RESUMEN
BACKGROUND: The aim of this retrospective study was to evaluate the dual efficacy of tocilizumab (TCZ) in the treatment of ICI-related arthritis (ICI-AR) and the prevention of relapses after rechallenge. PATIENTS AND METHODS: We identified 26 patients with ICI-AR. The primary objectives were to evaluate TCZ efficacy in ICI-AR treatment and as secondary prophylaxis during ICI rechallenge in 11 of them. Patients received prednisone (CS) at 0.3 mg/kg tapered at 0.05 mg/kg weekly for six weeks. TCZ was administered at a dose of 8 mg/kg Q2w. In the subgroup receiving secondary prophylaxis (rechallenge n=11), TCZ was reintroduced with the same regimen concurrently with ICI rechallenge, and without the addition of CS. A control group of patients (rechallenge n=5) was rechallenged without TCZ. Secondary endpoints included post rechallenge evaluation of ICI duration, reintroduction of CS > 0.1 mg/kg/day, ICI-RA flares, and DCR. RESULTS: The median age of the patients was 70 years. The median follow-up from ICI initiation was 864 days. Among the 20 patients treated with TCZ for ICI-AR, all (100%) achieved an ACR70 response rate, defined as greater than 70% improvement, at 10 weeks. 81% of these patients achieved steroid-free remission after 24 weeks on TCZ. The median follow-up period was 552 days in rechallenged patients. The results demonstrated a reduction in ICI-AR relapses upon ICI rechallenge in patients receiving TCZ prophylaxis as compared to patients who did not receive prophylaxis (17% vs 40%). The requirement for CS was completely abolished with prophylaxis (0% vs 20%), and the mean duration of ICI treatment was notably extended from 113 to 206 days. The 12-month post-rechallenge outcomes showed a disease control rate (DCR) of 77%. During TCZ prophylaxis, CXCL9 remained elevated, showing no decline from their levels at the onset of ICI-AR CONCLUSIONS: In addition to treating ICI-AR, TCZ demonstrated efficacy as a secondary prophylactic agent, preventing the recurrence symptoms and lengthening ICI treatment duration after ICI rechallenge.
RESUMEN
La comprobada acción local de la lodopovidona sobre las proteínas y su efecto antiexudativo en el linfocele, complicación del paciente transplantado renal, nos indujó a usarlo en el tratamiento del hidrocele. En esta experiencia se realizó un ensayo clínico prospectivo en doce pacientes de la consulta urológica del Hospital Universitario de Caracas, con hidroceles no complicados, los cuales fueron tratados con lodopovidona al 10 por ciento, localmente después de aspirar su contenido. Todos los pacientes fueron evaluados pre y postoperatoriamente por examen clínico y ultrasonido escrotal. En control a los 2 y 4 meses probó la acción eficaz de la lodopovidona en la resolución completa del hidrocele, sin complicaciones importantes ni efectos colaterales