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[PMID]:29465536
[Au] Autor:Yan X; Jin J
[Ad] Endereço:Department of Hepatology, The First Hospital of Jilin University, Changchun, Jilin, China.
[Ti] Título:Primary cutaneous amyloidosis associated with autoimmune hepatitis-primary biliary cirrhosis overlap syndrome and Sjögren syndrome: A case report.
[So] Source:Medicine (Baltimore);97(8):e0004, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Primary cutaneous amyloidosis (PCA) is a localized skin disorder characterized by the abnormal deposition of amyloid in the extracellular matrix of the dermis. The association between PCA and other diseases, although rare, has been documented for various autoimmune diseases. PCA associated with autoimmune hepatitis-primary biliary cirrhosis (AIH-PBC) overlap syndrome and Sjögren syndrome (SS) has not been previously reported in the literature. PATIENT CONCERNS: A 50-year-old woman presented with progressive abnormal liver enzyme levels and was referred to our department. DIAGNOSES: Due to the patient's symptoms, laboratory test results, radiographic findings, and pathologic results, she was diagnosed with PCA associated with AIH-PBC overlap syndrome and SS. INTERVENTIONS: She was subsequently treated with a combination of ursodeoxycholic acid (UDCA), prednisone, and azathioprine. OUTCOMES: While this treatment can achieve therapeutic success, it cannot prevent complications from cirrhosis. This patient remains alive but experienced an emergent gastrointestinal hemorrhage. LESSONS: While we acknowledge that this is a single case, these findings extend our knowledge of immunological diseases associated with PCA and suggest a common, immune-mediated pathogenic pathway between PCA, AIH-PBC overlap syndrome, and SS. After 12 years of follow up, clinical manifestations have developed, and these autoimmune diseases have progressed. The combination of UDCA, prednisone, and azathioprine can achieve therapeutic success but cannot prevent disease progression. Routine follow up for this patient is necessary to document disease progression.
[Mh] Termos MeSH primário: Amiloidose Familiar/imunologia
Hepatite Autoimune/complicações
Cirrose Hepática Biliar/complicações
Síndrome de Sjogren/complicações
Dermatopatias Genéticas/imunologia
Doenças do Tecido Conjuntivo Indiferenciado/complicações
[Mh] Termos MeSH secundário: Amiloidose Familiar/tratamento farmacológico
Anti-Inflamatórios/administração & dosagem
Azatioprina/administração & dosagem
Colagogos e Coleréticos/administração & dosagem
Quimioterapia Combinada
Feminino
Hepatite Autoimune/tratamento farmacológico
Hepatite Autoimune/imunologia
Seres Humanos
Imunossupressores/administração & dosagem
Cirrose Hepática Biliar/tratamento farmacológico
Cirrose Hepática Biliar/imunologia
Meia-Idade
Prednisona/administração & dosagem
Síndrome de Sjogren/tratamento farmacológico
Síndrome de Sjogren/imunologia
Dermatopatias Genéticas/tratamento farmacológico
Resultado do Tratamento
Doenças do Tecido Conjuntivo Indiferenciado/tratamento farmacológico
Doenças do Tecido Conjuntivo Indiferenciado/imunologia
Ácido Ursodesoxicólico/administração & dosagem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Inflammatory Agents); 0 (Cholagogues and Choleretics); 0 (Immunosuppressive Agents); 724L30Y2QR (Ursodeoxycholic Acid); MRK240IY2L (Azathioprine); VB0R961HZT (Prednisone)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000010004


  2 / 13838 MEDLINE  
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[PMID]:29328564
[Au] Autor:Stojkovic-Filipovic J; Lekic B; Milcic D; Milinkovic MV
[Ti] Título:Pemphigus herpetiformis - a case report of a rare form of pemphigus and review of the literature.
[So] Source:Vojnosanit Pregl;73(10):967-72, 2016 Oct.
[Is] ISSN:0042-8450
[Cp] País de publicação:Serbia
[La] Idioma:eng
[Ab] Resumo:Introduction: Pemphigus herpetiformis is the rare variant of pemphigus with characteristic clinical features, histopathological findings different from the convectional pemphigus, and immunological findings consistent with pemphigus. Case report: We presented a 65-year-old woman with initial pruritus followed by pruritic urticarial papules and plaques, some with annular rings of tense vesicles on the periphery, on the trunk and extremities, with no mucous lesions. Histopathological examination demonstrated spongiosis and intraepidermal vesicles in the mid or subcorneal epidermis in some biopsy specimen, with neutrophil and eosinophil infiltrate. Direct immunoflorescent microscopy revealed intercellular IgG deposition, most prominent in the upper layers of epidermis. Indirect immunoflorescent microscopy showed intercellular binding of IgG autoantibodies in the patient's sera. Initially the patient was threated with systemic corticosteroids and azathioprine, but dapson provided complete clinical remission. Conclusion: This entity was established 40 years ago, and around 100 patients have been reported worldwide. It is important to be aware of this particular form of pemphigus because clinical presentation, course of the disease and therapeutic approach are different from conventional forms of pemphigus.
[Mh] Termos MeSH primário: Dermatite Herpetiforme/patologia
Pênfigo/patologia
Pele/patologia
[Mh] Termos MeSH secundário: Corticosteroides/uso terapêutico
Idoso
Autoanticorpos/sangue
Azatioprina/uso terapêutico
Biomarcadores/sangue
Biópsia
Dapsona/uso terapêutico
Dermatite Herpetiforme/tratamento farmacológico
Dermatite Herpetiforme/imunologia
Feminino
Imunofluorescência
Seres Humanos
Imunoglobulina G/sangue
Pênfigo/tratamento farmacológico
Pênfigo/imunologia
Indução de Remissão
Pele/efeitos dos fármacos
Pele/imunologia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); 0 (Autoantibodies); 0 (Biomarkers); 0 (Immunoglobulin G); 8W5C518302 (Dapsone); MRK240IY2L (Azathioprine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180113
[St] Status:MEDLINE
[do] DOI:10.2298/VSP150617044S


  3 / 13838 MEDLINE  
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[PMID]:29309107
[Au] Autor:Tarabar D; Kandolf-Sekulovic L; Tatomirovic Z; Mijuskovic Z; Milenkovic Z; Tarabar O; Pecelj-Brocic T
[Ti] Título:Cutaneous side effects caused by treatment for inflammatory bowel disease.
[So] Source:Vojnosanit Pregl;73(4):382-9, 2016 Apr.
[Is] ISSN:0042-8450
[Cp] País de publicação:Serbia
[La] Idioma:eng
[Mh] Termos MeSH primário: Erupção por Droga/etiologia
Doenças Inflamatórias Intestinais/tratamento farmacológico
[Mh] Termos MeSH secundário: Corticosteroides/efeitos adversos
Anti-Inflamatórios não Esteroides/efeitos adversos
Azatioprina/efeitos adversos
Ciclosporina/efeitos adversos
Erupção por Droga/terapia
Seres Humanos
Imunossupressores/efeitos adversos
Mercaptopurina/efeitos adversos
Mesalamina/efeitos adversos
Metotrexato/efeitos adversos
Fator de Necrose Tumoral alfa/antagonistas & inibidores
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); 0 (Anti-Inflammatory Agents, Non-Steroidal); 0 (Immunosuppressive Agents); 0 (Tumor Necrosis Factor-alpha); 4Q81I59GXC (Mesalamine); 83HN0GTJ6D (Cyclosporine); E7WED276I5 (Mercaptopurine); MRK240IY2L (Azathioprine); YL5FZ2Y5U1 (Methotrexate)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180109
[St] Status:MEDLINE
[do] DOI:10.2298/VSP151123023D


  4 / 13838 MEDLINE  
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[PMID]:29238021
[Au] Autor:Kiboshi T; Isoda K; Furukawa K; Wakahara T; Otani K; Ueda K; Konma J; Teramura K; Ueno N; Fujiwara H; Shoda T
[Ad] Endereço:Department of Rheumatology, Yodogawa Christian Hospital.
[Ti] Título:[Granulomatosis with Polyangiitis Complicated with Gastrointestinal Perforation: A Case Report and Review of Literature].
[So] Source:Nihon Rinsho Meneki Gakkai Kaishi;40(5):382-386, 2017.
[Is] ISSN:1349-7413
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:  A 51-year-old man was detected nasal bleeding, multiple pulmonary nodule and mass, urinalysis abnormality, renal involvement and high titer of proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA), and was suspected of granulomatosis with polyangiitis and initiated with steroid pulse therapy. On the day after the start of steroid pulse therapy, generalized peritonitis due to ileal perforation occurred, and emergency ileectomy and peritonitis surgery were performed. Induction therapy with steroid pulse therapy, plasma exchange and intravenous cyclophosphamide therapy (IVCY) and maintenance therapy with glucocorticoid and azathioprine led to good therapeutic outcomes. Gastrointestinal perforation in GPA is a rare complication, and we examined the clinical features, treatment contents, and prognosis of GPA with gastrointestinal perforation from this case and previous reports. Lung involvements were complicated in all reported cases. Gastrointestinal perforations in GPA were frequent in the small intestine, occurred just before and immediately after the start of treatment, and were severe involvement with poor prognosis because of the high mortality rate (46.7%). The frequency of ear, nose and upper respiratory tract lesions in the surviving group was significantly higher than in the dead group (survival 87.5%, death 28.3%, P = 0.041). IVCY were more frequently used in the surviving group (62.5%) than the death group (16.7%), but it was not significantly. GPA complicated with gastrointestinal perforation is a severe condition with poor prognosis, but there is a possibility to improve prognosis by early diagnosis and early initiation of strong treatment.
[Mh] Termos MeSH primário: Granulomatose com Poliangiite/complicações
Granulomatose com Poliangiite/terapia
Íleo
Perfuração Intestinal/etiologia
Troca Plasmática
[Mh] Termos MeSH secundário: Anticorpos Anticitoplasma de Neutrófilos/sangue
Azatioprina/administração & dosagem
Biomarcadores/sangue
Ciclofosfamida/administração & dosagem
Diagnóstico Precoce
Granulomatose com Poliangiite/diagnóstico
Seres Humanos
Perfuração Intestinal/cirurgia
Masculino
Metilprednisolona/administração & dosagem
Meia-Idade
Mieloblastina/imunologia
Prognóstico
Pulsoterapia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antibodies, Antineutrophil Cytoplasmic); 0 (Biomarkers); 8N3DW7272P (Cyclophosphamide); EC 3.4.21.76 (Myeloblastin); MRK240IY2L (Azathioprine); X4W7ZR7023 (Methylprednisolone)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180112
[Lr] Data última revisão:
180112
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE
[do] DOI:10.2177/jsci.40.382


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[PMID]:29226420
[Au] Autor:Broekman MMTJ; Wanten GJ; de Jong DJ
[Ad] Endereço:Department of Gastroenterology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
[Ti] Título:Editorial: thiopurine-induced myelosuppression and infections in inflammatory bowel disease patients with a normal TPMT genotype-the perils of ageing. Authors' reply.
[So] Source:Aliment Pharmacol Ther;47(1):130-131, 2018 01.
[Is] ISSN:1365-2036
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Envelhecimento
Doenças Inflamatórias Intestinais
[Mh] Termos MeSH secundário: Azatioprina
Genótipo
Seres Humanos
Imunossupressores
Mercaptopurina
Metiltransferases/genética
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Nm] Nome de substância:
0 (Immunosuppressive Agents); E7WED276I5 (Mercaptopurine); EC 2.1.1.- (Methyltransferases); MRK240IY2L (Azathioprine)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171220
[Lr] Data última revisão:
171220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE
[do] DOI:10.1111/apt.14395


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[PMID]:29226409
[Au] Autor:Willington AJ; Gearry RB
[Ad] Endereço:Department of Gastroenterology, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand.
[Ti] Título:Editorial: thiopurine-induced myelosuppression and infections in inflammatory bowel disease patients with a normal TPMT genotype-the perils of ageing.
[So] Source:Aliment Pharmacol Ther;47(1):129-130, 2018 01.
[Is] ISSN:1365-2036
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Envelhecimento
Doenças Inflamatórias Intestinais
[Mh] Termos MeSH secundário: Azatioprina
Genótipo
Seres Humanos
Imunossupressores
Mercaptopurina
Metiltransferases/genética
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Nm] Nome de substância:
0 (Immunosuppressive Agents); E7WED276I5 (Mercaptopurine); EC 2.1.1.- (Methyltransferases); MRK240IY2L (Azathioprine)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171220
[Lr] Data última revisão:
171220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE
[do] DOI:10.1111/apt.14370


  7 / 13838 MEDLINE  
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[PMID]:29226406
[Au] Autor:Meijer B; de Boer NKH
[Ad] Endereço:Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands.
[Ti] Título:Letter: thiopurines - is less really more?
[So] Source:Aliment Pharmacol Ther;47(1):149, 2018 01.
[Is] ISSN:1365-2036
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Azatioprina
Mercaptopurina
[Mh] Termos MeSH secundário: Seres Humanos
Imunossupressores
Doenças Inflamatórias Intestinais
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
0 (Immunosuppressive Agents); E7WED276I5 (Mercaptopurine); MRK240IY2L (Azathioprine)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171220
[Lr] Data última revisão:
171220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE
[do] DOI:10.1111/apt.14375


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[PMID]:28449228
[Au] Autor:Roblin X; Boschetti G; Williet N; Nancey S; Marotte H; Berger A; Phelip JM; Peyrin-Biroulet L; Colombel JF; Del Tedesco E; Paul S; Flourie B
[Ad] Endereço:Department of Gastroenterology, University Hospital of Saint Etienne, Saint Etienne, France.
[Ti] Título:Azathioprine dose reduction in inflammatory bowel disease patients on combination therapy: an open-label, prospective and randomised clinical trial.
[So] Source:Aliment Pharmacol Ther;46(2):142-149, 2017 07.
[Is] ISSN:1365-2036
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Infliximab (IFX) combined with azathioprine (AZA) is more effective than IFX monotherapy in inflammatory bowel disease (IBD). AIM: To identify the AZA optimal dose that is required for efficacy when receiving combination therapy. METHODS: Patients with IBD in durable remission on combination therapy were enrolled in a 1-year, open-label, prospective trial after randomisation into three groups: AZA steady (2-2.5 mg/kg/day, n=28) vs AZA down (dose was halved 1-1.25 mg/kg/day, n=27) vs AZA stopped (n=26). Primary endpoint was failure defined as occurrence of a clinical relapse and/or any change in IBD therapy. RESULTS: Eighty-one patients were included. Five (17.9%), 3 (11.1%), and 8 (30.8%) patients experienced failure at 1 year in groups AZA steady, AZA down and AZA stopped, respectively (P=.1 across the groups). The median trough levels of IFX at inclusion were close to those measured at the end of follow-up in group AZA steady (3.65 vs 3.45 µg/mL, P=.9) and in group AZA down (3.95 vs 3.60 µg/mL, P=.5), whereas these levels dropped from 4.25 to 2.15 µg/mL (P=.02) in group AZA stopped. Four (14.3%), four (14.8%) and 11 (42.3%) patients experienced an unfavourable evolution of IFX pharmacokinetics in groups AZA steady, AZA down and AZA stopped, respectively. A threshold of 6-TGN <105 pmoles/8.10 RBC was associated with an unfavourable evolution of IFX pharmacokinetics. CONCLUSIONS: Under combination therapy, AZA dose reduction, but not withdrawal, appears to be as effective as continuation of AZA at full dose.
[Mh] Termos MeSH primário: Antirreumáticos/uso terapêutico
Azatioprina/uso terapêutico
Doenças Inflamatórias Intestinais/tratamento farmacológico
Infliximab/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Idoso
Antirreumáticos/administração & dosagem
Antirreumáticos/efeitos adversos
Azatioprina/administração & dosagem
Azatioprina/efeitos adversos
Protocolos Clínicos
Relação Dose-Resposta a Droga
Esquema de Medicação
Quimioterapia Combinada
Feminino
Seres Humanos
Infliximab/administração & dosagem
Infliximab/efeitos adversos
Masculino
Meia-Idade
Estudos Prospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antirheumatic Agents); B72HH48FLU (Infliximab); MRK240IY2L (Azathioprine)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171220
[Lr] Data última revisão:
171220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE
[do] DOI:10.1111/apt.14106


  9 / 13838 MEDLINE  
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[PMID]:29049193
[Au] Autor:Gómez-Gómez A; Loza E; Rosario MP; Espinosa G; Morales JMGR; Herreras JM; Muñoz-Fernández S; Cordero-Coma M
[Ad] Endereço:aReumatología HM Hospitales-Hospital Universitario HM Sanchinarro, Madrid bReumatología, Hospital Universitario Infanta Sofía, Madrid cInstituto de Salud Musculoesuqelética, Madrid dDepartment of Autoimmune Diseases, Institut Clinic de Medicina i Dermatologia, Hospital Clínic, Barcelona eUnidad de Inmunología, Complejo Asistencial Universitario e Instituto de Biomedicina Universidad de León (IBIOMED), León fInstituto Universitario de Oftalmobiología (IOBA), Universitdad de Valladolid, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Hospital Clínico Universitario de Valladolid gUniversidad Europea de Madrid, Madrid hUnidad de Uveitis, Complejo Asistencial Universitario e Instituto de Biomedicina Universidad de León (IBIOMED), León, Spain.
[Ti] Título:Efficacy and safety of immunomodulatory drugs in patients with anterior uveitis: A systematic literature review.
[So] Source:Medicine (Baltimore);96(42):e8045, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: To assess the efficacy and safety of immunomodulatory drugs in patients with noninfectious anterior uveitis (AU). METHODS: Systematic review of studies were retrieved from Medline (1961 to March 2016), Embase (1961 to March 2016), and Cochrane Library (up to March 2016), and a complementary hand search was also performed. The selection criteria were as follows: (population) noninfectious AU patients, adults; (intervention) immunomodulatory drugs (any dose, regimen, route of administration, duration of treatment); (outcome) control of inflammation, steroid-sparing effect, AU flares, adverse events, and so on; (study design) systematic literature reviews, randomized controlled trials, and observational studies. The study quality was assessed using the Jadad scale and according to The Oxford Centre for Evidence-based Medicine (update 2009). RESULTS: We included 13 studies of moderate-poor quality, with a mean duration from 5 months to 20 years, and number of AU patients ranging from 9 to 274. Patient's demographic and clinical characteristics were very heterogeneous. In most cases, uveitis anatomic classification criteria and outcomes definitions were unclear. Some of the studies only included AU patients with a systemic disease associated, mostly spondyloarthritis, others, mixed populations (idiopathic and systemic disease associated patients), and in some articles this data is not described. We found that methotrexate, cyclosporine A, azathioprine, adalimumab, and golimumab might prevent AU flares, improve ocular inflammation and visual acuity, and decrease systemic steroids doses. CONCLUSIONS: Although there is a lack of robust evidence, methotrexate, cyclosporine A, azathioprine, adalimumab, and golimumab might be effective in AU patients.
[Mh] Termos MeSH primário: Imunossupressores/uso terapêutico
Uveíte Anterior/tratamento farmacológico
[Mh] Termos MeSH secundário: Adalimumab/uso terapêutico
Adulto
Anticorpos Monoclonais/uso terapêutico
Azatioprina/uso terapêutico
Ciclosporina/uso terapêutico
Feminino
Seres Humanos
Masculino
Metotrexato/uso terapêutico
Meia-Idade
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Antibodies, Monoclonal); 0 (Immunosuppressive Agents); 83HN0GTJ6D (Cyclosporine); 91X1KLU43E (golimumab); FYS6T7F842 (Adalimumab); MRK240IY2L (Azathioprine); YL5FZ2Y5U1 (Methotrexate)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171020
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008045


  10 / 13838 MEDLINE  
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[PMID]:28977502
[Au] Autor:de Joode AAE; Sanders JSF; Puéchal X; Guillevin LP; Hiemstra TF; Flossmann O; Rasmussen N; Westman K; Jayne DR; Stegeman CA
[Ad] Endereço:Department of Internal Medicine and Nephrology, University Medical Center Groningen, Groningen, the Netherlands.
[Ti] Título:Long term azathioprine maintenance therapy in ANCA-associated vasculitis: combined results of long-term follow-up data.
[So] Source:Rheumatology (Oxford);56(11):1894-1901, 2017 Nov 01.
[Is] ISSN:1462-0332
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objective: We studied whether in ANCA-associated vasculitis patients, duration of AZA maintenance influenced relapse rate during long-term follow-up. Methods: Three hundred and eighty newly diagnosed ANCA-associated vasculitis patients from six European multicentre studies treated with AZA maintenance were included; 58% were male, median age at diagnosis 59.4 years (interquartile range: 48.3-68.2 years); granulomatosis with polyangiitis, n = 236; microscopic polyangiitis, n = 132; or renal limited vasculitis, n = 12. Patients were grouped according to the duration of AZA maintenance after remission induction: ⩽18 months, ⩽24 months, ⩽36 months, ⩽48 months or > 48 months. Primary outcome was relapse-free survival at 60 months. Results: During follow-up, 84 first relapses occurred during AZA-maintenance therapy (1 relapse per 117 patient months) and 71 after withdrawal of AZA (1 relapse/113 months). During the first 12 months after withdrawal, 20 relapses occurred (1 relapse/119 months) and 29 relapses >12 months after withdrawal (1 relapse/186 months). Relapse-free survival at 60 months was 65.3% for patients receiving AZA maintenance >18 months after diagnosis vs 55% for those who discontinued maintenance ⩽18 months (P = 0.11). Relapse-free survival was associated with induction therapy (i.v. vs oral) and ANCA specificity (PR3-ANCA vs MPO-ANCA/negative). Conclusion: Post hoc analysis of combined trial data suggest that stopping AZA maintenance therapy does not lead to a significant increase in relapse rate and AZA maintenance for more than 18 months after diagnosis does not significantly influence relapse-free survival. ANCA specificity has more effect on relapse-free survival than duration of maintenance therapy and should be used to tailor therapy individually.
[Mh] Termos MeSH primário: Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico
Azatioprina/uso terapêutico
Imunossupressores/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Idoso
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/imunologia
Anticorpos Anticitoplasma de Neutrófilos/imunologia
Intervalo Livre de Doença
Feminino
Seguimentos
Granulomatose com Poliangiite/tratamento farmacológico
Granulomatose com Poliangiite/imunologia
Seres Humanos
Nefropatias/tratamento farmacológico
Nefropatias/imunologia
Quimioterapia de Manutenção
Masculino
Poliangiite Microscópica/tratamento farmacológico
Poliangiite Microscópica/imunologia
Meia-Idade
Mieloblastina/imunologia
Peroxidase/imunologia
Recidiva
Fatores de Tempo
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Antineutrophil Cytoplasmic); 0 (Immunosuppressive Agents); EC 1.11.1.7 (Peroxidase); EC 3.4.21.76 (Myeloblastin); MRK240IY2L (Azathioprine)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171106
[Lr] Data última revisão:
171106
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171005
[St] Status:MEDLINE
[do] DOI:10.1093/rheumatology/kex281



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