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1.
Epilepsy Res ; 167: 106453, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32927329

RESUMEN

In the wake of the pandemic COVID-19 and nationwide lockdowns gripping many countries globally, the national healthcare systems are either overwhelmed or preparing to combat this pandemic. Despite all the containment measures in place, experts opine that this novel coronavirus is here to stay as a pandemic or an endemic. Hence, it is apt to be prepared for the confrontation and its aftermath. From protecting the vulnerable individuals to providing quality care for all health conditions and maintaining essential drug supplies, it is going to be a grueling voyage. Preparedness to sustain optimal care for each health condition is a must. With a higher risk for severe COVID-19 disease in infants, need of high-dose hormonal therapy with a concern of consequent severe disease, presence of comorbidities, and a need for frequent investigations and follow-up; children with West syndrome constitute a distinctive group with special concerns. In this viewpoint, we discuss the important issues and concerns related to the management of West syndrome during COVID-19 pandemic in the South Asian context and provide potential solutions to these concerns based on the current evidence, adeptness, and consensus. Some plausible solutions include the continuation of containment and mitigation measures for COVID-19, therapeutic decision- making for West syndrome based on risk stratification, and tele-epileptology.


Asunto(s)
Corticoesteroides/uso terapéutico , Hormona Adrenocorticotrópica/uso terapéutico , Anticonvulsivantes/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Espasmos Infantiles/tratamiento farmacológico , Telemedicina , Vigabatrin/uso terapéutico , Corticoesteroides/provisión & distribución , Hormona Adrenocorticotrópica/provisión & distribución , Anticonvulsivantes/provisión & distribución , Antivirales/administración & dosificación , Betacoronavirus , Toma de Decisiones Clínicas , Prestación de Atención de Salud , Interacciones Farmacológicas , Humanos , Lactante , Pandemias , Tiempo de Tratamiento , Vigabatrin/provisión & distribución
4.
BMC Cardiovasc Disord ; 20(1): 236, 2020 05 19.
Artículo en Inglés | MEDLINE | ID: mdl-32429846

RESUMEN

BACKGROUND: Takotsubo cardiomyopathy (TTC) has been widely recognized in recent decades and is triggered by either physical or psychological stressors. CASE PRESENTATION: A 70-year-old woman presented to the Emergency Department due to confusion, hypotension, fever, chills, and cough. She had a one-year history of diabetes insipidus. Pituitary function examination at admission revealed decreased thyroid, sex and adrenal hormones. Pituitary MRI displayed findings suggestive of nonhemorrhagic pituitary apoplexy. Electrocardiogram (ECG) revealed T-wave inversion and extended QT interval. Transthoracic echocardiogram (TTE) showed left ventricular apical dysplasia and ballooning, accompanied by reduced left ventricular ejection fraction. Coronary angiography (CAG) revealed no obvious coronary arterial stenosis. The left ventriculogram demonstrated an octopus clathrate appearance. Most ECG and TTE changes recovered 10 days later. CONCLUSIONS: To the best of our knowledge, this is the first report of newly diagnosed TTC associated with pituitary apoplexy.


Asunto(s)
Apoplejia Hipofisaria/complicaciones , Cardiomiopatía de Takotsubo/etiología , Hormona Adrenocorticotrópica/uso terapéutico , Anciano , Fármacos Cardiovasculares/uso terapéutico , Femenino , Terapia de Reemplazo de Hormonas , Humanos , Apoplejia Hipofisaria/diagnóstico por imagen , Apoplejia Hipofisaria/tratamiento farmacológico , Apoplejia Hipofisaria/fisiopatología , Cardiomiopatía de Takotsubo/diagnóstico por imagen , Cardiomiopatía de Takotsubo/tratamiento farmacológico , Cardiomiopatía de Takotsubo/fisiopatología , Tiroxina/uso terapéutico , Resultado del Tratamiento , Función Ventricular Izquierda
5.
Dev Med Child Neurol ; 62(5): 575-580, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-31903560

RESUMEN

AIM: To compare the efficacy and safety of prednisolone/prednisone and adrenocorticotropic hormone (ACTH) in the treatment of infantile spasms using a meta-analysis of randomized controlled trials (RCTs). METHOD: In a systematic literature search of electronic databases (MEDLINE, Embase, the Cochrane Library), we identified RCTs that assessed prednisolone/prednisone compared with ACTH/tetracosactide in patients with infantile spasms. The electroclinical response and adverse events were evaluated. RESULTS: Six RCTs (616 participants) were included in the meta-analysis. Compared with prednisolone/prednisone, ACTH/tetracosactide was not superior in terms of cessation of spasms at day 14 (relative risk 1.19, 95% confidence interval [CI] 0.74-1.92), day 42 (relative risk 1.02, 95% CI 0.63-1.65), and resolution of hypsarrhythmia on electroencephalogram (relative risk 1.14, 95% CI 0.71-1.81); the incidences of common adverse reactions caused by ACTH/tetracosactide were not lower than that of prednisolone/prednisone for irritability (relative risk 0.79, 95% CI 0.57-1.10), increased appetite (relative risk 0.78, 95% CI 0.57-1.08), weight gain (relative risk 0.86, 95% CI 0.56-1.32), and gastrointestinal upset (relative risk 0.60, 95% CI 0.35-1.02), though it seemed less frequent. INTERPRETATION: Prednisolone/prednisone elicits a similar electroclinical response as ACTH for infantile spasms, which indicates that it can be an alternative to ACTH for treating infantile spasms. What this paper adds Prednisolone/prednisone is as effective as adrenocorticotropic hormone (ACTH) in electroclinical response of infantile spasms. Prednisolone/prednisone and ACTH cause similar and tolerable adverse effects, whose incidences are comparable. High-dose prednisone/prednisolone might be preferable to low dose for achieving freedom from spasms.


Asunto(s)
Hormona Adrenocorticotrópica/uso terapéutico , Parasimpatolíticos/uso terapéutico , Prednisolona/uso terapéutico , Prednisona/uso terapéutico , Espasmos Infantiles/tratamiento farmacológico , Humanos , Lactante , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
7.
J Neurol Sci ; 407: 116505, 2019 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-31706456

RESUMEN

BACKGROUND: Current treatments after an episode of optic neuritis have limited success protecting the retinal nerves and restoring visual function. OBJECTIVE: To assess the effectiveness of Repository Corticotropin Injection (RCI) after the onset of optic neuritis. METHODS: Twenty-four adults were treated with RCI within 2 weeks of symptom onset. Seven exams over 400 days measured low- and high-contrast visual acuity (LCVA and HCVA) and spectral domain optical coherence tomography of the retinal structures. Differences between and among affected and contralateral eyes were assessed using linear mixed models. RESULTS: HCVA improved in the affected eye over the study (36.2 letters to 52.5), and LCVA improved in both the affected eye (1.8 letters to 6.8) and the contralateral eye (8.3 letters to 11.7). These functional improvements occurred concurrent to a thinning in the papillomacular bundle and the ganglion cell, inner plexiform, and retinal nerve fiber layers, while the inner nuclear, outer plexiform, outer nuclear, and photoreceptor layers thickened. CONCLUSION: The eyes affected by the ON and treated with RCI improved in both LCVA and HCVA, and unexpectedly LCVA improved in the contralateral eye as well. This functional improvement was mirrored by structural changes in the retina. This study lays the groundwork for future studies to explore potential neuro-protective and neuro-restorative effects of RCI.


Asunto(s)
Hormona Adrenocorticotrópica/uso terapéutico , Neuritis Óptica/tratamiento farmacológico , Retina/efectos de los fármacos , Agudeza Visual/efectos de los fármacos , Hormona Adrenocorticotrópica/administración & dosificación , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neuritis Óptica/diagnóstico por imagen , Neuritis Óptica/fisiopatología , Retina/diagnóstico por imagen , Retina/fisiopatología , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Agudeza Visual/fisiología , Adulto Joven
8.
Ann Clin Transl Neurol ; 6(11): 2270-2281, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31657133

RESUMEN

OBJECTIVE: To compare the therapeutic effectiveness of oral corticosteroids with that of adrenocorticotrophic hormone for infantile spasms. METHODS: PubMed, Embase, Scopus, and the Cochrane library were searched to retrieve studies published before December 2018 to identify pediatric patients with a diagnosis of infantile spasms. The interventions of oral corticosteroids and adrenocorticotrophic hormone were compared. We included only randomized controlled trials that reported the cessation of spasms as treatment response. The primary outcome was clinical spasm cessation on day 13 or 14. The secondary outcomes were the resolution of hypsarrhythmia, side effects, continued spasm control, spasm relapse rate, and subsequent epilepsy rate. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the study-level quality assessment was conducted using the Cochrane risk-of-bias tool. RESULTS: After extensive review, 39 articles were included for meticulous evaluation. Five randomized controlled trials with a total of 239 individuals were eligible for further analysis. No significant difference was detected between the corticosteroids and adrenocorticotrophic hormone in the cessation of clinical spasms (odds ratio [OR]: 0.54; 95% confidence interval [CI]: 0.16 to 1.81; P = 0.32). The subgroups of high-dose prednisolone versus adrenocorticotrophic hormone and low-dose prednisone versus adrenocorticotrophic hormone also exhibited no significant difference. Furthermore, the two subgroups did not differ in terms of hypsarrhythmia resolution, side effects, relapse rate, or subsequent epilepsy rate. INTERPRETATION: This meta-analysis suggests that high-dose prednisolone is not inferior to adrenocorticotrophic hormone and that it be considered a safe and effective alternative treatment.


Asunto(s)
Corticoesteroides/uso terapéutico , Hormona Adrenocorticotrópica/uso terapéutico , Espasmos Infantiles/tratamiento farmacológico , Antiinflamatorios/uso terapéutico , Humanos , Lactante , Prednisolona/uso terapéutico , Prednisona/uso terapéutico
10.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(9): 845-850, 2019 Sep.
Artículo en Chino | MEDLINE | ID: mdl-31506140

RESUMEN

OBJECTIVE: To investigate the factors in first-time adrenocorticotropic hormone (ACTH) therapy and their influence on spasm control time in infants with infantile spasms. METHODS: A total of 72 infants with infantile spasms who were admitted from January 2008 to October 2013 were enrolled. Their clinical data were collected, and the exposure factors for infantile spasms were selected. A Cox proportional-hazards regression model analysis was performed for these factors to analyze their influence on spasm control time. RESULTS: Clarification of the etiology (known or unexplained etiology), frequency of spasms before treatment, and presence or absence of combination therapy (ACTH used alone or in combination with magnesium sulfate) had a significant influence on spasm control time in infants with infantile spasms. The infants with a known etiology had a significantly shorter spasm control time than those with unexplained etiology, and the infants with a low frequency of spasms before treatment and receiving ACTH combined with magnesium sulfate early had a significantly longer spasm control time than their counterparts (P<0.05). CONCLUSIONS: For infants with infantile spasms at initial diagnosis, etiology should be clarified, which may helpful for evaluating prognosis. A combination of ACTH and magnesium sulfate should be given as soon as possible, which may improve their prognosis.


Asunto(s)
Hormona Adrenocorticotrópica/uso terapéutico , Espasmos Infantiles , Anticonvulsivantes , Humanos , Lactante , Modelos de Riesgos Proporcionales , Espasmo , Espasmos Infantiles/tratamiento farmacológico
12.
Pediatr Neurol ; 99: 16-22, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31331669

RESUMEN

BACKGROUND: There is ongoing debate regarding the comparative effectiveness of adrenocorticotropic hormone and prednisolone in the treatment of infantile spasms. With a large cohort and extended follow-up, we set out to evaluate a protocol in which adrenocorticotropic hormone is reserved for prednisolone nonresponders. METHODS: The following standardized hormonal therapy protocol was adopted. Patients initially receive prednisolone (8 mg/kg/day [maximum 60 mg/day], divided in three daily doses for 14 days). Prednisolone responders taper it over 14 days, whereas prednisolone nonresponders immediately transition to natural adrenocorticotropic hormone (150 U/m2/day, divided in two daily doses for 14 days). We evaluated short-term response, defined as video-electroenecphaloagraphy-confirmed resolution of both epileptic spasms and hypsarrhythmia on day 14, without relapse for 28 additional days. We then evaluated long-term relapse and calculated the rates of sustained response at six, 12, and 18 months. RESULTS: We identified 102 children with infantile spasms who were treated with prednisolone. Prior exposure to hormonal therapy and vigabatrin was observed among 12% and 35% of patients, respectively. Sixty (59%) patients responded to prednisolone, and 13 (33%) prednisolone nonresponders then responded to adrenocorticotropic hormone. Cumulative response to prednisolone and adrenocorticotropic hormone (if needed) was higher among treatment-naive patients (84%) than among patients with prior exposure to first-line treatment (51%), with P < 0.001. Relapse was relatively common among all subgroups. CONCLUSION: Short-term response to prednisolone was favorable and higher among treatment-naive patients. These data suggest that prednisolone is a reasonable approach to initial therapy and that adrenocorticotropic hormone exhibits substantial efficacy after prednisolone failure.


Asunto(s)
Hormona Adrenocorticotrópica/administración & dosificación , Prednisolona/administración & dosificación , Espasmos Infantiles/tratamiento farmacológico , Hormona Adrenocorticotrópica/efectos adversos , Hormona Adrenocorticotrópica/uso terapéutico , Anticonvulsivantes/uso terapéutico , Protocolos Clínicos , Estudios de Cohortes , Susceptibilidad a Enfermedades , Esquema de Medicación , Evaluación de Medicamentos , Resistencia a Medicamentos , Sustitución de Medicamentos , Electroencefalografía , Femenino , Humanos , Hipertensión/inducido químicamente , Lactante , Infecciones/etiología , Masculino , Prednisolona/efectos adversos , Prednisolona/farmacología , Prednisolona/uso terapéutico , Recurrencia , Estudios Retrospectivos , Resultado del Tratamiento , Grabación en Video , Vigabatrin/uso terapéutico
14.
Epilepsy Res ; 152: 31-34, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30875634

RESUMEN

Epileptic spasms during infancy (infantile spasms) represent a serious treatment and social problem despite their rare occurrence. Current treatments include hormonal therapy (adrenocorticotropin-ACTH or corticosteroids) or vigabatrin (per se or in the combination). These treatments are partially effective and with potentially significant adverse effects. Thus, the search for new effective drugs is warranted. We tested efficacy of a novel fusion peptide AQB-565 developed by Aequus Biopharma in a model of infantile spasms consisting of prenatal exposure to betamethasone and repeated postnatal trigger of spasms with N-methyl-d-aspartic acid (NMDA). AQB-565 molecule includes the first 24 amino acids of ACTH, a ten amino acid linker and a modified melanocyte-stimulating hormone molecule. In contrast to ACTH with almost uniform activity over all peripheral and central melanocortin receptor isoforms, AQB is preferentially active on central melanocortin receptors MC3 and MC4. Here, we used equivalent doses of rat ACTH (full molecule) and AQB-565 and compared their efficacy in a prospective randomized test against of repeated bouts of spasms on postnatal days (P)12, P13 and P15 in the rat model. All doses of ACTH (range 0.02-1.0 mg/kg s.c.) and all doses but one of AQB-565 in the same range suppressed spasms in P15 rats (treatment stopped on P14). There was no dose-dependent effect and both compounds had all-or-none effect that is similar to clinical outcome of hormonal treatment of infantile spasms in children. Thus, AQB-565 may represent a novel treatment of infantile spasms similarly effective as ACTH but with potentially limited side effects.


Asunto(s)
Hormona Adrenocorticotrópica/uso terapéutico , Hormonas Estimuladoras de los Melanocitos/uso terapéutico , Espasmos Infantiles/tratamiento farmacológico , Hormona Adrenocorticotrópica/química , Hormona Adrenocorticotrópica/metabolismo , Factores de Edad , Análisis de Varianza , Animales , Animales Recién Nacidos , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Electroencefalografía , Agonistas de Aminoácidos Excitadores/toxicidad , Femenino , Humanos , Lactante , Masculino , Hormonas Estimuladoras de los Melanocitos/química , Hormonas Estimuladoras de los Melanocitos/metabolismo , N-Metilaspartato/toxicidad , Péptidos/química , Péptidos/metabolismo , Péptidos/uso terapéutico , Embarazo , Efectos Tardíos de la Exposición Prenatal/inducido químicamente , Ratas , Ratas Sprague-Dawley , Espasmos Infantiles/inducido químicamente , Resultado del Tratamiento
15.
Epilepsia ; 60(3): 441-451, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30801699

RESUMEN

OBJECTIVE: To compare the efficacy and safety of the ketogenic diet (KD) with standard adrenocorticotropic hormone (ACTH) treatment in infants with West syndrome. METHODS: In this parallel-cohort (PC) randomized controlled trial (RCT), infants were randomly allocated to KD or high-dose ACTH. Those who could not be randomized were followed in a PC. Primary end point was electroclinical remission at day 28. Secondary end points were time to electroclinical remission, relapse after initial response, seizure freedom at last follow-up, adverse effects, and developmental progress. RESULTS: One hundred one infants were included: 32 in the RCT (16 KD; 16 ACTH) and 69 in the PC (37 KD; 32 ACTH). Electroclinical remission at day 28 was similar between KD and ACTH (RCT: 62% vs 69%; PC: 41% vs 38%; combined cohort: 47% vs 48%; KD vs ACTH, respectively). In the combined cohort, time to electroclinical remission was similar between both treatments (14 days for KD, 16 days for ACTH). However, relapse rates were 16% (KD) and 43% (ACTH, P = 0.09), and seizure freedom at last follow-up was 40% (KD) and 27% (ACTH, P = 0.18). Adverse effects needing acute medical intervention occurred more often with ACTH (30% with KD, 94% with ACTH, P < 0.001). Age-appropriate psychomotor development and adaptive behavior were similar. Without prior vigabatrin (VGB) treatment, remission at day 28 was 47% (KD) and 80% (ACTH, P = 0.02); relapse rates were 29% (KD) and 56% (ACTH, P = 0.13). Consequently, seizure freedom at last follow-up was similar. In infants with prior VGB, seizure freedom at last follow-up was 48% (KD) and 21% (ACTH, P = 0.05). SIGNIFICANCE: The study is underpowered; therefore, its results should be interpreted with caution. KD is as effective as ACTH in the long term but is better tolerated. Without prior VGB treatment, ACTH remains the first choice to achieve short-term remission. However, with prior VGB, KD was at least as effective as ACTH in the short term and was associated with lower relapse rates in the long term; therefore, it represents an appropriate second-line treatment after VGB.


Asunto(s)
Hormona Adrenocorticotrópica/uso terapéutico , Dieta Cetogénica , Espasmos Infantiles/terapia , Hormona Adrenocorticotrópica/administración & dosificación , Hormona Adrenocorticotrópica/efectos adversos , Preescolar , Dieta Cetogénica/efectos adversos , Dieta Cetogénica/métodos , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Espasmos Infantiles/dietoterapia , Espasmos Infantiles/tratamiento farmacológico , Resultado del Tratamiento
16.
Am J Kidney Dis ; 74(2): 256-262, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-30765104

RESUMEN

Despite little evidence supporting its superiority to glucocorticoid therapy, use and expenditures for repository corticotropin (rACTH) injection (H.P. Acthar Gel; Mallinckrodt) have increased dramatically in the last 5 years, particularly among a small number of nephrologists, rheumatologists, and neurologists. Recently, the manufacturer justified the extremely high and rapidly increasing cost of rACTH by citing the ongoing need to generate clinical data to support its use. We test this assertion by investigating the quality and provenance of the evidence likely to emerge in the foreseeable future. We identified all completed, in-progress, and proposed studies of rACTH registered at ClinicalTrials.gov. 75 studies representing 2,953 participants met inclusion criteria. Studies addressed primarily nephrologic (n = 23), rheumatologic (n = 28), and neurologic (n =22) indications. Of the 23 studies proposed for renal indications (enrollment, 33 ± 49 [mean ± SD]), 11 were not randomized, 8 compared only different rACTH treatment regimens, and 4 compared rACTH to placebo. No studies of rACTH proposed for renal indications included an rACTH-free arm receiving active treatment (ie, another form of immunosuppression). We conclude that evidence emerging in the foreseeable future is unlikely to broadly support rACTH use over lower-cost glucocorticoid-based alternatives for renal indications.


Asunto(s)
Hormona Adrenocorticotrópica/uso terapéutico , Glucocorticoides/uso terapéutico , Síndrome Nefrótico/tratamiento farmacológico , Ensayos Clínicos como Asunto , Humanos , Prednisolona/uso terapéutico
17.
J Ocul Pharmacol Ther ; 35(3): 182-188, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30676837

RESUMEN

INTRODUCTION: Repository corticotropin injection (RCI) has immune-modulatory and anti-inflammatory effects and is approved for multiple indications, including severe and acute chronic allergic and inflammatory processes involving the eye and adnexa. This study describes patient characteristics, treatment patterns, and physicians' assessments of patients with uveitis treated with RCI. METHODS: This was a retrospective medical record review of US patients. Eligible patients had a diagnosis of uveitis, received RCI in the past 12 months, and had completed or were receiving RCI treatment at the time of data collection. Baseline characteristics and after-treatment clinical data are descriptively reported. RESULTS: The study included 91 patients (mean age 41 years, 62% female, and mean time since diagnosis 3.98 years). Most patients had moderate (n = 48, 53%) to severe (n = 21, 23%) visual impairment, and none was blind before RCI therapy. Patients used an average of 2.5 medications before RCI. Initial RCI dosing regimens, dose adjustments, and treatment durations were different for each patient. Concomitant medication use and dosages were reduced during RCI; 76 patients (84%) improved, 15 patients (16%) stayed the same, and none worsened; 86% of patients had improvements in vision. CONCLUSIONS: Physicians individualized RCI therapy among patients who suffered uveitis for several years and when previous therapies were inadequate. Most patients improved after initiating RCI, most commonly in vision. The findings support use of RCI for uveitis and provide a better understanding of patient characteristics and practice patterns to guide appropriate use.


Asunto(s)
Hormona Adrenocorticotrópica/uso terapéutico , Inflamación/tratamiento farmacológico , Registros Médicos , Uveítis/tratamiento farmacológico , Administración Tópica , Adolescente , Hormona Adrenocorticotrópica/administración & dosificación , Adulto , Anciano , Niño , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Inflamación/diagnóstico , Inyecciones Intraoculares , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos , Uveítis/diagnóstico , Adulto Joven
18.
Clin Exp Rheumatol ; 37(1): 137-145, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30183601

RESUMEN

OBJECTIVES: Acute gout is traditionally treated with NSAIDs, corticosteroids, and colchicine. However, the presence of comorbid conditions and advancing age, often seen in hospitalised patients, may prevent their use. We reviewed the published data on the use of ACTH in the treatment of acute gouty arthritis. METHODS: A search was performed up to June 2017. We included clinical trials or case studies/series where ACTH had been administered in human subjects as a treatment for acute gout or pseudogout. RESULTS: Data consistently demonstrated ACTH to be fast-acting, typically relieving the painful symptoms of acute gout within 24 h of treatment. Furthermore, the average number of days needed to achieve 100% resolution of gout symptoms in patients treated with ACTH was similar to those of the corticosteroid triamcinolone. Retrospective data confirm the efficacy of ACTH or the synthetic analogue Synacthen in the treatment of acute gout in patients with comorbidities such as cardiovascular disease, chronic kidney disease, and hypertension, including those who were hospitalised, with all patients responding after 1-3 doses. ACTH appears to be well-tolerated with side effects being minor and transient in nature. Importantly, ACTH/Synacthen has no clinically significant effect on glucose and potassium levels or blood pressure. Clinical evidence from available case studies supports these findings. CONCLUSIONS: ACTH is a fast acting, efficacious and well-tolerated option for patients with acute gout when traditional therapies have failed or are contraindicated. However, large, carefully designed, randomised controlled trials are required to confirm these findings.


Asunto(s)
Hormona Adrenocorticotrópica/fisiología , Hormona Adrenocorticotrópica/uso terapéutico , Artritis Gotosa , Supresores de la Gota/uso terapéutico , Enfermedad Aguda , Antiinflamatorios no Esteroideos/uso terapéutico , Artritis Gotosa/tratamiento farmacológico , Colchicina/uso terapéutico , Gota , Humanos , Estudios Retrospectivos , Resultado del Tratamiento
19.
Transplantation ; 103(1): 202-209, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-29894413

RESUMEN

BACKGROUND: Treatment of focal segmental glomerular sclerosis (FSGS) after kidney transplantation is challenging with unpredictable outcomes. The objective was to investigate the use of adrenocorticotropic hormone (ACTH) analogue gel in kidney transplant recipients with de novo or recurrent FSGS resistant to therapeutic plasma exchange (TPE) and/or rituximab. METHODS: We performed a retrospective review of cases of de novo or recurrent resistant FSGS at 2 large US transplant centers between April 2012 and December 2016. Proteinuria was measured by urine protein to creatinine ratio. RESULTS: We identified 20 cases of posttransplant recurrent and de novo FSGS resistant to conventional therapy with TPE and rituximab. Mean ± SD age was 49 ± 15.5 years, 14 (70%) were male, 13 (65%) were whites, and 8 (38%) had previous kidney transplants. Median (interquartile range) of recurrent and de novo FSGS was 3 (0.75-7.5) months posttransplant. The majority of patients, 15 (75%), received TPE as a treatment at the time of diagnosis and 10 (50%) received rituximab, which was started before the use of ACTH gel. There was a significant improvement of urine protein to creatinine ratio from a mean ± SD of 8.6 ± 7.6 g/g before ACTH gel to 3.3 ± 2.3 g/g after the use of ACTH gel (P = 0.004). Ten (50%) patients achieved complete or partial remission. CONCLUSIONS: Although, the response varied among the recipients, ACTH gel might be an effective therapy for posttransplant resistant FSGS cases that fail to respond to TPE and rituximab.


Asunto(s)
Hormona Adrenocorticotrópica/uso terapéutico , Glomeruloesclerosis Focal y Segmentaria/terapia , Trasplante de Riñón , Hormona Adrenocorticotrópica/efectos adversos , Hormona Adrenocorticotrópica/análogos & derivados , Adulto , Anciano , Anciano de 80 o más Años , Baltimore , Femenino , Geles , Glomeruloesclerosis Focal y Segmentaria/diagnóstico , Humanos , Trasplante de Riñón/efectos adversos , Masculino , Persona de Mediana Edad , Missouri , Intercambio Plasmático , Recurrencia , Inducción de Remisión , Estudios Retrospectivos , Rituximab/uso terapéutico , Factores de Tiempo , Resultado del Tratamiento
20.
Clin EEG Neurosci ; 50(1): 51-55, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29984606

RESUMEN

PURPOSE: Acute encephalopathy with biphasic seizures and reduced diffusion (AESD) is a leading cause of childhood-onset encephalopathy in Japan. Children with AESD frequently develop intractable epilepsy, whereas their treatment options remain to be determined. METHOD: We present 2 unrelated girls, who developed AESD at 25 months (case 1) and 12 months of age (case 2). Both cases underwent intensive cares from the first day of illness, whereas severe neurological impairments were left on discharge. They showed repeated signs of epileptic spasms at 2 months (case 1) and 8 months (case 2) after the onset of AESD. Video-monitoring electroencephalograms (EEG) detected the recurrent attacks accompanying slow-wave bursts and transient suppressions of the precedent epileptiform discharges, as typically observed in epileptic spasms. RESULTS: Intramuscular injection of adrenocorticotropic hormone (ACTH, 0.0125 mg/kg/d) was introduced within 1 month from the onset of epileptic spasms and continued for 2 weeks. The ACTH treatment disrupted the paroxysmal activity in EEG, and it has relieved these patients from epileptic seizures for more than 1 year. CONCLUSION: This report illustrates the potential efficacy of ACTH for a group of children with epileptic spasms after AESD.


Asunto(s)
Hormona Adrenocorticotrópica/uso terapéutico , Encefalopatías/complicaciones , Epilepsia/tratamiento farmacológico , Convulsiones/tratamiento farmacológico , Espasmo/tratamiento farmacológico , Encéfalo/efectos de los fármacos , Encéfalo/patología , Encéfalo/fisiopatología , Preescolar , Electroencefalografía , Epilepsia/complicaciones , Femenino , Humanos , Lactante , Convulsiones/complicaciones , Espasmo/complicaciones , Resultado del Tratamiento
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