RESUMO
BACKGROUND: Infliximab (IFX) trough concentrations (Cmin) have been linked to treatment efficacy in psoriatic patients. Inter-individual IFX Cmin variability and factors influencing IFX pharmacokinetics could explain differences in treatment response. OBJECTIVE: To evaluate the association between IFX Cmin and clinical outcomes in psoriatic patients. METHODS: Prospective study of 33 patients with moderate to severe psoriasis receiving IFX at Bellvitge University Hospital, between October 2013 and November 2016. IFX Cmin and antibodies toward infliximab (ATI) were measured. RESULTS: We collected 155 IFX Cmin and ATI values (mean age, 46 (14) years; 11 (33.3%) women). Mean IFX Cmin was 2.5 (2.4) mg/L and ATIs were detected in six patients, resulting in undetectable IFX Cmin. IFX Cmin was significantly associated with ATI and body mass index (BMI) (ß -2.51, 95% CI -3.56 to -1.4 and ß -0.05, 95% CI -0.09 to -0.01). PASI score and PASI 90/100 response were significantly associated with IFX Cmin (IRR 0.80, 95% CI 0.70 to 0.92; OR 1.79, 95% CI 1.18 to 2.71 and OR 1.79, 95% CI 1.14 to 2.81). CONCLUSION: IFX Cmin significantly influences PASI 90/100 response rates. IFX Cmin wa significantly associated with ATI and BMI. The observed inter-individual variability in IFX Cmin supports the need for IFX drug monitoring.
Assuntos
Fármacos Dermatológicos/uso terapêutico , Infliximab/uso terapêutico , Psoríase/tratamento farmacológico , Adulto , Índice de Massa Corporal , Fármacos Dermatológicos/farmacocinética , Feminino , Meia-Vida , Humanos , Infliximab/farmacocinética , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Psoríase/patologia , Índice de Gravidade de DoençaRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Antirretrovirais/economia , Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/economia , Inibidores da Protease de HIV/economia , Inibidores da Protease de HIV/uso terapêutico , Lopinavir/economia , Lopinavir/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Ritonavir/economia , Ritonavir/uso terapêuticoAssuntos
Antirretrovirais/economia , Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/economia , Inibidores da Protease de HIV/economia , Inibidores da Protease de HIV/uso terapêutico , Lopinavir/economia , Lopinavir/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Ritonavir/economia , Ritonavir/uso terapêutico , Feminino , Humanos , MasculinoAssuntos
Adenina/análogos & derivados , Antivirais/administração & dosagem , Benzoxazinas/administração & dosagem , Desoxicitidina/análogos & derivados , Organofosfonatos/administração & dosagem , Adenina/administração & dosagem , Alcinos , Ciclopropanos , Desoxicitidina/administração & dosagem , Combinação de Medicamentos , Emtricitabina , Hospitais , Humanos , TenofovirRESUMO
Several reports have described a decrease in valproic acid (VPA) serum concentrations when carbapenem therapy is administered. The exact mechanism of this pharmacokinetic interaction is unknown, although several experimental studies have been carried out in animals. Because of these interactions, plasma concentrations of VPA in these patients should be monitored and, whenever possible, VPA or carbapenem therapy should be substituted by other drugs. We describe the cases of two epileptic children who simultaneously received meropenem and VPA. Concentrations of VPA decreased to subtherapeutic levels. We review the various mechanisms for this interaction proposed to date, as well as all reported cases.
Assuntos
Antibacterianos/farmacocinética , Anticonvulsivantes/farmacocinética , Tienamicinas/farmacocinética , Ácido Valproico/farmacocinética , Criança , Pré-Escolar , Interações Medicamentosas , Feminino , Humanos , Masculino , MeropenémRESUMO
Se ha descrito que la administración de antibióticos carbapenémicos puede producir la disminución de las concentraciones plasmáticas de ácido valproico (VPA). El mecanismo por el que se produce esta interacción farmacocinética no está claro, a pesar de los estudios publicados en modelos animales. Dada la interacción, se aconseja la monitorización de concentración y la sustitución, siempre que sea posible, del VPA por otro antiepiléptico o del carbapenem por un antibiótico de otro grupo. Se describen los casos de 2 niños epilépticos que recibieron simultáneamente meropenem y VPA y en los que se observa una disminución de las concentraciones plasmáticas de VPA hasta niveles subterapéuticos. Se recogen los mecanismos propuestos para la interacción y los casos publicados hasta la fecha
Several reports have described a decrease in valproic acid (VPA) serum concentrations when carbapenem therapy is administered. The exact mechanism of this pharmacokinetic interaction is unknown, although several experimental studies have been carried out in animals. Because of these interactions, plasma concentrations of VPA in these patients should be monitored and, whenever possible, VPA or carbapenem therapy should be substituted by other drugs. We describe the cases of two epileptic children who simultaneously received meropenem and VPA. Concentrations of VPA decreased to subtherapeutic levels. We review the various mechanisms for this interaction proposed to date, as well as all reported cases
