Concomitant use of immunomodulators with anti-TNF in Crohn's disease: yes or no?
ABSTRACT Today up to 40% of Crohn's disease patients receive a concomitant therapy of TNF blockers in combination with thiopurines or methotrexate. Although data of prospective controlled trails are rare, some recently published studies indicate a more rapid onset of remission and increased mucosal healing following concomitant therapy in short term. However, data confirming the need or benefit of concomitant immunosuppressive therapy once remission has been reached remains unknown. Concomitant therapy lowers TNF-alpha induced immunogenicity, but the question of whether ATI formation also lowers the efficiency of TNF-alpha antagonists has not yet been answered to a level that would justify the use of concomitant immunosuppression. Knowing that immunosuppression increases the risk for opportunistic infections and lymphomas the potential risks and of concomitant therapy must be well balanced against the benefit. This article aims to interpret the available data on the efficiency, immunogenicity, and safety of concomitant therapy in patients under anti-TNF therapy.
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Conference Paper: Comparing 3-D protein structures similarity by using fractal features[Show abstract] [Hide abstract]
ABSTRACT: We propose a new method for finding similarity in 3-D protein structure comparison. Different from the other existing methods, our method is grounded in the theory of fractal geometry. The proposed feature vectors of protein structures are simple to implement. The method is very fast because it requires neither alignment of the chains nor any chain-chain comparison. We calculate the fractal features of a set of 200 protein structures selected from PDB(Protein Data Bank). The experimental result shows that our method is very effective in classification of 3-D protein structures.Computational Systems Bioinformatics Conference, 2004. CSB 2004. Proceedings. 2004 IEEE; 09/2004
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ABSTRACT: Inflammatory bowel diseases (IBD), namely Crohn's disease and ulcerative colitis, are burdened by high medical costs which are mostly dependent on hospital inpatient treatment. New biologic therapies, which target specific cytokines in the inflammatory cascade leading to the intestinal lesions, including tumor necrosis factor (TNF)-α, have revolutionized the management of IBD by offering a therapeutic chance to patients in whom conventional therapies failed. However, the relatively high costs of biologic drugs, together with their potential toxicity due to infections and malignancies, have led to debate regarding their indiscriminate use in IBD patients. The purpose of this review is to deal with the optimal use and cost-effectiveness of the two main monoclonal anti-TNF-α agents currently used in the management of IBD patients, i.e. the chimeric human/murine antibody infliximab and the fully human antibody adalimumab.Internal and Emergency Medicine 10/2011; 6 Suppl 1(S1):17-27. DOI:10.1007/s11739-011-0673-9 · 2.41 Impact Factor
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ABSTRACT: Complications associated with Crohn's disease (CD) are common and influence treatment decisions and outcomes. Appropriate early treatment may offer a therapeutic advantage to patients. The aim of our study was to indentify predictive factors for occurrence of complications at the time of CD diagnosis. The study population consisted of 269 CD patients treated during a ten year period. Risk factors compared between complicated and non-complicated disease included phenotypical characteristics, disease classification and the presence of NOD2/CARD15 mutations and single nucleotide polymorphisms in selected autophagy and phagosome genes. Complete data was obtained for 146 patients with an average follow up of 12years. Sixty five patients (44%) developed a complication during follow up. The only independent risk factors associated with developing a complication were smoking and male gender. There was no association between developing complications and the presence of selected SNPs (P=0.07 for Tyrosine residue on both alleles in NCF4 SNP rs4821544 and P=0.06 for a Guanine residue on both alleles in ATG16L SNP rs2241880). Multivariate analysis using a backwards logistic regression model left only male gender as an independent statistically significant association with complicated disease (OR 2.6017, 95% CI: 1.17 to 5.75). The median time to developing a complication was 4years, and the most common complication was the need for surgical intervention (54%). In the present study, a risk factor for developing CD complication was male gender. Further studies are warranted to assess additional risk factors and how such findings should affect therapy.Journal of Crohn s and Colitis 12/2011; 5(6):592-7. DOI:10.1016/j.crohns.2011.06.002 · 3.56 Impact Factor