Purpose: To assess the feasibility of a study design that may determine whether subcutaneous administration of the interleukin-2 receptor antibody daclizumab can safely reduce the dependence on standard systemic corti...Purpose: To assess the feasibility of a study design that may determine whether subcutaneous administration of the interleukin-2 receptor antibody daclizumab can safely reduce the dependence on standard systemic corticosteroids or other immunosuppressive regimens in patients with sight-threatening, noninfectious intermediate uveitis, posterior uveitis, or panuveitis. Design: Prospective, multicenter, nonrandomized, noncomparative, open-label interventional trial. Participants: Fifteen patients, 5 each at 3 clinical centers, with noninfectious intermediate, posterior, or panuveitis, who require a currently stable immunosuppression regimen of systemic corticosteroids and/or other systemic treatments to control noninfectious intraocular inflammation. Methods: After enrollment and baseline ophthalmic evaluations, 2 induction treatments were given 2 weeks apart using subcutaneous (SC) daclizumab at 2 mg/kg. Subcutaneous daclizumab maintenance treatments were then continued every 2 weeks at 1 mg/kg for 6 months. The initial immunosuppression load was tapered over 8 to 12 weeks in a staggered fashion beginning with the first induction treatment. Safety evaluations were performed at each treatment visit, with a primary efficacy evaluation at 12 weeks and a repeat efficacy evaluation at 26 weeks. Main Outcome Measures: Best-corrected visual acuity (Early Treatment of Diabetic Retinopathy Study [ETDRS]method)with a concurrent taper of concomitant systemic immunosuppression medication load (tabulated by use of a weighted scoring system) was assessed; target for success was defined as a 50%or greater reduction in concomitant immunosuppression load by 12 weeks while maintaining visual acuity within 5 ETDRS letters of baseline. Ocular inflammation was assessed at each visit with standardized grading scales. Results: Ten of 15 patients (67%) receiving SC daclizumab treatments every other week successfully achieved the primary efficacy end point of reducing their concomitant immunosuppression load by at least 50%while maintainin展开更多
To clarify the current status of treatments and outcomes of patients with myas thenia gravis (MG) in Japan, a total of 470 patients (164 men and 306 women; mea n age 41 years) were recruited from 19 Japanese tertiary ...To clarify the current status of treatments and outcomes of patients with myas thenia gravis (MG) in Japan, a total of 470 patients (164 men and 306 women; mea n age 41 years) were recruited from 19 Japanese tertiary medical centers in 1999 -2000. Thymectomy was performed in 319 (68%) of the patients. Patients who rec eived thymectomy were younger (p=0.01) and had more severe disabilities (p < 0.0 1) than patients without thymectomy. Irrespective of receiving thymectomy, most of the patients were administered corticosteroids (64%), other immunosuppressiv e agents (10%), or cholinesterase inhibitors (86%). Of 395 patients followed u p for more than 12 months after treatment (mean 8.0 years), 30%(34%of thymecto mized and 21%of non thymectomized patients) were in remission (no symptoms wit h/without medication), 34%had only ocular symptoms, and the remaining 35%still had weakness of bulbar or limb muscles at the end of follow up. The prognosis of MG in Japan was generally favorable, but despite the frequent use of thymecto my and immunosuppressive treatments, approximately one third of patients still had generalized weakness. More effective or intensive treatments are required to improve the prognosis.展开更多
Pyoderma gangrenosum (PG) is a neutrophilic dermatosis of unknown ori gin. Sys temic agents occasionally administered provide either incomplete long-term con trol of the disease or have been associated with serious ad...Pyoderma gangrenosum (PG) is a neutrophilic dermatosis of unknown ori gin. Sys temic agents occasionally administered provide either incomplete long-term con trol of the disease or have been associated with serious adverse side effects af ter chronic administration. We present two patients with PG successfully treated with low-dose colchicine. Antimitotic, anti-inflammatory and immunomodulati ng properties of colchicine might account for its beneficial effects in PG patie nts. Colchicine is effective and well tolerated in low doses by most patients. I n addition, it is inexpensive and safer for longterm treatment than corticostero ids and other immunosuppressive agents. Colchicine may be proposed either as a s ingle agent or as a corticosteroid-sparing agent for early treatment of PG.展开更多
Objective: To determine the effect of dapsone on glucocorticoid-dependent patients with active or maintenance-phase pemphigus vulgaris. Design: Retrospective study of consecutive patients treated with dapsone. Setting...Objective: To determine the effect of dapsone on glucocorticoid-dependent patients with active or maintenance-phase pemphigus vulgaris. Design: Retrospective study of consecutive patients treated with dapsone. Setting: University of Pen nsylvania, Philadelphia (a tertiary referral hospital). Patients: We observed 9 consecutive adult patients with pemphigus vulgaris being treated with immunosuppressants who were unable to taper prednisone use without abrupt worsening of their disease. Interventions: Dapsone treatment added to prednisone and other immunosuppressive therapy. Main Outcome Measure: Steroid dosage. Results: All patients were unable to taper their steroid dose during the 3 months prior to the initiation of dapsone therapy or had active disease that was not well controlled by prednisone prior to dapsone treatment. With the exception of 1 patient with uncontrolled disease, all 9 patients were able to taper their steroid dose below the adrenal replacement level during dapsone treatment. Maintenance-phase patients taking 15 mg/d or more of prednisone (n=5) experienced a mean±SEM drop of 67%±7.1%in prednisone dose by 4 months of maximal dapsone treatment and an 84%±3.5%drop in prednisone dose after 8 months of dapsone treatment. Conclusions: These retrospective study findings suggest that dapsone reduces steroid dependence in patientswith pemphigus vulgaris, provided they are in themaintenance phase of their disease. These data support the need for a prospective, randomized trial to confirm these findings.展开更多
文摘Purpose: To assess the feasibility of a study design that may determine whether subcutaneous administration of the interleukin-2 receptor antibody daclizumab can safely reduce the dependence on standard systemic corticosteroids or other immunosuppressive regimens in patients with sight-threatening, noninfectious intermediate uveitis, posterior uveitis, or panuveitis. Design: Prospective, multicenter, nonrandomized, noncomparative, open-label interventional trial. Participants: Fifteen patients, 5 each at 3 clinical centers, with noninfectious intermediate, posterior, or panuveitis, who require a currently stable immunosuppression regimen of systemic corticosteroids and/or other systemic treatments to control noninfectious intraocular inflammation. Methods: After enrollment and baseline ophthalmic evaluations, 2 induction treatments were given 2 weeks apart using subcutaneous (SC) daclizumab at 2 mg/kg. Subcutaneous daclizumab maintenance treatments were then continued every 2 weeks at 1 mg/kg for 6 months. The initial immunosuppression load was tapered over 8 to 12 weeks in a staggered fashion beginning with the first induction treatment. Safety evaluations were performed at each treatment visit, with a primary efficacy evaluation at 12 weeks and a repeat efficacy evaluation at 26 weeks. Main Outcome Measures: Best-corrected visual acuity (Early Treatment of Diabetic Retinopathy Study [ETDRS]method)with a concurrent taper of concomitant systemic immunosuppression medication load (tabulated by use of a weighted scoring system) was assessed; target for success was defined as a 50%or greater reduction in concomitant immunosuppression load by 12 weeks while maintaining visual acuity within 5 ETDRS letters of baseline. Ocular inflammation was assessed at each visit with standardized grading scales. Results: Ten of 15 patients (67%) receiving SC daclizumab treatments every other week successfully achieved the primary efficacy end point of reducing their concomitant immunosuppression load by at least 50%while maintainin
文摘To clarify the current status of treatments and outcomes of patients with myas thenia gravis (MG) in Japan, a total of 470 patients (164 men and 306 women; mea n age 41 years) were recruited from 19 Japanese tertiary medical centers in 1999 -2000. Thymectomy was performed in 319 (68%) of the patients. Patients who rec eived thymectomy were younger (p=0.01) and had more severe disabilities (p < 0.0 1) than patients without thymectomy. Irrespective of receiving thymectomy, most of the patients were administered corticosteroids (64%), other immunosuppressiv e agents (10%), or cholinesterase inhibitors (86%). Of 395 patients followed u p for more than 12 months after treatment (mean 8.0 years), 30%(34%of thymecto mized and 21%of non thymectomized patients) were in remission (no symptoms wit h/without medication), 34%had only ocular symptoms, and the remaining 35%still had weakness of bulbar or limb muscles at the end of follow up. The prognosis of MG in Japan was generally favorable, but despite the frequent use of thymecto my and immunosuppressive treatments, approximately one third of patients still had generalized weakness. More effective or intensive treatments are required to improve the prognosis.
文摘Pyoderma gangrenosum (PG) is a neutrophilic dermatosis of unknown ori gin. Sys temic agents occasionally administered provide either incomplete long-term con trol of the disease or have been associated with serious adverse side effects af ter chronic administration. We present two patients with PG successfully treated with low-dose colchicine. Antimitotic, anti-inflammatory and immunomodulati ng properties of colchicine might account for its beneficial effects in PG patie nts. Colchicine is effective and well tolerated in low doses by most patients. I n addition, it is inexpensive and safer for longterm treatment than corticostero ids and other immunosuppressive agents. Colchicine may be proposed either as a s ingle agent or as a corticosteroid-sparing agent for early treatment of PG.
文摘Objective: To determine the effect of dapsone on glucocorticoid-dependent patients with active or maintenance-phase pemphigus vulgaris. Design: Retrospective study of consecutive patients treated with dapsone. Setting: University of Pen nsylvania, Philadelphia (a tertiary referral hospital). Patients: We observed 9 consecutive adult patients with pemphigus vulgaris being treated with immunosuppressants who were unable to taper prednisone use without abrupt worsening of their disease. Interventions: Dapsone treatment added to prednisone and other immunosuppressive therapy. Main Outcome Measure: Steroid dosage. Results: All patients were unable to taper their steroid dose during the 3 months prior to the initiation of dapsone therapy or had active disease that was not well controlled by prednisone prior to dapsone treatment. With the exception of 1 patient with uncontrolled disease, all 9 patients were able to taper their steroid dose below the adrenal replacement level during dapsone treatment. Maintenance-phase patients taking 15 mg/d or more of prednisone (n=5) experienced a mean±SEM drop of 67%±7.1%in prednisone dose by 4 months of maximal dapsone treatment and an 84%±3.5%drop in prednisone dose after 8 months of dapsone treatment. Conclusions: These retrospective study findings suggest that dapsone reduces steroid dependence in patientswith pemphigus vulgaris, provided they are in themaintenance phase of their disease. These data support the need for a prospective, randomized trial to confirm these findings.
