RESUMO
BACKGROUND: The monoclonal antibody natalizumab (NAT) inhibits the migration of lymphocytes throughout the blood-brain barrier by blocking very late antigen (VLA)-4 interactions, thereby reducing inflammatory central nervous system (CNS) activity in patients with multiple sclerosis (MS). We evaluated the effects of different NAT treatment regimens. METHODS: We developed and optimised a NAT assay to measure free NAT, cell-bound NAT and VLA-4 expression levels in blood and cerebrospinal fluid (CSF) of patients using standard and prolonged treatment intervals and after the cessation of therapy. RESULTS: In paired CSF and blood samples of NAT-treated MS patients, NAT concentrations in CSF were approximately 100-fold lower than those in serum. Cell-bound NAT and mean VLA-4 expression levels in CSF were comparable with those in blood. After the cessation of therapy, the kinetics of free NAT, cell-bound NAT and VLA-4 expression levels differed. Prolonged intervals greater than 4 weeks between infusions caused a gradual reduction of free and cell-bound NAT concentrations. Sera from patients with and without NAT-neutralising antibodies could be identified in a blinded assessment. The NAT-neutralising antibodies removed NAT from the cell surface in vivo and in vitro. Intercellular NAT exchange was detected in vitro. CONCLUSIONS: Incorporating assays to measure free and cell-bound NAT into clinical practice can help to determine the optimal individual NAT dosing regimen for patients with MS.
Assuntos
Fatores Imunológicos , Esclerose Múltipla , Natalizumab , Adulto , Anticorpos/farmacologia , Antígenos CD , Avaliação da Deficiência , Feminino , Citometria de Fluxo , Seguimentos , Humanos , Fatores Imunológicos/sangue , Fatores Imunológicos/líquido cefalorraquidiano , Fatores Imunológicos/uso terapêutico , Integrina alfa4beta1/metabolismo , Linfócitos/efeitos dos fármacos , Linfócitos/metabolismo , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/sangue , Esclerose Múltipla/líquido cefalorraquidiano , Esclerose Múltipla/tratamento farmacológico , Natalizumab/sangue , Natalizumab/líquido cefalorraquidiano , Natalizumab/uso terapêutico , Fatores de Tempo , Molécula 1 de Adesão de Célula Vascular/metabolismoRESUMO
Digital ulcers represent a major vascular complication of systemic sclerosis (SSc) and can be difficult to treat with the common vasodilators. Herein, we report on a 39-year-old patient with recalcitrant SSc-related digital ulcers treated successfully with sitaxentan (100 mg q.d.), a selective endothelin type A receptor antagonist. During the 6 months of treatment, we noticed a remarkable decrease in pain, a nearly complete healing of the preexistent ulcers and no development of new ulcers. No side effects were noted.
Assuntos
Antagonistas do Receptor de Endotelina A , Dermatoses da Mão/tratamento farmacológico , Escleroderma Sistêmico/tratamento farmacológico , Úlcera Cutânea/tratamento farmacológico , Adulto , Anlodipino/uso terapêutico , Progressão da Doença , Relação Dose-Resposta a Droga , Esquema de Medicação , Quimioterapia Combinada , Feminino , Dedos , Seguimentos , Dermatoses da Mão/etiologia , Humanos , Metotrexato/uso terapêutico , Receptor de Endotelina A/uso terapêutico , Medição de Risco , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/diagnóstico , Índice de Gravidade de Doença , Úlcera Cutânea/etiologia , Resultado do TratamentoRESUMO
Drugs antagonizing tumor necrosis factor (TNF) alpha have been increasingly and successfully used in the treatment of psoriasis vulgaris and psoriatic arthritis. We report a patient with TNF receptor 1-associated periodic syndrome (TRAPS) who received TNF-alpha antagonist etanercept. A month later, the patient developed for the first time generalized psoriasis vulgaris. This paradoxical phenomenon has been reported sporadically in patients receiving TNF-alpha antagonists for other inflammatory diseases. The cause of psoriasis induced by TNF-alpha antagonists is still obscure.