- Combination Immunosuppression in IBD. [Journal Article]
- IBInflamm Bowel Dis 2018 Feb 15; 24(3):539-545
- Whether to use biologic treatment for inflammatory bowel disease as monotherapy or in combination with immunosuppressives has been a matter of debate in the last 2 decades. Combination therapy was no...
Whether to use biologic treatment for inflammatory bowel disease as monotherapy or in combination with immunosuppressives has been a matter of debate in the last 2 decades. Combination therapy was not superior in any of the registration trials for Crohn's disease and ulcerative colitis for TNF antagonists, vedolizumab, or ustekinumab. It needs to be mentioned, though, that none of these trials were powered to detect such differences, and that many patients entered the trial after having failed conventional immunosuppressives.Postmarketing studies revealed that patients on background immunosuppression have a lower risk of immunogenicity (often resulting in infusion/injection reactions) than patients on monotherapy. In the SONIC and UC-SUCCESS trials, superiority of the combination azathioprine-infliximab was demonstrated in Crohn's disease and ulcerative colitis, respectively. This trial design has not been used with any other biologic for IBD, so far. Meanwhile, it has also become clear that combination treatment with TNF antagonists is associated with increased toxicity, mainly infections, but also malignancy such as lymphoproliferative disease. This toxicity could perhaps be reduced by using lower doses of immunosuppressives, a strategy that has been shown to be equally potent in reducing immunogenicity. Additionally, combination treatment could be used for a limited period of time (12 months or even shorter) since most immunogenicity develops in the beginning of the biologic treatment. Patients who develop anti-drug-antibodies later on can often be rescued by reintroduction of thiopurines or methotrexate.In summary, combination treatment is certainly beneficial with infliximab, at least in the first 12 months of treatment. With other TNF antagonists, vedolizumab, and ustekinumab, the available data do not offer clear guidance. In patients without increased risk of toxicity, and certainly in those with limited treatment options, it may be wise to offer combination treatment with all biologics for the time being and at least during the initiation phase.
- Long-term continuation of methotrexate therapy in giant cell arteritis patients in clinical practice. [Journal Article]
- CEClin Exp Rheumatol 2018 Jan-Feb; 36(1):173
- [Juvenile idiopathic arthritis]. [Journal Article]
- NTNed Tijdschr Tandheelkd 2018; 125(2):81-86
- Juvenile idiopathic arthritis (JIA) is the most common cause of chronic inflammation of the joints in childhood. Currently, JIA is divided into 7 subtypes, distinguished on the basis of the symptoms ...
Juvenile idiopathic arthritis (JIA) is the most common cause of chronic inflammation of the joints in childhood. Currently, JIA is divided into 7 subtypes, distinguished on the basis of the symptoms present in the first six months of the illness. Pharmacological treatment is different for every subtype. With all forms of JIA, dental problems can occur. These can include an increasing incidence of dental caries, stomatitis with the use of methotrexate, oral candidiasis with the use of immunosuppressive medication and temporal mandibular joint (TMJ) arthritis. The detection of TMJ arthritis seems to be especially difficult in daily practice. Dentists could play a role in identifying the TMJ complication in children with JIA.
- Recent advances in the treatment of rheumatoid arthritis. [Journal Article]
- COCurr Opin Rheumatol 2018 Feb 15
- CONCLUSIONS: With the greatly expanded armamentarium of RA treatment options available, it is important for clinicians to understand the data regarding drug efficacy and safety. With remission increasingly attainable, effective drug tapering strategies are needed. Although tapering trials do exist, more studies will be needed to help guide clinical practice.
- Clinico-epidemiological Profile of Pediatric Rheumatology Disorders in Eastern India. [Journal Article]
- JNJ Nat Sci Biol Med 2018 Jan-Jun; 9(1):19-22
- CONCLUSIONS: The clinical and epidemiological profile of children with rheumatological disorders in our patient group was different from the European countries and Western world. There is a need for introspecting the lack of using biological agents and its potential impact in managing JIA in our patient group.
- The Efficacy and Safety of Methotrexate versus Interferon in Cutaneous T-cell Lymphomas. [Journal Article]
- JDJ Dermatolog Treat 2018 Feb 19; :1-22
- CONCLUSIONS: The most significant finding of our study was that patients with cutaneous T cell lymphoma treated with IFN had a better response rate and significantly shorter response time compared with those treated with MTX. Additionally, patients had less disease progression on IFN than with MTX regardless of subtype of T cell lymphoma and stage of disease.
- Brentuximab vedotin is effective for rheumatoid arthritis in a patient with relapsed methotrexate-associated Hodgkin lymphoma. [Letter]
- AHAnn Hematol 2018 Feb 17
- Time spent in inactive disease before MTX withdrawal is relevant with regard to the flare risk in patients with JIA. [Journal Article]
- ARAnn Rheum Dis 2018 Feb 16
- CONCLUSIONS: Patients who spent at least 12 months in inactive disease before MTX discontinuation had a significantly lower flare rate.
- Poly(lactic-co-glycolic) Acid as a Slow-Release Drug-Carrying Matrix for Methotrexate Coated onto Intraocular Lenses to Conquer Posterior Capsule Opacification. [Journal Article]
- CECurr Eye Res 2018 Feb 16; :1-7
- CONCLUSIONS: In view of the strong inhibition of PCO in vitro with the lack of toxic effects on a corneal cell line, MTX encapsulating microspheres seem to be a promising method for modifying IOL.
New Search Next
- Contradictory and weak evidence on the effectiveness of anti-emetics for MTX-intolerance in JIA-patients. [Letter]
- PRPediatr Rheumatol Online J 2018 Feb 15; 16(1):13