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Managing Adverse Effects and Drug Intolerance
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
Nikitas Alexander P. Skliros, Antonios A. Argyris, Athanase D. Protogerou
Adverse drug reactions can also be categorized according to their presentation as allergy, drug intolerance or side effect; these terms sometimes overlap. Allergy refers to a systematic response of immunological basis which is understood and studied (17,19,21–24). Side effects are adverse effects of the drug without an immunological background (e.g. cough caused by angiotensin-converting enzyme inhibitors or oedema caused by calcium channel blockers) occurring at normal doses and related to the pharmacological properties of the medication (1,14,15,17). They are quite common and well recognized. Drug intolerance is not so well defined, and its mechanisms of action are not well understood. This type of effect may be due in part to a pharmacological mode of action and in part to the patient’s susceptibility, and refers to any subjective or objective adverse reaction not included in the other two categories (25–28). The nocebo effect – that is, the appearance of an adverse effect after exposure to a non-harmful substance – may be a causative factor related to drug intolerance (29). Special patient characteristics such as anxiety and somatization connected with a nocebo effect can lead to a higher possibility of drug intolerance presentation (27,30). Intolerance to multiple antihypertensive drugs is strongly associated with panic attacks, anxiety and depression, and is also strongly associated with increased psychiatric morbidity (25).
Hypersensitivity and Urticaria
Published in Gabriella Fabbrocini, Mario E. Lacouture, Antonella Tosti, Dermatologic Reactions to Cancer Therapies, 2019
Cataldo Patruno, Maria Ferrillo, Maria Vastarella
However, reactions also may arise as a result of nonimmunologic mechanisms and caused by drug intolerance (idiosyncratic or pseudoallergic). Symptoms of a drug-induced pseudoallergic or anaphylactoid reaction resulting from the direct release of histamine and producing flushing, rash, pruritus, urticaria, hypotension, and mucous secretion can sometimes make it difficult to distinguish it from a true DHR. Symptoms are generally more severe in anaphylactic than in anaphylactoid reactions with cardiovascular collapse and bronchospasm occurring more frequently in the former and cutaneous manifestations seen more often in the latter (4).
Overview of HIV Infection
Published in Mark J. Rosen, James M. Beck, Human Immunodeficiency Virus and the Lung, 1998
ACTG 081 was a open-label, randomized trial that evaluated the effectiveness of three treatment strategies in preventing first-episode PCP in HIV-infected persons with CD4 lymphocyte counts of fewer than 200/um (124). The study arms were TMP-SMX (one double-strength tablet bid), dapsone (50 mg bid), or aerosolized pentamidine (300 mg once per month). Subjects experiencing drug intolerance were assigned to an alternative therapy in a prescribed manner: 842 patients were studied for a median follow-up of 39 months. There were 137 reported cases of PCP during the follow-up period. The estimated 36-month risk of PCP was 18%, 17%, and 21% (p = NS), respectively for TMP-SMX, dapsone, and aerosolized pentamidine. For persons with fewer than 100 CD4 cells per microliter, the risk was 33% for aerosolized pentamidine, compared with 19% with TMP-
Epidemiology of moderate-to-severe psoriasis: a comparison between psoriasis patients treated with biological agents, conventional systemic drugs and topical agents
Published in Journal of Dermatological Treatment, 2022
Emanuel Marques, Zoltán Paluch, Petr Boháč, Ondřej Slanař, Jaromír Běláček, Jana Hercogová
The objective was to study and compare a variety of comorbidities and epidemiological factors between 3 groups of psoriatic patients treated differently (Tables 2 and 3). Data was obtained by means of a questionnaire. During our study some patients were forced to rotate different agents within their stratum/type of therapy, while others had to be shifted to a different therapy type. The most common reasons were drug intolerance or loss of treatment efficacy. Concretely, 24 (8.3%) of our patients used both conventional systemic agents and biologics during our research period – from these 9 (3.1%) individuals used acitretin and methotrexate concomitantly with biological agents, the remaining 15 (5.2%) were treated with only one systemic agent at a time. For this reason, patients were included in as many groups as many therapy(ies) they had – that is, if a patient was on conventional systemic agents, but was later forced to initiate biological therapy, then he/she was included in both group 2 and 3. Patients using any form of therapy/agent for less than 8 weeks were not included in our research study. All patients were treated according to the recommendations of the Summary of Product Characteristics of each drug.
Bimekizumab: a dual IL-17A and IL-17F inhibitor for the treatment of psoriasis and psoriatic arthritis
Published in Expert Review of Clinical Immunology, 2021
Zara Ali, Raymond Matthews, Ali Al-Janabi, Richard B Warren
The role of the IL-23/IL-17 pathway in the pathogenesis of psoriasis and PsA is well established. Recent attempts to treat these conditions have focused on the development of biological inhibitors that target these immune pathways. Although there have been a number of therapies successfully brought to the clinic that have achieved high levels of efficacy, there remains a proportion of patients who fail to respond to therapy, and more who exhibit reduced response to current therapies as time progresses. The development of anti-drug antibodies, or adaptive changes to underlying immune-mediated process may lead to reduced response to therapy over time, whereas the emergence of adverse events and drug intolerance can prove as barriers to continuation of therapy. Therefore, there remains impetus to develop additional biological therapies with the remit of finding a treatment that can rapidly provide and maintain skin clearance with an acceptable safety profile in the majority of patients.
The Effect of Body Mass Index on Treatment Outcomes in Patients with Metastatic Non-Small Cell Lung Cancer Treated with Platinum-Based Therapy
Published in Nutrition and Cancer, 2021
Aysegul Sakin, Suleyman Sahin, Muhammed Mustafa atci, Nurgul Yasar, Cumhur Demir, Caglayan Geredeli, Abdullah Sakin, Sener Cihan
All patients received a platinum-based combination regimen; 167 (71.7%) patients received cisplatin (75 mg/m2 IV, on day 1, every 21 day) and 66 (28.3%) patients received carboplatin (AUC five IV, on day 1, every 21 day). Platine was combined with Gemcitabine (1000-1250mg/m2 IV, on day 1 and 8, every 21 day) in 100 (42.9%) patients, paclitaxel (175 mg/m2 IV, on day 1, every 21 day) in 43 (18.5%) patients, docetaxel (75 mg/m2 IV, on day 1, every 21 day) in 40 (17.2%) patients, pemetrexed (500 mg/m2 IV, on day 1, with B12 and Folic acid replacement, every 21 day) in 25 (10.7%) patients, and vinorelbine (40 mg/m2 IV, on day 1 and 8, every 21 day) in 25 (10.7%) patients. Eleven patients (4.7%) had complete response. The treatment in 16 (6.9%) patients was changed due to drug intolerance or side effects. In total, any grade of adverse events occurred in 104 (44.6%) patients. Eighty (35.1%) patients were able to receive a second-line ChT. The data regarding the treatments of the groups are summarized in Table 2.