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Bonnesen K, Poulsen CFB, Schmidt SAJ, Sørensen HT, Schmidt M. Autoimmune blistering disorders and cardiovascular risks: A population-based cohort study. J Am Acad Dermatol 2024; 91:82-90. [PMID: 38492858 DOI: 10.1016/j.jaad.2024.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/22/2024] [Accepted: 02/27/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Autoimmune blistering disorders (ABDs) might elevate cardiovascular risk, but studies are lacking. OBJECTIVE The objective of this study was to examine if ABDs elevate the risk of atherosclerotic cardiovascular disease, heart failure, arrhythmia, venous thromboembolism, and cardiovascular death. METHODS A population-based cohort of Danish patients with ABD (≥18 years of age) diagnosed during 1996-2021 (n = 3322) was compared with an age- and sex-matched comparison cohort from the general population (n = 33,195). RESULTS Compared with the general population, patients with ABDs had higher 1-year risks of atherosclerotic cardiovascular disease (3.4% vs 1.6%), heart failure (1.9% vs 0.7%), arrhythmia (3.8% vs 1.3%), venous thromboembolism (1.9% vs 0.3%), and cardiovascular death (3.3% vs 0.9%). The elevated risk persisted after 10 years for all outcomes but arrhythmia. The hazard ratios associating ABDs with the outcomes during the entire follow-up were 1.24 (1.09-1.40) for atherosclerotic cardiovascular disease, 1.48 (1.24-1.77) for heart failure, 1.16 (1.02-1.32) for arrhythmia, 1.87 (1.50-2.34) for venous thromboembolism, and 2.01 (1.76-2.29) for cardiovascular death. The elevated cardiovascular risk was observed for both pemphigus and pemphigoid. LIMITATIONS Our findings might only generalize to patients with ABDs without prevalent cardiovascular diseases. CONCLUSION Patients with ABDs had an elevated cardiovascular risk compared with age- and sex-matched controls.
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Affiliation(s)
- Kasper Bonnesen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Christian F B Poulsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Gødstrup Regional Hospital, Herning, Denmark; Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Sigrun A J Schmidt
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Gødstrup Regional Hospital, Herning, Denmark
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2
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Rahhal A, Provan D, Ghanima W, González-López TJ, Shunnar K, Najim M, Ahmed AO, Rozi W, Arabi A, Yassin M. A practical guide to the management of immune thrombocytopenia co-existing with acute coronary syndrome. Front Med (Lausanne) 2024; 11:1348941. [PMID: 38665297 PMCID: PMC11043582 DOI: 10.3389/fmed.2024.1348941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/19/2024] [Indexed: 04/28/2024] Open
Abstract
Introduction Immune thrombocytopenia (ITP) management with co-existing acute coronary syndrome (ACS) remains challenging as it requires a clinically relevant balance between the risk and outcomes of thrombosis and the risk of bleeding. However, the literature evaluating the treatment approaches in this high-risk population is scarce. Methods and Results In this review, we aimed to summarize the available literature on the safety of ITP first- and second-line therapies to provide a practical guide on the management of ITP co-existing with ACS. We recommend holding antithrombotic therapy, including antiplatelet agents and anticoagulation, in severe thrombocytopenia with a platelet count < 30 × 109/L and using a single antiplatelet agent when the platelet count falls between 30 and 50 × 109/L. We provide a stepwise approach according to platelet count and response to initial therapy, starting with corticosteroids, with or without intravenous immunoglobulin (IVIG) with a dose limit of 35 g, followed by thrombopoietin receptor agonists (TPO-RAs) to a target platelet count of 200 × 109/L and then rituximab. Conclusion Our review may serve as a practical guide for clinicians in the management of ITP co-existing with ACS.
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Affiliation(s)
- Alaa Rahhal
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
| | - Drew Provan
- Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Waleed Ghanima
- Østfold Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Khaled Shunnar
- Cardiology Department, Hamad Medical Corporation, Doha, Qatar
| | - Mostafa Najim
- Internal Medicine Department, Rochester Regional Health—Unity Hospital, New York, NY, United States
| | - Ashraf Omer Ahmed
- Internal Medicine Department, Yale New Haven Health, Bridgeport, CT, United States
| | - Waail Rozi
- Internal Medicine Department, Rochester Regional Health—Unity Hospital, New York, NY, United States
| | | | - Mohamed Yassin
- Hematology Department, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
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3
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Arabyan G, Hambartzhumian R, Lim AM, Quizon M, Oberndorf J, Ghazaleh JA, Sharma D. An Unusual Case of Delayed-Onset Rituximab-Induced Ventricular Tachycardia: A Case Report. J Investig Med High Impact Case Rep 2024; 12:23247096241255813. [PMID: 38767122 PMCID: PMC11107307 DOI: 10.1177/23247096241255813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 04/22/2024] [Accepted: 05/01/2024] [Indexed: 05/22/2024] Open
Abstract
Cardiac disease associated with cancer treatment is a common adverse effect that is well-treated with appropriate monitoring. However, some cardiac adverse effects with cancer treatment are not well-understood, in particular rituximab-associated ventricular tachycardia. We present the fourth case of rituximab-associated ventricular tachycardia in a patient who is rituximab-naive and who does not have known cardiac disease history. This patient developed non-sustained polymorphic ventricular tachycardia 14 hours after rituximab was started and 6 hours after it was stopped, and after extensive monitoring including a 30-day event monitor, did not develop further significant runs of ventricular tachycardia.
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4
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Mishra NN, Sharma A, Shalini S, Sharma S, Jain P, Sharma RK, Chander H, Prasad J, Anvikar AR, Chand S. National Control Laboratory Assessment of Quality of Rituximab Biosimilars in India. Monoclon Antib Immunodiagn Immunother 2022; 41:260-274. [DOI: 10.1089/mab.2021.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
| | - Anu Sharma
- Therapeutic Antibody Laboratory, National Institute of Biologicals, Noida, India
| | - Swati Shalini
- Therapeutic Antibody Laboratory, National Institute of Biologicals, Noida, India
| | - Sonia Sharma
- Therapeutic Antibody Laboratory, National Institute of Biologicals, Noida, India
| | - Paras Jain
- Therapeutic Antibody Laboratory, National Institute of Biologicals, Noida, India
| | - Ratnesh K. Sharma
- Therapeutic Antibody Laboratory, National Institute of Biologicals, Noida, India
| | - Harish Chander
- Therapeutic Antibody Laboratory, National Institute of Biologicals, Noida, India
| | - J.P. Prasad
- Therapeutic Antibody Laboratory, National Institute of Biologicals, Noida, India
| | - Anupkumar R. Anvikar
- Therapeutic Antibody Laboratory, National Institute of Biologicals, Noida, India
| | - Subhash Chand
- Therapeutic Antibody Laboratory, National Institute of Biologicals, Noida, India
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5
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Li X, Xiang N, Wang Z. Ginsenoside Rg2 attenuates myocardial fibrosis and improves cardiac function after myocardial infarction via AKT signaling pathway. Biosci Biotechnol Biochem 2020; 84:2199-2206. [PMID: 32706304 DOI: 10.1080/09168451.2020.1793292] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
With the popularization of percutaneous coronary intervention technology in clinical applications, the mortality rate of acute myocardial infarction has been significantly reduced. However, ventricular remodeling following myocardial infarction (MI) has attracted extensive attention for that it can cause malignant arrhythmia, heart failure, and even death. We aimed to investigate the effects of ginsenoside Rg2 on cardiac function and myocardial fibrosis after MI and its potential mechanism. The results demonstrated that ginsenoside Rg2 improved cardiac function and inhibited collagen deposition in mice after MI. In addition, ginsenoside Rg2 reduced the levels of fibrosis-associated genes Collagen I (Col 1), Collagen III (Col 3), and alpha-smooth muscle actin (α-SMA) by activating phosphorylated AKT in angiotensin II-induced cardiac fibroblasts. Taken together, ginsenoside Rg2 improves cardiac function and attenuates cardiac fibrosis via the AKT pathway, suggesting that ginsenoside Rg2 may be a promising drug for the prevention of ventricular remodeling after MI. Abbreviations: MI: myocardial infarction; AMI: acute myocardial infarction; LAD: left anterior descending; ECM: extracellular matrix; Col 1: collagen I; Col 3: collagen III; α-SMA: alpha-smooth muscle actin; ROS: reactive oxygen species; SOD: superoxide dismutase; GSH: glutathione; HO-1: heme oxygenase-1; WST8: water-soluble tetrazolium salt 8.
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Affiliation(s)
- Xianghai Li
- Department of Traditional Chinese Medicine, Affiliated Hospital of Guizhou Medical University , Guiyang, Guizhou Province, China
| | - Ning Xiang
- Department of Geriatric Medicine, Affiliated Hospital of Guizhou Medical University , Guiyang, Guizhou Province, China
| | - Zhengrong Wang
- Department of Traditional Chinese Medicine, Affiliated Hospital of Guizhou Medical University , Guiyang, Guizhou Province, China
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Secondary prophylaxis of an acute coronary syndrome during rituximab infusion. Med Clin (Barc) 2020; 154:69-70. [PMID: 31178296 DOI: 10.1016/j.medcli.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/04/2019] [Indexed: 11/21/2022]
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7
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Han DJ. Complication from Desensitization. KIDNEY TRANSPLANTATION IN SENSITIZED PATIENTS 2020. [PMCID: PMC7122531 DOI: 10.1007/978-981-10-7046-4_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Sensitization to human leukocyte antigens (HLAs) has been one of the major clinical challenges for successful kidney transplantation. In end-stage renal disease, kidney transplantation provides benefits compared with dialysis in terms of improved patient survival better quality of life, and lower ongoing costs after the first year. Living donor kidney transplantation has an advantage with improved allograft survival, and performed earlier and electively compared with deceased donor transplantation. However sensitized patients are increasing in number on transplant waiting lists, and their prospect of getting a transplant is less than nonsensitized patients due to immunological incompatibility with the donor. Strategy for sensitized patients are listing for a compatible deceased donor transplant or, if they have a living donor, either selecting a kidney exchange program or undergoing a desensitization procedure. Desensitization procedures may be undertaken to increase access to either living or deceased donor transplants, and in some situations may also be employed to facilitate participation in a kidney exchange, in less immunological barrier to be overcome. The question of whether individuals are better off with a desensitization treatment followed by HLA-incompatible living donor transplantation or waiting on the deceased donor kidney transplant list for a compatible transplant has recently been addressed by two large multicenter studies, with conflicting results. A multicenter study from the United States published in the New England Journal of Medicine [365;318 326.2011] concluded that there was a strong survival benefit for sensitized patients undergoing desensitization followed by HLA-incompatible living donor kidney transplant compared with those remaining on the waiting list. Of interest, a second study, published in the Lancet, [389;727 734.2017] found no significant survival advantage for desensitized patients compared with similar patients remaining on the waiting list in the United Kingdom. Controversies still remain regarding how desensitization can be achieved and which techniques are effective and safe. In this chapter various complications from the desensitization will be dealt with in current use of medications or armamentum.
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8
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Sharif K, Watad A, Bragazzi NL, Asher E, Abu Much A, Horowitz Y, Lidar M, Shoenfeld Y, Amital H. Anterior ST-elevation myocardial infarction induced by rituximab infusion: A case report and review of the literature. J Clin Pharm Ther 2018; 42:356-362. [PMID: 28440561 DOI: 10.1111/jcpt.12522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/05/2017] [Indexed: 12/23/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Rituximab is a chimeric monoclonal anti-CD20 antibody approved for the treatment of some lymphoid malignancies as well as for autoimmune diseases including rheumatoid arthritis (RA), idiopathic thrombocytopenic purpura (ITP) and vasculitis. Generally, rituximab is well tolerated; nevertheless, some patients develop adverse effects including infusion reactions. Albeit rare, these reactions may in some cases be life-threatening conditions. Rituximab cardiovascular side effects include more common effects such as hypertension, oedema and rare cases of arrhythmias and myocardial infarction. CASE SUMMARY In this article, we report a case of a 58-year-old man with a history of overlap syndrome including RA and limited scleroderma who was treated with rituximab and developed a dramatic ST-elevation myocardial infarction (STEMI) during the drug administration. WHAT IS NEW AND CONCLUSION This report underlines previous published reports emphasizing the awareness of such an association. This communication also warrants the importance of screening for ischaemic heart disease in selected cases of patients treated with rituximab.
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Affiliation(s)
- K Sharif
- Department of Medicine "B", Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - A Watad
- Department of Medicine "B", Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - N L Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - E Asher
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.,The Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - A Abu Much
- Department of Medicine "B", Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.,The Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Y Horowitz
- Department of Medicine "B", Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel
| | - M Lidar
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.,Rheumatology Unit, Sheba Medical Center, Tel-Hashomer, Israel
| | - Y Shoenfeld
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - H Amital
- Department of Medicine "B", Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
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