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Biologic Therapies for Rheumatoid Arthritis
Published in Thomas F. Kresina, Monoclonal Antibodies, Cytokines, and Arthritis, 2020
Ian R. Mackay, Merrill J. Rowley, Claude C. A. Bernard
The CD4 T cell has an important role in both the afferent and efferent limbs of immune response. On the efferent side, the CD4 T cell may have cytotoxic potential per se but more probably mediates effects, including tissue damage, through the release of inflammatory cytokines, as exemplified by the cutaneous delayed-type hypersensitivity reaction. Biologic therapy directed to the CD4 T cell could limit both afferent and efferent processes. The containment of afferent activity of CD4 T cells is referred to in Sec. III.C, T Cell Antigen Receptor. Biologic therapy relevant to cytokines is discussed in the next section.
Advanced therapies and future treatments
Published in Gwyn Samuel Williams, Mark Westcott, Carlos Pavesio, Bushra Thajudeen, Practical Uveitis, 2017
Gwyn Samuel Williams, Mark Westcott
These medications were developed for use in rheumatology first and as things stand now, with a few notable exceptions, rheumatologists are still their masters with regards to inflammatory eye disease. Almost universally ophthalmologists do not prescribe or monitor biologic therapies for uveitis and our role is to recognise which patients could benefit and to send them to our rheumatology colleagues to do the needful. These medications delivered systemically are powerful and side effects and interactions can affect almost any part of the body, such that for now eye departments are not geared to take over controlling these medications. On top of this the funding system in the United Kingdom is such that it would be a nightmare if we had to organise our own biologic services and any attempt to transfer this responsibility to us should be resisted at all costs, unless your unit is very large or you have a special research interest. For this reason we do not go into detail on how to monitor these medications here. There are two main issues that concern us as ophthalmologists: How do we know which patients to send for biologic therapy?What are the various types of biologic therapy currently available?
Current biologic therapies (including IL-17) and monitoring guidelines
Published in M. Alan Menter, Caitriona Ryan, Psoriasis, 2017
Bruce E. Strober, Jenna M. Wald
Currently, there are five biologic therapies approved by the U.S. Food and Drug Administration (FDA) for the treatment of moderate-to-severe plaque psoriasis. These drugs can be classified as (1) tumor necrosis factor-alpha (TNF-α) inhibitors, (2) interleukin (IL)-12/23 inhibitors, and (3) IL-17 pathway inhibitors. As the number of targets of biologic therapies continues to broaden, it is important that practitioners follow both the FDA and specialty-specific recommendations for screening and monitoring patients on long-term treatment. This chapter will review the efficacy and adverse effects of each drug (and its class) and suggest pretreatment screening tests and ongoing monitoring that should be considered for each biologic therapy. Efficacy of treatments is described as the reduction of Psoriasis Area and Severity Index (PASI) score as reported in phase 3 clinical trials.
Mepolizumab for the treatment of chronic rhinosinusitis with nasal polyps in adults
Published in Expert Review of Respiratory Medicine, 2023
Josh Neposlan, Leigh J Sowerby, Ameen Biadsee
Major barriers to the widespread adoption of mepolizumab in the real world include uncertainties surrounding both the financial and physiological consequences of long-term treatment. The issue of cost remains a critical concern among clinicians who are considering biologics like mepolizumab for their patients. Biologic therapy has yet to be proven cost-effective compared to surgery as an initial intervention for refractory CRSwNP, but its use may be the right choice for some patients as repeat surgeries are common and confer a significant cost to patients and the healthcare system over time. Expert consensus currently recommends that patients with CRSwNP have at least one appropriate ESS with AMT prior to initiating treatment with biologics [61]. Treatment response should be evaluated regularly if biologic therapy is to be initiated, with clinical trials suggesting 16 weeks to be a threshold by which objective and subjective improvement should be seen.
Refractory systemic onset juvenile idiopathic arthritis: current challenges and future perspectives
Published in Annals of Medicine, 2022
William G. Ambler, Kabita Nanda, Karen Brandt Onel, Susan Shenoi
Combination biologic therapy may be beneficial in some refractory patients. One case series reports a 17 year old patient with SJIA with persistent systemic and arthritic disease on tocilizumab monotherapy and anakinra monotherapy (with concomitant methotrexate and glucocorticoids) [77]. However, when low doses of tocilizumab (2 mg/kg) and anakinra were used simultaneously, the patient achieved inactive disease. Abatacept has been used with success in combination with anakinra in a case series [59]. Abatacept, a soluble cytotoxic T-lymphocyte associated protein 4 fused the Fc portion of immunoglobulin (CTLA-4-Ig), inhibits T cell co-stimulation [60]. In this case series, 4 patients with glucocorticoid dependent disease despite use of anakinra, methotrexate, and cyclosporine had significant improvement in disease control and were able to reduce glucocorticoid dosage with the addition of abatacept Given the importance of T cells in the development of chronic synovitis in SJIA, this may be a promising option as add-on therapy. Despite the more frequent use of combination therapy, there is minimal data on the safety or efficacy of combination therapy.
Assessment of endoscopic response using pan-enteric capsule endoscopy in Crohn’s disease; the Sensitivity to Change (STOC) study
Published in Scandinavian Journal of Gastroenterology, 2022
Adriaan Volkers, Peter Bossuyt, Jitteke de Jong, Lieven Pouillon, Krisztina Gecse, Marjolijn Duijvestein, Cyriel Ponsioen, Geert D’Haens, Mark Löwenberg
Adult (≥18 years) CD patients with signs of active disease, based on clinical (Crohn’s disease activity Index (CDAI) >150 points) and biochemical (fecal calprotectin (FCP) >250 ug/g and/or C-reactive protein (CRP) >5 mg/L) parameters were approached to participate in this study. Patients were included if biologic therapy was indicated. If ulcers had been documented at endoscopy three months prior to screening, patients could also be included independent of CRP and FCP outcomes. Patients were excluded if they had a proven bowel stricture, active draining fistulas, a history of more than one IBD related bowel resection or (sub)total colectomy. Other exclusion criteria included short bowel syndrome, stoma, pacemaker or intra-cardiac device, pregnancy or an immediate need to undergo magnetic resonance imaging (MRI). A dissolvable patency capsule examination was performed in patients with clinical suspicion of intestinal strictures.