#14#
Revisiones-Ciencias
Sociales (todas) *** Reviews-Social Sciences (all)
AGENTES
INMUNOSUPRESORES *** IMMUNOSUPPRESSIVE COMPOUNDS
(Conceptos
/ Keywords: Immunosuppressive comp; Muromonab-cd3; Sirolimus; Tacrolimus;
Cyclosporine; Mycophenolic acid; Antilymphocyte serum; Immunosuppressive comp.
used in oncology, etc).
Enero /
January 2001 --- Marzo / March 2004
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Only articles written in Spanish and/or English are included.
[1]
TÍTULO / TITLE: - International
Federation of Clinical Chemistry/International Association of Therapeutic Drug
Monitoring and Clinical Toxicology working group on immunosuppressive drug
monitoring.
REVISTA
/ JOURNAL: - Ther Drug Monit 2002 Feb;24(1):59-67.
AUTORES
/ AUTHORS: - Holt DW; Armstrong VW; Griesmacher A;
Morris RG; Napoli KL; Shaw LM
INSTITUCIÓN
/ INSTITUTION: - Analytical Unit, St George’s Hospital
Medical School, London, UK. d.holt@sghms.ac.uk
RESUMEN
/ SUMMARY: - Issues surrounding the measurement and
interpretation of immunosuppressive drug concentrations have been summarized in
a number of consensus documents. The Scientific Division of the International
Federation of Clinical Chemistry has formed a working group in collaboration
with the International Association of Therapeutic Drug Monitoring and Clinical
Toxicology. This paper sets out the goals of the working group in light of the
developments that have occurred in the field of immunosuppressive drug
monitoring since the publication of the last consensus documents.
----------------------------------------------------
[2]
TÍTULO / TITLE: - Treatment of atopic
dermatitis and impact on quality of life: a review with emphasis on topical
non-corticosteroids.
REVISTA
/ JOURNAL: - Pharmacoeconomics 2003;21(3):159-79.
AUTORES
/ AUTHORS: - Schiffner R; Schiffner-Rohe J; Landthaler
M; Stolz W
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, University of
Regensburg, Regensburg, Germany. jr.schiffner@t-online.de
RESUMEN
/ SUMMARY: - Atopic dermatitis (AD) is a chronic skin
disease with increasing prevalence and rising costs. Stigmatisation and
pruritus are only some aspects of potential quality-of-life (QOL) impairments.
AD is not curable and repeated treatments are often necessary. At present,
treatment with topically-applied corticosteroids is state-of-the-art for mild
to moderate flare-ups. However, many patients are worried about the use of
corticosteroids due to the widespread fear of adverse effects. In this review
the present literature is analysed concerning impact on quality of life for
topically-applicable alternatives to the state-of-the-art treatment. For comparison
reasons, data from other treatment modalities are additionally given.
Characteristics of studies were analysed using ‘general’ (year and mode of
publication, type and aim of study, number of patients, and clinical
measurement) and ‘QOL specific’ criteria (type and number of QOL measurements
including relevance for study aim and age group, validation in used language,
sensitivity to change, and improvement at end of study). QOL data are published
only in the minority of studies evaluating treatment efficacy and do not cover
the variety of possible therapies. Data are available for tacrolimus,
pimecrolimus, UVA/UVB combination and UVB narrowband (topical
non-corticosteroidal treatments), as well as for topical corticosteroids,
cyclosporin, and inpatient treatment. All studies provided a marked improvement
in quality of life after therapy. One study assessed quality of life after a
treatment-free follow-up period obtaining a clear increase in impact on quality
of life. Since studies used different QOL measurements and vary in inclusion
criteria, treatment schedules and presentation of results, a comparison of QOL
improvement is not recommended. A single randomised study compared topically
applied non-corticosteroidal treatment (UVA/UVB combination) with another
treatment modality (cyclosporin) and found no difference in QOL improvement. At
present, there is a clear lack of controlled randomised studies evaluating
different active treatment modalities and their impact on quality of life.
Consensus meetings are desirable to formulate guidelines for the selection and
correct use of QOL measurements. Patients’ fear of side effects (e.g.
concerning corticosteroids) should be integrated in QOL questionnaires for
evaluation of possible compliance problems and real costs. Since relapse after
treatment is frequent in AD, QOL measurements should also be performed after a
treatment-free follow-up period. At present, we can not answer the question
‘which treatment best improves quality of life in AD?’. N. Ref:: 128
----------------------------------------------------
[3]
TÍTULO / TITLE: - Kidney transplantation
from living-unrelated donors: comparison of outcome with living-related and
cadaveric transplants under current immunosuppressive protocols.
REVISTA
/ JOURNAL: - Urology 2003 Dec;62(6):1002-6.
AUTORES
/ AUTHORS: - Chkhotua AB; Klein T; Shabtai E; Yussim A;
Bar-Nathan N; Shaharabani E; Lustig S; Mor E
INSTITUCIÓN
/ INSTITUTION: - National Centre of Urology, Tbilisi,
Georgia.
RESUMEN
/ SUMMARY: - OBJECTIVES: Living-unrelated donors may
become an additional organ source for patients on the kidney waiting list. We
studied the impact of a combination of calcineurin inhibitors and
mycophenolate-mofetil together with steroids on the outcomes of living-related
(LRD), unrelated (LUR), and cadaver transplantation. METHODS: Between September
1997 and January 2000, 129 patients underwent LRD (n = 80) or LUR (n = 49)
kidney transplantation, and another 173 patients received a cadaveric kidney.
Immunosuppressive protocols consisted of mycophenolate-mofetil with
cyclosporine-Neoral (41%) or tacrolimus (59%) plus steroids. We compared the
patient and graft survival data, rejection rate, and graft functional
parameters. RESULTS: LRD recipients were younger (33.6 years) than LUR (47.8
years) and cadaver (43.7 years) donor recipients (P <0.001). HLA matching
was higher in LRD patients (P <0.001). Acute rejection developed in 28.6% of
LUR versus 27.5% of LRD transplants and 29.7% of cadaver kidney recipients (P =
not significant). The creatinine level at 1, 2, and 3 years after transplant
was 1.63, 1.73, and 1.70 mg% for LRD patients; 1.48, 1.48, and 1.32 mg% for LUR
patients; and 1.75, 1.68, and 1.67 mg% for cadaver kidney recipients (P = not
significant), respectively. No difference in patient survival rates was found
among the groups. The 1, 2, and 3-year graft survival rates were significantly
better in recipients of LRD (91.3%, 90.0%, and 87.5%, respectively) and LUR
transplants (89.8%, 87.8%, and 87.8%, respectively) than in cadaver kidney
recipients (81.5%, 78.6%, 76.3%, respectively; P <0.01). CONCLUSIONS:
Despite HLA disparity, the rejection and survival rates of LUR transplants
under current immunosuppressive protocols are comparable to those of LRD and
better than those of cadaveric transplants.
----------------------------------------------------
[4]
TÍTULO / TITLE: - Rejection rate in
living donor kidney transplantation with and without basiliximab in
tacrolimus/mycophenolate mofetil-based protocol.
REVISTA
/ JOURNAL: - Transplant Proc 2003 Mar;35(2):653-4.
AUTORES
/ AUTHORS: - Rahamimov R; Yussim A; After T; Lustig S;
Bar-Nathan N; Shaharabani E; Shapira Z; Shabthai E; Mor E
INSTITUCIÓN
/ INSTITUTION: - Department of Transplantation, Rabin
Medical Center, Beilinson Campus, Petah-Tiqwa, Israel. rutir@clalit.org.il
----------------------------------------------------
[5]
TÍTULO / TITLE: - The FDA guidelines for
the treatment of psoriasis using cyclosporine A: are they adequate?
REVISTA
/ JOURNAL: - Cutis 2002 Nov;70(5):288-90.
AUTORES
/ AUTHORS: - Zackheim HS
INSTITUCIÓN
/ INSTITUTION: - Department of Dermatology, University of
California, San Francisco, USA. hszackheim@orca.ucsf.edu
RESUMEN
/ SUMMARY: - I present a review of the current US Food
and Drug Administration (FDA) guidelines for using cyclosporine A (CSA) to
treat psoriasis, with particular emphasis on the period for which CSA may be
administered. My concern is that, without violating the guidelines, CSA could
be given for a prolonged period with only very brief time-outs. I also review
the risks for renal toxicity, malignancy, and other side effects from prolonged
administration. N.
Ref:: 18
----------------------------------------------------
[6]
TÍTULO / TITLE: - Role of chiral
chromatography in therapeutic drug monitoring and in clinical and forensic
toxicology.
REVISTA
/ JOURNAL: - Ther Drug Monit 2002 Apr;24(2):290-6.
AUTORES
/ AUTHORS: - Williams ML; Wainer IW
INSTITUCIÓN
/ INSTITUTION: - Department of Oncology, Leicester
University, Leicester, United Kingdom.
RESUMEN
/ SUMMARY: - Advances in chiral chromatographic
separations have given pharmacologists and toxicologists the tools to examine
unexpected clinical results involving chiral drugs. The ability to unravel
complex phenomena associated with drug transport and drug metabolism is
presented in this manuscript. The relation between the chirality of the drug
mefloquine and the intracellular concentrations of the drug cyclosporine is
illustrated by examining the effect of the enantiomers of mefloquine on the
transport activity of P-glycoprotein (Pgp). These studies were conducted using
a liquid chromatographic column containing immobilized Pgp. The results
demonstrated that (+)-mefloquine competitively displaced the Pgp substrate
cyclosporine whereas (-)-mefloquine had no effect on cyclosporine-Pgp binding.
The data suggest that cyclosporine cellular and CNS concentrations can be
increased through the concomitant administration of (+)-mefloquine. The use of
chirality in clinical and forensic situations is also illustrated by the
metabolism of the enantiomers of ketamine (KET). The plasma concentrations of
(+)-KET and (-)-KET and the norketamine metabolites (+)-NK and (-)-NK were
measured in rat plasma using enantioselective gas chromatography. The
separations were accomplished using a gas chromatography chiral stationary
phase based on beta-cyclodextrin. The pharmacokinetic profiles of (+)-, (-)-KET
and (+)-, (-)-NK were determined in control and protein-calorie malnourished
(PCM) rats to determine the effect of PCM on ketamine metabolism and clearance.
The results indicate that PCM produced a significant and stereoselective
decrease in KET and NK metabolism. The data suggest that the effects of
environmental factors (smoking, alcohol use, diet) and drug interactions
(coadministered agents) can be measured using the changes in stereochemical
metabolic and pharmacokinetic patterns of KET and similar drugs. N. Ref:: 33
----------------------------------------------------
[7]
TÍTULO / TITLE: - Suggested guidelines
for the use of tacrolimus in cardiac transplant recipients.
REVISTA
/ JOURNAL: - J Heart Lung Transplant 2001
Jul;20(7):734-8.
AUTORES
/ AUTHORS: - Taylor DO; Barr ML; Meiser BM; Pham SM;
Mentzer RM; Gass AL
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Division of
Cardiology, University of Utah, Salt Lake City, Utah 84132, USA. N. Ref:: 11
----------------------------------------------------
[8]
TÍTULO / TITLE: - Tailoring
immunosuppressive therapy based on donor and recipient risk factors.
REVISTA
/ JOURNAL: - Transplant Proc 2001 May;33(3):2207-11.
AUTORES
/ AUTHORS: - First MR
INSTITUCIÓN
/ INSTITUTION: - University of Cincinnati Medical Center,
Cincinnati, Ohio 45267-0585, USA. N.
Ref:: 35
----------------------------------------------------
[9]
TÍTULO / TITLE: - Maintenance
immunosuppression in the renal transplant recipient: an overview.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S25-35.
AUTORES
/ AUTHORS: - Gaston RS
INSTITUCIÓN
/ INSTITUTION: - Division of Nephrology, University of
Alabama at Birmingham, Birmingham, AL 35294, USA. rgaston@nrtc.uab.edu
RESUMEN
/ SUMMARY: - Managing maintenance immunosuppressive
regimens after kidney transplantation is often challenging and confusing,
requiring careful attention to efficacy, dosing, adverse effects, and costs of
multiple medications. Most protocols combine a primary immunosuppressant
(cyclosporine or tacrolimus) with one or two adjunctive agents (azathioprine,
mycophenolate mofetil, sirolimus, corticosteroids). Avoiding drug-drug
interactions is a major part of effective immunosuppressant management, and
special situations (eg, pregnancy, intravenous dosing, caring for minority
patients) can prove especially daunting. This review summarizes available data
regarding current practices in maintenance immunosuppression, emphasizing
issues that arise in day-to-day management of renal transplant recipients. N. Ref:: 69
----------------------------------------------------
[10]
TÍTULO / TITLE: - Donor specific
transfusion in kidney transplantation: effect of different immunosuppressive
protocols on graft outcome.
REVISTA
/ JOURNAL: - Transplant Proc 2001 Aug;33(5):2787-8.
AUTORES
/ AUTHORS: - Barbari A; Stephan A; Masri MA; Joubran N;
Dagher O; Kamel G
INSTITUCIÓN
/ INSTITUTION: - Department ofNephrology and
Transplantation, Rizk Hospital, Beirut, Lebanon.
----------------------------------------------------
[11]
- Castellano -
TÍTULO / TITLE:Presente y futuro del trasplante
renal. Present and future of kidney transplantation.
REVISTA
/ JOURNAL: - Actas Urol Esp. Acceso gratuito al texto
completo.
●●
Enlace a la Editora de la Revista http://www.aeu.es/actas/
●●
Cita: Actas Urológicas Españolas: <> 2002 Nov-Dec;26(10):731-58.
AUTORES
/ AUTHORS: - Burgos FJ; Alcaraz A; Castillon I;
Gonzalez Martin M; Lledo E; Matesanz R; Marcen R; Montanes P; Pascual J
INSTITUCIÓN
/ INSTITUTION: - Servicio de Urologia, Hospital Ramon y
Cajal, Universidad Alcala, Madrid.
RESUMEN
/ SUMMARY: - Renal transplant is the treatment of
choice for the patient with end stage renal disease. España is the country with
the highest donation rate (33 ppm). However, at present this figure is
stabilized. The development of non-beating heart programmes, living-donor
nephrectomy (specially laparoscopic nephrectomy) programmes, and may be
xenotransplantation in a non-immediate future could increase the
transplantation activity. The knowledge of preservation mechanisms, specially
with the use of perfusion machines allows to rescue for transplantation kidneys
with a long warm-ischemia time. Furthermore, these machines are useful for
analyzing viability markers. The new immunosuppressive drugs: Tacrolimus,
Mycophenolate-Mophetil, Rapamycin and monoclonal antibodies against alpha chain
of the interleukine-2 receptor (Basoliximab and Dazcizumab) have reduced the
incidence of acute rejection in the immediate renal transplant period. However,
its effect in the long-term follow-up period is still a matter of controversy.
The incidence of tumour in the renal transplant recipient is increased,
specially those of lymphoma, skin cancer and Kaposi sarcoma. Periodical exams
for detecting the development of tumours are mandatory in this population.
Finally, xenotransplantation is an attractive alternative, although
immunological, infective and ethical barriers should previously be
resolved. N. Ref:: 92
----------------------------------------------------
[12]
TÍTULO / TITLE: - Pharmacokinetic aspects
of treating infections in the intensive care unit: focus on drug interactions.
REVISTA
/ JOURNAL: - Clin Pharmacokinet 2001;40(11):833-68.
AUTORES
/ AUTHORS: - Pea F; Furlanut M
INSTITUCIÓN
/ INSTITUTION: - Institute of Clinical Pharmacology and
Toxicology, Department of Experimental and Clinical Pathology and Medicine,
Medical School, University of Udine, Italy. federico.pea@med.uniud.it
RESUMEN
/ SUMMARY: - Pharmacokinetic interactions involving
anti-infective drugs may be important in the intensive care unit (ICU).
Although some interactions involve absorption or distribution, the most
clinically relevant interactions during anti-infective treatment involve the
elimination phase. Cytochrome P450 (CYP) 1A2, 2C9, 2C19, 2D6 and 3A4 are the
major isoforms responsible for oxidative metabolism of drugs. Macrolides
(especially troleandomycin and erythromycin versus CYP3A4), fluoroquinolones
(especially enoxacin, ciprofloxacin and norfloxacin versus CYP1A2) and azole
antifungals (especially fluconazole versus CYP2C9 and CYP2C19, and ketoconazole
and itraconazole versus CYP3A4) are all inhibitors of CYP-mediated metabolism
and may therefore be responsible for toxicity of other coadministered drugs by
decreasing their clearance. On the other hand, rifampicin is a nonspecific
inducer of CYP-mediated metabolism (especially of CYP2C9, CYP2C19 and CYP3A4)
and may therefore cause therapeutic failure of other coadministered drugs by
increasing their clearance. Drugs frequently used in the ICU that are at risk
of clinically relevant pharrmacokinetic interactions with anti-infective agents
include some benzodiazepines (especially midazolam and triazolam),
immunosuppressive agents (cyclosporin, tacrolimus), antiasthmatic agents
(theophylline), opioid analgesics (alfentanil), anticonvulsants (phenytoin,
carbamazepine), calcium antagonists (verapamil, nifedipine, felodipine) and
anticoagulants (warfarin). Some lipophilic anti-infective agents inhibit
(clarithromycin, itraconazole) or induce (rifampicin) the transmembrane
transporter P-glycoprotein, which promotes excretion from renal tubular and
intestinal cells. This results in a decrease or increase, respectively, in the
clearance of P-glycoprotein substrates at the renal level and an increase or
decrease, respectively, of their oral bioavailability at the intestinal level.
Hydrophilic anti-infective agents are often eliminated unchanged by renal
glomerular filtration and tubular secretion, and are therefore involved in
competition for excretion. Beta-lactams are known to compete with other drugs
for renal tubular secretion mediated by the organic anion transport system, but
this is frequently not of major concern, given their wide therapeutic index.
However, there is a risk of nephrotoxicity and neurotoxicity with some
cephalosporins and carbapenems. Therapeutic failure with these hydrophilic
compounds may be due to haemodynamically active coadministered drugs, such as
dopamine, dobutamine and furosemide, which increase their renal clearance by
means of enhanced cardiac output and/or renal blood flow. Therefore,
coadministration of some drugs should be avoided, or at least careful
therapeutic drug monitoring should be performed when available. Monitoring may
be especially helpful when there is some coexisting pathophysiological
condition affecting drug disposition, for example malabsorption or marked instability
of the systemic circulation or of renal or hepatic function. N. Ref:: 397
----------------------------------------------------
[13]
TÍTULO / TITLE: - Outcomes in kidney
transplantation.
REVISTA
/ JOURNAL: - Semin Nephrol 2003 May;23(3):306-16.
AUTORES
/ AUTHORS: - Djamali A; Premasathian N; Pirsch JD
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine and Surgery,
University of Wisconsin Medical School, Madison, WI 53792, USA.
RESUMEN
/ SUMMARY: - It is estimated that there are greater
than 100000 kidney transplant recipients with a functioning graft in the United
States. Recent advances in immunosuppression have improved short-term graft
survival rates and decreased early mortality by decreasing the incidence and
therapy for acute rejection episodes. For those accepted on the waiting list,
transplant prolongs patient survival compared with remaining on dialysis.
During the 1990s, 3 new immunosuppressive drugs were introduced in clinical
kidney transplantation. All were approved for use by the Food and Drug
Administration after large, controlled, randomized trials. Mycophenolate
mofetil (MMF), when combined with cyclosporine (CSA) and prednisone, lowered
acute rejection rates by nearly 50% compared with control. Tacrolimus compared
with CSA also significantly reduced acute rejection rates in kidney transplant
recipients, but was associated with a significant increase in posttransplant
diabetes mellitus (PTDM) in the early trials. When evaluated in combination
with MMF, the incidence of PTDM was much lower. At the end of the decade,
sirolimus was shown in several randomized trials to lower acute rejection rates
and is believed to be less nephrotoxic compared with calcineurin inhibitors.
All of the randomized trials were not statistically powered to assess long-term
superiority. Registry analyses have been performed that appear to show some
long-term benefit of immunosuppressive therapy with MMF. Other outcome
assessments in kidney transplant recipients include risk factors for chronic
allograft nephropathy, hypertension, hyperlipidemia, and bone disease. Although
there are few randomized trials, understanding of the significance of these
common complications has progressed and strategies for therapy and intervention
have been developed. This article focuses on the randomized trials of
immunosuppressive therapy and complications associated with use of these drugs.
In addition, we review the current management and intervention for the
comorbidities associated with the long-term clinical management of the kidney
transplant recipient. N.
Ref:: 78
----------------------------------------------------
[14]
TÍTULO / TITLE: - Evolution of
immunosuppression and continued importance of acute rejection in renal
transplantation.
REVISTA
/ JOURNAL: - Am J Kidney Dis 2001 Dec;38(6 Suppl
6):S2-9.
AUTORES
/ AUTHORS: - Chan L; Gaston R; Hariharan S
INSTITUCIÓN
/ INSTITUTION: - Department of Renal Medicine, University
of Colorado Health Sciences Center, Denver, CO 80262, USA. Larry.Chan@uchsc.edu
RESUMEN
/ SUMMARY: - As steady improvement in short-term kidney
graft survival and long-term outcomes prolongs the lives of transplant
patients, responsibility for their care is shifting away from transplant
specialists and into the hands of community nephrologists. Therefore, community
nephrologists need to have a deeper understanding of immunosuppressive
therapies than ever before. Pharmacologic immunosuppression has been
continuously evolving over the past two decades. Azathioprine was introduced in
the early 1960s. Introduction of cyclosporine (CsA) in 1983 revolutionized
short-term outcomes after renal transplantation. The first monoclonal antibody
immunosuppressant, OKT3, was introduced in 1986. The 1990s saw the introduction
of a number of important new agents, including mycophenolate mofetil (MMF),
tacrolimus, and a microemulsion CsA, as well as two new monoclonal antibodies.
Combinations of these new agents, along with improving clinical care, have
produced 1-year patient survival approaching 100% and graft survival exceeding
90%. The newest class of agents, the first of which is sirolimus, is called
target of rapamycin (TOR) inhibitors and is used with CsA for maintenance
therapy. Immunosuppressive drug therapy after kidney transplantation continues
to evolve. There is a variety of pharmacologic combinations from which to
choose, based on immunologic risk and side effect profiles. As new regimens are
developed, ongoing communications between the transplant center and community
nephrologists will be required to implement therapeutic changes and optimize
patient care successfully. N.
Ref:: 59
----------------------------------------------------
[15]
TÍTULO / TITLE: - How to manage patients
with lupus nephritis.
REVISTA
/ JOURNAL: - Best Pract Res Clin Rheumatol 2002
Apr;16(2):195-210.
●●
Enlace al texto completo (gratuito o de pago) 1053/berh.2001.0221
AUTORES
/ AUTHORS: - Esdaile JM
INSTITUCIÓN
/ INSTITUTION: - Division of Rheumatology, University of
British Columbia, Canada.
RESUMEN
/ SUMMARY: - The clinical and renal biopsy predictors
of assistance in determining therapy are reviewed. While pulse cyclophosphamide
remains the most effective treatment for proliferative nephritis, there is
increasing interest in other agents, such as azathioprine, particularly to
maintain remission. While lupus membranous nephropathy has attracted limited
study, preliminary work suggests a role for cyclophosphamide. Newer therapies,
including cyclosporine A, mycophenolate mofetil, immunoadsorption, intravenous
immune globulin, LJP-394, high-dose immunoablation and nucleoside analogues
require further study but offer hope for those failing conventional
treatments. N. Ref:: 60
----------------------------------------------------
[16]
TÍTULO / TITLE: - Issues of adherence to
immunosuppressant therapy after solid-organ transplantation.
REVISTA
/ JOURNAL: - Drugs 2002;62(4):567-75.
AUTORES
/ AUTHORS: - Chisholm MA
INSTITUCIÓN
/ INSTITUTION: - Department of Clinical and Administrative
Sciences, University of Georgia College of Pharmacy and Department of Medicine,
Medical College of Georgia, Augusta, Georgia, USA. mchishol@mail.mcg.edu
RESUMEN
/ SUMMARY: - Nonadherence to immunosuppressant therapy
constitutes a major barrier to post-transplant care. Failure of transplant
recipients to take prescribed drugs properly may not only be a significant
obstacle to optimal graft function but it may also result in decreased quality
of life and productivity, increased morbidity and healthcare cost, and death.
Despite the obvious importance of adherence to immunosuppressant therapy,
nonadherence is frequent among transplant recipients, with rates ranging from 2
to 68%. This manuscript briefly discusses several issues concerning adherence
to immunosuppressant therapy of solid-organ transplant recipients; presents a
literature review concerning adherence to immunosuppressant therapy by
solid-organ transplant recipients; and suggests strategies that may be used to
enhance medication adherence. Although many of the studies have results that
conflict concerning factors associated with immunosuppressive nonadherence,
most of the investigators concluded that nonadherent behaviour is usually not
predictable. Because of possible adverse events, emphasis should be placed on
increasing medication adherence in all transplant recipients. N. Ref:: 28
----------------------------------------------------
[17]
TÍTULO / TITLE: - Sirolimus eluting
stent: a new era in interventional cardiology?
REVISTA
/ JOURNAL: - Curr Pharm Des 2003;9(13):1077-94.
AUTORES
/ AUTHORS: - Windecker S; Roffi M; Meier B
INSTITUCIÓN
/ INSTITUTION: - Swiss Cardiovascular Center Bern,
University Hospital, Bern, Switzerland. Bernhard.Meier@insel.ch
RESUMEN
/ SUMMARY: - Coronary artery stents have emerged as the
preferred tool for percutaneous coronary interventions during the past decade
by eliminating abrupt vessel closure and reducing restenosis compared with
balloon angioplasty. While coronary artery stents prevent constrictive arterial
remodeling and elastic recoil, the implantation is associated with more severe
arterial vascular injury than balloon angioplasty alone. The arterial injury
initiates a vasculoproliferative response with smooth muscle cell proliferation
and migration as well as extracellular matrix formation, which may lead to
severe neointimal hyperplasia with in-stent restenosis in 10-30% of cases.
Sirolimus, a naturally occurring macrocyclic lactone, has been identified as a
pharmacological cell cycle inhibitor with potent antiproliferative and
antimigratory effects on vascular smooth muscle cells in vitro. The systemic
administration of sirolimus has been shown to effectively reduce neointimal
hyperplasia in experimental restenosis models. Subsequently, sirolimus has been
incorporated at therapeutically important doses into biocompatible polymers,
which made it suitable for stent-based drug elution. Investigation of sirolimus
eluting stents in both experimental and clinical restenosis studies have
demonstrated dramatic reductions in neointimal hyperplasia. Accordingly,
sirolimus eluting stents offer an attractive mode of local drug delivery by
minimizing systemic toxicity and maximizing local dose requirements. In
addition, sirolimus eluting stents hold great promise to effectively prevent
restenosis. N. Ref:: 104
----------------------------------------------------
[18]
TÍTULO / TITLE: - Limited sampling
strategies for estimating cyclosporin area under the concentration-time curve:
review of current algorithms.
REVISTA
/ JOURNAL: - Ther Drug Monit 2001 Apr;23(2):100-14.
AUTORES
/ AUTHORS: - David OJ; Johnston A
INSTITUCIÓN
/ INSTITUTION: - Department of Clinical Pharmacology, St.
Bartholomew’s & the Royal London School of Medicine and Dentistry, United
Kingdom.
RESUMEN
/ SUMMARY: - Cyclosporin, the drug of first choice in
transplantation surgery, is characterized by a low therapeutic index and
variable absorption, so close monitoring of the drug is required to optimize
the dosing. Predose blood cyclosporin levels are measured routinely for
therapeutic monitoring, but this approach is not optimal because the area under
the concentration-time curve (AUC) correlates better with clinical events.
However, conventional methods of measuring AUC require many blood samples,
which is not viable in a routine clinical setting. AUC monitoring can be
simplified for use in a clinical setting by using a limited sampling strategy
(LSS) that allows AUC to be estimated using a small number of blood samples
collected at specific times. This article reviews the current literature on
estimating cyclosporin AUC using LSS. Thirty-eight papers suggesting the use of
specific time points were found. LSS has been developed for different
transplant types, with different dosing regimens, and with different assays.
Most authors suggested either two- or three-sample equations. Results from
authors who validated their models suggest that equations defined on one
transplant type may be applicable to other transplant types, to both adults and
children, and to early or late after transplantation. Moreover, it seems that
there is flexibility in the choice of equations available to clinicians. The
number of samples to collect for accurate estimations is a matter of debate,
but a wise choice can minimize the number. The choice of the optimal LSS and
validation are discussed. N.
Ref:: 102
----------------------------------------------------
[19]
TÍTULO / TITLE: - A view on beta cell
transplantation in diabetes.
REVISTA
/ JOURNAL: - Ann N Y Acad Sci 2002 Apr;958:69-76.
AUTORES
/ AUTHORS: - Pipeleers D; Keymeulen B; Chatenoud L;
Hendrieckx C; Ling Z; Mathieu C; Roep B; Ysebaert D
INSTITUCIÓN
/ INSTITUTION: - Free University of Brussels (VUB),
Brussels, Belgium. Daniel.Pipeleers@vub.ac.be
RESUMEN
/ SUMMARY: - Organ donors also offer a source of
insulin-producing tissue that might be used for the treatment of diabetes.
Clinical protocols for transplantation of this tissue aim for the prevention of
chronic diabetes complications without introducing new serious side effects.
Pancreas and islet cell transplantation are discussed in this perspective. The
future of islet cell implants looks favorable but depends on finding ways to
induce immune tolerance to the donor beta cells. Clinical trials can take
advantage of relevant progress in animal models. In a limited study, recipient
treatment with antilymphocyte antibodies and culture of donor cell preparations
appeared useful to induce a state of operational immune tolerance in type 1
diabetic patients, as indirectly judged by graft survival and by analysis of
auto- and alloreactivities in recipients. Use of cultured beta cell
preparations also allows donor cell recruitment from suboptimal donor organs
and increases the degree of standardization and quality control of islet cell
grafts. The future of these grafts will depend on the development of techniques
for the neogenesis of beta cells. N.
Ref:: 47
----------------------------------------------------
[20]
TÍTULO / TITLE: - n-3 Fatty acids and
their role in nephrologic practice.
REVISTA
/ JOURNAL: - Curr Opin Nephrol Hypertens 2001
Sep;10(5):639-42.
AUTORES
/ AUTHORS: - Donadio JV
INSTITUCIÓN
/ INSTITUTION: - Mayo Clinic and Foundation, Rochester,
Minnesota 55905, USA. donadio.james@mayo.edu
RESUMEN
/ SUMMARY: - During the past year, a newly reported
clinical trial has strengthened the argument for recommending daily treatment
with n-3 polyunsaturated fatty acids in patients with immunoglobulin A
nephropathy (the most common form of primary glomerulonephritis in the world)
who are at high risk for progression of renal disease. Studies are underway
that involve a combination of cyclosporine A, a commonly prescribed
immunosuppressive agent in solid-organ transplantation, with a high-potency n-3
polyunsaturated fatty acid to reduce cyclosporine toxicity. Two studies
reported during the past year show promise that dietary supplementation with
n-3 polyunsaturated fatty acids will substantially decrease vascular access
graft thrombosis in patients receiving maintenance hemodialysis, and may reduce
hypercalciuria in patients who suffer from kidney stones. N. Ref:: 26
----------------------------------------------------
[21]
TÍTULO / TITLE: - Solid-state
fermentation: a promising microbial technology for secondary metabolite
production.
REVISTA
/ JOURNAL: - Appl Microbiol Biotechnol 2001 Apr;55(3):284-9.
AUTORES
/ AUTHORS: - Robinson T; Singh D; Nigam P
INSTITUCIÓN
/ INSTITUTION: - Biotechnology Research Group, University
of Ulster, Coleraine, UK.
RESUMEN
/ SUMMARY: - Solid state (substrate) fermentation (SSF)
has been used successfully for the production of enzymes and secondary
metabolites. These products are associated with the stationary phase of
microbial growth and are produced on an industrial scale for use in agriculture
and the treatment of disease. Many of these secondary metabolites are still
produced by submerged liquid fermentations (SmF) even though production by this
method has been shown to be less efficient than SSF. As large-scale production
increases further, so do the costs and energy demands. SSF has been shown to
produce a more stable product, requiring less energy, in smaller fermenters,
with easier downstream processing measures. In this article we review an
important area of biotechnology, since the recent evidence indicates that
bacteria and fungi, growing under SSF conditions, are more than capable of
supplying the growing global demand for secondary metabolites. N. Ref:: 53
----------------------------------------------------
[22]
TÍTULO / TITLE: - Immunosuppressants in
advanced clinical development for organ transplantation and selected autoimmune
diseases.
REVISTA
/ JOURNAL: - Expert Opin Emerg Drugs 2003
May;8(1):47-62.
AUTORES
/ AUTHORS: - Kovarik JM; Burtin P
INSTITUCIÓN
/ INSTITUTION: - Novartis Pharmaceuticals, 4002 Basel,
Switzerland. john.kovarik@pharma.novartis.com
RESUMEN
/ SUMMARY: - Immunosuppressants dampen the immune
response or restore balance among immune system components. They are primarily
used to prevent allograft rejection after organ transplantation and to prevent
or treat disease flares in autoimmune diseases. Immunosuppressants available at
present include the calcineurin inhibitors (cyclosporin, tacrolimus),
antimetabolites (azathioprine, leflunomide, methotrexate, mycophenolate mofetil),
antiproliferatives (sirolimus), monoclonal antibodies to T lymphocyte
(basiliximab, daclizumab, muromonab-CD3) and anticytokines (anakinra,
etanercept, infliximab). The immunosuppressive market grows at a rate of >
10% yearly, with total sales in 2001 of US$2.7 billion. Immunotherapy in
transplantation and autoimmune diseases is tending towards the use of
multi-drug regimens tailored for the individual patient. At least 23 new
immunosuppressants are currently in advanced clinical testing or preregistration,
and can be divided into three groups. First, emerging drugs targeting
intracellular ligands in immune cells are primarily analogues of
currently-marketed agents, which attempt to provide improved pharmaceutical or
safety profiles compared with the prototype compound. They are largely being
developed in organ transplantation. Second, emerging drugs targeting cell
surface ligands on immune cells attempt to antagonise novel molecular sites to
interfere with immune cell activation via costimulatory signals, immune cell
adhesion to tissues or the vasculature and immune cell trafficking. These
agents are being primarily developed in rheumatoid arthritis, psoriasis and/or
multiple sclerosis. Finally, emerging drugs acting as anticytokines, which
largely follow on from the success of those on the market, by antagonising the
function of tumour necrosis factor or a narrow selection of interleukins. All
are being assessed in rheumatoid arthritis. Drug development of
immunosuppressants is increasingly attempting to intervene in disease
progression over the long term. These efforts bring with them trial design and
regulatory issues, such as what markers can be used as trial outcome measures,
over what duration do trials need to be conducted and what labelling claims are
allowed. With the intensive activity in this field, it is likely that several
new drugs will reach the market in the coming decade. One caveat, however, is
that emerging immunosuppressants that are likely to capture a reasonable share
of this increasingly-fragmented market must demonstrate the ability to achieve
disease remission or long-term slowing of disease progression. N. Ref:: 55
----------------------------------------------------
[23]
TÍTULO / TITLE: - Influence of one human
leukocyte antigen mismatch on outcome of allogeneic bone marrow transplantation
from related donors.
REVISTA
/ JOURNAL: - Hematology 2003 Feb;8(1):27-33.
●●
Enlace al texto completo (gratuito o de pago) 1080/1024533031000072054
AUTORES
/ AUTHORS: - Hasegawa W; Lipton JH; Messner HA; Jamal
H; Yi QL; Daly AS; Kotchetkova N; Kiss TL
INSTITUCIÓN
/ INSTITUTION: - Bone Marrow Transplant Service, Princess
Margaret Hospital/University Health Network, Toronto, Ont, M5G 2M9, Canada.
RESUMEN
/ SUMMARY: - This study compares the clinical outcomes
of 60 consecutive patients who received an allogeneic blood or marrow stem cell
transplant (BMT) from one Human Leukocyte Antigen (HLA) mismatched related
donors with those of 120 matched patients who had HLA identical sibling donors.
The control patients were matched for diagnosis, disease status, conditioning regimen,
and age at BMT. All patients received standard CYA and MTX for GVHD
prophylaxis. The probability of overall survival (OS) at 5 years was 35% in the
study group compared to 56% in the control group. The relapse rates and acute
GVHD rates did not differ between the two groups. Graft failure was a
significant problem in the study group compared to the control group (13 vs.
0%, p < 0.0001). All cases of graft failure occurred in patients with a
mismatch in the host-versus-graft direction. BMT-related deaths were also
increased in the study group. Forty percent of deaths were caused by infection
in the study group vs. 19% in the control group (p < 0.01). In conclusion,
the OS of patients receiving marrow/stem cells from one antigen mismatched
related donors was inferior to that of controls with HLA-identical related
donors. There was an increase in mortality related to infections occurring in
the setting of an increased frequency of graft failure in these patients. N. Ref:: 21
----------------------------------------------------
[24]
TÍTULO / TITLE: - Perspectives of
drug-eluting stents: the next revolution.
REVISTA
/ JOURNAL: - Am J Cardiovasc Drugs 2002;2(3):163-72.
AUTORES
/ AUTHORS: - Moses JW; Kipshidze N; Leon MB
INSTITUCIÓN
/ INSTITUTION: - Lenox Hill Heart and Vascular Institute of
New York and Cardiovascular Research Foundation, New York, New York 10021, USA.
jmoses@lenoxhill.net
RESUMEN
/ SUMMARY: - Coronary stent implantation has become a
well established therapy in the management of coronary artery disease (CAD).
Although the Stent Restenosis Study (STRESS) and Belgium-Netherlands Stent
(BENESTENT) trials demonstrated convincingly that stenting is superior to
percutaneous transluminal coronary angioplasty with respect to restenosis in de
novo lesions, there is, however, still a high incidence (10 to 50%) of
restenosis following stent implantation. Improvements in stent design and
implantation techniques resulted in an increase in the use of coronary stents
and today, in most centers in the US and Europe, stenting has become the
predominant form of nonsurgical revascularization accounting for about 80% of
all percutaneous coronary intervention procedures. Coronary stents provide
luminal scaffolding that virtually eliminates elastic recoil and remodelling.
Stents, however, do not decrease neointimal hyperplasia and in fact lead to an
increase in the proliferative comportment of restenosis. Agents that inhibit
cell-cycle progression indirectly have also been tested as inhibitors of
vascular proliferation. When coated onto stents, sirolimus, a macrolide
antibiotic with immunosuppressive properties, and paclitaxel and dactinomycin,
both chemotherapeutic agents, induced cell-cycle arrest in smooth muscle cells
(SMC) and inhibited neointimal formation in animal models. Preliminary clinical
studies with drug-eluting stents produced dramatic results eliminating
restenosis in large and mid-size arteries. Quantitative coronary angiography
and intravascular ultrasound demonstrated virtually complete inhibition of
tissue growth at 6 and 12 months after sirolimus-eluting stent implantation.
Results are also very encouraging with paclitaxel-coated stents. However, it
needs to be proven that current drug-eluting stents will produce similar
results in ‘real life’ interventional practice (long lesions, lesions in small
vessels, in vein grafts, chronic total occlusions, and bifurcated and ostial
lesions). The ongoing randomized, double-blind sirolimus-coated Bx Velocity trade
mark balloon expandable stent in the treatment of patients with de novo
coronary artery lesions (SIRIUS) trial may answer some of these concerns. With
further improvements, including the expansion of drug-loading capacity, double
coatings and coatings with programmable pharmacokinetic capacity using advances
in nanotechnology (which may allow for more precise and controlled release of
less toxic and improved molecules), we think that in the next few years the
practice of interventional cardiology may undergo major changes. A new era of
dramatic improvements in the treatment of CAD may have dawned. The prospect of
approval of this technology should herald a host of clinical trials to revisit
basic assumptions about the place of coronary stenting in the contemporary care
of obstructive (and nonobstructive) CAD.
N. Ref:: 76
----------------------------------------------------
[25]
TÍTULO / TITLE: - Pyogenic granuloma in a
renal transplant patient: case report.
REVISTA
/ JOURNAL: - Spec Care Dentist 2001
Sep-Oct;21(5):187-90.
AUTORES
/ AUTHORS: - al-Zayer M; da Fonseca M; Ship JA
INSTITUCIÓN
/ INSTITUTION: - Department of Orthodontics and Pediatric
Dentistry, University of Michigan School of Dentistry, 1011 N. University Ave.,
Ann Arbor, MI 48109, USA.
RESUMEN
/ SUMMARY: - This case report describes a 14-year-old
female referred to Pediatric Dentistry for evaluation and treatment of
cyclosporine-induced gingival hyperplasia. Examination of the anterior
maxillary area showed a red, vascular, exophytic, soft-tissue mass which had
been excised a few months earlier without a histopathologic examination being
done. The mass did not appear consistent with gingival overgrowth induced by
long-term use of medication, and thus an excisional biopsy was performed, which
diagnosed the lesion as a pyogenic granuloma. A review of the literature and
management recommendations are discussed.
N. Ref:: 20
----------------------------------------------------
[26]
TÍTULO / TITLE: - Annual trends and
triple therapy--1991-2000.
REVISTA
/ JOURNAL: - Clin Transpl 2001;:247-69.
AUTORES
/ AUTHORS: - Nishikawa K; Terasaki PI
INSTITUCIÓN
/ INSTITUTION: - Terasaki Foundation Laboratory, Los
Angeles, CA, USA.
RESUMEN
/ SUMMARY: - 1. Although the number of cadaver donor
transplants did not increase substantially over the past 10 years, unrelated
living donor grafts increased from 153 in 1991 to 1,661 through 2000. Use of
spousal and other unrelated donor organs contributed to this increase. There
was a modest increase in living-related donor transplants from 2,328 in 1991 to
3,451 in 2000. 2. Cadaver donor graft survival at one year improved from 84% in
1991 to 90% in 2000. In contrast, one-year graft survival of living donor
transplants only improved from 93% in 1991 to 95% in 2000. 3. Throughout the
10-year period, approximately 13% of transplants were repeat transplants from
cadaver donors and roughly 8% were regrafts from live donors. 4. Cadaver donor
transplants into White recipients declined from 68% in 1991 to 60% in 2000. For
living donors, the percentage of White patients remained constant at about 70%.
5. Graft survival in patients of all races was about equal at one year but
diverged at 3 years, with Asians having the highest and Blacks having the
lowest 3-year graft survival rates. 6. Average donor age increased from 31.7 in
1991 to 36 in 2000 for cadaveric donor transplants and 37.9 in 1991 to 40.4 in
2000 for living donor transplants. Cadaveric kidneys from donors older than 50
years of age yielded significantly lower 3-year graft survival. 7. Average
recipient age for cadaveric donor transplants increased from 42.1 in 1991 to
46.8 in 2000. The average recipient age for living donor transplants also
increased steadily from 33.7 in 1991 to 42.9 in 2000. There was relatively
little effect on graft survival rates for advanced age recipients. 8. The
percentage of sensitized recipients receiving cadaver donor grafts declined
from 27% in 1991 to 21% in 2000. Similarly, sensitized recipients receiving
living donor grafts decreased from 17% in 1991 to 13% in 2000. Graft survival
in patients with more than 50% PRA was lower at 3 years for patients receiving
cadaveric donor grafts. Highly sensitized patients receiving living donor
grafts had graft survival rates similar to those who were not sensitized. 9.
Cold ischemia times decreased from an average of 24.2 hours in 1991 to 18.9
hours in 2000. Improved graft survival rates over those 10 years were noted in
all groups, and even cold ischemia times more than 36 hours yielded 3-year graft
survivals comparable to those with lower cold ischemia times in 1998. 10. The
need for dialysis has remained constant at about 23% over the last 10 years for
patients receiving kidneys from cadaveric donors. The rate of dialysis for
patients receiving kidneys from living donors was about 5% for each of the 10
years examined. First day anuria increased from 11% in 1991 to 16% in 2000 for
cadaver donor transplants and 3% in 1999 to 5% in 2000 for living donor grafts.
11. Cadaveric donor patients requiring dialysis had a 3-year graft survival
rate of 63% if there was no first day anuria and 56% if they had first day
anuria. This is in contrast to 80% 3-year graft survival for those with
immediate diuresis and no need for dialysis. The 3-year graft survival rate for
those receiving living donor grafts and needing dialysis was 58% if they had
first day diuresis and 41% if they ware anuric on the first day. Conversely,
those who had first day function and did not require dialysis had 89% 3-year
graft survival. 12. Among the patients receiving cadaveric grafts with first
day diuresis there was a marked reduction in those with rejection, from 21% in
1991 to 5% in 2000. Similarly, for this type of patient receiving living donor
grafts, the reduction was 17% in 1991 to 5% in 2000. However, graft survival
among these patients did not change significantly. The greatest improvement was
noted in those with first day anuria and no rejection. 13. Patients who did not
require dialysis, and had rejection prior to discharge decreased markedly from
17% in 1991 to 3% in 2000 in those receiving cadaveric grafts and 15% in 1991
to 3.9% in 2000 for those receiving living donors. Graft survival of cadaveric
transplants in those needing dialysis, with and without rejection, improved the
most in the 10 year period. 14. Hospitalization days for cadaveric transplant
recipients were reduced from 19 days in 1991 to 10 days in 2000 and 16 days in
1991 to 8 days in 2000 for recipients of living donor grafts. There was an
increase in discharge serum creatinine values from 2.3 mg/dl in 1991 to 3.3
mg/dl in 2000 for cadaver donor grafts. 15. Double therapy was utilized for
about 15% of cadaveric and living donors. There was a sharp increase in
induction therapy, peaking at 51% in 1994 and decreasing to 5% by 2000 for
cadaveric donor transplants. Induction did not improve graft survival for
either cadaver or living donor transplant recipients. 16. Triple therapy
improved graft survival of White and Black patients, but did not affect the
half-lives in either race. 17. The lower graft survival from older donors was
not affected by triple therapy for cadaver donor transplants. Triple therapy
removed the donor age effect for recipients of living donor grafts. 18. Triple
therapy practically eliminated the effect of sensitization for cadaveric donor
grafts. Both double and triple therapy virtually eliminated the sensitization
effect for living donors. 19. Triple therapy significantly improved the
survival of kidneys with more than 36 hours cold ischemia time so that 3-year
graft survival was 76% at 3 years compared with 81% for kidneys stored 1-12
hours. 20. Triple therapy improved the 3-year graft survival of kidneys with
first day anuria from 50% for double therapy to 69% for triple therapy in
cadaver donor transplants. For living donor transplants, there was a similar
improvement from 57% with double therapy to 72% with triple therapy. 21. Triple
therapy improved the 3-year cadaveric graft survival rate of kidneys requiring
dialysis from 51% with double therapy to 67% for triple therapy. There was a
similar improvement for living donors needing dialysis from 37% to 61% at 3
years.
----------------------------------------------------
[27]
TÍTULO / TITLE: - Non-ribosomal peptide
synthetases as technological platforms for the synthesis of highly modified
peptide bioeffectors—Cyclosporin synthetase as a complex example.
REVISTA
/ JOURNAL: - Biotechnol Annu Rev 2003;9:151-97.
AUTORES
/ AUTHORS: - Velkov T; Lawen A
INSTITUCIÓN
/ INSTITUTION: - Monash University, Department of
Biochemistry and Molecular Biology, School of Biomedical Sciences, P.O. Box
13D, Melbourne, Victoria 3800, Australia.
RESUMEN
/ SUMMARY: - Many microbial peptide secondary
metabolites possess important medicinal properties, of which the
immunosuppressant cyclosporin A is an example. The enormous structural and
functional diversity of these low-molecular weight peptides is attributable to
their mode of biosynthesis. Peptide secondary metabolites are assembled
non-ribosomally by multi-functional enzymes, termed non-ribosomal peptide
synthetases. These systems consist of a multi-modular arrangement of the
functional domains responsible for the catalysis of the partial reactions of
peptide assembly. The extensive homology shared among NRPS systems allows for
the generalisation of the knowledge garnered from studies of systems of diverse
origins. In this review we shall focus the contemporary knowledge of
non-ribosomal peptide biosynthesis on the structure and function of the
cyclosporin biosynthetic system, with some emphasis on the re-direction of the
biosynthetic potential of this system by combinatorial approaches. N. Ref:: 205
----------------------------------------------------
[28]
TÍTULO / TITLE: - Pharmacoeconomics of
drug therapy for atopic dermatitis.
REVISTA
/ JOURNAL: - Expert Opin Pharmacother 2002
Mar;3(3):249-55.
AUTORES
/ AUTHORS: - Lamb SR; Rademaker M
INSTITUCIÓN
/ INSTITUTION: - Leeds Centre of Dermatology, Great George
Street, Leeds, West Yorkshire, LS1 3EX, UK.
RESUMEN
/ SUMMARY: - Atopic dermatitis is an increasingly
prevalent common childhood disease. While the majority of patients have mild
disease, atopic dermatitis can cause considerable distress to patients and
their caregivers, with significant social and financial cost to families. With
a prevalence of 15 - 20% in Western countries, atopic dermatitis also has a
considerable health and societal cost to the community. Many new treatments
have been shown to be therapeutically effective, particularly in severe disease,
including cyclosporin A (Neoral, Novartis AG), interferon, tacrolimus (Fujisawa
Pharmaceutical Co. Ltd.) and iv. immunoglobulin. These are expensive when
compared to standard treatments like emollients and topical corticosteroids and
have significant adverse effects that limit their use. Additional costs related
to monitoring are incurred and the long-term safety of these treatments is yet
to be determined. However, an advantage over more traditional therapies is
their ability to produce benefits even after treatment ceases. Treatments that
produce long-term remissions have a greater likelihood of being cost-effective.
With monetary constraints on healthcare and the importance governments place on
reducing drug costs, economic evaluations are becoming an increasingly
important factor for drug acceptance. Those evaluating cost-effectiveness
should pay particular attention to the potential reduction in indirect and
intangible costs. Unfortunately, there is a dearth of cost-effectiveness
studies in atopic eczema and this needs to be addressed with some urgency. N. Ref:: 43
----------------------------------------------------
[29]
TÍTULO / TITLE: - An update in transplant
immunosuppressive therapy.
REVISTA
/ JOURNAL: - Med Health R I 2002 Apr;85(4):131-3.
AUTORES
/ AUTHORS: - Thursby MA; Yango AF; Gohh RY
INSTITUCIÓN
/ INSTITUTION: - Rhode Island Hospital, Division of Renal
Diseases, 593 Eddy Street, Providence, RI 02903, USA. Mthursby@lifespan.org N. Ref:: 10
----------------------------------------------------
[30]
TÍTULO / TITLE: - Kidney transplantation
from living donors: comparison of results between related and unrelated donor
transplants under new immunosuppressive protocols.
REVISTA
/ JOURNAL: - Isr Med Assoc J 2003 Sep;5(9):622-5.
AUTORES
/ AUTHORS: - Chkhotua AB; Klein T; Shabtai EL; Yussim
A; Bar-Nathan N; Shaharabani E; Lustig S; Mor E
INSTITUCIÓN
/ INSTITUTION: - National Center of Urology, Tbilisi,
Georgia.
RESUMEN
/ SUMMARY: - BACKGROUND: Recent advances in
immunosuppressive therapy have led to a substantial improvement in the outcome
of kidney transplantation. Living unrelated donors may become a source of
additional organs for patients on the kidney waiting list. OBJECTIVES: To study
the impact of the combination of calcineurin inhibitors and
mycophenolate-mofetile, together with steroids, on outcomes of living related
and unrelated transplants. METHODS: Between September 1997 and January 2000,
129 patients underwent living related (n = 80) or unrelated (n = 49) kidney
transplant. The mean follow-up was 28.2 months. Immunosuppressive protocols
consisted of MMF with cyclosporine (41%) or tacrolimus (59%), plus steroids.
Patient and graft survival data, rejection rate, and graft functional parameters
were compared between the groups. RESULTS: LUD recipients were older (47.8 vs.
33.6 years) with a higher number of re-transplants (24.5% vs. 11.2% in LRD
recipients, P < 0.05). Human leukocyte antigen matching was higher in LRD
recipients (P < 0.001). Acute rejection developed in 28.6% of LUD and 27.5%
of LRD transplants (P = NS). Creatinine levels at 1, 2 and 3 years
post-transplant were 1.6, 1.7 and 1.7 mg/dl for LRD patients and 1.5, 1.5 and
1.3 mg/dl for LUD recipients (P = NS). There was no difference in patient
survival rates between the groups. One, 2 and 3 years graft survival rates were
similar in LRD (91.3%, 90% and 87.5%) and LUD (89.8%, 87.8% and 87.8%)
recipients. CONCLUSIONS: Despite HLA disparity, rejection and survival rates of
living unrelated transplants under current immunosuppressive protocols are
comparable to those of living related transplants.
----------------------------------------------------
[31]
TÍTULO / TITLE: - Evolution of biologic
therapies for the treatment of psoriasis.
REVISTA
/ JOURNAL: - Skinmed 2003 Sep-Oct;2(5):286-94.
AUTORES
/ AUTHORS: - Gordon KB; McCormick TS
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine, Division of
Dermatology, Loyola University, Stritch School of Medicine, Maywood, IL 60153,
USA. kgordon@lumc.edu
RESUMEN
/ SUMMARY: - Over the past three decades, laboratory
and clinical research findings have shown that T cells are the primary
mediators of psoriasis pathogenesis and that psoriasis can be treated by
eliminating these T cells or interfering with their activation or activity.
Based on these observations, many new biologic therapies to treat psoriasis are
now in development. These agents, developed primarily through recombinant DNA
techniques, are designed to target T cells and the immunologic cascade
associated with their activation. Four basic strategic approaches that focus on
the steps involved in the immunopathology of psoriasis are: 1) elimination of
the pathogenic T cells; 2) inhibition of T-cell activation, proliferation, and
migration; 3) immune deviation to down-regulate the type 1 (TH1) response
predominant in psoriasis; and 4) blockade of cytokine production. The goal of
these new therapies is to improve the treatment of psoriasis, particularly
moderate to severe disease, with agents that are well tolerated and safe for
long-term use. N.
Ref:: 52
----------------------------------------------------
[32]
TÍTULO / TITLE: - An evidence-based pilot
study exploring relationships between psychologic and physiologic factors in
post-lung-transplant adolescents with cystic fibrosis.
REVISTA
/ JOURNAL: - J Pediatr Nurs 2003 Jun;18(3):216-20.
●●
Enlace al texto completo (gratuito o de pago) 1053/jpdn.2003.41
AUTORES
/ AUTHORS: - Sredl D; Werner T; Springhart D; Watkins
D; Shaner M; McBride G
INSTITUCIÓN
/ INSTITUTION: - St. Louis Children’s Hospital, St. Louis,
MO, USA.
RESUMEN
/ SUMMARY: - After using an evidence-based approach to
address clinical practice questions, a pilot study was designed to explore the
relationships among anxiety and depression self-report data, cyclosporine (CSA)
trough values, and biopsy rejection grades within a posttransplant sample of
adolescents with cystic fibrosis. Thirteen study participants completed the
Revised Children’s Manifest Anxiety Scale (RCMAS) and the Children’s Depression
Inventory (CDI), and had CSA trough levels and biopsy data collected. There was
a statistically significant correlation between depression and inflammatory
rejection levels. Adolescents with benign rejection scores had lower depression
scores than adolescents with higher levels of rejection scores. The data also
showed a statistically significant inverse correlation between CSA trough
levels and inflammatory rejection levels. Posttransplant success depends on
compliance with a strict, antirejection regimen. Adolescence is a turbulent
time when many stressors can result in risk-taking behavior such as medication
noncompliance and anxiety and depression. Regular psychologic monitoring of
posttransplant adolescent patients may be warranted to identify increasing
psychologic distress and proactive opportunities for health care intervention.
This pilot study is an example of a clinical research question that evolved
from a practice situation in which nurses caring for posttransplant adolescents
with cystic fibrosis surmised that there were many psychologic issues
influencing successful transplant outcomes. Nursing observations suggested a
strong connection between poorer medication control, greater risk for
rejection, and signs of depression and/or anxiety. The nurse researchers were interested
in identifying significant relationships between psychologic factors and
physiologic factors, and in discovering objective ways to better assess the
psychologic needs of this patient population. A thorough search was conducted
of the research literature, and the best clinical practices of other
institutions were investigated. There was a lack of transplant research
literature on adolescents, and although excellent ideas were generated from
inquiries to other institutions, there was a lack of best evidence to answer
the clinical questions about this group of patients. The initial clinical
question became a research question to determine more about this specific
patient population. This article is an example of a clinical research pilot
study that resulted from an evidence-based practice process. Pilot studies are
springboards for other, more refined research: They help to point the way, or
to clarify what the real issues may be. For nurses, they serve as an
opportunity to hone critical thinking skills and to contribute to the
scientific foundation of our profession.
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[33]
TÍTULO / TITLE: - More economical use of
cyclosporine through combination drug therapy.
REVISTA
/ JOURNAL: - J Am Anim Hosp Assoc 2002
May-Jun;38(3):205-8.
AUTORES
/ AUTHORS: - Daigle JC
INSTITUCIÓN
/ INSTITUTION: - Veterinary Specialists of South Florida,
Cooper City 33024, USA. N.
Ref:: 30
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