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methotrexate and long term effects

Dyfrig A Hughes, Giovanna Culeddu, Catrin Plumpton, Eifiona Wood, Andrew D Dick, Ashley P Jones, Andrew McKay, Paula R Williamson, Sandrine Compeyrot Lacassagne, Ben Hardwick, Helen Hickey, Patricia Woo, Michael W Beresford, Athimalaipet V Ramanan
OBJECTIVES: To investigate the cost-effectiveness of adalimumab in combination with methotrexate, compared with methotrexate alone, for the management of uveitis associated with Juvenile Idiopathic Arthritis (JIA-U). DESIGN: A cost-utility analysis based on a clinical trial and decision analytic model. PARTICIPANTS: Children and adolescents aged 2 to 18 years with persistently active JIA-U, despite optimized methotrexate treatment for at least 12 weeks...
October 15, 2018: Ophthalmology
Peter L Thompson, S Mark Nidorf
PURPOSE OF REVIEW: Inflammation has been shown to be central to the development and progression of atherosclerosis. Despite detailed understanding of its central role and the cellular dynamics, which contribute to atherosclerotic inflammation, there has been slow progress in finding suitable agents to treat it. The recent CANTOS trial showed that the interleukin-1β inhibitor canakinumab can improve outcomes after acute coronary syndromes. Being a monoclonal antibody, it is expensive and inconvenient to administer for long-term treatment...
October 12, 2018: Current Opinion in Lipidology
Sarah J Nagle, Nirav N Shah, Alex Ganetsky, Daniel J Landsburg, Sunita D Nasta, Anthony Mato, Stephen J Schuster, Ran Reshef, Donald E Tsai, Jakub Svoboda
Aim: To describe the long-term outcomes of patients with lymphoma in the CNS treated with rituximab, temozolomide and high-dose methotrexate without consolidation therapy. Patients & methods: A retrospective cohort study of 46 consecutive patients with primary CNS lymphoma (PCNSL, 27 patients) or secondary CNS involvement of diffuse large B-cell lymphoma (DLBCL, 19 patients) who were treated with rituximab on day 1 in combination with high-dose methotrexate (days 1 and 15) and temozolomide (days 1-5) in 28-day cycles without further consolidation...
December 2017: International Journal of Hematologic Oncology
Wei-Ning Ku, Chun-Ju Lin, Yi-Yu Tsai
We report the rescue effects of adalimumab (HUMIRA® ) therapy in a case of refractory pediatric panuveitis complicated with steroid-induced glaucoma. A 13-year-old girl had suffered from blurred vision since January 2013. Bilateral idiopathic panuveitis with macular edema (ME) was diagnosed. She had previously been treated with systemic steroids, methotrexate, cyclosporine, and mycophenolate. All treatments had failed to suppress the ocular inflammation and ME persisted. Intravitreal dexamethasone implant injections were given to both eyes and ME subsided; however, complications with steroid-induced glaucoma and cataract occurred...
July 2018: Taiwan Journal of Ophthalmology
Nobunori Takahashi, Toshihisa Kojima, Daihei Kida, Atsushi Kaneko, Yuji Hirano, Takayoshi Fujibayashi, Yuichiro Yabe, Hideki Takagi, Takeshi Oguchi, Masahiro Hanabayashi, Takefumi Kato, Koji Funahashi, Masatoshi Hayashi, Seiji Tsuboi, Yasuhide Kanayama, Yasumori Sobue, Nobuyuki Asai, Takuya Matsumoto, Tatsuo Watanabe, Shuji Asai, Naoki Ishiguro
OBJECTIVE: To study the clinical effectiveness and long-term retention rate of abatacept (ABA) in elderly rheumatoid arthritis (RA) patients in daily clinical practice. METHODS: A retrospective cohort study was performed using data from a multicenter registry. Our study population comprised 500 consecutive RA patients treated with ABA. We compared clinical effectiveness and ABA retention rates between the Young (≤ 62 years), Middle (62 to 72 years), and Elderly (≥ 72 years) groups...
September 15, 2018: Modern Rheumatology
Gene Schwartz, Amy S Paller
Children who are recalcitrant to topical therapy for their moderate to severe plaque psoriasis and/or highly visible lesions may be candidates for systemic therapy. Methotrexate has been the most commonly used systemic agent in children. However, at least 25% of patients are now treated with biologics, especially tumor necrosis factor-α inhibitors, and their use is expanding as their availability, demonstrated safety and efficacy, and practitioner experience are increasing. In the United States, etanercept is Food and Drug Administration approved for ages 6 years and older and ustekinumab for 12 years of age and older...
September 2018: Seminars in Cutaneous Medicine and Surgery
Jackson M May, Mark R Waddle, Daniel H Miller, William C Stross, Tasneem A Kaleem, Byron C May, Robert C Miller, Liuyan Jiang, Gerald W Strong, Daniel M Trifiletti, Kaisorn L Chaichana, Ronald Reimer, Han W Tun, Jennifer L Peterson
BACKGROUND: Histiocytic sarcoma (HS) is an aggressive malignant neoplasm. HS in the central nervous system is exceptionally rare and associated with a poor prognosis. This report documents a case of primary HS of the central nervous system with treatment including surgery, radiotherapy, and chemotherapy. CASE PRESENTATION: Our patient was a 47 year old female presenting with progressive ataxia, headaches, imbalance, nausea, vomiting, and diplopia. MRI showed a heterogeneously enhancing lesion approximately 2...
September 5, 2018: Radiation Oncology
Maya H Buch, Alyssa Johnsen, Michael Schiff
OBJECTIVES: To explore antinuclear autoantibody (ANA) and anti-double-stranded DNA (anti-dsDNA) autoantibody development during abatacept and tumour necrosis factor inhibitor (TNFi) treatment, and effects of switching from TNFi to abatacept in ANA/anti-dsDNA autoantibody-positive patients. METHODS: This was a post hoc analysis of biologic-naïve patients with active RA in ATTEST and AMPLE. In AMPLE, patients received subcutaneous abatacept or adalimumab (2 years)...
August 21, 2018: Clinical and Experimental Rheumatology
Slavica Pavlov-Dolijanovic, Nada Vujasinovic Stupar, Vladimir Zugic, Predrag Ostojic, Ana Zekovic, Tatjana Zivanovic Radnic, Ivan Jeremic, Ivana Tadic
The study aims to analyze the effects of induction treatment with cyclophosphamide (CYC) pulse therapy followed by maintenance treatment with other mild immunosuppressive agents on lung function in scleroderma (SSc) patients. Thirty patients with SSc (mean age 52 years, mean disease duration < 2 years) with forced vital capacity (FVC) ≤ 80% and/or diffusing capacity of carbon monoxide (DLco) ≤ 70% were included. Monthly CYC pulses were given for 6 months (induction treatment), followed by 3-monthly maintenance pulses for the next 18 months, and during the next 5 years patients received other mild immunosupressive therapy brought by the competent rheumatologist...
August 24, 2018: Clinical Rheumatology
Zuzana Sipkova, Elizabeth A Insull, Joel David, Helen E Turner, Shay Keren, Jonathan H Norris
OBJECTIVES: The current first-line treatment for management of active thyroid eye disease (TED) is high-dose intravenous corticosteroids, which have the potential for serious adverse effects. Our aim was to evaluate the effect of steroid-sparing agents (SSAs) in patients with moderate-to-severe active TED, using methotrexate as first-line. METHODS: Presented is a retrospective, four-year, single-centre, consecutive case series of patients with moderate-to-severe TED treated using the Oxford protocol...
August 13, 2018: Clinical Endocrinology
Morouj Ismail, Hiba Hasan, Youmna El-Orfali, Hanan Ismail, Ghada Khawaja
Rheumatoid arthritis (RA) is a painful chronic autoimmune disease affecting the joints. Its first-line therapy, Methotrexate (MTX), although effective in ameliorating the progress of the disease, induces hepatotoxicity over long-term usage. Thus, seeking natural compounds with fewer side effects could be an alternative therapeutic approach. This study aimed to investigate the anti-inflammatory, antiarthritic, and antioxidative effects of synthetic trans -Δ9-tetrahydrocannabinol (Δ9-THC) dissolved in sesame oil (Dronabinol) against MTX in adjuvant-induced arthritis (AIA) rat model...
2018: Evidence-based Complementary and Alternative Medicine: ECAM
Tarek Ben Othman, Hela Ghedira, Nour Ben Abdejlil, Amel Lakhal, Lamia Torjemane, Leila Ben Hamed, Slama Hamida, Bechir Zouari, Saloua Ladeb
Human recombinant granulocyte colony stimulating factor reduces the duration of neutropenia following HLA-identical allogeneic bone marrow transplantation. However, its use remains controversial due to the risk of increasing the incidence of acute graft-versus-host disease (GVHD) and slower platelet recovery. To clarify these risks, we conducted a prospective randomized placebo-controlled trial of filgrastim 5 µg/kg/day i.v. from day 7 post-transplant until neutrophil recovery in 145 consecutive adults undergoing HLA-identical allogeneic bone marrow transplantation, with cyclosporine and methotrexate as GVHD prophylaxis...
July 21, 2018: Biology of Blood and Marrow Transplantation
Gustavo A Budmann, Ludmila García Franco, Alejandra Pringe
Purpose: To report a case of pediatric Vogt-Koyanagi-Harada (VKH) successfully treated with infliximab and methotrexate for ten years. Observations: A 9-year-old Hispanic girl with VKH disease, was successfully treated with oral methotrexate 15 mg/week and oral prednisone 40 mg/day (1mg/kg/day). But when oral prednisone was tapered to 10 mg/day over a 3-month period, inflammation recurred. Patient was considered as corticosteroid-dependent thus infliximab 7mg/kg/pulse was started on days 0, 15, 60 and every 60 days thereafter...
September 2018: American Journal of Ophthalmology Case Reports
Jing Wen, Rochelle R Maxwell, Alexander J Wolf, Menachem Spira, Maria E Gulinello, Peter D Cole
Methotrexate is a dihydrofolate reductase inhibitor widely employed in curative treatment for children with acute lymphoblastic leukemia (ALL). However, methotrexate administration is also associated with persistent cognitive deficits among long-term childhood cancer survivors. Animal models of methotrexate-induced cognitive deficits have primarily utilized adult animals. The purpose of present study is to investigate the neurotoxicity of methotrexate in juvenile rats and its relevant mechanisms. The doses and schedule of systemic and intrathecal methotrexate, given from post-natal age 3-7 weeks, were chosen to model the effects of repeated methotrexate dosing on the developing brains of young children with ALL...
September 1, 2018: Neuropharmacology
Luca Quartuccio, Giorgia Gregoraci, Miriam Isola, Salvatore De Vita
AIM: The aim of the present study was to define subsets of patients suffering from polymyalgia rheumatica, where methotrexate (MTX) up to 20 mg/week might be more effective. METHODS: A total of 100 patients with polymyalgia rheumatica treated with MTX were studied. The criteria for MTX introduction were: (i) relapse during the first month of therapy, when tapering glucocorticoids (GC); (ii) requiring long-term GC (i.e. >24 consecutive months); (iii) requiring ≥5 mg/day of prednisone equivalents after 4 months of GC therapy; (iv) GC-related side-effects; and (v) a high risk of GC-related side-effects...
September 2018: Geriatrics & Gerontology International
Edward C Keystone, Ferdinand C Breedveld, Hartmut Kupper, Yihan Li, Stefan Florentinus, Iain Sainsbury
Objective: To evaluate long-term clinical, functional and radiographic outcomes in an open-label extension (OLE) study in patients with rheumatoid arthritis (RA) receiving adalimumab monotherapy or adalimumab+methotrexate following attainment of low disease activity (LDA) with adalimumab+methotrexate. Methods: Methotrexate-naive patients with early RA were randomised to adalimumab, methotrexate or adalimumab +methotrexate in a double-blind, 2-year study. Patients who completed the study and achieved LDA (28-joint Disease Activity Score using C reactive protein (DAS28(CRP)<3...
2018: RMD Open
Shelli R Kesler, Robert Ogg, Wilburn E Reddick, Nicholas Phillips, Matthew Scoggins, John O Glass, Yin Ting Cheung, Ching-Hon Pui, Leslie L Robison, Melissa M Hudson, Kevin R Krull
Chemotherapeutic agents used to treat acute lymphoblastic leukemia (ALL), the most common cancer affecting young children, have been associated with long-term cognitive impairments that reduce quality of life. Executive dysfunction is one of the most consistently observed deficits and can have substantial and pervasive effects on academic success, occupational achievement, psychosocial function, and psychiatric status. We examined the neural mechanisms of executive dysfunction by measuring structural and functional connectomes in 161 long-term survivors of pediatric ALL, age 8-21 years, who were treated on a single contemporary chemotherapy-only protocol for standard/high- or low-risk disease...
August 2018: Brain Connectivity
Jinlong Zhao, Xueyan Zhang, Xiangshi Sun, Menghui Zhao, Changhui Yu, Robert J Lee, Fengying Sun, Yulin Zhou, Youxin Li, Lesheng Teng
Methotrexate (MTX), as a disease modifying antirheumatic drug (DMARD), was first line drug to treat rheumatoid arthritis. However, the severe side effect during long term and high dosage usage limit its application. The aim of this study was to develop dual-functional lipid polymeric hybrid pH-responsive nanoparticles to deliver MTX to inflamed joints selectively. The designed MTX loaded stearic acid-octa-arginine and folic acid decorated poly lactic-co-glycolic acid (PLGA) -PK3-based lipid polymeric hybrid nanoparticles (Sta-R8-FA-PPLPNs/MTX) were composed of PK3, Folate-PEG-PLGA, egg PC, and Sta-R8...
September 2018: European Journal of Pharmaceutics and Biopharmaceutics
Diego Strianese
PURPOSE: To present an update on the efficacy and safety of immunosuppressive therapy for thyroid eye disease (TED) and to offer a general recommendation for management of TED, in light of these reports. METHODS: Data were retrieved from a literature search on PubMed, using the following words: thyroid eye disease, immunosuppressant, corticosteroid, methotrexate, azathioprine, cyclosporine, cyclophosphamide, rituximab, etanercept, adalimumab, tocilizumab, teprotumumab, adverse effects, side effects, and complications...
July 2018: Ophthalmic Plastic and Reconstructive Surgery
K Olek-Hrab, J Maj, E Chmielowska, A Jankowska-Konsur, B Olszewska, B Kręcisz, P Iwankowski, M Mackiewicz-Wysocka, Z Adamski, R Nowicki, M Sokolowska-Wojdylo
OBJECTIVE: The first report concerning methotrexate (MTX) in the treatment of Mycosis fungoides (MF) was published in 1964 by Wright. The mechanism of MTX action in the treatment of primary cutaneous T-cell lymphoma (CTCL) has been not explained in detail yet (the anti-inflammatory, immunomodulating, immunosuppressive, and cytostatic actions have been under discussion). PATIENTS AND METHODS: This is a retrospective analysis of 79 MF patients in 4 dermatology clinical centers in Poland...
June 2018: European Review for Medical and Pharmacological Sciences
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