RESUMO
A pesar de que el riesgo de reactivación de la hepatitis B en los pacientes tratados con inmunosupresores es conocido desde hace años y de la existencia de recomendaciones, los datos procedentes de algunas encuestas indican que el estudio del perfil serológico de la infección por el VHB antes de iniciar el tratamiento inmunosupresor no es una práctica universal. Teniendo en cuenta las consecuencias graves que puede comportar la reactivación de la infección por el VHB, creemos que es necesario divulgar la importancia de este problema entre los profesionales sanitarios que prescriben estos tratamientos así como de las recomendaciones a seguir. De hecho, en los últimos años, es cada vez más frecuente el empleo de quimioterapia e inmunosupresores potentes en pacientes con procesos neoplásicos y en patología no neoplásica de diversas especialidades, aumentando la población de pacientes con riesgo de reactivación del VHB
Although the risk of reactivation of hepatitis B in patients treated with immunosuppressants has been known for years and, if there are recommendations, data from some surveys indicate that the study of the serological profile of HBV infection before starting immunosuppressive treatment is not universal practice. Taking into account the serious consequences that the reactivation of the infection with HBV may entail, we believe that it is necessary to disclose the importance of this problem among the health professionals who prescribe these treatments as well as the recommendations to be followed. In fact, in recent years, the use of chemotherapy and potent immunosuppressants in patients with neoplastic processes and in non-neoplastic pathology of various specialties has been increasingly frequent, increasing the population of patients at risk of reactivation of HBV
Assuntos
Humanos , Hepatite B/tratamento farmacológico , História Natural , Fatores de Risco , Hepatite B/prevenção & controle , Hepatite B/induzido quimicamente , Imunossupressores/efeitos adversos , Ativação Viral/efeitos dos fármacos , Imunossupressores/administração & dosagem , Tratamento Biológico/efeitos adversosRESUMO
Although the risk of reactivation of hepatitis B in patients treated with immunosuppressants has been known for years and, if there are recommendations, data from some surveys indicate that the study of the serological profile of HBV infection before starting immunosuppressive treatment is not universal practice. Taking into account the serious consequences that the reactivation of the infection with HBV may entail, we believe that it is necessary to disclose the importance of this problem among the health professionals who prescribe these treatments as well as the recommendations to be followed. In fact, in recent years, the use of chemotherapy and potent immunosuppressants in patients with neoplastic processes and in non-neoplastic pathology of various specialties has been increasingly frequent, increasing the population of patients at risk of reactivation of HBV.
Assuntos
Antineoplásicos/efeitos adversos , Vírus da Hepatite B/fisiologia , Hepatite B Crônica/virologia , Imunossupressores/efeitos adversos , Ativação Viral/efeitos dos fármacos , Antineoplásicos/farmacologia , Antineoplásicos/uso terapêutico , Antirreumáticos/efeitos adversos , Doenças Assintomáticas , DNA Viral/sangue , Inibidores Enzimáticos/efeitos adversos , Anticorpos Anti-Hepatite B/sangue , Antígenos do Núcleo do Vírus da Hepatite B/imunologia , Antígenos de Superfície da Hepatite B/sangue , Hepatite B Crônica/sangue , Hepatite B Crônica/complicações , Hepatócitos/efeitos dos fármacos , Hepatócitos/virologia , Humanos , Imunossupressores/farmacologia , Imunossupressores/uso terapêutico , Neoplasias/complicações , Fatores de Risco , Viremia/etiologia , Replicação ViralRESUMO
Cancer patients with severe renal dysfunction represent a challenge for the physician. This is the first case report on the use of denosumab in a dialysis patient with bone metastases. We present the clinical case of a 45-year-old woman who had hepatorenal polycystic disease, diagnosed during childhood, and stage IV chronic kidney failure at the time of breast cancer diagnosis. Three years after surgery plus adjuvant hormonal therapy she suffered a further worsening of renal function, requiring dialysis, and very advanced bone metastasis in the hip with severe pain. As pamidronate was the only bone agent available in the center, she received it for 4 months (before a dialysis session), during which time the bone metastases stabilized. In March 2014, the patient switched to denosumab (which had become available in the center), and continued with hormone therapy. Seven months after denosumab initiation, the patient had almost complete pain relief, and the bone metastases exhibited radiological improvement. The tolerability was excellent, without any related adverse event. There were no changes in albumin-adjusted serum calcium, serum phosphorus, and intact parathyroid hormone, except for a transient and mild hypocalcemia at 3 months and an increase in intact parathyroid hormone levels, which required adjustment of vitamin D analog dose. Denosumab can be administered to prevent skeletal-related events in patients with bone metastasis from solid tumors and severely impaired renal function, even in those requiring dialysis. In this particular patient, the safety was good.
