RESUMO
BACKGROUND: Alemtuzumab is a highly effective therapy for relapsing-remitting multiple sclerosis (RRMS), and immune thrombocytopenia (ITP) has been identified as a risk. OBJECTIVE: To examine ITP incidence, treatment, and outcomes during the clinical development of alemtuzumab for RRMS and discuss postmarketing experience outside clinical trials. METHODS: CAMMS223 and Comparison of Alemtuzumab and Rebif® Efficacy in Multiple Sclerosis (CARE-MS) I and II investigated two annual courses of alemtuzumab 12 mg (or 24 mg in CAMMS223/CARE-MS II) versus subcutaneous interferon beta-1a three times per week. Patients completing core studies could enroll in an extension. Monthly monitoring for ITP continued until 48 months after the last alemtuzumab infusion. RESULTS: Of 1485 alemtuzumab-treated MS patients in the clinical development program, 33 (2.2%) developed ITP (alemtuzumab 12 mg, 24 [2.0%]; alemtuzumab 24 mg, 9 [3.3%]) over median 6.1 years of follow-up after the first infusion; most had a sustained response to first-line ITP therapy with corticosteroids, platelets, and/or intravenous immunoglobulin. All cases occurred within 48 months of the last alemtuzumab infusion. Postmarketing surveillance data suggest that the ITP incidence is not higher in clinical practice than in clinical trials. CONCLUSION: Alemtuzumab-associated ITP occurs in approximately 2% of patients and is responsive to therapy. Careful monitoring is key for detection and favorable outcomes.
Assuntos
Alemtuzumab/efeitos adversos , Fatores Imunológicos/efeitos adversos , Interferon beta-1a/efeitos adversos , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Púrpura Trombocitopênica Idiopática , Adulto , Alemtuzumab/administração & dosagem , Feminino , Seguimentos , Humanos , Fatores Imunológicos/administração & dosagem , Incidência , Interferon beta-1a/administração & dosagem , Masculino , Pessoa de Meia-Idade , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Púrpura Trombocitopênica Idiopática/epidemiologia , Púrpura Trombocitopênica Idiopática/etiologiaRESUMO
Most brainstem infarcts are caused by pontine strokes. When a bilateral pontine or brainstem stroke occurs, it can result in an image called the "heart appearance" sign. Sequential pontine strokes have not yet been described to cause the "heart appearance" sign. We report a case of sequential pontine strokes in a 47-year-old man with no relevant medical history. He presented with acute left-sided hemiparesis. Initial brain MRI showed a right-sided pontine infarction. Two weeks later, the patient's left side hemiparesis and dysarthria worsened, and he developed right-sided facial paralysis. The brain MRI showed a left-sided pontine infarction that looked like the "heart appearance" sign. The patient had a good recovery. This report highlights a case of atypical pontine stroke recurrence two weeks apart and discusses branch artery disease as a possible etiologic cause.
RESUMO
Este texto tem por objetivo apresentar algumas considerações sobre as formas de inclusão que acontecem de forma digital na sociedade brasileira atual, com relação a um grupo específico, os idosos. Inicialmente discutimos sobre a que se referem os termos "exclusão" e "inclusão", seguindo-se as definições do que se entende por "exclusão e inclusão digital", para então, apresentarmos quais são os aspectos e estratégias capazes de induzir à inclusão digital. A seguir, mostramos os resultados da primeira pesquisa sobre o chamado "E-Social" brasileiro, seguidos de outra pesquisa, especificamente sobre o número e as formas de inclusão da terceira idade na world wide web, junto a uma proposição de duas categorias para classificá-los. Ao final, dispomos as conclusões sobre todo o material.