène Pasquet, Isabelle Pellier, Christophe Piguet, Philippe Vic, Sophie Bayart, Aude Marie-Cardine, Marc Michel, Yves Perel, Nathalie Aladjidi
Childhood autoimmune haemolytic anaemia (AIHA) requires second-line immunosuppressive therapy in 30-50% of cases. It appears that rituximab is indicated in such circumstances. This prospective national study reports the practice, efficacy and tolerance of rituximab in children with isolated AIHA and AIHA in the setting of Evans syndrome (ES). Sixty-one children were given rituximab between 2000 and 2014. The median interval from diagnosis to rituximab was 9·9 [interquartile range (IQR) 1·6-28·5] months. Forty-six patients responded (75%) and the 6-year relapse-free survival (RFS) was 48%...
April 26, 2017: British Journal of Haematology
https://www.readbyqxmd.com/read/28432716/deciphering-tacrolimus-induced-toxicity-in-pancreatic-%C3%AE-cells
#18
J Triñanes, A E Rodriguez-Rodriguez, Y Brito, A Wagner, A P J De Vries, G Cuesto, A Acebes, E Salido, A Torres, E Porrini
β-cell transcription factors like: FoxO1, MafA, PDX-1, NeuroD, are dysfunctional in type 2 diabetes (T2DM). PTDM resembles T2DM and reflects interaction between pre-transplant insulin resistance and immunosuppressants, mainly calcineurin inhibitors. We evaluated the effect of tacrolimus, cyclosporine-A and metabolic stressors (glucose+palmitate) on insulinoma β-cells (INS-1) in vitro and in pancreata of obese and lean Zucker rats. Cells were cultured for five days with 100μM palmitate and 22mM glucose; cyclosporin-A (250ng/mL) or tacrolimus (15ng/mL) were added the last 48h...
April 22, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28384413/comparative-effectiveness-of-tacrolimus-based-steroid-sparing-versus-steroid-maintenance-regimens-in-kidney-transplantation-results-from-discrete-event-simulation
#19
Vibha C A Desai, Yann Ferrand, Teresa M Cavanaugh, Christina M L Kelton, J Jaime Caro, Jens Goebel, Pamela C Heaton
BACKGROUND: Corticosteroids used as immunosuppressants to prevent acute rejection (AR) and graft loss (GL) following kidney transplantation are associated with serious cardiovascular and other adverse events. Evidence from short-term randomized controlled trials suggests that many patients on a tacrolimus-based immunosuppressant regimen can withdraw from steroids without increased AR or GL risk. OBJECTIVES: To measure the long-term tradeoff between GL and adverse events for a heterogeneous-risk population and determine the optimal timing of steroid withdrawal...
April 1, 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/28375828/autologous-peripheral-blood-haematopoietic-stem-cell-transplantation-for-systemic-lupus-erythematosus-the-observation-of-long-term-outcomes-in-a-chinese-centre
#20
Can Cao, Menglei Wang, Jing Sun, Xuebiao Peng, Qifa Liu, Liang Huang, Yanyan Chai, Kuan Lai, Pingjiao Chen, Qingxiu Liu, Qian Li, Yusheng Peng, Hao Xiong, Jing Zhang, Minghua Chen, Kang Zeng
OBJECTIVES: We aimed to evaluate the safety and long-term efficacy of autologous peripheral blood haematopoietic stem cell transplantation (APHSCT). METHODS: We did not want to evaluate the efficacy of antibodies but rather the clinical response by investigating progression-free survival and serologic response by assessing autoantibody titres and complement levels. RESULTS: Overall, 22 patients with SLE (17 females; median age, 23 years) undergoing APHSCT were included...
March 31, 2017: Clinical and Experimental Rheumatology
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