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Kuehl B, Shear NH. The Evolution of Topical Formulations in Psoriasis. Skin Therapy Lett 2018; 23:5-9. [PMID: 30086183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Most people with mild-to-moderate psoriasis manage their disease with topical therapies. However, adherence to topical treatment remains a challenge, as the daily application creates a significant treatment burden. New topical therapeutic options need to offer higher efficacy and better patient acceptability, including easier application, to reduce treatment burden and enhance patient adherence. Topical foam vehicles are innovative alternatives to creams and ointments, addressing many patient challenges with traditional vehicles. Well-designed foam vehicles are easily spread over large areas of the skin, while importantly not leaving a greasy or oily film on the skin after application. Calcipotriol/betamethasone diproprionate aerosol foam is a new psoriasis treatment option that is rapidly effective, offers greater efficacy versus ointment and gel formulations, and has been shown to increase patient treatment satisfaction. Hence, by addressing the several crucial unmet clinical needs in patients with mild-to-moderate psoriasis, this optimized foam formulation is poised to improve treatment follow-through.
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Affiliation(s)
- B Kuehl
- Scientific Insights Consulting Group Inc., Mississauga, ON, Canada
| | - N H Shear
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
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Easaw JC, Shea-Budgell MA, Wu CMJ, Czaykowski PM, Kassis J, Kuehl B, Lim HJ, MacNeil M, Martinusen D, McFarlane PA, Meek E, Moodley O, Shivakumar S, Tagalakis V, Welch S, Kavan P. Canadian consensus recommendations on the management of venous thromboembolism in patients with cancer. Part 2: treatment. ACTA ACUST UNITED AC 2015; 22:144-55. [PMID: 25908913 DOI: 10.3747/co.22.2587] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Patients with cancer are at increased risk of venous thromboembolism (vte). Anticoagulation therapy is used to treat vte; however, patients with cancer have unique clinical circumstances that can often make decisions surrounding the administration of therapeutic anticoagulation complicated. No national Canadian guidelines on the management of established cancer-associated thrombosis have been published. We therefore aimed to develop a consensus-based, evidence-informed guideline on the topic. PubMed was searched for clinical trials and meta-analyses published between 2002 and 2013. Reference lists of key articles were hand-searched for additional publications. Content experts from across Canada were assembled to review the evidence and make recommendations. Low molecular weight heparin is the treatment of choice for cancer patients with established vte. Direct oral anticoagulants are not recommended for the treatment of vte at this time. Specific clinical scenarios, including the presence of an indwelling venous catheter, renal insufficiency, and thrombocytopenia, warrant modifications in the therapeutic administration of anticoagulation therapy. Patients with recurrent vte should receive extended (>3 months) anticoagulant therapy. Incidental vte should generally be treated in the same manner as symptomatic vte. There is no evidence to support the monitoring of anti-factor Xa levels in clinically stable cancer patients receiving prophylactic anticoagulation; however, levels of anti-factor Xa could be checked at baseline and periodically thereafter in patients with renal insufficiency. Follow-up and education about the signs and symptoms of vte are important components of ongoing patient care.
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Affiliation(s)
- J C Easaw
- Alberta: Department of Oncology, Faculty of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary (Easaw, Shea-Budgell); Cancer Strategic Clinical Network, Alberta Health Services, Calgary (Shea-Budgell); Division of Hematology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton (Wu); Guideline Utilization Resource Unit, CancerControl Alberta, Alberta Health Services, Calgary (Meek)
| | - M A Shea-Budgell
- Alberta: Department of Oncology, Faculty of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary (Easaw, Shea-Budgell); Cancer Strategic Clinical Network, Alberta Health Services, Calgary (Shea-Budgell); Division of Hematology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton (Wu); Guideline Utilization Resource Unit, CancerControl Alberta, Alberta Health Services, Calgary (Meek)
| | - C M J Wu
- Alberta: Department of Oncology, Faculty of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary (Easaw, Shea-Budgell); Cancer Strategic Clinical Network, Alberta Health Services, Calgary (Shea-Budgell); Division of Hematology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton (Wu); Guideline Utilization Resource Unit, CancerControl Alberta, Alberta Health Services, Calgary (Meek)
| | - P M Czaykowski
- Manitoba: Department of Medicine, University of Manitoba, Cancer Care Manitoba, Winnipeg (Czaykowski)
| | - J Kassis
- Quebec: Hôpital Maisonneuve-Rosemont, Montreal (Kassis); Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal (Tagalakis); Department of Oncology, Faculty of Medicine, McGill University, Montreal (Kavan)
| | - B Kuehl
- Ontario: Scientific Insights Consulting Group, Mississauga (Kuehl); Department of Medicine, St. Michael's Hospital Division of Nephrology, University of Toronto, Toronto (McFarlane); Department of Oncology, Western University, London (Welch)
| | - H J Lim
- British Columbia: Department of Medical Oncology, BC Cancer Agency, Vancouver (Lim); BC Provincial Renal Agency and Faculty of Pharmaceutical Sciences, University of British Columbia and Royal Jubilee Hospital, Victoria (Martinusen)
| | - M MacNeil
- Nova Scotia: Department of Medicine, Dalhousie University, Halifax (MacNeil); Department of Medicine, Dalhousie University and Capital District Health Authority, Halifax (Shivakumar)
| | - D Martinusen
- British Columbia: Department of Medical Oncology, BC Cancer Agency, Vancouver (Lim); BC Provincial Renal Agency and Faculty of Pharmaceutical Sciences, University of British Columbia and Royal Jubilee Hospital, Victoria (Martinusen)
| | - P A McFarlane
- Ontario: Scientific Insights Consulting Group, Mississauga (Kuehl); Department of Medicine, St. Michael's Hospital Division of Nephrology, University of Toronto, Toronto (McFarlane); Department of Oncology, Western University, London (Welch)
| | - E Meek
- Alberta: Department of Oncology, Faculty of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary (Easaw, Shea-Budgell); Cancer Strategic Clinical Network, Alberta Health Services, Calgary (Shea-Budgell); Division of Hematology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton (Wu); Guideline Utilization Resource Unit, CancerControl Alberta, Alberta Health Services, Calgary (Meek)
| | - O Moodley
- Saskatchewan: Department of Medicine, Division of Hematology, University of Saskatchewan, Saskatoon (Moodley)
| | - S Shivakumar
- Nova Scotia: Department of Medicine, Dalhousie University, Halifax (MacNeil); Department of Medicine, Dalhousie University and Capital District Health Authority, Halifax (Shivakumar)
| | - V Tagalakis
- Quebec: Hôpital Maisonneuve-Rosemont, Montreal (Kassis); Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal (Tagalakis); Department of Oncology, Faculty of Medicine, McGill University, Montreal (Kavan)
| | - S Welch
- Ontario: Scientific Insights Consulting Group, Mississauga (Kuehl); Department of Medicine, St. Michael's Hospital Division of Nephrology, University of Toronto, Toronto (McFarlane); Department of Oncology, Western University, London (Welch)
| | - P Kavan
- Quebec: Hôpital Maisonneuve-Rosemont, Montreal (Kassis); Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal (Tagalakis); Department of Oncology, Faculty of Medicine, McGill University, Montreal (Kavan)
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Easaw J, Shea–Budgell M, Wu C, Czaykowski P, Kassis J, Kuehl B, Lim H, MacNeil M, Martinusen D, McFarlane P, Meek E, Moodley O, Shivakumar S, Tagalakis V, Welch S, Kavan P. Canadian consensus recommendations on the management of venous thromboembolism in patients with cancer. Part 1: prophylaxis. Curr Oncol 2015; 22:133-43. [PMID: 25908912 PMCID: PMC4399610 DOI: 10.3747/co.22.2586] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Patients with cancer are at increased risk of venous thromboembolism (vte). Anticoagulation therapy has been shown to prevent vte; however, unique clinical circumstances in patients with cancer can often complicate the decisions surrounding the administration of prophylactic anticoagulation. No national Canadian guidelines on the prevention of cancer-associated thrombosis have been published. We therefore aimed to develop a consensus-based, evidence-informed guideline on the topic. PubMed was searched for clinical trials and meta-analyses published between 2002 and 2013. Reference lists of key articles were hand-searched for additional publications. Content experts from across Canada were assembled to review the evidence and make recommendations. Low molecular weight heparin can be used prophylactically in cancer patients at high risk of developing vte. Direct oral anticoagulants are not recommended for vte prophylaxis at this time. Specific clinical scenarios, including renal insufficiency, thrombocytopenia, liver disease, and obesity can warrant modifications in the administration of prophylactic anticoagulant therapy. There is no evidence to support the monitoring of anti-factor Xa levels in clinically stable cancer patients receiving prophylactic anticoagulation; however, factor Xa levels could be checked at baseline and periodically in patients with renal insufficiency. The use of anticoagulation therapy to prolong survival in cancer patients without the presence of risk factors for vte is not recommended.
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Affiliation(s)
- J.C. Easaw
- Alberta: Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary (Easaw, Shea– Budgell); Cancer Strategic Clinical Network, Alberta Health Services, Calgary (Shea–Budgell); Division of Hematology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton (Wu); Guideline Utilization Resource Unit, CancerControl Alberta, Alberta Health Services, Calgary (Meek)
| | - M.A. Shea–Budgell
- Alberta: Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary (Easaw, Shea– Budgell); Cancer Strategic Clinical Network, Alberta Health Services, Calgary (Shea–Budgell); Division of Hematology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton (Wu); Guideline Utilization Resource Unit, CancerControl Alberta, Alberta Health Services, Calgary (Meek)
| | - C.M.J. Wu
- Alberta: Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary (Easaw, Shea– Budgell); Cancer Strategic Clinical Network, Alberta Health Services, Calgary (Shea–Budgell); Division of Hematology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton (Wu); Guideline Utilization Resource Unit, CancerControl Alberta, Alberta Health Services, Calgary (Meek)
| | - P.M. Czaykowski
- Manitoba: Department of Medicine, University of Manitoba, Cancer Care Manitoba, Winnipeg (Czaykowski)
| | - J. Kassis
- Quebec: Hôpital Maisonneuve–Rosemont, Montreal (Kassis); Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal (Tagalakis); Department of Oncology, Faculty of Medicine, McGill University, Montreal (Kavan)
| | - B. Kuehl
- Ontario: Scientific Insights Consulting Group, Mississauga (Kuehl); Department of Medicine, St. Michael’s Hospital Division of Nephrology, University of Toronto, Toronto (McFarlane); Department of Oncology, Western University, London (Welch)
| | - H.J. Lim
- British Columbia: Department of Medical Oncology, BC Cancer Agency, Vancouver (Lim); BC Provincial Renal Agency and Faculty of Pharmaceutical Sciences, University of British Columbia and Royal Jubilee Hospital, Victoria (Martinusen)
| | - M. MacNeil
- Nova Scotia: Department of Medicine, Dalhousie University, Halifax (MacNeil); Department of Medicine, Dalhousie University and Capital District Health Authority, Halifax (Shivakumar)
| | - D. Martinusen
- British Columbia: Department of Medical Oncology, BC Cancer Agency, Vancouver (Lim); BC Provincial Renal Agency and Faculty of Pharmaceutical Sciences, University of British Columbia and Royal Jubilee Hospital, Victoria (Martinusen)
| | - P.A. McFarlane
- Ontario: Scientific Insights Consulting Group, Mississauga (Kuehl); Department of Medicine, St. Michael’s Hospital Division of Nephrology, University of Toronto, Toronto (McFarlane); Department of Oncology, Western University, London (Welch)
| | - E. Meek
- Alberta: Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary (Easaw, Shea– Budgell); Cancer Strategic Clinical Network, Alberta Health Services, Calgary (Shea–Budgell); Division of Hematology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton (Wu); Guideline Utilization Resource Unit, CancerControl Alberta, Alberta Health Services, Calgary (Meek)
| | - O. Moodley
- Saskatchewan: Department of Medicine, Division of Hematology, University of Saskatchewan, Saskatoon (Moodley)
| | - S. Shivakumar
- Nova Scotia: Department of Medicine, Dalhousie University, Halifax (MacNeil); Department of Medicine, Dalhousie University and Capital District Health Authority, Halifax (Shivakumar)
| | - V. Tagalakis
- Quebec: Hôpital Maisonneuve–Rosemont, Montreal (Kassis); Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal (Tagalakis); Department of Oncology, Faculty of Medicine, McGill University, Montreal (Kavan)
| | - S. Welch
- Ontario: Scientific Insights Consulting Group, Mississauga (Kuehl); Department of Medicine, St. Michael’s Hospital Division of Nephrology, University of Toronto, Toronto (McFarlane); Department of Oncology, Western University, London (Welch)
| | - P. Kavan
- Quebec: Hôpital Maisonneuve–Rosemont, Montreal (Kassis); Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal (Tagalakis); Department of Oncology, Faculty of Medicine, McGill University, Montreal (Kavan)
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Yan H, Solozobova V, Zhang P, Armant O, Kuehl B, Brenner-Weiss G, Blattner C. p53 is active in murine stem cells and alters the transcriptome in a manner that is reminiscent of mutant p53. Cell Death Dis 2015; 6:e1662. [PMID: 25719246 PMCID: PMC4669809 DOI: 10.1038/cddis.2015.33] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 12/15/2014] [Accepted: 01/15/2015] [Indexed: 12/30/2022]
Abstract
Since it was found that p53 is highly expressed in murine embryonic stem cells, it remained a mystery whether p53 is active in this cell type. We show that a significant part of p53 is localised in the nucleus of murine embryonic stem cells and that the majority of this nuclear p53 is bound to DNA. According to its nuclear localisation, we show that p53 alters the transcriptional program of stem cells. Nevertheless, the anti-proliferative activity of p53 is compromised in stem cells, and this control is due, at least in part, to the high amount of MdmX that is present in embryonic stem cells and bound to p53. Instead of the anti-proliferative activity that p53 has in differentiated cells, p53 controls transcription of pro-proliferative genes in embryonic stem cells including c-myc and c-jun. The impeded anti-proliferative activity of p53 and the induction of certain proto-oncogenes by p53 in murine embryonic stem cells can explain why stem cells proliferate efficiently despite having high levels of p53.
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Affiliation(s)
- H Yan
- 1] Karlsruhe Institute of Technology, Institute of Toxicology and Genetics, Karlsruhe, Germany [2] University of Heidelberg, Heidelberg, Germany
| | - V Solozobova
- Karlsruhe Institute of Technology, Institute of Toxicology and Genetics, Karlsruhe, Germany
| | - P Zhang
- 1] Karlsruhe Institute of Technology, Institute of Toxicology and Genetics, Karlsruhe, Germany [2] University of Heidelberg, Heidelberg, Germany
| | - O Armant
- Karlsruhe Institute of Technology, Institute of Toxicology and Genetics, Karlsruhe, Germany
| | - B Kuehl
- Karlsruhe Institute of Technology, Institute of Functional Interfaces, Karlsruhe, Germany
| | - G Brenner-Weiss
- Karlsruhe Institute of Technology, Institute of Functional Interfaces, Karlsruhe, Germany
| | - C Blattner
- Karlsruhe Institute of Technology, Institute of Toxicology and Genetics, Karlsruhe, Germany
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