Cyclosporine for Chronic Spontaneous Urticaria: A Meta-Analysis and Systematic Review. Martes 13 de octubre.

De

 Cyclosporine for Chronic Spontaneous Urticaria: A Meta-Analysis and Systematic Review


Authors: Kanokvalai Kulthanan  1 , Pichanee Chaweekulrat  1 , Chulaluk Komoltri  2 , Saowalak Hunnangkul  2 , Papapit Tuchinda  3 , Leena Chularojanamontri  1 , Marcus Maurer  4


Abstract

Background: Despite widely recommended usage of cyclosporine A (CsA) in chronic spontaneous urticaria (CSU), there is no meta-analysis concerning its efficacy and safety.


Objective: To meta-analyze and review the efficacy and safety of CsA in CSU.


Methods: Efficacy was assessed by the relative change in urticaria activity score at 4 weeks and response rates at 4, 8, and 12 weeks. Safety was assessed by analyzing the number of patients with 1 or more adverse event.


Results: Eighteen studies (909 participants) including 2 randomized controlled trials were included, with 125, 363, and 266 patients with CSU receiving very low (<2 mg/kg/d), low (from 2 to< 4 mg/kg/d), and moderate (4-5 mg/kg/d) doses of CsA, respectively. After 4 weeks, the mean relative change in urticaria activity score of CsA-treated patients was -17.89, whereas that of controls was -2.3. The overall response rate to CsA treatment with low to moderate doses at 4, 8, and 12 weeks was 54%, 66%, and 73%, respectively. No studies of very low-dose CsA evaluated response rates at 4, 8, and 12 weeks. Among patients treated with very low, low, and moderate doses of CsA, 6%, 23%, and 57% experienced 1 or more adverse event, respectively.


Conclusions: Given the limited number and quality of studies, our results should be interpreted with caution. CsA is effective at low to moderate doses. Adverse events appear to be dose dependent and occur in more than half the patients treated with moderate doses of CsA. We suggest that the appropriate dosage of CsA for CSU may range from 1 to 5 mg/kg/d, and 3 mg/kg/d is a reasonable starting dose for most patients.


10.1016/j.jaip.2017.07.017

Comentarios

  1. Jaime Sosa15 de octubre de 2020, 7:10

    Dado el número y la calidad limitados de los estudios, esta revision abre una nueva necesidad a mas RCTs. Se demuestra que la CsA es eficaz en dosis bajas a moderadas. Los eventos adversos parecen depender de la dosis y ocurren en más de la mitad de los pacientes tratados con dosis moderadas de CsA sin embargo son efectos "reversibles" cuando se retira la dosis del medicamento que es apropiada para la UCE de 1 a 5 mg / kg / d, y 3 mg / kg / d es una dosis inicial que puede funcionar para la mayoría de los pacientes.

    ResponderEliminar

Publicar un comentario

Entradas populares de este blog

ICON: Diagnosis and management of allergic conjunctivitis. Miércoles 25 de marzo

De
ICON: Diagnosis and management of allergic conjunctivitis. Authors: Bielory L1, Delgado L2, Katelaris CH3, Leonardi A4, Rosario N5, Vichyanoud P6. Author information Abstract Ocular allergy (OA), interchangeably known as allergic conjunctivitis, is a common immunological hypersensitivity disorder affecting up to 40% of the population. Ocular allergy has been increasing in frequency, with symptoms of itching, redness, and swelling that significantly impacts an individual's quality of life (QOL). Ocular allergy is an often underdiagnosed and undertreated health problem, because only 10% of patients with OA symptoms seek medical attention, whereas most patients manage with over-the-counter medications and complementary nonpharmacological remedies. The clinical course, duration, severity, and co-morbidities are varied and depend, in part, on the specific ocular tissues that are affected and on immunologic mechanism(s) involved, both local and systemic. It is frequently associat...
Leer más

Instructivo para la vigilancia en salud pública intensificada de infección respiratoria aguda asociada al nuevo coronavirus 2019 (COVID-19).

De
 Instructivo para la vigilancia en salud pública intensificada de infección respiratoria aguda asociada al nuevo coronavirus 2019 (COVID-19).  Fecha de actualización: viernes 20 de marzo 2020 Versión: 7 1. Introducción El 31 de diciembre de 2019 la Comisión Municipal de Salud y Sanidad de Wuhan (provincia de Hubei, China) informó sobre un agrupamiento de 27 casos de neumonía de etiología desconocida con inicio de síntomas el 8 de diciembre; los casos reportaban antecedente de exposición común a un mercado de mariscos, pescados y animales vivos en la ciudad de Wuhan. El 7 de enero de 2020, las autoridades chinas identificaron como agente causante del brote un nuevo tipo de virus de la familia Coronaviridae, que fue denominado “nuevo coronavirus”, SARS-COV-2 (1). Dado que los casos de coronavirus suelen causar síntomas respiratorios, la Organización Mundial de la Salud (OMS) ha emitido recomendaciones de protec...
Leer más

BCG Vaccination Enhances the Immunogenicity of Subsequent Influenza Vaccination in Healthy Volunteers: A Randomized, Placebo-Controlled Pilot Study. Martes 14 de abril

De
BCG Vaccination Enhances the Immunogenicity of Subsequent Influenza Vaccination in Healthy Volunteers: A Randomized, Placebo-Controlled Pilot Study Authors: Jenneke Leentjens 1, Matthijs Kox 2, Robin Stokman 2, Jelle Gerretsen 2, Dimitri A Diavatopoulos 3, Reinout van Crevel 4, Guus F Rimmelzwaan 5, Peter Pickkers 2, Mihai G Netea 4 Abstract Background: Influenza-related morbidity and mortality remain high. Seasonal vaccination is the backbone of influenza management but does not always result in protective antibody titers. Nonspecific effects of BCG vaccination related to enhanced function of myeloid antigen-presenting cells have been reported. We hypothesized that BCG vaccination could also enhance immune responses to influenza vaccination. Methods: Healthy volunteers received either live attenuated BCG vaccine (n = 20) or placebo (n = 20) in a randomized fashion, followed by intramuscular injection of trivalent influenza vaccine 14 days later. Hemagglutination-inhibiting (H...
Leer más