This case demonstrates a probable relationship between the rate of infusion of iloprost and the paradoxical reaction of Raynaud phenomenon.
Introducción: Ustekinumab surge como una alternativa terapéutica en enfermedad de Crohn en pacientes con fracaso a anti-TNF. Sin embargo, en muchas ocasiones, es habitual tener que reducir/acortar sus tiempos de administración para evitar el fracaso terapéutico. El objetivo de esta revisión sistemática es evaluar la efectividad de la intensificación de ustekinumab mediante el acortamiento de su intervalo terapéutico. Método: Se realizó una revisión sistemática de la literatura basada en las directrices de la declaración PRISMA. Se consultaron las bases de datos Medline, Embase y Web of Science, incluyéndose estudios con adultos diagnosticados de enfermedad de Crohn moderada o grave a los que se le hubiera realizado como intervención un cambio de posología del fármaco ustekinumab mediante acortamiento de intervalo a cada 4 semanas. Resultados: Se incluyeron 5 artículos, siendo uno de ellos una revisión sistemática. A los 6 meses se muestran tasas de remisión clínica en torno al 45%, una reducción media de 3 puntos en el índice de Harvey Bradshaw sobre el nivel basal, así como una normalización de niveles de PCR en un 21% de los pacientes. Conclusiones: Los resultados apoyan el uso del acortamiento de intervalo de ustekinumab como una opción terapéutica efectiva y útil para pacientes con pérdida de respuesta a la pauta habitual. Sin embargo, se recomienda realizar nuevos estudios de diseño experimental que aumenten el nivel de evidencia existente.
BackgroundDesensitisation has been used for some decades now so that patients can be treated with the drug causing the hypersensitivity reaction when an alternative drug with similar efficacy/safety is not available.PurposeTo describe the pemetrexed desensitisation protocol and our experience in one patient with a previous anaphylactic reaction to pemetrexed.Material and methodsA 43-year-old man with stage IV lung adenocarcinoma was treated with cisplatin-pemetrexed, followed by pemetrexed monotherapy 880 mg. During the nineteenth cycle he developed face and hand erythema with urticaria and general discomfort, resolved with dexchlorpheniramine and hydrocortisone.The patient underwent skin testing with pemetrexed 25 mg/ml and intradermal testing with different drug dilutions 1/10.000 to 1/10, obtaining a positive result.A published standardised 12-step desensitisation protocol developed by Castells MC et al.1 was adapted to pemetrexed desensitisation.ResultsThe drug was administered in the Medical Intensive Care Unit. Before admission the patient was premedicated with cetirizine 10 mg, ranitidine 150 mg, montelukast 10 mg and acetylsalicylic acid 300 mg (11–12 h before pemetrexed) and dexamethasone 20 mg (8 and 16 h before pemetrexed).On admission he was premedicated with intravenous ranitidine 50 mg, dexchlorpheniramine 5 mg and dexamethasone 8 mg 1 h before 3 sequential pemetrexed solutions (rate of infusion): a) 1/100 dilution: 0.0352 mg/ml (2, 5, 10 and 20 ml/h each for 15 min, b) 1/10 dilution: 0.352 mg/ml (5, 10, 20 and 40 ml/h each for 15 min) and c) dilution 1/1: 3.520 mg/ml (10, 20, 40 ml/ h each for 15 min and 75 ml/h until reaching the total amount of 880 mg).The patient was monitored continuously during desensitisation; no reactions occurred. The patient did not receive any more pemetrexed.ConclusionThe protocol was safe and well tolerated by our patient.Desensitisation protocols stand out as an alternative to the standard continuous treatment in patients who are allergic to their chemotherapy agents.ReferenceCastells MC, Tennant NM, Sloane DE, et al. Hypersensitivity reactions to chemotherapy: outcomes and safety of rapid desensitization in 13 cases. J Allergy Clin Immunol 2008;122(3):574–80No conflict of interest.
BackgroundToxic epidermal necrolysis (TEN) is a rare but severe cutaneous adverse reaction with a high rate of mortality and morbidity.PurposeTo report a case of TEN after abiraterone and zoledronic acid exposure.Material and methodsRetrospective review of the electronic medical record (Ianus) and records of chemotherapy ordered and dispensed (Farmis and Silicon).A literature search was conducted of keyword terms “abiraterone AND toxic epidermal necrolysis” and “zoledronic AND toxic epidermal necrolysis” in PubMed and EudraVigilance database until March 2014.The suspicion was reported to the pharmacovigilance centre.ResultsThe case involved a 74 year-old male without any history of drug allergies, diagnosed with prostate adenocarcinoma in 2004, who received a second-line treatment with abiraterone 1,000 mg/day, prednisone 10 mg/day and zoledronic with dose adjusted for renal function.48 h after zoledronic administration (15 days after starting abiraterone) fever and pruriginous erythema appeared on the chest, but later extended involving the face, oral and nasal mucosa and back of the hands, sloughing of 70% of the body surface area.SCORTEN scale, severity-of-illness score validated for TEN, was ≥4; mortality ≥60%.The patient received supportive care without complications, after 2 weeks had been discharged.No case reports were found in the published literature. This is the first case report in EudraVigivilance for abiraterone and the seventh for zoledronic.He was not re-exposed to the suspected offending agents zoledronic and abiraterone.The causality assessment of TEN was regarded as possible by pharmacovigilance centre for both drugs.ConclusionTEN is a rare life-threatening reaction; it is important for health care professionals to evaluate and report any severe reactions that may be associated with newly-marketed drugs.Post-marketing drug experience is needed to develop an accurate safety profile.ReferencesJ Invest Dermatol 2008;128:35–44Farm Hosp 2013;37:74–84No conflict of interest.
Introducción: Cabozantinib es un fármaco indicado en el tratamiento de cáncer renal y hepatocarcinoma con eficacia demostrada en ensayos clínicos. Sin embargo, cuando analizamos su perfil de seguridad, los propios ensayos pivotales muestran un elevado porcentaje de efectos adversos, siendo necesario en muchos casos reducir la dosis o interrumpir el tratamiento debido a la toxicidad. Por ello, nuestro estudio pretende analizar la tolerabilidad y seguridad de cabozantinib en nuestra población. Método: Estudio observacional, retrospectivo y unicéntrico. Se evaluaron diferentes variables relacionadas con la seguridad y tolerabilidad del fármaco. Para valorar la toxicidad se utilizaron los criterios del National Cancer Institute (CTCAE versión 5.0). La tolerancia se evaluó basándose en la presencia de efectos adversos durante el tratamiento con cabozantinib. Se realizó un análisis estadístico descriptivo e inferencial de los datos. Resultados: Se incluyeron un total de 17 pacientes (edad media: 63,5 años). Todos ellos presentaron efectos adversos. Las principales toxicidades presentadas de cualquier grado fueron astenia, diarrea, toxicidad cutánea, hipomagnesemia, hipertransaminemia y síndrome palmo-plantar. Un 41,2% fueron de grado 3, siendo las principales reacciones adversas la hipertransaminemia y la hipomagnesemia. Un 23,5% necesitaron un ingreso hospitalario debido a la toxicidad del fármaco. Un 94,1% de pacientes precisaron reducción de dosis por toxicidad a 40 mg. Conclusiones: Cabozantinib presenta un perfil de seguridad poco favorable con un alto porcentaje de efectos adversos que obligan a la reducción de dosis o a la interrupción del tratamiento.
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