China
Africa
Explore chapters and articles related to this topic
Urinary Tract Disease
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Pregnancy in KT are considered high risk and should be followed by an integrated multidisciplinary team including a transplant physician, nephrologist, diabetologist, and a maternal-fetal medicine specialist. Knowledge of what immunosuppressive agents can be used in pregnant KT patients, in order to avoid teratogenic medications. Azathioprine and steroids are the most often employed and best known drugs. Tacrolimus and cyclosporine are also frequently used in pregnancy. Mycophenolate mofetil is to be avoided as teratogenic, while only few studies have considered the use of m-Tor inhibitors, Rituximab, and Simulect in pregnancy, whose use is also discouraged (Table 17.9). Levels of calcineurin inhibitors (i.e cyclosporine, tacrolimus) should be checked monthly (consider twice monthly in the first and second trimester), to adjust doses when levels decrease [41, 42].
Immunomodulating Agents in Gastrointestinal Disease
Published in Thomas F. Kresina, Immune Modulating Agents, 2020
Samir A. Shah, Athos Bousvaros, A. Christopher Stevens
Mycophenolate mofetil has been principally utilized as rescue therapy in individuals with refractory renal allograft rejection and has received FDA approval for this use. Published studies of phase I and II trials suggest allograft rescue can occur in 50%-70% of patients with refractory renal allograft rejection (as defined by a need for high-dose steroids and/or anti-CD3) [185,186]. In addition, primary maintenance immunosuppression with MMF, prednisone, and CyA was associated with a low rate of allograft rejection [186]. The dose of MMF in human adults ranges from 2000 to 3500 mg/24 hr given in two divided doses; one study suggested that higher doses resulted in a decreased incidence of rejection [184].
Drugs Affecting the Musculoskeletal System
Published in Radhwan Nidal Al-Zidan, Drugs in Pregnancy, 2020
Risk Summary: The use of Mycophenolate Mofetil should be avoided in pregnant women because the pregnancy experience in humans has shown the risk of teratogenicity associated with the use of this drug.
Chitosan based controlled release drug delivery of mycophenolate mofetil loaded in nanocarriers system: synthesis and in-vitro evaluation
Published in Drug Development and Industrial Pharmacy, 2021
Muhammad Zaman, Asma Iqbal, Syed Farhan Haider Rizvi, Muhammad Ajaz Hussain, Talha Jamshaid, Muhammad Jamshaid
Mycophenolate mofetil (MMF) is an immunosuppressive agent and is used for the prophylaxis of organ rejection in patients after organ transplant. It ought to be used with cyclosporine and corticosteroids [9]. MMF belongs to Biopharmaceutical Classification System Class II, which means, having low solubility and high permeability [10]. Inside the body, MMF rapidly converts to MPA and acts by inhibiting the proliferation of B and T lymphocytes by inhibiting the de novo pathway of purine synthesis. MPA acts as an inosine monophosphate dehydrogenase inhibitor (IMPDH). Inosine monophosphate dehydrogenase is an enzyme required for the de novo synthesis of purines. As T and B cells rely solely on this pathway for the production of guanosine nucleotide, and thus their DNA, the proliferation of these cells is inhibited by MPA. Other cells can use both the de novo pathway and the salvage pathway for purine synthesis. The latter pathway is not dependent on the inosine monophosphate dehydrogenase and therefore is not affected by MMF. Thus, MMF not only blocks lymphocyte proliferation but also prevents humoral immune responses. Furthermore, by depleting guanosine triphosphate (GTP), MMF can inhibit the glycosylation of adhesion molecules and the binding of activated human lymphocytes to activated human endothelial cells [11–13].
Cytokine release syndrome after haploidentical hematopoietic stem cell transplantation with antithymocyte globulin: risk factors analysis and poor impact on outcomes for non-remisssion patients
Published in Hematology, 2021
Ziwei Xu, Xi Zhou, Xiaoyan Zhao, Xuan Lu, Liang Tang, Wei Shi, Han Yan, Yong You, Huafang Wang
All patients received uniform GVHD prophylaxis with rATG, tacrolimus, short-term methotrexate, mycophenolate mofetil, and basiliximab. Tacrolimus was administered orally twice daily at a dose of 0.05 mg/kg/d from day −3 to maintain blood levels between 5 and 10 ng/mL until day +60. If no aGVHD occurred, tacrolimus was tapered by 5% weekly and discontinued on the day +180. MTX was administered intravenously at dosages of 15 mg/m2 on day +1 and 10 mg/m2 on day +3, +6 and +11. Mycophenolate mofetil (1000 mg/d, orally twice daily) was administered from day +7. MMF was discontinued around day +60 if the patient was engrafted and free of GVHD, aGVHD and cGVHD were graded according to the consensus criteria [19,20]. Anti-CD25 MoAb (Basiliximab) was given intravenously at a dose of 20 mg on day 0 and days +4 [21,22]. ATG (Thymoglobulin, Sanofi, Paris, France) were administered intravenously at a dose of 2, 2.5 mg/kg, 3 mg/kg daily from day −3 to d −1. Conditioning regimens classified based on consensus criteria were mainly myeloablative conditioning [23].
An evaluation of baricitinib as a therapeutic option for adult patients with moderate to severe atopic dermatitis
Published in Expert Opinion on Pharmacotherapy, 2020
Jocelyn T. Mendes, Esther A. Balogh, Lindsay C. Strowd, Steven R. Feldman
Phototherapy is a second-line treatment modality utilized as monotherapy or in combination with topical agents [9]. Systemic immunomodulatory therapies are used off-label for moderate-to-severe AD that is recalcitrant to topical modalities [9]. Currently recommended systemic agents include cyclosporine, azathioprine, and methotrexate. Mycophenolate mofetil is an alternative agent for select cases, such as in patients with contraindications to the aforementioned therapies. However, systemic therapies are associated with serious adverse effects (SAE) and are used only for refractory AD. Systemic corticosteroids (SCS) are not routinely recommended and are utilized only during acute flares or as bridge-therapy to a steroid-sparing agent. SCS were the sole therapy approved by the U.S. Food and Drug Administration (FDA) for moderate-to-severe AD until dupilumab was approved in 2017 [10].