1
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Tham HL, Davis JL. Pharmacology of drugs used in autoimmune dermatopathies in cats and dogs: A narrative review. Vet Dermatol 2024; 35:453-476. [PMID: 38708551 DOI: 10.1111/vde.13253] [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: 08/16/2023] [Revised: 02/15/2024] [Accepted: 04/12/2024] [Indexed: 05/07/2024]
Abstract
Immunosuppressive drugs are the mainstay of treatment for many feline and canine autoimmune skin diseases, either as monotherapy or in combination with other drugs. Treatment with these drugs is often lifelong and may have long-term consequences on the affected animal's overall quality-of-life. Clinicians need to understand the pharmacology of immunosuppressants in planning and executing the treatment regimen for the best possible clinical outcome, as well as reducing the risk of adverse effects. This review paper will focus on the mechanism of action, pharmacokinetics and pharmacodynamics, clinical uses and adverse effects of immunosuppressive drugs used to treat autoimmune dermatoses in cats and dogs. These include glucocorticoids, ciclosporin A, azathioprine, chlorambucil, mycophenolate mofetil, oclacitinib and Bruton's tyrosine kinase inhibitors.
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Affiliation(s)
- Heng L Tham
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
| | - Jennifer L Davis
- Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
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2
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Sandler M, Yu J. Patch testing while immunosuppressed: potential risks and benefits. Expert Rev Clin Immunol 2024; 20:455-461. [PMID: 38140898 DOI: 10.1080/1744666x.2023.2299730] [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: 10/01/2023] [Accepted: 12/21/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Allergic contact dermatitis (ACD) is a common cutaneous inflammatory skin disorder that is diagnosed via epicutaneous patch testing (PT). ACD may also coexist with other systemic inflammatory conditions such as atopic dermatitis and psoriasis. Many of the treatments used to manage severe ACD, along with other systemic conditions, interact with and suppress the immune system, thereby potentially interfering with the mechanism of PT. There is uncertainty in the literature regarding the effects of immunosuppression on the results of PT. METHODS A comprehensive literature review was conducted using PubMed and Google Scholar to identify articles relevant to the topic of this review. Only articles available in English were included. AREAS COVERED This review discusses the impact of immunomodulating therapies on the results of PT. We summarize the available evidence and provide updated recommendations for several immunomodulating drugs commonly used in patients undergoing PT. EXPERT OPINION In general, the results of PT are most reliable when performed without immunosuppression. If this is not feasible, it is best to have patients on as low a dose of immunosuppression as possible, but it may not be necessary to stop or change an immunomodulating drug prior to PT.
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Affiliation(s)
- Mykayla Sandler
- Harvard Medical School, Boston, MA, USA
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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3
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Renukuntla SV, Kolekar KK, Phulari YJ. Variable Presentations of Photodermatoses - A Case Series. Indian J Dermatol 2023; 68:686-689. [PMID: 38371556 PMCID: PMC10868969 DOI: 10.4103/ijd.ijd_542_23] [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] [Indexed: 02/20/2024] Open
Abstract
Photodermatoses represent a broad spectrum of skin diseases caused because of exposure to ultraviolet radiation. It is categorized mainly as idiopathic photosensitive disorders, drug or chemical induced photosensitivity reactions, DNA repair-deficiency photodermatoses and photoaggravated dermatoses. Despite being under the photodermatoses umbrella, the pathophysiology of each type of photodermatoses varies. We reported 4 cases of photodermatoses including azathioprine induced pellagra, adult onset actinic prurigo, and photoallergic contact dermatitis due to NSAIDs and cutting fluids. Photoprotection with the usage of photoprotective clothing, broad-spectrum sunscreen application and avoidance of photosensitizing drugs and chemicals are crucial.
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Affiliation(s)
- Sri Vaishnavi Renukuntla
- From the Department of Dermatology, D. Y. Patil Medical College and Hospital, Kolhapur, Maharashtra, India
| | - Ketan K. Kolekar
- From the Department of Dermatology, D. Y. Patil Medical College and Hospital, Kolhapur, Maharashtra, India
| | - Yoganand J. Phulari
- From the Department of Dermatology, D. Y. Patil Medical College and Hospital, Kolhapur, Maharashtra, India
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4
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Fan Z, He Y, Sun W, Li Z, Ye C, Wang C. Clinical characteristics, diagnosis and management of Sweet syndrome induced by azathioprine. Clin Exp Med 2023; 23:3581-3587. [PMID: 37432535 DOI: 10.1007/s10238-023-01135-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/29/2023] [Indexed: 07/12/2023]
Abstract
Sweet syndrome is a rare complication of azathioprine treatment with unelucidated clinical features. The purpose of this study was to investigate the clinical characteristics of azathioprine-induced Sweet syndrome (AISS) and provide a reference for diagnosis, treatment and prognosis. We collected relevant case reports of AISS by searching Chinese and English databases from 1960 to December 31, 2022, extracted the data and carried out a retrospective analysis. The median age of the 44 patients was 50 (range 9-89) years, and they included 32 males (72.7%). Fever (86.4%) and arthralgia (31.8%) were the most common clinical symptoms. The skin lesions were mainly pustules (54.5%), papules (40.9%), plaques (40.9%) and nodules (31.8%), which were mainly distributed on the extremities (54.5%), face (38.6%) and hands (36.4%). Laboratory examination revealed neutropenia (65.9%) as well as elevated C-reactive protein (63.6%) and erythrocyte sedimentation (40.9%) rates. Histopathology of the lesioned skin showed neutrophil infiltration (93.2%) and dermal edema (38.6%). Symptom relief was achieved at a median time of 7 days (range 2-28 days) after azathioprine discontinuation in all patients. Nine patients (20.5%) had skin lesions that recurred within 24 h after taking azathioprine again. Clinicians and pharmacists should grasp the regularity and characteristics of AISS and should not recommend the readministration of azathioprine, to avoid the recurrence of Sweet syndrome.
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Affiliation(s)
- Zhiqiang Fan
- Department of Pharmacy, The First Hospital of Hunan University of Chinese Medicine, Changsha, 410007, Hunan, China
- College of Pharmacy, Changsha Medical University, Changsha, 410219, Hunan, China
| | - Yang He
- Department of Pharmacy, The First Hospital of Hunan University of Chinese Medicine, Changsha, 410007, Hunan, China
- College of Pharmacy, Changsha Medical University, Changsha, 410219, Hunan, China
| | - Wei Sun
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, YueLu District, Changsha, 410013, Hunan, China
| | - Zuojun Li
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, YueLu District, Changsha, 410013, Hunan, China
| | - Chao Ye
- Department of Pharmacy, The Third Hospital of Changsha, Changsha, 410015, Hunan, China.
| | - Chunjiang Wang
- College of Pharmacy, Changsha Medical University, Changsha, 410219, Hunan, China.
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, YueLu District, Changsha, 410013, Hunan, China.
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5
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Gan C, Mahil S, Pink A, Rodrigues M. Atopic dermatitis in skin of colour. Part 2: considerations in clinical presentation and treatment options. Clin Exp Dermatol 2023; 48:1091-1101. [PMID: 37119261 DOI: 10.1093/ced/llad162] [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] [Received: 12/10/2022] [Revised: 03/09/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
Recent advances in atopic dermatitis (AD) present the condition as a heterogeneous disease of distinct endotypes across ethnic groups. AD in people with skin of colour may appear psoriasiform, lichenoid, scaly or papular, with a violaceous colour and there is a higher prevalence of post-inflammatory dyspigmentation compared with affected individuals of White ethnicity. These differences in clinical presentation may limit the use of AD assessment tools in people with skin of colour, leading to the potential for misdiagnosis and underestimation of severity, particularly in relation to assessment of erythema. Recent targeted therapies for AD have been studied in multiple ethnic groups; however, ethnicity-based subgroup analysis is often not performed. Further research is required to understand whether treatment responses or safety may differ among ethnic groups.
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Affiliation(s)
- Christian Gan
- Department of Dermatology, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Dermatology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Satveer Mahil
- St John's Institute of Dermatology, Guy's and St Thomas NHS Foundation Trust and King's College London, London, UK
| | - Andrew Pink
- St John's Institute of Dermatology, Guy's and St Thomas NHS Foundation Trust and King's College London, London, UK
| | - Michelle Rodrigues
- Department of Dermatology, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Chroma Dermatology, Pigment and Skin of Colour Centre, VIC, Australia
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6
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Zuberbier T, Peter J, Staubach P, Chularojanamontri L, Kulthanan K. Potential Therapeutic Approaches for Chronic Urticaria: Beyond H1-Antihistamines and Biologics. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2265-2273. [PMID: 37356753 DOI: 10.1016/j.jaip.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/31/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023]
Abstract
Chronic urticaria is a disease that can significantly impact a patient's quality of life and ability to function. There are effective treatment options, such as nonsedating antihistamines or biologics, but some patients do not respond to these therapies, or the therapies are not available or affordable to all patients. This review aims to summarize potential treatment strategies for patients (1) who do not respond to antihistamines and (2) cannot readily access or do not respond to biologics. The review emphasizes the importance of sound clinical practice, including correct diagnosis of chronic urticaria phenotypes, treatment of associated comorbidities, and consideration of add-on pharmacological and nonpharmacological approaches. Although some treatments may lack high-quality evidence, they may still be justifiable in certain cases, provided that there is shared decision-making, regular reassessment, and early recognition of adverse events.
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Affiliation(s)
- Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany.
| | - Jonny Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Petra Staubach
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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7
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Shen X. Research progress on pathogenesis and clinical treatment of neuromyelitis optica spectrum disorders (NMOSDs). Clin Neurol Neurosurg 2023; 231:107850. [PMID: 37390569 DOI: 10.1016/j.clineuro.2023.107850] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 04/11/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023]
Abstract
Neuromyelitis optica spectrum disorders (NMOSDs) are characteristically referred to as various central nervous system (CNS)-based inflammatory and astrocytopathic disorders, often manifested by the axonal damage and immune-mediated demyelination targeting optic nerves and the spinal cord. This review article presents a detailed view of the etiology, pathogenesis, and prescribed treatment options for NMOSD therapy. Initially, we present the epidemiology of NMOSDs, highlighting the geographical and ethnical differences in the incidence and prevalence rates of NMOSDs. Further, the etiology and pathogenesis of NMOSDs are emphasized, providing discussions relevant to various genetic, environmental, and immune-related factors. Finally, the applied treatment strategies for curing NMOSD are discussed, exploring the perspectives for developing emergent innovative treatment strategies.
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Affiliation(s)
- Xinyu Shen
- Department of Neurology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200000, PR China.
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8
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Park JE, Lee H, Oliva P, Kirsch K, Kim B, Ahn JI, Alverez CN, Gaikwad S, Krausz KW, O’Connor R, Rai G, Simeonov A, Mock BA, Gonzalez FJ, Lee KS, Jacobson KA. Structural Optimization and Anticancer Activity of Polo-like Kinase 1 (Plk1) Polo-Box Domain (PBD) Inhibitors and Their Prodrugs. ACS Pharmacol Transl Sci 2023; 6:422-446. [PMID: 36926457 PMCID: PMC10012257 DOI: 10.1021/acsptsci.2c00250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Indexed: 02/22/2023]
Abstract
Polo-like kinase 1 (Plk1), a mitotic kinase whose activity is widely upregulated in various human cancers, is considered an attractive target for anticancer drug discovery. Aside from the kinase domain, the C-terminal noncatalytic polo-box domain (PBD), which mediates the interaction with the enzyme's binding targets or substrates, has emerged as an alternative target for developing a new class of inhibitors. Various reported small molecule PBD inhibitors exhibit poor cellular efficacy and/or selectivity. Here, we report structure-activity relationship (SAR) studies on triazoloquinazolinone-derived inhibitors, such as 43 (a 1-thioxo-2,4-dihydrothieno[2,3-e][1,2,4]triazolo[4,3-a]pyrimidin-5(1H)-one) that effectively block Plk1, but not Plk2 and Plk3 PBDs, with improved affinity and drug-like properties. The range of prodrug moieties needed for thiol group masking of the active drugs has been expanded to increase cell permeability and mechanism-based cancer cell (L363 and HeLa) death. For example, a 5-thio-1-methyl-4-nitroimidazolyl prodrug 80, derived from 43, showed an improved cellular potency (GI50 4.1 μM). As expected, 80 effectively blocked Plk1 from localizing to centrosomes and kinetochores and consequently induced potent mitotic block and apoptotic cell death. Another prodrug 78 containing 9-fluorophenyl in place of the thiophene-containing heterocycle in 80 also induced a comparable degree of anti-Plk1 PBD effect. However, orally administered 78 was rapidly converted in the bloodstream to parent drug 15, which was shown be relatively stable toward in vivo oxidation due to its 9-fluorophenyl group in comparison to unsubstituted phenyl. Further derivatization of these inhibitors, particularly to improve the systemic prodrug stability, could lead to a new class of therapeutics against Plk1-addicted cancers.
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Affiliation(s)
- Jung-Eun Park
- Cancer
Innovation Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Hobin Lee
- Cancer
Innovation Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, United States
- Laboratory
of Bioorganic Chemistry, National Institute
of Diabetes and Digestive and Kidney Diseases, National Institutes
of Health, Bethesda, Maryland 20892, United States
| | - Paola Oliva
- Laboratory
of Bioorganic Chemistry, National Institute
of Diabetes and Digestive and Kidney Diseases, National Institutes
of Health, Bethesda, Maryland 20892, United States
| | - Klara Kirsch
- Cancer
Innovation Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Bora Kim
- Cancer
Innovation Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Jong Il Ahn
- Cancer
Innovation Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Celeste N. Alverez
- Cancer
Innovation Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, United States
- Division
of Preclinical Innovation, National Center
for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland 20850, United States
| | - Snehal Gaikwad
- Laboratory
of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, National Institutes of
Health, Bethesda, Maryland 20892, United States
| | - Kristopher W. Krausz
- Cancer
Innovation Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Robert O’Connor
- Laboratory
of Bioorganic Chemistry, National Institute
of Diabetes and Digestive and Kidney Diseases, National Institutes
of Health, Bethesda, Maryland 20892, United States
| | - Ganesha Rai
- Division
of Preclinical Innovation, National Center
for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland 20850, United States
| | - Anton Simeonov
- Division
of Preclinical Innovation, National Center
for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland 20850, United States
| | - Beverly A. Mock
- Laboratory
of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, National Institutes of
Health, Bethesda, Maryland 20892, United States
| | - Frank J. Gonzalez
- Cancer
Innovation Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Kyung S. Lee
- Cancer
Innovation Laboratory, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Kenneth A. Jacobson
- Laboratory
of Bioorganic Chemistry, National Institute
of Diabetes and Digestive and Kidney Diseases, National Institutes
of Health, Bethesda, Maryland 20892, United States
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9
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Fatima S, Abbas T, Refat MA, Harris JE, Lim HW, Hamzavi IH, Mohammad TF. Systemic therapies in vitiligo: a review. Int J Dermatol 2023; 62:279-289. [PMID: 35133006 DOI: 10.1111/ijd.16114] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 12/09/2021] [Accepted: 01/05/2022] [Indexed: 11/28/2022]
Abstract
Vitiligo is characterized by the development of depigmented macules and patches. Autoimmunity has been established as a factor in disease pathogenesis, leading to utilization of immunosuppressive agents. Topical immunosuppressants are commonly used; however, this treatment modality is often cumbersome and inefficient, as many patients have active disease with extensive body surface area involvement. Prompt and aggressive treatment of vitiligo is important, as this may prevent progression and improve quality of life. To meet these challenges and improve patient outcomes, interest in systemic therapies has grown. Currently, oral therapies are rarely prescribed, likely due to concerns with systemic side effects and unclear efficacy. This article provides a brief overview on the use of systemic agents in treating vitiligo in order to provide additional therapeutic options to clinicians.
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Affiliation(s)
- Sakeena Fatima
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Tazeen Abbas
- Department of Emergency Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Maggi A Refat
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - John E Harris
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Henry W Lim
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Iltefat H Hamzavi
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Tasneem F Mohammad
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
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10
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Thomas JL, Tee MW, Harp J, Magro C. Azathioprine hypersensitivity syndrome manifesting as subcutaneous Sweet syndrome and acute pancreatitis. J Cutan Pathol 2023; 50:127-130. [PMID: 35983669 DOI: 10.1111/cup.14315] [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: 01/25/2022] [Revised: 08/03/2022] [Accepted: 08/15/2022] [Indexed: 01/24/2023]
Abstract
Azathioprine (AZA) is a commonly used immunosuppressive therapy that has been implicated in a number of cutaneous and systemic inflammatory reactions. Initiation of AZA has been associated with a hypersensitivity syndrome manifesting as acute pancreatitis and Sweet syndrome. Subcutaneous Sweet syndrome is a rare variant of Sweet syndrome where the dominant localization of inflammation is within the subcutaneous fat; it is commonly associated with underlying myeloproliferative disease. However, it has not been reported in the literature as a cutaneous manifestation of AZA hypersensitivity syndrome. We present a unique case of acute pancreatitis and biopsy-proven subcutaneous Sweet syndrome following the initiation of AZA with resolution upon discontinuation.
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Affiliation(s)
| | - Michael W Tee
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
| | - Joanna Harp
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
| | - Cynthia Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
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11
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Chedid T, Moisset X, Clavelou P. Rationale for off-label treatments use in primary progressive multiple sclerosis: A review of the literature. Rev Neurol (Paris) 2022; 178:932-938. [PMID: 35851485 DOI: 10.1016/j.neurol.2022.02.461] [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: 07/29/2021] [Revised: 12/18/2021] [Accepted: 02/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Until recently, few therapeutic options, other than symptomatic treatment, were available for patients with primary progressive multiple sclerosis (PPMS). Ocrelizumab is the only approved treatment in this indication, and only since 2017. However, many patients in France are receiving off-label treatments for PPMS, mainly rituximab, mycophenolate mofetil, methotrexate, cyclophosphamide, and azathioprine. OBJECTIVE To evaluate published data concerning the efficacy of these five treatments frequently used as off-label disease-modifying therapies. METHODS We reviewed and summarized the studies published in Pubmed since the inception of the database. RESULTS Evidence from randomized controlled trials is lacking to support the use of these treatments as disease-modifying therapies in PPMS. CONCLUSION The literature lacks dedicated studies to support the off-label use of these disease-modifying therapies in PPMS. However, some limited data are available in the literature suggesting that the use of rituximab and cyclophosphamide could potentially be of some interest in specific subpopulations.
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Affiliation(s)
- T Chedid
- Hospital Center of Périgueux, 80, avenue Georges Pompidou, 24000 Périgueux, France.
| | - X Moisset
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, 63000 Clermont-Ferrand, France
| | - P Clavelou
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, 63000 Clermont-Ferrand, France
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12
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Bracho-Borro M, Franco-Ruiz PA, Magaña M. The Use of Azathioprine in Atopic Dermatitis. A Review. Dermatol Ther 2022; 35:e15665. [PMID: 35751547 DOI: 10.1111/dth.15665] [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: 05/18/2022] [Accepted: 06/19/2022] [Indexed: 11/26/2022]
Abstract
Most patients with atopic dermatitis (AD) have a good response to topical treatment. However, some need systemic therapy in order to satisfactorily control the disease. Azathioprine is an accessible drug for patients in many countries, including underdeveloped countries, and therefore it's used by many dermatologists in moderate and severe AD. It is important to have a deep knowledge and understanding about this drug since it is an alternative therapy as a steroid-sparing agent and an affordable one. However, when it comes to systemic therapy for AD, it's not always clear its indications and it is necessary to have a closer follow-up of the patient. In this paper we describe thoroughly it's indications in AD, the mechanism of action of the drug, as well as the interactions, adverse effects, adequate monitoring, and precautions in special population that must be considered when prescribing azathioprine. This review will help dermatologists prescribe it safely to all patients who require it. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Maria Bracho-Borro
- Service of Dermatology, Hospital General de México Dr. Eduardo Liceaga, S. S. (Ministry of Health) Mexico City, México
| | - Paulina Ailed Franco-Ruiz
- Service of Dermatology, Hospital General de México Dr. Eduardo Liceaga, S. S. (Ministry of Health) Mexico City, México
| | - Mario Magaña
- Service of Dermatology, Hospital General de México Dr. Eduardo Liceaga, S. S. (Ministry of Health) Mexico City, México
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13
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Pyoderma Gangrenosum: An Updated Literature Review on Established and Emerging Pharmacological Treatments. Am J Clin Dermatol 2022; 23:615-634. [PMID: 35606650 PMCID: PMC9464730 DOI: 10.1007/s40257-022-00699-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 12/12/2022]
Abstract
Pyoderma gangrenosum is a rare inflammatory skin disease classified within the group of neutrophilic dermatoses and clinically characterized by painful, rapidly evolving cutaneous ulcers with undermined, irregular, erythematous-violaceous edges. Pyoderma gangrenosum pathogenesis is complex and involves a profound dysregulation of components of both innate and adaptive immunity in genetically predisposed individuals, with the follicular unit increasingly recognized as the putative initial target. T helper 17/T helper 1-skewed inflammation and exaggerated inflammasome activation lead to a dysregulated neutrophil-dominant milieu with high levels of tumor necrosis factor-α, interleukin (IL)-1β, IL-1α, IL-8, IL-12, IL-15, IL-17, IL-23, and IL-36. Low-evidence studies and a lack of validated diagnostic and response criteria have hindered the discovery and validation of new effective treatments for pyoderma gangrenosum. We review established and emerging treatments for pyoderma gangrenosum. A therapeutic algorithm based on available evidence is also provided. For emerging treatments, we review target molecules and their role in the pathogenesis of pyoderma gangrenosum.
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14
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Petri M. Drug monitoring in systemic lupus erythematosus. Curr Opin Pharmacol 2022; 64:102225. [PMID: 35490454 DOI: 10.1016/j.coph.2022.102225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022]
Abstract
Therapeutic drug monitoring (TDM) is not yet accepted by systemic lupus erythematosus (SLE) treatment guidelines. Studies in SLE, however, have proven benefit in three areas: identification of non-adherence or poor adherence; targets for clinical benefit; and ranges of toxicity. This review covers the data on three medications commonly used for SLE, drawing on studies from both the SLE and non-SLE literature.
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Affiliation(s)
- Michelle Petri
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Rheumatology, 1830 E. Monument Street, Suite 7500, Baltimore, MD, 21205, USA.
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15
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Labib A, Ju T, Vander Does A, Yosipovitch G. Immunotargets and Therapy for Prurigo Nodularis. Immunotargets Ther 2022; 11:11-21. [PMID: 35502157 PMCID: PMC9056055 DOI: 10.2147/itt.s316602] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/08/2022] [Indexed: 12/18/2022] Open
Abstract
Prurigo nodularis is a chronic inflammatory skin disease consisting of severely pruritic nodules that can be very debilitating for patients. The basis of this skin condition is immunological dysregulation and neural amplification, driven by T-lymphocytes, mast cells, eosinophilic granulocytes, macrophages, and cytokines mediating itchy processes. Further complicating this already taxing diagnosis is the lack of approved treatment and consensus on management; although there are off-label treatments utilized as therapy. Immunomodulators are the cornerstone of treatment for PN, and additional novel therapies targeting key players in the immunological cascade are currently undergoing investigation. In this review, we will highlight targets of the immune cascade and explore current immunomodulating treatments as well as immunotherapies on the horizon for the management of prurigo nodularis.
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Affiliation(s)
- Angelina Labib
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Teresa Ju
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ashley Vander Does
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
- Correspondence: Gil Yosipovitch, Dr Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, 1600 NW 10th Ave RMSB Building 2067B, Miami, FL, USA, Tel +1 305 213-5824, Email
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16
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COMPUTER SIMULATION OF THE COMBINED USE OF AZATHIOPRINE WITH METHYLPREDNISOLONE UNDER THE CONDITIONS OF PHARMACOTHERAPY OF MYASTHENIA GRAVIS. WORLD OF MEDICINE AND BIOLOGY 2022. [DOI: 10.26724/2079-8334-2022-3-81-88-93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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Bose S, Madke B. A comprehensive review of immunosuppressive drugs in pediatric dermatoses: Part I - Corticosteroids, azathioprine, and cyclosporine-A. INDIAN JOURNAL OF PAEDIATRIC DERMATOLOGY 2022. [DOI: 10.4103/ijpd.ijpd_83_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Zhou X, Cheng L, Wang Y, Gou H, Ju K, Lan T, Zhan T, Li G, Gu Y, Sun Y, Xu Y, Sun Y, Zhou Y, Li W. Effect of NUDT15 polymorphisms on early hematological safety of low-dose azathioprine in Chinese patients with pemphigus vulgaris: A prospective cohort study. J Dermatol 2021; 49:402-410. [PMID: 34866237 PMCID: PMC9299774 DOI: 10.1111/1346-8138.16265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 02/05/2023]
Abstract
Azathioprine (AZA) is the preferred immunosuppressant for treating pemphigus vulgaris (PV), with discontinuation mainly attributed to hematological adverse events (AE). Reportedly, nucleoside diphosphate‐linked moiety X‐type motif 15 (NUDT15) polymorphisms have been strongly associated with thiopurine‐induced leukopenia. To investigate hematological AE of low‐dose AZA based on NUDT15 genotypes among patients with PV, a prospective cohort study was conducted in patients with PV, followed‐up for the first 8 weeks after AZA administration. All patients were divided into wild homozygous and heterozygous NUDT15 groups. Both groups initiated AZA at low dose (50 mg/day) and continued with different dose‐escalating approaches. Bone marrow suppression was considered the principal outcome. Overall, 62 patients with PV were enrolled (48 in the wild homozygous NUDT15 group vs. 14 in the heterozygous NUDT15 group). Except for median maintenance doses of AZA, no statistically significant differences were observed between the two groups in terms of age, sex, white blood cells, neutrophil count, platelet count, hemoglobin level, median final doses of corticosteroids (mg prednisone equivalent), pemphigus disease area index, and anti‐desmoglein 1/3 autoantibodies. In both groups, patients presented similar hematological AE and treatment responses after administration of different low‐dose AZA treatment strategies. Low‐dose AZA based on NUDT15 genotypes can reduce the risk of early hematological AE among patients with PV.
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Affiliation(s)
- Xingli Zhou
- Department of Dermatology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
| | - Liangliang Cheng
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yiyi Wang
- Department of Dermatology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Gou
- Department of Dermatology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Ju
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - TianJiao Lan
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Tongying Zhan
- Department of Dermatology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
| | - GaoJie Li
- Department of Dermatology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanxia Gu
- Department of Dermatology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yeting Sun
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Xu
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yukun Sun
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yanhong Zhou
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Li
- Department of Dermatology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
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19
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Vera G, Mangeant R, Stiebing S, Berhault Y, Fabis F, Cailly T, Collot V. Thiofunctionalization of Electron‐Rich Heteroarenes through Magnesiation and Trapping with Octasulfur. Adv Synth Catal 2021. [DOI: 10.1002/adsc.202100869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gonzalo Vera
- Normandie Univ UNICAEN Centre d'Etudes et de Recherche sur le Médicament de Normandie (CERMN) 14000 Caen France
| | - Reynald Mangeant
- Normandie Univ UNICAEN Centre d'Etudes et de Recherche sur le Médicament de Normandie (CERMN) 14000 Caen France
| | - Silvia Stiebing
- Normandie Univ UNICAEN Centre d'Etudes et de Recherche sur le Médicament de Normandie (CERMN) 14000 Caen France
| | - Yohann Berhault
- Normandie Univ UNICAEN Centre d'Etudes et de Recherche sur le Médicament de Normandie (CERMN) 14000 Caen France
| | - Frédéric Fabis
- Normandie Univ UNICAEN Centre d'Etudes et de Recherche sur le Médicament de Normandie (CERMN) 14000 Caen France
| | - Thomas Cailly
- Normandie Univ UNICAEN Centre d'Etudes et de Recherche sur le Médicament de Normandie (CERMN) 14000 Caen France
- Normandie Univ UNICAEN IMOGERE 14000 Caen France
- CHU Côte de Nacre Department of Nuclear Medicine 14000 Caen France
- Institut Blood and Brain@Caen-Normandie (BB@C) Boulevard Henri Becquerel 14074 Caen France
| | - Valérie Collot
- Normandie Univ UNICAEN Centre d'Etudes et de Recherche sur le Médicament de Normandie (CERMN) 14000 Caen France
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20
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Abtahi‐Naeini B, Rajabi P, Dehghani S. Azathioprine-induced pellagra in a child with autoimmune hepatitis: A case report and literature review. Clin Case Rep 2021; 9:e04975. [PMID: 34703606 PMCID: PMC8521196 DOI: 10.1002/ccr3.4975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/22/2021] [Accepted: 09/25/2021] [Indexed: 11/06/2022] Open
Abstract
Pellagra is a clinical syndrome resulting from niacin deficiency with variety of manifestations. Azathioprine is among drugs that can lead to such condition. Physicians should be aware as proper management can lead to full resolution.
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Affiliation(s)
- Bahareh Abtahi‐Naeini
- Pediatric Dermatology Division of Department of PediatricsImam Hossein Children's Hospital, Isfahan University of Medical SciencesIsfahanIran
- Skin Diseases and Leishmaniasis Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Parvin Rajabi
- Department of PathologyIsfahan University of Medical SciencesIsfahanIran
| | - Shakiba Dehghani
- School of medicineIsfahan University of Medical SciencesIsfahanIran
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21
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Phelps DW, Fletcher AA, Rodriguez-Nunez I, Balik-Meisner MR, Tokarz DA, Reif DM, Germolec DR, Yoder JA. In vivo assessment of respiratory burst inhibition by xenobiotic exposure using larval zebrafish. J Immunotoxicol 2021; 17:94-104. [PMID: 32407153 DOI: 10.1080/1547691x.2020.1748772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Currently, assessment of the potential immunotoxicity of a given agent involves a tiered approach for hazard identification and mechanistic studies, including observational studies, evaluation of immune function, and measurement of susceptibility to infectious and neoplastic diseases. These studies generally use costly low-throughput mammalian models. Zebrafish, however, offer an excellent alternative due to their rapid development, ease of maintenance, and homology to mammalian immune system function and development. Larval zebrafish also are a convenient model to study the innate immune system with no interference from the adaptive immune system. In this study, a respiratory burst assay (RBA) was utilized to measure reactive oxygen species (ROS) production after developmental xenobiotic exposure. Embryos were exposed to non-teratogenic doses of chemicals and at 96 h post-fertilization, the ability to produce ROS was measured. Using the RBA, 12 compounds with varying immune-suppressive properties were screened. Seven compounds neither suppressed nor enhanced the respiratory burst; five reproducibly suppressed global ROS production, but with varying potencies: benzo[a]pyrene, 17β-estradiol, lead acetate, methoxychlor, and phenanthrene. These five compounds have all previously been reported as immunosuppressive in mammalian innate immunity assays. To evaluate whether the suppression of ROS by these compounds was a result of decreased immune cell numbers, flow cytometry with transgenic zebrafish larvae was used to count the numbers of neutrophils and macrophages after chemical exposure. With this assay, benzo[a]pyrene was found to be the only chemical that induced a change in the number of immune cells by increasing macrophage but not neutrophil numbers. Taken together, this work demonstrates the utility of zebrafish larvae as a vertebrate model for identifying compounds that impact innate immune function at non-teratogenic levels and validates measuring ROS production and phagocyte numbers as metrics for monitoring how xenobiotic exposure alters the innate immune system.
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Affiliation(s)
- Drake W Phelps
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA
| | - Ashley A Fletcher
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Ivan Rodriguez-Nunez
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | | | - Debra A Tokarz
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.,Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
| | - David M Reif
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA.,Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA.,Bioinformatics Research Center, North Carolina State University, Raleigh, NC, USA
| | - Dori R Germolec
- National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Jeffrey A Yoder
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA.,Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
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22
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Multiple-Molecule Drug Design Based on Systems Biology Approaches and Deep Neural Network to Mitigate Human Skin Aging. Molecules 2021; 26:molecules26113178. [PMID: 34073305 PMCID: PMC8197996 DOI: 10.3390/molecules26113178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 01/23/2023] Open
Abstract
Human skin aging is affected by various biological signaling pathways, microenvironment factors and epigenetic regulations. With the increasing demand for cosmetics and pharmaceuticals to prevent or reverse skin aging year by year, designing multiple-molecule drugs for mitigating skin aging is indispensable. In this study, we developed strategies for systems medicine design based on systems biology methods and deep neural networks. We constructed the candidate genomewide genetic and epigenetic network (GWGEN) via big database mining. After doing systems modeling and applying system identification, system order detection and principle network projection methods with real time-profile microarray data, we could obtain core signaling pathways and identify essential biomarkers based on the skin aging molecular progression mechanisms. Afterwards, we trained a deep neural network of drug–target interaction in advance and applied it to predict the potential candidate drugs based on our identified biomarkers. To narrow down the candidate drugs, we designed two filters considering drug regulation ability and drug sensitivity. With the proposed systems medicine design procedure, we not only shed the light on the skin aging molecular progression mechanisms but also suggested two multiple-molecule drugs for mitigating human skin aging from young adulthood to middle age and middle age to old age, respectively.
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23
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Chavez-Alvarez S, Herz-Ruelas M, Villarreal-Martinez A, Ocampo-Candiani J, Garza-Garza R, Gomez-Flores M. Azathioprine: its uses in dermatology. An Bras Dermatol 2020; 95:731-736. [PMID: 33250113 PMCID: PMC7672387 DOI: 10.1016/j.abd.2020.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/19/2020] [Indexed: 01/19/2023] Open
Abstract
This is a narrative review of azathioprine. This medication is immunomodulatory and immunosuppressive, and it has been used widely through different medical specialties to modify disease. It has been proven useful for several dermatoses and it has encountered success when used as an off-label indication for other dermatologic diseases. Its mechanism of action is described thoroughly, as well as precautions for monitoring adequate levels in patients using it. Dermatologists should also be aware of the possible adverse events it may present. In dermatology it can be used in bullous and autoimmune diseases, and in other conditions, including intractable pruritus, atopic dermatitis, photodermatoses, psoriasis, and others. Azathioprine offers an alternative as a steroid-sparing agent and this review helps dermatologists prescribe it safely to all patients who require it.
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Affiliation(s)
- Sonia Chavez-Alvarez
- Department of Dermatology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Nuevo León, Mexico
| | - Maira Herz-Ruelas
- Department of Dermatology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Nuevo León, Mexico
| | - Alejandra Villarreal-Martinez
- Department of Dermatology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Nuevo León, Mexico
| | - Jorge Ocampo-Candiani
- Department of Dermatology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Nuevo León, Mexico
| | | | - Minerva Gomez-Flores
- Department of Dermatology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Nuevo León, Mexico.
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24
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Verma KK, Patra S, Bhari N. Is weekly azathioprine pulse effective and safe in dermatological conditions? Dermatol Ther 2020; 34:e14513. [PMID: 33166048 DOI: 10.1111/dth.14513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/06/2020] [Accepted: 10/29/2020] [Indexed: 11/28/2022]
Abstract
Azathioprine, a purine synthesis inhibitor is widely used as an effective immunosuppressant in several immune mediated diseases, usually in a dose of 2 to 2.5 mg/kg per day. The pulse dose of azathioprine is an unique once weekly dosing regimen, which has been used as an alternative to daily dose regimen in some immune mediated dermatologic disorders. In this review, we looked at a specific dosing regimen, "weekly azathioprine pulse" with respect to its efficacy and safety in the treatment of dermatologic diseases. We performed a literature search for studies on azathioprine weekly pulse in dermatology in various scientific databases using keywords "azathioprine-pulse", "dermatology", "weekly azathioprine", and so on. Dosing regimens, indications, efficacy, monitoring, and side effect profile as described in these studies were recorded. Evidence level of the regimens used in various indications was also calculated. We could find six published studies using azathioprine weekly pulse, of which three were randomized comparative clinical trials. Azathioprine pulse was administered in a dose of 300 mg (6 tablets of 50 mg each) every week in all the studies. It has been found to be effective in management of contact dermatitis due to parthenium (IB), chronic plaque psoriasis (IIB), and alopecia areata (IB). Adverse effect profile was found to be almost similar to daily azathioprine. Weekly azathioprine pulse, therefore, appears to be an effective and safe alternative to daily azathioprine in the management of immune mediated disorders in dermatology. Although studies are limited, this regimen seems promising and further studies are warranted.
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Affiliation(s)
- Kaushal K Verma
- Department of Dermatology and Venereology, All India Institute of Medical Science, New Delhi, India
| | - Suman Patra
- Department of Dermatology and Venereology, All India Institute of Medical Science, New Delhi, India
| | - Neetu Bhari
- Department of Dermatology and Venereology, All India Institute of Medical Science, New Delhi, India
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25
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Cai S, Perng WT, Huang JY, Chiou JY, Dong L, Wei JC. Neoplasm Risk in Rheumatic Diseases Has No Correlation With Conventional Synthetic Disease-Modifying Anti-rheumatic Drugs Usage-A Population-Based Nested Case-Control Study. Front Med (Lausanne) 2020; 7:473. [PMID: 32984368 PMCID: PMC7479172 DOI: 10.3389/fmed.2020.00473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/14/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: To investigate whether there is an elevated neoplasm risk in patients with rheumatic diseases treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Methods: A population-based nested case-control study was performed by retrieving all patients newly diagnosed with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriatic arthritis (PsA) or psoriasis vulgaris (PsO) from the 2000 Longitudinal Health Insurance Database (LHID 2000) in Taiwan. Two hundred and sixty-one patients with neoplasm from 1997 to 2013 were enrolled in this study, and controls were matched in a 1:1 ratio with age, sex, and year of enrollment. Composition of demographic indices, comorbidities, medication usage, and differences in days of prescription of different medications between neoplasm and neoplasm-free (control) groups were compared. Results: Between the control and neoplasm groups, no differences in ratio were observed in the usage of hydroxychloroquine (50.96 vs. 49.04%, p = 0.6616), methotrexate (26.82 vs. 27.59%, p = 0.8441), azathioprine (3.45 vs. 3.07%, p = 0.8052), and cyclophosphamide (1.15 vs. 2.30%, p = 0.3131) from enrollment to index date. Medications within 3 years before the index date in patients that had ≥3 months of comparable duration also showed no difference (hydroxychloroquine: 33.06 vs. 30.25%, p = 0.6404; methotrexate: 20.66 vs. 25.21%, p = 0.4018; azathioprine: 2.48 vs. 2.52%, p = 0.9835; cyclophosphamide: 0.83 vs. 0.84%, p = 0.9906). We also made a subgroup analysis focusing on RA and SLE patients; no difference between control and neoplasm group in both the ratio of usage and days of prescription of hydroxychloroquine, methotrexate, azathioprine, and cyclophosphamide was observed. Conclusion: Neoplasm risk in patients with rheumatic diseases has no correlation with csDMARD usage.
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Affiliation(s)
- Shaozhe Cai
- Department of Rheumatology and Immunology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wuu-Tsun Perng
- Department of Recreational Sport and Health Promotion, National Pingtung University of Science and Technology, Neipu, Taiwan
| | - Jing Y Huang
- Center for Health Data Science, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Jeng-Yuan Chiou
- School of Health Policy and Management, Chung Shan Medical University, Taichung, Taiwan
| | - Lingli Dong
- Department of Rheumatology and Immunology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - James C Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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26
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Drug-Induced Neutropenia During Treatment of Non-Neoplastic Dermatologic Diseases: A Review. Clin Drug Investig 2020; 40:915-926. [PMID: 32691244 DOI: 10.1007/s40261-020-00956-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Idiosyncratic drug-induced neutropenia (DIN) is a rare, potentially fatal adverse reaction. A literature search was performed on Pubmed and Embase, targeting articles indicating neutropenia as a complication during the treatment of non-neoplastic dermatological disorders. In 66 identified articles, the common incriminated drugs included conventional oral immunomodulators, topical cytotoxic agents, antibacterials, antifungals, biologics and targeted synthetic disease-modifying antirheumatic drugs, non-steroidal anti-inflammatory drugs, and retinoids, with dapsone being reported most often. The duration of drug exposure before the diagnosis of neutropenia varied, but mostly ranged from days to weeks. The majority of patients recovered after drug discontinuation and supportive management including antibiotics and granulocyte colony-stimulating factor, but fatal cases were reported. The proposed pathogenesis of DIN consists of direct drug toxicity and immune-mediated reaction. Certain genetic variants, individual variability in enzyme efficiency, and concomitant use of other drugs may increase the risk of DIN. Being familiar with the most commonly implicated agents and risk factors helps early identification and prompt management of this potentially fatal complication.
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27
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Kim WI, Park TH, Yoon SY, Whang KU, Cho MK, Kim S. Neutropenic fever with diffuse alopecia in a patient with pemphigus foliaceus during azathioprine treatment. Dermatol Ther 2020; 33:e13466. [DOI: 10.1111/dth.13466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/11/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Woo Il Kim
- Department of Dermatology Soonchunhyang University Hospital Seoul South Korea
| | - Tae Heum Park
- Department of Dermatology Soonchunhyang University Hospital Seoul South Korea
| | - Seug Yun Yoon
- Division of Hematology and Oncology, Department of Internal Medicine Soonchunhyang University Hospital Seoul South Korea
| | - Kyu Uang Whang
- Department of Dermatology Soonchunhyang University Hospital Seoul South Korea
| | - Moon Kyun Cho
- Department of Dermatology Soonchunhyang University Hospital Seoul South Korea
| | - Sooyoung Kim
- Department of Dermatology Soonchunhyang University Hospital Seoul South Korea
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28
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Bhilare S, Shet H, Sanghvi YS, Kapdi AR. Discovery, Synthesis, and Scale-up of Efficient Palladium Catalysts Useful for the Modification of Nucleosides and Heteroarenes. Molecules 2020; 25:E1645. [PMID: 32260100 PMCID: PMC7181029 DOI: 10.3390/molecules25071645] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 02/07/2023] Open
Abstract
Nucleic acid derivatives are imperative biomolecules and are involved in life governing processes. The chemical modification of nucleic acid is a fascinating area for researchers due to the potential activity exhibited as antiviral and antitumor agents. In addition, these molecules are also of interest toward conducting useful biochemical, pharmaceutical, and mutagenic study. For accessing such synthetically useful structures and features, transition-metal catalyzed processes have been proven over the years to be an excellent tool for carrying out the various transformations with ease and under mild reaction conditions. Amidst various transition-metal catalyzed processes available for nucleoside modification, Pd-catalyzed cross-coupling reactions have proven to be perhaps the most efficient, successful, and broadly applicable reactions in both academia and industry. Pd-catalyzed C-C and C-heteroatom bond forming reactions have been widely used for the modification of the heterocyclic moiety in the nucleosides, although a single catalyst system that could address all the different requirements for nucleoside modifications isvery rare or non-existent. With this in mind, we present herein a review showcasing the recent developments and improvements from our research groups toward the development of Pd-catalyzed strategies including drug synthesis using a single efficient catalyst system for the modification of nucleosides and other heterocycles. The review also highlights the improvement in conditions or the yield of various bio-active nucleosides or commercial drugs possessing the nucleoside structural core. Scale ups wherever performed (up to 100 g) of molecules of commercial importance have also been disclosed.
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Affiliation(s)
- Shatrughn Bhilare
- Department of Chemistry, Institute of Chemical Technology, Nathalal Parekh Road, Matunga, Mumbai 400019, India;
| | - Harshita Shet
- Department of Chemistry, Institute of Chemical Technology-Indian Oil Odisha Campus, IIT Kharagpur Extension Centre, MouzaSamantpuri, Bhubaneswar 751013, Odisha, India;
| | - Yogesh S. Sanghvi
- Rasayan Inc., 2802, Crystal Ridge Road, Encinitas, CA 92024-6615, USA;
| | - Anant R. Kapdi
- Department of Chemistry, Institute of Chemical Technology, Nathalal Parekh Road, Matunga, Mumbai 400019, India;
- Department of Chemistry, Institute of Chemical Technology-Indian Oil Odisha Campus, IIT Kharagpur Extension Centre, MouzaSamantpuri, Bhubaneswar 751013, Odisha, India;
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Lotti T, Agarwal K, Podder I, Satolli F, Kassir M, Schwartz RA, Wollina U, Grabbe S, Navarini AA, Mueller SM, Goldust M. Safety of the current drug treatments for vitiligo. Expert Opin Drug Saf 2020; 19:499-511. [PMID: 32067513 DOI: 10.1080/14740338.2020.1729737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Vitiligo is an acquired depigmenting skin disorder adversely affecting the patient's quality of life. Despite the presence of several treatment modalities, ranging from medical to physical to surgical options, none is curative. Each modality has its own drawbacks and side effects. Thus, the treatment modality needs to be tailored for each individual patient taking into consideration the disease characteristics and also its efficacy and safety to obtain a favorable risk-benefit ratio.Areas covered: This review highlights the different treatment modalities utilized in vitiligo up until 4 November 2019 along with their adverse effects and contraindications, if any.Expert opinion: All the medications have their own adverse effects and contraindications. We have included the most commonly used topical corticosteroids, which may result in striae, cutaneous atrophy, and tachyphylaxis, to the recently introduced biologics, which may induce hypersensitivity reactions, systemic toxicities, and even malignancies. However, more long-term studies are needed to assess the safety of these medications, especially the newer ones, to provide a safe and effective treatment for this disorder.
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Affiliation(s)
- Torello Lotti
- Department of Dermatology, University of Studies Guglielmo Marconi, Rome, Italy
| | | | | | | | | | | | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Alexander A Navarini
- Department of Dermatology & Allergy, University Hospital of Basel, Basel, Switzerland
| | - Simon M Mueller
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Mohamad Goldust
- Department of Dermatology, University Hospital Basel, Basel, Switzerland.,University of Rome G. Marconi, Rome, Italy.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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Fallah A, Hadjmohammadi MR. Low-density-solvent-based air-assisted liquid–liquid microextraction of azathioprine based on multivariate optimization and its trace determination in biological samples. JOURNAL OF THE IRANIAN CHEMICAL SOCIETY 2020. [DOI: 10.1007/s13738-020-01895-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
Introduction: Treatment for chronic pruritus ranges from use of topical formulations to newer biologic agents. Targeting treatment to the underlying etiology is key in reducing the burden of disease while avoiding systemic or adverse effects.Areas covered: This review details the effective medical treatments used in various etiologies of chronic itch with a focus on the potential adverse effects and safety data available for each.Expert opinion: New drug developments in the areas of neural signaling and immune targeting show great promise for the future of chronic itch treatment. These new therapies broaden the available treatment options but also pose new considerations for safety and adverse effects.
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Affiliation(s)
- Kayla Fourzali
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Akbari F, Didehban K, Farhang M. Solubility of solid intermediate of pharmaceutical compounds in pure organic solvents using semi-empirical models. Eur J Pharm Sci 2020; 143:105209. [PMID: 31881270 DOI: 10.1016/j.ejps.2019.105209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/07/2019] [Accepted: 12/22/2019] [Indexed: 11/29/2022]
Abstract
A new semi-theoretical equation is suggested for correlation of solid-liquid solubility data with temperature. The (solid + liquid) equilibrium for Terephthaldialdehyde, 4-Nitro-o-phennylenediamine, 2,4-dihydro- 5-methyl-2-(4-methylphenyl)-3H-pyrazol-3-one (also named 1-(p-tolyl)-3-methyl-5pyrazolone (PTMP)), 2-Amino-5-methylthiazole and 5-chloro-1-methyl-4-nitroimidazole in 18 solvents is correlated with semi-empirical models at temperatures T = 273.15-318.15 K under a pressure of 101.2 kPa. Moreover, a modified Apelblat model, λh model, Wilson model, NRTL model, new flexible equation as Akbari, Dideban and Farhang model (ADF) and for first time the modified Scatchard-Hildebrand equation were utilized to calculate the experiment values. The performance of both ADF and modified Scatchard-Hildebrand equation have been checked by calculating the solubility data with the AARD% of 1.3808% (for 775 data points) and 0.65% (for 100 data points), respectively. The Wilson model is applied to estimate the mixing Gibbs energy, mixing enthalpy, mixing entropy, activity coefficient (ln γ1∞) and reduced excess enthalpy (H1E, ∞) at infinitesimal concentration were calculated.
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Affiliation(s)
- Falamarz Akbari
- Department of Chemistry, Eram Institute of Higher Education, P. O. Box, 71957-46733, Shiraz, Iran.
| | - Khadijeh Didehban
- Department of Chemistry, Payame Noor University, P. O. Box, 19395-3697, Tehran, Iran
| | - Mona Farhang
- Department of Chemistry, Payame Noor University, P. O. Box, 19395-3697, Tehran, Iran
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Huang PW, Tseng YH, Tsai TF. Predictive Value of NUDT15 Variants on Neutropenia Among Han Chinese Patients with Dermatologic Diseases: A Single-Center Observational Study. Dermatol Ther (Heidelb) 2020; 10:263-271. [PMID: 32062783 PMCID: PMC7090103 DOI: 10.1007/s13555-020-00360-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Azathioprine is a synthetic purine analogue derived from 6-mercaptopurine which acts by disrupting nucleic acid synthesis and interfering with T cell activation. It is effective in dermatology diseases related to the immune system. However, its side effects, including severe neutropenia, kept patients from using it. Mutations in thiopurine methyltransferase (TPMT) and inosine triphosphate pyrophosphohydrolase (ITPA) genes account for the major genetic polymorphism markers for azathioprine adverse risk factors in Caucasians, but not in Asians. The predictive value of the nucleoside diphosphate-linked moiety X motif 15 gene (NUDT15) has been studied in various diseases among different populations. The aim of our study was to determine the contribution of NUDT15 mutations in azathioprine-induced neutropenia in Han Chinese patients with dermatologic diseases. Methods The study enrolled all consecutive patients, older than 13 years old, with dermatological diseases currently treated orally with azathioprine in our clinic. Samples were also collected from patients with documented leukopenia in our prior study that examined the association between TPMT, ITPA, and neutropenia after informed reconsent. Complete blood count, differential count, and hepatic and renal function were checked regularly. The DNA samples for NUDT15 genotype were obtained from the patients. Results In total, we enrolled 56 patients (39 male, 17 female). The NUDT15 genotypes are mostly C/C (N = 36, 64.29%). Heterozygous variant (C/T) accounts for 30.36% (N = 17) and homozygous variant (T/T) accounts for 5.36% (N = 3). Among these patients, 15 patients (26.79%) developed neutropenia, including all three patients carry homozygous variant (T/T). The age-, sex-, and dose-adjusted risk of heterozygous variant compared to wild type is 9.383 (95% CI 1.32–66.96). Conclusions Pretreatment screening of NUDT15 might reduce the chance of azathioprine-induced neutropenia in Han Chinese patients with dermatologic diseases.
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Affiliation(s)
- Po-Wei Huang
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, Taiwan
| | - Yu-Hsian Tseng
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, Taiwan.
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34
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Syed A, Devi VK. Potential of targeted drug delivery systems in treatment of rheumatoid arthritis. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2019.101217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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35
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Crow LD, Kaizer-Salk KA, Juszczak HM, Arron ST. Medications Associated with Increased Risk of Keratinocyte Carcinoma. Dermatol Clin 2019; 37:297-305. [DOI: 10.1016/j.det.2019.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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36
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Hiroyasu S, Turner CT, Richardson KC, Granville DJ. Proteases in Pemphigoid Diseases. Front Immunol 2019; 10:1454. [PMID: 31297118 PMCID: PMC6607946 DOI: 10.3389/fimmu.2019.01454] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 06/10/2019] [Indexed: 12/28/2022] Open
Abstract
Pemphigoid diseases are a subgroup of autoimmune skin diseases characterized by widespread tense blisters. Standard of care typically involves immunosuppressive treatments, which may be insufficient and are often associated with significant adverse events. As such, a deeper understanding of the pathomechanism(s) of pemphigoid diseases is necessary in order to identify improved therapeutic approaches. A major initiator of pemphigoid diseases is the accumulation of autoantibodies against proteins at the dermal-epidermal junction (DEJ), followed by protease activation at the lesion. The contribution of proteases to pemphigoid disease pathogenesis has been investigated using a combination of in vitro and in vivo models. These studies suggest proteolytic degradation of anchoring proteins proximal to the DEJ is crucial for dermal-epidermal separation and blister formation. In addition, proteases can also augment inflammation, expose autoantigenic cryptic epitopes, and/or provoke autoantigen spreading, which are all important in pemphigoid disease pathology. The present review summarizes and critically evaluates the current understanding with respect to the role of proteases in pemphigoid diseases.
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Affiliation(s)
- Sho Hiroyasu
- International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute (VCHRI), Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- BC Professional Firefighters' Burn and Wound Healing Group, Vancouver Coastal Health Research Institute (VCHRI), University of British Columbia (UBC), Vancouver, BC, Canada
| | - Christopher T. Turner
- International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute (VCHRI), Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- BC Professional Firefighters' Burn and Wound Healing Group, Vancouver Coastal Health Research Institute (VCHRI), University of British Columbia (UBC), Vancouver, BC, Canada
| | - Katlyn C. Richardson
- International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute (VCHRI), Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- BC Professional Firefighters' Burn and Wound Healing Group, Vancouver Coastal Health Research Institute (VCHRI), University of British Columbia (UBC), Vancouver, BC, Canada
| | - David J. Granville
- International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute (VCHRI), Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- BC Professional Firefighters' Burn and Wound Healing Group, Vancouver Coastal Health Research Institute (VCHRI), University of British Columbia (UBC), Vancouver, BC, Canada
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37
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Daneshjou R, Huddart R, Klein TE, Altman RB. Pharmacogenomics in dermatology: tools for understanding gene-drug associations. ACTA ACUST UNITED AC 2019; 38:E19-E24. [PMID: 31051019 DOI: 10.12788/j.sder.2019.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Pharmacogenomics aims to associate human genetic variability with differences in drug phenotypes in order to tailor drug treatment to individual patients. The massive amount of genetic data generated from large cohorts of patients with variable drug phenotypes have led to advances in this field. Understanding the application of pharmacogenomics in dermatology could inform clinical practice and provide insight for future research. The Pharmacogenomics Knowledge Base and the Clinical Pharmacogenetics Implementation Consortium are among the resources to help clinicians and researchers navigate the many gene-drug associations that have already been discovered. The implementation of clinical pharmacogenomics within health care systems remains an area of ongoing development. This review provides an introduction to the field of pharmacogenomics and to current pharmacogenomics resources using examples of gene-drug associations relevant to the field of dermatology.
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Affiliation(s)
- Roxana Daneshjou
- Department of Dermatology, Stanford School of Medicine, Redwood City, California.
| | - Rachel Huddart
- Department of Biomedical Data Science, Stanford School of Medicine, Stanford, California
| | - Teri E Klein
- Department of Biomedical Data Science, Stanford School of Medicine, Stanford, California.,Department of Medicine, Stanford School of Medicine, Stanford, California
| | - Russ B Altman
- Department of Biomedical Data Science, Stanford School of Medicine, Stanford, California.,Department of Medicine, Stanford School of Medicine, Stanford, California.,Department of Biomedical Engineering, Stanford Schools of Engineering & Medicine, Stanford, California.,Department of Genetics, Stanford School of Medicine, Stanford, California
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38
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Malan M, Xuejingzi W, Si J, Quan SJ. Hailey-Hailey disease: the role of azathioprine an immunomodulator. Pan Afr Med J 2019; 32:65. [PMID: 31223357 PMCID: PMC6560993 DOI: 10.11604/pamj.2019.32.65.17877] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 01/09/2019] [Indexed: 12/02/2022] Open
Abstract
Hailey-Hailey disease (HHD) is a rare autosomal dominant hereditary blistering and erosions disorder affecting the intertriginous regions of the body. There is still no treatment protocol for this disease thus clinicians are highly advised to draw up individualized treatment plan. In this case report, we discuss a case of HHD in a 58-year-old Chinese man who was successfully treated with azathioprine in Hubei province.
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Affiliation(s)
- Malumani Malan
- Department of Dermatology and Venereology at Zhongnan Hospital of Wuhan University, Wuhan City, Hubei Province, China.,Livingstone Central Hospital, Southern Zambia
| | - Wu Xuejingzi
- Department of Dermatology and Venereology at Zhongnan Hospital of Wuhan University, Wuhan City, Hubei Province, China
| | - Jiang Si
- Department of Dermatology and Venereology at Zhongnan Hospital of Wuhan University, Wuhan City, Hubei Province, China
| | - Song Ji Quan
- Department of Dermatology and Venereology at Zhongnan Hospital of Wuhan University, Wuhan City, Hubei Province, China
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39
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Covaci OI, Samohvalov D, Manta CM, Buhalteanu L, Barbatu A, Baibarac M, Daescu M, Matea A, Gherca D. Novel anhydrous solid-state form of Azathioprine: The assessing of crystal structure by powder X-Ray diffraction, Infrared Absorption Spectroscopy and Raman scattering. J Mol Struct 2019. [DOI: 10.1016/j.molstruc.2018.10.065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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40
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Zhao C, Liu T, Ma C, Li H, Li Z, Guo J. Azathioprine-induced pellagra in neuromyelitis optica: A case report and review of literature. Mult Scler Relat Disord 2018; 25:104-107. [PMID: 30059893 DOI: 10.1016/j.msard.2018.07.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/16/2018] [Accepted: 07/20/2018] [Indexed: 02/01/2023]
Abstract
Neuromyelitis optica (NMO), also known as Devic's disease, is a classical autoimmune disorder of the central nervous system (CNS). The relapsing-remitting disease course contributes to application of a variety of immunosuppressants to prevent further relapses after high-dose methylprednisolone pulse therapy for acute attacks. Azathioprine is one of the most widely used immunosuppressive drugs during the remission stage of NMO due to its good efficacy and favorable side-effect profile. Even if, enough attention should be paid to some rare but devastating adverse events, such as pellagra. Herein, we reported that a well-nourished patient experienced serious pellagra while receiving oral azathioprine for treating her NMO. Moreover, literature on azathioprine-induced pellagra was reviewed to raise concerns regarding patient safety.
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Affiliation(s)
- Cong Zhao
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Tao Liu
- Department of Dermatology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Chao Ma
- Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Hongzeng Li
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Zhuyi Li
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Jun Guo
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
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Nomura H, Kurihara Y, Saito M, Fukushima A, Shintani Y, Shiiyama R, Toshima S, Kamata A, Yamagami J, Funakoshi T, Kameyama K, Amagai M, Kubo A, Umegaki-Arao N. Azathioprine-induced alopecia and leukopenia associated with NUDT15 polymorphisms. J Eur Acad Dermatol Venereol 2018; 32:e386-e389. [PMID: 29704867 DOI: 10.1111/jdv.15028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- H Nomura
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Y Kurihara
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - M Saito
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - A Fukushima
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Y Shintani
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - R Shiiyama
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - S Toshima
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - A Kamata
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - J Yamagami
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - T Funakoshi
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - K Kameyama
- Division of Diagnostic Pathology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - M Amagai
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - A Kubo
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - N Umegaki-Arao
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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Costa PDSS, Fraga LR, Kowalski TW, Daxbacher ELR, Schuler-Faccini L, Vianna FSL. Erythema Nodosum Leprosum: Update and challenges on the treatment of a neglected condition. Acta Trop 2018; 183:134-141. [PMID: 29474830 DOI: 10.1016/j.actatropica.2018.02.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 01/25/2023]
Abstract
Erythema Nodosum Leprosum (ENL) occurs due to the immunological complication of multibacillary leprosy and is characterized by painful nodules and systemic compromising. It is usually recurrent and/or chronic and has both physical and economic impact on the patient, being a very important cause of disability. In addition, ENL is a major health problem in countries where leprosy is endemic. Therefore, adequate control of this condition is important. The management of ENL aims to control acute inflammation and neuritis and prevent the onset of new episodes. However, all currently available treatment modalities have one or two drawbacks and are not effective for all patients. Corticosteroid is the anti-inflammatory of choice in ENL but may cause dependence, especially for chronic patients. Thalidomide has a rapid action but its use is limited due the teratogenicity and neurotoxicity. Clofazimine and pentoxifylline have slow action and have important adverse effects. Finally, there is no pattern or guidelines for treating these patients, becoming more difficult to evaluate and to control this condition. This review aims to show the main drugs used in the treatment of ENL and the challenges in the management of the reaction.
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Olender D, Żwawiak J, Zaprutko L. Multidirectional Efficacy of Biologically Active Nitro Compounds Included in Medicines. Pharmaceuticals (Basel) 2018; 11:E54. [PMID: 29844300 PMCID: PMC6027522 DOI: 10.3390/ph11020054] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 05/23/2018] [Accepted: 05/25/2018] [Indexed: 01/27/2023] Open
Abstract
The current concept in searching for new bioactive products, including mainly original active substances with potential application in pharmacy and medicine, is based on compounds with a previously determined structure, well-known properties, and biological activity profile. Nowadays, many commonly used drugs originated from natural sources. Moreover, some natural materials have become the source of leading structures for processing further chemical modifications. Many organic compounds with great therapeutic significance have the nitro group in their structure. Very often, nitro compounds are active substances in many well-known preparations belonging to different groups of medicines that are classified according to their pharmacological potencies. Moreover, the nitro group is part of the chemical structure of veterinary drugs. In this review, we describe many bioactive substances with the nitro group, divided into ten categories, including substances with exciting activity and that are currently undergoing clinical trials.
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Affiliation(s)
- Dorota Olender
- Department of Organic Chemistry, Pharmaceutical Faculty, Poznan University of Medical Sciences, Grunwaldzka 6, 60-780 Poznan, Poland.
| | - Justyna Żwawiak
- Department of Organic Chemistry, Pharmaceutical Faculty, Poznan University of Medical Sciences, Grunwaldzka 6, 60-780 Poznan, Poland.
| | - Lucjusz Zaprutko
- Department of Organic Chemistry, Pharmaceutical Faculty, Poznan University of Medical Sciences, Grunwaldzka 6, 60-780 Poznan, Poland.
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44
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Nguyen T, Koo J. Purine Synthesis Inhibitors, 6-thioguanine and Azathioprine: Forgotten Treatment Options in Psoriasis and Psoriatic Arthritis. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/247553030915a00105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The thiopurine drugs azathioprine and 6-thioguanine have been shown to induce significant clinical improvement in patients with moderate to severe psoriasis and/or psoriatic arthritis. Objective The aim of this paper is to present a comprehensive review of the available literature concerning the off-label role of thiopurine drugs in the treatment of psoriasis and psoriatic arthritis. Methods Studies published with English abstracts between 1960 and 2008 identified in MEDLINE and PubMed with the keywords purine synthesis inhibitors, thiopurine, 6-thioguanine, azathioprine, psoriasis and psoriatic arthritis were reviewed. Results Although 6-thioguanine and azathioprine have shown significant efficacy, their side effect profiles have discouraged their use for moderate to severe psoriasis. Conclusion For treatment of psoriasis and psoriatic arthritis, purine synthesis inhibitors should not be forgotten. They represent an entirely different option and provide an alternative therapy, especially for difficult cases.
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Affiliation(s)
- Thao Nguyen
- Department of Dermatology Psoriasis and Skin Treatment Center, University of California, San Francisco, Calif
| | - John Koo
- Department of Dermatology Psoriasis and Skin Treatment Center, University of California, San Francisco, Calif
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45
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Leis-Dosil V, Prats-Caelles I. Practical Management of Immunosuppressants in Dermatology. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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46
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Simsek M, Lambalk CB, Wilschut JA, Mulder CJJ, de Boer NKH. The associations of thiopurines with male fertility and paternally exposed offspring: a systematic review and meta-analysis. Hum Reprod Update 2017; 24:192-206. [PMID: 29190351 DOI: 10.1093/humupd/dmx034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/03/2017] [Accepted: 11/13/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Thiopurines are widely used immunosuppressive agents. In high dosages, they inhibit the purine synthesis and are considered to be possibly harmful to spermatogenesis, and subsequently to men's fertility and their offspring. However, the clear association between thiopurine exposure and male fertility and reproduction safety, if any, is still poorly understood. OBJECTIVE AND RATIONALE The aim of this review was to systematically summarize and meta-analyse the available data, derived from animal and human studies, regarding the influence of thiopurine exposure on fertility and conception safety in men and their offspring. SEARCH METHODS A systematic literature search of the MEDLINE and EMBASE databases was performed using a combination of relevant terms related to 'thiopurines', 'fertility', 'conception', 'reproduction', 'semen quality' and 'birth outcome', combined with 'male', 'men', 'father' and 'paternal'. The search was not restricted exclusively to human subjects, neither to a type of disease or condition, to gather all available studies with regards to this topic. All published articles on thiopurines and male fertility, written in English and published until May 2017, were screened for eligibility. The GRADE guidelines were used to assess the quality of evidence of the included articles. OUTCOMES A total of 28 studies (including 14 observational studies in humans) were included in this review and six of these were included in the meta-analysis. In various rodents, thiopurines adversely affected the germ cells (in administered doses of 2 to 20 times the human equivalent dose). In human studies, thiopurine therapy was not evidently associated with impaired testicular function or semen quality in 83 men with a variety of underlying diseases. In total, 53 out of 975 offspring with congenital anomalies (5.4%, the background prevalence is 3%), possibly as a result of paternal thiopurine exposure, were described in all studies together. The risk of congenital anomalies was not significantly increased when compared with offspring without paternal thiopurine exposure (4.7%) (pooled odds ratio 1.32, 95% confidence interval 0.75, 2.34). WIDER IMPLICATIONS Thiopurines have spermatotoxic effects in rodents. In humans, overall data are limited and derived from underpowered studies, and therefore not conclusive with regards to the possible effects of thiopurines on spermatogenesis or paternally exposed offspring. Larger, epidemiological trials evaluating the safety of thiopurines to men's fertility and their offspring are mandatory to adequately counsel thiopurine treated men who wish to conceive.
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Affiliation(s)
- Melek Simsek
- Department of Gastroenterology and Hepatology, VU University Medical Centre (VUmc), PO Box 7075, 1081 HZ, Amsterdam, The Netherlands
| | - Cornelis B Lambalk
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, VU University medical centre (VUmc), PO Box 7075, 1007 MB, Amsterdam, the Netherlands
| | - Janneke A Wilschut
- Department of Epidemiology and Biostatistics, VU University (VU), Medical Faculty (F-wing), 1081 HV, Amsterdam, The Netherlands
| | - Chris J J Mulder
- Department of Gastroenterology and Hepatology, VU University Medical Centre (VUmc), PO Box 7075, 1081 HZ, Amsterdam, The Netherlands
| | - Nanne K H de Boer
- Department of Gastroenterology and Hepatology, VU University Medical Centre (VUmc), PO Box 7075, 1081 HZ, Amsterdam, The Netherlands
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Ilyas M, Colegio OR, Kaplan B, Sharma A. Cutaneous Toxicities From Transplantation-Related Medications. Am J Transplant 2017; 17:2782-2789. [PMID: 28452165 DOI: 10.1111/ajt.14337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/22/2017] [Accepted: 04/22/2017] [Indexed: 01/25/2023]
Abstract
Despite the abundance of information on cutaneous malignancies associated with solid organ transplantation in the transplant literature, there is limited information regarding nonmalignant skin changes after transplantation. There are numerous skin toxicities secondary to immunosuppressive and other transplant-related medications that can vary in presentation, severity, and prognosis. To limit associated morbidity and mortality, solid organ transplant recipient care providers should effectively identify and manage cutaneous manifestations secondary to drug toxicity. Toxicities from the following transplant-related medications will be discussed: antithymocyte globulins, systemic steroids, cyclosporine, tacrolimus, azathioprine, mycophenolate mofetil, mammalian target of rapamycin inhibitors sirolimus and everolimus, basiliximab and daclizumab, belatacept, and voriconazole.
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Affiliation(s)
- M Ilyas
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ
| | - O R Colegio
- Departments of Dermatology, Pathology and Surgery, Yale University, New Haven, CT
| | - B Kaplan
- Department of Nephrology, Mayo Clinic Arizona, Scottsdale, AZ
| | - A Sharma
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ
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Lee M, Seo J, Bang D, Kim DY. Thiopurine S-Methyltransferase Polymorphisms in Korean Dermatologic Patients. Ann Dermatol 2017; 29:529-535. [PMID: 28966507 PMCID: PMC5597644 DOI: 10.5021/ad.2017.29.5.529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/29/2016] [Accepted: 10/14/2016] [Indexed: 11/08/2022] Open
Abstract
Background Thiopurine S-methyltransferase (TPMT) is an important enzyme in the metabolism of thiopurines including azathioprine (AZA), 6-mercaptopurine, and 6-thioguanine. TPMT genotyping is widely used for screening of AZA-related toxicity during routine clinical practice in Korea. However, the data of TPMT genotypes and its AZA-related toxicity have not been studied in the field of dermatology. Objective The aim of this study was to evaluate the genetic basis of TPMT polymorphism in Korean dermatologic patients and subsequently to investigate the relationship between mutant TPMT and adverse responses to AZA treatment. Methods This study was retrospective, single-center study. One hundred forty-nine Korean dermatologic patients who underwent TPMT screening test were included. Each patient's medical records, the result of TPMT screening test, dose and treatment period of AZA, and side effects, were reviewed. Laboratory tests were assessed at each visit in order to monitor adverse drug reactions. Leukopenia grading was used in accordance with the common terminology criteria for adverse events (CTCAE) ver. 4.03. Results Behçet's disease was the leading disorder among the patients. The frequency of TPMT mutation was 4.0% (6/149) among the participants in this study. Four of the six patients with genetic alterations were treated with a low-dose AZA regimen, but no AZA-related adverse events were observed. Conclusion Our results suggest that 1) TPMT polymorphisms in Korean dermatologic patients are similar to those previously reported in Asian patients with the most common mutant allele being TPMT*3C and 2) AZA can be used in the patients with these polymorphisms under a careful dosing regimen.
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Affiliation(s)
- Minseok Lee
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jimyung Seo
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dongsik Bang
- Department of Dermatology, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea
| | - Do Young Kim
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Leis-Dosil VM, Prats-Caelles I. Practical Management of Immunosuppressants in Dermatology. ACTAS DERMO-SIFILIOGRAFICAS 2017; 109:24-34. [PMID: 28964393 DOI: 10.1016/j.ad.2017.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/24/2017] [Accepted: 05/14/2017] [Indexed: 12/17/2022] Open
Abstract
The treatment of inflammatory and autoimmune diseases is challenging because of their frequency and complexity. Treatment of these diseases is based on the suppression of the patient's immune system using corticosteroids, corticosteroid-sparing immunosuppressive agents, and biologic drugs, making an understanding of the management of immunosuppressive therapy essential. Before an immunosuppressive agent is prescribed, a study must be carried out to identify contraindications, detect latent infections, and determine the most appropriate dose. During treatment, regular monitoring is required to detect adverse effects. The clinician must be familiar with the time lag between start of treatment and onset of the immunosuppressive effect as well as the maximum recommended duration of treatment and cumulative dose for each drug. As dermatologists we are accustomed to using these immunosuppressive agents, but we should have a good knowledge of the guidelines for their use and the monitoring required in each case if we are to reduce variability and avoid potentially serious adverse effects.
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Affiliation(s)
- V M Leis-Dosil
- Sección de Dermatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España.
| | - I Prats-Caelles
- Sección de Dermatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
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Nandoskar A, Raffel J, Scalfari AS, Friede T, Nicholas RS. Pharmacological Approaches to the Management of Secondary Progressive Multiple Sclerosis. Drugs 2017; 77:885-910. [PMID: 28429241 DOI: 10.1007/s40265-017-0726-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
It is well recognised that the majority of the impact of multiple sclerosis (MS), both personal and societal, arises in the progressive phase where disability accumulates inexorably. As such, progressive MS (PMS) has been the target of pharmacological therapies for many years. However, there are no current licensed treatments for PMS. This stands in marked contrast to relapsing remitting MS (RRMS) where trials have resulted in numerous licensed therapies. PMS has proven to be a more difficult challenge compared to RRMS and this review focuses on secondary progressive MS (SPMS), where relapses occur before the onset of gradual, irreversible disability, and not primary progressive MS where disability accumulation occurs without prior relapses. Although there are similarities between the two forms, in both cases pinpointing when PMS starts is difficult in a condition in which disability can vary from day to day. There is also an overlap between the pathology of relapsing and progressive MS and this has contributed to the lack of well-defined outcomes, both surrogates and clinically relevant outcomes in PMS. In this review, we used the search term 'randomised controlled clinical drug trials in secondary progressive MS' in publications since 1988 together with recently completed trials where results were available. We found 34 trials involving 21 different molecules, of which 38% were successful in reaching their primary outcome. In general, the trials were well designed (e.g. double blind) with sample sizes ranging from 35 to 1949 subjects. The majority were parallel group, but there were also multi-arm and multidose trials as well as the more recent use of adaptive designs. The disability outcome most commonly used was the Expanded Disability Status Scale (EDSS) in all phases, but also magnetic resonance imaging (MRI)-measured brain atrophy has been utilised as a surrogate endpoint in phase II studies. The majority of the treatments tested in SPMS over the years were initially successful in RRMS. This has a number of implications in terms of targeting SPMS, but principally implies that the optimal strategy to target SPMS is to utilise the prodrome of relapses to initiate a therapy that will aim to both prevent progression and slow its accumulation. This approach is in agreement with the early targeting of MS but requires treatments that are both effective and safe if it is to be used before disability is a major problem. Recent successes will hopefully result in the first licensed therapy for PMS and enable us to test this approach.
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Affiliation(s)
- A Nandoskar
- Wolfson Neuroscience Laboratories, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, 160 Du Cane Road, London, W12 0NN, UK
| | - J Raffel
- Wolfson Neuroscience Laboratories, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, 160 Du Cane Road, London, W12 0NN, UK
| | - A S Scalfari
- Wolfson Neuroscience Laboratories, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, 160 Du Cane Road, London, W12 0NN, UK
| | - T Friede
- Department of Medical Statistics, University Medical Center Göttingen, Humboltallee 32, 37073, Göttingen, Germany
| | - R S Nicholas
- Wolfson Neuroscience Laboratories, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, 160 Du Cane Road, London, W12 0NN, UK.
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