- |||||||||| Venclexta (venetoclax) / Roche, AbbVie, Gazyva (obinutuzumab) / Roche, Biogen
Phase 1b/2 Study of Vipor (Venetoclax, Ibrutinib, Prednisone, Obinutuzumab, and Lenalidomide) in Relapsed/Refractory and Untreated Mantle Cell Lymphoma: Safety, Efficacy, and Molecular Analysis (GWCC - Hall B5, Level 1) - Nov 5, 2021 - Abstract #ASH2021ASH_5224;
Most common G3-4 AEs were hematologic with no febrile neutropenia observed when given with G-CSF ppx. High preliminary activity is noted in MCL pts with fixed-duration ViPOR x 6C, including CRs in refractory, post-BTKi, and post-CAR-T pts.
- |||||||||| Venclexta (venetoclax) / Roche, AbbVie
Evaluating the Safety of Outpatient Ramp up of Venetoclax in Acute Myeloid Leukemia and Myelodysplastic Syndrome (GWCC - Hall B5, Level 1) - Nov 5, 2021 - Abstract #ASH2021ASH_3934;
No patients received rasburicase prior to initiating venetoclax...Limitations of this study include the heterogeneous population and the retrospective nature of the study. Although 35% of our patients were not prescribed the standard venetoclax ramp up dose, this highlights the existing challenges of treating elderly AML and MDS patients.
- |||||||||| trimethoprim/sulfamethoxazole / Generic mfg., allopurinol / Generic mfg.
Journal: Impaired purine homeostasis plays a primary role in trimethoprim-mediated induction of virulence genes in Burkholderia thailandensis. (Pubmed Central) - Nov 4, 2021
Our gene expression data suggest that malR expression is repressed by both MftR and by a separate transcription factor, which also responds to a metabolite that accumulates on exposure to trimethoprim. Since allopurinol elicits a similar increase in malR/malA expression as trimethoprim, we suggest that impaired purine homeostasis plays a primary role in trimethoprim-mediated induction of malR and in turn malA.
- |||||||||| colchicine / Generic mfg., febuxostat / Generic mfg., allopurinol / Generic mfg.
Review, Journal: Something Old, Something New: the ACR Gout Treatment Guideline and Its Evolution from 2012 to 2020. (Pubmed Central) - Nov 4, 2021
We discuss the methodological approach to each guideline (RAND versus GRADE), as well as the final recommendations for gout flare treatment, use of imaging, urate-lowering therapy, lifestyle changes, and genetic testing prior to initiation of allopurinol in each guideline, as well as lingering issues that the 2020 guidelines have not addressed. We dissect both the 2012 and 2020 ACR gout guidelines to summarize the key similarities and differences between the two as well as discuss how the authors came to the recommendations that they did for each set of guidelines.
- |||||||||| carbamazepine / Generic mfg.
Journal: Prevention of Drug Hypersensitivity Reactions: Prescreening and Premedication. (Pubmed Central) - Oct 29, 2021
Premedication with antihistamine and systemic corticosteroids is another therapeutic strategy to prevent infusion reactions for certain biologicals and chemotherapeutic agents, in cases of perioperative anaphylaxis, ICM and GCM DHR, and clonal mast cell disorders. Rapid drug desensitization may also be used to induce temporary tolerance in situations where there are limited alternative drugs.
- |||||||||| allopurinol / Generic mfg.
Review, Journal: Hyperuricemia and Its Association With Ischemic Stroke. (Pubmed Central) - Oct 29, 2021
This narrative review aims to investigate the role of SUA as an independent risk factor for AIS along with the proposed biological mechanisms by thoroughly appraising research findings from relevant full-text articles and abstracts indexed in PubMed and the Cochrane Library. In this literature, we will be discussing hyperuricemia, AIS, the association between the two, and the use of antihyperuricemic medications on stroke prognosis. This review will also shed new light on studies that have begun to provide insight into the predictive role of hyperuricemia in AIS.
- |||||||||| ibrutinib / Generic mfg.
[VIRTUAL] TREATMENT OF AN ELDERLY PATIENT WITH CHRONIC LYMPHOCYTIC LEUKEMIA USING IBRUTINIB IN 1ST LINE () - Oct 27, 2021 - Abstract #HEMO2021HEMO_1665;
On physical examination, he did not present alterations, as well as lymph node enlargement, at any time of follow-up. Symptom of asthenia appeared concomitantly with anemia and, after the disease had progressed, the patient's treatment was chosen. Once considering an elderly patient with a high lymphoproliferative load, prednisone 60 mg and allopurinol were initially prescribed, while the process of requesting Ibrutinib 420 mg daily was carried out based on the ALLIANCE protocol A041202, taking about 2 months to be released by the health insurance. With the start of specific treatment, the patient showed a complete response in about 7 months, without developing signs of toxicity or side effects, as well as diarrhea, atrial fibrillation, infections, hemorrhagic events or arthralgias. The patient is under follow-up with returns every 3 months, with no recurrence and had a lymphocyte count below 5000/mm3, a fact that led us to request a DRM test, even though this was not the objective of this drug (we await this result). Discussion and Conclusion CLL is a lymphoproliferative disorder characterized by the progressive accumulation of lymphocytes that are monoclonal, with CD5+ B lymphocytes undergoing malignant transformation. It affects mostly elderly and male people, such as the patient in this case. The onset of the disease is usually insidious and with non-specific symptoms, with asymptomatic patients. With a variable survival rate, between about 2 and 20 years, with an average rate of 10 years, there are well-established criteria to indicate the start of treatment, among them we can mention the duplication of lymphocytes with a time of less than 6 months or related symptoms the disease. There are several therapeutic options, including Ibrutinib, an oral drug, Bruton's tyrosine kinase inhibitor, blocking the signaling pathway of the B cell receptor, important for the survival and proliferation of clonal lymphocytes, currently, in general, with indication in the first line for a patient with del17, but according to a recent study, Ibrutinib was shown to be superior to chemotherapy in elderly patients with CLL. In the case under Discussion , Ibrutinib was chosen in the first line, as, in addition to being an elderly patient, at the time of disease progression, we were at the beginning of the SARS-CoV2 pandemic, at a time when there was great fear about possible adverse events related to standard chemotherapy, especially from an infectious point of view, in an elderly patient in the context of the pandemic. Although Ibrutinib represents a great therapeutic advance, the issue of costs and possible toxicities must be considered, since it is a continuous long-term treatment.
- |||||||||| Jakafi oral (ruxolitinib) / Novartis, Incyte
[VIRTUAL] CLINICAL CONDUCT OF PATIENT WITH PRIMARY MYELOFIBROSIS AND HEREDITARY HEMOCHROMATOSIS - CLINICAL CASE REPORT () - Oct 27, 2021 - Abstract #HEMO2021HEMO_455;
Cytogenetics without abnormalities. Due to hyperferritinemia above 1000 ug/L, the Nuclear Magnetic Resonance with T2*, showed moderate iron deposit in the liver, with an estimated value of 7 mg/g and heterozygosity for the C212Y mutation of the HFE gene, confirming the diagnosis of hemochromatosis. Treatment was started with HU 1000 mg/day, allopurinol 300 mg/day, Acetyl Salicylic Acid 100 mg/day and Rivaroxaban 20 mg/day, with satisfactory evolution of the condition and continued outpatient follow-up. Discussion PM Results from an expansion of clonal myeloid cells , with mutations such as JAK-2, CALR, MPL. Asthenia, weight loss, hepatosplenomegaly, anemia, leukocytosis and medullary fibrosis may be present in individuals over 60 years of age, with a mean survival of 6 years. The most used prognostic score is the DIPSS, which takes into account anemia, constitutional symptoms, peripheral blood blasts, white blood cell count and age. The treatment of choice is HSCT, the only one with curative possibility, but treatments with HU and ruxolitinib are also options, cytological control and improved survival, respectively. Splenectomy is indicated in cases of refractory hypersplenism. Concomitance with hemochromatosis is a very rare event, with no reports in the research platforms used. The treatment of hemochromatosis must take into account periodic bleeding, which is an impediment in patients with severe anemia such as the patient in question. We opted for the use of iron chelator Deferasirox and judicialization of Ruxolitinib, with the patient progressing satisfactorily.Conclusion The concomitance between MP and hemochromatosis is demonstrated, showing the coexistence of two rare diseases, whose diagnosis must be remembered and clinical control carefully managed , since there are limitations of therapeutic bleedings in the presence of severe anemia.
- |||||||||| febuxostat / Generic mfg., allopurinol / Generic mfg.
Journal: Bis-thiobarbiturates as Promising Xanthine Oxidase Inhibitors: Synthesis and Biological Evaluation. (Pubmed Central) - Oct 25, 2021
The most powerful bis-thiobarbiturate within this set showed in vitro IC of 1.79 μM, which was about ten-fold better than Allo inhibition, together with suitable low cytotoxicity. In silico molecular properties such as drug-likeness, pharmacokinetics, and toxicity of this promising barbiturate were also analyzed and herein discussed.
- |||||||||| imatinib / Generic mfg.
Clinical, Journal: Patterns of Tyrosine Kinase Inhibitor Utilization in Newly Treated Patients With Chronic Myeloid Leukemia: An Exhaustive Population-Based Study in France. (Pubmed Central) - Oct 22, 2021
Patients received a mean of 16.7 (Standard Deviation (SD) 9.6) medications over the first year of follow-up, and a mean of 2.7 (SD 2.3) concomitant medications on the day of first TKI prescription: 24.4% of the patients received allopurinol, 6.4% proton pump inhibitors (PPI) and 6.5% antihypertensive agents. When treatment with TKI was initiated, incident CML patients presented with comorbidities and polypharmacy, which merits attention because of the persistent use of these concomitant drugs and the potential increased risk of drug-drug interactions.
- |||||||||| metformin / Generic mfg., allopurinol / Generic mfg.
Review, Journal: Left Ventricular Hypertrophy in Diabetic Cardiomyopathy: A Target for Intervention. (Pubmed Central) - Oct 22, 2021
The recognition of asymptomatic LVH may offer an opportune target for intervention with cardio-protective therapy in these at-risk patients. In this article, we provide a review of some of the key clinical studies that evaluated the effects of allopurinol, SGLT2 inhibitor and metformin in regressing LVH in patients with and without T2DM.
- |||||||||| febuxostat / Generic mfg., allopurinol / Generic mfg., rosuvastatin / Generic mfg.
Journal: Febuxostat, But Not Allopurinol, Markedly Raises the Plasma Concentrations of the Breast Cancer Resistance Protein Substrate Rosuvastatin. (Pubmed Central) - Oct 20, 2021
Febuxostat may, therefore, serve as a useful index inhibitor of BCRP in drug-drug interaction studies in humans. Moreover, concomitant use of febuxostat may increase the exposure to BCRP substrate drugs and, thus, the risk of dose-dependent adverse effects.
- |||||||||| colchicine / Generic mfg., allopurinol / Generic mfg.
Journal: Medications for gout and its comorbidities: mutual benefits? (Pubmed Central) - Oct 20, 2021
The renal benefit of ULT among patients with gout remains unclear. SGLT-2 inhibitors may benefit diabetic patients who have gout as a comorbidity.
- |||||||||| allopurinol / Generic mfg.
[VIRTUAL] Dihydroxyadenine Crystals Leading to Renal Graft Loss () - Oct 17, 2021 - Abstract #KIDNEYWEEK2021KIDNEY_WEEK_3335;
DHA stone formation can occur even when APRT levels are normal or detectable. It is of utmost importance to continue allopurinol in patients with known DHA stones as genetic testing and APRT level may be misleading and stopping allopurinol will result in irreversible kidney damage Intratubular and cytoplasmic DHA crytals.
- |||||||||| Thymoglobulin (anti-thymocyte globulin (rabbit)) / Sanofi
[VIRTUAL] 2,8-Dihydroxyadenine Crystalline Nephropathy in Transplanted Kidney () - Oct 17, 2021 - Abstract #KIDNEYWEEK2021KIDNEY_WEEK_3320;
The patient received a living donor kidney transplant from his daughter on 10/15/2020 with Thymoglobulin and steroid induction followed by maintenance immunosuppression with tacrolimus, mycophenylate, and prednisone...To prevent allograft failure, high index of suspicion and early biopsy is important. In addition to allopurinol, low purine diet, and increased hydration, CNI minimization and utilization of Belatacept is an effective strategy to minimize vascular and tubular injury and prevent further precipitation of crystals.
- |||||||||| ivermectin oral / Generic mfg.
[VIRTUAL] Ivermectin-Induced ANCA Vasculitis () - Oct 17, 2021 - Abstract #KIDNEYWEEK2021KIDNEY_WEEK_2619;
He received prednisone 1mg/kg,3 biweekly doses of intravenous cyclophosphamide, 10 doses of plasmapheresis, and was initiated on dialysis...Commonly implicated drugs are hydralazine, levamisole-contaminated cocaine, propylthiouracil, allopurinol. Although no case of Ivermectin-induced AAV has been reported, we recommend a high index of suspicion as prompt cessation of the offending drug can significantly improve prognosis in drug-associated AAV.
- |||||||||| Krystexxa (pegloticase) / Horizon Therapeutics
[VIRTUAL] Improving the Management of Gout in Patients with CKD or Kidney Transplant: Effect of Online Education () - Oct 17, 2021 - Abstract #KIDNEYWEEK2021KIDNEY_WEEK_2193;
Specific areas of improvement include: Treat-to-target strategy with a target of serum UA level < 6 mg/dL in patients taking urate lowering therapy (20% relative improvement, P<.05) Starting low-dose allopurinol in a patient previously diagnosed with gout and stage 3 CKD, presenting with painful subcutaneous tophi (25% relative improvement, P<.01) Recommending pegloticase without dose adjustment for the management of refractory gout in patients with stage 4 or 5 CKD (222% relative improvement, P<.001) Post-education, 48% of nephrologists had a measurable increase in confidence in their ability to manage patients with CKD who may develop gout. Conclusion This study demonstrated the success of online, segmented, mini-lectures on improving the evidence-based knowledge, competence, and confidence of nephrologists in appropriately managing gout in patients with CKD or kidney transplant.
- |||||||||| colchicine / Generic mfg., febuxostat / Generic mfg., allopurinol / Generic mfg.
[VIRTUAL] Characterization of Gout in US Patients Treated with Hemodialysis (HD) and Peritoneal Dialysis (PD) () - Oct 17, 2021 - Abstract #KIDNEYWEEK2021KIDNEY_WEEK_2133;
True prevalence was likely higher than observed when considering under-ascertainment of gout diagnosis history. This report provides a snapshot of gout in the US dialysis population and offers opportunities to expand on research to improve awareness and care for patients with gout and ESRD.
- |||||||||| allopurinol / Generic mfg.
[VIRTUAL] Association of Oxypurinol Exposure with Progression of CKD: Pre-Specified Substudy Results from the CKD-FIX Trial () - Oct 17, 2021 - Abstract #KIDNEYWEEK2021KIDNEY_WEEK_1661;
Funding Private Foundation Support Group or Team Name CKD-FIX Study Group Trial Steering Committee Background The CKD-FIX trial evaluated the effect of allopurinol on eGFR slope over 104 weeks in patients with chronic kidney disease (CKD) and risk of progression...Conclusion In CKD-FIX participants, exposure to oxypurinol was not associated with change in eGFR. However, reduction in serum urate concentration was dependent on plasma oxypurinol exposure.
- |||||||||| [VIRTUAL] LADY IN RED: A FATAL CASE OF DRESS () - Oct 13, 2021 - Abstract #CHEST2021CHEST_731;
She went to an urgent care where she was prescribed a methylprednisolone dose pack, diphenhydramine as needed, and metronidazole for possible colitis...She was started on IV fluids and Piperacillin/Tazobactam... Careful monitoring of patients on allopurinol therapy can prevent fatal cases of DRESS.
- |||||||||| cetirizine oral / Generic mfg., cyclosporine / Generic mfg., allopurinol / Generic mfg.
Journal: Toxic Epidermal Necrolysis Caused by Allopurinol: A Serious but Still Underestimated Adverse Reaction. (Pubmed Central) - Oct 12, 2021
Ambulatory supportive therapy using prednisolone and cetirizine was started but failed...Massive fluid replacement, prednisolone, and cyclosporine were used as anti-inflammatory therapy...CONCLUSIONS With the prescription of allopurinol, there should be awareness of potentially life-threatening complications such as SJS or TEN. Patients with SJS or TEN should be immediately transferred to an ICU with dermatological expertise and multidisciplinary therapy.
- |||||||||| allopurinol / Generic mfg.
Journal: Characterising Alzheimer's disease through integrative NMR- and LC-MS-based metabolomics. (Pubmed Central) - Oct 9, 2021
While no significant EV-derived metabolites were found differentiating patients from healthy individuals, six serum metabolites were found important; valine (p = 0.001, fold change, FC = 0.8), histidine (p = 0.001, FC = 0.9), allopurinol riboside (p = 0.002, FC = 0.2), inosine (p = 0.002, FC = 0.3), 4-pyridoxic acid (p = 0.006, FC = 1.6), and guanosine (p = 0.004, FC = 0.3)...Using a combination of LC-MS and NMR methodologies we identified several altered mechanisms possibly related to AD pathology. EVs require additional optimization prior to their possible utilization as a biological material for AD-related metabolomics studies.
- |||||||||| furosemide / Generic mfg., bumetanide / Generic mfg.
Journal: DRESS syndrome following furosemide administration: An unusual association. (Pubmed Central) - Oct 8, 2021
EVs require additional optimization prior to their possible utilization as a biological material for AD-related metabolomics studies. We add to the literature another case of furosemide-induced DRESS with the particularity of cross reactivity with bumetanide.
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