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Lin MX, Zang D, Liu CG, Han X, Chen J. Immune checkpoint inhibitor-related pneumonitis: research advances in prediction and management. Front Immunol 2024; 15:1266850. [PMID: 38426102 PMCID: PMC10902117 DOI: 10.3389/fimmu.2024.1266850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
The advent of immune-checkpoint inhibitors (ICIs) has revolutionized the treatment of malignant solid tumors in the last decade, producing lasting benefits in a subset of patients. However, unattended excessive immune responses may lead to immune-related adverse events (irAEs). IrAEs can manifest in different organs within the body, with pulmonary toxicity commonly referred to as immune checkpoint inhibitor-related pneumonitis (CIP). The CIP incidence remains high and is anticipated to rise further as the therapeutic indications for ICIs expand to encompass a wider range of malignancies. The diagnosis and treatment of CIP is difficult due to the large individual differences in its pathogenesis and severity, and severe CIP often leads to a poor prognosis for patients. This review summarizes the current state of clinical research on the incidence, risk factors, predictive biomarkers, diagnosis, and treatment for CIP, and we address future directions for the prevention and accurate prediction of CIP.
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Affiliation(s)
| | | | | | | | - Jun Chen
- Department of Oncology, The Second Hospital of Dalian Medical University, Dalian, China
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Hassona Y, Altoum D, Alqaisi D, Taimeh D, Sawair F. Management of auto-immune blistering disease in an older patient with severe intellectual disability. SPECIAL CARE IN DENTISTRY 2024; 44:117-123. [PMID: 37016562 DOI: 10.1111/scd.12854] [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: 12/27/2022] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 04/06/2023]
Abstract
Management of chronic oral mucosal diseases might be challenging in older individuals with intellectual disability because of associated comorbidities, variable clinical presentations, and various barriers imposed by the intellectual disability. This report describes the presentation and management of pemphigus vulgaris in an older female with severe intellectual disability.
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Affiliation(s)
- Yazan Hassona
- School of Dentistry, The University of Jordan, Amman, Jordan
| | - Dana Altoum
- School of Dentistry, The University of Jordan, Amman, Jordan
| | - Dua'a Alqaisi
- School of Dentistry, The University of Jordan, Amman, Jordan
| | - Dina Taimeh
- School of Dentistry, The University of Jordan, Amman, Jordan
| | - Faleh Sawair
- School of Dentistry, The University of Jordan, Amman, Jordan
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Madsen JM, Obling LER, Rytoft L, Folke F, Hassager C, Andersen LB, Vejlstrup N, Bang LE, Engstrøm T, Lønborg JT. Pre-hospital pulse glucocorticoid therapy in patients with ST-segment elevation myocardial infarction transferred for primary percutaneous coronary intervention: a randomized controlled trial (PULSE-MI). Trials 2023; 24:808. [PMID: 38102687 PMCID: PMC10724922 DOI: 10.1186/s13063-023-07830-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/23/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Inflammation in ST-segment elevation myocardial infarction (STEMI) is an important contributor to both acute myocardial ischemia and reperfusion injury after primary percutaneous coronary intervention (PCI). Methylprednisolone is a glucocorticoid with potent anti-inflammatory properties with an acute effect and is used as an effective and safe treatment of a wide range of acute diseases. The trial aims to investigate the cardioprotective effects of pulse-dose methylprednisolone administered in the pre-hospital setting in patients with STEMI transferred for primary PCI. METHODS This trial is a randomized, blinded, placebo-controlled prospective clinical phase II trial. Inclusion will continue until 378 patients with STEMI have been evaluated for the primary endpoint. Patients will be randomized 1:1 to a bolus of 250 mg methylprednisolone intravenous or matching placebo over a period of 5 min in the pre-hospital setting. All patients with STEMI transferred for primary PCI at Rigshospitalet, Copenhagen University Hospital, Denmark, will be screened for eligibility. The main eligibility criteria are age ≥ 18 years, acute onset of chest pain with < 12 h duration, STEMI on electrocardiogram, no known allergy to glucocorticoids or no previous coronary artery bypass grafting, previous acute myocardial infarction in assumed culprit, or a history with previous maniac/psychotic episodes. Primary outcome is final infarct size measured by late gadolinium enhancement on cardiac magnetic resonance (CMR) 3 months after STEMI. Secondary outcomes comprise key CMR efficacy parameters, clinical endpoints at 3 months, the peak of cardiac biomarkers, and safety. DISCUSSION We hypothesize that pulse-dose methylprednisolone administrated in the pre-hospital setting decreases inflammation and thus reduces final infarct size in patients with STEMI treated with primary PCI. TRIAL REGISTRATION EU-CT number: 2022-500762-10-00; Submitted May 5, 2022. CLINICALTRIALS gov Identifier: NCT05462730; Submitted July 7, 2022, first posted July 18, 2022.
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Affiliation(s)
- Jasmine Melissa Madsen
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | | | - Laura Rytoft
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, Copenhagen, Denmark, and Department of Cardiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Niels Vejlstrup
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lia Evi Bang
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jacob Thomsen Lønborg
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Ogyu K, Mashima Y, Nishi A, Kusudo K, Kato H, Kurose S, Uchida H, Fujisawa D, Mimura M, Takeuchi H. Intravenous pulse methylprednisolone and corticosteroid-induced psychiatric disorders: A retrospective study. J Psychosom Res 2023; 167:111179. [PMID: 36801660 DOI: 10.1016/j.jpsychores.2023.111179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/29/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Corticosteroids can cause psychiatric symptoms known as corticosteroid-induced psychiatric disorders (CIPDs). Little is known regarding the relationship between intravenous pulse methylprednisolone (IVMP) and CIPDs. Therefore, we aimed to examine the relationship between corticosteroid use and CIPDs in this retrospective study. METHODS Patients who were prescribed corticosteroids during their hospitalization at a university hospital and referred to our consultation-liaison service were selected. Patients diagnosed with CIPDs according to the ICD-10 codes were included. The incidence rates were compared between patients receiving IVMP and those receiving any other corticosteroid treatment. The association between IVMP and CIPDs was examined by classifying patients with CIPD into three groups according to the use of IVMP and timing of CIPD onset. RESULTS Of the 14,585 patients who received corticosteroids, 85 were diagnosed with CIPDs, with an incidence rate of 0.6%. Among the 523 patients who received IVMP, the incidence rate of CIPDs was 6.1% (n = 32), which was significantly higher than that in patients receiving any other corticosteroid treatment. Among the patients with CIPDs, 12 (14.1%) developed CIPDs during IVMP, 19 (22.4%) developed CIPDs after IVMP, and 49 (57.6%) developed CIPDs without IVMP. There was no significant difference in the doses at the time of CIPD improvement among the three groups when we excluded one patient whose CIPD improved during IVMP. CONCLUSION Patients receiving IVMP were more likely to develop CIPDs than those who did not receive IVMP. Furthermore, corticosteroid doses at the time of improvement of CIPDs were constant, regardless of IVMP use.
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Affiliation(s)
- Kamiyu Ogyu
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Yuki Mashima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Akira Nishi
- Department of Psychiatry, Sakuragaoka Memorial Hospital, Tokyo, Japan
| | - Keisuke Kusudo
- Department of Psychiatry, National Hospital Organization Chiba Medical Center, Chiba, Japan
| | - Hideo Kato
- Department of Epileptology, National Center of Neurology and Psychiatry Hospital, Tokyo, Japan
| | - Shin Kurose
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Department of Functional Brain Imaging, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Division of Clinical Safety, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyoshi Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
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Scolnik M, Brance ML, Fernández-Ávila DG, Inoue Sato E, de Souza AWS, Magri SJ, Saldarriaga-Rivera LM, Ugarte-Gil MF, Flores-Suarez LF, Babini A, Zamora NV, Acosta Felquer ML, Vergara F, Carlevaris L, Scarafia S, Soriano Guppy ER, Unizony S. Pan American League of Associations for Rheumatology guidelines for the treatment of giant cell arteritis. THE LANCET. RHEUMATOLOGY 2022; 4:e864-e872. [PMID: 38261393 DOI: 10.1016/s2665-9913(22)00260-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/20/2022] [Accepted: 08/30/2022] [Indexed: 11/27/2022]
Abstract
Considerable variability exists in the way that health-care providers treat patients with giant cell arteritis in Latin America, with patients commonly exposed to excessive amounts of glucocorticoids. In addition, large health disparities prevail in this region due to socioeconomic factors, which influence access to care, including biological treatments. For these reasons, the Pan American League of Associations for Rheumatology developed the first evidence-based giant cell arteritis treatment guidelines tailored for Latin America. A panel of vasculitis experts from Mexico, Colombia, Peru, Brazil, and Argentina generated clinically meaningful questions related to the treatment of giant cell arteritis in the population, intervention, comparator, and outcome (PICO) format. Following the grading of recommendations, assessment, development, and evaluation methodology, a team of methodologists did a systematic literature search, extracted and summarised the effects of the interventions, and graded the quality of the evidence. The panel of vasculitis experts voted on each PICO question and made recommendations, which required at least 70% agreement among the voting members to be included in the guidelines. Nine recommendations and one expert opinion statement for the treatment of giant cell arteritis were developed considering the most up-to-date evidence and the socioeconomic characteristics of Latin America. These recommendations include guidance for the use of glucocorticoids, tocilizumab, methotrexate, and aspirin for patients with giant cell arteritis.
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Affiliation(s)
- Marina Scolnik
- Rheumatology Unit, Department of Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Maria L Brance
- School of Medicine, National Rosario University, Santa Fe, Argentina
| | | | - Emilia Inoue Sato
- Medicine Department, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Sebastián J Magri
- Rheumatology Unit, Hospital Italiano de La Plata, La Plata, Argentina
| | | | | | - Luis F Flores-Suarez
- Primary Systemic Vasculitides Clinic, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Alejandra Babini
- Rheumatology Unit, Hospital Italiano de Cordoba, Cordoba, Argentina
| | | | - María L Acosta Felquer
- Rheumatology Unit, Department of Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Santiago Scarafia
- Rheumatology Unit, Hospital Municipal San Cayetano, Virreyes, Argentina
| | - Enrique R Soriano Guppy
- Rheumatology Unit, Department of Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sebastian Unizony
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Lai KC, Hsiao YH, Chen SC. Pulse corticosteroid therapy in the treatment of steroid-refractory immune checkpoint inhibitor-related pneumonitis: Case report and review. Front Immunol 2022; 13:994064. [PMID: 36119082 PMCID: PMC9471419 DOI: 10.3389/fimmu.2022.994064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) have demonstrated promising therapeutic outcomes in treating a variety of malignancies, but immune-related adverse events (irAE) may develop. Among all the irAE, immune-related pneumonitis was relatively common and life-threatening. High-dose corticosteroid was recommended for the initial management, but a part of patients developed steroid-refractory pneumonitis. Other immunosuppressants were recommended, but the optimal treatment is still controversial. Here, we report two cases of steroid-refractory immune-related pneumonitis who were successfully treated with pulse corticosteroid therapy. Case 1 was hepatocellular carcinoma treated with nivolumab for 5 months. She developed acute respiratory distress syndrome due to grade 4 immune-related pneumonitis that was refractory to intravenous methylprednisolone 2 mg/kg/day treatment. Methylprednisolone 500 mg for 3 days followed by 2 mg/kg/day steroid as maintenance therapy was given. Subsequently, her pneumonitis was regressed, and the endotracheal tube was successfully removed on day 9 after the start of pulse therapy. Case 2 presented with grade 4 immune-related pneumonitis in spite the use of methylprednisolone 1 mg/kg for his skin rash. Pulse corticosteroid therapy was prescribed, then his pneumonitis was completely regressed on day 12. In this report, we demonstrated the potential role of pulse corticosteroid therapy for steroid-refractory pneumonitis.
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Affiliation(s)
- Kuan-Chang Lai
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Han Hsiao
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - San-Chi Chen
- Division of Medical Oncology, Center for Immuno-oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- *Correspondence: San-Chi Chen,
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Tan RSJ, ng KT, Xin CE, Atan R, Yunos NM, Hasan MS. High Dose versus Low Dose Corticosteroids in COVID-19 patients: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth 2022; 36:3576-3586. [PMID: 35715291 PMCID: PMC9101704 DOI: 10.1053/j.jvca.2022.05.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/11/2022] [Accepted: 05/08/2022] [Indexed: 11/21/2022]
Abstract
Objectives The clinical efficacy of corticosteroids remains unclear. The primary aim of this systematic review and meta-analysis was to evaluate the use of high-dose versus low- dose corticosteroids on the mortality rate of COVID-19 patients. Design Systematic review and meta-analysis. Setting Electronic search for randomized controlled trials and observational studies (MEDLINE, EMBASE, CENTRAL). Participants Hospitalized adults ≥ 18 years old who were SARS-CoV-2 PCR positive. Interventions High-dose and low-dose corticosteroids. Measurements and Main Results A total of twelve studies (n=2759 patients) were included in this review. The pooled analysis demonstrated no significant difference in mortality rate between the high-dose and low-dose corticosteroids groups (n=2632; OR: 1.07 [95%CI 0.67, 1.72], p=0.77, I2=76%, trial sequential analysis=inconclusive). No significant differences were observed in the incidence of intensive care unit (ICU) admission rate (n=1544; OR: 0.77[95%CI 0.43, 1.37], p=0.37, I2= 72%), duration of hospital stay (n=1615; MD: 0.53[95%CI -1.36, 2.41], p=0.58, I2=87%), respiratory support (n=1694; OR: 1.51[95%CI 0.77, 2.96], p=0.23, I2=84%), duration of mechanical ventilation (n=419; MD: -1.44[95%CI -4.27, 1.40], p=0.32, I2=93%), incidence of hyperglycemia (n=516, OR: 0.91[95%CI 0.58, 1.43], p=0.68, I2=0%) and infection rate (n=1485, OR: 0.86[95%CI 0.64, 1.16], p=0.33, I2=29%). Conclusion The meta-analysis demonstrated high-dose corticosteroids did not reduce mortality rate. However, high-dose corticosteroids did not pose higher risk of hyperglycemia and infection rate for COVID-19 patients. Due to the inconclusive trial sequential analysis, substantial heterogeneity and low level of evidence, future large-scale randomized clinical trials are warranted to improve the certainty of evidence for the use of high-dose compared to low-dose corticosteroids in COVID-19 patients.
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Impact of previous corticosteroid exposure on outcomes of patients receiving immune checkpoint inhibitors for advanced non-small cell lung cancer: a retrospective observational study. Cancer Chemother Pharmacol 2022; 89:529-537. [PMID: 35301584 DOI: 10.1007/s00280-022-04416-4] [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: 01/09/2022] [Accepted: 03/02/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Immunosuppressive dosing of corticosteroids at the start of treatment impairs immune checkpoint inhibitor (ICI) efficacy in advanced non-small cell lung cancer (NSCLC). Previous cumulative dose and intake modality of corticosteroids may result in different levels of immunosuppression. We sought to determine whether these aspects could predict disease control and survival in NSCLC patients receiving ICIs. METHODS We conducted a retrospective single-center study, including patients treated with ICI as second-line therapy at our institution between July 2015 and February 2021. A prednisone equivalent threshold of 700 mg defined low (LCD) or high (HCD) cumulative dosing during the 90 days before starting ICIs. At least one 5-day course of ≥ 10 mg prednisone equivalent determined whether the intake was pulse (PCD, ≤ 5 days) or continuous (CCD, > 5 days). RESULTS We included 113 consecutive patients. Durable control benefit and no clinical benefit (NCB) were reported in 53 (47%) and 60 (53%) of the cases, respectively. ECOG PS 1-2, negative PD-L1 expression, HCD, and CCD were significantly related to NCB in multivariate analysis. The median PFS was 4.6 months (95%CI: 3.9-6.3) and median OS was 6.9 months (95% CI: 6.0-8.9) after a median follow-up time of 43.5 months (95% CI: 32.6-54.4). Multivariate analysis of survival confirmed ECOG PS 1-2 (p = 0.005), negative PD-L1 expression (p = 0.002), and CCD (p = 0.001) significantly correlated with an increased risk of mortality. CONCLUSIONS These findings imply that immunosuppressive corticosteroid dosing before ICIs, even of short duration, might affect survival. The constraints of this study and lack of reliable comparisons suggest a hypothesis-generating value of these results.
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Wada-Irimada M, Tsuchiyama K, Sasaki R, Hatchome N, Watabe A, Kimura Y, Yamasaki K, Aiba S. Efficacy and safety of i.v. methylprednisolone pulse therapy for vitiligo: A retrospective study of 58 therapy experiences for 33 vitiligo patients. J Dermatol 2021; 48:1090-1093. [PMID: 33768620 DOI: 10.1111/1346-8138.15858] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/17/2021] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
Systemic corticosteroid is indicated for vitiligo, especially for generalized and progressive vitiligo. However, no consensus exists yet for the dosages and modalities of systemic corticosteroid treatments for vitiligo. The purpose of this study is to validate the efficacy and safety of i.v. methylprednisolone pulse therapy (IVMP) for patients with progressive generalized vitiligo. We retrospectively reviewed the medical records of vitiligo patients treated in our institute for 10 years between January 2010 and December 2019. Among 525 vitiligo patients treated in 10 years, 33 vitiligo patients (aged, 8-78 years; 18 female and 15 males) received IVMP, a single course of daily 500 mg methylprednisolone application (8 mg/kg/day for children) for 3 consecutive days. We observed that 14 of 25 (56%) achieved stable condition without lesion progression, and 12 of 19 (63%) had more than 25% repigmentation at 6 months after IVMP. A group of Vitiligo Area Scoring Index over 10 included more patients with Vitiligo Disease Activity Score of +3 and +4 disease progression at 6 months after the IVMP. We did not observe any severe adverse events relating to the IVMP procedures. In conclusion, IVMP is a safe and effective treatment for progressive generalized vitiligo.
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Affiliation(s)
- Moyuka Wada-Irimada
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenichiro Tsuchiyama
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Rui Sasaki
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naokazu Hatchome
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akiko Watabe
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yutaka Kimura
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenshi Yamasaki
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Setsuya Aiba
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
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