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Fernandez E, Phillips E, Saeed HN. Ocular involvement in allergic drug reactions. Curr Opin Allergy Clin Immunol 2023; 23:397-408. [PMID: 37493235 DOI: 10.1097/aci.0000000000000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
PURPOSE OF REVIEW Many systemic medications have been observed to cause ocular toxicity. A subset of these reactions is thought to involve immunomodulation or a hypersensitivity reaction. As new medications are developed, ocular adverse effects are becoming increasingly prevalent. Herein we review immune-mediated drug reactions affecting they eye with special attention to the hypersensitivity mechanisms leading to ocular toxicity. RECENT FINDINGS Recent work has focused on mechanisms and risk of immune-mediated ocular adverse drug reactions including genetic susceptibility and loss of ocular immune privilege. SUMMARY Given the consequences of immune-mediated ocular adverse drug reactions, clinicians must be aware of these to facilitate early recognition and management. The prompt involvement of an ophthalmologist for diagnosis and management is often essential to preserve vision and avoid long-term morbidity.
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Affiliation(s)
- Edward Fernandez
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine
| | - Elizabeth Phillips
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine
- Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hajirah N Saeed
- Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, Illinois
- Department of Ophthalmology, Loyola University Medical Center, Maywood, IL, USA
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Zhao RZ, Zhang GX, Zhang WT, Yu WJ, Du L, Toledo MC, Olivera Leal IR, O'Farrill ZL, Izquierdo G. Ocular manifestations of multiple sclerosis in patients from three countries: A Web-based survey. Eur J Ophthalmol 2021; 32:2975-2981. [PMID: 34939452 DOI: 10.1177/11206721211069457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study evaluates the epidemiological characteristics, ophthalmological manifestations, and different therapeutic options available for patients with multiple sclerosis (MS) in China, Spain, and Cuba. METHODS A self-designed questionnaire was used to conduct a comparable descriptive cross-sectional study on patients with MS. The survey included patients' demographic data, ocular manifestations related to MS, and treatment methodology followed in the three countries. The online survey was designed using the Wenjuanxing survey platform, and a survey link was circulated through WhatsApp, WeChat, and emails. Quantitative data were expressed as mean and standard deviation, the Kruskal-Wallis test was used for non-parametric variables. Qualitative data were expressed as numerical and percentage. The chi-square test (χ2) was used to compare the group's response categories. The statistical difference was considered significant when p < 0.05. RESULTS The female-to-male ratio in all the three countries was 2-3:1, and relapsing-remitting MS (RRMS) was the most frequent in all three countries. Vision loss was slow and progressive in half of the patients from the three countries, with no significant differences (p = 0.524). A higher percentage of steroid treatment was observed in Chinese patients in comparison with the patients from other two countries (p < 0.001), and a similar trend was seen in the use of traditional medicines. Almost one-third of patients who did not receive any treatment recovered spontaneously in all the three countries (p = 0.097). CONCLUSIONS MS occurs more frequently in the relapsing-remitting clinical form and there is a clear female predominance. The first ocular crisis or clinical debut of MS is characterized by slow and progressive visual impairment, increasing and adding to other ocular manifestations during its evolutionary course. Spontaneous recovery of vision after an attack of optic neuritis in the course of MS is possible.
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Affiliation(s)
- Run-Ze Zhao
- Department of Ophthalmology, Eye Institute of PLA, 66352Xijing Hospital, Fourth Military Medical University, Shaanxi, The People of Republic of China.,Department of Ophthalmology, 113046Hermanos Ameijeiras Hospital, Havana, Cuba
| | - Guo-Xun Zhang
- Department of Neurology, 105849Yan'an University, Shaanxi, The People of Republic of China.,Multiple Sclerosis Unit, Neurology Service, 222071Vithas Nisa Hospital, Seville, Spain
| | - Wen-Ting Zhang
- Institute of Biomedicine of Seville, IBIS (University of Seville, HUVR, Government of Andalusia, CSIC), Spain; Department of Medical Biochemistry and Molecular Biology and Immunology, 16778University of Seville, 41009, Spain
| | - Wen-Jin Yu
- Department of Neurology, Xijing Hospital,Fourth Military Medicine University, Shaanxi, The People of Republic of China
| | - Lu Du
- Department of Ophthalmology, Eye Institute of PLA, 66352Xijing Hospital, Fourth Military Medical University, Shaanxi, The People of Republic of China
| | | | - I R Olivera Leal
- Department of Neurology, Hermanos Ameijeiras Hospital, Havana, Cuba
| | | | - G Izquierdo
- Multiple Sclerosis Unit, Neurology Service, 222071Vithas Nisa Hospital, Seville, Spain
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Muñoz-Ortiz J, Reyes-Guanes J, Zapata-Bravo E, Mora-Muñoz L, Reyes-Hurtado JA, Tierradentro-García LO, Rojas-Carabali W, Gómez-Suarez M, de-la-Torre A. Ocular adverse events from pharmacological treatment in patients with multiple sclerosis-A systematic review of the literature. Syst Rev 2021; 10:280. [PMID: 34711264 PMCID: PMC8554884 DOI: 10.1186/s13643-021-01782-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 07/28/2021] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The aim of this study was to review the scientific evidence and describe the ocular treatment-emergent adverse events (TEAEs) related to pharmacological treatment in patients with multiple sclerosis. METHODS A systematic review of literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines in the MEDLINE, LILACS, EMBASE, and COCHRANE databases. Articles were filtered based on title and abstract considering the selection criteria and subsequently filtered by full-text reading. The resulting articles were evaluated using the Joanna Briggs Institute Quality Tools. Study characteristics and results were extracted and presented in structured tables to conduct a narrative synthesis. RESULTS A total of 2852 published articles were extracted using our strategy. After removing duplicates, 2841 articles were screened based on title and abstract, 102 articles were evaluated using quality tools, and 69 articles were filtered by full-text reading. Through this search strategy, 60 articles met all the inclusion criteria and seven articles, through a search update conducted in the same manner, were included. This resulted in 67 articles meeting the inclusion criteria, of which 11 were experimental and 56 were observational. The therapies related to ocular TEAEs were alemtuzumab, amantadine, fingolimod, steroids, CTLA-4 Ig, estriol, interferon β, natalizumab, hyperbaric oxygen, rituximab, siponimod, teriflunomide, and tovaxin. Fingolimod and siponimod were commonly associated with macular edema, interferon β was associated with retinopathy, alemtuzumab was associated with thyroid eye disease, amantadine was associated with corneal edema, and steroids were associated with acute retinal necrosis. Opportunistic infections were also found, and there was one life-threatening case. CONCLUSIONS Our search revealed different methodological assessments of the topic. However, longitudinal studies regarding ocular TEAEs related to multiple sclerosis therapy are necessary to provide evidence-based recommendations, especially in understudied regions such as Latin America and Africa. Physicians should monitor ocular symptoms in patients being treated for multiple sclerosis and consider an interdisciplinary approach. SYSTEMATIC REVIEW REGISTRATION PROSPERO ID CRD42020106886.
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Affiliation(s)
- Juliana Muñoz-Ortiz
- Neuroscience Research Group "NeURos", Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63C - 69, Bogotá, Colombia.,Escuela Barraquer Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Juliana Reyes-Guanes
- Escuela Barraquer Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Estefanía Zapata-Bravo
- Neuroscience Research Group "NeURos", Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63C - 69, Bogotá, Colombia
| | - Laura Mora-Muñoz
- Neuroscience Research Group "NeURos", Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63C - 69, Bogotá, Colombia
| | - Juan Antonio Reyes-Hurtado
- Neuroscience Research Group "NeURos", Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63C - 69, Bogotá, Colombia
| | - Luis Octavio Tierradentro-García
- Neuroscience Research Group "NeURos", Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63C - 69, Bogotá, Colombia
| | - William Rojas-Carabali
- Neuroscience Research Group "NeURos", Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63C - 69, Bogotá, Colombia
| | - Marcela Gómez-Suarez
- Escuela Barraquer Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Alejandra de-la-Torre
- Neuroscience Research Group "NeURos", Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63C - 69, Bogotá, Colombia.
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Abstract
Multiple sclerosis (MS) is a neurological inflammatory disorder known to attack the heavily myelinated regions of the nervous system including the optic nerves, cerebellum, brainstem and spinal cord. This review will discuss the clinical manifestations and investigations for MS and other similar neurological inflammatory disorders affecting vision, as well as the effects of MS treatments on vision. Assessment of visual pathways is critical, considering MS can involve multiple components of the visual pathway, including optic nerves, uvea, retina and occipital cortex. Optical coherence tomography is increasingly being recognised as a highly sensitive tool in detecting subclinical optic nerve changes. Magnetic resonance imaging (MRI) is critical in MS diagnosis and in predicting long-term disability. Optic neuritis in MS involves unilateral vision loss, with characteristic pain on eye movement. The visual loss in neuromyelitis optica spectrum disorder tends to be more severe with preferential altitudinal field loss, chiasmal and tract lesions are also more common. Other differential diagnoses include chronic relapsing inflammatory optic neuropathy and giant cell arteritis. Leber's hereditary optic neuropathy affects young males and visual loss tends to be painless and subacute, typically involving both optic nerves. MS lesions in the vestibulocerebellum, brainstem, thalamus and basal ganglia may lead to abnormalities of gaze, saccades, pursuit and nystagmus which can be identified on eye examination. Medial longitudinal fasciculus lesions can cause another frequent presentation of MS, internuclear ophthalmoplegia, with failure of ipsilateral eye adduction and contralateral eye abduction nystagmus. Treatments for MS include high-dose corticosteroids for acute relapses and disease-modifying medications for relapse prevention. These therapies may also have adverse effects on vision, including central serous retinopathy with corticosteroid therapy and macular oedema with fingolimod.
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Affiliation(s)
- Roshan Dhanapalaratnam
- Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Maria Markoulli
- School of Optometry and Vision Science, University of New South Wales Sydney, Sydney, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, Australia
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Dağıstan H, Hamamcı M. Nasolacrimal transition time in patients with multiple sclerosis. Eur Arch Otorhinolaryngol 2021; 278:3357-3362. [PMID: 33452918 DOI: 10.1007/s00405-021-06603-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/03/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To measure the duration of nasolacrimal transition in patients with Multiple Sclerosis (MS), to compare the findings with the healthy population and to investigate the relationship between MS-related disability and nasolacrimal transition time. METHODS A total of 73 individuals including 37 patients with relapsing-remitting MS and 36 healthy volunteers were included in the study. In both groups the nasolacrimal transition time was measured using flurosein drops. The degree of disability of MS patients was calculated according to the Expanded Disability Status Scale (EDSS). RESULTS There was a significant difference between MS patients and control group in terms of the median value of nasolacrimal transition time in (240 s (min: 85, max: 724) and 58.5 s (min: 21, max: 428), respectively) (p < 0.001). A positive correlation was found between EDSS scores and nasolacrimal transition time of MS patients (r = 0.384, p = 0.019). CONCLUSION This study showed that nasolacrimal transition time is prolonged in MS patients and there is a relationship between the degree of MS-related disability and the nasolacrimal transition time. This is the first study in the literature on this subject and the results of our study have the potential to shed light on the causes of common infections in MS patients. Long-term prospective studies are needed to further investigate the relationship between prolonged nasolacrimal transition and infections in MS patients.
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Affiliation(s)
- Hakan Dağıstan
- Department of Otolaryngology, Yozgat Bozok University School of Medicine, Atatürk Yolu 7. Km, 66100, Yozgat, Turkey.
| | - Mehmet Hamamcı
- Department of Neurology, Yozgat Bozok University School of Medicine, Yozgat, Turkey
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Abraham A, Nicholson L, Dick A, Rice C, Atan D. Intermediate uveitis associated with MS: Diagnosis, clinical features, pathogenic mechanisms, and recommendations for management. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:e909. [PMID: 33127747 PMCID: PMC7641065 DOI: 10.1212/nxi.0000000000000909] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/10/2020] [Indexed: 01/02/2023]
Abstract
Uveitis is a major cause of visual impairment and blindness among working-age adults, accounting for 10% of legal blindness in the United States. Among people with MS, the prevalence of uveitis is 10 times higher than among the general population, and because MS and uveitis share similar genetic risk factors and immunologic effector pathways, it is not clear whether uveitis is one of the manifestations of MS or a coincident disorder. This uncertainty raises several diagnostic and management issues for clinicians who look after these patients, particularly with regard to recognizing visual symptoms resulting from demyelination, intraocular inflammation, or the visual complications of disease modifying drugs for MS, e.g., fingolimod. Likewise, management decisions regarding patients with uveitis are influenced by the risk of precipitating or exacerbating episodes of demyelination, e.g., following anti-tumor necrosis factor biologic therapy, and other neurologic complications of immunosuppressive treatments for uveitis. In this review, we explore the similarities in the pathophysiology, clinical features, and treatment of patients with uveitis and MS. Based on the latest evidence, we make a set of recommendations to help guide neurologists and ophthalmologists to best manage patients affected by both conditions.
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Affiliation(s)
- Alan Abraham
- From the Translational Health Sciences (L.N., A.D., C.R., D.A.), Bristol Medical School, University of Bristol; Bristol Eye Hospital (A.A.,A.D., D.A.), University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom; UCL- Institute of Ophthalmology and NIHR Biomedical Research Centre (A.D.), Moorfields Eye Hospital and UCL-Institute of Ophthalmology; and Clinical Neurosciences (C.R.), Southmead Hospital, North Bristol NHS Trust, United Kingdom.
| | - Lindsay Nicholson
- From the Translational Health Sciences (L.N., A.D., C.R., D.A.), Bristol Medical School, University of Bristol; Bristol Eye Hospital (A.A.,A.D., D.A.), University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom; UCL- Institute of Ophthalmology and NIHR Biomedical Research Centre (A.D.), Moorfields Eye Hospital and UCL-Institute of Ophthalmology; and Clinical Neurosciences (C.R.), Southmead Hospital, North Bristol NHS Trust, United Kingdom
| | - Andrew Dick
- From the Translational Health Sciences (L.N., A.D., C.R., D.A.), Bristol Medical School, University of Bristol; Bristol Eye Hospital (A.A.,A.D., D.A.), University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom; UCL- Institute of Ophthalmology and NIHR Biomedical Research Centre (A.D.), Moorfields Eye Hospital and UCL-Institute of Ophthalmology; and Clinical Neurosciences (C.R.), Southmead Hospital, North Bristol NHS Trust, United Kingdom
| | - Claire Rice
- From the Translational Health Sciences (L.N., A.D., C.R., D.A.), Bristol Medical School, University of Bristol; Bristol Eye Hospital (A.A.,A.D., D.A.), University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom; UCL- Institute of Ophthalmology and NIHR Biomedical Research Centre (A.D.), Moorfields Eye Hospital and UCL-Institute of Ophthalmology; and Clinical Neurosciences (C.R.), Southmead Hospital, North Bristol NHS Trust, United Kingdom
| | - Denize Atan
- From the Translational Health Sciences (L.N., A.D., C.R., D.A.), Bristol Medical School, University of Bristol; Bristol Eye Hospital (A.A.,A.D., D.A.), University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom; UCL- Institute of Ophthalmology and NIHR Biomedical Research Centre (A.D.), Moorfields Eye Hospital and UCL-Institute of Ophthalmology; and Clinical Neurosciences (C.R.), Southmead Hospital, North Bristol NHS Trust, United Kingdom
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Toxische Retinopathien. Ophthalmologe 2020; 117:1247-1266. [DOI: 10.1007/s00347-020-01260-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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8
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Lewallen CF, Wan Q, Maminishkis A, Stoy W, Kolb I, Hotaling N, Bharti K, Forest CR. High-yield, automated intracellular electrophysiology in retinal pigment epithelia. J Neurosci Methods 2019; 328:108442. [PMID: 31562888 PMCID: PMC7071944 DOI: 10.1016/j.jneumeth.2019.108442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Recent advancements with induced pluripotent stem cell-derived (iPSC) retinal pigment epithelium (RPE) have made disease modeling and cell therapy for macular degeneration feasible. However, current techniques for intracellular electrophysiology - used to validate epithelial function - are painstaking and require manual skill; limiting experimental throughput. NEW METHOD A five-stage algorithm, leveraging advances in automated patch clamping, systematically derived and optimized, improves yield and reduces skill when compared to conventional, manual techniques. RESULTS The automated algorithm improves yield per attempt from 17% (manually, n = 23) to 22% (automated, n = 120) (chi-squared, p = 0.004). Specifically for RPE, depressing the local cell membrane by 6 μm and electroporating (buzzing) just prior to this depth (5 μm) maximized yield. COMPARISON WITH EXISTING METHOD Conventionally, intracellular epithelial electrophysiology is performed by manually lowering a pipette with a micromanipulator, blindly, towards a monolayer of cells and spontaneously stopping when the magnitude of the instantaneous measured membrane potential decreased below a predetermined threshold. The new method automatically measures the pipette tip resistance during the descent, detects the cell surface, indents the cell membrane, and briefly buzzes to electroporate the membrane while descending, overall achieving a higher yield than conventional methods. CONCLUSIONS This paper presents an algorithm for high-yield, automated intracellular electrophysiology in epithelia; optimized for human RPE. Automation reduces required user skill and training while, simultaneously, improving yield. This algorithm could enable large-scale exploration of drug toxicity and physiological function verification for numerous kinds of epithelia.
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Affiliation(s)
- Colby F Lewallen
- Georgia Institute of Technology, G.W. Woodruff School of Mechanical Engineering, Atlanta, GA 30332, USA.
| | - Qin Wan
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Arvydas Maminishkis
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - William Stoy
- Georgia Institute of Technology, Wallace H Coulter Department of Biomedical Engineering, Atlanta, GA 30332, USA
| | - Ilya Kolb
- Georgia Institute of Technology, Wallace H Coulter Department of Biomedical Engineering, Atlanta, GA 30332, USA; HHMI Janelia Research Campus, Howard Hughes Medical Institute, Ashburn VA 20147, USA
| | - Nathan Hotaling
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Kapil Bharti
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Craig R Forest
- Georgia Institute of Technology, G.W. Woodruff School of Mechanical Engineering, Atlanta, GA 30332, USA
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Fingolimod (FTY720) improves the functional recovery and myelin preservation of the optic pathway in focal demyelination model of rat optic chiasm. Brain Res Bull 2019; 153:109-121. [DOI: 10.1016/j.brainresbull.2019.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/09/2019] [Accepted: 08/18/2019] [Indexed: 12/21/2022]
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Brancatella A, Viola N, Brogioni S, Montanelli L, Sardella C, Vitti P, Marcocci C, Lupi I, Latrofa F. Graves' Disease Induced by Immune Checkpoint Inhibitors: A Case Report and Review of the Literature. Eur Thyroid J 2019; 8:192-195. [PMID: 31602361 PMCID: PMC6738242 DOI: 10.1159/000501824] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/29/2019] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION In the last few years, immune checkpoint inhibitors (ICPis) have become a common treatment of cancer. ICPis are associated with peculiar immune side effects, termed immune-related adverse events (irAEs). Thyroid disfunction is a common irAE, but clinical manifestation, severity, and pathogenesis can be variable. While destructive thyroiditis and hypothyroidism are the most common thyroid irAEs induced by ICPis, autoimmune hyperthyroidism (Graves' disease) is rare. We describe a case of a Graves' disease induced by anti-PD-1 therapy and we review the previous reports on this issue. CASE PRESENTATION A 51-year-old man developed an overt autoimmune hyperthyroidism 2 months after he had started nivolumab (anti-PD-1) therapy for a metastatic non-small cell lung cancer. Although TSH-receptor autoantibodies (TRAb) were negative, the persistence of hyperthyroidism, the hypervascular pattern at thyroid ultrasound, and the high uptake at thyroid scintigraphy were all features suggestive of Graves' disease. Methimazole was started with the prompt restoration of euthyroidism. TRAb remained undetectable during the entire follow-up. CONCLUSIONS Autoimmune hyperthyroidism can be induced by anti-PD-1 treatment. TRAb were negative in both cases of nivolumab-induced Graves' disease described to date. A correct differential diagnosis between destructive thyroiditis and autoimmune hyperthyroidism is crucial for the appropriate treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Francesco Latrofa
- *Francesco Latrofa, MD, Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Ospedale Cisanello, Via Paradisa 2, IT–56124 Pisa (Italy), E-Mail
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Wang L, Qi CH, Zhong R, Yuan C, Zhong QY. Efficacy of alemtuzumab and natalizumab in the treatment of different stages of multiple sclerosis patients. Medicine (Baltimore) 2018; 97:e9908. [PMID: 29465579 PMCID: PMC5841993 DOI: 10.1097/md.0000000000009908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is an autoimmune disease, in which the insulating covers of nerve cells in the brain and spinal cord are demyelinated. This study was conducted to compare the efficacy of alemtuzumab and natalizumab in the treatment of different stages of MS patients. METHODS A total of 585 patients diagnosed with MS and hospitalized were included and analyzed after which they were divided into the primary progressive MS A and B groups, the relapsing-remitting MS (RRMS) C and D groups, and the secondary progressive MS E and F groups. Patients in A, C, and E groups were administered alemtuzumab while those in B, D, and F groups were administered natalizumab for the treatment. The expanded disability status scale (EDSS) scores and the EDSS difference were calculated before and after treatment. The number of head magnetic resonance imaging enhanced lesions in the patients, recurrence time and recurrence rate were measured before and after treatment. RESULTS The EDSS score of the RRMS group was significantly lower than that of the primary progressive MS group and the secondary progressive MS group. After 12 months of treatment, the EDSS score of RRMS patients treated with natalizumab was significantly lower compared with the patients with alemtuzumab, and the difference before and after treatment was significantly higher than alemtuzumab. The recurrence rate of the RRMS-D group was significantly lower than the RRMS-C group. After 12 months of treatment, compared with the RRMS-C group, a significant reduction was observed in the number of head magnetic resonance imaging enhanced lesions and longer recurrence time in the RRMS-D group. CONCLUSION The efficacy of natalizumab was better than alemtuzumab in the treatment of patients in the RRMS group, while there was no significant difference among other stages of MS patients, which provided the theoretical basis and clinical guidance for the treatment of different stages of MS.
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Affiliation(s)
- Li Wang
- Department of Pharmacy, Jining No.1 People's Hospital, Jining
| | - Chun-Hui Qi
- Department of Pharmacy, Weifang People's Hospital, Weifang
| | - Ren Zhong
- Department of Neurology, Zhucheng People's Hospital, Zhucheng, P.R. China
| | - Chao Yuan
- Department of Pharmacy, Weifang People's Hospital, Weifang
| | - Qiu-Yue Zhong
- Department of Pharmacy, Weifang People's Hospital, Weifang
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