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Miscellaneous Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Immunosuppressants reduce the immune response by toxic effects on, downregulation of, and/or decreased production of immune system components, especially T cells. A higher incidence of neoplastic disease is associated with chronic long-term use of immunosuppressants with risk increasing above the general population within five years of transplant (Nasser-Ghodsi et al., 2021). The relevance of this association with exposure in utero is unknown.
Allergic and Immunologic Reactions
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Saira N. Agarwala, Aspen R. Trautz, Sylvia Hsu
Management: Treatment includes bed rest and leg elevation, NSAIDs, salicylates, and saturated solution of potassium iodide (450–1500 mg/day) if indicated. In resistant or recurrent cases, other systemic immunosuppressants can be considered. When determined, the management of the underlying condition is key.
The Host Response to Grafts and Transplantation Immunology
Published in Julius P. Kreier, Infection, Resistance, and Immunity, 2022
A wide variety of immunosuppressive drugs and treatments have been evaluated in clinical transplantation studies. Many procedures like high energy irradiation, which destroys all dividing cells, or thoracic duct drainage, which removes graft reactive T cells, are either too destructive or too complicated to be practical. Many drugs, like cyclophosphamide, are similar to irradiation in that the negative effects of the treatment exceed the benefits. These treatments are often so immunosuppressive that they leave the patient too susceptible to infection and cancer. Immunosuppressive drugs that improve graft acceptance with minimal undesirable side effects that are in general use today are azathioprine, prednisone, anti-TCR monoclonal antibodies, antilymphocyte globulin, Cyclosporine A, and FK506. The various immunosuppressants operate by different mechanisms. In fact, therapeutic strategies use combinations of these drugs in controlling acute graft rejection.
Shedding light on key pharmacological knowledge and strategies for pediatric atopic dermatitis
Published in Expert Review of Clinical Pharmacology, 2023
Ariana Moreno, Yael Renert-Yuval, Emma Guttman-Yassky
When AD cannot be controlled by topical medications, systemic therapy is often the last option, especially in pediatric patients. The most used systemic treatments for severe pediatric AD refractory to other agents, including dupilumab, are cyclosporine, followed by methotrexate, mycophenolate, azathioprineazathioprine, and rarely oral corticosteroids, as reported by a survey from the Society for Pediatric Dermatology [136]. The most common concerns associated with systemic immunosuppressants includes adverse events and the potential risk for toxicity, which are increased with long termlong-term use [136]. It is recommended to consider alternative concurring diagnoses, optimize topical therapy (including coexisting infections), avoid AD triggers, improve patient and caregiver education, carefully assess the impact on quality of life, and to consider the option for a phototherapy trial prior to initiating systemic immunosuppressants [137,138].
Comparison between outcomes of IgA nephropathy with nephrotic-range proteinuria and nephrotic syndrome: do podocytes play a role?
Published in Renal Failure, 2022
Yizhen Chen, Aicheng Yang, Yuansheng Hou, Longhui Liu, Jiehua Lin, Xiaodan Huang, Jundu Li, Xusheng Liu, Fuhua Lu, Qizhan Lin, Haifeng Yang, Shuling Yue, Shujun Jiang, Lixin Wang, Chuan Zou
In this study, all clinical data were obtained for all patients during renal biopsies, including gender, age, mean arterial pressure (MAP) defined as diastolic pressure plus one-third of the pulse pressure, 24-h urinary protein excretion, serum albumin (ALB), body mass index (BMI), total cholesterol (TC), triglyceride (TG), serum creatinine (Scr) and eGFR (calculated by the CKD-EPI equation). The urine protein-to-creatinine ratio (UPCR) was recorded at 6 months and the last follow-up. In terms of medication, regardless of the duration and dose, immunosuppression was defined as treatment with corticosteroids and/or immunosuppressant (cyclophosphamide, tacrolimus, mycophenolate, etc.). RASi was defined as treatment with angiotensin-converting-enzyme inhibitors (ACEi) and angiotensin-receptor-blockers (ARB) after renal biopsy.
5 reasons to encourage anti-SARS-CoV-2 vaccination in patients with rheumatic diseases
Published in Expert Review of Clinical Immunology, 2021
Francesca Motta, Carlo Selmi, Maria De Santis
Regarding the timing of immunomodulatory therapy in relation to vaccination, the guidance was given with the intent of optimizing response to the vaccine, assuming that patients have a controlled disease allowing for temporary drug discontinuation. According to these recommendations, all drugs should be continued around the time of single or double vaccine administration while methotrexate, JAK inhibitors, abatacept, cyclophosphamide, and rituximab should be withhold or their timing modified for vaccination. A definite consensus was not reached for vaccination timing in patients receiving prednisone-equivalent doses ≥20 mg per day [3]. While recommendations are quite consistent, the appropriate withholding of immunosuppressants for vaccination should be evaluated in light of immunization obtained and the risks of disease flares should be carefully gauged in each case.