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Most cases occurred within 1 day of receiving Lemtrada

The Food and Drug Administration (FDA) has issued a warning regarding rare cases of ischemic and hemorrhagic stroke and cervicocephalic arterial dissection in patients with multiple sclerosis (MS) shortly after receiving Lemtrada (alemtuzumab; Sanofi Genzyme). Alemtuzumab, a monoclonal antibody, is also approved for the treatment of B-cell chronic lymphocytic leukemia (B-CLL) under the brand name Campath (alemtuzumab; Sanofi Genzyme).

Sine the approval of Lemtrada in 2014, the Agency has identified 13 cases worldwide of ischemic and hemorrhagic stroke or arterial dissection that occurred shortly after the patient received Lemtrada; 1 patient who suffered a hemorrhagic stroke died. Most cases (12/13) occurred within 1 day of receiving Lemtrada; 1 patient reported symptoms 3 days after starting treatment. While the etiology is unknown, the adverse events appear to have occurred within the same time frame as cytokine release syndrome, an inflammatory response associated with Lemtrada use. Reports of ischemic stroke and intracerebral hemorrhage have also been documented in patients treated with Campath for B-cell CLL and other leukemias/lymphomas.

The prescribing information and Medication Guide for Lemtrada have been updated with a new warning to reflect these risks. In addition, the risk of stroke has been added to the existing Boxed Warning. The Campath drug labeling has also been updated to include these risks in the Adverse Reactions section under Postmarketing Experience.

Healthcare professionals should advise patients at each infusion to seek medical attention if they experience symptoms of ischemic or hemorrhagic stroke or cervicocephalic arterial dissection. Patients who complain of symptoms suggestive of these conditions should be promptly evaluated.

Managed ingestion of peanut protein might assist construct tolerance in peanut allergy victims. Authors of a brand new research printed within the New England Journal of Drugs say an oral immunotherapy drug they examined might be the primary FDA-approved remedy of its form for individuals with peanut allergy. The remedy, known as AR101, is derived from peanut protein.

“The outcomes of this landmark trial are more likely to result in the primary FDA-approved remedy for meals allergy in 2019,” mentioned Christina Ciaccio, MD, MSc, affiliate professor of pediatrics and medication at UChicago Drugs and research co-author. “At UChicago Drugs Comer Youngsters’s Hospital, we had been thrilled to be a part of this pivotal trial and for the chance to vary the lives of those kids and their households.”

Researchers in 10 international locations throughout North America and Europe carried out the trial, often called the Peanut Allergy Oral Immunotherapy Research of AR101 for Desensitization trial, or PALISADE, for brief. Of 496 eligible individuals ages four to 17, 372 obtained the AR101 oral remedy, whereas the rest obtained a placebo drug. On the finish of the trial, greater than two-thirds of the group taking the energetic drug had been in a position to tolerate a dose of peanut protein equal to about two peanut kernels.

“Virtually 6 million American kids are presently dwelling with a life-threatening meals allergy,” mentioned Ciaccio. “Each three minutes, a meals allergy response sends somebody to the emergency room, contributing to the whole annual value of caring for kids with meals allergy of practically $ 25 billion. Regardless of this, not a single remedy for meals allergy has been accredited by the FDA.”

In line with the research, oral immunotherapy for peanut allergy has been beneficial towards in most scientific settings as a result of previous trials have been restricted by small pattern sizes and differing methodologies. The PALISADE trial has proven, nevertheless, that oral immunotherapy is an affordable remedy possibility. Contributors of the PALISADE trial had been instructed to proceed the usual of look after peanut allergy, which meant eliminating peanuts from their diets and carrying self-injectable epinephrine (an emergency medical remedy for unintentional publicity).

Qualifying individuals began with a one-day supervised improve in dosage from zero.5 mg of peanut protein as much as 6 mg, a rise each two weeks from three mg to 240 mg and a 24-week “upkeep part” at 300 mg. When adversarial reactions occurred, the research protocol allowed for changes to the dosing schedule. In comparison with the placebo group, individuals who took AR101 had much less extreme allergy signs.

“Earlier than this remedy, households having been dwelling with fixed anxiousness that one flawed chunk will ship their beloved one to the emergency room, or worse. Now, we have now a security internet that we are able to present to children that may stop an allergic response in the event that they by chance take a chunk of a peanut-containing meals.”

An antibody that binds concurrently to 2 distinct areas of the HER2 receptor to dam the expansion of most cancers cells has proven promising indicators of anti-tumor exercise in a variety of cancers together with these of the gullet (esophagus), abdomen and bowel.

Outcomes from the part I scientific trial of the drug, referred to as ZW25, had been introduced earlier this 12 months , however up to date outcomes, specializing in sufferers with esophageal, abdomen, bowel and a number of other different cancers pushed by HER2, have been introduced at present (Wednesday) on the 30th EORTC-NCI-AACR Symposium on Molecular Targets and Most cancers Therapeutics in Dublin, Eire.

HER2, a member of the human epidermal progress issue receptor household, is greatest recognized for the position it performs in breast most cancers. Trastuzumab (Herceptin) is an efficient remedy for HER2‑constructive breast cancers. Abdomen cancers which are pushed by HER2 additionally reply nicely to trastuzumab, but when most cancers returns in these sufferers, there aren’t any additional accepted HER2‑focused brokers. Sadly, for sufferers with different HER2‑pushed cancers, there are at the moment no accepted HER2‑focused brokers.

Dr Murali Beeram, a medical oncologist and scientific investigator on the START Middle for Most cancers Care, San Antonio, USA, informed the Symposium that as of 16 October a complete of 24 sufferers, who had obtained a number of earlier therapies (a mean of 4) however whose cancers had returned, have been given between one and ten cycles of ZW25 since becoming a member of the part I trial, which began in September 2016 (both 10 mg/kg weekly or 20 mg/kg each different week). All had HER2 constructive cancers, together with cancers of the oesophagus and abdomen (gastroesophageal) (10 sufferers), bowel (5), gall bladder (three), bile duct (1), cervix (1), endometrial (1) fallopian tube (1), pores and skin (adnexal) (1), and parotid gland (1), and eight of those sufferers stay within the trial.

The most recent ends in 17 sufferers with responses accessible for analysis present that 13 skilled shrinkage of their tumor. The median time the sufferers survived with out their illness progressing was 6.21 months. Unintended effects have been principally gentle or average with the commonest being diarrhea or a response to the infusion of the drug.

Dr Beeram mentioned: “As a clinician, I’m excited by the one agent anti-tumor exercise and tolerability we’re seeing with ZW25, notably in these patents with superior HER2‑expressing cancers which have progressed after a number of prior therapies, together with HER2‑focused brokers.The truth is, trastuzumab is the one HER2‑focused remedy accepted for gastric most cancers and there aren’t any accepted HER2-targeted therapies for different kinds of most cancers which are pushed by the HER2 receptor. ZW25 has been nicely tolerated to this point, which ought to enable it for use together with different brokers for probably even higher responses.”

ZW25 is an antibody that may concurrently bind two distinct areas of the HER2 receptor, a protein that promotes the expansion of most cancers cells. Dr Beeram defined: “This distinctive design ends in a number of mechanisms of motion, together with twin HER2 sign blockade, elevated binding, and elimination of HER2 protein from the most cancers cell floor; it additionally stimulates the immune system to assault the most cancers cells. This has led to encouraging anti-tumor exercise in sufferers whose tumors have stopped responding to accepted therapies, and who’re in determined want of recent medicines that present anti-tumor exercise with out extreme poisonous uncomfortable side effects. The spectacular exercise of ZW25, mixed with its tolerability, is notable and needs to be investigated additional.”

Along with the cancers already talked about, a variety of others are also pushed by the HER2 protein; they embody cancers of the womb, ovaries, lung and bladder. Zymeworks, the corporate that developed ZW25, has expanded the research and a part II/III research for sufferers with oesophageal, abdomen, and different cancers is deliberate for subsequent 12 months. As well as, research are deliberate to research ZW25 together with different anti-cancer medicine in sufferers with cancers which have an overabundance of HER2 receptors and copies of the HER2 gene, and likewise in these with fewer HER2 receptors and gene copies.

Co-chair of the EORTC-NCI-AACR Symposium, Professor Antoni Ribas from the College of California Los Angeles, who was not concerned within the analysis, commented: “Though these are early outcomes on a small variety of sufferers, they recommend that this new HER2 focused antibody can affect difficult-to-treat cancers which have both failed to answer earlier therapies or have recurred. We look ahead to additional outcomes from this research, in addition to the additional research which are deliberate.”