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Immunosuppressant Agents (immunosuppressant + agent)
Selected AbstractsNeuroprotective effects of an immunosuppressant agent on diffusion/perfusion mismatch in transient focal ischemiaMAGNETIC RESONANCE IN MEDICINE, Issue 6 2004Toshihiko Ebisu Abstract The immunosuppressant FK506 (tacrolimus) exerts potent neuroprotection following focal ischemia in animals; however, the separate effects of FK506 on the ischemic core and penumbra have not been reported. The ischemic penumbra is clinically defined as the difference between a large abnormal area on perfusion-weighted imaging (PWI) and a smaller lesion on diffusion-weighted imaging (DWI). The goal of this study was to determine the effect of FK506 on DWI/PWI match and mismatch areas in transient focal ischemia in rats. Twelve rats were subjected to 1 hr of transient middle cerebral artery (MCA) occlusion, and given an intravenous injection of a placebo (N = 6) or 1 mg/kg FK506 (N = 6) immediately before reperfusion. Magnetic resonance imaging (MRI) was performed during MCA occlusion, and 0.5, 1, and 24 hr after reperfusion. FK506 significantly protected the ischemic brain only in the mismatch cortex where the initial apparent diffusion coefficient (ADC) was normal and there was a mild reduction of cerebral blood flow (CBF). This is the first report to describe the protective effects of FK506 on ischemic penumbra, as measured by DWI/PWI mismatch. The findings provide direct evidence for the utility of DWI/PWI mismatch as a guideline for therapeutic intervention with FK506. Magn Reson Med 51:1173,1180, 2004. © 2004 Wiley-Liss, Inc. [source] Long-term oral tacrolimus therapy in refractory to infliximab fistulizing Crohn's disease.INFLAMMATORY BOWEL DISEASES, Issue 1 2005A Pilot Study Abstract Aims: To evaluate efficacy and safety of oral tacrolimus in cases of fistulizing Crohn's disease (FCD), which is refractory to conventional therapy including infliximab. Methods: Patients with fistulas, previously and unsuccessfully treated with all conventional therapy (i.e., antibiotics, azathioprine, or 6-mercaptopurine and infliximab), were enrolled in a prospective, uncontrolled, open-label study of long-term treatment with oral tacrolimus (0.05 mg/kg every12 h). The evaluation of the clinical response was complemented by use of the perianal Crohn's disease activity index (PCDAI) and magnetic resonance imaging-based score (MRS) with determined periodicity. Results: Ten patients were included in the study (enterocutaneous fistula, 3 patients; perianal fistula, 4 patients; rectovaginal fistula, 3 patients) with 6 to 24 months of follow-up. Five patients were steroid-dependent, and 4 patients needed maintenance treatment with immunosuppressant agents. Four patients (40%) achieved complete clinical responses, which were verified by PCDAI and MRS. Five patients (50%) achieved partial responses (i.e., important decreases in fistula drainage, size, discomfort, and PCDAI/MRS values). Decreases in both the PCDAI and MRS were statistically significant (P < 0.05). All steroid-dependent patients stopped therapy with prednisone, and concomitant immunosuppressive therapy was tapered. The response was maintained, and no new flare-up of the disease was observed. Only mild adverse events were detected (1 patient withdrew from treatment due to headache), and no case of nephrotoxicity or diabetes was detected. One patient had received no benefit from therapy after 6 months. Conclusions: Oral tacrolimus could be an effective and safe treatment for patients with FCD, even if there has been no response to infliximab treatment. Randomized studies are needed to compare oral tacrolimus with infliximab in terms of efficacy, safety, and costs. [source] Infliximab and other immunomodulating drugs in patients with inflammatory bowel disease and the risk of serious bacterial infectionsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2009S. SCHNEEWEISS Summary Background, There remain concerns about the safety of infliximab therapy in patients with inflammatory bowel disease (IBD). Aim, To assess the association between the initiation of infliximab and other immunomodulating drugs and the risk of serious bacterial infection in the treatment of IBD. Methods, We assembled a cohort study of patients with IBD, including Crohn's disease (CD) and ulcerative colitis (UC). All patients initiating an immunomodulating drug between January 2001 and April 2006 were identified in British Columbia from linked health care utilization databases. Exposure of interest was initiation of infliximab or corticosteroids compared with initiation of other immunosuppressive agents, including azathioprine, mercaptopurine (MP) and methotrexate (MTX). Outcome of interest was serious bacterial infections requiring hospitalization, including Clostridium difficile. Results, Among 10 662 IBD patients, the incidence rate of bacteriaemia ranged from 3.8 per 1000 person-years (95% confidence interval 2.1,6.2) for other immunosuppressive agents to 7.4 (3.3,19.3) for infliximab with slightly higher rate for serious bacterial infections resulting in an adjusted relative risk 1.4 (0.47,4.24). Clostridium difficile infections occurred in 0/1000 (0,5.4) among 521 infliximab initiations and 14/1000 (10.6,18.2) for corticosteroids. Corticosteroid initiation tripled the risk of C. difficile infections (RR = 3.4; 1.9,6.1) compared with other immunosuppressant agents. This corticosteroid effect was neither dose-dependent nor duration-dependent. Bacteriaemia and other serious bacterial infections were not increased by corticosteroids or infliximab (5 events). Conclusions, In a population-based cohort of patients with IBD, we found no meaningful association between infliximab and serious bacterial infections, although some subgroups had few events. Corticosteroid initiation increased the risk for C. difficile infections in these patients. [source] Hidradenitis Suppurativa (Acne inversa): Management of a Recalcitrant DiseasePEDIATRIC DERMATOLOGY, Issue 5 2007Joseph Lam M.D. Topical and systemic antibiotics, hormonal therapies, oral retinoids, immunosuppressant agents, and surgical treatment are some of the therapeutic alternatives used for this often recalcitrant and frequently troublesome disorder. This article reviews the pathophysiology of hidradenitis suppurativa, an evidence-based analysis of standard treatments, and recent advances in the therapy of this disorder. [source] Bisphosphonate associated osteonecrosis: an unusual caseAUSTRALIAN DENTAL JOURNAL, Issue 3 2010P Mehanna Abstract The management of bisphosphonate associated osteonecrosis of the jaws (bisphosphonate associated ONJ) is emerging as a significant problem in the field of dentistry and oral and maxillofacial surgery. We present a case of a 55-year-old female taking oral bisphosphonates, steroids and immunosuppressant agents presenting with a life-threatening neck swelling. We discuss management options, as well as recent guidelines for treatment. [source] | ||||||||||