DOCSLIB.ORG

Comparative Effectiveness of Biological Medicines in Rheumatoid Arthritis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Comparative Effectiveness of Biological Medicines in Rheumatoid Arthritis RESEARCH Comparative effectiveness of biological medicines in rheumatoid BMJ: first published as 10.1136/bmj.m2288 on 7 July 2020. Downloaded from arthritis: systematic review and network meta-analysis including aggregate results from reanalysed individual patient data Kirsten Janke,1 Katharina Biester,1 Dietmar Krause,3 Bernd Richter,4 Christoph Schürmann,2 Katharina Hirsch,2 Helmut Hörn,1 Michaela Florina Kerekes,1 Petra Kohlepp,1 Beate Wieseler1 1Drug Assessment Department, ABSTRACT from reanalyses of individual patient data allowed Institute for Quality and OBJECTIVE extensive analyses yielding sufficiently similar Efficiency in Health Care, Im To assess the comparative effectiveness of biological populations and homogeneous study results for Mediapark 8, Cologne 50670, Germany medicines in rheumatoid arthritis in sufficiently network meta-analyses, including up to 35 studies 2Medical Biometry Department, similar patient populations, based on the current on eight biological medicines combined with Institute for Quality and definitions of key outcomes. methotrexate. These analyses showed few statistically Efficiency in Health Care, significant differences between the combination Cologne, Germany DESIGN treatments. For example, anakinra showed less 3Rheumatology Practice Systematic review and network meta-analysis Gladbeck, Gladbeck, Germany including aggregate results from reanalysed individual benefit than almost all the other seven biological 4Cochrane Metabolic and patient data. medicines regarding clinical remission or low disease Endocrine Disorders Group, activity (clinical disease activity index ≤2.8 or ≤10, DATA SOURCES Institute of General Practice, respectively) and certolizumab pegol showed more Clinical study reports and aggregate results from Medical Faculty of the Heinrich- harm than the other seven biological medicines Heine-University Düsseldorf, reanalyses of individual patient data on key outcomes regarding serious adverse events or infections. Düsseldorf, Germany for rheumatoid arthritis provided by study sponsors Some outcomes had very wide 95% confidence Correspondence to: B Wieseler for studies conducted up to 2017, and several [email protected] intervals, potentially implying unidentified differences databases and registries from inception up to (ORCID 0000-0002-3519-754X) between the eight biological medicines, but wide February 2017. Additional material is published 95% confidence intervals were less prominent for online only. To view please visit ELIGIBILITY CRITERIA FOR SELECTING STUDIES the journal online. low disease activity, serious adverse events, and Randomised controlled trials investigating patient C ite this as: BMJ2020;370:m2288 infections. Owing to a lack of head-to-head trials, relevant outcomes in adults with rheumatoid arthritis http://www.bmj.com/ http://dx.doi.org/10.1136 bmj.m2288 results were mainly based on indirect comparisons treated with biological medicines in combination with with a limited number of studies, and recently Accepted: 30 April 2020 methotrexate after methotrexate failure for at least 24 approved Janus kinase inhibitors could not be weeks. included. RESULTS CONCLUSIONS 45 eligible trials were identified. Combining data For patients with rheumatoid arthritis after from clinical study reports and aggregate results methotrexate failure, only minor differences in benefits and harms were seen between biological on 26 September 2021 by guest. Protected copyright. medicines in combination with methotrexate. WH AT IS ALREADY KNOWN ON THIS TOPIC However, the analysis was hampered by a lack of long Previous meta-analyses have shown that most biological medicines combined term direct comparisons. The substantial information with methotrexate are more effective at controlling disease activity in rheumatoid gain achieved by the reanalysis of individual patient arthritis than treatment with methotrexate alone data calls for the routine availability of individual patient data. However, the comparative benefits and harms of the biological medicines are still under discussion Previous network meta-analyses on this topic have included heterogeneous Introduction patient populations and older definitions of key outcomes such as clinical Rheumatoid arthritis is one of the most common chro­ remission and low disease activity, making the results of these analyses nic inflammatory diseases. Joint inflammation can lead inconclusive to pain, stiffness, swelling, structural damage, and im­ paired function.1­3 Ultimately, rheumatoid arthritis can WH AT THIS STUDY ADDS cause progressive disability and premature death.4­7 Inclusion of data from clinical study reports and reanalyses from individual Treatment for the rheumatoid arthritis primarily patient data has enabled the inclusion of similar patient populations and aims to reduce disease activity to a level where patients unknown results on current definitions of clinical remission and low disease are free of signs and symptoms of inflammatory activity activity and other endpoints in this network meta-analysis (that is, clinical remission).8 Low disease activity can This systematic review and network meta-analysis indicates minor differences also be an acceptable treatment goal, especially for between biological medicines for the treatment of rheumatoid arthritis, when patients with previous treatment failure.9 The most combined with methotrexate after methotrexate failure recent and stringent definitions for clinical remission This information could be important for clinical practice, considering the changes and low disease activity have been suggested by the in treatment strategies for rheumatoid arthritis and the increasing number of American College of Rheumatology (ACR) and the 10 biosimilar biological medicines available European League Against Rheumatism (EULAR). the bmj | BMJ 2020;370:m2288 | doi: 10.1136/bmj.m2288 1 RESEARCH Current options for rheumatoid arthritis include all sponsored published and unpublished studies disease modifying antirheumatic drugs (DMARDs), investigating the biological medicine concerned, and BMJ: first published as 10.1136/bmj.m2288 on 7 July 2020. Downloaded from which can be combined with non­steroidal anti­ of CONSORT compliant documents (in general, the inflammatory drugs (NSAIDs) and corticosteroids.3 9 11 complete clinical study reports) on all relevant studies DMARDs are divided into conventional synthetic selected by IQWiG. This procedure was required to DMARDs (eg, methotrexate), targeted synthetic DMARDs avoid bias due to selective provision of data. For (Janus kinase inhibitors), and biological DMARDs all investigator initiated trials selected by IQWiG, (biological medicines or bDMARD).12 Although a wide sponsors were also asked to supply complete clinical range of biological medicines is available, their com­ study reports, if available. parative effectiveness is still under discussion. To meet both the methodological requirements of This systematic review of randomised controlled a network meta­analysis and the current recommen­ trials aimed to compare the benefits and harms of dations of rheumatoid arthritis societies, we aimed biological medicines in combination with methotrexate to include results from sufficiently similar patient in patients with rheumatoid arthritis after methotrexate populations and to use the most current definitions failure. Given the many biological medicines available, of rheumatoid arthritis outcomes. For this purpose, we used a network meta­analysis to compare several aggregate results of two types of reanalyses of different treatments. An important prerequisite for individual patient data from the studies included such an analysis is the similarity of the studies were requested from the study sponsors. Firstly, if included. We obtained similar patient populations by only a subpopulation of the overall study population using aggregate results from systematic reanalyses of was relevant for the current systematic review, individual patient data performed by study sponsors aggregate results from a reanalysis of characteristics for those studies with heterogeneous populations. We of this subpopulation (eg, of the patients without pre­ also obtained aggregate results according to current treatment with biological medicines) and results on definitions of clinical remission and low disease all outcomes were requested. Secondly, for all studies activity by reanalyses of individual patient data by or study subpopulations included, aggregate results study sponsors. from reanalyses of clinical remission (clinical disease The systematic review formed part of a health activity index (CDAI) ≤2.8) and low disease activity technology assessment of biological medicines in (CDAI ≤10) were requested, if not already available in rheumatoid arthritis conducted by the German health the study documentation. http://www.bmj.com/ technology assessment agency, the Institute for Quality We included published and unpublished studies and Efficiency in Health Care (IQWiG). The full report with the following characteristics: randomised clinical (in German) and protocol are available on the IQWiG trials of adults (aged ≥18) with rheumatoid arthritis website.13 IQWiG’s methodological approach for and a minimum study duration of 24 weeks comparing systematic reviews is described in its methods paper.14 biological medicines with each other or with a potential common comparator for inclusion in a net­ Methods work meta­analysis. Studies were included if the Search strategy and study
Load more

Recommended publications
  • The Use of Biologic Agents in the Treatment of Oral Lesions Due to Pemphigus and Behçet's Disease: a Systematic Review
    Davis GE, Sarandev G, Vaughan AT, Al-Eryani K, Enciso R. The Use of Biologic Agents in the Treatment of Oral Lesions due to Pemphigus and Behçet’s Disease: A Systematic Review. J Anesthesiol & Pain Therapy. 2020;1(1):14-23 Systematic Review Open Access The Use of Biologic Agents in the Treatment of Oral Lesions due to Pemphigus and Behçet’s Disease: A Systematic Review Gerald E. Davis II1,2, George Sarandev1, Alexander T. Vaughan1, Kamal Al-Eryani3, Reyes Enciso4* 1Advanced graduate, Master of Science Program in Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA 2Assistant Dean of Academic Affairs, Assistant Professor, Restorative Dentistry, Meharry Medical College, School of Dentistry, Nashville, Tennessee, USA 3Assistant Professor of Clinical Dentistry, Division of Periodontology, Dental Hygiene & Diagnostic Sciences, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA 4Associate Professor (Instructional), Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA Article Info Abstract Article Notes Background: Current treatments for pemphigus and Behçet’s disease, such Received: : March 11, 2019 as corticosteroids, have long-term serious adverse effects. Accepted: : April 29, 2020 Objective: The objective of this systematic review was to evaluate the *Correspondence: efficacy of biologic agents (biopharmaceuticals manufactured via a biological *Dr. Reyes Enciso, Associate Professor (Instructional), Division source) on the treatment of intraoral lesions associated with pemphigus and of Dental Public Health and Pediatric Dentistry, Herman Ostrow Behçet’s disease compared to glucocorticoids or placebo. School of Dentistry of USC, Los Angeles, California, USA; Email: [email protected].
    [Show full text]
  • Review Anti-Cytokine Biologic Treatment Beyond Anti-TNF in Behçet's Disease
    Review Anti-cytokine biologic treatment beyond anti-TNF in Behçet’s disease A. Arida, P.P. Sfikakis First Department of Propedeutic Internal ABSTRACT and thrombotic complications (1-3). Medicine Laikon Hospital, Athens, Unmet therapeutic needs in Behçet’s Treatment varies according to type and University Medical School, Greece. disease have drawn recent attention to severity of disease manifestations. Cor- Aikaterini Arida, MD biological agents targeting cytokines ticosteroids, interferon-alpha and con- Petros P. Sfikakis, MD other than TNF. The anti-IL-17 anti- ventional immunosuppressive drugs, Please address correspondence to: body secukinumab and the anti-IL-2 such as azathioprine, cyclosporine-A, Petros P. Sfikakis, MD, receptor antibody daclizumab were not cyclophosphamide and methotrexate, First Department of Propedeutic superior to placebo for ocular Behçet’s and Internal Medicine, are used either alone or in combination Laikon Hospital, in randomised controlled trials, com- for vital organ involvement. During the Athens University Medical School, prising 118 and 17 patients, respec- last decade there has been increased use Ag Thoma, 17, tively. The anti-IL-1 agents anakinra of anti-TNF monoclonal antibodies in GR-11527 Athens, Greece. and canakinumab and the anti-IL-6 patients with BD who were refractory E-mail: [email protected] agent tocilizumab were given to iso- to conventional treatment or developed Received on June 7, 2014; accepted in lated refractory disease patients, who life-threatening complications (4, 5). revised form on September 17, 2014. were either anti-TNF naïve (n=9) or Anti-TNF treatment has been shown to Clin Exp Rheumatol 2014; 32 (Suppl. 84): experienced (n=18).
    [Show full text]
  • Presenters: Philip R
    UC Davis Dermatology Online Journal Title Anakinra-responsive lichen planus in a woman with Erdheim-Chester disease: a therapeutic enigma Permalink https://escholarship.org/uc/item/8109j4cw Journal Dermatology Online Journal, 20(1) Authors Cohen, Philip R Kurzrock, Razelle Publication Date 2014 DOI 10.5070/D3201021241 License https://creativecommons.org/licenses/by-nc-nd/4.0/ 4.0 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Volume 20 Number 1 January 2014 Case Report Anakinra-responsive lichen planus in a woman with Erdheim-Chester disease: a therapeutic enigma Philip R. Cohen, MD1 and Razelle Kurzrock, MD2 Dermatology Online Journal 20 (1): 1 1Division of Dermatology, University of California San Diego, San Diego, California; 2Center for Personalized Cancer Therapy and Division of Hematology and Oncology, University of California San Diego—Moores Cancer Center, La Jolla, California. Correspondence: Philip R. Cohen, MD 10991 Twinleaf Court San Diego, CA 92131-3643 [email protected] Abstract Background: Anakinra is a recombinant form of interleukin-1 receptor antagonist. It is the drug of choice for Schnitzler syndrome and cryopyrin-associated periodic syndromes. It has also recently been demonstrated to have activity in the treatment of the non-Langerhans cell histiocytosis known as Erdheim-Chester disease. Purpose: To describe the activity of anakinra in a patient with co-existing lichen planus and Erdheim-Chester disease. Methods: A 43-year-old woman with progressive Erdheim-Chester disease presented for management of her night sweats and chills, systemic skeletal bone pain, and neurologic (diabetes insipidus) manifestations. She also had widespread cutaneous lichen planus.
    [Show full text]
  • Asthma Agents
    APPROVED PA Criteria Initial Approval Date: July 10, 2019 Revised Date: January 20, 2021 CRITERIA FOR PRIOR AUTHORIZATION Asthma Agents BILLING CODE TYPE For drug coverage and provider type information, see the KMAP Reference Codes webpage. MANUAL GUIDELINES Prior authorization will be required for all current and future dose forms available. All medication-specific criteria, including drug-specific indication, age, and dose for each agent is defined in Table 1 below. Benralizumab (Fasenra®) Dupilumab (Dupixent®) Mepolizumab (Nucala®) Omalizumab (Xolair®) Reslizumab (Cinqair®) GENERAL CRITERIA FOR INITIAL PRIOR AUTHORIZATION: (must meet all of the following) • Must be approved for the indication, age, and not exceed dosing limits listed in Table 1. • Must be prescribed by or in consultation with a pulmonologist, allergist, or immunologist.1,2 • For all agents listed, the preferred PDL drug, which treats the PA indication, is required unless the patient meets the non-preferred PDL PA criteria. • Must have experienced ≥ 2 exacerbations within the last 12 months despite meeting all of the following (exacerbation is defined as requiring the use of oral/systemic corticosteroids, urgent care/hospital admission, or intubation: o Patient adherence to two long-term controller medications, including a high-dose inhaled corticosteroid 1,2 (ICS) and a long-acting beta2-agonist (LABA) listed in Table 2. ▪ Combination ICS/LABA and ICS/LABA/LAMA products meet the requirement of two controller medications. o Patient must have had an adequate trial (at least 90 consecutive days) of a leukotriene modifier or a long-acting muscarinic antagonist (LAMA) as a third long-term controller medication listed in Table 2.
    [Show full text]
  • Cimzia (Certolizumab Pegol) AHM
    Cimzia (Certolizumab Pegol) AHM Clinical Indications • Cimzia (Certolizumab Pegol) is considered medically necessary for adult members 18 years of age or older with moderately-to-severely active disease when ALL of the following conditions are met o Moderately-to-severely active Crohn's disease as manifested by 1 or more of the following . Diarrhea . Abdominal pain . Bleeding . Weight loss . Perianal disease . Internal fistulae . Intestinal obstruction . Megacolon . Extra-intestinal manifestations: arthritis or spondylitis o Crohn's disease has remained active despite treatment with 1 or more of the following . Corticosteroids . 6-mercaptopurine/azathioprine • Certollizumab pegol (see note) is considered medically necessary for persons with active psoriatic arthritis who meet criteria in Psoriasis and Psoriatic Arthritis: Biological Therapies. • Cimzia, (Certolizumab Pegol), alone or in combination with methotrexate (MTX), is considered medically necessary for the treatment of adult members 18 years of age or older with moderately-to-severely active rheumatoid arthritis (RA). • Cimzia (Certolizumab pegol is considered medically necessary for reducing signs and symptoms of members with active ankylosing spondylitis who have an inadequate response to 2 or more NSAIDs. • Cimzia (Certolizumab Pegol) is considered investigational for all other indications (e.g.,ocular inflammation/uveitis; not an all-inclusive list) because its effectiveness for indications other than the ones listed above has not been established. Notes • There are several brands of targeted immune modulators on the market. There is a lack of reliable evidence that any one brand of targeted immune modulator is superior to other brands for medically necessary indications. Enbrel (etanercept), Humira (adalimumab), Remicade (infliximab), Simponi (golimumab), Simponi Aria (golimumab intravneous), and Stelara (ustekinumab) brands of targeted immune modulators ("least cost brands of targeted immune modulators") are less costly to the plan.
    [Show full text]
  • Treatment of Refractory Pityriasis Rubra Pilaris with Novel Phosphodiesterase 4
    Letters Discussion | Acrodermatitis continua of Hallopeau, also Additional Contributions: We thank the patient for granting permission to known as acrodermatitis perstans and dermatitis repens, publish this information. is a rare inflammatory pustular dermatosis of the distal fin- 1. Saunier J, Debarbieux S, Jullien D, Garnier L, Dalle S, Thomas L. Acrodermatitis continua of Hallopeau treated successfully with ustekinumab gers and toes. It is considered a variant of pustular psoriasis and acitretin after failure of tumour necrosis factor blockade and anakinra. or, less commonly, its own pustular psoriasis-like indepen- Dermatology. 2015;230(2):97-100. 1 dent entity. Precise pathophysiology and incidence 2. Kiszewski AE, De Villa D, Scheibel I, Ricachnevsky N. An infant with are unknown. Case literature suggests predominance in acrodermatitis continua of Hallopeau: successful treatment with thalidomide women, but the disease affects both sexes and, rarely, and UVB therapy. Pediatr Dermatol. 2009;26(1):105-106. children.2 3. Jo SJ, Park JY, Yoon HS, Youn JI. Case of acrodermatitis continua accompanied by psoriatic arthritis. J Dermatol. 2006;33(11):787-791. Acrodermatitis continua of Hallopeau initially presents 4. Sehgal VN, Verma P, Sharma S, et al. Acrodermatitis continua of Hallopeau: as erythema overlying the distal digits that evolves into evolution of treatment options. Int J Dermatol. 2011;50(10):1195-1211. pustules.2 The nail bed is often involved, with paronychial 5. Lutz V, Lipsker D. Acitretin- and tumor necrosis factor inhibitor-resistant 3 and subungual involvement and atrophic skin changes. acrodermatitis continua of Hallopeau responsive to the interleukin 1 receptor Most patients experience a chronic, relapsing course involv- antagonist anakinra.
    [Show full text]
  • Arcalyst® (Rilonacept)
    Arcalyst® (rilonacept) (Subcutaneous) Document Number: IC-0182 Last Review Date: 01/05/2021 Date of Origin: 11/07/2013 Dates Reviewed: 11/2013, 08/2014, 07/2015, 04/2016, 04/2017, 04/2018, 08/2018, 08/2019, 08/2020, 01/2021 I. Length of Authorization Coverage will be provided for 6 months and may be renewed. II. Dosing Limits A. Quantity Limit (max daily dose) [NDC Unit]: Arcalyst 220 mg injection: 8 vials every 28 days B. Max Units (per dose and over time) [HCPCS Unit]: Cryopyrin-Associated Periodic Syndromes (CAPS) Loading Dose given on Day 1: 320 billable units Maintenance Dose: 160 billable units every 7 days Deficiency of Interleukin-1 Receptor Antagonist (DIRA) 320 billable units every 7 days III. Initial Approval Criteria 1 Coverage is provided in the following conditions: Patient is up to date with all vaccinations, in accordance with current vaccination guidelines, prior to initiating therapy; AND Universal Criteria 1 Patient has been evaluated and screened for the presence of latent tuberculosis (TB) infection prior to initiating treatment and will receive ongoing monitoring for the presence of TB during treatment; AND Patient does not have an active infection, including clinically important localized infections; AND Must not be administered concurrently with live vaccines; AND Proprietary & Confidential © 2021 Magellan Health, Inc. Patient is not on concurrent therapy with other IL-1 blocking agents (e.g., canakinumab, anakinra*, etc.) [*Note: For DIRA, anakinra must be discontinued 24 hours prior to starting Arcalyst];
    [Show full text]
  • CDER List of Licensed Biological Products With
    Center for Drug Evaluation and Research List of Licensed Biological Products with (1) Reference Product Exclusivity and (2) Biosimilarity or Interchangeability Evaluations to Date DATE OF FIRST REFERENCE PRODUCT DATE OF LICENSURE LICENSURE EXCLUSIVITY EXPIRY DATE INTERCHANGEABLE (I)/ BLA STN PRODUCT (PROPER) NAME PROPRIETARY NAME (mo/day/yr) (mo/day/yr) (mo/day/yr) BIOSIMILAR (B) WITHDRAWN 125118 abatacept Orencia 12/23/05 NA NA 103575 abciximab ReoPro 12/22/94 NA NA Yes 125274 abobotulinumtoxinA Dysport 04/29/09 125057 adalimumab Humira 12/31/02 NA NA 761071 adalimumab-adaz Hyrimoz 10/30/18 B 761058 adalimumab-adbm Cyltezo 08/25/17 B 761118 adalimumab-afzb Abrilada 11/15/19 B 761024 adalimumab-atto Amjevita 09/23/16 B 761059 adalimumab-bwwd Hadlima 07/23/19 B 125427 ado-trastuzumab emtansine Kadcyla 02/22/13 125387 aflibercept Eylea 11/18/11 103979 agalsidase beta Fabrazyme 04/24/03 NA NA 125431 albiglutide Tanzeum 04/15/14 017835 albumin chromated CR-51 serum Chromalbin 02/23/76 103293 aldesleukin Proleukin 05/05/92 NA NA 103948 alemtuzumab Campath, Lemtrada 05/07/01 NA NA 125141 alglucosidase alfa Myozyme 04/28/06 NA NA 125291 alglucosidase alfa Lumizyme 05/24/10 125559 alirocumab Praluent 07/24/15 103172 alteplase, cathflo activase Activase 11/13/87 NA NA 103950 anakinra Kineret 11/14/01 NA NA 020304 aprotinin Trasylol 12/29/93 125513 asfotase alfa Strensiq 10/23/15 101063 asparaginase Elspar 01/10/78 NA NA 125359 asparaginase erwinia chrysanthemi Erwinaze 11/18/11 761034 atezolizumab Tecentriq 05/18/16 761049 avelumab Bavencio 03/23/17
    [Show full text]
  • Immunopharmacology: a Guide to Novel Therapeutic Tools - Francesco Roselli, Emilio Jirillo
    PHARMACOLOGY – Vol. II - Immunopharmacology: A Guide to Novel Therapeutic Tools - Francesco Roselli, Emilio Jirillo IMMUNOPHARMACOLOGY: A GUIDE TO NOVEL THERAPEUTIC TOOLS Francesco Roselli Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy Emilio Jirillo Department of Internal Medicine, Immunology and Infectious Disease, University of Bari, Italy National Institute for Digestive Disease, Castellana Grotte, Bari, Italy Keywords: Immunopharmacology, immunosuppressive agents, immunomodulating agents, Rituximab, Natalizumab, Efalizumab, Abatacept, Betalacept, Alefacept, Basiliximab, Daclizumab, Infliximab, Etanercept, Adalimumab, Anakinra, Tocilizumab, Omalizumab, Interleukin-2, Denileukin diftitox, Interferon-γ, Interleukin-12 Contents 1. Introduction 2. B cell targeted molecule: Rituximab 3. Lymphocyte trafficking inhibitors: Natalizumab and Efalizumab 3.1 Natalizumab 3.2 Efalizumab 4. Costimulation antagonists: Abatacept, Betalacept, Alefacept 4.1 Abatacept 4.2 Betalacept 4.3 Alefacept 5. Interleukin-2 Receptor antagonists: Basiliximab, Daclizumab 5.1 Basiliximab 5.2 Daclizumab 6. Antagonists of soluble mediators of inflammation 6.1 TNF-α antagonists: Infliximab, Etanercept, Adalimumab 6.1.1 Infliximab 6.1.2 Etanercept 6.1.3 Adalimumab 6.2 Interleukin-1UNESCO Receptor Antagonist (Anakinra) – EOLSS 6.3 Interleukin-6 receptor antagonist (tocilizumab) 7. Antagonist of IgE: Omalizumab 8. Interleukin therapySAMPLE in oncology CHAPTERS 8.1 Interleukin-2 8.2 Interleukin-2/diphtheria toxin conjugate (Ontak) 8.3 Interferon-γ and Interleukin-12 9. Perspectives and future developments Glossary Bibliography Biographical Sketches Summary ©Encyclopedia of Life Support Systems (EOLSS) PHARMACOLOGY – Vol. II - Immunopharmacology: A Guide to Novel Therapeutic Tools - Francesco Roselli, Emilio Jirillo Immunopharmacology is that area of pharmacological sciences dealing with the selective modulation (i.e. upregulation or downregulation) of specific immune responses and, in particular, of immune cell subsets.
    [Show full text]
  • Use of Anti-Cytokine Therapy in Kidney Transplant Recipients with COVID-19
    Journal of Clinical Medicine Article Use of Anti-Cytokine Therapy in Kidney Transplant Recipients with COVID-19 Marta Bodro 1,*, Frederic Cofan 2, Jose Ríos 3, Sabina Herrera 1, Laura Linares 1, María Angeles Marcos 4, Alex Soriano 1 , Asunción Moreno 1 and Fritz Diekmann 2 1 Infectious Diseased Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona and Hospital Clinic, 08036 Barcelona, Spain; [email protected] (S.H.); [email protected] (L.L.); [email protected] (A.S.); [email protected] (A.M.) 2 Department of Nephrology and Renal Transplantation, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona and Hospital Clinic, 08036 Barcelona, Spain; [email protected] (F.C.); [email protected] (F.D.) 3 Medical Statistics Core Facility, Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; [email protected] 4 Microbiology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona and Hospital Clinic, 08036 Barcelona, Spain; [email protected] * Correspondence: [email protected] Abstract: In the context of the coronavirus disease 2019 (COVID-19) pandemic, we aimed to evaluate the impact of anti-cytokine therapies (AT) in kidney transplant recipients requiring hospitalization due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This is an observa- tional retrospective study, which included patients from March to May 2020. An inverse probability of treatment weighting from a propensity score to receive AT was used in all statistical analyses, Citation: Bodro, M.; Cofan, F.; and we applied a bootstrap procedure in order to calculate an estimation of the 2.5th and 97.5th Ríos, J.; Herrera, S.; Linares, L.; percentiles of odds ratio (OR).
    [Show full text]
  • Ocular Immunotherapy and Immunomodulation
    Ocular Immunotherapy and Immunomodulation Brian C. Gilger, DVM, MS, Dipl. ACVO, Dipl. ABT, Professor of Ophthalmology Department of Clinical Sciences, College of Veterinary Medicine North Carolina State University, Raleigh, NC Immunotherapy is a hot topic in ophthalmology because of the recent advancements in cellular and intracytoplasmic mechanisms that control inflammation and immunology. There are many suspected ocular surface and intraocular inflammatory diseases that are thought to be mainly immune-mediated in origin or involved in the disease pathogenesis. Steroidal medications are the most frequently used “immunotherapy” medication in veterinary medicine. However, this drug is truly taking the “sledge hammer” approach to therapy, with lots of peripheral damage (i.e., side effects). Steroidal and non-steroidal therapy will be reviewed in other lectures. The newer medications are designed to be more specific in their treatment approach and thus, have fewer side effects. Most of these medications are systemically administered, although local injections, including intraocular injections, are being evaluated in humans and experimentally. Please see the accompanying recent review article that extensively reviews immunomodulating medications in human ocular disease (Surv Ophthalmol 56:474-510, 2011). Also see the Vet Clinics of North America publication on use of immuosuppressive drugs in dogs and cats (Vet Clin Small Anim 43 (2013) 1149– 1170). The ocular penetration, both topically and via the systemic route have not been studied extensively for many drugs, but one would assume that with the blood-aqueous barrier disrupted, most blood-borne medications should enter the eye easily. The purpose of these notes and lectures is to review existing and emerging immunomodulation drugs to better our understanding of immunotherapy of ocular disease.
    [Show full text]
  • Medical Dermatology Update OCTOBER 11, 2018
    Medical Dermatology Update OCTOBER 11, 2018 FRANCISCA KARTONO, DO, FAAD DERMATOLOGY SPECIALISTS OF CANTON, MI DERMATOLOGY SPECIALISTS OF BRIGHTON, MI I have no relevant disclosures Will discuss off-label use of medications Outline Selected topics in Dermatology in the world of : 1. Atopic eczema 2. Psoriasis 3. Hidradenitis Suppurativa 4. Non-surgical treatment of NMSC: eBx 5. Photomedicine Atopic dermatitis review Most common skin disease in general population/ humans 7% adults and 15-25% children in US Age of onset : 85% are diagnosed by the age of 5 Strong genetic component (30%). Not all explained by FLG mutation. Need for new agents to control the disease is unmet. Majority treatment options for moderate to severe disease are still off-label Complex interplay of epidermal skin barrier dysfunction , atopic march , immune pathways & environmental factors Need multipronged approach J Invest Dermatol. 2015 Jan;135(1):56-66 ] Drucker AM. Allergy Asthma Proc. 2017;38:3–8. Pediatric allergy and immunology. 2013;24(5):476-486. Bieber T. Ann Dermatol. 2010;22:125–137. Journal of clinical sleep medicine. 2010;6(6):581-588. SilverbergJI,SimpsonEL. Pediatr Allergy Immunol. 2013;24:476–486. Pediatric dermatology. 2009;26(2):143-149. https://nationaleczema.org/eczema/ Pediatrics. Sep 2004;114(3):607-611. AD: Guidelines of care Latest AAD Guidelines of treatment from 2014 : Pre-crisaborole,& dupilumab Updated Guidelines AD guidelines article Ann Aller Asthma Immunol 120(2018): 10-22 Prevention of AD Effective skin emollients since birth may prevent exposure to AD triggers, bacteria, microbes Emolients from birth can prevent AD ? 2 prospective RCT , showed 50% reduction in risk for eczema by 6-8 months of age.
    [Show full text]