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Mycophenolate Mofetil Plus Glucocorticoid Reduces Relapse Risk in ITP
Initial treatment with mycophenolate mofetil plus treatment side effects . Patients treated with mycophenolate mofetil , however , reported significantly a glucocorticoid was associated with a greater response and reduced risk of relapsed or refractory disease compared with glucocorticoid alone in patients Short-Form Health Survey , as well as greater fatigue
worse QoL as measured by version 2 of the 36-Item
with immune thrombocytopenia ( ITP ). However , the as measured by version 4 of the Functional Assessment of Chronic Illness Therapy – Fatigue scale . combination regimen was associated with decreased quality of life ( QoL ), researchers reported in a study published in the New England Journal of Medicine .
According to researchers led by Charlotte Bradbury , MBBCh , PhD , of the University of Bristol in the U . K ., the recommended induction therapy for ITP is high-dose glucocorticoids , yet significant challenges associated with this treatment option include side effects , variations in response , and high rates of relapse . In the U . K ., mycophenolate mofetil is widely used as a second-line therapy for ITP , although there are no head-to-head or randomized controlled trials comparing this treatment option against other regimens as a first-line therapy in the ITP patient population .
To bridge this research gap , Dr . Bradbury and colleagues designed the FLIGHT trial , which compared the combination of mycophenolate mofetil and a glucocorticoid with glucocorticoid monotherapy as initial treatment for ITP . The trial included 120 patients with ITP who were randomly assigned to either :
Reference
• glucocorticoid and mycophenolate mofetil ( n = 59 )
• glucocorticoid alone ( n = 61 )
Based on their findings , the study investigators wrote that “ mycophenolate mofetil could be used in patients for whom laboratory and clinical markers suggest that a glucocorticoid-only regimen would be expected to fail ,” suggesting a place for the therapy in optimized , personalized treatment . The researchers added that early initiation of mycophenolate mofetil may also be useful for cases in which “ early disease control with avoidance of relapse is a priority , either from the patient ’ s perspective or on clinical grounds , such as when severe bleeding or additional bleeding risk factors ( e . g ., the patient is receiving anticoagulation or antiplatelet therapy ) are present .”
“ [ Mycophenolate mofetil may be useful for cases in which ] early disease control with avoidance of relapse is a priority ... such as when severe bleeding or additional bleeding risk factors are present .”
— Charlotte Bradbury , MBBCh , PhD
Study authors report no relevant conflicts of interest .
Bradbury CA , Pell J , Hill Q , et al . Mycophenolate mofetil for first-line treatment of immune thrombocytopenia . N Engl J Med . 2021 ; 385 ( 10 ): 885-895 .
Treatment failure , defined as a platelet count less than 30 × 10 9 / L and use of a second-line therapy , was the primary endpoint of the study . Additional endpoints the investigators examined were response rates , side effects , bleeding , patientreported QoL , and serious adverse events .
The mean ages of patients in the combined versus the monotherapy groups were 56.9 and 53.1 years , respectively . In the overall cohort , approximately 52.4 % of patients were male . The mean platelet level was 7.9 × 10 9 / L in the mycophenolate mofetil plus glucocorticoid group and 6.5 × 10 9 / L in the glucocorticoid-only group . Patients were followed for up to two years following initiation of their assigned study treatment .
Patients randomly assigned to the mycophenolate mofetil combination arm experienced significantly fewer treatment failures compared with those assigned to glucocorticoid alone ( 22 % vs . 44 %, respectively ; hazard ratio = 0.41 ; p = 0.008 ). Initial treatment with the combination regimen was also associated with a significantly greater complete treatment response , defined as those with platelet counts greater than 100 × 10 9 / L ( 91.5 % vs . 63.9 %; p < 0.001 ).
There was no difference between the combination group and the monotherapy arm in terms of the incidence of bleeding , need for rescue treatments , or
Anemia , Inflammation Associated With Worse Outcomes in Patients With Coronary Artery Disease
Anemia is strongly associated with immune activation in patients with coronary artery disease ( CAD ), and a combination of both anemia and increased markers for inflammation may drive higher rates of adverse outcomes among patients with CAD , according to a study led by Lukas Lanser , MD , of the Innsbruck Medical University in Austria .
According to the researchers , the data from this study suggest inflammation could be an underlying cause of anemia development in a significant proportion of patients with CAD . “ Therefore , it might be useful to differentiate between patients with anemia of chronic disease , irondeficiency anemia or multifactorial anemia to better predict their risks to die within the next years and to choose the best therapy option ,” the researchers wrote .
The study was an analysis of patient data from the Ludwigshafen Risk and Cardiovascular Health ( LURIC ) study , which included 3,316 patients with CAD who were hospitalized between 1997 and 2000 . Hospitalization occurred because of chest pain or non-invasive test results suggestive of myocardial ischemia . Experienced angiographers examined patient angiograms and estimated the maximal luminal narrowing via visual analysis .
Patients in the study were followed for 10 years . Researchers evaluated the event-free survival ( EFS ) rate , which was defined as the duration between first hospitalization and death . Additionally , the investigators examined markers of immune activation ( i . e ., neopterin , interleukin [ IL ] -12 , IL-6 , high-sensitivity C-reactive protein , fibrinogen , serum amyloid A ), as
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