The document summarizes two clinical trials - SIROCCO and CALIMA - that evaluated the efficacy and safety of benralizumab in treating severe asthma. Both trials found that benralizumab significantly reduced annual asthma exacerbation rates in patients with high baseline eosinophil counts who were uncontrolled on standard treatment. SIROCCO saw greater efficacy than CALIMA, possibly due to regional differences. Adverse events were also reported. The trials demonstrated benralizumab's potential as an additional treatment option for severe eosinophilic asthma.
This document summarizes research on benralizumab, an interleukin-5 receptor antagonist, for the treatment of severe eosinophilic asthma. It discusses results from two phase 3 clinical trials, SIROCCO and CALIMA, which found that benralizumab significantly reduced annual asthma exacerbation rates compared to placebo in patients with elevated blood eosinophil counts. It also summarizes findings from the ZONDA trial, which showed benralizumab allowed for significant steroid-sparing effects in patients with severe asthma and persistent eosinophilia despite high-dose corticosteroids. The document reviews the mechanism of action, clinical efficacy, and safety profile of benralizumab based on these major clinical trials.
Recent Advances in the Treatment of Childhood Asthma - Robert LemanskeJuan Carlos Ivancevich
Congreso Latinoamericano de Alergia, Asma e Inmunología 2015
Presidente: Alfonso Mario Cepeda Sarabia
Comité Organizador Local: Edgardo Jares, Anahí Yañez, Estrella Asayag
Presidentes Sociedad Latinoamericana de Alergia, Asma e Inmunología, Slaai:
2013-2015: Alfonso Mario Cepeda Sarabia - 2015-2017: Juan Carlos Sisul Alvariza
Buenos Aires, marzo 14-16, 2015
This document summarizes key issues in HIV psychiatry, including:
1. Common psychiatric issues associated with HIV like adjustment, depression, and neurocognitive deficits.
2. Guidelines for treating depression, psychosis, and other mental illnesses in HIV patients.
3. The persistence of HIV-associated neurocognitive disorders even in patients on antiretroviral therapy.
4. The concept of HIV compartmentalization in the central nervous system and challenges in treating neuroAIDS.
5. Recommendations for first-line psychiatric medications based on liver metabolism and drug-drug interactions with antiretrovirals.
This document discusses and compares the properties, clinical trials, and safety profiles of the direct oral anticoagulants dabigatran, rivaroxaban, and apixaban. It summarizes the results of major clinical trials demonstrating the non-inferiority of these drugs compared to warfarin for treating and preventing venous thromboembolism. It also notes that monitoring of renal function is important when using these drugs due to renal clearance and dose adjustments.
This document discusses the use of anti-leukotriene drugs in treating allergic diseases such as asthma. It provides guidelines on using anti-leukotrienes as add-on therapy to inhaled corticosteroids when asthma is not well controlled, and mentions studies showing anti-leukotrienes are effective in treating mild persistent asthma in children and reducing exacerbations in adults. The document also discusses using anti-leukotrienes to treat exercise-induced bronchospasm, allergic rhinitis, aspirin-exacerbated respiratory disease, and as a corticosteroid-sparing agent. It provides an overview of clinical studies that have evaluated the efficacy of anti-le
The document summarizes two clinical trials - SIROCCO and CALIMA - that evaluated the efficacy and safety of benralizumab in treating severe asthma. Both trials found that benralizumab significantly reduced annual asthma exacerbation rates in patients with high baseline eosinophil counts who were uncontrolled on standard treatment. SIROCCO saw greater efficacy than CALIMA, possibly due to regional differences. Adverse events were also reported. The trials demonstrated benralizumab's potential as an additional treatment option for severe eosinophilic asthma.
This document summarizes research on benralizumab, an interleukin-5 receptor antagonist, for the treatment of severe eosinophilic asthma. It discusses results from two phase 3 clinical trials, SIROCCO and CALIMA, which found that benralizumab significantly reduced annual asthma exacerbation rates compared to placebo in patients with elevated blood eosinophil counts. It also summarizes findings from the ZONDA trial, which showed benralizumab allowed for significant steroid-sparing effects in patients with severe asthma and persistent eosinophilia despite high-dose corticosteroids. The document reviews the mechanism of action, clinical efficacy, and safety profile of benralizumab based on these major clinical trials.
Recent Advances in the Treatment of Childhood Asthma - Robert LemanskeJuan Carlos Ivancevich
Congreso Latinoamericano de Alergia, Asma e Inmunología 2015
Presidente: Alfonso Mario Cepeda Sarabia
Comité Organizador Local: Edgardo Jares, Anahí Yañez, Estrella Asayag
Presidentes Sociedad Latinoamericana de Alergia, Asma e Inmunología, Slaai:
2013-2015: Alfonso Mario Cepeda Sarabia - 2015-2017: Juan Carlos Sisul Alvariza
Buenos Aires, marzo 14-16, 2015
This document summarizes key issues in HIV psychiatry, including:
1. Common psychiatric issues associated with HIV like adjustment, depression, and neurocognitive deficits.
2. Guidelines for treating depression, psychosis, and other mental illnesses in HIV patients.
3. The persistence of HIV-associated neurocognitive disorders even in patients on antiretroviral therapy.
4. The concept of HIV compartmentalization in the central nervous system and challenges in treating neuroAIDS.
5. Recommendations for first-line psychiatric medications based on liver metabolism and drug-drug interactions with antiretrovirals.
This document discusses and compares the properties, clinical trials, and safety profiles of the direct oral anticoagulants dabigatran, rivaroxaban, and apixaban. It summarizes the results of major clinical trials demonstrating the non-inferiority of these drugs compared to warfarin for treating and preventing venous thromboembolism. It also notes that monitoring of renal function is important when using these drugs due to renal clearance and dose adjustments.
This document discusses the use of anti-leukotriene drugs in treating allergic diseases such as asthma. It provides guidelines on using anti-leukotrienes as add-on therapy to inhaled corticosteroids when asthma is not well controlled, and mentions studies showing anti-leukotrienes are effective in treating mild persistent asthma in children and reducing exacerbations in adults. The document also discusses using anti-leukotrienes to treat exercise-induced bronchospasm, allergic rhinitis, aspirin-exacerbated respiratory disease, and as a corticosteroid-sparing agent. It provides an overview of clinical studies that have evaluated the efficacy of anti-le
1) The document discusses standards of care for respiratory tract infections in daily practice, including treatment guidelines for acute bronchitis and community-acquired pneumonia (CAP).
2) For acute bronchitis, antibiotics are not recommended for most cases as viruses are usually the cause. For CAP severity, factors like vital signs and comorbidities are used to determine treatment approach.
3) Treatment guidelines for outpatient CAP include doxycycline or macrolide antibiotics depending on risk factors. Hospitalized patients may receive broader spectrum antibiotics like levofloxacin or combination therapy.
The document discusses principles for antibiotic use in critically ill patients, including:
1) Starting with broad-spectrum empiric therapy based on local microbiological data and guidelines.
2) Reassessing and de-escalating treatment based on culture results and the patient's clinical response.
3) Factors that increase the risk of resistant pathogens like hospital-acquired infections require broader initial coverage.
1) A study investigated whether administering a recombinant DNA plasmid expressing the Mycobacterial leprae heat shock protein 65 (Hsp65) could attenuate an established allergic airway response in mice.
2) Mice were first sensitized and challenged with ovalbumin to induce allergy, then treated with the recombinant Hsp65 plasmid.
3) The treatment inhibited eosinophilia, pulmonary inflammation, Th2 cytokines, and mucus production associated with the allergic response. This inhibition was dependent on increased production of the anti-inflammatory cytokine IL-10.
A New Adult Onset Acquired Immunodeficiency - Slide set by Professor Katie Fl...WAidid
A presentation of Professor Katie Flanagan on disseminated mycobacterial infection in a Malaysian lady with IFN-γ autoAbs successfully treated with Rituximab, and a review of the literature on this rare condition.
This document discusses diagnostic tests for NSAID/ASA hypersensitivity, including the nasal provocation test and basophil activation test. It provides details on:
1. A study that evaluated the efficacy of the nasal provocation test and basophil activation test in diagnosing various subtypes of ASA hypersensitivity, finding the nasal test detected 60% of cases while the combination of the two tests increased sensitivity.
2. Guidelines for oral and nasal aspirin provocation tests, noting oral challenges have higher sensitivity but nasal tests are safer with lower risk of systemic reactions.
3. A study that assessed the nasal provocation test and basophil activation test's ability to diagnose different clinical patterns of ASA sensitivity, finding
This document discusses targeted therapies for severe asthma. It defines severe asthma and notes that phenotyping patients and personalized therapy could improve outcomes. Biomarkers like sputum eosinophils, FeNO and blood IgE can help identify phenotypes. Potential targeted therapies are described for T-2 mediated pathways like anti-IgE Omalizumab and anti-IL-5 therapies Mepolizumab and Reslizumab. Issues with current targeted therapies and new approaches like bronchial thermoplasty and allergen immunotherapy are also mentioned.
Hypersensitivity reactions to nonsteroidal anti-inflammatory drugsNatacha Santos
Reis-Ferreira A, Santos N, Botelho C, Castro E, Cernadas JR. Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs: single versus multiple reactors. Allergy 2011;66(Suppl.94):51-52.
Chmis20161143c chiesi haemophilia b gene therapy advisory boardTim Robinson
This document provides an agenda and summaries from a gene therapy advisory board meeting on haemophilia B.
The agenda covers current approaches to haemophilia B gene therapy, defining target efficacy, and identifying the potential place in therapy for gene therapy approaches including Chiesi's.
Summaries were presented on the Nathwani trial which showed sustained, dose-dependent factor IX expression from 1-4 years after a single AAV gene therapy intervention. Individual responses varied but the high dose led to near normal FIX levels and large reductions in bleeding and factor use. Other clinical gene therapy trials for haemophilia B using different vectors were also summarized.
This document provides an overview of current and emerging antibody treatments for multiple sclerosis (MS). It discusses approved therapies like natalizumab, alemtuzumab, and daclizumab. Natalizumab works by inhibiting lymphocyte binding to endothelial cells. Alemtuzumab depletes CD52+ lymphocytes. Daclizumab antagonizes CD25-mediated T cell activation. Emerging therapies discussed include ofatumumab, ustekinumab, and secukinumab which target CD20, IL-12/IL-23, and IL-17A respectively. The document also reviews the mechanisms of action, efficacy data, safety issues like PML risk, and ongoing clinical trials of these antibody treatments for MS.
Among patients taking warfarin who experienced INR levels above 3.0 (overanticoagulation), 20.5% developed presumptive warfarin-related nephropathy (WRN) defined as a rise in creatinine of 0.3 mg/dL or more within a week. The risk was higher among patients with chronic kidney disease (CKD), 33% of whom developed WRN, compared to 16.5% of patients without CKD. WRN was associated with higher mortality even after controlling for covariates. A prospective study is needed to further understand risk factors and consequences of WRN.
1) Several studies were summarized that looked at interventions in critically ill patients, including using levosimendan to prevent organ dysfunction in sepsis, decompressive craniectomy for traumatic brain injury, early vasopressin vs other drugs for kidney failure, and immediate CT scanning vs conventional imaging for trauma patients.
2) Other studies examined outcomes with early renal replacement therapy, conservative oxygen therapy vs conventional, video vs direct laryngoscopy for intubation, and using high-flow nasal cannula vs other supports post-extubation. The results were mixed with some interventions showing benefit and others no difference.
David Haas, MD, professor at Vanderbilt University School of Medicine, presents "Pharmacogenomics of HIV therapy" for AIDS Clinical Rounds at UC San Diego
1) TNF inhibitors like infliximab, etanercept, adalimumab, and golimumab are effective in treating the signs and symptoms of axial spondyloarthritis by reducing inflammation.
2) NSAIDs are first-line treatment but some patients may require treatment with disease-modifying antirheumatic drugs (DMARDs) like sulfasalazine or biologic DMARDs that target cytokines like TNF and IL-17.
3) Treatment is aimed at controlling symptoms and inflammation through both pharmacological and non-pharmacological methods, with the goal of improving quality of life and physical function.
The document discusses predictors of tolerance to non-invasive ventilation (NIV) and survival in patients with amyotrophic lateral sclerosis (ALS). It finds that younger age of onset, limb-onset symptoms rather than bulbar symptoms, and earlier use of NIV may predict better tolerance of NIV and longer survival. The document also suggests that multidisciplinary care in specialized ALS clinics may improve prognosis compared to general neurologist care. Organizing integrated care across reference centers and local providers may help improve outcomes for ALS patients.
Asthma is the most frequent chronic illness in children and is a common noncommunicable disease (NCD) that affects both adults and children. Coughing, wheezing, chest tightness, and shortness of breath are among the symptoms. This presentation target therapies for Asthma including its clinical use, etc. For more information, please contact us: 9779030507.
1) The document discusses standards of care for respiratory tract infections in daily practice, including treatment guidelines for acute bronchitis and community-acquired pneumonia (CAP).
2) For acute bronchitis, antibiotics are not recommended for most cases as viruses are usually the cause. For CAP severity, factors like vital signs and comorbidities are used to determine treatment approach.
3) Treatment guidelines for outpatient CAP include doxycycline or macrolide antibiotics depending on risk factors. Hospitalized patients may receive broader spectrum antibiotics like levofloxacin or combination therapy.
The document discusses principles for antibiotic use in critically ill patients, including:
1) Starting with broad-spectrum empiric therapy based on local microbiological data and guidelines.
2) Reassessing and de-escalating treatment based on culture results and the patient's clinical response.
3) Factors that increase the risk of resistant pathogens like hospital-acquired infections require broader initial coverage.
1) A study investigated whether administering a recombinant DNA plasmid expressing the Mycobacterial leprae heat shock protein 65 (Hsp65) could attenuate an established allergic airway response in mice.
2) Mice were first sensitized and challenged with ovalbumin to induce allergy, then treated with the recombinant Hsp65 plasmid.
3) The treatment inhibited eosinophilia, pulmonary inflammation, Th2 cytokines, and mucus production associated with the allergic response. This inhibition was dependent on increased production of the anti-inflammatory cytokine IL-10.
A New Adult Onset Acquired Immunodeficiency - Slide set by Professor Katie Fl...WAidid
A presentation of Professor Katie Flanagan on disseminated mycobacterial infection in a Malaysian lady with IFN-γ autoAbs successfully treated with Rituximab, and a review of the literature on this rare condition.
This document discusses diagnostic tests for NSAID/ASA hypersensitivity, including the nasal provocation test and basophil activation test. It provides details on:
1. A study that evaluated the efficacy of the nasal provocation test and basophil activation test in diagnosing various subtypes of ASA hypersensitivity, finding the nasal test detected 60% of cases while the combination of the two tests increased sensitivity.
2. Guidelines for oral and nasal aspirin provocation tests, noting oral challenges have higher sensitivity but nasal tests are safer with lower risk of systemic reactions.
3. A study that assessed the nasal provocation test and basophil activation test's ability to diagnose different clinical patterns of ASA sensitivity, finding
This document discusses targeted therapies for severe asthma. It defines severe asthma and notes that phenotyping patients and personalized therapy could improve outcomes. Biomarkers like sputum eosinophils, FeNO and blood IgE can help identify phenotypes. Potential targeted therapies are described for T-2 mediated pathways like anti-IgE Omalizumab and anti-IL-5 therapies Mepolizumab and Reslizumab. Issues with current targeted therapies and new approaches like bronchial thermoplasty and allergen immunotherapy are also mentioned.
Hypersensitivity reactions to nonsteroidal anti-inflammatory drugsNatacha Santos
Reis-Ferreira A, Santos N, Botelho C, Castro E, Cernadas JR. Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs: single versus multiple reactors. Allergy 2011;66(Suppl.94):51-52.
Chmis20161143c chiesi haemophilia b gene therapy advisory boardTim Robinson
This document provides an agenda and summaries from a gene therapy advisory board meeting on haemophilia B.
The agenda covers current approaches to haemophilia B gene therapy, defining target efficacy, and identifying the potential place in therapy for gene therapy approaches including Chiesi's.
Summaries were presented on the Nathwani trial which showed sustained, dose-dependent factor IX expression from 1-4 years after a single AAV gene therapy intervention. Individual responses varied but the high dose led to near normal FIX levels and large reductions in bleeding and factor use. Other clinical gene therapy trials for haemophilia B using different vectors were also summarized.
This document provides an overview of current and emerging antibody treatments for multiple sclerosis (MS). It discusses approved therapies like natalizumab, alemtuzumab, and daclizumab. Natalizumab works by inhibiting lymphocyte binding to endothelial cells. Alemtuzumab depletes CD52+ lymphocytes. Daclizumab antagonizes CD25-mediated T cell activation. Emerging therapies discussed include ofatumumab, ustekinumab, and secukinumab which target CD20, IL-12/IL-23, and IL-17A respectively. The document also reviews the mechanisms of action, efficacy data, safety issues like PML risk, and ongoing clinical trials of these antibody treatments for MS.
Among patients taking warfarin who experienced INR levels above 3.0 (overanticoagulation), 20.5% developed presumptive warfarin-related nephropathy (WRN) defined as a rise in creatinine of 0.3 mg/dL or more within a week. The risk was higher among patients with chronic kidney disease (CKD), 33% of whom developed WRN, compared to 16.5% of patients without CKD. WRN was associated with higher mortality even after controlling for covariates. A prospective study is needed to further understand risk factors and consequences of WRN.
1) Several studies were summarized that looked at interventions in critically ill patients, including using levosimendan to prevent organ dysfunction in sepsis, decompressive craniectomy for traumatic brain injury, early vasopressin vs other drugs for kidney failure, and immediate CT scanning vs conventional imaging for trauma patients.
2) Other studies examined outcomes with early renal replacement therapy, conservative oxygen therapy vs conventional, video vs direct laryngoscopy for intubation, and using high-flow nasal cannula vs other supports post-extubation. The results were mixed with some interventions showing benefit and others no difference.
David Haas, MD, professor at Vanderbilt University School of Medicine, presents "Pharmacogenomics of HIV therapy" for AIDS Clinical Rounds at UC San Diego
1) TNF inhibitors like infliximab, etanercept, adalimumab, and golimumab are effective in treating the signs and symptoms of axial spondyloarthritis by reducing inflammation.
2) NSAIDs are first-line treatment but some patients may require treatment with disease-modifying antirheumatic drugs (DMARDs) like sulfasalazine or biologic DMARDs that target cytokines like TNF and IL-17.
3) Treatment is aimed at controlling symptoms and inflammation through both pharmacological and non-pharmacological methods, with the goal of improving quality of life and physical function.
The document discusses predictors of tolerance to non-invasive ventilation (NIV) and survival in patients with amyotrophic lateral sclerosis (ALS). It finds that younger age of onset, limb-onset symptoms rather than bulbar symptoms, and earlier use of NIV may predict better tolerance of NIV and longer survival. The document also suggests that multidisciplinary care in specialized ALS clinics may improve prognosis compared to general neurologist care. Organizing integrated care across reference centers and local providers may help improve outcomes for ALS patients.
Asthma is the most frequent chronic illness in children and is a common noncommunicable disease (NCD) that affects both adults and children. Coughing, wheezing, chest tightness, and shortness of breath are among the symptoms. This presentation target therapies for Asthma including its clinical use, etc. For more information, please contact us: 9779030507.
Jonathan Corren, MD, discusses asthma management in this CME activity titled "Targeted Treatment in Severe Asthma: Moving Toward Precision Medicine." For the full presentation, downloadable infographics, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2It37Pk. CME credit will be available until June 3, 2019.
Biologic therapies target specific inflammatory pathways involved in asthma. Omalizumab targets IgE and is approved for severe allergic asthma. It reduces exacerbations and lowers corticosteroid needs. Mepolizumab targets IL-5 and reduces exacerbations in severe eosinophilic asthma. Anti-IL-4/IL-13 and anti-IL-17 therapies are also under investigation. While biologics show promise for uncontrolled asthma, their high cost, parenteral administration, and potential adverse effects limit broader use. Accurate patient phenotyping is key to matching the right therapy.
The study found that in adults presenting with acute asthma exacerbations, the addition of the ketolide telithromycin to standard therapy resulted in greater improvement in asthma symptoms and lung function compared to placebo, especially in those who tested positive for atypical bacterial infections like Chlamydia pneumoniae and Mycoplasma pneumoniae. However, the benefits did not persist beyond 10 days of treatment and telithromycin was associated with more nausea.
The document reviews biologic therapies for severe asthma. It provides a case summary of a patient with severe eosinophilic asthma. It then outlines the educational aims, definitions, pathophysiology, and classes of biologic therapies. For each biologic class, it summarizes key trials showing reductions in exacerbation rates. It identifies predictors of response and side effects. The take home messages are that all biologics effectively reduce exacerbations, anti-IL5 therapies are superior for patients on oral corticosteroids, and drug availability and other indications should be considered when choosing therapy.
Jonathan Corren, MD, and Paul Yamauchi, MD, prepared useful Practice Aids pertaining to allergic and inflammatory diseases for this CME/MOC/CNE/CPE activity titled "Advances in the Management of Allergic and Inflammatory Diseases: Highlights From Washington, DC and San Francisco." For the full presentation, monograph, complete CME/MOC/CNE/CPE information, and to apply for credit, please visit us at http://bit.ly/2OQpC1n. CME/MOC/CNE/CPE credit will be available until April 11, 2020.
Lupus Nephritis Dilemma - Prof. Mohsen El KosiMNDU net
This document discusses Lupus Nephritis (LN), a common complication of Systemic Lupus Erythematosus (SLE) that affects the kidneys. It covers the epidemiology and diagnostic criteria of SLE, outlines current treatment options for LN including steroids, immunosuppressants, and biologics, and discusses ongoing clinical trials. It also examines challenges in LN management such as variability in histological classification systems and lack of consensus on treatment protocols. Overall, the document provides an overview of LN as a complex condition with ongoing efforts to improve diagnosis and outcomes.
This document provides an overview and objectives for an asthma medication refresher presentation. It discusses classifying asthma medications by mechanism of action and identifying appropriate patients for different medications or combinations. It also covers precautions, side effects of newer medications, delivery devices, and the role of biologic medications. Control-based asthma management is reviewed, along with the 2007 standard of care and options for severe uncontrolled asthma. Various asthma medications and phenotypes are described.
The document discusses treatment options for lupus nephritis, specifically comparing cyclophosphamide to alternative therapies. It finds that while cyclophosphamide is effective for inducing remission, it has significant toxicity risks. Studies show mycophenolate mofetil and low-dose cyclophosphamide have similar efficacy with fewer side effects. Many patients also experience treatment failure or relapse even with standard therapies, highlighting the need for improved maintenance regimens and new treatment agents.
Reynold A. Panettieri, Jr., MD, prepared useful practice aids pertaining to COPD management for this CME activity titled "The Role of the Eosinophil in COPD: Implications for Precision Care and Novel Treatments." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2IqQtR0. CME credit will be available until May 24, 2019.
Newer Aeds Recommendations And Practice ParametersPramod Krishnan
The document discusses efficacy and tolerability of newer antiepileptic drugs based on numerous studies. It summarizes that lamotrigine is effective for initial monotherapy in new onset partial seizures in adults and children, and as add-on therapy for refractory partial epilepsy. Topiramate is effective as add-on therapy for refractory partial seizures in adults and children, and for monotherapy in refractory partial seizures and idiopathic generalized tonic-clonic seizures. Both drugs show efficacy in Lennox-Gastaut syndrome but may worsen myoclonic seizures. Tolerability varies with dose and titration speed.
Severe or difficult-to-treat asthma affects approximately 15% of asthma patients and is characterized by persistent symptoms and exacerbations despite high-dose controller medications. These patients experience greater morbidity and increased healthcare use. Characteristics of severe asthma include irreversible airflow obstruction, neutrophilic inflammation, ongoing mediator release, and reduced association with atopy. Management involves accurate diagnosis, treatment of risk factors and comorbidities, appropriate medication including biologics like omeklizumab, and ongoing patient education and support.
201911 - Tripodi - Immunoterapia specifica alla luce della e-mobile health?Asmallergie
1. The document discusses using digital solutions like mobile health to improve allergen immunotherapy (AIT) by combining clinical research data and mobile health for AIT prescription.
2. It proposes the "@IT-2020" process, a flexible 4-step modular approach for prescribing AIT for pollen allergy patients in Southern Europe/Mediterranean countries, to be validated in a pilot study (2016-2017) and multicenter study (2018-2019).
3. The 4 diagnostic steps of "@IT-2020" and validation testing are described, aiming to determine genuine vs false sensitization, primary sensitization, and the relationship between sensitization and symptoms to guide personalized AIT prescription.
201911 - Rossi - L'asma grave è sempre “grave”?Asmallergie
This document discusses a study of 437 patients with severe asthma (GINA step V) in Italy. The main findings were:
- The average annual exacerbation rate was 3.75.
- The mean blood eosinophil level was 536.7 cells/mcL and average serum total IgE was 470.3 kU/L.
- 64% were on regular oral corticosteroids, 57% with omalizumab and 11.2% with mepolizumab.
- The most common comorbidities were rhinitis, nasal polyposis, and bronchiectasis. Bronchiectasis was associated with more frequent severe exacerbations.
201911 - Conte - Asma eosinofilico: i farmaci biologici che contrastano l'azi...Asmallergie
This document summarizes a presentation about eosinophilic asthma and biological drugs that target interleukin-5 (IL-5). It discusses the role of eosinophils and IL-5 in asthma, clinical studies of anti-IL-5 drugs like mepolizumab and benralizumab, and real-world experience with these therapies. The presentation covers the pathophysiology of eosinophilic asthma, how anti-IL-5 drugs work, results from major clinical trials showing reduced exacerbations and oral corticosteroid use, and insights from real-world studies on treatment response and outcomes. It emphasizes the importance of patient phenotypes and endotypes in guiding therapy selection for severe asthma.
201911 - Villalta - Novità in ambito di diagnostica molecolare nella sensibil...Asmallergie
This document discusses advances in molecular diagnostics for mite sensitization. It begins with a brief history of allergy to house dust mites and an overview of the major allergenic molecules from mites, including Der p 1, Der p 2, and Der p 23. It describes the concept of "molecular spreading" where the IgE response spreads from initial sensitization to major allergens to include other milder allergens over time. The document then covers classical and molecular diagnostic techniques for mite allergy. It concludes by discussing the potential predictive role of antibody patterns to different mite allergens.
20181110 - Polla - Nuove associazioni inalatorie nella terapia dell’asma bron...Asmallergie
This document discusses new inhaler combinations for treating asthma. It summarizes several clinical studies that evaluated the efficacy of combining inhaled corticosteroids and long-acting muscarinic antagonists to control asthma symptoms. One study of over 5,000 patients found that combining these drugs reduced the risk of exacerbations compared to inhaled corticosteroids alone. The document also references guidelines from GINA that recommend stepwise treatment with inhaled corticosteroids and adding long-acting beta-agonists or tiotropium for uncontrolled asthma.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
3. Schleich F, et al. Resp Med 2014; 108: 1723 - 1732
Caratteristiche demografiche:
✓ Sesso femminile 57%
✓ Atopia 70%
✓ Late-onset ( ≥ 40 a) 31%
4. Ilmarinen P et al, JACI Pract 2018 in press
2% pts elegible for anti-IL-5 treatment if:
✓ Daily use of medium to high ICS + LABA
✓ Blood eosinophil count ≥ 300 c/mL
✓ FeNO ≥ 50 ppb
✓ ≥ 2 exhacerbations /previous year
7. Varricchi G et al, Curr Opin Allergy Clin Immunol 2016
Eosinofilo espone un ampio spettro
di recettori di superficie molto
importanti per la sua funzione
pleiotrofica
8. Varricchi G et al, Curr Opin Allergy Clin Immunol 2016
E a sua volta modula la funzione di
una moltitudine di cellule della
risposta immune innata ed adattativa
9. Varricchi G et al, Curr Opin Allergy Clin Immunol 2016
IL-5 gioca un ruolo fondamentale
sulla proliferazione, sulla
maturazione a livello del midollo
osseo, sul reclutamento e
l’attivazione dell’eosinofilo nel sito di
infiammazione
Nel tessuto bronchiale:
Iperproduzione di muco
Remodelling delle vie aeree
10. Elisabeth H Bel, Chest; December 2017
Sempre maggiore definizione di singoli target d’azione
12. Pelaia C et al, Bio Med Res Int 2018
Afucosylate: > affinity to FcgRIIIa
Humanized
IgG1k anti-IL-5Ra chain
On cortesy of Prof. A. Matucci
BENRALIZUMAB
13. FcgRIIIa
BENRALIZUMAB
Il grado di fucosilazione della catena
CH2 del frammento Fc delle
Immunoglobuline ne modifica
l’immunogenicità e la capacità di
legame al recettore Fc𝜸RIIIa espresso
su macrofagi, neutrofili ed NK
Afucosilazione:
❖ Aumenta da 5 a 50 volte l’affinità di
legame al recettore
❖ Amplifica di 1000 volte il
meccanismo di ADCC
On cortesy of Prof. A. Matucci
14. BENRALIZUMAB: IgG1k anti-IL-5Ra chain
NK cell
FcgRIIIa
Mechanisms of action:
▪ Neutralizing activity of IL-5 by blocking IL-5-receptor
▪ Eosinophils apoptosis (ADCC) not inducing degranulation
Cytotoxic mediators
Benralizumab
IL-5-receptor: A KEY TARGET
On cortesy of Prof. A. Matucci
15. L’apoptosi dell’eosinofilo mediata da Benralizumab non è associata al rilascio di mediatori tossici
Respiratory Medicine 111 (2016)
Nel paziente asmatico il
livello di EDN ha una
stretta correlazione con
l’eosinofilia periferica
v
16. Kolbeck R et al, Allergy Clin Immunol ,, June 2010
17. Lavoiette M et al, JACI 132 (2013), November
Studio Fase I
Blood eosinophilia
decreases within 6-24
hours after benralizumab
18. Lavoiette M et al, JACI 132 (2013), November
Studio Fase I
Bone marrow
eosinophilis and
eosinophil precursors
Induced sputum eosinophils
- 95,1%
EOS NEUT
19. Lavoiette M et al, JACI 132 (2013), November
Studio Fase I
Airway mucosal eosinophil counts
(green)
20. L’eosinofilo residente a livello
bronchiale pare avere un grado di
maturazione maggiore che lo rende
meno sensibile all’azione di IL-5 e
pertanto meno responsivo all’azione
di mAB anti-IL-5 e IL-5R
21. CALIMA2
Efficacy and safety study of
benralizumab in adults and
adolescents with asthma
inadequately controlled on
medium- to high-dosage
ICS/LABA
SIROCCO4
Efficacy and safety study of
benralizumab added to high-
dosage ICS/LABA in patients with
uncontrolled asthma
ZONDA3
Efficacy and safety study of
benralizumab to
reduce OCS use in patients with
uncontrolled asthma on high-
dosage ICS/LABA and chronic
OCS therapy
BORA7
Safety extension study of
benralizumab in asthmatic adults
and adolescents on ICS/LABA
GREGALE6
Functionality and reliability of the
APFS in an at-home setting and
performance of the APFS after
use
BISE5
Efficacy and safety study of
benralizumab in adults with mild
to moderate persistent asthma
Windward Programme: 6 studi fase III
22. STUDY N° of
patients
(A/Plac)
Duration
(wks)
Asthma level Outcomes
SIROCCO 798/407 56 Severe • Reduction of
exacerbation
• Improvement of FEV1
CALIMA 866/440 56 Severe • Reduction of
exacerbation
• Improvement of FEV1
ZONDA 145/75 28 OCS dependent Oral steroid reduction
Benralizumab: 3 Studi Registrativi
23. 2016
Benralizumab Placebo
Treatment allocation N. 267 267
Age 47.6 48.6
Gender, females N. (%) 174 (65) 180 (67)
Baseline pre-bronchodilator
FEV1 (mean L)
1.66 1.65
Baseline pre-bronchodilator
FEV1 (%)
55.5 56.4
Blood eosinophil count, mean
cells/ml
500 500
Bleecker ER et al, The Lancet (2016), Vol 388, October 29
48W
24. Bleecker ER et al, The Lancet (2016), Vol 388, October 29
AER
25. Bleecker ER et al, The Lancet (2016), Vol 388, October 29
FEV1
26. 2016
FitzGerald JM et al, The Lancet (2016), Vol 388, October 29
Benralizumab Placebo
Treatment allocation N. 239 248
Age 49.6 48.5
Gender, females N. (%) 138 (58) 145 (58)
Baseline pre-bronchodilator
FEV1 (mean L)
1.76 1.82
Baseline pre-bronchodilator
FEV1 (%)
57.0 58.2
Blood eosinophil count, mean
cells/ml
500 510
56W
33. Nair P et al, The N Engl J Med (2017), 376; 25, June 22
34. Nair P et al, The N Engl J Med (2017), 376; 25, June 22
35. Nair P et al, The N Engl J Med (2017), 376; 25, June 22
OCS reduction
AER
36. Within the literature chronic OCS use has been
reported in 11-46% of patients with severe asthma
In the United States 11-38% of patients with
severe asthma receive chronic OCS
In Europe 16-57% of patients with severe asthma
receive OCS therapy
44. Adverse Events During On-Treatment Period
BORA Benralizumab Q4W plus ICS/LABA Benralizumab Q8W plus ICS/LABA
SIROCCO/CALIMA Benralizumab
Q4W
(n=518)
Placebo
(n=265)
Benralizumab
Q8W
(n=512)
Placebo
(n=281)
Any AE 364 (70%) 181 (68%) 361 (71%) 183 (65%)
Any AE leading to treatment discontinuation 10 (2%) 8 (3%) 8 (2%) 5 (2%)
AEs in ≥10% of patientsa
Viral upper respiratory tract infection
Worsening asthma
78 (15%)
49 (9%)
36 (14%)
27 (10%)
80 (16%)
41 (8%)
41 (15%)
19 (7%)
• Similar percentages of patients experienced AEs in BORA and SIROCCO/CALIMA (65–
71% vs. 71–75%, respectively)1,2
• Comparable percentages of patients had AEs leading to discontinuations
in BORA and SIROCCO/CALIMA (2–3% vs. 2%, respectively)1,2
Data are n (%), where n is the number of patients. aAs defined in the Medical Dictionary for Regulatory Activities version 20.0.
1. Bleecker ER, et al. Lancet. 2016;388:2115–27. 2. FitzGerald JM, et al. Lancet. 2016;388:2128–41.
45. Serie Generale n. 96 del 26-4-2018
Fasenra è indicato come terapia
di mantenimento aggiuntiva in
pazienti adulti con asma
eosinofilo severo non
adeguatamente controllato
malgrado l’impiego di
corticosteroidi per via inalatoria
a dosi elevate e beta2 agonisti a
lunga durata d’azione.
53. Take home messages
Benralizumab ha un effetto diretto sull’eosinofilo diversamente dagli altri anti-IL5
L’apoptosi NK dipendente dell’eosinofilo avviene senza il rilascio di mediatori tossici
La deplezione degli eosinofili è molto rapida ed avviene in tutti i distretti, anche nelle vie aeree
Il miglioramento degli outcome clinici è maggiore nei pz più gravi
Trends futuri: allo studio nuovi scenari terapeutici