Novel diagnostic approaches and cost–benefit balance of treatment of immune-mediated and rare disease in the era of biologic drugs: Lessons from the 15th Turin Congress on Immune Pathology and Orphan Disease

Roccatello, Dario

doi:10.1016/j.autrev.2012.11.002

Cited by 4 publications

(1 citation statement)

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“…Since immunosuppressants are used to treat SLE patients who are not optimally controlled on other forms of therapy and because SLE is a chronic disease with persistent inflammatory disease activity, this paper further highlights the need for treatment options with better long-term safety profiles. Biologics, which have more targeted mechanisms of action, are now being used to treat immune-mediated disorders, such as SLE, and, in theory, use of these targeted agents may result in fewer drug-related adverse events than conventional immunosuppressants; however, the cost implications of using these treatments for SLE remain unknown [63, 64]. Belimumab is the first biologic therapy introduced for SLE, but has not been used for a sufficient period of time to calculate a cost-benefit analysis as has been done with biologics for some other conditions [65].…”

Section: Discussionmentioning

confidence: 99%

Adverse Event Burden, Resource Use, and Costs Associated with Immunosuppressant Medications for the Treatment of Systemic Lupus Erythematosus: A Systematic Literature Review

Oglesby

Shaul²,

Pokora³

et al. 2013

International Journal of Rheumatology

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This paper assessed the burden of adverse events (AEs) associated with azathioprine (AZA), cyclophosphamide (CYC), mycophenolate mofetil (MMF), methotrexate (MTX), and cyclosporine (CsA) in patients with systemic lupus erythematosus (SLE). Thirty-eight publications were included. Incidence of AEs ranged from 42.8% to 97.3%. Common AEs included infections (2.4–77%), gastrointestinal AEs (3.2–66.7%), and amenorrhea and/or ovarian complications (0–71%). More hematological cytopenias were associated with AZA (14 episodes) than MMF (2 episodes). CYC was associated with more infections than MMF (40–77% versus 12.5–32%, resp.) or AZA (17–77% versus 11–29%, resp.). Rates of hospitalized infections were similar between MMF and AZA patients, but higher for those taking CYC. There were more gynecological toxicities with CYC than MMF (32–36% versus 3.6–6%, resp.) or AZA (32–71% versus 8–18%, resp.). Discontinuation rates due to AEs were 0–44.4% across these medications. In summary, the incidence of AEs associated with SLE immunosuppressants was consistently high as reported in the literature; discontinuations due to these AEs were similar across treatments. Studies on the economic impact of these AEs were sparse and warrant further study. This paper highlights the need for more treatment options with better safety profiles.

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Section: Discussionmentioning

confidence: 99%

Adverse Event Burden, Resource Use, and Costs Associated with Immunosuppressant Medications for the Treatment of Systemic Lupus Erythematosus: A Systematic Literature Review

Oglesby

Shaul²,

Pokora³

et al. 2013

International Journal of Rheumatology

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Unique Topics and Issues in Rheumatology and Clinical Immunology

Selmi

2014

Clinic Rev Allerg Immunol

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Clinicians are facing unexpected issues in everyday practice, and these may become counterintuitive or challenging. Illustrative examples are provided by the hypersensitivity to universally used immunosuppressants such as corticosteroids or antibiotics such as beta-lactam. Secondly, additional issues are represented by the discovery of new pathogenetic mechanisms involved in rheumatoid and psoriatic arthritis or other chronic inflammatory diseases, genomic susceptibility to enigmatic diseases such as giant cell arteritis, or the shared role of specific mediators such as semaphorins. Third, the therapeutic armamentarium has dramatically changed over the past decade following the introduction of biotechnological drugs, and new mechanisms are being proposed to reduce adverse events or increase the drug effectiveness, particularly on cardiovascular comorbidities. Finally, rare diseases continue to represent difficult cases, as for Cogan's syndrome, with limited literature available for clinical recommendations. For these reason, the present issue of Clinical Reviews in Allergy and Immunology is timely and dedicated to these and other unique topics in clinical immunology and allergy. The aim of this issue is thus to help clinicians involved in internal medicine as well as allergists and clinical immunologists while discussing new pathways that will prove important in the near future.

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