Progressive multifocal leukoencephalopathy is the most common serious complication related to natalizumab. However, serious haematological complications are very uncommon during treatment with natalizumab. Here we rep...Progressive multifocal leukoencephalopathy is the most common serious complication related to natalizumab. However, serious haematological complications are very uncommon during treatment with natalizumab. Here we reported the case of an 18-year-old man with a 4-year history of relapsing-re- mitting multiple sclerosis. He was treated firstly by Teriflunomide for 1 year, but he presented relapses and his MRI shows new contrast-enhancing lesions. Therefore, we decided to switch from Teriflunomide to Natalizumab. The patient presented with profound anaemia after the 16<sup>th</sup> infusions treatment with Natalizumab. The patient’s hemoglobin was 3.2 g/dL with a lower blood reticulocyte value. After red cell transfusions and cessation of Natalizumab, anaemia resolved. Natalizumab was changed by an anti-CD20 monoclonal antibody. The patient had a stable course of multiple sclerosis at 13 months after initiation of Rituximab. We should alert clinicians to be aware of the possibility of anaemia during treatment by Natalizumab.展开更多
In inflammatory bowel disease(IBD), tumor necro-sis factor plays an important role in mediating infla-mmation, but several other pathways are also involved in eliciting an inflammatory response. One such pathway is th...In inflammatory bowel disease(IBD), tumor necro-sis factor plays an important role in mediating infla-mmation, but several other pathways are also involved in eliciting an inflammatory response. One such pathway is the invasion of the intestinal mucosa by leukocytes. Leukocytes within the systemic circulation move to sites of inflammation, and blocking this pathway could be an important treatment strategy for IBD. Anti-integrin therapy blocks the action of integrin on the surface of circulating immune cells and endothelial cell adhesion molecules, thereby inhibiting the interactions between leukocytes and intestinal blood vessels. Natalizumab, which acts on α4-integrin, was the first such drug to be approved for Crohn's disease, but its use is limited due to the risk of progressive multifocal leukoencephalopathy. Vedolizumab produces few systemic adverse effects because it acts on gut-trophic α4β7 integrin, and has been approved and is being used to treat IBD. Currently, several anti-integrin drugs, including etrolizumab, which acts on β7-integrin, and PF-00547569, which targets mucosal addressin cell adhesion molecule-1, are undergoing clinical trials and the results are being closely watched.展开更多
Multiple sclerosis(MS) is a chronic inflammatory condition of the central nervous system determined by a presumed autoimmune process mainly directed against myelin components but also involving axons and neurons. Acut...Multiple sclerosis(MS) is a chronic inflammatory condition of the central nervous system determined by a presumed autoimmune process mainly directed against myelin components but also involving axons and neurons. Acute demyelination shows as clinical relapses that may fully or partially resolve, while chronic demyelination and neuroaxonal injury lead to persistent and irreversible neurological symptoms, often progressing over time. Currently approved disease-modifying therapies are immunomodulatory or immunosuppressive drugs that significantly although variably reduce the frequency of attacks of the relapsing forms of the disease. However, they have limited efficacy in preventing the transition to the progressive phase of MS and are of no benefit after it has started. It is therefore likely that the potential advantage of a given treatment is condensed in a relatively limited window of opportunity for each patient, depending on individual characteristics and disease stage, most frequently but not necessarily in the early phase of the disease. In addition, a sizable proportion of patients with MS may have a very mild clinical course not requiring a disease-modifying therapy. Finally, individual response to existing therapies for MS varies significantly across subjects and the risk of serious adverse events remains an issue, particularly for the newest agents. The present review is aimed at critically describing current treatment strategies for MS with a particular focus on the decision of starting, switching and stopping commercially available immunomodulatory and immunosuppressive therapies.展开更多
文摘Progressive multifocal leukoencephalopathy is the most common serious complication related to natalizumab. However, serious haematological complications are very uncommon during treatment with natalizumab. Here we reported the case of an 18-year-old man with a 4-year history of relapsing-re- mitting multiple sclerosis. He was treated firstly by Teriflunomide for 1 year, but he presented relapses and his MRI shows new contrast-enhancing lesions. Therefore, we decided to switch from Teriflunomide to Natalizumab. The patient presented with profound anaemia after the 16<sup>th</sup> infusions treatment with Natalizumab. The patient’s hemoglobin was 3.2 g/dL with a lower blood reticulocyte value. After red cell transfusions and cessation of Natalizumab, anaemia resolved. Natalizumab was changed by an anti-CD20 monoclonal antibody. The patient had a stable course of multiple sclerosis at 13 months after initiation of Rituximab. We should alert clinicians to be aware of the possibility of anaemia during treatment by Natalizumab.
文摘In inflammatory bowel disease(IBD), tumor necro-sis factor plays an important role in mediating infla-mmation, but several other pathways are also involved in eliciting an inflammatory response. One such pathway is the invasion of the intestinal mucosa by leukocytes. Leukocytes within the systemic circulation move to sites of inflammation, and blocking this pathway could be an important treatment strategy for IBD. Anti-integrin therapy blocks the action of integrin on the surface of circulating immune cells and endothelial cell adhesion molecules, thereby inhibiting the interactions between leukocytes and intestinal blood vessels. Natalizumab, which acts on α4-integrin, was the first such drug to be approved for Crohn's disease, but its use is limited due to the risk of progressive multifocal leukoencephalopathy. Vedolizumab produces few systemic adverse effects because it acts on gut-trophic α4β7 integrin, and has been approved and is being used to treat IBD. Currently, several anti-integrin drugs, including etrolizumab, which acts on β7-integrin, and PF-00547569, which targets mucosal addressin cell adhesion molecule-1, are undergoing clinical trials and the results are being closely watched.
文摘Multiple sclerosis(MS) is a chronic inflammatory condition of the central nervous system determined by a presumed autoimmune process mainly directed against myelin components but also involving axons and neurons. Acute demyelination shows as clinical relapses that may fully or partially resolve, while chronic demyelination and neuroaxonal injury lead to persistent and irreversible neurological symptoms, often progressing over time. Currently approved disease-modifying therapies are immunomodulatory or immunosuppressive drugs that significantly although variably reduce the frequency of attacks of the relapsing forms of the disease. However, they have limited efficacy in preventing the transition to the progressive phase of MS and are of no benefit after it has started. It is therefore likely that the potential advantage of a given treatment is condensed in a relatively limited window of opportunity for each patient, depending on individual characteristics and disease stage, most frequently but not necessarily in the early phase of the disease. In addition, a sizable proportion of patients with MS may have a very mild clinical course not requiring a disease-modifying therapy. Finally, individual response to existing therapies for MS varies significantly across subjects and the risk of serious adverse events remains an issue, particularly for the newest agents. The present review is aimed at critically describing current treatment strategies for MS with a particular focus on the decision of starting, switching and stopping commercially available immunomodulatory and immunosuppressive therapies.
