Mechanisms of Action and Clinical Applications of Cytotoxic Drugs in Rheumatic Disorders

Nashel, David J.

doi:10.1016/s0025-7125(16)31021-5

Cited by 29 publications

(6 citation statements)

References 135 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The cytotoxic agent azathioprine has been implicated as an infection risk factor in several studies (12,15), but exonerated in others (7,13). With respect to CYC, several investigators have indicated that it does not generally increase the risk for nonfatal bacterial infections in SLE, although it does increase the likelihood of fungal and viral infections (1,18,19). It has also been suggested that the risk of infection during CYC treatment of active SLE is closely dependent on the dose of concomitantly administered corticosteroids (20).…”

mentioning

confidence: 99%

Risk factors for serious infection during treatment with cyclophosphamide and high‐dose corticosteroids for systemic lupus erythematosus

Pryor

Bologna

Kahl

1996

Arthritis & Rheumatism

213

122

View full text Add to dashboard Cite

Objective. To determine risk factors for serious infection during treatment with cyclophosphamide (CYC) and high-dose corticosteroids in systemic lupus erythematosus (SLE).Methods. Records of 100 SLE patients who had received CYC were examined for documentation of serious infections that occurred during CYC therapy and the subsequent 3 months.Results. Infection occurred in 45 of 100 patients during CYC therapy. Patients with infection were more likely to have multiple organ disease (4Wo versus 2Wo; P = OM), a lower nadir in the white blood cell (WBC) count (2,818 versus 3,558 celldpl; P = 0.02), and a higher maximum corticosteroid dose (195 versus 73 mg; P S 0.01) than patients without infection. Infection occurred with equal prevalence in those who received intravenous (IV) (39%) or oral (40%) CYC, but was more common with use of sequential IV and oral therapy (68%). By multivariate analysis, the strongest association with infection was a WBC nadir $3,000 cells/pl (odds ratio [OR] 2.8, 95% confidence interval [95% CI] 1.4-5.5) and use of sequential IV and oral CYC (OR 23, 95% CI 12-43), Infection occurred in more CYC-treated patients taking concomitant steroids than in those treated with high-dose steroids alone (45% versus 12%; P = 0.001). Fatal and opportunistic infections during CYC therapy were associated with a low WBC nadir and a high ma)rimum corticosteroid dose.Conelusion. Submitted for publication July 12, 1995; accepted in revised form March 11, 1996. the treatment regimen. The likelihood of infection in this setting is enhanced by CYC-induced reductions in the total WBC count C3, OOO cells/pl and by sequential IV and oral therapy. Both of these factors may be indicators of aggressive cytotoxic treatment, underscoring the need for close observation during treatment to minimize the risk of serious infection.

show abstract

mentioning

confidence: 99%

Risk factors for serious infection during treatment with cyclophosphamide and high‐dose corticosteroids for systemic lupus erythematosus

Pryor

Bologna

Kahl

1996

Arthritis & Rheumatism

213

122

View full text Add to dashboard Cite

show abstract

“…Prednisone (55,56) cyclosporine A (57), and azathioprine (58) have deleterious effects on whole-body and muscle protein metabolism. In particular, steroids have been shown to mainly stimulate protein breakdown and amino acid oxidation and to directly antagonize insulin action at the muscle site; cyclosporin and azathioprine have been shown to inhibit, with different mechanisms, intracellular protein synthesis.…”

Section: Discussionmentioning

confidence: 99%

Combined pancreas and kidney transplantation normalizes protein metabolism in insulin-dependent diabetic-uremic patients.

Luzi¹,

Battezzati²,

Perseghin³

et al. 1994

J. Clin. Invest.

View full text Add to dashboard Cite

In order to assess the combined and separate effects of pancreas and kidney transplant on whole-body protein metabolism, 9 insulin-dependent diabetic-uremic patients (IDDUP), 14 patients after combined kidney-pancreas transplantation (KPTx), and 6 insulin-dependent diabetic patients with isolated kidney transplant (K-Tx), were studied in the basal postabsorptive state and during euglycemic hyperinsulinemia (study 1). 11-14ClLeucine infusion and indirect calorimetry were utilized to assess leucine metabolism. The subjects were studied again with a combined infusion ofinsulin and amino acids, given to mimic postprandial amino acid levels (study 2). Amol* m-2. min-') (P = NS vs. CON). During hyperinsulinemia (study 1), IDDUP showed a defective decrease of leucine (42% vs. 53%; P < 0.05), BCAA (38% vs. 47%, P < 0.05), ELF (28% vs. 33%, P < 0.05), and LO (0% vs. 32%, P < 0.05) with respect to CON. Isolated kidney transplant reverted the defective inhibition of ELF (34%, P = NS vs. CON) of IDDUP, but not the inhibition of LO (18%, P < 0.05 vs. CON) by insulin. Combined kidney and pancreas transplantation normalized all kinetic parameters of insulin-mediated protein turnover. During combined hyperinsulinemia and hyperaminoacidemia (study 2), IDDUP showed a defective stimulation of NOLD

show abstract

“…Langerhans hücrelerinin sayısını ve antijen sunma özelliklerini azaltır. T lenfosit fonksiyonlarını ve B lenfositlerinin antikor oluşumunu baskılar 2,7,8 . Immunsupresif özelliği dışında antiinflamatuar etkileri de olan azatiyoprinin 7 dermatolojideki kullanım alanı oldukça geniştir.…”

Section: Azatiyoprinunclassified

Dermatolojik hastalıkların tedavisinde immunmodülasyon

Özgen¹,

Seçkin²

2013

TURKDERM

View full text Add to dashboard Cite

ÖzetDermatolojide kullanılan topikal ya da sistemik tedavilerin çok büyük bir kısmının, hatta fiziksel tedavi yöntemlerinin bile etki mekanizmaları arasında immünolojik etkiler önemli yer tutmaktadır. Bu etkiler, tedavi edilen hastalığa göre değişmek üzere, immun sistemin baskılanması ya da stimüle edilmesi veya mevcut fonksiyonların değiştirilmesi yönünde olabilir. Bu makalede, dermatolojik hastalıkların tedavisindeki etkilerini başlıca immunmodülasyon yoluyla gösteren ilaçlar anlatılmaktadır. Makalede yer alan tedavi seçenekleri azatiyoprin, mikofenolat mofetil, siklosporin, glukokortikosteroidler, topikal kalsinörin inhibitörleri, foto(kemo)terapi, intravenöz immunglobulin, interferon, rituksimab, omalizumab, imiquimod ve ekstrakorporeal fotoferez, özellikle immunmodülasyon yönündeki etkilerini vurgulayan bir bakış açısıyla anlatılmış, bu ajanların kullanım şekillerine, tedavi protokollerine, tedavi sırasında monitörizasyon konusundaki önemli noktalara yer verilmemiştir. Sum maryImmunological effects have an important role in the action mechanisms of the majority of topical and systemic agents, and even some physical treatment modalities in dermatology. Depending on the disease being treated, these effects may be suppression or stimulation of the immune system as well as modulation of the existing functions. Agents that show their effects mainly by immunmodulation in the treatment of dermatological diseases are discussed in the present article. Treatment alternatives included in the article, azathioprine, mycophenolate mofetil, cyclosporine, glucocorticosteroids, topical calcineurin inhibitors, photo(chemo)therapy, intravenous immunoglobuline, interferon, rituximab, omalizumab, imiquimod and extracorporeal photopheresis are discussed focusing especially on their immunomodulatory effects without any mention on their prescribing details, treatment protocols and monitorization aspects. (Turkderm 2013; 47 Girişİmmun sistem, dermatolojik hastalıkların pek çoğunun patogenezinde önemli rol oynamaktadır. Dermatolojide kullanılan tedaviler, hastalık patogenezinde ön planda yer alan immünolojik mekanizmaları hedef alarak etki gösterebilmektedir. Bu etki, tedavi edilen hastalığa göre değişmek üzere, immun sistemin baskılanması ya da stimüle edilmesi veya mevcut fonksiyonların değiştirilmesi yönünde olabilir. Aslında dermatolojide kullanılan topikal ya da sistemik tedavilerin çok büyük bir kısmının, hatta fiziksel tedavi yöntemlerinin bile etki mekanizmaları arasında immünolojik etkiler önemli yer tutmaktadır. Bu makalede, dermatolojik hastalıkların tedavisindeki etkilerini başlıca immunmodülasyon yoluyla gösteren ilaçlar anlatılmaktadır. Ancak, immunmodülasyon, değişen derecede, pek çok dermatolojik tedavi ajanı için geçerli bir etki mekanizması olduğundan, bu makale, bu tedavilerin tümünü kapsamamaktadır. Ayrıca makalede yer alan tedavi seçenekleri, özellikle immunmodülasyon yönündeki etkilerini vurgulayan bir bakış açısıyla anlatılmış, kullanım şekilleri, yan etkileri, monitörizasyon gibi konulara ayrıntılı yer veri...

show abstract

Mechanisms of Action and Clinical Applications of Cytotoxic Drugs in Rheumatic Disorders

Cited by 29 publications

References 135 publications

Risk factors for serious infection during treatment with cyclophosphamide and high‐dose corticosteroids for systemic lupus erythematosus

Risk factors for serious infection during treatment with cyclophosphamide and high‐dose corticosteroids for systemic lupus erythematosus

Combined pancreas and kidney transplantation normalizes protein metabolism in insulin-dependent diabetic-uremic patients.

Dermatolojik hastalıkların tedavisinde immunmodülasyon

Contact Info

Product

Resources

About