PPI and CVD.pptx
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A 70-year-old man presented with chest pain for 7 hours. He has a history of smoking, diabetes, and blood transfusion due to melena. Examination found epigastric pain and EKG showed ST depression. He underwent PCI and stent placement for CAD. The correct management is aspirin and clopidogrel for 12 months with omeprazole as a gastric protector due to risk of gastrointestinal bleeding from antiplatelet drugs in a patient with prior history of melena.
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Cell Therapy Expansion and Challenges in Autoimmune Disease
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.
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- 1. PPI and CVD Deri Arara, MD
- 2. Deri Arara, MD Mr. C, 70 years old Anamnesis : Chest pain since 7 hours before admission. Prior history of smoker and diabetes. 2 years ago also had history of blood transfusion due to melena. Physical examination: Vas :5 ; Thorax : in normal limit, abdomen: epigastric pain (+) EKG : Sinus Rythm, ST depression at V3-V6 Lab: Hb 10.5 gr/dl, leukocyte 7.000, eGFR 40 cc/min
- 3. Deri Arara, MD Patient then underwent early PCI and implanted stent at proximal LAD (CAD 1 VD) Which one is correct management regarding of duration and also gastric protector for this patient ? a. Aspirin + Clopidogrel for 12 months + ranitidine as gastric protector b. Aspirin + Clopidogrel for 12 months + omeprazole as gastric protector c. Aspirin + Clopidogrel for 12 months without gastric protector d. Aspirin + Clopidogrel for 6 months + rabeprazole (pariet) as gastric protector e. Aspirin + Clopidogrel for 6 months + omeprazole as gastric protector
- 4. 62
- 5. Antiplatelet and PPI Saven, et al. Cureus. 2022. 14(2): e 21885 Scott, et al. Expert Opin Drug MetabToxicol. 2014; 10 (2): 175-89
- 6. Flowchart of the antiplatelet and PPI co- administration recommendations Scott, et al. Expert Opin Drug MetabToxicol. 2014; 10 (2): 175-89
- 7. Deri Arara, MD Thank You