New brodalumab psoriasis outcome data suggests that intermittent treatment is as effective as continuous dosing. Is it time to re‐evaluate our treatment regimens?

2020 ◽  
Vol 183 (6) ◽  
pp. 984-985
Author(s):  
P. Babakinejad ◽  
P.J. Hampton
Keyword(s):  
Outcome Data ◽  
Intermittent Treatment ◽  
Treatment Regimens ◽  
Continuous Dosing

Nontuberculous mycobacteria infections of peritoneal dialysis patients: A multicenter study

2020 ◽  
pp. 089686082092346
Author(s):  
Alon Bnaya ◽  
Yonit Wiener-Well ◽  
Hila Soetendorp ◽  
Yael Einbinder ◽  
Yossi Paitan ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Nontuberculous Mycobacteria ◽  
Delayed Diagnosis ◽  
Outcome Data ◽  
Antimicrobial Treatment ◽  
Exit Site ◽  
Diagnostic Challenge ◽  
Exit Site Infection ◽  
Treatment Regimens ◽  
Medical Centers

Objectives: Nontuberculous mycobacteria (NTM) infections pose a diagnostic challenge in peritoneal dialysis (PD) patients. In this study, we sought to identify findings that are suggestive of NTM infection in PD adult patients. Methods: All patients with NTM exit-site infection (ESI) with/without tunnel infection and peritonitis identified during the last decade in eight medical centers in Israel were included. Clinical, microbiological, and outcome data were collected and analyzed. Results: Thirty patients were identified; 16 had ESI (53%) and 14 had peritonitis (47%). Median age was 65 years (interquartile range 52–76). Abdominal pain and cloudy PD fluid were reported in all patients with peritonitis, whereas exit-site discharge and granulation tissue were common in patients with ESI. Fourteen patients (47%) had negative cultures prior NTM diagnosis, and isolation of diphtheroids or Corynebacterium spp. was reported in 9 of 30 patients (30%). Antimicrobial treatment prior to diagnosis was documented in 13 of 30 patients (43%). Delayed diagnosis was frequent. Treatment regimens and duration of therapy varied widely. In 26 of 30 (87%) patients, catheter was removed and 19 of 30 patients (63%) required permanent transition to hemodialysis. Two patients with peritonitis (2 of 14, 14%) and seven with ESI (7 of 16, 44%) were eligible for continuation of PD. Conclusions: Culture negative peritonitis, isolation of diphtheroids or Corynebacterium spp., previous exposure to antibiotics, and/or a refractory infection should all prompt consideration of PD-related NTM infection and timely workup. Catheter removal is recommended aside prolonged antimicrobial therapy. In select patients with ESI, continuation of PD may be feasible.

scholarly journals X-linked lymphoproliferative disease due to SAP/SH2D1A deficiency: a multicenter study on the manifestations, management and outcome of the disease

Blood ◽  
2011 ◽  
Vol 117 (1) ◽  
pp. 53-62 ◽  
Author(s):  
Claire Booth ◽  
Kimberly C. Gilmour ◽  
Paul Veys ◽  
Andrew R. Gennery ◽  
Mary A. Slatter ◽  
...  
Keyword(s):  
Clinical Manifestations ◽  
Treatment Strategies ◽  
Lymphoproliferative Disease ◽  
Outcome Data ◽  
Epstein Barr Virus Infection ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Treatment Regimens ◽  
Barr Virus ◽  
Epstein Barr

Abstract X-linked lymphoproliferative disease (XLP1) is a rare immunodeficiency characterized by severe immune dysregulation and caused by mutations in the SH2D1A/SAP gene. Clinical manifestations are varied and include hemophagocytic lymphohistiocytosis (HLH), lymphoma and dysgammaglobulinemia, often triggered by Epstein-Barr virus infection. Historical data published before improved treatment regimens shows very poor outcome. We describe a large cohort of 91 genetically defined XLP1 patients collected from centers worldwide and report characteristics and outcome data for 43 patients receiving hematopoietic stem cell transplant (HSCT) and 48 untransplanted patients. The advent of better treatment strategies for HLH and malignancy has greatly reduced mortality for these patients, but HLH still remains the most severe feature of XLP1. Survival after allogeneic HSCT is 81.4% with good immune reconstitution in the large majority of patients and little evidence of posttransplant lymphoproliferative disease. However, survival falls to 50% in patients with HLH as a feature of disease. Untransplanted patients have an overall survival of 62.5% with the majority on immunoglobulin replacement therapy, but the outcome for those untransplanted after HLH is extremely poor (18.8%). HSCT should be undertaken in all patients with HLH, because outcome without transplant is extremely poor. The outcome of HSCT for other manifestations of XLP1 is very good, and if HSCT is not undertaken immediately, patients must be monitored closely for evidence of disease progression.

scholarly journals Improved Survival of Older Patients with Mantle Cell Lymphoma (MCL) with Front-Line Cytarabine-Based Immunochemotherapy

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2965-2965 ◽  
Author(s):  
Sumita Ratnasingam ◽  
Michael Gilbertson ◽  
Zoe McQuilten ◽  
Kay T Htun ◽  
George Grigoriadis ◽  
...  
Keyword(s):  
Board Of Directors ◽  
Older Patients ◽  
Cox Regression ◽  
Outcome Data ◽  
Advisory Committees ◽  
Durable Response ◽  
Treatment Regimens ◽  
Risk Of Death ◽  
Transfusion Requirements ◽  
Significant Difference

Abstract Introduction While the role of cytarabine-based immunochemotherapy (ICT) and autologous stem cell transplantation (ASCT) in untreated younger patients with MCL is well established, the utility of 'more intense' approaches in older patients is uncertain. Despite a median age at presentation of 60 years or more there are few therapeutic trials focussing on older patients. With the development of targeted agents, the need to define the optimal ICT strategy for comparison is pressing. Methods The primary aim of this study was to compare the safety and efficacy of first line ICT based therapy in patients with MCL aged over 60 years. Treatment and outcome data were collected for patients treated between 2000-2015 across a combined health-care network servicing the south-eastern, south-western and central corridor of the Australian state of Victoria (catchment area >2 million patients encompassing four major academic tertiary referral centers). Eligible patients had MCL diagnosed according to WHO 2008 criteria, confirmed by either fluorescence in situ hybridization for t(11;14) translocation or immunohistochemistry for cyclin D1 expression. Only cases with adequate information, including baseline characteristics, treatment regimens and outcome, were included. Overall survival (OS) and progression free survival (PFS) were modelled using Cox regression. For ICT comparison, patients undergoing ASCT were censored at the time of transplant. Differences in hospitalization and transfusion were analyzed using the Mann-Whitney U test. Results 52 patients met inclusion criteria with a median age of 69 (range 60-91; M/F >3:1), of which 23 patients were >70 years. Most patients had advanced disease on staging, >1 extra-nodal site and an intermediate-high MIPI score. All received rituximab with initial therapy. Treatment regimens included: R-CHOP-like (31), alternating R-CHOP/R-DHAC (10), R-HyperCVAD/R-MA (7) and other (4). Eleven patients underwent ASCT. The median follow up for surviving patients was 40 months. Type of chemotherapy and up-front ASCT were the only variables influencing PFS and OS. Cytarabine-based ICT was associated with an improved median PFS (not reached vs 35 months, HR 0.27 [0.08-0.93], p=0.018) and OS (not reached vs 54 months, HR 0.28 [0.08-0.94], p=0.039) compared to R-CHOP-like regimens. Patients undergoing ASCT were younger (mostly < 70 years) and demonstrated improved median OS (not reached vs 46 months, HR 0.124 [0.017-0.921], p=0.041). No statistically significant difference in efficacy between R-HyperCVAD/R-MA and R-CHOP/R-DHAC could be determined due to low numbers. Both group of patients receiving cytarabine demonstrated durable response over time. However, those receiving R-HyperCVAD/R-MA experienced greater toxicity with increased hospitalisation: median 54 [31-72] v 20 [6-77] days, p=0.023 and transfusion requirements: median 13 [7-24] v 2 [0-5] red cell units, p=0.001; median 6 [2-15] v. 0 [0-1] platelet pools, p=0.001. Conclusion In older patients with previously untreated MCL, cytarabine-based ICT resulted in a significant improvement in OS, with a 72% reduction in the risk of death relative to CHOP-like therapy. Cytarabine-based ICT is highly efficacious and well tolerated and should serve as a benchmark with which to compare targeted therapies. ASCT should also be considered in selected older patients. Table Table. Disclosures Quach: Amgen: Membership on an entity's Board of Directors or advisory committees; Janssen Cilag: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees. Opat:Roche: Consultancy, Honoraria, Other: Provision of subsidised drugs, Research Funding.

scholarly journals Development of a Breast Cancer Treatment Program in Port-au-Prince, Haiti: Experiences From the Field

2016 ◽  
Vol 2 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Vincent DeGennaro ◽  
Rachel Libby ◽  
Elizabeth Patberg ◽  
Dieudina Gabriel ◽  
Samer Al-Quran ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Treatment Program ◽  
Medical Training ◽  
Low Cost ◽  
Breast Cancer Treatment ◽  
Outcome Data ◽  
Lessons Learned ◽  
Chemotherapy Drugs ◽  
Treatment Regimens

Purpose The nonprofit Project Medishare launched a breast cancer treatment program in Port-au-Prince in July 2013 to address the demand for breast cancer care in Haiti. We outline the development of the program, highlight specific challenges, and discuss key considerations for others working in global oncology. Methods We reflected on our experiences in the key areas of developing partnerships, building laboratory capacity, conducting medical training, using treatment algorithms, and ensuring access to safe, low-cost chemotherapy drugs. We also critically reviewed our costs and quality measures. Results The program has treated a total of 139 patients with breast cancer with strong adherence to treatment regimens in 85% of patients. In 273 chemotherapy administrations, no serious exposure or adverse safety events were reported by staff. The mortality rate for 94 patients for whom we have complete data was 24% with a median survival time of 53 months. Our outcome data were likely influenced by stage at presentation, with more than half of patients presenting more than 12 months after first noticing a tumor. Future efforts will therefore focus on continuing to improve the level of care, while working with local partners to spread awareness, increase screening, and get more women into care earlier in the course of their disease. Conclusion Our experiences may inform others working to implement protocol-based cancer treatment programs in resource-poor settings and can provide valuable lessons learned for future global oncology efforts.

scholarly journals Evaluation of Rifapentine in Long-Term Treatment Regimens for Tuberculosis in Mice

1999 ◽  
Vol 43 (10) ◽  
pp. 2356-2360 ◽  
Author(s):  
Anne M. J. A. Lenaerts ◽  
Sharon E. Chase ◽  
Alex J. Chmielewski ◽  
Michael H. Cynamon
Keyword(s):  
Term Treatment ◽  
New Drugs ◽  
Intermittent Treatment ◽  
Bacterial Regrowth ◽  
Treatment Regimens ◽  
Weekly Treatment ◽  
Long Term Treatment ◽  
Apparent Clearance ◽  
Antituberculosis Chemotherapy

ABSTRACT Besides direct bactericidal activity, long-term effectiveness is one of the most important features to consider when developing new drugs for chemotherapy. In this study, we evaluated the ability of rifapentine (RFP), in monotherapy and combination therapy, to completely eradicate a Mycobacterium tuberculosis infection and to prevent relapse posttreatment in a Swiss mouse model. The combination of RFP, isoniazid (INH), and pyrazinamide (PZA) administered daily resulted in an apparent clearance of M. tuberculosis organisms in the lungs and spleens of infected mice after 10 weeks of treatment. However, 3 months after the cessation of therapy, bacterial regrowth occurred in mice treated for a 12-week period, indicating a relapse of infection. In intermittent treatment regimens of RFP in combination with INH and PZA, sterilization was achieved when mice were treated two to five times per week for 9 weeks. Bacterial growth was still observed in the once-weekly treatment group. Our results show that mouse models can predict important parameters for new drugs. We stress the necessity for long-term posttreatment observation in animal models for the routine evaluation of new drugs for antituberculosis chemotherapy.

scholarly journals Long-term bedaquiline-related treatment outcomes in patients with extensively drug-resistant tuberculosis from South Africa

2018 ◽  
Vol 51 (5) ◽  
pp. 1800544 ◽  
Author(s):  
Olatunde Olayanju ◽  
Jason Limberis ◽  
Aliasgar Esmail ◽  
Suzette Oelofse ◽  
Phindile Gina ◽  
...  
Keyword(s):  
Outcome Data ◽  
Favourable Outcome ◽  
Cd4 Count ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Treatment Regimens ◽  
Resistant Tuberculosis ◽  
Extensively Drug Resistant ◽  
African Patients

Optimal treatment regimens for patients with extensively drug-resistant tuberculosis (XDR-TB) remain unclear. Long-term prospective outcome data comparing XDR-TB regimens with and without bedaquiline from an endemic setting are lacking.We prospectively followed-up 272 South African patients (49.3% HIV-infected; median CD4 count 169 cells·µL−1) with newly diagnosed XDR-TB between 2008 and 2017. Outcomes were compared between those who had not received bedaquiline (pre-2013; n=204) and those who had (post-2013; n=68; 80.9% received linezolid in addition).The 24-month favourable outcome rate was substantially better in the bedaquiline versus the non-bedaquiline group (66.2% (45 out of 68) versus 13.2% (27 out of 204); p<0.001). In addition, the bedaquiline group exhibited reduced 24-month rates of treatment failure (5.9% versus 26.0%; p<0.001) and default (1.5% versus 15.2%; p<0.001). However, linezolid was withdrawn in 32.7% (18 out of 55) of patients in the bedaquiline group because of adverse events. Admission weight >50 kg, an increasing number of anti-TB drugs and bedaquiline were independent predictors of survival (the bedaquiline survival effect remained significant in HIV-infected persons, irrespective of CD4 count).XDR-TB patients receiving a backbone of bedaquiline and linezolid had substantially better favourable outcomes compared to those not using these drugs. These data inform the selection of XDR-TB treatment regimens and roll-out of newer drugs in TB-endemic countries.

Primary non-Hodgkin lymphoma of the colon among patients in the Veterans Affairs Health System.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 554-554
Author(s):  
T. Tashi ◽  
R. Thota ◽  
J. Krishnamurthy ◽  
A. R. Sama ◽  
I. T. Aldoss ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
B Cell Lymphoma ◽  
Outcome Data ◽  
Aggressive Lymphoma ◽  
Treatment Regimens ◽  
Aggressive Disease ◽  
Non Hodgkin Lymphoma ◽  
Colon Cancers ◽  
Histological Data ◽  
Indolent Disease

554 Background: Primary non-Hodgkin lymphoma (NHL) of the colon is rare. There are no randomized controlled trials describing treatment outcomes for this tumor. We provide the largest descriptive study of this tumor to date. Methods: Retrospective analysis of 109 patients diagnosed with primary non-Hodgkin lymphoma of the colon from 1995 to 2008 was done via the Veteran's Affairs Central Cancer Registry. By definition, all cases presented with a lymphomatous involvement of the colon as the first manifestation of their disease with no previous diagnosis of NHL of any type or site. Demographic, staging, histology, treatment, and outcome data was recorded. Lymphomas were classified as aggressive versus indolent based on their histology. Results: There were 36,260 colon cancers diagnosed in 1995-2008 of which 109 (0.3%) were primary non-Hodgkin colon lymphomas. The median age of diagnosis was 67 years. 55 pts had aggressive disease, 27 pts had indolent disease, and 27 pts had inadequate histological data. Diffuse large B cell lymphoma (73%) was the most common aggressive lymphoma whereas it was marginal zone (56%) in the indolent group. The indolent group had 5- year survival rate of 76.9% compared to 48.6% for the aggressive group. Both groups had received different treatment regimens as seen in the Table with variable mean survival outcomes. Conclusions: Our data suggests addition of postoperative adjuvant chemotherapy appears superior to surgery alone in the treatment of aggressive disease whereas it does not appear to provide any benefit in the treatment of indolent disease. However, patient numbers are too small to draw definite conclusions and warrant future investigation in multinational randomized fashion. [Table: see text] No significant financial relationships to disclose.

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