Hydroxychloroquine in systemic lupus erythematosus and rheumatoid arthritis and its safety in pregnancy

Abarientos, C; Sperber, Kirk; Shapiro, Deborah L.; Aronow, Wilbert S.; Chao, Chun Peng; Ash, Julia

doi:10.1517/14740338.2011.566555

Cited by 87 publications

(60 citation statements)

References 74 publications

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“…A higher risk of premature rupture of membranes has been reported. Other relevant side effects include infectious risk, and the increased risk of gestational diabetes [346]CHydroxy-chloroquineThis synthetic anti-malaric agent crosses the placenta but was not found to be associated with foetal toxicity [217–219]B To be avoided [341 – 349]Cyclo-phosphamideThis alkylating agent is contraindicated in pregnancy; a few reports suggest that pregnancy termination is common in the case of inadvertent use or need for life saving therapy. A few positive reports, mainly in women with SLE are also available [68]DMycophenolateSevere foetal malformations are reported, mainly involving cardiovascular and cranial malformations.…”

Section: Indications and Goals For Follow-upmentioning

confidence: 99%

A best practice position statement on pregnancy in chronic kidney disease: the Italian Study Group on Kidney and Pregnancy

Castellino²,

et al. 2016

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Pregnancy is increasingly undertaken in patients with chronic kidney disease (CKD) and, conversely, CKD is increasingly diagnosed in pregnancy: up to 3 % of pregnancies are estimated to be complicated by CKD. The heterogeneity of CKD (accounting for stage, hypertension and proteinuria) and the rarity of several kidney diseases make risk assessment difficult and therapeutic strategies are often based upon scattered experiences and small series. In this setting, the aim of this position statement of the Kidney and Pregnancy Study Group of the Italian Society of Nephrology is to review the literature, and discuss the experience in the clinical management of CKD in pregnancy. CKD is associated with an increased risk for adverse pregnancy-related outcomes since its early stage, also in the absence of hypertension and proteinuria, thus supporting the need for a multidisciplinary follow-up in all CKD patients. CKD stage, hypertension and proteinuria are interrelated, but they are also independent risk factors for adverse pregnancy-related outcomes. Among the different kidney diseases, patients with glomerulonephritis and immunologic diseases are at higher risk of developing or increasing proteinuria and hypertension, a picture often difficult to differentiate from preeclampsia. The risk is higher in active immunologic diseases, and in those cases that are detected or flare up during pregnancy. Referral to tertiary care centres for multidisciplinary follow-up and tailored approaches are warranted. The risk of maternal death is, almost exclusively, reported in systemic lupus erythematosus and vasculitis, which share with diabetic nephropathy an increased risk for perinatal death of the babies. Conversely, patients with kidney malformation, autosomal-dominant polycystic kidney disease, stone disease, and previous upper urinary tract infections are at higher risk for urinary tract infections, in turn associated with prematurity. No risk for malformations other than those related to familiar urinary tract malformations is reported in CKD patients, with the possible exception of diabetic nephropathy. Risks of worsening of the renal function are differently reported, but are higher in advanced CKD. Strict follow-up is needed, also to identify the best balance between maternal and foetal risks. The need for further multicentre studies is underlined.

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Section: Indications and Goals For Follow-upmentioning

confidence: 99%

A best practice position statement on pregnancy in chronic kidney disease: the Italian Study Group on Kidney and Pregnancy

Castellino²,

et al. 2016

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“…38, 39 Unfortunately, the immunomodulatory properties of these inhibitors have an adverse effect on antitumor immunity. 11, 40 Thus, clinically promising chemotherapeutical strategies based on combinations of autophagy inhibitors with conventional anticancer drugs currently face the limitation that autophagy inhibition is not restricted to cancer cells but also affects immune cells.…”

Section: Discussionmentioning

confidence: 99%

Disruption of autophagy by the histone deacetylase inhibitor MGCD0103 and its therapeutic implication in B-cell chronic lymphocytic leukemia

et al. 2014

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Evading apoptosis is a hallmark of B-cell chronic lymphocytic leukemia (CLL) cells and an obstacle to current chemotherapeutic approaches. Inhibiting histone deacetylase (HDAC) has emerged as a promising strategy to induce cell death in malignant cells. We have previously reported that the HDAC inhibitor MGCD0103 induces CLL cell death by activating the intrinsic pathway of apoptosis. Here, we show that MGCD0103 decreases the autophagic flux in primary CLL cells. Activation of the PI3K/AKT/mTOR pathway, together with the activation of caspases, and to a minor extent CAPN1, resulting in cleavage of autophagy components, were involved in MGCD0103-mediated inhibition of autophagy. In addition, MGCD0103 directly modulated the expression of critical autophagy genes at the transcriptional level that may contribute to autophagy impairment. Besides, we demonstrate that autophagy is a pro-survival mechanism in CLL whose disruption potentiates cell death induced by anticancer molecules including HDAC and cyclin-dependent kinase inhibitors. In particular, our data highlight the therapeutic potential of MGCD0103 as not only an inducer of apoptosis but also an autophagy suppressor in both combination regimens with molecules like flavopiridol, known to induce protective autophagy in CLL cells, or as an alternative to circumvent undesired immunomodulatory effects seen in the clinic with conventional autophagy inhibitors.

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“…Os estudos publicados não identificaram qualquer aumento no risco de malformações congénitas ou toxicidade retiniana. [108][109][110][111][112][113] De acordo com o consenso da EULAR, a administração da hidroxicloroquina pode ser continuada durante toda a gestação. 5 A utilização de hidroxicloroquina parece segura durante a amamentação, verificando-se uma exposição mínima do lactente através do leite materno.…”

Section: Hidroxicloroquina (Categoria De Risco C Pela Fda)unclassified

Gravidez, Aleitamento e Fármacos em Dermatologia - Tratamento Sistémico

Cesar

Azevedo

Mota

2016

SPDV

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RESUMO -O crescente número de fármacos empregues na prática dermatológica e venereológica exige do dermatologista um conhecimento atualizado relativo à sua segurança. No caso particular de mulheres grávidas ou que amamentem, a decisão sobre se se deve ou não tratar com um determinado fármaco deve basear-se numa avaliação ponderada dos benefícios para a saúde materna e dos riscos potenciais para o bem-estar fetal ou do lactente. Quando estas doentes necessitam terapêuticas tópicas ou sistémicas, a maioria pode ser adequadamente tratada com opções consideradas seguras e eficazes. Na primeira parte deste artigo são abordados os dados mais recentes relativos à segurança de alguns dos medicamentos sisté-micos mais comummente usados em contexto dermatológico, na mulher em idade fértil. PALAVRAS-CHAVE -Agentes Dermatológicos/uso terapêutico; Aleitamento/efeito dos medicamentos; Complicações na Gravidez/quimioterapia; Doenças da Pele/quimioterapia; Doenças de Pele/tratamento; Gravidez. Pregnancy, Lactation and Drugs in DermatologySystemic Therapy ABSTRACT -The increasing number of drugs used in dermatological a venereological practice demands from the dermatologist INTRODUÇÃOAo tratar doentes grávidas ou durante o período de aleitamento é fundamental um conhecimento dos potenciais efeitos adversos dos medicamentos sobre o desenvolvimento do feto ou do lactente. O risco de teratogenicidade e a capacidade de cada fármaco ser excretado no leite materno permite, na maioria das ocasiões, optar por alternativas seguras no tratamento de doenças do foro dermatológico em mulheres durante o período gestacional e durante a amamentação.Este artigo de revisão tem por objetivo abordar os dados disponíveis referentes à segurança (ou falta dela) de alguns dos fármacos mais comummente prescritos em contexto dermatológico e venereológico nas mulheres em idade fér-til. A primeira parte deste artigo aborda os fármacos administrados por via sistémica e a segunda parte irá abordar os fármacos de aplicação local. Corticosteróides sistémicos (categoria de risco C pela Food Drug Administration -FDA)A dexametasona e a betametasona não sofrem metabolização placentária significativa, passando inalterados através da placenta.1 Já a prednisolona sofre conversão em metabolitos inativos pela placenta humana, o que limita a sua passagem para o embrião/feto, pelo que é a opção

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Hydroxychloroquine in systemic lupus erythematosus and rheumatoid arthritis and its safety in pregnancy

Cited by 87 publications

References 74 publications

A best practice position statement on pregnancy in chronic kidney disease: the Italian Study Group on Kidney and Pregnancy

A best practice position statement on pregnancy in chronic kidney disease: the Italian Study Group on Kidney and Pregnancy

Disruption of autophagy by the histone deacetylase inhibitor MGCD0103 and its therapeutic implication in B-cell chronic lymphocytic leukemia

Gravidez, Aleitamento e Fármacos em Dermatologia - Tratamento Sistémico

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