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1.
Medicine (Baltimore) ; 100(40): e27368, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34622837

RESUMO

BACKGROUND: Biological therapy is effective for the treatment of psoriasis and psoriatic arthritis; however, adverse effects related to immunosuppression, such as viral infections, have been reported. Amongst these infections, herpes zoster (HZ) is common. OBJECTIVE: To evaluate the risk of HZ in psoriasis and psoriatic arthritis patients treated with biological therapy. DATA SOURCES: A comprehensive literature search of PubMed, Embase, and Web of Science was performed using certain keywords until October 9, 2020. Nine studies were included after a detailed assessment. STUDY ELIGIBILITY CRITERIA: The eligibility criteria included randomized controlled trials (RCTs) and observational studies of patients with psoriasis or psoriatic arthritis treated with biological therapies; compared with non-biological therapies, non-biological systemic therapies, or controls; with the incidence of HZ reported in case and control groups. The Cochrane risk of bias tool and Newcastle-Ottawa scale were used to assess the quality of the RCTs and observational studies, respectively. Data were extracted from 9 eligible studies and then analyzed using Stata software (Version 12.0). RESULTS: The risk of HZ in biological therapies was higher than that in non-biological (odds ratios [OR]: 1.48; 95% confidence interval [CI]: 1.18-1.86; I2 = 0%) and non-biological systemic (OR: 1.32; 95% CI: 1.02-1.71; I2 = 0%) therapies. Furthermore, the risk of HZ associated with tumor necrosis factor-α inhibitors increased significantly (OR: 1.50; 95% CI: 1.11-2.02; I2 = 0%). Notably, infliximab (OR: 2.43; 95% CI: 1.31-4.50; I2 = 0%) and etanercept (OR: 1.65; 95% CI: 1.07-2.56; I2 = 0%) increased the risk of HZ, while adalimumab (OR: 1.21; 95% CI: 0.64-2.30; I2 = 0%), ustekinumab (OR: 2.20; 95% CI: 0.89-5.44; I2 = 0%), alefacept (OR: 1.46; 95% CI: 0.20-10.47; I2 = 0%), and efalizumab (OR: 1.58; 95% CI: 0.22-11.34; I2 = 0%) did not. LIMITATIONS: Few RCTs have reported HZ incidents; thus, our results require confirmation via large-scale RCTs. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Biological therapies, especially tumor necrosis factor-α inhibitors, may lead to the risk of HZ in psoriasis and psoriatic arthritis patients. Amongst these agents, infliximab and etanercept have been shown to significantly increase the risk of HZ. Additionally, younger age and female sex may be risk factors. SYSTEMATIC REVIEW REGISTRATION NUMBER: INPLASY202110027.


Assuntos
Antirreumáticos/efeitos adversos , Artrite Psoriásica/tratamento farmacológico , Fatores Biológicos/efeitos adversos , Herpes Zoster/induzido quimicamente , Adulto , Idoso , Antirreumáticos/administração & dosagem , Fatores Biológicos/administração & dosagem , Feminino , Humanos , Imunossupressão/efeitos adversos , Imunossupressão/métodos , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco
2.
Emerg Med Clin North Am ; 39(4): 839-850, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34600641

RESUMO

Abdominal pain is a common reason for emergency department visits, with many patients not receiving a definitive diagnosis for their symptoms. Non-gastrointestinal causes need to be considered in the workup of abdominal pain. A high index of suspicion is needed in order to develop a broad differential, and a thorough history and physical examination is paramount. This article will discuss some of these diagnoses, including can't miss diagnoses, common non-abdominal causes, and rare etiologies of abdominal pain.


Assuntos
Dor Abdominal/etiologia , Síndrome Coronariana Aguda/diagnóstico , Doenças das Glândulas Suprarrenais/diagnóstico , Anemia Falciforme/diagnóstico , Angioedemas Hereditários/diagnóstico , Doenças da Aorta/diagnóstico , COVID-19/diagnóstico , Cetoacidose Diabética/diagnóstico , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Feminino , Insuficiência Cardíaca/complicações , Herpes Zoster/diagnóstico , Humanos , Intoxicação por Chumbo/diagnóstico , Transtornos de Enxaqueca/diagnóstico , Torção Ovariana/diagnóstico , Doença Inflamatória Pélvica/diagnóstico , Pneumonia/diagnóstico , Porfiria Aguda Intermitente/diagnóstico , Gravidez , Gravidez Ectópica/diagnóstico , Embolia Pulmonar/diagnóstico , Púrpura de Schoenlein-Henoch/diagnóstico , Tireotoxicose/diagnóstico , Uremia/diagnóstico
3.
Rev Med Suisse ; 17(753): 1684-1689, 2021 Oct 06.
Artigo em Francês | MEDLINE | ID: mdl-34614308

RESUMO

The development of vesicles on the pinna and external auditory canal will often correspond to a herpes zoster infection of one of the many nerves innervating the external ear. In case of associated facial paralysis, vertigo or sudden deafness the patient should undergo a thorough neuro-otologic examination and receive appropriate treatment. This article proposes a reminder of the various clinical presentations of herpes zoster oticus with some neuro-anatomical considerations.


Assuntos
Herpes Zoster , Orelha Externa , Herpes Zoster/diagnóstico , Humanos
4.
Rev Assoc Med Bras (1992) ; 67(4): 585-589, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34495065

RESUMO

OBJECTIVE: The aim of this study was to evaluate the efficacy of high-voltage pulsed radiofrequency in comparison with standard-voltage pulsed radiofrequency for the treatment of elderly patients with acute herpes zoster neuralgia. METHODS: Sixty-four elderly acute herpes zoster neuralgia patients were randomly assigned to the standard-voltage pulsed radiofrequency group (i.e., group S, 32 cases) and the high-voltage pulsed radiofrequency group (i.e., group H, 32 cases), which received the standard-voltage and high-voltage pulsed radiofrequency treatment, respectively. The doses of gabapentin and tramadol for analgesia were adjusted based on pain degree of patients. The therapeutic effectiveness were assessed using the numeric rating scale and the sleep quality scale. The doses of gabapentin and tramadol before pulsed radiofrequency and 1, 2, 4, 8, and 12 weeks after pulsed radiofrequency were measured. The incidence of clinically meaningful postherpetic neuralgia (pulsed radiofrequency) 12 weeks after pulsed radiofrequency was noted. RESULTS: After pulsed radiofrequency, the numeric rating scale score and the doses of gabapentin and tramadol in group H were significantly lower than those in group S, respectively (p<0.05). The sleep quality scale score in group H was significantly higher than that in group S (p<0.05). The incidence of clinically meaningful pulsed radiofrequency in group H was significantly lower than that in group S (p<0.05). CONCLUSION: For the treatment of elderly patients with acute herpes zoster neuralgia, when compared with the standard-voltage pulsed radiofrequency, the high-voltage pulsed radiofrequency can rapidly and steadily reduce the pain degree, improve the sleep quality, reduce the doses of anticonvulsants and analgesics, and decrease the incidence of clinically meaningful postherpetic neuralgia.


Assuntos
Herpes Zoster , Neuralgia Pós-Herpética , Neuralgia , Tratamento por Radiofrequência Pulsada , Idoso , Herpes Zoster/complicações , Humanos , Neuralgia Pós-Herpética/terapia , Manejo da Dor
5.
BMJ Case Rep ; 14(9)2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479882

RESUMO

Localised herpes zoster infections spread by direct contact with active skin lesion, but airborne transmission is rare. We report a case of varicella from airborne transmission of a localised herpes zoster infection in a family. The patient was a 15-year-old boy who had never been vaccinated against the varicella-zoster virus (VZV). He likely developed varicella from his father, whom the patient lived with. The patient's father developed a localised herpes zoster infection 2 weeks prior. The patient's varicella was hypothesised to be due to VZV spread via airborne transmission from the father's localised infection. To decrease the number of varicella cases, routine vaccination of children against VZV is essential, and immunisation against VZV in middle-aged and elderly patients is also necessary.


Assuntos
Varicela , Herpes Zoster , Dermatopatias , Adolescente , Idoso , Criança , Herpesvirus Humano 3 , Humanos , Masculino , Pessoa de Meia-Idade , Vacinação
6.
Hematology ; 26(1): 663-669, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34493151

RESUMO

OBJECTIVE: Infections in ruxolitinib-treated myeloproliferative neoplasm (MPN) patients were reported frequently. This work aimed to systematically estimate the risk of infection associated with ruxolitinib in MPN patients. METHODS: The PUBMED, CNKI, EMBASE, Cochrane and CBM databases were searched to identify all related studies. Odds ratio (OR) and 95% confidence interval (CI) were used to express the difference between groups. I2 was calculated to evaluate heterogeneity. Revman software was used to conduct the analysis. RESULTS: Eleven randomized control trials were included in this analysis. The risk of overall infections was not different at the early stage of ruxolitinib use (OR, 95%CI: 1.23, [0.91, 1.67]). In the extension phase, overall infection was significantly lower in patients receiving ruxolitinib (OR, 95%CI: 0.53, [0.36, 0.79]). Herpes zoster infection was at higher risk both at early stage and in the extension phase (OR, 95%CI: 7.39, [1.33, 41.07]), (OR, 95%CI: 5.23, [1.46, 18.79]), respectively. CONCLUSION: Our study suggested that ruxolitinib increased the risk of herpes zoster infection. However, current studies were not enough to estimate the effects of ruxolitinib on the risk of overall infection in patients with myeloproliferative neoplasm.


Assuntos
Herpes Zoster , Transtornos Mieloproliferativos , Pirazóis , Feminino , Neoplasias Hematológicas/tratamento farmacológico , Neoplasias Hematológicas/epidemiologia , Herpes Zoster/induzido quimicamente , Herpes Zoster/epidemiologia , Humanos , Masculino , Transtornos Mieloproliferativos/tratamento farmacológico , Transtornos Mieloproliferativos/epidemiologia , Pirazóis/efeitos adversos , Pirazóis/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
BMC Infect Dis ; 21(1): 996, 2021 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-34556030

RESUMO

BACKGROUND: Meningitis retention syndrome (MRS) is a rare condition that presents with acute urinary retention as a complication of aseptic meningitis. Cases of MRS due to varicella zoster virus (VZV) infection without a rash are rare. We report the case of a patient who had no signs of meningitis or VZV infection, including a rash. CASE PRESENTATION: A 58-year-old man presented with dysesthesia of the lower limbs and acute urinary retention. He had fever but no rash and no signs of meningitis. He was diagnosed to have VZV infection based on the detection of VZV DNA in the cerebrospinal fluid. He responded satisfactorily to a course of intravenous acyclovir and experienced no sequelae during a 2-year follow-up period. CONCLUSION: MRS due to aseptic meningitis of viral origin should be considered in the differential diagnosis of acute urinary retention even in the absence of specific signs and symptoms of meningitis or a suggestive rash.


Assuntos
Exantema , Herpes Zoster , Meningite Asséptica , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Herpes Zoster/tratamento farmacológico , Herpesvirus Humano 3 , Humanos , Masculino , Meningite Asséptica/diagnóstico , Meningite Asséptica/tratamento farmacológico , Pessoa de Meia-Idade
9.
BMC Infect Dis ; 21(1): 963, 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34530756

RESUMO

BACKGROUND: Varicella-zoster virus (VZV) infection may induce central nervous system complications in HIV/AIDS patients. However, it is rare to have paraplegia caused by VZV infection but no herpes zoster clinically. Asymptomatic VZV infection in HIV/AIDS patient increased the difficulty of diagnosis. CASE PRESENTATION: We reported a 41-year-old male AIDS patient with rare asymptomatic VZV infection-induced paraplegia after his anti-retroviral therapy initiation. MRI of the spinal cord showed the morphology of the thoracic spinal cord was irregular and locally inflated. The patient was confirmed as VZV induced thoracic myelomyelitis by using the cerebrospinal fluid for metagenomic next-generation sequencing (mNGS). CONCLUSIONS: mNGS may contribute to disease diagnosis for asymptomatic VZV infection-induced myelitis.


Assuntos
Síndrome de Imunodeficiência Adquirida , Herpes Zoster , Infecção pelo Vírus da Varicela-Zoster , Adulto , Herpes Zoster/complicações , Herpes Zoster/diagnóstico , Herpesvirus Humano 3/genética , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Paraplegia/diagnóstico , Infecção pelo Vírus da Varicela-Zoster/complicações , Infecção pelo Vírus da Varicela-Zoster/diagnóstico
10.
Eur J Med Res ; 26(1): 92, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34384499

RESUMO

PURPOSE: Herpes zoster (HZ), or shingles, is a clinical syndrome resulting from the reactivation of latent varicella zoster virus (VZV) within the sensory ganglia. We evaluated the safety and tolerability of ES16001 (ethanol extract of Elaeocarpus sylvestris var. ellipticus), a novel inhibitor of varicella zoster virus reactivation in healthy adults. METHOD: Single-center, randomized, double-blind, placebo-controlled, single and multiple ascending dose (SAD and MAD, respectively) studies were conducted in 20- to 45-year-old healthy adults without chronic disease. In the SAD study (n = 32), subjects randomly received a single oral dose of 240, 480, 960, or 1440 mg ES16001 or a placebo. In the MAD study (n = 16), subjects randomly received once daily doses of 480 or 960 mg ES16001 or a placebo for 5 days. The safety and tolerability of the drug were evaluated by monitoring participants' treatment emergent adverse events (TEAEs) and vital signs, electrocardiograms (ECGs), physical examinations, and clinical laboratory tests. RESULTS: In the SAD study, 11 adverse reactions were seen in 5 subjects, and in the MAD study, 8 adverse reactions were seen in 6 subjects. All adverse reactions were mild, and no serious adverse reactions occurred. The most common adverse reaction was an increase in alanine aminotransferase (ALT), but all test values were in the clinically non-significant range, and their clinical significance was judged to be small considering the fact that most of the test values returned to normal immediately after the end of drug administration. CONCLUSION: ES16001 has good safety and tolerability when administered both once and repeatedly to healthy subjects. Further research is needed to identify any possible drug-induced hepatotoxicity, which appears infrequently. Our findings provide a rationale for further clinical investigations of ES16001 for the prevention of HZ. TRIAL REGISTRATION: CRIS, KCT0006066. Registered 7 April 2021-Retrospectively registered, https://cris.nih.go.kr/cris/search/detailSearch.do/19071 ).


Assuntos
Antivirais/efeitos adversos , Elaeocarpaceae/química , Herpes Zoster/tratamento farmacológico , Extratos Vegetais/efeitos adversos , Adulto , Alanina Transaminase/sangue , Antivirais/administração & dosagem , Antivirais/farmacologia , Antivirais/uso terapêutico , Tolerância a Medicamentos , Feminino , Herpes Zoster/prevenção & controle , Humanos , Masculino , Extratos Vegetais/administração & dosagem , Extratos Vegetais/farmacologia , Extratos Vegetais/uso terapêutico , Ativação Viral/efeitos dos fármacos
11.
BMJ Case Rep ; 14(8)2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34413031

RESUMO

A 51-year-old woman with Crohn's disease presented with a bullous rash on her left arm and axilla 2 days after receiving her second dose of the recombinant adjuvant Shingrix vaccine. PCR for herpes simplex virus (HSV) 1, HSV 2 and varicella zoster virus was negative. Punch biopsy revealed changes that were consistent with a bullous fixed drug eruption. She was successfully treated oral prednisone and topical triamcinolone cream. This is the first known case of a bullous fixed drug eruption due to the recombinant adjuvant Shingrix vaccine.


Assuntos
Erupção por Droga , Herpes Zoster , Vacinas , Adjuvantes Imunológicos/efeitos adversos , Erupção por Droga/etiologia , Feminino , Herpes Zoster/tratamento farmacológico , Herpesvirus Humano 3 , Humanos , Pessoa de Meia-Idade
12.
Medicine (Baltimore) ; 100(33): e26863, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414937

RESUMO

ABSTRACT: Inflammatory bowel disease is associated with an increased risk of opportunistic infections. This study aimed to investigate the incidence rate of herpes zoster in patients with inflammatory bowel disease.A meta-analysis was conducted by searching PubMed literature published from January 2000 to July 2019. The main outcome was the incidence rate of a new diagnosis of herpes zoster in patients previously diagnosed with inflammatory bowel disease. The incidence rate ratio (IRR) and 95% confidence interval (95% CI) for herpes zoster associated with inflammatory bowel disease was measured.A total of 6 eligible cohort studies matching the entry criteria were included in the meta-analysis, providing 216,552 participants with inflammatory bowel disease and 790 events of herpes zoster among these participants with inflammatory bowel disease. The pooled incidence rate of developing herpes zoster was 10.41 per 1000 person-years in the inflammatory bowel disease group and 6.10 per 1000 person-years in the non-inflammatory bowel disease group, respectively. The meta-analysis demonstrated that patients with inflammatory bowel disease were associated with 1.68-fold increased risk of developing herpes zoster when compared to those without inflammatory bowel disease (IRR = 1.68, 95% CI = 1.53-1.84). Crohn disease and ulcerative colitis were associated with an increased risk of developing herpes zoster (IRR = 1.67, 95% CI = 1.40-1.98 for Crohn disease and IRR = 1.49, 95% CI = 1.34-1.65 for ulcerative colitis, respectively).Patients with inflammatory bowel disease are at increased risk of developing herpes zoster. We suggest that the vaccination should be considered at the time of inflammatory bowel disease being diagnosed.


Assuntos
Herpes Zoster/epidemiologia , Herpes Zoster/etiologia , Doenças Inflamatórias Intestinais/complicações , Estudos de Coortes , Humanos , Incidência , Estudos Retrospectivos
13.
Vaccine ; 39(36): 5091-5094, 2021 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-34348844

RESUMO

A two-dose series of the recombinant zoster vaccine (RZV, Shingrix) was licensed by the Food and Drug Administration in 2017 and recommended by the Advisory Committee on Immunization Practices in 2018 for adults in the United States age 50 years and older. Despite the health benefits of shingles vaccination, coverage has remained low, with financial barriers among healthcare providers identified as one potential factor. This study estimates the reimbursement levels for RZV among a large sample of privately insured individuals in the US from the 2018 IBM® MarketScan® Commercial Claims and Encounters database. Of 198,534 claims for an RZV dose, the mean reimbursement was $149. Most claims (83%) exceeded $140, which was the private sector vaccine price reported on the CDC vaccine price list in April 2018. These results can be useful for providers considering procuring RZV and for state immunization programs considering ways to improve vaccination coverage.


Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Seguro , Adulto , Herpes Zoster/prevenção & controle , Humanos , Pessoa de Meia-Idade , Setor Privado , Estados Unidos , Vacinas Sintéticas
14.
Medicine (Baltimore) ; 100(31): e26785, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397828

RESUMO

BACKGROUND: There are still controversies between the curative effect of acupuncture combined with cupping therapy and western medicine for post-herpetic neuralgia (PHN). Our meta-analysis fully incorporates the research of acupuncture combined with cupping therapy versus Western medicine for PHN, aiming to explore the difference in the efficacy of the 2 therapies, so as to provide guidance for clinical treatment. METHODS: We searched PubMed, Embase, Cochrane Library, CNKI, Wanfang, CQVIP, CBM, from establishment of the database to September, 2020. Include studies that are clearly defined as PHN or herpes zoster, and exclude duplicate publications; studies with no full text, incomplete information, or inability to extract data; the definition of exposure is quite different from most literature; animal experiments. RESULTS: The total effective rate (relative ratio [RR] = 1.21, 95% confidence interval [CI]: 1.12-1.31) and the rate of remarkable effect (RR = 1.46, 95% CI: 1.30-1.63) of acupuncture and moxibustion combined with cupping in the treatment of PHN were significantly higher than that of conventional western medicine. The visual analogue scale score of acupuncture and moxibustion combined with cupping for PHN was significantly lower than that of conventional western medicine treatment (WMD = -1.77, 95% CI [-2.79, -0.75]). In addition, acupuncture and moxibustion combined with cupping therapy significantly reduced the occurrence of PHN compared with conventional western medicine treatment after treatment of acute herpes zoster (RR = 0.30, 95% CI: 0.20-0.45). In order to explore the differences in the efficacy and preventive effects of different types of acupuncture and cupping therapy, we have further conducted a subgroup analysis. CONCLUSION: The effect of acupuncture and moxibustion combined with cupping in the treatment of PHN is significantly higher than that of conventional western medicine, and it can significantly prevent the occurrence of PHN. Chinese medicine should be used more widely in the treatment of PHN.


Assuntos
Terapia por Acupuntura/normas , Ventosaterapia/normas , Moxibustão/normas , Neuralgia Pós-Herpética/terapia , Terapia por Acupuntura/métodos , Ventosaterapia/métodos , Herpes Zoster/complicações , Humanos , Moxibustão/métodos , Neuralgia Pós-Herpética/etiologia
16.
Indian J Ophthalmol ; 69(9): 2532-2535, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34427261

RESUMO

We report the occurrence of unilateral central retinal vein occlusion (CRVO) in a young yoga enthusiast who presented amidst the COVID-19 pandemic. Subtle signs of uveitis when systemically investigated revealed a multitude of causes, but ocular fluid polymerase chain reaction was positive for varicella zoster virus (VZV). The prompt initiation of antivirals resulted in a good visual outcome. Our case describes the rare presentation of VZV retinal vasculitis as CRVO in a young healthy individual and highlights the importance of early antiviral therapy for favorable outcomes.


Assuntos
COVID-19 , Varicela , Herpes Zoster , Vasculite Retiniana , Oclusão da Veia Retiniana , Humanos , Pandemias , Vasculite Retiniana/diagnóstico , Vasculite Retiniana/etiologia , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/tratamento farmacológico , Oclusão da Veia Retiniana/etiologia , SARS-CoV-2
18.
BMJ Case Rep ; 14(8)2021 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-34462272

RESUMO

Transverse myelitis is a rare neurological complication seen with varicella-zoster virus (VZV) infection, which is common among immunocompromised hosts. It can occur during the primary VZV infection or reactivation of latent infection. It is a complication that requires prompt diagnosis and treatment. The present case is that of a 28-year-old immunocompetent man, who presented with fever, rash and acute-onset spastic paraparesis with bladder involvement. Causes such as herpes simplex 1 and 2, cytomegalovirus, enterovirus and Epstein-Barr virus infection were ruled out. On evaluation, he was diagnosed with acute primary disseminated VZV infection with parainfectious transverse myelitis, based on positive cerebrospinal fluid multiplex PCR (PCR) and serum VZV IgM antibodies. He was treated with intravenous acyclovir and steroids, with which he improved significantly.


Assuntos
Varicela , Infecções por Vírus Epstein-Barr , Herpes Zoster , Mielite Transversa , Mielite , Adulto , Herpes Zoster/complicações , Herpes Zoster/diagnóstico , Herpes Zoster/tratamento farmacológico , Herpesvirus Humano 3 , Herpesvirus Humano 4 , Humanos , Masculino , Mielite Transversa/diagnóstico , Mielite Transversa/tratamento farmacológico , Mielite Transversa/etiologia
19.
J Drugs Dermatol ; 20(8): 898-900, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34397201

RESUMO

Vaccination is an important intervention in preventing the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Messenger RNA (mRNA) vaccines from Pfizer™ and Moderna™ are the first to market in the United States, and while cutaneous adverse events have been reported in clinical trials for both of these vaccines, they have not been well characterized. Here we report a case of a patient who developed herpes zoster after receiving the Moderna™ COVID-19 vaccine. Dermatologists should familiarize themselves with this and other potential cutaneous adverse events associated with COVID-19 vaccination. J Drugs Dermatol. 2021;20(8):898-900. doi:10.36849/JDD.6146.


Assuntos
Vacinas contra COVID-19/efeitos adversos , COVID-19 , Herpes Zoster , Vacinação , COVID-19/prevenção & controle , Herpes Zoster/induzido quimicamente , Herpes Zoster/diagnóstico , Humanos , Estados Unidos , Vacinação/efeitos adversos
20.
Am J Clin Dermatol ; 22(5): 693-707, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34406619

RESUMO

BACKGROUND: Pivotal phase III studies demonstrated that abrocitinib, an oral, once-daily, JAK1-selective inhibitor, is effective treatment for moderate-to-severe atopic dermatitis (AD) as monotherapy and in combination with topical therapy. OBJECTIVE: The aim of this study was to evaluate the long-term safety of abrocitinib 200 mg and 100 mg in an integrated analysis of a phase IIb study, four phase III studies, and one long-term extension study. METHODS: Two cohorts were analyzed: a placebo-controlled cohort from 12- to 16-week studies and an all-abrocitinib cohort including patients who received one or more abrocitinib doses. Adverse events (AEs) of interest and laboratory data are reported. RESULTS: Total exposure in the all-abrocitinib cohort (n = 2856) was 1614 patient-years (PY); exposure was ≥ 24 weeks in 1248 patients and ≥ 48 weeks in 606 (maximum 108 weeks). In the placebo-controlled cohort (n = 1540), dose-related AEs (200 mg, 100 mg, placebo) were nausea (14.6%, 6.1%, 2.0%), headache (7.8%, 5.9%, 3.5%), and acne (4.7%, 1.6%, 0%). Platelet count was reduced transiently in a dose-dependent manner; 2/2718 patients (200-mg group) had confirmed platelet counts of < 50 × 103/mm3 at week 4. Incidence rates (IRs) were 2.33/100PY and 2.65/100 PY for serious infection, 4.34/100PY and 2.04/100PY for herpes zoster, and 11.83/100PY and 8.73/100PY for herpes simplex in the 200-mg and 100-mg groups, respectively. IRs for nonmelanoma skin cancer, other malignancies, and major adverse cardiovascular events were < 0.5/100PY for both doses. Five venous thromboembolism events occurred (IR 0.30/100PY), all in the 200-mg group. There were three deaths due to gastric carcinoma (diagnosed at day 43), sudden death, and COVID-19. CONCLUSION: Abrocitinib, with proper patient and dose selection, has a manageable tolerability and longer-term safety profile appropriate for long-term use in patients with moderate-to-severe AD. TRIAL REGISTRIES: ClinicalTrials.gov: NCT02780167, NCT03349060, NCT03575871, NCT03720470, NCT03627767, NCT03422822.


Assuntos
Dermatite Atópica/tratamento farmacológico , Infecções/epidemiologia , Inibidores de Proteínas Quinases/efeitos adversos , Pirimidinas/efeitos adversos , Neoplasias Cutâneas/epidemiologia , Sulfonamidas/efeitos adversos , Acne Vulgar/induzido quimicamente , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Feminino , Cefaleia/induzido quimicamente , Herpes Simples/epidemiologia , Herpes Zoster/epidemiologia , Humanos , Incidência , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Contagem de Plaquetas , Inibidores de Proteínas Quinases/administração & dosagem , Pirimidinas/administração & dosagem , Fatores de Risco , Sulfonamidas/administração & dosagem , Fatores de Tempo , Tromboembolia Venosa/epidemiologia , Adulto Jovem
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