ABSTRACT
OBJETIVOS: Emitir recomendaciones sobre aspectos prácticos de la monitorización de los niveles de fármacos biológicos que puedan ser de utilidad para reumatólogos. MÉTODOS: Se realizó una revisión sistemática de la literatura de estudios en los que se determinaron niveles de fármaco y de anticuerpos antifármaco en pacientes con artritis reumatoide o espondiloartritis para estudiar si podían predecir diferentes desenlaces. Con los resultados de la revisión un grupo de expertos discutió bajo qué circunstancias podría ser útil la solicitud de niveles de fármacos biológicos y sus anticuerpos, lo que se concretó en una serie de preguntas clínicas que fueron respondidas con la evidencia científica disponible y creándose algoritmos para facilitar la toma de decisiones. RESULTADOS: Se establece que la determinación de los niveles de fármaco puede ser especialmente útil en 2 situaciones clínicas, cuando hay fallo al tratamiento (primario o secundario) y en remisión mantenida. Se revisa también qué técnica de laboratorio y momento para tomar la muestra son los más adecuados para la medición, y se establecen recomendaciones sobre la interpretación de los niveles de fármaco y sobre factores a tener en cuenta (por ejemplo, índice de masa corporal y fármacos modificadores de la enfermedad). CONCLUSIONES: Se han elaborado algoritmos y establecido posibles pautas y directrices para solicitar niveles de fármaco y de anticuerpos antifármaco en pacientes con artritis reumatoide y espondiloartritis, basados en la evidencia, que pueden ayudar a la toma de decisiones clínicas
OBJECTIVES: Issue recommendations on practical aspects of the monitoring of levels of biological drugs that may be useful for rheumatologists. METHODS: We conducted a systematic review of studies in which drug and anti-drug antibody levels were determined in patients with rheumatoid arthritis (RA) or spondyloarthritis (SpA) to study whether they could predict different outcomes. In light of the results of the review, a group of experts discussed under what circumstances testing biological drug levels and their antibodies could be useful. The discussion resulted in a series of clinical questions that were answered with the scientific evidence collected, and in algorithms that facilitate decision making. RESULTS: It was established that the determination of drug levels can be especially useful in two clinical situations, on treatment failure (primary or secondary) and on sustained remission. It is also reviewed which laboratory technique and timing for sample drawing are the most suitable for the measurement. Recommendations are issued on the interpretation of drug levels and on factors to be taken into account (for example, body mass index and disease modifying drugs). CONCLUSIONS: Evidence-based algorithms and guidelines have been established to test drug levels and anti-drug antibodies in patients with RA and SpA, which can help clinical decision making
Subject(s)
Humans , Biological Therapy/methods , Biological Factors/analysis , Drug Monitoring/methods , Antirheumatic Agents/analysis , Antibodies, Monoclonal, Humanized/analysis , Rheumatic Diseases/drug therapy , Medication Therapy Management/organization & administration , Biological Products/analysisABSTRACT
Resumen La Artritis Idiopática Juvenil es la enfermedad reumática más frecuente en niños. Es una enfermedad crónica, degenerativa y de etiología desconocida; que puede dejar múltiples secuelas en la población pediátrica. Consta de siete afecciones definidas por la International League of Associations for Rheumatology del 2001: Artritis Sistémica, Oligoartritis, Artritis con Factor Reumatoide positivo o Factor Reumatoide negativo, Artritis relacionada a entesitis, Artritis psoriasica y Artritis indiferenciada; distintas tanto en el aspecto clínico, patogénico como evolutivo. Esta enfermedad se caracteriza por una alteración de la regulación del sistema inmunitario innato con una falta de linfocitos T autorreactivos y autoanticuerpos. La inflamación continua estimula el cierre rápido y prematuro del cartílago de crecimiento provocando un acortamiento óseo. Para llegar a su diagnóstico no se requiere más que una buena historia clínica y examen físico, ya que no hay laboratorios o gabinete lo bastante sensible que nos puedan ayudar. Fármacos como el metrotexate y los inhibidores del factor de necrosis tumoral han venido a modificar la evolución de la enfermedad y mejorar la calidad de vida de estos pacientes.
Abstract Juvenile idiopathic arthritis is the most common rheumatic disease in children. It is a chronic and degenerative disease, with an unknown etiology; that can leave multiple sequels in the pediatric population. There are seven conditions defined by 2001 International League of Associations for Rheumatology: Systemic Arthritis, Oligoarthritis, Arthritis with positive rheumatoid factor or negative rheumatoid factor, enthesitis-related arthritis and undifferentiated arthritis; distinct in clinical, pathogenetic and evolutionary aspects. This disease is characterized by an alteration on the regulation of the innate immune system with a lack of autoreactive lymphocytes T and autoantibodies. Continuous inflammation stimulates the rapid and premature closure of the growth cartilage causing bone shortening. To arrive at the diagnosis, it is only necessary to have a good medical history and physical exam, since there are no laboratory test sensitive enough to help us. Drugs such as methotrexate and tumor necrosis factor inhibitors have come to modify the evolution of the disease and improve the quality of life of these patients.
Subject(s)
Humans , Child, Preschool , Child , Adolescent , Arthritis, Juvenile/diagnosis , Arthritis, Juvenile/drug therapy , Synovial Fluid/drug effects , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Antirheumatic Agents/analysis , Tumor Necrosis Factors/therapeutic useABSTRACT
Rheumatoid arthritis (RA) is a chronic inflammatory disorder that causes pain, systemic complications and premature mortality. Depression has also been identified as a problem for persons with RA. This association remaining significant even after the degree of disease activity is controlled. In the present study, the efficacy of combination therapeutic effect of antidepressant (amitriptyline) with Disease Modifying Anti rheumatoid drug (leflunomide) was determined in rheumatoid arthritis pain associated depression in Freund's complete adjuvant (FCA) induced arthritic rats. Drug treatment was started 9 days after induction of FCA induced arthritis in rats. The antiarthritic activity was assessed by measuring paw volume, weight-bearing, hematological, biochemical, serological parameters, Radiographic analysis and Histopathology of tibiotarsal joints. The antidepressant activity was assessed by Forced swimming test, Rota-rod test and confirmed by estimation of brain neuro transmitters (serotonin and norepinephrine) level. Results of this study revealed that leflunomide and amitriptyline combination showed more significant (p<0.001) antiarthritic and antidepressant action and leflunomide alone treatment showed significant (p<0.001) antiarthritic activity only as compared to arthritic control. The leflunomide and low dose amitriptyline combination found to be more effective in pain associated depression in rheumatoid arthritic rats
Subject(s)
Animals , Male , Rats , Arthritis , Depression/chemically induced , Antidepressive Agents/analysis , Arthritis, Rheumatoid/classification , Pharmaceutical Preparations/administration & dosage , Antirheumatic Agents/analysisABSTRACT
ABSTRACT Natural compounds are a gold mine for treating rheumatoid arthritis (RA). The etiology of this disease is linked to inflammation, where cytokines play an important role. Strategies have been drafted for targeting cytokines as a therapeutic option in patients with RA. Inhibiting cytokines with natural compounds has become a major focus for the development of drugs to treat RA. Here, a structure-based drug design approach was employed to identify novel leads to target the interleukin 6 receptor (IL-6R). A total of 48,531 compounds of natural origin were screened. Two of these compounds were shortlisted for molecular docking simulation and tested for inhibiting gp130 dimerization in human macrophages. The results show that Lead5 (CID5329098) significantly inhibited the release of gp130 in a dose-dependent manner, similar to the inhibitory effect of LMT-28 (p<0.005). This study provides an atomic scale outcome of a single natural compound that can be developed into a RA drug
Subject(s)
Arthritis, Rheumatoid/drug therapy , Cytokines , Receptors, Interleukin , Antirheumatic Agents/analysisABSTRACT
Los medicamentos de origen biotecnológico pueden ser anticuerpos monoclonales o moléculas pequeñas diseñadas para actuar sobre blancos terapéuticos definidos. Se hizo una búsqueda de publicaciones en PubMed y ScienceDirect, FDA. Se obtuvo la información sobre mecanismos de acción, blancos terapéuticos, principales aspectos farmacocinéticos, reacciones adversas más frecuentes e importantes y los usos aprobados y en investigación. Se describen los anticuerpos monoclonales según los grupos farmacológicos a los que pertenecen, inhibidores de la tirosina cinasa; inhibidores del proteasoma y bloqueadores de la coestimulación de células T. Son significativos los avances en el tratamiento del cáncer y enfermedades reumáticas, pero van acompañados de elevados costos y toxicidad no despreciable
Biotechnology drugs may be monoclonal antibodies or small molecules designed to act on defined therapeutic targets. Was made a search in PubMed, ScienceDirect and FDA. Information on mechanisms of action, therapeutic targets, main pharmacokinetic aspects, more frequent and significant adverse reactions and approved uses and research was obtained. It describes monoclonal antibodies as the drug groups to which they belong, tyrosine kinase inhibitors; proteasome inhibitors and blockers of T cell costimulation. Are significant advances in the treatment of many diseases, especially cancer and rheumatic diseases, but are accompanied by high costs and frequent toxicity
Subject(s)
Biotechnology/trends , Antibodies, Monoclonal/analysis , Proteasome Inhibitors/analysis , Protein-Tyrosine Kinases/antagonists & inhibitors , Costimulatory and Inhibitory T-Cell Receptors/analysis , Antineoplastic Agents/analysis , Anti-Inflammatory Agents/analysis , Antirheumatic Agents/analysisABSTRACT
Se desarrolló una técnica para el control de calidad de las tabletas de ribofen, con el empleo de la espectrofotometría UV y la cromatografía líquida de alta resolución, que incluye la identificación, disolución, uniformidad de dosis y valoración. Las tabletas cumplen con los índices de calidad establecidos en la técnica. Se estudio la especificidad, linealidad, precisión, exactitud y se corroboró la validez de estos parámetros en ambos métodos
Subject(s)
Antirheumatic Agents/analysis , Anti-Inflammatory Agents, Non-Steroidal/analysis , Chemistry, Pharmaceutical , Chromatography, High Pressure Liquid/methods , ortho-Aminobenzoates/analysis , Quality Control , Quality of Homeopathic Remedies , Spectrophotometry, UltravioletABSTRACT
Se desarrolló una técnica para el control de calidad de las tabletas de ribofen, con el empleo de la espectrofotometría UV y la cromatografía líquida de alta resolución, que incluye la identificación, disolución, uniformidad de dosis y valoración. Las tabletas cumplen con los índices de calidad establecidos en la técnica. Se estudio la especificidad, linealidad, precisión, exactitud y se corroboró la validez de estos parámetros en ambos métodos(AU)