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Bourque DL, Neumayr A, Libman M, Chen LH. Treatment strategies for nitroimidazole-refractory giardiasis: a systematic review. J Travel Med 2022; 29:6340793. [PMID: 34350966 DOI: 10.1093/jtm/taab120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/24/2022]
Abstract
RATIONALE FOR REVIEW Giardiasis is one of the most common human protozoal infections worldwide. First-line therapy of giardiasis includes nitroimidazole antibiotics. However, treatment failure with nitroimidazoles is increasingly reported, with up to 45% of patients not responding to initial treatment. There is no clear consensus on the approach to the management of nitroimidazole-refractory giardiasis. This systematic review aims to summarize the literature on pharmacotherapy for nitroimidazole-refractory giardiasis. METHODS We conducted a systematic review of the literature to determine the optimal management strategies for nitroimidazole-refractory giardiasis. We searched Pubmed/MEDLINE, Embase and Cochrane library using the following search terms 'Giardia' AND 'treatment failure' OR 'refractory giardia' OR 'resistant giardia' with date limits of 1 January 1970 to 30 June 2021. We included all reports on humans, which described clinical outcomes of individuals with treatment refractory giardiasis, including case series and case reports. A descriptive synthesis of the data was conducted with pooling of data for interventions. KEY FINDINGS Included in this review were five prospective studies, three retrospective studies, seven case series and nine case reports. Across these reports, a wide heterogeneity of treatment regimens was employed, including retreatment with an alternative nitroimidazole, combination therapy with a nitroimidazole and another agent and monotherapy with non-nitroimidazole regimens, including quinacrine, paromomycin and nitazoxanide. Retreatment with a nitroimidazole was not an effective therapy for refractory giardiasis. However, treatment with a nitroimidazole in combination with albendazole had a cure rate of 66.9%. In the included studies, quinacrine monotherapy was administered to a total of 179 patients, with a clinical cure rate of 88.8%. Overall, quinacrine was fairly well tolerated. CONCLUSIONS Reports on the treatment of nitroimidazole-refractory giardiasis demonstrate a heterogeneous approach to treatment. Of these, quinacrine appeared to be highly effective, though more data on its safety are needed.
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Petitdemange A, Felten R, Sibilia J, Martin T, Arnaud L. Prescription strategy of antimalarials in cutaneous and systemic lupus erythematosus: an international survey. Ther Adv Musculoskelet Dis 2021; 13:1759720X211002595. [PMID: 34046091 PMCID: PMC8138289 DOI: 10.1177/1759720x211002595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/23/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Antimalarial agents (AMs), mainly hydroxychloroquine (HCQ) and chloroquine,
are the cornerstone of treatment of cutaneous and systemic lupus
erythematosus. However, many aspects of AM prescription remain empirical.
The aim of this study was to assess the modalities of AM prescription among
physicians treating patients with lupus and to verify the assumption that AM
use is heterogeneous and frequently at variance with international
guidelines. Methods: We performed an international cross-sectional study among physicians involved
in lupus care, using a web-based survey (from September 2019 to July 2020)
addressing the main controversial aspects of AM prescription. Results: A total of 298 physicians [median age: 42 (interquartile range: 17) years,
mainly internists and rheumatologists] from 35 countries participated to the
study. A total of 93% used HCQ as the first-line AM, 69.5% used fixed doses
of AMs (mainly 400 mg/day for HCQ) and only 37.9% adjusted the dose in case
of renal failure. The main reasons for measuring HCQ blood levels were
suspected non-adherence (55.7%) and failure of AM treatment (34.1%). In case
of AM failure, 58.0% added an immunosuppressive agent. In case of remission,
49.7% maintained the same dose of AM, whereas 48.3% reduced the dose.
One-third of respondents reported not following the American screening
guidelines on AM retinal toxicity and 40.9% started retinal screening from
the first year of treatment. Conclusion: This study highlights the strong heterogeneity of AM prescription in lupus,
as well as several key unmet needs regarding AMs. This may be improved by
developing more comprehensive recommendations and favoring dissemination
among physicians.
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Affiliation(s)
- Arthur Petitdemange
- Service de Rhumatologie, Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Renaud Felten
- Service de Rhumatologie, Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jean Sibilia
- Service de Rhumatologie, Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thierry Martin
- Service d'Immunologie Clinique et de Médecine Interne, Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Laurent Arnaud
- Service de Rhumatologie, Centre National de Référence des Maladies Autoimmunes et Systémiques Rares (RESO), Hôpital de Hautepierre, 1 Avenue Molière BP 83049, Strasbourg Cedex, 67098, France
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Garzel B, Hu T, Li L, Lu Y, Heyward S, Polli J, Zhang L, Huang SM, Raufman JP, Wang H. Metformin Disrupts Bile Acid Efflux by Repressing Bile Salt Export Pump Expression. Pharm Res 2020; 37:26. [PMID: 31907698 DOI: 10.1007/s11095-019-2753-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/26/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE The bile salt export pump (BSEP), a key player in hepatic bile acid clearance, has been the center of research on drug-induced cholestasis. However, such studies focus primarily on the direct inhibition of BSEP, often overlooking the potential impact of transcriptional repression. This work aims to explore the disruption of bile acid efflux caused by drug-induced BSEP repression. METHODS BSEP activity was analyzed in human primary hepatocytes (HPH) using a traditional biliary-clearance experiment and a modified efflux assay, which includes a 72-h pretreatment prior to efflux measurement. Relative mRNA and protein expressions were examined by RT-PCR and Western blotting, respectively. RESULTS Metformin concentration-dependently repressed BSEP expression in HPH. Although metformin did not directly inhibit BSEP activity, longer metformin exposure reduced BSEP transport function in HPH by down-regulating BSEP expression. BSEP repression by metformin was found to be AMP-activated protein kinase-independent. Additional screening of 10 reported cholestatic non-BSEP inhibitors revealed that the anti-cancer drug tamoxifen also markedly repressed BSEP expression and reduced BSEP activity in HPH. CONCLUSIONS Repression of BSEP alone is sufficient to disrupt hepatic bile acid efflux. Metformin and tamoxifen appear to be prototypes of a class of BSEP repressors that may cause drug-induced cholestasis through gene repression instead of direct BSEP inhibition.
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Affiliation(s)
- Brandy Garzel
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, 20 Penn Street, Baltimore, Maryland, 21201, USA
| | - Tao Hu
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, 20 Penn Street, Baltimore, Maryland, 21201, USA
| | - Linhao Li
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, 20 Penn Street, Baltimore, Maryland, 21201, USA
| | - Yuanfu Lu
- Key Laboratory of Pharmacology of Ministry of Education, Zunyi Medical University, Zunyi, China
| | - Scott Heyward
- BioIVT, 1450 S Rolling Road, Baltimore, Maryland, 21227, USA
| | - James Polli
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, 20 Penn Street, Baltimore, Maryland, 21201, USA
| | - Lei Zhang
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, 20993, USA
| | - Shiew-Mei Huang
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, 20993, USA
| | - Jean-Pierre Raufman
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, Maryland, 21201, USA.,VA Maryland Health Care System, 10 N. Greene Street, Baltimore, Maryland, 21201, USA
| | - Hongbing Wang
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, 20 Penn Street, Baltimore, Maryland, 21201, USA.
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Riley DS, Barber MS, Kienle GS, Aronson JK, von Schoen-Angerer T, Tugwell P, Kiene H, Helfand M, Altman DG, Sox H, Werthmann PG, Moher D, Rison RA, Shamseer L, Koch CA, Sun GH, Hanaway P, Sudak NL, Kaszkin-Bettag M, Carpenter JE, Gagnier JJ. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol 2017; 89:218-235. [PMID: 28529185 DOI: 10.1016/j.jclinepi.2017.04.026] [Citation(s) in RCA: 805] [Impact Index Per Article: 115.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/14/2017] [Accepted: 04/27/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Well-written and transparent case reports (1) reveal early signals of potential benefits, harms, and information on the use of resources; (2) provide information for clinical research and clinical practice guidelines, and (3) inform medical education. High-quality case reports are more likely when authors follow reporting guidelines. During 2011-2012, a group of clinicians, researchers, and journal editors developed recommendations for the accurate reporting of information in case reports that resulted in the CARE (CAse REport) Statement and Checklist. They were presented at the 2013 International Congress on Peer Review and Biomedical Publication, have been endorsed by multiple medical journals, and translated into nine languages. OBJECTIVES This explanation and elaboration document has the objective to increase the use and dissemination of the CARE Checklist in writing and publishing case reports. ARTICLE DESIGN AND SETTING Each item from the CARE Checklist is explained and accompanied by published examples. The explanations and examples in this document are designed to support the writing of high-quality case reports by authors and their critical appraisal by editors, peer reviewers, and readers. RESULTS AND CONCLUSION This article and the 2013 CARE Statement and Checklist, available from the CARE website [www.care-statement.org] and the EQUATOR Network [www.equator-network.org], are resources for improving the completeness and transparency of case reports.
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Affiliation(s)
- David S Riley
- Integrative Medicine Institute, 2437A NW Overton Street, Portland, OR 97210, USA; Helfgott Research Institute, 2220 SW 1st Ave, Portland, OR 97201, USA.
| | - Melissa S Barber
- Integrative Medicine Institute, 2437A NW Overton Street, Portland, OR 97210, USA
| | - Gunver S Kienle
- Senior Research Scientist, University of Freiburg, Fahnenbergplatz, 79085 Freiburg im Breisgau, Germany; Senior Research Scientist, Institute for Applied Epistemology and Medical Methodology at the University of Witten-Herdecke, Zechenweg 6, 79111 Freiburg im Breisgau, Germany
| | - Jeffrey K Aronson
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Tido von Schoen-Angerer
- Department of Pediatrics, Centre médical de La Chapelle, Chemin de Compostelle 7, 1212 Grand-Lancy, Genève, Switzerland; ACIM Institute, Filderklinik, Im Haberschlai 7, 70794 Filderstadt-Bonlanden, Germany
| | - Peter Tugwell
- Department of Medicine University of Ottawa, 451 Smyth Rd, Ottawa, ON, Canada K1H 8M5
| | - Helmut Kiene
- Senior Research Scientist, Institute for Applied Epistemology and Medical Methodology at the University of Witten-Herdecke, Zechenweg 6, 79111 Freiburg im Breisgau, Germany
| | - Mark Helfand
- Departmenty of Medical Informatics and C linical Epidemiology, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA
| | - Douglas G Altman
- University of Oxford, Center for Statistics - Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK
| | - Harold Sox
- Professor Medicine and of The Dartmouth Institute, Geisel School of Medicine at Dartmouth, 31 Faraway Lane, West Lebanon, NH 03784-4401, USA
| | - Paul G Werthmann
- Senior Research Scientist, Institute for Applied Epistemology and Medical Methodology at the University of Witten-Herdecke, Zechenweg 6, 79111 Freiburg im Breisgau, Germany
| | - David Moher
- Senior Scientist, Ottawa Methods Centre, Ottawa Hospital Research Institute, 501 Smythe Road, Ottawa, ON, Canada K1H 8L6
| | - Richard A Rison
- PIH Health Hospital-Whittier, Neurology Consultants Medicine Group, University of Southern California Keck School of Medicine, 12291 Washington Blvd # 303, Whittier, CA 90606, USA
| | - Larissa Shamseer
- Senior Scientist, Ottawa Methods Centre, Ottawa Hospital Research Institute, 501 Smythe Road, Ottawa, ON, Canada K1H 8L6
| | - Christian A Koch
- Professor of Medicine, Director - Endocrinology at the University of Mississippi Medical Center, 2500 N. State Street, Jacson, MS 39216, USA
| | - Gordon H Sun
- Medical Director of Inpatient Services at Rancho Los Amigos National Rehabilitation Center, 7601 Imperial Highway, Downey, CA 90242, USA
| | - Patrick Hanaway
- Cener for Functional Medicine, Cleveland Clinic, Mail Code H-18, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Nancy L Sudak
- Essentia Health - Duluth, 420 East First Street, Duluth, MN 55805-1951, USA
| | | | - James E Carpenter
- Department Chair, Orthopaedic Surgery, 24 Frank Lloyd Wright Drive, Lobby A, Ann Arbor, MI 48106, USA
| | - Joel J Gagnier
- Department of Orthopaedic Surgery, 24 Frank Lloyd Wright Drive, Lobby A, Ann Arbor, MI 48106, USA; Department of Epidemiology, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA
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