Systemic Immunomodulatory Drugs Research Articles

Use of immunomodulatory treatment for non-infectious uveitis: an International Ocular Inflammation Society report of real-world practice

BackgroundNon-infectious uveitis is a diverse group of inflammatory conditions that collectively account for substantial blindness worldwide. Expert guidelines and results of clinical trials guide treatment, but real-world clinical care is...

Immunomodulators for Non-Melanoma Skin Cancers: Updated Perspectives.

Non-melanoma skin cancers (NMSCs) are the most common cancers worldwide and may be associated with significant morbidity and mortality, especially in immunosuppressed populations. Successful management of NMSC must take primary, secondary and tertiary prevention strategies into consideration. In response to an improved understanding of the pathophysiology of NMSC and associated risk factors, multiple systemic and topical immunomodulatory drugs have been developed and integrated into clinical practice. Many of these drugs are efficacious in the prevention and treatment of precursor lesions (actinic keratoses; AKs), low-risk NMSC, and advanced disease. The identification of patients at high risk for the development of NMSC is critical in reducing disease morbidity. Understanding the various treatment options available and their comparative effectiveness is paramount for developing a personalized treatment regimen for such patients. This review article provides an updated overview of the various topical and systemic immunomodulatory drugs available for the prevention and treatment of NMSC, and the published data supporting their use in clinical practice.

Experience in managing psoriasis patients receiving targeted therapy during the COVID-19 pandemic

Introduction. With the onset of the COVID-19 pandemic the dermatological manifestations of the infection are widely discussed along with the correct management tactics for patients with severe chronic dermatoses, primarily those on immunosuppressive therapy. Immunocompromised patients are overly vulnerable to infections, which is especially important in the context of the pandemic. The article provides up-to-date literature information regarding the general risks of infection in patients receiving systemic immunomodulatory agents for the treatment of psoriasis, as well as evidence based treatment recommendations, including the example of our own clinical experience of using targeted therapy during the COVID-19 pandemic.Purpose of the study. The aim of the study was to analyze the therapeutic efficacy and safety of the systemic immunomodulatory drugs therapy in the context of the global COVID-19 pandemic.Materials and methods. The study included 142 patients with psoriasis receiving GEBD and small molecules therapy at the Department of Anti-Cytokine Therapy and Efferent Methods of Treatment of MNPCDK DZM. All patients were examined to determine their level of IgM and IgG antibodies to the SARS-CoV-2 virus strain in the blood serum. All patients continued to receive therapy according to their individual dosing regimen. The study was conducted at a time of high morbidity in the city of Moscow.Results. The overall morbidity among the studied patients was 13.4% of which the majority were patients with an asymptomatic course of the disease. It should be noted that there was a low incidence rate among patients receiving therapy with IL-17 inhibitors (secukinumab, netakimab).Conclusion. Our study confirms worldwide records that there is no evidence of an increased risk of COVID-19 among patients receiving targeted therapy for psoriasis. In our opinion, the discuntinuation of the current treatment can lead to unjustified risks, such as a relapse of psoriasis, including with severe manifestations and subsequent possible ineffectiveness when resuming therapy.Potentially, the termination of therapy that suppresses the production of proinflammatory cytokines will lead to an increase in the “cytokine storm” and a worsening of the course of viral infection when it occurs.

Clinical Features of Acute Anterior Uveitis with Complicated Course in a Slovenian Patient Population.

Purpose To report on patients who needed hospitalization due to acute anterior uveitis (AAU) and within this group to compare clinical features and outcomes of treatment of HLA-B27+ and HLA-B27− AAU in the population of Slovenian patients. Methods Retrospective study of hospitalized patients with AAU in the last 39 months at the Eye Hospital in Ljubljana. The data of AAU patients were retroactively studied and compared on the basis of HLA-B27 antigen presence: visual acuity upon admission, visual outcome, the presence of hypopyon, fibrinous reaction, posterior iris synechiae, and complications, such as elevated intraocular pressure, cataract, and cystoid macular edema (CME). We compared the investigations in the diagnostic process, the associated systemic disease, and the treatment administered. Statistical analyses included Student's t-test Fisher's exact test, and the Kolmogorov–Smirnov test. A p value of <0.05 was considered statistically significant. Results A total of 37 hospitalized patients with AAU were included. HLA-B27 antigen was detected in 73% of patients. In the HLA-B27+ group, women were more commonly affected, while the males were more affected in the HLA-B27− group. The occurrence of fibrin was significantly more common in HLA-B27+ patients, as well as hypopyon and posterior synechiae; only fibrin reached the statistical significance (p < 0.05). The incidence of cataracts, ocular hypertension, and glaucoma did not differ significantly between the two groups. HLA-B27+ AAU was more often associated with systemic diseases, and patients in this group were more frequently treated with systemic immunomodulatory drugs, however, no difference reached the statistical significance. We did not notice any major differences in the final visual acuity in the comparing groups. Conclusion Almost ¾ of AAU patients that required hospitalization were HLA-B27+. In this group, disease was more severe, more frequently associated with ocular complications and systemic disease, but final visual acuity was the same in both groups. HLA-B27 typing has no prognostic value in our group of complicated AAU patients, but it eases the decision about necessary diagnostics and treatment.

Comparative safety of systemic immunomodulatory medications in adults with atopic dermatitis

Severe atopic dermatitis (AD) is increasingly treated with systemic immunomodulatory drugs, yet their safety is unclear. We evaluated the comparative risk of serious bacterial and opportunistic infections among patients with severe AD using systemic immunomodulatory medications in routine care. In a population-based claims data study, we identified adult patients with AD who were treated with systemic drugs. The incidence of serious bacterial and opportunistic infections leading to hospitalization was computed by using International Classification of Disease diagnosis codes. Relative risks (RRs) were computed after 1-to-1 propensity score matching. Up to 232,611 patients with AD were eligible. The incidence of serious infections was 7.53 (7.18-7.89) risk per 1,000 patients among systemic nonbiologic-treated patients, 7.38 (5.68-9.57) risk per 1,000 patients among phototherapy-treated patients, and 2.6 (0.45-14.3) risk per 1,000 patients among dupilumab users. After matching, cyclosporine had a significantly reduced 6-month risk (RR 0.87) and prednisone (RR 1.78), azathioprine (RR 1.89), and mycophenolate (RR 3.31) showed increased risks compared with methotrexate. A small number of dupilumab users showed no increased risk (RR 0.33, 95% confidence interval 0.03-3.20). Some comparisons involved small population sizes. In this population-based study of adult AD patients, cyclosporine and methotrexate have the lowest 6-month risks of serious infections. Increased risks were observed for prednisone, azathioprine, and mycophenolate relative to methotrexate.

Orofacial granulomatosis in children − a review

Abstract: Orofacial granulomatosis (OFG) is an uncommon chronic inflammatory disorder that can present in childhood. It has a range of clinical manifestations with the common features being lip swelling and oral ulceration. It can be idiopathic or associated with systemic granulomatous conditions such as Crohn's disease and sarcoidosis. Patients presenting with features suggestive of OFG, with or without gastrointestinal symptoms, should be referred promptly to secondary care. The management of OFG is often challenging and includes dietary restrictions; topical, intralesional and systemic corticosteroids; and other systemic immunomodulatory drugs. This condition can lead to significant psychological morbidity for the child if left untreated. CPD/Clinical Relevance: Orofacial granulomatosis can present in childhood and its features may be first noted on routine check-up with a general dental practitioner (GDP).

Intravitreal Dexamethasone Implant for Treatment of Refractory Behçet Posterior Uveitis: One-year Follow-up Results

ABSTRACTPurpose: To investigate the results of dexamethasone (DEX) implant in the treatment of eyes with refractory Behçet posterior uveitis.Methods: A total of 17 eyes of 12 patients with active Behçet posterior uveitis were enrolled in the study. A single intravitreal injection of DEX implant was applied to each eye. Best corrected visual acuity (BCVA), central macular thickness (CMT), vitreous haze score, and intraocular pressure (IOP) were determined, at baseline and control visits of months 1, 3, 6, and 12.Results: The mean BCVA was significantly increased from baseline at each control visit (all p < 0.05). The mean CMT and vitreous haze score were significantly decreased from baseline at each control visit (all p < 0.05). Three eyes showed IOP spikes requiring topical anti-glaucomatous treatment.Conclusions: A single injection of DEX implant was safe and effective, as an additional treatment to systemic immunomodulatory drugs, in the treatment of refractory Behçet posterior uveitis, for a 6-month period.

Liposomal local therapy of sinunasal symptoms in ANCA associated vasculitis

GPA, eGPA and MPA constitute the group of AAV. ENT manifestations are part of the typical clinical picture of these diseases. Usually, patients are treated with systemic immunomodulatory drugs, mostly based on organ affection. In clinical routine, an insufficient decrease of sinunasal manifestations during a solely systemic therapeutic concept can repeatedly be -observed. Between February 2009 and November 2012, 20 patients with AAV were diagnosed in or referred to our department for further treatment. Clinical symptoms and manifestations were measured by the use of international accepted activity scores. The effect of a local therapy with liposomes for a period of 2 months on sinunasal symptoms was prospectively evaluated by using visual analogue scales and standardized questionnaires. Within the described collective 100% of patients did show ENT-symptoms at the time of initial diagnosis. Every patient did receive immunomodulatory therapy, but in 61.1% of cases there was just slight or no improvement on sinunasal symptoms. After a 2-month period of liposomal local therapy, a significant reduction of sinunasal complaints could be observed, both evaluated via visual analogue scales (p<0.001 to p=0.014, depending on the evaluated symptom) and standardized questionnaires (p<0.001). The local application of liposomes in addition to a systemic therapy is effective in alleviating sinunasal manifestations in patients with AAV.

Klinik und Therapie chronisch rezidivierender Aphthen

Recurrent aphthous ulcers are the most common inflammatory lesions of the oral mucosa, occurring in up to 10% of the population and even more common in children. The history, morphological characteristics, predilection sides and typical stages of aphthae help to distinguish them from other diseases that may exhibit aphthous-like lesions. Underlying diseases should be excluded. The main goals of therapy are to minimize pain and functional disabilities as well as decrease frequency and severity of recurrences. Topical symptomatic relief is the standard of care for simple cases of recurrent aphthosis. In cases of major aphthosis or systemic involvement, topical therapies are still useful but should be combined with systemic therapy, such as colchicine, pentoxifylline or prednisolone. In case of Adamantiades-Behçet disease, systemic immunomodulatory drugs can inhibit the development of new lesions. This overview summarizes morphological and presentation forms of aphthae, differential diagnoses and evidence-based therapeutic possibilities.

Graft rejection in keratoplasty ‐ what are the benefits of systemic immune modulation?

AbstractPurpose Graft rejection is one of the major causes of corneal transplant failure after keratoplasty, especially in case of an ocular or systemic inflammatory disease. To reduce the patient’s immune reaction against the corneal allograft, topical or systemic immunosuppression is a clinical necessity. This talk provides an overview of the benefits of systemic immunosuppression and of its indications.Methods The advantages and disadvantages of the use of systemic immunomodulatory drugs in the prevention of corneal allograft rejection after keratoplasty will be analyzed and demonstrated.Results Various systemic immunomodulatory drugs are available to prevent or to reduce the risk of corneal allograft rejection. The use of systemic immunosuppressive drugs may be limited by side effects.Conclusion Systemic immunosuppression prolongs corneal allograft survival and reduces the risk of graft rejections. While the use of systemic immunosuppressive drugs is beneficial in the perioperative stage, the long‐term‐use is restricted to high‐risk settings.