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Long-term Maintenance Therapy (long-term + maintenance_therapy)
Selected AbstractsReview article: infliximab therapy for inflammatory bowel disease , seven years onALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2006P. RUTGEERTS Summary Infliximab, the chimeric monoclonal IgG1 antibody to tumour necrosis factor, is indicated for refractory luminal and fistulizing Crohn's disease and extra-intestinal manifestations of inflammatory bowel disease. Recently, the active ulcerative colitis trials (ACT) studies have shown that infliximab is also efficacious to treat ulcerative colitis resistant to standard therapy. Induction with 5 mg/kg infliximab at weeks 0, 2 and 6 is advocated. The response to infliximab is improved when concomitant immunosuppressive therapy is given. As the majority of patients will relapse if not retreated, a long-term strategy is necessary. Although episodic therapy can be used, the optimal strategy is systematic maintenance treatment with 5 mg/kg intravenous (i.v.) every 8 weeks. Long-term maintenance therapy with infliximab results in a reduction of the rate of complications, hospitalizations and surgeries associated with Crohn's disease. Safety problems with the monoclonal antibody infliximab treatment mainly concern the formation of antibodies to infliximab, which may lead to infusion reactions, loss of response and serum sickness-like delayed infusion reactions. Latent tuberculosis needs to be screened for. The rate of other opportunistic infections is slightly increased mainly in patients treated concomitantly with immunosuppression. There is no evidence that malignancy rates in patients treated with antitumour necrosis factor strategies are increased. [source] Positioning biologic agents in the treatment of Crohn's disease,INFLAMMATORY BOWEL DISEASES, Issue 10 2009Stephen B. Hanauer MD Abstract One decade after the emergence of biologic therapy for Crohn's disease (CD), our treatment algorithms are beginning to change. Once reserved for patients with refractory disease, disease unresponsive to conventional therapies, or those requiring multiple courses of corticosteroids, there is increasing evidence that early, aggressive interventions with immunosuppressants or biologic therapies targeting tumor necrosis factor-, or ,-4 integrins can alter the natural history of CD by reducing the transmural complications of structuring and fistulization and the nearly inevitable requisite for surgical resections. More recent trials are beginning to suggest that intervention with combination therapy for selected patients with a poor prognosis may modify the long-term course of CD. Selection of patients with features predicting a complex or progressive course and early, combined intervention is now possible. Future studies are still needed to best identify predictors of response to individual agents with differing mechanisms of action, as well as to optimize the risk-benefit of long-term maintenance therapy. (Inflamm Bowel Dis 2009) [source] Synchronised therapy and high-dose cyclophosphamide in proliferative lupus nephritisJOURNAL OF CLINICAL APHERESIS, Issue 2 2002Maria Giovanna Danieli Abstract The aim of this open study was to compare the outcomes and side effects of plasmapheresis (PP) in patients with proliferative lupus nephritis treated with cyclophosphamide (Cyc) boluses. The study involved 28 consecutive patients. All of the patients met the ACR modified criteria for SLE and underwent a qualifying renal biopsy. In group I, patients were treated with synchronised therapy (PP, 50 ml/kg, followed by pulse Cyc, 750 mg/m2, repeated monthly for 6 months), whereas in group II, they were given only intermittent Cyc boluses (at the same dosage). The data were collected in the patients' records according to a standardised protocol. Patients were followed-up for a mean of 4 years. The disease-free survival was analysed using Kaplan-Meier estimated survival curves ([S(t)]). At the end of the 6-month treatment period, a statistically significant number of patients in group I (75%) was in complete remission in comparison to group II (31%) (P < 0.02), whereas at long-term follow-up, these percentages were similar (41% vs. 50%, P = n.s.). The main functional and immunological parameters showed a normalisation in both groups. The risk of a poor renal outcome significantly correlated with high serum creatinine levels at the onset of nephritis (P < 0.05). We documented a higher rate of infectious complications in group I. This study reports that synchronised therapy is useful in inducing a faster remission in patients with proliferative lupus nephritis. However, it is not superior to conventional therapy at long term follow-up analysis. Positive results should be reinforced by a long-term maintenance therapy. J. Clin. Apheresis 17:72,77, 2002. © 2002 Wiley-Liss, Inc. [source] Changes of gastric histology in patients with erosive oesophagitis receiving long-term lansoprazole maintenance therapyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2010M. M. Haber Aliment Pharmacol Ther 2010; 32: 83,96 Summary Background, Changes in gastric histology associated with long-term maintenance therapy with lansoprazole for erosive oesophagitis have not been well described. Aim, To evaluate the effect on gastric histology of long-term dose-titrated lansoprazole administered as maintenance therapy for up to 82 months in patients with erosive oesophagitis. Methods, Sequential gastric biopsy specimens were obtained for evaluation of histological changes and Helicobacter pylori infection status. Results, Active and chronic inflammation improved from baseline to final visit in a majority of patients receiving long-term therapy with lansoprazole, irrespective of baseline H. pylori infection status. Reductions in active inflammation in the gastric body and antrum were seen in 53% (17/32) and 67% (20/30) of H. pylori -positive patients, respectively, and in 88% (7/8) and 86% (12/14) of H. pylori -negative patients, respectively. Reductions in chronic inflammation in the gastric body and antrum were seen in 38% (12/32) and 47% (15/32) of H. pylori -positive patients, respectively, and in 58% (70/121) and 57% (68/120) of H. pylori -negative patients, respectively. No clinically meaningful increases in hyperplasia, dysplasia, neoplasia, intestinal metaplasia or atrophy were observed during the follow-up period. Conclusions, Lansoprazole administered as maintenance therapy for up to 6 years in patients with erosive oesophagitis demonstrated gastric mucosal safety and was well tolerated. [source] Sustained long-term remissions with weekly interferon maintenance therapy in hairy cell leukemiaASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 3 2010Raj RAMAKRISHNA Abstract Aim: This study evaluates the efficacy of weekly ,-interferon (IFN) maintenance therapy in hairy cell leukaemia (HCL), a disease that remains incurable. Method: Nine patients (six male, three female, aged 41,69 yrs) with hairy cell leukaemia (HCL) received IFN 3mU s.c. once weekly as long-term maintenance therapy after achieving optimal clinical and hematological response to initial therapy with thrice weekly IFN. Results: Eight of the nine patients are in a state of sustained response at 3,17 years (median 12 years). Conclusion: Our results are similar to those from three previous studies using long-term IFN maintenance therapy, bringing the total number of patients in sustained remission to 118. We hope these reports will lead to a multi-centre, phase III study of IFN maintenance therapy (including pegylated IFN, given less frequently) in HCL patients achieving optimal response to initial therapy, be it IFN or a purine analogue. [source] Levonorgestrel-releasing intrauterine system (Mirena®) and Depot medroxyprogesterone acetate (Depoprovera) as long-term maintenance therapy for patients with moderate and severe endometriosis: A randomised controlled trialAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2010Alice Yuen Kwan WONG Background:, Progestogen therapy has been found to be useful in controlling endometriosis. For patients after conservative surgery, long-term medical maintenance therapy should be sought to prevent recurrence and control symptoms. Levonorgestrel-releasing intrauterine system (LNG-IUS) may be a useful form of prolonged progestogen therapy for endometriosis. Aims:, To evaluate and compare the efficacy and safety of LNG-IUS to depot medroxyprogesterone acetate (MPA) for patients with moderate or severe endometriosis following conservative surgery, in terms of symptoms control, recurrence prevention and patients' acceptance. Methods:, A total of 30 patients after conservative surgery for endometriosis underwent randomisation. Of these patients, 15 received LNG-IUS and 15 had three-monthly depot MPA for three years. Their symptom control, recurrence, compliance and change in bone mineral density (BMD) were compared. The data were analysed using student's t -test and chi-square test. Results:, Symptoms and recurrence were controlled by both therapies. The compliance was better in LNG-IUS Group with 13 patients staying on their therapy versus seven patients in Depot MPA Group. LNG-IUS users had a significantly better change in BMD (+0.023, +0.071 g/cm2) than Depot MPA users (,0.030, ,0.017 g/cm2) in both hip and lumbar regions. Conclusions:, Levonorgestrel-releasing intrauterine system was effective in symptom control and prevention of recurrence. LNG-IUS users showed a better compliance. After three years, bone gain was noted with LNG-IUS, but bone loss with depot MPA. [source] | ||||||||||