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[PMID]:29370152
[Au] Autor:Dooling KL; Guo A; Patel M; Lee GM; Moore K; Belongia EA; Harpaz R
[Ti] Título:Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines.
[So] Source:MMWR Morb Mortal Wkly Rep;67(3):103-108, 2018 Jan 26.
[Is] ISSN:1545-861X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:On October 20, 2017, Zoster Vaccine Recombinant, Adjuvanted (Shingrix, GlaxoSmithKline, [GSK] Research Triangle Park, North Carolina), a 2-dose, subunit vaccine containing recombinant glycoprotein E in combination with a novel adjuvant (AS01 ), was approved by the Food and Drug Administration for the prevention of herpes zoster in adults aged ≥50 years. The vaccine consists of 2 doses (0.5 mL each), administered intramuscularly, 2-6 months apart (1). On October 25, 2017, the Advisory Committee on Immunization Practices (ACIP) recommended the recombinant zoster vaccine (RZV) for use in immunocompetent adults aged ≥50 years.
[Mh] Termos MeSH primário: Vacina contra Herpes Zoster/administração & dosagem
Herpes Zoster/prevenção & controle
Guias de Prática Clínica como Assunto
[Mh] Termos MeSH secundário: Comitês Consultivos
Idoso
Seres Humanos
Esquemas de Imunização
Imunocompetência
Meia-Idade
Estados Unidos
United States Food and Drug Administration
Vacinas Atenuadas/administração & dosagem
Vacinas Sintéticas/administração & dosagem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Herpes Zoster Vaccine); 0 (Vaccines, Attenuated); 0 (Vaccines, Synthetic)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE
[do] DOI:10.15585/mmwr.mm6703a5


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[PMID]:27772619
[Au] Autor:Abad CL; Razonable RR
[Ad] Endereço:Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN.
[Ti] Título:α Herpes Virus Infections Among Renal Transplant Recipients.
[So] Source:Semin Nephrol;36(5):344-350, 2016 09.
[Is] ISSN:1558-4488
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The α herpes viruses HSV-1, HSV-2, and VZV often reactivate in the setting of immune suppression after solid organ transplantation. Oral or genital mucocutaneous disease is the most common clinical manifestation of HSV disease while VZV manifests as varicella (or chickenpox) or reactivation herpes zoster, characterized by a diffuse rash, or a painful unilateral vesicular eruption in a dermatomal distribution, respectively. The diagnosis of HSV and VZV is primarily based on history and clinical presentation, although diagnostic tests may be necessary for atypical presentations of disease. Treatment usually involves oral or intravenous antiviral therapy, depending on severity of illness.
[Mh] Termos MeSH primário: Varicela/induzido quimicamente
Rejeição de Enxerto/prevenção & controle
Herpes Simples/induzido quimicamente
Herpes Zoster/induzido quimicamente
Imunossupressores/efeitos adversos
Falência Renal Crônica/cirurgia
Transplante de Rim
[Mh] Termos MeSH secundário: Antivirais/uso terapêutico
Varicela/diagnóstico
Varicela/tratamento farmacológico
Varicela/prevenção & controle
Vacina contra Varicela/uso terapêutico
Técnicas de Cultura
Técnica Direta de Fluorescência para Anticorpo
Herpes Simples/diagnóstico
Herpes Simples/tratamento farmacológico
Herpes Zoster/diagnóstico
Herpes Zoster/tratamento farmacológico
Herpes Zoster/prevenção & controle
Herpesvirus Humano 1
Herpesvirus Humano 2
Herpesvirus Humano 3
Seres Humanos
Reação em Cadeia da Polimerase
Testes Sorológicos
Ativação Viral
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antiviral Agents); 0 (Chickenpox Vaccine); 0 (Immunosuppressive Agents)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:29384888
[Au] Autor:Seo YG; Kim SH; Choi SS; Lee MK; Lee CH; Kim JE
[Ad] Endereço:Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do.
[Ti] Título:Effectiveness of continuous epidural analgesia on acute herpes zoster and postherpetic neuralgia: A retrospective study.
[So] Source:Medicine (Baltimore);97(5):e9837, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Despite early treatment of herpes zoster (HZ), postherpetic neuralgia (PHN) can persist. This study was designed to compare the therapeutic and pain relief effects of continuous epidural analgesia (CEA) on the chronic phase as well as the acute phase of HZ with standard medical treatment.Medical records of 227 patients with moderate to severe zoster-associated pain that had not responded to standard medications were retrospectively reviewed. Patients received standard treatment alone (medical group) or standard treatment plus concurrent CEA (epidural group). The acute and chronic groups were classified according to a 4-week cut-off with regard to time between the onset of the rash and the first treatment. Four groups were studied: Group A (acute/medical group); Group B (acute/epidural group); Group C (chronic/medical group); and Group D (chronic/epidural group). Pain was assessed using the visual analog scale (VAS) and measured every 2 weeks for 6 months. We compared the pain rating at 6 months after the first treatment with the initial pain rating. Response to treatment was defined as a ≥50% reduction in pain severity since the initial visit. Remission was considered complete for patients whose VAS pain score was ≤2 for >3 successive visits and who no longer needed medical support.Patients who received a combination of standard treatment plus CEA (Groups B and D) had significantly higher response to treatment (P = .001) than patients receiving standard treatment alone (Groups A and C). The adjusted odds ratio (OR) for response to treatment in the epidural group versus the medical group was 5.17 (95% confidence interval [CI]: 1.75-15.23) in the acute group and 5.37 (95% CI: 1.62-17.79) in the chronic groups. The adjusted OR for complete remission in the epidural group versus the medical group was 3.05 (95% CI: 1.20-7.73) in the acute group and 4.46 (95% CI: 1.20-16.54) in the chronic group.CEA can effectively relieve pain caused by PHN and acute HZ and increase remission rates. Combining CEA with standard medical treatment may offer a clinical advantage in the management of pain caused by PHN as well as acute HZ.
[Mh] Termos MeSH primário: Amidas/uso terapêutico
Analgesia Epidural
Anestésicos/uso terapêutico
Fentanila/uso terapêutico
Herpes Zoster/tratamento farmacológico
Neuralgia Pós-Herpética/tratamento farmacológico
[Mh] Termos MeSH secundário: Idoso
Feminino
Herpes Zoster/complicações
Herpes Zoster/diagnóstico
Seres Humanos
Masculino
Meia-Idade
Neuralgia Pós-Herpética/diagnóstico
Neuralgia Pós-Herpética/virologia
Medição da Dor
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Amides); 0 (Anesthetics); 7IO5LYA57N (ropivacaine); UF599785JZ (Fentanyl)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009837


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[PMID]:29310348
[Au] Autor:Mao J; McPheeters JT; Finelli L
[Ad] Endereço:Optum, Eden Prairie, MN.
[Ti] Título:Healthcare utilization and costs among patients with herpes zoster and solid tumor malignancy on chemotherapy: A retrospective cohort study.
[So] Source:Medicine (Baltimore);96(48):e8746, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Immunosuppressed patients with solid tumor malignancies (STMs) are particularly vulnerable to herpes zoster (HZ). This study estimated the incidence of HZ and evaluated healthcare resource utilization and costs for persons with STM receiving chemotherapy with and without incident HZ.We conducted a retrospective claims study of adults with STM receiving chemotherapy between January 1, 2010 and June 30, 2014. Patients were followed from their first chemotherapy date through development of HZ, health plan disenrollment, the study end date, or 24 months. HZ incidence was calculated and stratified by patient characteristics. Adjusted HZ incidence was estimated using Poisson regression. Healthcare resource utilization and costs were compared between patients with HZ (cases) and propensity score-matched controls without HZ during a variable follow-up period. Adjusted healthcare costs were estimated using Lin regression to control for informative censoring.Of 155,480 patients with STM receiving chemotherapy, 3100 (2.0%) developed HZ, yielding an adjusted HZ incidence rate of 13.8/1000 person-years (PY). HZ cases (n = 3004) had significantly higher healthcare resource utilization than matched controls (n = 15,020). Adjusted annual costs were $48,077 for cases vs $41,645 for matched controls, corresponding to a differential cost of $6432 annually.After adjustment for potential confounders, patients with STM receiving chemotherapy had an HZ incidence of 13.8/1000 PY; those who developed HZ used more healthcare resources and incurred higher costs than those who did not. These findings suggest that HZ prevention by vaccination could improve outcomes and reduce costs in this population.
[Mh] Termos MeSH primário: Custos de Cuidados de Saúde
Herpes Zoster/complicações
Herpes Zoster/epidemiologia
Neoplasias/tratamento farmacológico
Aceitação pelo Paciente de Cuidados de Saúde
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Estudos de Casos e Controles
Feminino
Seres Humanos
Hospedeiro Imunocomprometido
Incidência
Masculino
Meia-Idade
Pontuação de Propensão
Estudos Retrospectivos
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180115
[Lr] Data última revisão:
180115
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180110
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008746


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[PMID]:29202939
[Au] Autor:Kawai K; Yawn BP
[Ad] Endereço:Clinical Research Center, Boston Children's Hospital and Harvard Medical School, Boston, MA. Electronic address: kosuke.kawai@childrens.harvard.edu.
[Ti] Título:Risk Factors for Herpes Zoster: A Systematic Review and Meta-analysis.
[So] Source:Mayo Clin Proc;92(12):1806-1821, 2017 Dec.
[Is] ISSN:1942-5546
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To systematically review studies examining risk factors for herpes zoster (HZ). METHODS: We performed a literature search using PubMed, EMBASE, and Web of Science for articles published from January 1, 2003, to February 1, 2017. A random-effects model was used to summarize the risk ratio (RR) or odds ratio (OR) and 95% CI. RESULTS: Of the 3450 studies screened, we included 84 studies in the systematic review and conducted meta-analysis in 62 studies. Women were at increased risk of HZ compared with men (pooled adjusted RR, 1.31; 95% CI, 1.27-1.34). Black individuals had almost half the risk of HZ as white individuals (pooled RR, 0.54; 95% CI, 0.47-0.63). Family history was found to be a risk factor for HZ (pooled OR, 3.59; 95% CI, 2.39-5.40). Autoimmune diseases, including rheumatoid arthritis (pooled RR, 1.67; 95% CI, 1.41-1.98) and systemic lupus erythematosus (pooled RR, 2.10; 95% CI, 1.40-3.15), were associated with an elevated risk of HZ. Other comorbidities were associated with an increased risk of HZ, with the pooled RRs ranging from 1.25 (95% CI, 1.13-1.39) for asthma to 1.30 (95% CI, 1.17-1.45) for diabetes mellitus and 1.31 (95% CI, 1.22-1.41) for chronic obstructive pulmonary disease. CONCLUSION: Our review revealed that female sex, race/ethnicity, family history, and comorbidities are risk factors for HZ. Efforts are needed to increase the uptake of zoster vaccination.
[Mh] Termos MeSH primário: Herpes Zoster/diagnóstico
Herpes Zoster/epidemiologia
[Mh] Termos MeSH secundário: Artrite Reumatoide/epidemiologia
Doenças Autoimunes/epidemiologia
Comorbidade
Diabetes Mellitus Tipo 2/epidemiologia
Feminino
Seres Humanos
Lúpus Eritematoso Sistêmico/epidemiologia
Masculino
Razão de Chances
Doença Pulmonar Obstrutiva Crônica/epidemiologia
Fatores Sexuais
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171212
[Lr] Data última revisão:
171212
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE


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[PMID]:27777201
[Au] Autor:Cui JZ; Zhang JW; Zhang Y; Ma ZL
[Ad] Endereço:Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China. E-mail: cuijizheng@126.com.
[Ti] Título:[Efficacy of intracutaneous methylene blue injection for moderate to severe acute thoracic herpes zoster pain and prevention of postherpetic neuralgia in elderly patients].
[So] Source:Nan Fang Yi Ke Da Xue Xue Bao;36(10):1377-1381, 2016 Oct 20.
[Is] ISSN:1673-4254
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:OBJECTIVE: To evaluate the clinical efficacy of intradermal injection of methylene blue for treatment of moderate to severe acute thoracic herpes zoster and prevention of postherpetica neuralgia in elderly patients. METHODS: Sixty-four elderly patients with herpes zoster were randomized to receive a 10-day course of intradermal injection of methylene blue and lidocaine plus oral valaciclovir (group A, 32 cases) and intradermal injection of lidocaine plus oral valaciclovir (group B).Herpes evaluation index, pain rating index, incidence of postherpetic neuralgia, and comprehensive therapeutic effect were compared between the two groups at 11, 30 and 60 days after the treatment. RESULTS: The baseline characteristics were comparable between the two groups (all P>0.05). Compared with that in group B, the time for no new blister formation, blister incrustation and decrustation, and pain relief was significantly shortened in group A (P<0.05) with also obviously lower pain intensity after the treatment. The incidence of postherpetic neuralgia was significantly lower in group A than in group B at 30 days (P<0.05), but not at 60 and 90 days after the treatment. The total clinical response rate was 93.8% in group A, much higher than that in group B (62.5%, P<0.05). CONCLUSION: Intradermal injection of methylene blue can effectively shorten the disease course, reduce the pain intensity and prevent the development of postherpetic neuralgia in elderly patients with herpes zoster.
[Mh] Termos MeSH primário: Herpes Zoster/complicações
Azul de Metileno/administração & dosagem
Neuralgia Pós-Herpética/terapia
[Mh] Termos MeSH secundário: Aciclovir/administração & dosagem
Aciclovir/análogos & derivados
Aciclovir/uso terapêutico
Idoso
Seres Humanos
Incidência
Injeções Intradérmicas
Lidocaína/administração & dosagem
Lidocaína/uso terapêutico
Azul de Metileno/uso terapêutico
Medição da Dor
Valina/administração & dosagem
Valina/análogos & derivados
Valina/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
98PI200987 (Lidocaine); HG18B9YRS7 (Valine); MZ1IW7Q79D (valacyclovir); T42P99266K (Methylene Blue); X4HES1O11F (Acyclovir)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE


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[PMID]:28748773
[Au] Autor:Jin L; Xu S; Maple PAC; Xu W; Brown KE
[Ad] Endereço:Virus Reference Department,National Infections Service,Public Health England,London,UK.
[Ti] Título:Differentiation between wild-type and vaccines strains of varicella zoster virus (VZV) based on four single nucleotide polymorphisms.
[So] Source:Epidemiol Infect;145(12):2618-2625, 2017 09.
[Is] ISSN:1469-4409
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Varicella-zoster virus (VZV) infection (chickenpox) results in latency and subsequent reactivation manifests as shingles. Effective attenuated vaccines (vOka) are available for prevention of both illnesses. In this study, an amplicon-based sequencing method capable of differentiating between VZV wild-type (wt) strains and vOka vaccine is described. A total of 44 vesicular fluid specimens collected from 43 patients (16 from China and 27 from the UK) with either chickenpox or shingles were investigated, of which 10 had received previous vaccination. Four sets of polymerase chain reactions were set up simultaneously with primers amplifying regions encompassing four single nucleotide polymorphisms (SNPs), '69349-106262-107252-108111'. Nucleotide sequences were generated by Sanger sequencing. All samples except one had a wt SNP profile of 'A-T-T-T'. The sample collected from a patient who received vaccine 7-10 days ago, along with VZV vaccine preparations, Zostavax and Baike-varicella gave a SNP profile 'G-C-C-C'. The results show that this method can distinguish vaccine-derived virus from wt viruses from main four clades, (clades 1-4) and should be of utility worldwide.
[Mh] Termos MeSH primário: Vacina contra Varicela/genética
Herpesvirus Humano 3/genética
Reação em Cadeia da Polimerase
Polimorfismo de Nucleotídeo Único
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Varicela/virologia
Vacina contra Varicela/classificação
Criança
Pré-Escolar
China
Inglaterra
Feminino
Herpes Zoster/virologia
Herpesvirus Humano 3/classificação
Seres Humanos
Lactente
Masculino
Meia-Idade
Escócia
Análise de Sequência de DNA
Vacinas Atenuadas/classificação
Vacinas Atenuadas/genética
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Chickenpox Vaccine); 0 (Vaccines, Attenuated)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171125
[Lr] Data última revisão:
171125
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.1017/S0950268817001509


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[PMID]:28917467
[Au] Autor:Chen YC; Lu PH
[Ad] Endereço:Department of Dermatology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
[Ti] Título:Body mass index is negatively associated with the intensity of acute zoster-associated pain in Taiwanese: A cross-sectional study.
[So] Source:J Am Acad Dermatol;77(4):779-782.e1, 2017 10.
[Is] ISSN:1097-6787
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Índice de Massa Corporal
Herpes Zoster/complicações
Herpes Zoster/diagnóstico
Neuralgia Pós-Herpética/diagnóstico
Dor/fisiopatologia
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Idoso
Estudos Transversais
Feminino
Herpes Zoster/tratamento farmacológico
Seres Humanos
Masculino
Meia-Idade
Neuralgia Pós-Herpética/epidemiologia
Dor/etiologia
Medição da Dor
Medição de Risco
Índice de Gravidade de Doença
Fatores Sexuais
Inquéritos e Questionários
Taiwan
Centros de Atenção Terciária
[Pt] Tipo de publicação:LETTER
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170918
[St] Status:MEDLINE


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[PMID]:28845604
[Au] Autor:Winthrop KL; Curtis JR; Lindsey S; Tanaka Y; Yamaoka K; Valdez H; Hirose T; Nduaka CI; Wang L; Mendelsohn AM; Fan H; Chen C; Bananis E
[Ad] Endereço:Oregon Health and Science University, Portland.
[Ti] Título:Herpes Zoster and Tofacitinib: Clinical Outcomes and the Risk of Concomitant Therapy.
[So] Source:Arthritis Rheumatol;69(10):1960-1968, 2017 Oct.
[Is] ISSN:2326-5205
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Patients with rheumatoid arthritis (RA) are at increased risk of herpes zoster (HZ), and the risk appears to be increased in patients treated with tofacitinib. The aim of this study was to evaluate whether concomitant treatment with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or glucocorticoids (GCs) contributes to the increased risk of HZ in RA patients treated with tofacitinib. METHODS: HZ cases were identified from the databases of 2 phase I, 9 phase II, 6 phase III, and 2 long-term extension studies of tofacitinib in RA patients. Crude incidence rates (IRs) of all HZ events (serious and nonserious) per 100 patient-years (with 95% confidence intervals [95% CIs]) were calculated for unique patients. Within phase III studies, we described HZ rates according to concomitant csDMARD treatment and baseline GC use. A multivariable Cox proportional hazards regression model was used to evaluate HZ risk factors across studies. RESULTS: Across all studies (6,192 patients; 16,839 patient-years), HZ was reported in 636 tofacitinib-treated patients (IR 4.0, 95% CI 3.7-4.4). In most cases (93%), HZ was classified as nonserious, and the majority of patients (94%) had involvement of only 1 dermatome. HZ IRs varied across regions, from 2.4 (95% CI 2.0-2.9) in Eastern Europe to 8.0 (95% CI 6.6-9.6) in Japan and 8.4 (95% CI 6.4-10.9) in Korea. Within phase III studies, HZ IRs varied according to tofacitinib dose, background csDMARD treatment, and baseline use of GCs. The IRs were numerically lowest for monotherapy with tofacitinib 5 mg twice daily without GCs (IR 0.56 [95% CI 0.07-2.01]) and highest for tofacitinib 10 mg twice daily with csDMARDs and GCs (IR 5.44 [95% CI 3.72-7.68]). Age, GC use, tofacitinib dose, and enrollment within Asia were independent risk factors for HZ. CONCLUSION: Patients receiving treatment with tofacitinib and GCs appear to have a greater risk of developing HZ compared with patients receiving tofacitinib monotherapy without GCs.
[Mh] Termos MeSH primário: Antirreumáticos/uso terapêutico
Artrite Reumatoide/tratamento farmacológico
Glucocorticoides/uso terapêutico
Herpes Zoster/epidemiologia
Piperidinas/uso terapêutico
Inibidores de Proteínas Quinases/uso terapêutico
Pirimidinas/uso terapêutico
Pirróis/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Idoso
Artrite Reumatoide/epidemiologia
Cloroquina/uso terapêutico
Ensaios Clínicos como Assunto
Bases de Dados Factuais
Relação Dose-Resposta a Droga
Quimioterapia Combinada
Feminino
Seres Humanos
Incidência
Isoxazóis/uso terapêutico
Masculino
Metotrexato/uso terapêutico
Meia-Idade
Análise Multivariada
Modelos de Riscos Proporcionais
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antirheumatic Agents); 0 (Glucocorticoids); 0 (Isoxazoles); 0 (Piperidines); 0 (Protein Kinase Inhibitors); 0 (Pyrimidines); 0 (Pyrroles); 87LA6FU830 (tofacitinib); 886U3H6UFF (Chloroquine); G162GK9U4W (leflunomide); YL5FZ2Y5U1 (Methotrexate)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170829
[St] Status:MEDLINE
[do] DOI:10.1002/art.40189


  10 / 8200 MEDLINE  
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[PMID]:28845577
[Au] Autor:Winthrop KL; Wouters AG; Choy EH; Soma K; Hodge JA; Nduaka CI; Biswas P; Needle E; Passador S; Mojcik CF; Rigby WF
[Ad] Endereço:Oregon Health and Science University, Portland.
[Ti] Título:The Safety and Immunogenicity of Live Zoster Vaccination in Patients With Rheumatoid Arthritis Before Starting Tofacitinib: A Randomized Phase II Trial.
[So] Source:Arthritis Rheumatol;69(10):1969-1977, 2017 Oct.
[Is] ISSN:2326-5205
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Patients with rheumatoid arthritis (RA) are at increased risk of herpes zoster, and vaccination is recommended for patients ages 50 years and older, prior to starting treatment with biologic agents or tofacitinib. Tofacitinib is an oral JAK inhibitor for the treatment of RA. We evaluated its effect on the immune response and safety of live zoster vaccine (LZV). METHODS: In this phase II, 14-week, placebo-controlled trial, patients ages 50 years and older who had active RA and were receiving background methotrexate were given LZV and randomized to receive tofacitinib 5 mg twice daily or placebo 2-3 weeks postvaccination. We measured humoral responses (varicella zoster virus [VZV]-specific IgG level as determined by glycoprotein enzyme-linked immunosorbent assay) and cell-mediated responses (VZV-specific T cell enumeration, as determined by enzyme-linked immunospot assay) at baseline and 2 weeks, 6 weeks, and 14 weeks postvaccination. End points included the geometric mean fold rise (GMFR) in VZV-specific IgG levels (primary end point) and T cells (number of spot-forming cells/10 peripheral blood mononuclear cells) at 6 weeks postvaccination. RESULTS: One hundred twelve patients were randomized to receive tofacitinib (n = 55) or placebo (n = 57). Six weeks postvaccination, the GMFR in VZV-specific IgG levels was 2.11 in the tofacitinib group and 1.74 in the placebo group, and the VZV-specific T cell GMFR was similar in the tofacitinib group and the placebo group (1.50 and 1.29, respectively). Serious adverse events occurred in 3 patients in the tofacitinib group (5.5%) and 0 patients (0.0%) in the placebo group. One patient, who lacked preexisting VZV immunity, developed cutaneous vaccine dissemination 2 days after starting tofacitinib (16 days postvaccination). This resolved after tofacitinib was discontinued and the patient received antiviral treatment. CONCLUSION: Patients who began treatment with tofacitinib 2-3 weeks after receiving LZV had VZV-specific humoral and cell-mediated immune responses to LZV similar to those in placebo-treated patients. Vaccination appeared to be safe in all of the patients except 1 patient who lacked preexisting VZV immunity.
[Mh] Termos MeSH primário: Antirreumáticos/uso terapêutico
Artrite Reumatoide/tratamento farmacológico
Vacina contra Herpes Zoster/uso terapêutico
Herpes Zoster/prevenção & controle
Inibidores de Proteínas Quinases/uso terapêutico
[Mh] Termos MeSH secundário: Idoso
Anticorpos Antivirais/imunologia
Método Duplo-Cego
Quimioterapia Combinada
Ensaio de Imunoadsorção Enzimática
ELISPOT
Feminino
Vacina contra Herpes Zoster/imunologia
Herpesvirus Humano 3/imunologia
Seres Humanos
Imunogenicidade da Vacina/imunologia
Imunoglobulina G/imunologia
Masculino
Metotrexato/uso terapêutico
Meia-Idade
Piperidinas/uso terapêutico
Pirimidinas/uso terapêutico
Pirróis/uso terapêutico
Linfócitos T/imunologia
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE II; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antibodies, Viral); 0 (Antirheumatic Agents); 0 (Herpes Zoster Vaccine); 0 (Immunoglobulin G); 0 (Piperidines); 0 (Protein Kinase Inhibitors); 0 (Pyrimidines); 0 (Pyrroles); 87LA6FU830 (tofacitinib); YL5FZ2Y5U1 (Methotrexate)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170829
[St] Status:MEDLINE
[do] DOI:10.1002/art.40187



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