Tisztelt Edina!

Az immunmoduláns és a biológiai (immunmoduláns) kezelésnek sok formája létezik. Miként a mellékelt összefoglalókból láthatja itthon is széles körben alkalmazzuk. (Sajnos magyar összefoglalót nem tudok most mellékelni, de a hazai irodalomban megtalálhatók)

Endocrine Abstracts (2002) 4 P95
HIGH-DOSE INTRAVENOUS IMMUNOGLOBULIN (IVIG) TREATMENT OF PATIENTS WITH POST-PARTUM RELAPSED THYROID ASSOCIATED OPHTHALMOPATHY (TAO)

CS Balázs1, E Kiss1 & NR Farid2

1III.Department of Medicine-Enodcrinology, Kenézy Teaching Hospital, Debrecen, Hungary; 2Department of Medicine, Hemel Hempstead General Hospital, UK.


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Background:TAO is a progressive autoimmune potentially sight-threating disease. Various medical interventions have been reported which have potencially serious side effects.The high-dose intravenous immunoglobulin (IVIG) is known to have anti-inflammatory potential and it was used in pilot studies for patients with TAO. The aim of study : was to investigate the effect of IVIG on post-partum relapsed TAO and to test the some immunological parameters during and after therapy. Patients and Method: four patients with TAO had been treated before their pregnancy with bolus steroid and retroorbital irradiation therapy. Three month after delivery the eye symptomps relapsed and to avoid the side effects of steroids and irradiation we started the IVIG therapy. Schedule of IVIG:400 mg/kg/ day was given to 4 patients with TAO over 3-4 hr on four consecutive days.This therapeutic cycle was repeated one or more times depending on therapeutical results every 21 days.Duration of IVIG therapy was 3 months. Evaluated the therapy and monitored following laboratory data:clinical improvement was estimated by ATA (American Thyroid Association) standard criteria during the therapy. Orbital sonography or MRI was carried out for each patient.The following laboratory tests were made: IgG determination, anti-TSH receptor antibodies, determination of anti-thyroglobulin, anti-thyroid peroxidase, anti-eye muscle antibodies, measurement of neopterin-, soluble interleukin-2 receptor in the sera of patients before and during therapy. Results: The eye symptomps were ameliorated in three patients except N.4. Anti-TSH receptor-, anti-eye muscle antibodies and neopterin were significantly decreased after therapy. Substantial side effects were not found. It was concluded that IVIG therapy has a beneficial effect in severe types of post-partum relapsed TAO and decrease the autoimmune parameters which thought to be involved into pathomechanism. (Sponsored by OTKA T 037184/ 2002)


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J Biol Regul Homeost Agents. 2009 Jan-Mar;23(1):1-9.

Intravenous IgG: biological modulating molecules.
Luzi G, Bongiorno F, Paparo Barbaro S, Bruno G.

Abstract
Intravenous IgG has been adopted as treatment for various immune-related diseases, including immune thrombocytopenic purpura, autoimmune neuropathies, systemic lupus erythematosus, Guillain-Barré syndrome, myasthenia gravis, Kawasaki disease, skin blistering diseases. The intravenous administration of exogenously pooled human immunoglobulin was originally licensed as antibody replacement therapy in patients with primary immunodeficiencies, but in the last thirty years, despite a current lack of institutional approval, off-label IVIgG treatment of a consistent number of disorders has shown to be a useful approach with good clinical results. The mechanism of action of IVIgG is complex and is not fully understood. The current understanding and development in the immune modulant action of IVIgG has three basic mechanisms: 1) F(ab')2 mediated actions; 2) interaction of IgGFc molecule with Fc receptors (FcgammaR); 3) actions mediated by complement fractions binding within the Fc molecular structure. The mode of action of IVIgG involves expression and function of Fc receptors, idiotype network, complement and cytokine network, T and B cell differentiation, modulation of antigen-presenting cells (APC). The therapeutic action of IVIgG is also related to natural antibodies in maintaining immune homeostasis. In addition, IVIgG interaction through V regions with complementary V regions of antibodies may provide a rational basis for selection of various immune repertoires. Since there is a significant gap between the institutional approval and the use of IVIgG in various clinical conditions, for which there is no adequate testing or for which a small number of records does not allow a rigorous statistical approach, several public and private institutions (mostly insurance companies) and research centres have developed guidelines for evaluating a rational and deontological approach in various pathological situations where IVIgG is used. Mathematical models based on non-linear differential equations may represent another potentially useful system to better understand an IVIgG targeted use in individual subjects


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BMC Gastroenterol. 2009 Sep 10;9:66.

Efficacy and safety of infliximab induction therapy in Crohn's Disease in Central Europe--a Hungarian nationwide observational study.
Miheller P, Lakatos PL, Horváth G, Molnár T, Szamosi T, Czeglédi Z, Salamon A, Czimmer J, Rumi G, Palatka K, Papp M, Jakab Z, Szabó A, Gelley A, Lakatos L, Barta Z, Balázs C, Rácz I, Zeher M, Döbrönte Z, Altorjay I, Hunyady B, Simon L, Papp J, Banai J, Nagy F, Lonovics J, Ujszászy L, Muzes G, Herszényi L, Tulassay Z.

2nd Department of Medicine, Semmelweis University, Budapest, Hungary. mihpal@yahoo.co.uk

Abstract
BACKGROUND: Infliximab (IFX) has proven to be an effective addition to the therapeutic arsenal for refractory, fistulizing, and steroid dependent Crohn's disease (CD), with efficacy in the induction and maintenance of clinical remission of CD. Our objective in this study is to report the nationwide, multicenter experience with IFX induction therapy for CD in Hungary.

METHODS: During a 6-year-period, beginning in 2000, a total of 363 CD patients were treated with IFX as induction therapy (5 mg/kg IFX infusions given at week 0, 2 and 6) at eleven centers in Hungary in this observational study. Data analysis included patient demographics, important disease parameters and the outcome of IFX induction therapy.

RESULTS: Three hundred and sixty three patients (183 women and 180 men) were treated with IFX since 2000. Mean age was 33.5 +/- 11.2 years and the mean duration of disease was 6.7 +/- 6.1 years. The population included 114 patients (31.4%) with therapy-refractory CD, 195 patients (53.7%) with fistulas, 16 patients (4.4%) with both therapy-refractory CD and fistulas, and 26 patients (7.2%) with steroid dependent CD. Overall response rate was 86.2% (313/363). A higher response rate was observed in patients with shorter disease duration (p = 0.05, OR:0.54, 95%CI:0.29-0.99) and concomitant immunosuppressant therapy (p = 0.05, OR: 2.03, 95%CI:0.165-0.596). Concomitant steroid treatment did not enhance the efficacy of IFX induction therapy. Adverse events included 34 allergic reactions (9.4%), 17 delayed type hypersensitivity (4.7%), 16 infections (4.4%), and 3 malignancies (0.8%).

CONCLUSION: IFX was safe and effective treatment in this cohort of Hungarian CD patients. Based on our experience co-administration of immunosuppressant therapy is suggested in patients receiving IFX induction therapy. However, concomitant steroid treatment did not enhanced the efficacy of IFX induction therapy

Jó egészséget kívánok:

Prof. Dr. Balázs Csaba
2011-02-03 07:30:07