Objective: To demonstrate the effects of rituximab (RTX) in patients with rheumatoid arthritis-related interstitial lung disease (RA-ILD). Methods: A total of 165 patients who used RTX for the management of rheumatoid arthritis were retrospectively scrutinised. Among these, 26 patients diagnosed with RA-ILD were analysed (61.5% male, mean age at RTX infusion 61.4 ± 6.5 years). To evaluate the efficacy of RTX on lung response, patients with pulmonary function test results and/or thorax computed tomography (chest-CT) of pre- and post-RTX were compared. Disease progression was defined as either a decline of ≥10% in forced vital capacity (FVC) and/or a decline of ≥15% in diffusion capacity of carbon monoxide (DLCO), or an increase of parenchymal involvement on chest-CT images according to the radiologists’ assessment. Results: Among 26 patients, the most common radiologic pattern was usual interstitial pneumonia (42.3%), followed by non-specific interstitial pneumonia (38.5%). Data for lung response was available in 20 patients. Median pre- and post-RTX DLCO values were 71.0% (60.0–77.0) and 63.0% (47.0–74.0), respectively (p = 0.06). Median pre- and post-RTX FVC values were 74.0% (61.0–99.0) and 84.0% (63.0–100.0), respectively (p = 0.28). Overall, stabilization or regression of RA-ILD was provided in 13 (65.0%) patients, whereas 7 patients had progressive RA-ILD. Post-RTX, 5 patients were diagnosed with RA-ILD.
{"title":"Behandlungserfahrungen mit Rituximab bei Patienten mit rheumatoider Arthritis-assoziierter interstitieller Lungenerkrankung in Ankara, Türkei","authors":"Panagiota Xanthouli","doi":"10.1159/000531725","DOIUrl":"https://doi.org/10.1159/000531725","url":null,"abstract":"Objective: To demonstrate the effects of rituximab (RTX) in patients with rheumatoid arthritis-related interstitial lung disease (RA-ILD). Methods: A total of 165 patients who used RTX for the management of rheumatoid arthritis were retrospectively scrutinised. Among these, 26 patients diagnosed with RA-ILD were analysed (61.5% male, mean age at RTX infusion 61.4 ± 6.5 years). To evaluate the efficacy of RTX on lung response, patients with pulmonary function test results and/or thorax computed tomography (chest-CT) of pre- and post-RTX were compared. Disease progression was defined as either a decline of ≥10% in forced vital capacity (FVC) and/or a decline of ≥15% in diffusion capacity of carbon monoxide (DLCO), or an increase of parenchymal involvement on chest-CT images according to the radiologists’ assessment. Results: Among 26 patients, the most common radiologic pattern was usual interstitial pneumonia (42.3%), followed by non-specific interstitial pneumonia (38.5%). Data for lung response was available in 20 patients. Median pre- and post-RTX DLCO values were 71.0% (60.0–77.0) and 63.0% (47.0–74.0), respectively (p = 0.06). Median pre- and post-RTX FVC values were 74.0% (61.0–99.0) and 84.0% (63.0–100.0), respectively (p = 0.28). Overall, stabilization or regression of RA-ILD was provided in 13 (65.0%) patients, whereas 7 patients had progressive RA-ILD. Post-RTX, 5 patients were diagnosed with RA-ILD.","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135989084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Radical prostatectomy reduces mortality among patients with localized prostate cancer, however up to 35% of patients will experience biochemical recurrence, often treated with salvage radiotherapy. The objective of the study was to investigate long-term effects of salvage radiotherapy. Methods: A prospective, controlled, non-randomized trial at 14 Swedish center's including 4,003 patients scheduled for radical prostatectomy 2008-2011. A target trial emulation approach was used to identify eligible patients that was treated with salvage radiotherapy. The control group received no salvage radiotherapy. Outcomes were assessed by patient questionnaires on ordinal scales and statistical group comparisons were made using ordered logit regression with adjustment for baseline outcome and confounding factors. The primary endpoints were bowel, urinary and sexual function and bothering due to dysfunction at 8 years. Results: Eleven percent (330/3,139) of the analyzed study population received salvage radiotherapy. Fecal leakage, leakage of mucus and hematochezia were more common after receiving salvage radiotherapy compared with the control group; 4.5% versus 2.6% odds ratio (95% confidence interval [CI]): (1.90 [1.38; 2.62]), 6.8% versus 1.5% 4.14 (2.98; 5.76) and 8.6% versus 1.2% 4.14 (2.98; 5.76), respectively. Urinary incontinence, erectile dysfunction and hematuria were more common after receiving salvage radiotherapy, 34% versus 23% 2.23 (2.65; 3.00), 65% versus 57% 1.65 (1.18; 2.29) and 16% versus 1.6% 11.17 (5.68; 21.99), respectively. Conclusion: Salvage radiotherapy was associated with increased risk for fecal leakage, hematochezia, urinary incontinence and hematuria. Our results emphasize the importance of selecting patients for salvage radiotherapy to avoid overtreatment and to give high quality pre-treatment information to ensure patients' preparedness for late side-effects.Copyright (c) 2023 Stefan Carlsson, David Bock, Anna Lantz, Eva Angenete, Katarina Koss Modig, Jonas Hugosson, Anders Bjartell, Gunnar Steineck, Peter Wiklund, Eva Haglind
目的:根治性前列腺切除术降低了局限性前列腺癌患者的死亡率，但高达35%的患者会经历生化复发，通常采用补救性放疗治疗。本研究的目的是探讨补救性放射治疗的长期效果。方法:一项前瞻性、对照、非随机试验，在瑞典14个中心进行，包括4003名计划于2008-2011年行根治性前列腺切除术的患者。目标试验模拟方法用于确定接受补救性放射治疗的合格患者。对照组不进行补救性放疗。结果通过顺序量表的患者问卷进行评估，并使用有序logit回归进行统计组比较，调整基线结果和混杂因素。主要终点为8岁时的肠道、泌尿和性功能以及因功能障碍引起的困扰。结果:11%(330/ 3139)的分析研究人群接受了补救性放疗。补救性放疗后大便漏、粘液漏、便血较对照组多见;4.5%对2.6%的优势比(95%可信区间[CI]):(1.90 [1.38;2.62])， 6.8%对1.5% 4.14 (2.98;5.76)和8.6%对1.2% 4.14 (2.98;分别为5.76)。接受补救性放疗后尿失禁、勃起功能障碍和血尿更为常见，分别为34%和23% (2.23;3.00)， 65% vs 57% 1.65 (1.18;2.29)和1.6%对11.17 (5.68;分别为21.99)。结论:补救性放疗与粪漏、便血、尿失禁、血尿风险增加有关。我们的研究结果强调了选择患者进行补救性放疗的重要性，以避免过度治疗，并提供高质量的治疗前信息，以确保患者的健康;为后期副作用做好准备。版权所有(c) 2023 Stefan Carlsson, David Bock, Anna Lantz, Eva Angenete, Katarina Koss Modig, Jonas Hugosson, Anders Bjartell, Gunnar Steineck, Peter Wiklund, Eva Haglind
{"title":"Prostatakarzinom: Wie eine gezielte Strahlentherapie bei biochemischem Rezidiv das Leben nach der Operation beeinflusst","authors":"Henning Bahlburg","doi":"10.1159/000533184","DOIUrl":"https://doi.org/10.1159/000533184","url":null,"abstract":"Objective: Radical prostatectomy reduces mortality among patients with localized prostate cancer, however up to 35% of patients will experience biochemical recurrence, often treated with salvage radiotherapy. The objective of the study was to investigate long-term effects of salvage radiotherapy. Methods: A prospective, controlled, non-randomized trial at 14 Swedish center's including 4,003 patients scheduled for radical prostatectomy 2008-2011. A target trial emulation approach was used to identify eligible patients that was treated with salvage radiotherapy. The control group received no salvage radiotherapy. Outcomes were assessed by patient questionnaires on ordinal scales and statistical group comparisons were made using ordered logit regression with adjustment for baseline outcome and confounding factors. The primary endpoints were bowel, urinary and sexual function and bothering due to dysfunction at 8 years. Results: Eleven percent (330/3,139) of the analyzed study population received salvage radiotherapy. Fecal leakage, leakage of mucus and hematochezia were more common after receiving salvage radiotherapy compared with the control group; 4.5% versus 2.6% odds ratio (95% confidence interval [CI]): (1.90 [1.38; 2.62]), 6.8% versus 1.5% 4.14 (2.98; 5.76) and 8.6% versus 1.2% 4.14 (2.98; 5.76), respectively. Urinary incontinence, erectile dysfunction and hematuria were more common after receiving salvage radiotherapy, 34% versus 23% 2.23 (2.65; 3.00), 65% versus 57% 1.65 (1.18; 2.29) and 16% versus 1.6% 11.17 (5.68; 21.99), respectively. Conclusion: Salvage radiotherapy was associated with increased risk for fecal leakage, hematochezia, urinary incontinence and hematuria. Our results emphasize the importance of selecting patients for salvage radiotherapy to avoid overtreatment and to give high quality pre-treatment information to ensure patients' preparedness for late side-effects.Copyright (c) 2023 Stefan Carlsson, David Bock, Anna Lantz, Eva Angenete, Katarina Koss Modig, Jonas Hugosson, Anders Bjartell, Gunnar Steineck, Peter Wiklund, Eva Haglind","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136029375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
jeder von uns kennt das: Wir erleben in unserer klinischen Praxis eine Vielzahl an Patienten mit den unterschiedlichsten Krankheiten; seien es systemische Erkrankungen mit okulärer Beteiligung oder Augenerkrankungen per se. Reihen sich die meisten dieser pathologischen Manifestationen in die differentialdiagnostisch am häufigsten vorkommenden Entitäten ein, so verbleiben doch stets einige, bei denen wir als Ophthalmologen vor eine Herausforderung gestellt werden. Welche Pathogenese steckt hinter der klinischen Manifestation? Vor einer erfolgsversprechenden Therapie, ist die korrekte Diagnosestellung unabdingbar. Wir haben es in manchen Fällen sicherlich um ein Vielfaches einfacher als die Ophthalmologen vor 100 Jahren, als es noch nicht die Vielzahl an morphometrischen und funktionellen Diagnostika gab. Durch die heutzutage vorhandene multimodale Bildgebung und funktionellen Diagnostika haben wir ein großes Spektrum an Möglichkeiten, die wir im Rahmen der differentialdiagnostischen Abklärung für unsere Patienten einsetzen können. In der aktuellen Ausgabe habe ich Ihnen zwei interessante klinische Fälle aus der Praxis mitgebracht: Frau Zeisberg berichtet über eine plötzliche Sehstörung bei einem jungen Mädchen nach dem Sportunterricht mit deren differentialdiagnostischer Abklärung. Herr Skornia zeigt uns eine Augenbeteiligung bei einem 7-jährigen Junge mit dialysepflichtiger Niereninsuffizienz bei Joubert-Syndrom.
{"title":"OphthalmoCampus","authors":"","doi":"10.1159/000533379","DOIUrl":"https://doi.org/10.1159/000533379","url":null,"abstract":"jeder von uns kennt das: Wir erleben in unserer klinischen Praxis eine Vielzahl an Patienten mit den unterschiedlichsten Krankheiten; seien es systemische Erkrankungen mit okulärer Beteiligung oder Augenerkrankungen per se. Reihen sich die meisten dieser pathologischen Manifestationen in die differentialdiagnostisch am häufigsten vorkommenden Entitäten ein, so verbleiben doch stets einige, bei denen wir als Ophthalmologen vor eine Herausforderung gestellt werden. Welche Pathogenese steckt hinter der klinischen Manifestation? Vor einer erfolgsversprechenden Therapie, ist die korrekte Diagnosestellung unabdingbar. Wir haben es in manchen Fällen sicherlich um ein Vielfaches einfacher als die Ophthalmologen vor 100 Jahren, als es noch nicht die Vielzahl an morphometrischen und funktionellen Diagnostika gab. Durch die heutzutage vorhandene multimodale Bildgebung und funktionellen Diagnostika haben wir ein großes Spektrum an Möglichkeiten, die wir im Rahmen der differentialdiagnostischen Abklärung für unsere Patienten einsetzen können. In der aktuellen Ausgabe habe ich Ihnen zwei interessante klinische Fälle aus der Praxis mitgebracht: Frau Zeisberg berichtet über eine plötzliche Sehstörung bei einem jungen Mädchen nach dem Sportunterricht mit deren differentialdiagnostischer Abklärung. Herr Skornia zeigt uns eine Augenbeteiligung bei einem 7-jährigen Junge mit dialysepflichtiger Niereninsuffizienz bei Joubert-Syndrom.","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135312317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: Single-agent chemotherapies have limited activity and considerable toxicity in patients with platinum-resistant epithelial ovarian cancer (PROC). Mirvetuximab soravtansine (MIRV) is an antibody-drug conjugate targeting folate receptor α (FRα). SORAYA is a single-arm, phase II study evaluating efficacy and safety of MIRV in patients with PROC. Methods: SORAYA enrolled FRα-high patients with PROC who had received one to three prior therapies, including required bevacizumab. The primary end point was confirmed objective response rate (ORR) by investigator; duration of response was the key secondary end point. Results: One hundred six patients were enrolled; 105 were evaluable for efficacy. All patients had received prior bevacizumab, 51% had three prior lines of therapy, and 48% received a prior poly ADP-ribose polymerase inhibitor. Median follow-up was 13.4 months. ORR was 32.4% (95% CI, 23.6 to 42.2), including five complete and 29 partial responses. The median duration of response was 6.9 months (95% CI, 5.6 to 9.7). In patients with one to two priors, the ORR by investigator was 35.3% (95% CI, 22.4 to 49.9) and in patients with three priors was 30.2% (95% CI, 18.3 to 44.3). The ORR by investigator was 38.0% (95% CI, 24.7 to 52.8) in patients with prior poly ADP-ribose polymerase inhibitor exposure and 27.5% (95% CI, 15.9 to 41.7) in those without. The most common treatment-related adverse events (all grade and grade 3-4) were blurred vision (41% and 6%), keratopathy (29% and 9%), and nausea (29% and 0%). Treatment-related adverse events led to dose delays, reductions, and discontinuations in 33%, 20%, and 9% of patients, respectively. Conclusion: MIRV demonstrated consistent clinically meaningful antitumor activity and favorable tolerability and safety in patients with FRα-high PROC who had received up to three prior therapies, including bevacizumab, representing an important advance for this biomarker-selected population.
{"title":"Ovarialkarzinom: Antikörper-Wirkstoff-Konjugat übertrifft bisherige Ansprechraten beim platinresistenten Ovarialkarzinom","authors":"Martin Pölcher","doi":"10.1159/000533183","DOIUrl":"https://doi.org/10.1159/000533183","url":null,"abstract":"Purpose: Single-agent chemotherapies have limited activity and considerable toxicity in patients with platinum-resistant epithelial ovarian cancer (PROC). Mirvetuximab soravtansine (MIRV) is an antibody-drug conjugate targeting folate receptor α (FRα). SORAYA is a single-arm, phase II study evaluating efficacy and safety of MIRV in patients with PROC. Methods: SORAYA enrolled FRα-high patients with PROC who had received one to three prior therapies, including required bevacizumab. The primary end point was confirmed objective response rate (ORR) by investigator; duration of response was the key secondary end point. Results: One hundred six patients were enrolled; 105 were evaluable for efficacy. All patients had received prior bevacizumab, 51% had three prior lines of therapy, and 48% received a prior poly ADP-ribose polymerase inhibitor. Median follow-up was 13.4 months. ORR was 32.4% (95% CI, 23.6 to 42.2), including five complete and 29 partial responses. The median duration of response was 6.9 months (95% CI, 5.6 to 9.7). In patients with one to two priors, the ORR by investigator was 35.3% (95% CI, 22.4 to 49.9) and in patients with three priors was 30.2% (95% CI, 18.3 to 44.3). The ORR by investigator was 38.0% (95% CI, 24.7 to 52.8) in patients with prior poly ADP-ribose polymerase inhibitor exposure and 27.5% (95% CI, 15.9 to 41.7) in those without. The most common treatment-related adverse events (all grade and grade 3-4) were blurred vision (41% and 6%), keratopathy (29% and 9%), and nausea (29% and 0%). Treatment-related adverse events led to dose delays, reductions, and discontinuations in 33%, 20%, and 9% of patients, respectively. Conclusion: MIRV demonstrated consistent clinically meaningful antitumor activity and favorable tolerability and safety in patients with FRα-high PROC who had received up to three prior therapies, including bevacizumab, representing an important advance for this biomarker-selected population.","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136027491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fibrosis quística en niños: Tras las huellas silenciosas en América Latina","authors":"Irlanda Alvarado-Amador","doi":"10.1159/000534285","DOIUrl":"https://doi.org/10.1159/000534285","url":null,"abstract":"","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136208903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Las bronquiectasias suelen considerarse progresivas e irreversibles, por lo que los casos de regresión o reversión constituyen un paso importante para comprender los mecanismos fisiopatológicos subyacentes. El tratamiento de la fibrosis quística (FQ), causada por variantes patogénicas en el gen regulador de la conductancia transmembrana de la fibrosis quística (CFTR), es un ejemplo de éxito en la medicina personalizada. El reciente desarrollo de terapias moduladoras de CFTR ha revolucionado la atención médica. En cuestión de semanas se observan mejoras espectaculares en la función pulmonar, la producción de esputo, el desempeño durante el día y la calidad de vida. Sin embargo, en la actualidad se desconoce el efecto de la exposición a largo plazo al elexacaftor + tezacaftor + ivacaftor (ETI) sobre las anomalías estructurales. En esta serie de casos se describen tres adultos con FQ que han mostrado mejoría progresiva de los cambios cilíndricos, varicosos y, lo más importante, quísticos en bronquiectasias tras un tratamiento prolongado con ETI. Esto plantea la interesante cuestión de la reversibilidad de las bronquiectasias, así como los mecanismos implicados en el mantenimiento y la progresión de las bronquiectasias en relación con la FQ.
{"title":"La terapia con moduladores para la fibrosis quística puede revertir las bronquiectasias quísticas","authors":"Peter G. Middleton, Nicholas J. Simmonds","doi":"10.1159/000533461","DOIUrl":"https://doi.org/10.1159/000533461","url":null,"abstract":"Las bronquiectasias suelen considerarse progresivas e irreversibles, por lo que los casos de regresión o reversión constituyen un paso importante para comprender los mecanismos fisiopatológicos subyacentes. El tratamiento de la fibrosis quística (FQ), causada por variantes patogénicas en el gen regulador de la conductancia transmembrana de la fibrosis quística (<i>CFTR</i>), es un ejemplo de éxito en la medicina personalizada. El reciente desarrollo de terapias moduladoras de <i>CFTR</i> ha revolucionado la atención médica. En cuestión de semanas se observan mejoras espectaculares en la función pulmonar, la producción de esputo, el desempeño durante el día y la calidad de vida. Sin embargo, en la actualidad se desconoce el efecto de la exposición a largo plazo al elexacaftor + tezacaftor + ivacaftor (ETI) sobre las anomalías estructurales. En esta serie de casos se describen tres adultos con FQ que han mostrado mejoría progresiva de los cambios cilíndricos, varicosos y, lo más importante, quísticos en bronquiectasias tras un tratamiento prolongado con ETI. Esto plantea la interesante cuestión de la reversibilidad de las bronquiectasias, así como los mecanismos implicados en el mantenimiento y la progresión de las bronquiectasias en relación con la FQ.","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"130 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136209833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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