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The use of biologicals in the treatment of inflammatory diseases: a single center experience in a large Swiss university hospital


Manz, Salomon Miro. The use of biologicals in the treatment of inflammatory diseases: a single center experience in a large Swiss university hospital. 2017, University of Zurich, Faculty of Medicine.

Abstract

Background: Current therapy for inflammatory diseases is glucocorticoids (GCs) either as monotherapy or combined with immunosuppressive medications. The side effects of the GCs are often limiting, therefore new therapeutic options are urgently required. Biological agents such as rituximab, tocilizumab or anti TNF antibodies showed promising results. Hence, we investigated the impact of biologicals on the prescription of GCs, clinical improvement and laboratory findings.
Method: We performed a retrospective analysis of the medical history of 44 cases of severe or relapsing inflammatory diseases, which were not appropriately controlled with standard immunosuppressive therapy. Our focus was on GCs dosage, clinical improvement and inflammatory parameters.
Results: Rituximab treatment (n = 18) resulted in a significant decrease in the daily prednisone dosage and also a clear decrease in CRP levels and leucocyte counts. Another group of 10 patients were treated with anti TNF antibodies (adalimumab n = 8, infliximab n = 1, etanercept n = 1) and displayed an obvious decrease in the daily prednisone dosage as well as a significant decrease of the CRP level. Treatment of patients (n = 5) with tocilizumab showed a pronounced reduction of the daily prednisone dosage, whereas the decrease in CRP levels as well as leucocyte counts was less distinct. Patients treated with anti interleukin 1 antibodies (anakinra n = 10, canakinumab n = 1) showed also a pronounced decrease of the daily prednisone dosage, whereas again the reduction of CRP levels and the leucocyte counts was less distinct. Furthermore, 34 of 39 patients (87%, 5 no data) had a clinical improvement of their symptoms after 24 weeks of treatment.
Conclusion: We demonstrate that the GCs dosage can be reduced and the laboratory inflammation parameters tend to normalization under the treatment with biological agents. Biologicals should be considered if a patient with severe or relapsing inflammatory diseases cannot be treated with the standard immunosuppressive therapy or exerts severe side effects.

Abstract

Background: Current therapy for inflammatory diseases is glucocorticoids (GCs) either as monotherapy or combined with immunosuppressive medications. The side effects of the GCs are often limiting, therefore new therapeutic options are urgently required. Biological agents such as rituximab, tocilizumab or anti TNF antibodies showed promising results. Hence, we investigated the impact of biologicals on the prescription of GCs, clinical improvement and laboratory findings.
Method: We performed a retrospective analysis of the medical history of 44 cases of severe or relapsing inflammatory diseases, which were not appropriately controlled with standard immunosuppressive therapy. Our focus was on GCs dosage, clinical improvement and inflammatory parameters.
Results: Rituximab treatment (n = 18) resulted in a significant decrease in the daily prednisone dosage and also a clear decrease in CRP levels and leucocyte counts. Another group of 10 patients were treated with anti TNF antibodies (adalimumab n = 8, infliximab n = 1, etanercept n = 1) and displayed an obvious decrease in the daily prednisone dosage as well as a significant decrease of the CRP level. Treatment of patients (n = 5) with tocilizumab showed a pronounced reduction of the daily prednisone dosage, whereas the decrease in CRP levels as well as leucocyte counts was less distinct. Patients treated with anti interleukin 1 antibodies (anakinra n = 10, canakinumab n = 1) showed also a pronounced decrease of the daily prednisone dosage, whereas again the reduction of CRP levels and the leucocyte counts was less distinct. Furthermore, 34 of 39 patients (87%, 5 no data) had a clinical improvement of their symptoms after 24 weeks of treatment.
Conclusion: We demonstrate that the GCs dosage can be reduced and the laboratory inflammation parameters tend to normalization under the treatment with biological agents. Biologicals should be considered if a patient with severe or relapsing inflammatory diseases cannot be treated with the standard immunosuppressive therapy or exerts severe side effects.

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Additional indexing

Item Type:Dissertation
Referees:Scharl Michael, Battegay Edouard
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic and Policlinic for Internal Medicine
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2017
Deposited On:25 Jan 2018 12:14
Last Modified:19 Mar 2018 10:04
OA Status:Green

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