Bronchiolitis obliterans organizing pneumonia induced by drugs or radiotherapy
Philippe Camus, Edward C Rosenow in Drug-induced and Iatrogenic Respiratory Disease, 2010
Bucillamine is an anti-inflammatory agent developed in Japan with a structure similar to d-penicillamine. A 74-year-old woman with rheumatoid arthritis for 10 years had been taking bucillamine at 100 mg per day for 3 months and developed unproductive cough and shortness of breath.43 Fine crackles were detected at both lung bases. The chest X-ray showed patchy infiltrates bilaterally predominantly in the lower lungs. The chest CT scan showed ground-glass opacities adjoining bronchovascular bundles and air bronchograms with no honeycombing. The features were suggestive of BOOP. Because of severe hypoxaemia, a transbronchial biopsy and lavage were not performed. However, a drug lymphocyte stimulation test with bucillamine was positive. The bucillamine was discontinued and prednisolone 30 mg daily was given. She gradually improved, and by 2 months she had no cough or shortness of breath and the patchy infiltrates seen on the chest CT scan had nearly resolved.
What are the main challenges to the pharmacological management of cystinuria?
Published in Expert Opinion on Pharmacotherapy, 2020
Michael E. Rezaee, Andrew D. Rule, Vernon M. Pais
Although few, there are emerging potential pharmacological treatments for cystinuria. L-cystine dimethylester is a molecular imposter of L-cystine that is capable of inhibiting cysteine crystal growth in animal models [12]. However, this molecule has not yet been tested in humans. Further, selenium supplementation was recently shown to decrease cysteine crystal volume in a small cohort of cystinuria patients in the Middle East [13]. However, this finding requires further validation. Bucillamine, a third-generation di-thiol drug, is currently approved for rheumatoid arthritis in Asia. It has a lower side effect profile than tiopronin and D-penicillamine, but has not yet been evaluated in cystinuria [5]. Finally, α-lipoic acid (ALA) is a thiol-containing compound that is available as an over-the-counter supplement, shown to prevent cystine stone formation in animal models [14]. There is currently a Phase 2 clinical trial evaluating the efficacy of 1,200 mg of ALA three times a day in preventing cystine stone formation in cystinuria patients [15].
Expert opinion on emerging urate-lowering therapies
Published in Expert Opinion on Emerging Drugs, 2018
Lisa K Stamp, Tony R Merriman, Jasvinder A Singh
We have summarized select emerging therapies for gout in this editorial. Several potential new therapies are under investigation. Many emerging ULTs are uricosurics that lower SU by increasing its excretion, primarily by inhibition of URAT1, with added action on other urate-transporters such as OAT4, and OAT10. Bucillamine is being developed for its anti-inflammatory action (inhibition of interleukin-2) for the treatment of a gout flares. Arhalofenate with both urate-lowering as well as anti-inflammatory actions seems particularly attractive. A major challenge to the development and final regulatory pathway of these products hinges on establishing that these medications do not have unexpected adverse effects, and have sufficient efficacy to justify their approval for the treatment of gout.
Treatment of psoriatic arthritis complicated by systemic lupus erythematosus with the IL-17 blocker secukinumab and an analysis of the serum cytokine profile
Published in Modern Rheumatology Case Reports, 2020
Kojiro Sato, Yoshimi Aizaki, Yoshihiro Yoshida, Toshihide Mimura
A 36-year-old male with psoriasis was referred to the outpatient clinic of this department for the treatment of arthritis. He had been diagnosed approximately 5 years previously (200x – 5), with psoriasis vulgaris because of erythematous plaques on the trunk and extremities. He had since been treated with topical preparations, including corticosteroid. Three years later (200x – 2), he noted shoulder and wrist pain and was diagnosed with rheumatoid arthritis. Bucillamine (200 mg) was initiated but was not so effective. He was then diagnosed with PsA and bucillamine was switched to MTX. The laboratory test on that occasion revealed the positivity of antinuclear antibodies (1:320) as well as anti-double-stranded DNA (dsDNA) antibodies (58.0 IU/mL). Lymphocytopenia was also observed (701/μL). SLE comorbidity was suspected, and he was admitted to this hospital for further examination.
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