جستجوی مقالات مرتبط با کلیدواژه « adalimumab » در نشریات گروه « پزشکی »

Axial spondyloarthritis (axSpA) represents a chronic inflammatory condition primarily impacting axial joints, characterized by sacroiliitis and spondylitis. In axSpA patients, low back pain (LBP) typically assumes a chronic and inflammatory nature, where diagnostic delays can precipitate disability. However, atypical axSpA presentations pose challenges for early diagnosis and management. In the current study, we detail the case of a 39-year-old male presenting with acute, severe LBP and bilateral sacroiliitis. Initial treatment with non-steroidal anti-inflammatory drugs (NSAIDs), the standard first-line therapy, was discontinued due to severe gastrointestinal bleeding. Following a bone biopsy that excluded alternative etiologies, axSpA was confirmed based on diagnostic criteria. Elevated inflammatory markers, contraindications to NSAIDs, and magnetic resonance imaging findings prompted the initiation of anti-tumor necrosis factor (TNF) therapy. Remarkably, a marked improvement was observed in less than six weeks post anti-TNF therapy commencement. This case underscores the significance of recognizing atypical axSpA presentations and underscores the potential for swift and robust responses to anti-TNF agents. Optimal patient outcomes hinge upon effective disease pattern recognition and treatment selection.

 Adalimumab is a highly human monoclonal antibody that binds to tumor necrosis factor, a key proinflammatory cytokine pathogenic in psoriasis. It is considered as an influential factor in controlling moderate to severe psoriasis. This study aimed to evaluate the impact of Adalimumab on COVID-19 incidence in patients with psoriasis.

 This cross-sectional study was performed at Baqiyatallah Hospital in 2021. Eighty patients with psoriasis who referred to Baqiyatallah Hospital were included in the study. Patients were divided into two groups, one group was treated with Adalimumab, and the other group received the control treatment. The incidence of the disease was assessed by the history of COVID-19 signs and symptoms, positive RT‐ PCR testing and graphing, and physician diagnosis.

The mean age of patients was 39.5 (±7.9 S.D.). 36(45%) patients were infected with COVID-19, and 44 (55%) patients were not infected, and there was no significant difference between the two groups in the infection with COVID-19 (P value = 0.36). There was a significant relationship between infection with COVID-19 and the severity of psoriasis (P value=0.01).  Although, in the severe psoriasis group, which was significantly more affected by COVID-19, there was no statistically significant relationship between Adalimumab consumption and COVID-19 affection (P value = 0.19).

 PPsoriasis patients treated with Adalimumab are not more prone to COVID-19 infection. However, patients with severe psoriasis are more likely to develop COVID-19; this matter is not related to the use of Adalimumab, and it is not necessary to discontinue or change Adalimumab.

Tumor necrosis factor-alpha (TNF-alpha) inhibitors, such as adalimumab (ADA) and infliximab, are among the most effective biological drugs for inducing and maintaining remission in patients with moderate to severe inflammatory bowel disease (IBD). Studies have shown that the effectiveness of infliximab is increased with the concomitant use of immunosuppressive drugs. However, little is known about ADA. Our aim was to compare the efficacy of monotherapy with biosimilar ADA and combination therapy with ADA+azathioprine (AZA) in IBD patients.

In this retrospective cohort study, the medical records of anti-TNF-naïve IBD patients referred to a tertiary hospital in Tehran during 2019-2020 who received biosimilar ADA (CinnoRA®) were reviewed. We compared the effectiveness of treatment, serum levels of ADA, anti-adalimumab antibodies, and laboratory data between the two monotherapy and combination therapy groups.

A total of 65 patients were enrolled. Fifty-six (86.2%) patients had ulcerative colitis, and the remaining had Crohn’s disease. 50 patients (76.9%) received combination therapy, and 15 (23.1%) were in the monotherapy group. The rate of clinical remission in the combination therapy group (50%) did not differ significantly from the monotherapy group (40%). The drug levels were in the therapeutic range (≥7.5 µg/mL) in 57.5% of patients in the combination therapy group and 76.9% of those in the monotherapy group. The antibody test result was positive in 40% of patients taking AZA+ADA and 10% of patients in the ADA group, neither were significantly different.

Adding AZA may not play a significant role in improving the therapeutic effectiveness of ADA in treating IBD.

Sneddon-Wilkinson disease, also known as subcorneal pustulardermatosis (SPD), is a relapsing pustular dermatosis of unknownetiology. The vesiculopustules typically present on the trunkand intertriginous areas. The mainstay of SPD treatment isdapsone; second-line therapies include corticosteroids and otherimmunosuppressive drugs. Here, we report a case of recalcitrantsevere SPD that responded dramatically to adalimumab. Thepatient was a 30-year-old man who presented with generalizederythroderma and vesiculopustules on the trunk and extremities.In some pustules, the pus settled with gravity into the lowerhalf of the blister. He responded dramatically to a combinationof adalimumab (80 mg on day 1, 40 mg on day 7, and 40 mgbiweekly afterward) and prednisolone 50 mg daily. During followup,prednisolone was tapered to 5 mg daily over 2 months, andadalimumab was maintained biweekly; he is still in remissionafter 8 months. Thus, adalimumab can be used as an effectiveand easy-to-use treatment in refractory cases of SPD.

risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Despite the effectiveness of usingcombined conventional and biological disease-modifying anti-rheumatic drugs(bDMARDs) in managing rheumaticdiseases, there have been concerns that taking biological agents may have an additive effect on getting infected withCOVID-19. This study evaluates the impact of taking biological agents on altering the chance of getting infected withSARS-CoV-2 in rheumatoloid and lupus patients compared to traditional DMARDs.

We carried out a cross-sectional survey study from February 2020 to January 2021 on patients diagnosedwith lupus and rheumatid arthritis. COVID-19 infection was confirmed by the presence of symptoms and signs of the diseaseand para-clinical findings such as lymphopenia and elevated C-reactive protein (CRP) and positive chest CT scanor polymerase chain reaction (PCR) of COVID-19.

Out of 591 patients included in this study, 422 (71.4%) had rheumatoid arthritis (RA), and 169 (28.6%) hadsystemic lupus erythematosus (SLE). Among them, 56 (9.5%) cases were diagnosed with COVID-19 infection. Noassociation was found between age, gender, or type of rheumatological diseases and SARS-CoV-2. There was asignificant association between COVID-19 infection and treatment with biological drugs (P-value<0.05) regardless ofthe type of rheumatologic disease. Interestingly, the analysis revealed that the type of biologic drug also altered thechance of COVID-19 infection; In fact, patients who took TNF inhibitors were significantly at a higher risk of diseasethan those taking Rituximab (P-value=0.000). Identical results were observed among RA patients (P-value<0.001),however, all 5 (3%) lupus cases treated with Rituximab infected with covid 19.

This study develops a better understanding of the risk of immunosuppressive medications for SARSCoV-2 infection. Patients treated with conventional and biological medicine had a higher disease risk than those takingexclusively conventional drugs. However, more studies are required to deliberate the relation of the reviewed factorswith the severity of COVID-19.Level of evidence: II

In recent years, biological drugs, including antitumor necrosis factors, have revolutionized the treatment of inflammatory bowel disease (IBD); however, there is no consensus about the superiority of adalimumab over infliximab.

This study was designed to evaluate the efficacy of adalimumab for the management of IBD in the southwest region of Iran.

During this prospective observational study, the patients with active IBD and a history of no response to previous treatments that referred to an IBD clinic were included. Moreover, this study evaluated and compared the effectiveness of treatment, including clinical remission rate, disease activity index (the Mayo score in ulcerative colitis (UC) patients and the Crohn’s disease activity index (CDAI) in Crohn’s disease (CD) patients), clinical response, and side effects related to adalimumab injection in 0, 12th, 24th, and 52nd weeks after treatment.

A total of 71 patients, including 42 male and 29 female, with a mean age of 29 years, were included. In this study, 37 and 34 patients were diagnosed with UC (52.1%, 20 male and 17 female) and CD (47.8%, 22 male and 12 female), respectively. The time to remission in the UC group was significantly longer than in the CD group (10.05 and 1.71 months; P < 0.0001). Clinical remission rate (≥ 2 points reduction in the Mayo score) in the 12th week among UC patients after treatment with adalimumab was 67.5% and raised to 100% (all the UC patients) in the 24th and 52nd weeks after treatment. None of the UC patients experienced disease recurrence. In CD patients, the CDAI significantly decreased during the treatment time (P < 0.0001); however, all CD patients (100%) experienced disease recurrence after a mean time of 2.59 ± 0.55 months (within 2 - 4 months) (P < 0.0001). Failure of treatment was observed in 94.1% of CD patients (n = 32); nevertheless, none of the UC patients had treatment failure (P < 0.0001). There were no complications related to adalimumab, and no patients needed colectomy during the study period.

Adalimumab has a positive effect on the improvement of clinical symptoms, reduction of disease activity, prevention of disease recurrence, and need for colectomy in moderate to severe UC patients. However, adalimumab has no efficacy in the improvement of CD patients, and failure of treatment was observed in most of these patients. Adalimumab could be a therapeutic option for the management of UC with prior failure of treatment.

This multicenter study is the first one on Iranian children with very early onset ulcerative colitis (UC) and one of the few studies about the effect of biological therapy in children with UC under 7 years of age.

Children with very early onset inflammatory bowel disease (IBD) are diagnosed before 6 years of age

The current study was performed on 14 children under 7 years of age with severe UC. Children with severe UC whose therapy with corticosteroid and azathioprine as conventional treatment had failed were treated with infliximab (IFX) and later with adalimumab (ADA).

Among the total 14 participants, 6 (43%) patients were female. Mean patient age was 4.9 years (range = 3–7 years), mean age at diagnosis was 3.4 years (range = 1.5–6 years), and mean duration of illness was 1.5 years. At the end of 54 weeks of therapy with IFX, 2 (14%) patients were in remission, 2 (14%) patients were mild, and 4 (29%) patients were moderate, with no secondary treatment failure (during the maintenance phase). A total of 6 (43%) patients had primary treatment failure (no response after 14 weeks of therapy). These patients were treated with ADA. At the end of 52 weeks of therapy, 3 (50%) of those 6 (100%) patients were referred for colectomy, 1 (17%) was in remission, and 2 (33%) patients had mild severity.

The current study has shown that IFX is a safe and effective therapy for children with very early onset UC. ADA may be effective in the treatment of children with UC who are refractory to IFX.

To evaluate the inhibitory effect of adalimumab on diabetic nephropathyDN) through animal models.

We carried out the study in Weifang People’s Hospital, Weifang 261041, China in December 2020. Streptozotocin was used to induce DN in model animal Sprague-Dawley (SD) rats. The DN animal model was given treatment with adalimumab, and the inhibitory effect of adalimumab on the development process of DN was evaluated by detecting changes in blood glucose and urinary albumin levels. Meanwhile, the content of UN, Cr and CysC of the blood in different experimental groups was tested by weighing the ratio of kidney and performing ELISA to evaluate the protective effect of adalimumab on kidney of DN animal model. In addition, the changes in the transcription and translation levels of tumor necrosis factor α (TNF-α) and its downstream regulatory factors MCP-1 and NF-kB in kidney of different experimental groups were detected by fluorescence quantitative PCR and Western blot tests to further reveal the molecular mechanism of adalimumab inhibiting the diabetic nephropathy.

adalimumab could significantly downregulate blood glucose and urinary albumin levels (P <0.05). The renal body weight ratio and the contents of UN, Cr and Cysc in blood in the adalimumab group were significantly lower than those in the placebo group (P <0.05). Meanwhile, adalimumab could significantly downregulate the expression of these molecules (P <0.05).

adalimumab could exert its therapeutic effect on diabetic nephropathy through its specific targeting TNF-α signaling pathways.

Amyloidosis is a rare condition that develops when an irregular protein called amyloid accumulates in the organs and interferes with their normal function. In conjunction with other disorders such as rheumatoid arthritis (RA) and psoriasis, amyloidosis may occur due to a chronic inflammatory process. With treatment of the underlying disease, amyloidosis can be addressed. Certain forms of amyloidosis can lead to life-threatening organ failure. In fact, it can involve the heart, kidneys, and nervous system. As the signs and symptoms can imitate those of more common illnesses, amyloidosis is sometimes ignored. Early diagnosis may help minimize additional injury to organs. Precise diagnosis is important because based on the individual case, care differs greatly. Herein, we present a patient who was referred to our hospital with some manifestations of RA and psoriatic arthritis (PsA) that were compatible with amyloidosis and discuss the treatment of this patient.

To report a rare paradoxical development of systemic sarcoidosis in a patient taking adalimumab manifesting as multifocal choroidal infiltrates and seventh nerve palsy.

This was a single patient case report.

A 30‑year‑old man with a history of psoriatic arthritis on adalimumab presented with intermittent fevers and headaches. Initial infectious serology and initial ophthalmic examination were within normal limits. Over the next month, he developed a seventh nerve palsy, unilateral decreased visual acuity, and bilateral multifocal choroidal infiltrates. The patient was diagnosed with systemic sarcoidosis secondary to tumor necrosis factor alpha (TNFα) inhibitor use after a hilar lymph node biopsy. Upon treatment with high‑dose oral corticosteroids, the patient’s symptoms and choroidal lesions significantly improved.

This case report illustrates a rare presentation of ocular, neurologic, and systemic sarcoidosis presenting as a bilateral multifocal choroiditis and seventh nerve paresis in a patient treated with adalimumab. We highlight the importance of obtaining an ophthalmic evaluation in the management of this rare adverse effect of TNFα inhibitors.

Sarcoidosis is a granulomatous disease that can involve multiple organs including the lungs, eyes, nerves, and skin. Cosmetic tattooing can be a predisposing factor for sarcoidosis, and its incidence is likely to increase along with its popularity. A 47-year-old woman with symptoms of fever and polyarthritis along with erythema nodosum lesions on the legs, swollen eyebrows, and a history of multiple eyebrow tattooing was referred to our center. Since the signs and symptoms were positive for Löfgren’s syndrome triad including erythema nodosum, bilateral hilar lymphadenopathy, and polyarthritis, a diagnosis of acute sarcoidosis was made, and treatment was started accordingly. The patient was unresponsive to routine therapeutic agents used for sarcoidosis; however, she successfully responded to adalimumab. Our case indicates that systemic sarcoidosis could develop as a reaction to cosmetic tattooing, which might be refractory to conventional therapeutic agents including corticosteroids and non-biologic disease-modifying anti-rheumatic drugs, while tumor necrosis factor antagonists such as adalimumab, could lead to disease remission.

Increasing cytokines and reactive oxygen species (ROS) during ischemia reperfusion (I-R) leads to the lung damage. Adalimumab (Ada) is a potent tumor necrosis factor-alpha (TNF-α) inhibitor agent. We aimed to evaluate whether Ada would prevent the lung tissue from damage development over the I-R process. Twenty seven Wistar albino male rats were divided into three groups (each group had 9 rats). To the control group, only laparotomy procedure was carried out. For I-R group, first infrarenal abdominal aorta was cross-clamped during 2 hr, and then reperfusion was performed for 2 hr. To I-R+Ada group, first a single dose of 50 mg/kg Ada was given intraperitoneally and 5 days later, same I-R procedure was carried out. Levels of TNF-α, malondialdehyde (MDA), myeloperoxidase (MPO), endothelin-1 (ET-1) and caspase-3 enzyme activity of I-R group were higher than that of both I-R+ Ada [TNF-α (P=0.021), MDA (P=0.029), MPO (P=0.012), ET-1 (P=0.036, caspase-3 (P=0.007), respectively] and control group [TNF- α (P=0.008), MDA (P<0.001), MPO (P=0.001), ET-1 (P<0.001), caspase-3 (P<0.001), respectively]. In I-R group, severe damage was detected by hematoxylin-eosin staining. This damage was found less severe in Ada treatment group. The release of cytokines and ET-1 in a large proportion after I-R injury, and generating of ROS in excessive quantity could cause severe damage in the lung tissue. Ada could be considered as a protective agent for lung tissue during I-R process.

To assess changes in aqueous humor levels of different interleukins (IL), tumor necrosis factor (TNF)‑α and vascular endothelial growth factor (VEGF) in patients with uveitis treated with adalimumab. In this study, 24 aqueous humor samples including 12 pre‑ and post‑treatment samples from 6 patients with uveitis treated with subcutaneous adalimumab and 12 samples from patients with cataracts (serving as controls) were evaluated. The levels of IL‑1β, IL‑2, IL‑6, IL‑10, TNF‑α and VEGF were measured using a Luminex® 200™ flow cytometer (Merckmillipore, Merck KGaA, Darmstadt, Alemania) and a highly sensitive ELISA system. The levels of IL‑1β, IL‑2, IL‑6 and IL‑10 in the aqueous humor before and after treatment with adalimumab did not show significant differences. Aqueous VEGF levels significantly reduced after treatment with adalimumab (P = 0.028). Aqueous TNF‑α levels did not significantly change after treatment with adalimumab, however the post‑treatment level was significantly higher in patients as compared to control subjects (P = 0.032). IL‑2 showed significantly higher levels in uveitis patients before treatment as compared to controls (P = 0.024), while its post‑treatment levels were almost normalized. Decrease in the aqueous humor levels of VEGF and IL‑2 after treatment with systemic adalimumab indicates that anti‑TNF‑α therapy induces modifications of some inflammatory mediators involved in the pathogenesis of uveitis. Aqueous humor samples may be useful to assess the effect of adalimumab on intraocular inflammation through measurement of cytokines.