1) The Remission Clinic approach aims to halt progression of kidney disease through a multimodal strategy targeting urinary proteins with dual RAS inhibition using maximum tolerated doses of ACE inhibitors and ARBs, intensified blood pressure control, treatment of dyslipidemia with statins, smoking cessation, and lifestyle changes.
2) This approach achieved remission or regression of proteinuria and stabilized kidney function in most cases, almost fully preventing progression to end-stage renal disease.
3) Provided patients are closely monitored and treatment is cautiously up-titrated according to tolerability, this multimodal strategy may be safely applied in clinical practice to effectively reduce urinary proteins and prevent loss of renal function.
A review of the existing evidence that supports the current practice in perioperative medicine regarding Renin-angiotensin-aldosterone system antagonists, mainly ACE inhibitors and Angiotensin type 1 receptor blockers (ARB's).
Presented as the Cleveland Clinic Hospital Medicine Grand Rounds on April 1, 2009. CME AMA Category 1 - 1 hour.
Noacs use in patients other than atrial fibrillationDIPAK PATADE
1) The document discusses trials evaluating the direct oral anticoagulants (DOACs) dabigatran, rivaroxaban, and apixaban for various indications.
2) The RE-NOVATE trials found dabigatran non-inferior to enoxaparin for VTE prevention after hip replacement with comparable bleeding risks.
3) The RE-COVER trials found dabigatran non-inferior to warfarin for VTE treatment and secondary prevention with lower bleeding risks.
4) The EINSTEIN trials found rivaroxaban non-inferior to enoxaparin/warfarin for VTE treatment and
Hypertension is often difficult to treat effectively despite available drugs. Combination drug therapy is usually needed to control blood pressure, as monotherapy is only effective in 40-60% of patients. Using two drugs with different mechanisms of action can more effectively lower blood pressure than monotherapy alone. Common effective combinations include a diuretic paired with a renin-angiotensin system inhibitor, calcium channel blocker, or beta blocker. This helps control blood pressure through multiple pathways and limits side effects.
Role of raas inhibition in management of hypertensionKyaw Win
1) RAAS inhibition plays a central role in the pathogenesis of cardiovascular disease by modulating processes like vasoconstriction, inflammation, endothelial dysfunction, and atherosclerosis.
2) Both ACE inhibitors and ARBs have been shown to reduce target organ damage and improve endothelial function through various mechanisms such as increasing NO and reducing oxidative stress and inflammation.
3) Clinical trials provide evidence that RAAS inhibition can reduce atherosclerosis progression, cardiac hypertrophy, and events in conditions like coronary artery disease and heart failure.
This document discusses pharmacological management options for heart failure with reduced ejection fraction (HFrEF). The goals of treatment are to reduce symptoms, prolong survival, improve quality of life, and prevent disease progression. Key drug therapies recommended for prognosis include ACE inhibitors, ARBs, beta blockers, and mineralocorticoid receptor antagonists. Diuretics and digoxin are recommended to treat symptoms. Ivabradine may also be used for symptom control. Clinical trials have demonstrated the benefits of these drug classes in reducing mortality and hospitalizations.
This document discusses several novel biomarkers for acute coronary syndrome (ACS). It describes C-reactive protein (CRP) as a marker of extensive vascular inflammation. High-sensitivity CRP levels above 10 mg/L are more predictive of outcomes in ACS patients. Soluble CD40 ligand and myoglobin are also discussed as inflammation markers. Microalbuminuria is related to endothelial dysfunction and an increased risk of cardiovascular disease. Cystatin C and metalloproteinases are associated with arterial stiffness and plaque degradation. Several microRNAs such as miR-1, miR-133 and miR-208 are described as potential biomarkers for myocardial infarction, cardiac hypertrophy, and arrhythmias.
The success of neurohormonal blockade: looking back – looking forward: Beta-b...drucsamal
- The document summarizes the history of beta-blocker treatment for heart failure, from early studies in the 1970s showing potential benefits to large randomized controlled trials in the 1990s and 2000s firmly establishing mortality reduction.
- Key trials included MDC (1993) showing reduced mortality and heart transplantation, CIBIS-II (1999) showing reduced mortality with bisoprolol, MERIT-HF (1999) showing reduced mortality with metoprolol CR/XL, and COPERNICUS (2001) showing reduced mortality, hospitalizations, and worsening heart failure with carvedilol.
- Meta-analyses demonstrated a consistent mortality reduction of approximately 35% associated with beta-blocker use in
A review of the existing evidence that supports the current practice in perioperative medicine regarding Renin-angiotensin-aldosterone system antagonists, mainly ACE inhibitors and Angiotensin type 1 receptor blockers (ARB's).
Presented as the Cleveland Clinic Hospital Medicine Grand Rounds on April 1, 2009. CME AMA Category 1 - 1 hour.
Noacs use in patients other than atrial fibrillationDIPAK PATADE
1) The document discusses trials evaluating the direct oral anticoagulants (DOACs) dabigatran, rivaroxaban, and apixaban for various indications.
2) The RE-NOVATE trials found dabigatran non-inferior to enoxaparin for VTE prevention after hip replacement with comparable bleeding risks.
3) The RE-COVER trials found dabigatran non-inferior to warfarin for VTE treatment and secondary prevention with lower bleeding risks.
4) The EINSTEIN trials found rivaroxaban non-inferior to enoxaparin/warfarin for VTE treatment and
Hypertension is often difficult to treat effectively despite available drugs. Combination drug therapy is usually needed to control blood pressure, as monotherapy is only effective in 40-60% of patients. Using two drugs with different mechanisms of action can more effectively lower blood pressure than monotherapy alone. Common effective combinations include a diuretic paired with a renin-angiotensin system inhibitor, calcium channel blocker, or beta blocker. This helps control blood pressure through multiple pathways and limits side effects.
Role of raas inhibition in management of hypertensionKyaw Win
1) RAAS inhibition plays a central role in the pathogenesis of cardiovascular disease by modulating processes like vasoconstriction, inflammation, endothelial dysfunction, and atherosclerosis.
2) Both ACE inhibitors and ARBs have been shown to reduce target organ damage and improve endothelial function through various mechanisms such as increasing NO and reducing oxidative stress and inflammation.
3) Clinical trials provide evidence that RAAS inhibition can reduce atherosclerosis progression, cardiac hypertrophy, and events in conditions like coronary artery disease and heart failure.
This document discusses pharmacological management options for heart failure with reduced ejection fraction (HFrEF). The goals of treatment are to reduce symptoms, prolong survival, improve quality of life, and prevent disease progression. Key drug therapies recommended for prognosis include ACE inhibitors, ARBs, beta blockers, and mineralocorticoid receptor antagonists. Diuretics and digoxin are recommended to treat symptoms. Ivabradine may also be used for symptom control. Clinical trials have demonstrated the benefits of these drug classes in reducing mortality and hospitalizations.
This document discusses several novel biomarkers for acute coronary syndrome (ACS). It describes C-reactive protein (CRP) as a marker of extensive vascular inflammation. High-sensitivity CRP levels above 10 mg/L are more predictive of outcomes in ACS patients. Soluble CD40 ligand and myoglobin are also discussed as inflammation markers. Microalbuminuria is related to endothelial dysfunction and an increased risk of cardiovascular disease. Cystatin C and metalloproteinases are associated with arterial stiffness and plaque degradation. Several microRNAs such as miR-1, miR-133 and miR-208 are described as potential biomarkers for myocardial infarction, cardiac hypertrophy, and arrhythmias.
The success of neurohormonal blockade: looking back – looking forward: Beta-b...drucsamal
- The document summarizes the history of beta-blocker treatment for heart failure, from early studies in the 1970s showing potential benefits to large randomized controlled trials in the 1990s and 2000s firmly establishing mortality reduction.
- Key trials included MDC (1993) showing reduced mortality and heart transplantation, CIBIS-II (1999) showing reduced mortality with bisoprolol, MERIT-HF (1999) showing reduced mortality with metoprolol CR/XL, and COPERNICUS (2001) showing reduced mortality, hospitalizations, and worsening heart failure with carvedilol.
- Meta-analyses demonstrated a consistent mortality reduction of approximately 35% associated with beta-blocker use in
The document discusses the use of steroids in rheumatology. It notes that while steroids were initially hoped to dramatically alter the long-term course of rheumatoid arthritis, long-term high dose treatment can have serious adverse effects. Low dose steroids remain controversial for treating arthritis symptoms and progression. Corticosteroid pulse therapy, involving high intermittent IV doses, can provide clinical benefits but also risks like osteonecrosis. Overall, steroids may have an early role in controlling synovitis or bridging between disease-modifying drugs, but long-term use is not justified due to safety concerns.
Hussein drug therapy in aki 3 osama alshahat 2 pptxFarragBahbah
This document discusses acute kidney injury (AKI). It notes that AKI is often not recognized or coded for correctly. The incidence of AKI is increasing globally due to factors like comorbidities. Treatment for AKI is mainly supportive as there are no effective preventative or curative treatments. Several studies discussed found that diuretics and mannitol did not prevent AKI and may increase the risk of contrast-induced nephropathy. Hydration with sodium bicarbonate or saline was compared, with meta-analyses finding sodium bicarbonate may reduce the risk of AKI compared to saline. Dopamine and fenoldopam were also discussed but did not show clear benefits for preventing or treating AK
The REACH Registry study found that beta-blockers do not reduce the risk of cardiovascular events like death, heart attack, or stroke in stable outpatients with or without coronary artery disease. However, beta-blockers were found to lower the risk of secondary outcomes in patients who had a heart attack within the past year. The study followed over 45,000 patients for 4 years on average and compared outcomes in patients taking beta-blockers to those not taking them.
This document summarizes changes in the treatment of acute kidney injury (AKI) over the last 10 years. It discusses epidemiological data on AKI from a large trial showing high mortality. It covers prevention of contrast-induced nephropathy including hydration protocols and acetylcysteine. Dose and modality of renal replacement therapy are discussed, with studies showing benefits of continuous over intermittent dialysis. Management of fluid balance in sepsis and AKI is also summarized.
Contrast-induced nephropathy (CIN) is an acute kidney injury caused by radiocontrast media used in medical imaging. It is usually reversible and defined as an increase in serum creatinine of at least 0.3 mg/dL or 50% within 48 hours of contrast administration. Risk factors include pre-existing chronic kidney disease, diabetes, and higher contrast doses. Prevention focuses on hydration with isotonic saline before and after exposure, using low- or iso-osmolar contrast agents, and avoiding nephrotoxic drugs. Management involves treating the acute kidney injury while prevention remains the best approach to reducing risks of CIN.
This document summarizes the results of 56 clinical trials related to critical care medicine. It provides brief 1-3 sentence summaries of each trial including the intervention tested, population studied, and key results. The trials cover a wide range of topics including sepsis management, fluid resuscitation, sedation practices, mechanical ventilation strategies and more.
LCZ696 was more effective than enalapril in reducing the risks of CV death and HF hospitalization, CV death, HF hospitalization, and all-cause mortality in patients with heart failure with reduced ejection fraction. LCZ696 also provided incremental improvements in symptoms and physical limitations. LCZ696 was better tolerated than enalapril with lower rates of symptomatic hypotension, hyperkalemia, renal impairment, and cough.
Reducing Perioperative Cardiac Risk: Do Beta blockers Help?Terry Shaneyfelt
Review of the effect of beta blockers on perioperative cardiac events including updated recommendations by the ACC/AHA (August 2014. Watch my YouTube video (http://youtu.be/WPLXDm9Nzoc) describing these slides.
This document summarizes several key points about complications related to intensive care, focusing on delirium and ICU-acquired weakness.
The main points are:
1) Delirium and coma in the ICU can lead to acute brain dysfunction and increased mortality. Delirium is also associated with long-term cognitive impairment and brain atrophy.
2) ICU stays can cause rapid muscle weakness starting in the acute phase, and this is related to poorer quality of life and depression after discharge.
3) Delirium is characterized by acute changes in mental state and cognition. It occurs in 40-80% of patients on mechanical ventilation and affects prognosis even after ICU discharge.
Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms.
Presented at AHA by: Faiez Zannad, M.D., Ph.D., John J.V. McMurray, M.D., Henry Krum, M.B., PhD., Dirk J. van Veldhuisen, M.D.,Ph.D., Karl Swedberg, M.D., Ph.D, Harry Shi, M.S., John Vincent, M.B., PhD., Stuart J Pocock, Ph.D. and Bertram Pitt, M.D. for the EMPHASIS-HF Study Group * Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure
Courtesy of http://www.cardiovascularbusiness.com
This document discusses beta-blockers, including their discovery, mechanism of action, uses, side effects, and current research. Beta-blockers were discovered in 1962 and work by blocking beta-1 and beta-2 adrenoceptors. They are used to treat various cardiovascular conditions like hypertension, angina, and arrhythmias. While generally effective, they can cause side effects like bradycardia, bronchospasm, and hypoglycemia. Current research is exploring their potential roles in cancer treatment and fracture prevention.
1) The study examined the influence of continuing or withdrawing beta-blocker therapy on outcomes in patients hospitalized with heart failure.
2) It found that continuing beta-blocker therapy was associated with lower risks while withdrawing therapy was linked to excess mortality.
3) Continuing therapy was also generally well-tolerated according to the results.
This document discusses beta blockers and focuses on bisoprolol. It summarizes that:
1) Beta blockers are a class of drugs used to treat heart conditions like heart failure and hypertension, but they have diverse properties. Bisoprolol is a selective beta-1 blocker.
2) Studies show bisoprolol provides similar or better blood pressure control compared to other beta blockers like atenolol and metoprolol. It also provides superior heart rate reduction.
3) The CIBIS II trial found bisoprolol reduced all-cause mortality by 34% in heart failure patients when added to standard therapy of diuretics and ACE inhibitors.
This case report describes a 72-year-old man with chronic hepatitis B who developed suspected tenofovir disoproxil fumarate-associated Fanconi syndrome. The man was treated with TDF and entecavir for hepatitis B. Over four months his renal function declined, and he developed hypokalemia, metabolic acidosis, and acute kidney injury. All features improved after discontinuing TDF, supporting the diagnosis of TDF-associated Fanconi syndrome. The report reviews the mechanism and risk factors of TDF nephrotoxicity and recommends monitoring renal function in patients taking TDF.
This document summarizes evidence from major clinical trials supporting current pharmacological treatments for chronic heart failure (CHF). It discusses trials that demonstrated mortality benefits of ACE inhibitors, beta-blockers, aldosterone receptor antagonists, and hydralazine/isosorbide dinitrate combinations. Together, these trials established the current neurohormonal model of CHF and shifted focus to treatments targeting the renin-angiotensin-aldosterone system and sympathetic nervous system overactivation in CHF.
The document discusses several cases of glomerular disease:
1) A 27-year-old male with nephrotic syndrome and a kidney biopsy showing IgG and C3 deposits along the glomerular basement membrane consistent with membranous nephropathy.
2) A 78-year-old female admitted with nephrotic syndrome after a history of NSAID use, with a biopsy showing focal segmental glomerulosclerosis.
3) A 26-year-old male with nephrotic syndrome and renal impairment, whose biopsy demonstrated membranoproliferative glomerulonephritis with C3 deposition and subendothelial electron dense deposits. Follow up showed elevated
Approach to deceased donor transplantationVishal Golay
This document discusses the process of deceased donor organ transplantation. It covers donor identification, screening, certification of brain stem death, maintenance of potential donors, and counseling of family members. Key steps include confirming brain stem death through clinical tests, screening donors based on medical criteria, obtaining consent from relatives, and providing life support to optimize organ function prior to retrieval. The overall goal is to maximize the number of transplantable organs through proper donor care and management.
Journal club multitarget therapy lupus nephritis maintenance chaken CHAKEN MANIYAN
Multitarget therapy of tacrolimus, mycophenolate mofetil and steroids achieved a 45.9% complete remission rate in induction treatment of lupus nephritis. This study assessed the efficacy of continuing multitarget therapy versus switching to azathioprine as maintenance treatment over 18 months. The cumulative renal relapse rate was lower in the multitarget group at 5.47% compared to 7.62% in the azathioprine group. More patients in the multitarget group maintained complete remission during maintenance treatment with no significant differences in safety profiles between the groups.
This document discusses renal complications associated with hematologic malignancies and their treatment. It provides 3 key points:
1) Lymphomatous infiltration of the kidneys is a common but under-recognized complication of malignant lymphomas, seen in up to one-third of patients on autopsy. Bilateral symmetrical kidney enlargement is the most common imaging finding.
2) Chemotherapies used to treat hematologic malignancies can cause acute kidney injury through tumor lysis syndrome or direct nephrotoxicity. Ifosfamide, in particular, is associated with proximal tubule dysfunction and Fanconi syndrome.
3) Long-term renal complications of chemotherapy include chronic kidney disease, which may progress even after
12: 50 Boudou - Prevention of contrast - induced nephropathyEuro CTO Club
This document discusses contrast-induced nephropathy (CIN), a condition where renal function is impaired after contrast administration during medical imaging or procedures. The frequency of CIN has declined from around 15% to 7% in recent decades. CIN is associated with increased mortality, major adverse cardiac events, and longer hospital stays. Hydration with isotonic saline before and after the procedure, minimizing contrast volume, and short-term high-dose statin therapy can help prevent CIN, especially in those with reduced kidney function. The risk of CIN increases when the ratio of contrast volume to glomerular filtration rate exceeds certain thresholds. Strategies to minimize contrast volume such as selective injections can help reduce the risk of C
The document summarizes the renin-angiotensin aldosterone system (RAAS), which plays an important role in blood pressure regulation and fluid balance. It describes the key components and regulation of the RAAS, including renin secretion initiating a cascade where angiotensin I is converted to the active hormone angiotensin II. Angiotensin II acts through receptors like AT1 to stimulate effects like vasoconstriction and aldosterone release. Pharmacological agents that block parts of the RAAS pathway are used to treat hypertension and related conditions.
How Should One Decide Whom to Treat for Hypertension? How Should One Decide...MedicineAndHealthUSA
The document discusses approaches for deciding whom to treat for hypertension. It compares strategies focused on lowering blood pressure versus slowing disease progression. Screening tests can identify early markers of cardiovascular disease to guide more aggressive prevention strategies in high-risk individuals before blood pressure thresholds are met. Future paradigms may target treatment to slow progression across the disease continuum rather than achieve discrete treatment goals.
The document discusses the use of steroids in rheumatology. It notes that while steroids were initially hoped to dramatically alter the long-term course of rheumatoid arthritis, long-term high dose treatment can have serious adverse effects. Low dose steroids remain controversial for treating arthritis symptoms and progression. Corticosteroid pulse therapy, involving high intermittent IV doses, can provide clinical benefits but also risks like osteonecrosis. Overall, steroids may have an early role in controlling synovitis or bridging between disease-modifying drugs, but long-term use is not justified due to safety concerns.
Hussein drug therapy in aki 3 osama alshahat 2 pptxFarragBahbah
This document discusses acute kidney injury (AKI). It notes that AKI is often not recognized or coded for correctly. The incidence of AKI is increasing globally due to factors like comorbidities. Treatment for AKI is mainly supportive as there are no effective preventative or curative treatments. Several studies discussed found that diuretics and mannitol did not prevent AKI and may increase the risk of contrast-induced nephropathy. Hydration with sodium bicarbonate or saline was compared, with meta-analyses finding sodium bicarbonate may reduce the risk of AKI compared to saline. Dopamine and fenoldopam were also discussed but did not show clear benefits for preventing or treating AK
The REACH Registry study found that beta-blockers do not reduce the risk of cardiovascular events like death, heart attack, or stroke in stable outpatients with or without coronary artery disease. However, beta-blockers were found to lower the risk of secondary outcomes in patients who had a heart attack within the past year. The study followed over 45,000 patients for 4 years on average and compared outcomes in patients taking beta-blockers to those not taking them.
This document summarizes changes in the treatment of acute kidney injury (AKI) over the last 10 years. It discusses epidemiological data on AKI from a large trial showing high mortality. It covers prevention of contrast-induced nephropathy including hydration protocols and acetylcysteine. Dose and modality of renal replacement therapy are discussed, with studies showing benefits of continuous over intermittent dialysis. Management of fluid balance in sepsis and AKI is also summarized.
Contrast-induced nephropathy (CIN) is an acute kidney injury caused by radiocontrast media used in medical imaging. It is usually reversible and defined as an increase in serum creatinine of at least 0.3 mg/dL or 50% within 48 hours of contrast administration. Risk factors include pre-existing chronic kidney disease, diabetes, and higher contrast doses. Prevention focuses on hydration with isotonic saline before and after exposure, using low- or iso-osmolar contrast agents, and avoiding nephrotoxic drugs. Management involves treating the acute kidney injury while prevention remains the best approach to reducing risks of CIN.
This document summarizes the results of 56 clinical trials related to critical care medicine. It provides brief 1-3 sentence summaries of each trial including the intervention tested, population studied, and key results. The trials cover a wide range of topics including sepsis management, fluid resuscitation, sedation practices, mechanical ventilation strategies and more.
LCZ696 was more effective than enalapril in reducing the risks of CV death and HF hospitalization, CV death, HF hospitalization, and all-cause mortality in patients with heart failure with reduced ejection fraction. LCZ696 also provided incremental improvements in symptoms and physical limitations. LCZ696 was better tolerated than enalapril with lower rates of symptomatic hypotension, hyperkalemia, renal impairment, and cough.
Reducing Perioperative Cardiac Risk: Do Beta blockers Help?Terry Shaneyfelt
Review of the effect of beta blockers on perioperative cardiac events including updated recommendations by the ACC/AHA (August 2014. Watch my YouTube video (http://youtu.be/WPLXDm9Nzoc) describing these slides.
This document summarizes several key points about complications related to intensive care, focusing on delirium and ICU-acquired weakness.
The main points are:
1) Delirium and coma in the ICU can lead to acute brain dysfunction and increased mortality. Delirium is also associated with long-term cognitive impairment and brain atrophy.
2) ICU stays can cause rapid muscle weakness starting in the acute phase, and this is related to poorer quality of life and depression after discharge.
3) Delirium is characterized by acute changes in mental state and cognition. It occurs in 40-80% of patients on mechanical ventilation and affects prognosis even after ICU discharge.
Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms.
Presented at AHA by: Faiez Zannad, M.D., Ph.D., John J.V. McMurray, M.D., Henry Krum, M.B., PhD., Dirk J. van Veldhuisen, M.D.,Ph.D., Karl Swedberg, M.D., Ph.D, Harry Shi, M.S., John Vincent, M.B., PhD., Stuart J Pocock, Ph.D. and Bertram Pitt, M.D. for the EMPHASIS-HF Study Group * Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure
Courtesy of http://www.cardiovascularbusiness.com
This document discusses beta-blockers, including their discovery, mechanism of action, uses, side effects, and current research. Beta-blockers were discovered in 1962 and work by blocking beta-1 and beta-2 adrenoceptors. They are used to treat various cardiovascular conditions like hypertension, angina, and arrhythmias. While generally effective, they can cause side effects like bradycardia, bronchospasm, and hypoglycemia. Current research is exploring their potential roles in cancer treatment and fracture prevention.
1) The study examined the influence of continuing or withdrawing beta-blocker therapy on outcomes in patients hospitalized with heart failure.
2) It found that continuing beta-blocker therapy was associated with lower risks while withdrawing therapy was linked to excess mortality.
3) Continuing therapy was also generally well-tolerated according to the results.
This document discusses beta blockers and focuses on bisoprolol. It summarizes that:
1) Beta blockers are a class of drugs used to treat heart conditions like heart failure and hypertension, but they have diverse properties. Bisoprolol is a selective beta-1 blocker.
2) Studies show bisoprolol provides similar or better blood pressure control compared to other beta blockers like atenolol and metoprolol. It also provides superior heart rate reduction.
3) The CIBIS II trial found bisoprolol reduced all-cause mortality by 34% in heart failure patients when added to standard therapy of diuretics and ACE inhibitors.
This case report describes a 72-year-old man with chronic hepatitis B who developed suspected tenofovir disoproxil fumarate-associated Fanconi syndrome. The man was treated with TDF and entecavir for hepatitis B. Over four months his renal function declined, and he developed hypokalemia, metabolic acidosis, and acute kidney injury. All features improved after discontinuing TDF, supporting the diagnosis of TDF-associated Fanconi syndrome. The report reviews the mechanism and risk factors of TDF nephrotoxicity and recommends monitoring renal function in patients taking TDF.
This document summarizes evidence from major clinical trials supporting current pharmacological treatments for chronic heart failure (CHF). It discusses trials that demonstrated mortality benefits of ACE inhibitors, beta-blockers, aldosterone receptor antagonists, and hydralazine/isosorbide dinitrate combinations. Together, these trials established the current neurohormonal model of CHF and shifted focus to treatments targeting the renin-angiotensin-aldosterone system and sympathetic nervous system overactivation in CHF.
The document discusses several cases of glomerular disease:
1) A 27-year-old male with nephrotic syndrome and a kidney biopsy showing IgG and C3 deposits along the glomerular basement membrane consistent with membranous nephropathy.
2) A 78-year-old female admitted with nephrotic syndrome after a history of NSAID use, with a biopsy showing focal segmental glomerulosclerosis.
3) A 26-year-old male with nephrotic syndrome and renal impairment, whose biopsy demonstrated membranoproliferative glomerulonephritis with C3 deposition and subendothelial electron dense deposits. Follow up showed elevated
Approach to deceased donor transplantationVishal Golay
This document discusses the process of deceased donor organ transplantation. It covers donor identification, screening, certification of brain stem death, maintenance of potential donors, and counseling of family members. Key steps include confirming brain stem death through clinical tests, screening donors based on medical criteria, obtaining consent from relatives, and providing life support to optimize organ function prior to retrieval. The overall goal is to maximize the number of transplantable organs through proper donor care and management.
Journal club multitarget therapy lupus nephritis maintenance chaken CHAKEN MANIYAN
Multitarget therapy of tacrolimus, mycophenolate mofetil and steroids achieved a 45.9% complete remission rate in induction treatment of lupus nephritis. This study assessed the efficacy of continuing multitarget therapy versus switching to azathioprine as maintenance treatment over 18 months. The cumulative renal relapse rate was lower in the multitarget group at 5.47% compared to 7.62% in the azathioprine group. More patients in the multitarget group maintained complete remission during maintenance treatment with no significant differences in safety profiles between the groups.
This document discusses renal complications associated with hematologic malignancies and their treatment. It provides 3 key points:
1) Lymphomatous infiltration of the kidneys is a common but under-recognized complication of malignant lymphomas, seen in up to one-third of patients on autopsy. Bilateral symmetrical kidney enlargement is the most common imaging finding.
2) Chemotherapies used to treat hematologic malignancies can cause acute kidney injury through tumor lysis syndrome or direct nephrotoxicity. Ifosfamide, in particular, is associated with proximal tubule dysfunction and Fanconi syndrome.
3) Long-term renal complications of chemotherapy include chronic kidney disease, which may progress even after
12: 50 Boudou - Prevention of contrast - induced nephropathyEuro CTO Club
This document discusses contrast-induced nephropathy (CIN), a condition where renal function is impaired after contrast administration during medical imaging or procedures. The frequency of CIN has declined from around 15% to 7% in recent decades. CIN is associated with increased mortality, major adverse cardiac events, and longer hospital stays. Hydration with isotonic saline before and after the procedure, minimizing contrast volume, and short-term high-dose statin therapy can help prevent CIN, especially in those with reduced kidney function. The risk of CIN increases when the ratio of contrast volume to glomerular filtration rate exceeds certain thresholds. Strategies to minimize contrast volume such as selective injections can help reduce the risk of C
The document summarizes the renin-angiotensin aldosterone system (RAAS), which plays an important role in blood pressure regulation and fluid balance. It describes the key components and regulation of the RAAS, including renin secretion initiating a cascade where angiotensin I is converted to the active hormone angiotensin II. Angiotensin II acts through receptors like AT1 to stimulate effects like vasoconstriction and aldosterone release. Pharmacological agents that block parts of the RAAS pathway are used to treat hypertension and related conditions.
How Should One Decide Whom to Treat for Hypertension? How Should One Decide...MedicineAndHealthUSA
The document discusses approaches for deciding whom to treat for hypertension. It compares strategies focused on lowering blood pressure versus slowing disease progression. Screening tests can identify early markers of cardiovascular disease to guide more aggressive prevention strategies in high-risk individuals before blood pressure thresholds are met. Future paradigms may target treatment to slow progression across the disease continuum rather than achieve discrete treatment goals.
The document summarizes volunteer activities conducted by medical students to promote rare diseases. The students volunteered their time, knowledge, and energy to help patients without expecting financial rewards. They chose to focus on rare diseases because many students found genetics interesting, rare diseases affect many patients, and those suffering deserve support. Through projects like "Together for Rare People" and "Volunteers for Rare Diseases", students received training and worked with patients, their families, and specialists to increase awareness, provide counseling and support, and improve quality of life. The volunteer activities benefited both patients and students by developing practical skills and increasing medical knowledge.
This document provides guidelines from the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) for the management of dyslipidaemias. It was developed by a task force consisting of experts from across Europe. The guidelines cover evaluating total cardiovascular risk, lipid parameters, treatment targets, lifestyle modifications, and pharmacological therapies. They also provide guidance on managing dyslipidaemias in various clinical settings such as familial hyperlipidemias and in children. The guidelines are intended to help health professionals develop appropriate treatment plans for individual patients based on their risk factors and lipid levels.
1) The document discusses the relationship between health and economic growth, drawing on both the Lucas and Nelson-Phelps approaches. It proposes a theoretical framework that encompasses both the level and accumulation of health as factors that can impact growth.
2) Empirically, using cross-country regressions and instruments from previous studies, the document finds that both the initial level and rate of improvement in life expectancy have a significantly positive impact on GDP growth.
3) Looking specifically at OECD countries, the document finds evidence that only reductions in mortality below age 40 (not overall mortality improvements) generate productivity gains that explain the positive health-growth relationship.
Renal protection in chronic heart failure.pptxssuser7573c4
Sacubitril/valsartan is beneficial for preserving renal function in patients with chronic heart failure (CHF) through several mechanisms:
1) It inhibits neprilysin which degrades natriuretic peptides, increasing their levels and resulting in vasodilation, natriuresis, and reduced fibrosis.
2) By also blocking the angiotensin receptor, it counters the effects of renin-angiotensin-aldosterone system (RAAS) overactivation on blood pressure and sodium retention.
3) Evidence from trials like PARADIGM-HF and PARAGON-HF show sacubitril/valsartan reduces hospitalizations and death more than ACE
This editorial discusses the results of the ONTARGET trial, which found that dual therapy with an ACE inhibitor (ACEi) and angiotensin receptor blocker (ARB) did not provide additional cardiovascular or renal protection compared to monotherapy. The authors note that previous studies showed dual therapy further reduced blood pressure and albuminuria. However, in the ONTARGET subgroup with reduced kidney function and albuminuria, dual therapy did not lower blood pressure or albuminuria more than monotherapy. As a result, no additional renal protection was seen. The authors call for further analysis of why dual therapy did not have additional effects in this high-risk subgroup in ONTARGET.
Prof. a. el sebaeii.fluid management in patients with akiwessam1071
Acute renal failure (ARF) is common in intensive care units (ICUs) and is associated with high mortality. Early fluid management is important to prevent and treat ARF. While aggressive hydration and maintaining adequate blood pressure can help prevent ARF, both overhydration and underhydration should be avoided as they can worsen renal function. No intravenous fluid is ideal, and fluid choice and management should be tailored to the individual patient based on their fluid status and needs. Early initiation of renal replacement therapy should be considered for patients with complications from ARF such as fluid overload or electrolyte abnormalities.
Approximately 10 to 30 percent of patients with proliferative lupus nephritis progress to end-stage renal disease (ESRD), depending upon the severity of the disease, ancestral and socioeconomic factors, noncompliance, and the response to initial treatment.
Overall prognosis has improved in recent decades, perhaps due to the use of combined immunosuppression .
A case study on essential dosage adjustment in chronic renal insufficiencySriramNagarajan16
Renal disease alters the effects of many drugs. Drug doses of certain drugs have to be appropriately adjusted depending upon
the degree of renal impairment. Drug dosing errors in patients with renal impairment are common and can lead to
accumulation and toxicity leading to adverse effects and poor outcomes. A case of a 72 years old male patient with chronic
renal failure with other co morbid disease states like systemic hypertension, diabetes mellitus, osteoporosis and peripheral
artery disease has been discussed. Laboratory data revealed both elevated serum creatinine and urea levels. On the day of
admission the patient was in end stage renal disease as his calculated GFR was 12ml/min. Modified Diet for Renal Disease
equation was used to calculate the GFR and dose adjustments were made accordingly. Drugs prescribed to the patients
included ceftriaxone 1 g, Pentoxifylline 400 mg, Tapendadol 50 mg, Levocarnitine 500 mg, Alprazolam 0.5 mg, Alpha
calcidiol 0.25 mg, Atorvastatin 20 mg, Cilostazol 50 mg, Tramadol 50 mg, Esomeprazole 40mg, Calcium 250 mg, A
systematic medication chart review revealed that pentoxyfylline is the drug of choice with altered dosing recommendations in
this patient. Therapeutic duplication in the form of using pentoxyfylline and cilostazole to treat peripheral vascular disease
was also noted. Alprazolam was started at a higher dose for the geriatric patient.
This document summarizes the current evidence on whether angiotensin-converting enzyme inhibitors (ACEIs) should be stopped, started, or continued prior to administering contrast agents. While some early studies found ACEIs increased the risk of contrast-induced nephropathy (CIN), larger and more recent randomized controlled trials found no significant difference in CIN risk between continuing or stopping ACEIs prior to contrast. Overall, there is no clear evidence that changing ACEI therapy pre-procedure reduces CIN risk, so providers should continue patients' chronic ACEI regimens when administering contrast.
1) The document discusses the nephrotoxic effects of NSAIDs, classifying them and examining their pathophysiological effects and associated renal syndromes.
2) It analyzes selective COX-2 inhibitors and whether they are truly nephrotoxic. Nabumetone, sulindac, and low-dose ibuprofen appear to be the least nephrotoxic NSAIDs.
3) The take-home message is that NSAIDs should be used at the lowest effective dose for shortest duration possible and with careful monitoring in high-risk patients like the elderly. Selective COX-2 inhibitors and long-term paracetamol use are not necessarily safe alternatives.
Emerging MRA-Based Treatments for End-Stage Renal Disease (ESRD) Patients on ...wackysavior4064
- Chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients have high rates of cardiovascular disease mortality due to increased risk factors like hypertension, inflammation, and fibrosis.
- Recent studies have explored using mineralocorticoid receptor antagonists (MRAs) like spironolactone or eplerenone to treat CKD and ESRD patients given their cardiovascular benefits, but concerns about hyperkalemia have limited their use.
- Ongoing and planned clinical trials are investigating the effectiveness and safety of MRAs in reducing cardiovascular events for CKD and ESRD patients, including how new potassium-binding drugs may help address hyperkalemia risks.
The FIGARO-DKD trial evaluated the efficacy and safety of finerenone in reducing major adverse cardiovascular events in adults with type 2 diabetes and chronic kidney disease. Over 5300 patients were randomized 1:1 to receive finerenone or placebo on top of standard renin-angiotensin-aldosterone system inhibitor therapy. Finerenone showed a statistically significant 18% relative risk reduction in the primary composite outcome of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for heart failure compared to placebo. Hyperkalemia was the most common adverse effect but occurred at a lower rate than other mineralocorticoid receptor antagonists.
Jay B. Wish, MD, Anil K. Agarwal, MD, FASN, and Thomas C. Dowling, PharmD, PhD, FCCP, prepared useful practice aids pertaining to anemia in CKD for this CPE activity titled "Exploring Emerging Strategies in the Management of Anemia in Chronic Kidney Disease." For the full presentation, monograph, complete CPE information, and to apply for credit, please visit us at http://bit.ly/2PB1tOd. CPE credit will be available until December 30, 2020.
This document discusses renal protective agents for treating lupus nephritis and ANCA-associated vasculitis. It outlines classical agents like RAAS inhibitors, diuretics, and metformin. It also discusses promising future agents including finerenone, SGLT2 inhibitors, GLP1 receptor antagonists, and endothelin receptor antagonists. While these newer agents show potential for preserving renal function and reducing immunosuppressant exposure, the document notes that more research is still needed before widespread use due to challenges like excluding autoimmune patients from trials and long-term effects requiring further study.
Austin Renal Disorders is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Kidney Failure & Renal Disorders.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all the areas of Renal Disorders. Austin Renal Disorders accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Kidney Failure & Renal Disorders.
Austin Renal Disorders strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
1) A study examined the relationship between renal oxygen supply and demand in patients with and without acute kidney injury (AKI) after cardiac surgery.
2) The study found that patients with AKI had a higher slope in the relationship between renal oxygen consumption and glomerular filtration rate compared to controls, indicating impaired oxygen supply relative to demand.
3) This challenges the previous view that acute renal failure represents an "acute renal success" by reducing renal workload and preserving oxygen supply, and suggests AKI may actually involve renal hypoxic injury due to inadequate oxygen supply relative to demand.
This document discusses diuretics and their use in acute kidney injury (AKI). It begins with definitions of AKI and how it is measured. AKI, formerly called acute renal failure, is a clinical syndrome involving a decline in glomerular filtration rate and the accumulation of waste products. Measurement of renal function typically involves serum creatinine, though it has limitations.
The document then discusses the epidemiology of AKI, noting it occurs in 1-7% of hospitalized patients and carries high mortality, especially those requiring renal replacement therapy. High risk factors for AKI are discussed.
The bulk of the document focuses on diuretics - their definitions, classes including loop diuretics and mechanisms of
This document discusses how drugs are eliminated by the kidneys and the mechanisms of renal injury caused by various drugs. It notes that many drugs can injure the kidneys through a few common mechanisms, such as altering renal blood flow or causing direct tubular toxicity. It provides examples of specific drugs that can cause these types of renal injuries. The document also discusses factors that influence drug dosing in patients with renal impairment and principles for safely prescribing drugs in such patients.
Hepatorenal syndrome is a type of kidney failure seen in patients with liver disease, usually cirrhosis. It is characterized by severe vasodilation in the systemic circulation and constriction of the renal arteries. This leads to decreased renal blood flow and kidney dysfunction. There are two main types - type 1 is a rapidly progressive form with high mortality, while type 2 progresses more slowly over weeks to months. Treatment involves use of vasoconstrictors like terlipressin with albumin to increase renal blood flow. Liver transplantation offers the best chance of cure but is limited by availability and risk of complications in patients with hepatorenal syndrome.
This summary outlines the key findings of the EMPA-KIDNEY trial which evaluated the effect of empagliflozin treatment on kidney disease progression and cardiovascular outcomes in patients with chronic kidney disease (CKD). The randomized, double-blind trial involved over 6,600 patients with CKD across 8 countries. Patients received either empagliflozin 10mg or placebo daily. The primary outcome of kidney disease progression or cardiovascular death occurred in 13.1% of the empagliflozin group versus 16.9% of the placebo group, representing a 28% lower risk with empagliflozin. Secondary outcomes also favored empagliflozin treatment, including lower rates of hospitalization. The benefits were
This document discusses chronic kidney disease (CKD), including its pathophysiology, risk factors, and treatment strategies to slow progression. It notes that CKD progression involves both hemodynamic and non-hemodynamic mechanisms, such as activation of the renin-angiotensin-aldosterone system leading to inflammation and fibrosis. Blocking the RAAS through ACE inhibitors, ARBs, and blood pressure control has been shown to slow CKD progression by reducing proteinuria, glomerular hypertension, and inflammation. The document reviews several landmark clinical trials that established the renoprotective effects of RAAS inhibition in diabetic and non-diabetic kidney diseases.
The document discusses the cardiovascular benefits of SGLT2 inhibitors (SGLT2i). It summarizes studies showing that SGLT2i reduce stressed blood volume, improve cardiac structure and function through various mechanisms like preload reduction, improve diastolic function in human cardiomyocytes, and improve mitochondrial metabolism in myocardial cells. The document also discusses guidelines and studies demonstrating that SGLT2i improve outcomes like reducing hospitalizations for heart failure and can reverse left ventricular remodeling in patients with and without type 2 diabetes.
Similar to Approccio clinico per prevenire la progressione della patologia renale (20)
The document summarizes a study that investigated the effects of iron supplementation alone and in combination with vitamins on hematological status, oxidative stress, and erythrocyte membrane fluidity in anemic pregnant women. 164 anemic pregnant women were randomly assigned to receive placebo, iron alone, iron with folic acid, or iron with folic acid, retinol, and riboflavin for 2 months. The study found that supplementation significantly increased hemoglobin and ferritin levels and decreased oxidative stress markers in all treatment groups compared to placebo. Erythrocyte membrane fluidity also increased with supplementation.
Mitochondrial dysfunction and oxidative damage are thought to play a role in Parkinson's disease (PD) pathogenesis. Recent animal studies show that inhibiting mitochondrial complex I with rotenone closely mimics PD's biochemical and histological features. Several agents like creatine, coenzyme Q10, and acetyl-L-carnitine have shown benefits in animal models by modulating energy metabolism and reducing oxidative stress. These agents warrant further study as potential neuroprotective treatments for PD.
La conduzione del nervo surale dorsale in pazienti con carenza di vitamina B1...MerqurioEditore_redazione
This study investigated peripheral neuropathy in vitamin B12 deficient patients with megaloblastic anemia using dorsal sural nerve conduction studies and tibial sensory-evoked potentials. Dorsal sural nerve responses were absent in over half of patients but only one third had abnormalities on conventional nerve conduction studies. Patients with recordable dorsal sural nerves had prolonged latencies, reduced amplitudes, and slower conduction velocities compared to controls, suggesting dorsal sural nerve conduction is more sensitive for detecting early neuropathy. Over 70% of patients showed evidence of myelopathy on tibial sensory-evoked potentials and neurological examination.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
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
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.
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
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
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!
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
- 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
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.