Abstract:
:Introduction: Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease, which affects joints as well as extra-articular tissues. In the last decades, increasing targeted therapeutic options dramatically improved RA management by doubling the rate of patients achieving clinical remission. Currently, there is a need for management strategies aimed at limiting treatment-related adverse events and costs in good responders.Areas covered: Data on de-escalation of biologic drugs (especially for anti-TNF agents) are mainly available from post-hoc analyses of randomized controlled trials and from registry-based observational studies. This narrative review illustrates the rationales for dose tapering and expands to provide an overview of the efficacy of the different available strategies for reducing the exposure to biologic drugs in patients achieving a sustained clinical response. Selected studies are discussed as illustrative examples.Expert opinion: Withdrawal of biologic therapy might be attempted in limited patients with very early RA; conversely, established RA is more suitably managed with a progressive decrease of drug regimen, by either dose reduction or injection/infusion spacing. Further studies investigating potential factors predicting post-tapering disease relapse are warranted, in order to better identify the best candidates for a decreased-dose approach.
journal_name
Expert Rev Clin Immunoljournal_title
Expert review of clinical immunologyauthors
Cavalli G,Favalli EGdoi
10.1080/1744666X.2020.1686976subject
Has Abstractpub_date
2019-12-01 00:00:00pages
1313-1322issue
12eissn
1744-666Xissn
1744-8409journal_volume
15pub_type
杂志文章,评审abstract::Antiphospholipid antibodies (aPL Abs) are associated with thrombosis in patients with the antiphospholipid syndrome (APS). There is strong evidence that aPL Abs are pathogenic in vivo from studies in animal models. Furthermore, there are now convincing data indicating that activation of complement is involved in those...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章
doi:10.1586/1744666X.4.2.193
更新日期:2008-03-01 00:00:00
abstract:INTRODUCTION:Secondary immunodeficiency is becoming a greater medical concern as the usage of immunosuppressive and biological treatments has increased. Individuals with certain medical conditions, such as hematological malignancies, can also have secondary immunodeficiency. Immunoglobulin replacement therapy (IGRT), w...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章
doi:10.1080/1744666X.2020.1788939
更新日期:2020-07-01 00:00:00
abstract::The measuring tools for disease activity of rheumatoid arthritis have long been adapted for assessing the disease activity of psoriatic arthritis (PsA), particularly as regards peripheral arthritis. However, because of the multifactorial aspects and multiple domains of PsA, such as axial and peripheral joints, skin an...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章,评审
doi:10.1586/1744666X.2014.943663
更新日期:2014-09-01 00:00:00
abstract:INTRODUCTION:Dupilumab is a treatment option newly licensed for adolescents with moderate to severe atopic dermatitis (AD). It reduces type 2 inflammation by blocking the shared receptor subunit for IL-4/-13. Dupilumab affects three disease mechanisms in atopic dermatitis: the skin barrier, the Th2-cell differentiation...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章
doi:10.1080/1744666X.2020.1801420
更新日期:2020-07-01 00:00:00
abstract::Introduction: Patients affected by Inborn Errors of Immunity (IEI) represent a potential group-at-risk in the current COVID-19 pandemic. Studies on large and small cohorts of IEI reported a huge variability clinical manifestations associated to SARS-Cov-2, ranging from asymptomatic, mild, moderate/severe to death. A g...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章
doi:10.1080/1744666X.2021.1873767
更新日期:2021-01-15 00:00:00
abstract:INTRODUCTION:Rheumatoid arthritis (RA) is characterized by systemic synovitis causing joint destruction. With the development of biological disease-modifying anti-rheumatic drugs (bDMARDs) and combination of conventional DMARDs, clinical remission is perceived as an appropriate and realistic goal in many patients. Howe...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章,评审
doi:10.1080/1744666X.2016.1214576
更新日期:2016-09-01 00:00:00
abstract:INTRODUCTION:The etiology of atopic dermatitis (AD) is multifactorial with interaction between genetics, immune and environmental factors. Areas covered: We review the role of prenatal exposures, irritants and pruritogens, pathogens, climate factors, including temperature, humidity, ultraviolet radiation, outdoor and i...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章,评审
doi:10.1080/1744666X.2016.1212660
更新日期:2017-01-01 00:00:00
abstract::Obstructive lung diseases, in particular asthma and chronic obstructive pulmonary disease, are a worldwide health problem that is increasing in incidence. While significant progress has been made in the control of symptoms, further advances must be made in modifying the clinical situation in terms of disease progressi...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章
doi:10.1586/1744666X.1.2.263
更新日期:2005-07-01 00:00:00
abstract:INTRODUCTION:Allergic rhinitis (AR) is among the most common chronic conditions affecting both children and adults. It is the cause of significant morbidity from the symptoms and interference with sleep. It results in major impairment of performance both at school and at work. In the U.S. and certain parts of Europe, r...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章,评审
doi:10.1080/1744666X.2018.1538788
更新日期:2018-12-01 00:00:00
abstract::This article reports recent evidence on epidemiological data concerning monoclonal antibody (mAb) infusion-related anaphylaxis, as well as recent data on the correlation between mAb immunogenicity and safety profiles. Pathogenic mechanisms of mAb-related adverse reactions including hypersensitivity, IgE- and non-IgE-m...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章,评审
doi:10.1586/eci.10.90
更新日期:2011-01-01 00:00:00
abstract::Type 1 diabetes (T1D) is caused by T-cell-mediated destruction of the insulin-producing beta-cells in the pancreas. Genetic and immunological evidence from humans and mouse models indicates that CD4(+) T cells play a crucial role in the development and prevention of T1D. The dichotomy between CD4(+) T regulatory and e...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章
doi:10.1586/1744666X.3.4.557
更新日期:2007-07-01 00:00:00
abstract:INTRODUCTION:Autoimmune Inner Ear Disease (AIED) can be of a primary or secondary type. To date, a clear pathogenesis of the disease is still not available. Focusing on the secondary forms of AIED, the aim of this review is to (i) assess and describe the hearing involvement in patients affected by autoimmune diseases, ...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章
doi:10.1080/1744666X.2021.1879640
更新日期:2021-01-21 00:00:00
abstract:BACKGROUND:X-linked agammaglobulinemia (XLA) is characterized by the absence of immunoglobulin and B cells. Patients suffer from recurrent bacterial infections from early childhood, and require lifelong immunoglobulin replacement therapy. Mutations in BTK (Bruton's Tyrosine Kinase) are associated with this phenotype. S...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章
doi:10.1080/1744666X.2018.1413349
更新日期:2018-01-01 00:00:00
abstract:INTRODUCTION:Hypersensitivity pneumonitis (HP) is an immunologically induced lung disease that develops after inhalation of certain environmental antigens only in subjects with susceptibility to antigens. Therefore, both environmental and host immunological factors play important roles in the aetiology and pathogenesis...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章,评审
doi:10.1080/1744666X.2016.1182426
更新日期:2016-09-01 00:00:00
abstract::The course of inflammatory bowel diseases is heterogeneous and varies over time. Therefore, the search for predictive factors has increasingly become the focus of research. Mucosal healing has emerged as an important objective, as evidence indicates that it is associated with improved disease outcome. Nevertheless, ma...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章,评审
doi:10.1586/1744666X.2013.824675
更新日期:2013-09-01 00:00:00
abstract::The 12/15-lipoxygenase (LO) cascade governs the generation of 12-hydroperoxy-eicosatetraenoic acid (HPETE) and 15-HPETE from arachidonic acid. The 5-LO pathway plays a fundamental role in the biosynthesis of leukotrienes, essential inflammatory lipid mediators. Cyclooxygenase (COX)-1 and -2 biosynthetic pathways are r...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章
doi:10.1586/1744666X.2.4.649
更新日期:2006-07-01 00:00:00
abstract::Leptospirosis is re-emerging as a worldwide zoonosis and is caused by bacteria of the genus Leptospira. Human leptospirosis is associated with high temperature and humidity. Laboratory tests are indispensible for the early diagnosis and proper disease management. The demand for suitable leptospirosis point-of-care dia...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章,评审
doi:10.1586/eci.12.110
更新日期:2013-03-01 00:00:00
abstract::Metabolic syndrome is a highly atherogenic state in which hyperglycemia, dyslipidemia and hypertension cluster in one individual. Intra-abdominal visceral fat accumulation plays a key role in the development of these disorders and the occurrence of metabolic syndrome. We have investigated adipocyte functions intensive...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章
doi:10.1586/1744666X.3.1.39
更新日期:2007-01-01 00:00:00
abstract::Pathological similarities between sarcoidosis (SA) and tuberculosis (TB) suggest that mycobacterial antigen(s), in genetically different predisposed hosts, may be a cause of SA. The authors' work and other published comparative analyses of HLA and non-HLA alleles in patients with SA or TB from different ethnic groups ...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章,评审
doi:10.1586/eci.13.8
更新日期:2013-04-01 00:00:00
abstract:INTRODUCTION:Despite the emergence of newer immunomodulating agents for systemic lupus erythematosus (SLE), a substantial proportion of patients still do not respond optimally. While the mechanisms for the differential responses to drug therapy are unclear, variation in drug exposure with the same dosing protocol relat...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章,评审
doi:10.1080/1744666X.2016.1212659
更新日期:2017-01-01 00:00:00
abstract::The past decade has been an exciting period for clinical research and patient care in rheumatoid arthritis. This is mostly due to targeted biologic agents that have changed the outcome of this disease. Certolizumab pegol (Cimzia(®), UCB Inc., GA, USA), which targets TNF-α with a different mechanism of action than wide...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章,评审
doi:10.1586/eci.10.69
更新日期:2010-11-01 00:00:00
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journal_title:Expert review of clinical immunology
pub_type: 杂志文章,评审
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更新日期:2011-09-01 00:00:00
abstract::Treatment of idiopathic membranous nephropathy (IMN) is controversial. However, two randomized controlled trials (RCTs) reported that treatment with steroids alternated with an alkylating agent achieved significantly more remissions and better renal survival at 10 years in comparison with untreated controls. Short-ter...
journal_title:Expert review of clinical immunology
pub_type: 评论,杂志文章
doi:10.1586/eci.12.89
更新日期:2013-01-01 00:00:00
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journal_title:Expert review of clinical immunology
pub_type: 杂志文章,评审
doi:10.1080/1744666X.2018.1532291
更新日期:2018-11-01 00:00:00
abstract::Although training and exercise have several benefits, overdoing it might not necessarily be a good thing. For instance, elite athletes have an increased risk for asthma and allergy. Several mechanisms can be implicated for this risk, which include the interplay between environmental training factors and athlete's pers...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章,评审
doi:10.1586/1744666X.2015.1058158
更新日期:2015-01-01 00:00:00
abstract:INTRODUCTION:Adalimumab, an inhibitor of tumor necrosis factor-alpha (TNFα), is the only systemic non-corticosteroid agent which has been approved by the US Food and Drug Administration (FDA) for the treatment of non-infectious uveitis. Areas covered: The aim of this review is to summarize the research which demonstrat...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章,评审
doi:10.1080/1744666X.2017.1288097
更新日期:2017-03-01 00:00:00
abstract:INTRODUCTION:Rheumatoid arthritis (RA) is a complex disease in which different mechanisms are involved. Studies suggest a key role for aberrant pathways of T-cell activation in the initiation and perpetuation of disease. Abatacept is a fusion protein composed of the Fc region of the immunoglobulin G1 (IgG1) fused to th...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章,评审
doi:10.1080/1744666X.2019.1579642
更新日期:2019-04-01 00:00:00
abstract:INTRODUCTION:Remestemcel-L, a third-party, off-the-shelf preparation of bone-marrow derived mesenchymal stromal cells (MSCs), has been developed for experimental use in acute graft-versus-host disease (aGvHD) and other immune-mediated conditions. Several preclinical and clinical studies have indeed suggested the potent...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章,评审
doi:10.1080/1744666X.2016.1208086
更新日期:2017-01-01 00:00:00
abstract::Introduction: For late stage organ failure patients, transplantation is the best option to increase life expectancy with a superior quality of life. Unfortunately, after transplantation many patients are at risk of cellular and antibody-mediated rejection (ABMR). The latter is initiated by donor specific antibodies (D...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章,评审
doi:10.1080/1744666X.2020.1693262
更新日期:2019-12-01 00:00:00
abstract:INTRODUCTION:Genetic testing of patients with clinically diagnosed or suspected primary immunodeficiencies (PIDs) constitutes standard of care. Choice of testing modality and patient attributes can impact the likelihood of securing a diagnosis. AREAS COVERED:Published diagnostic rates for gene panel testing, exome seq...
journal_title:Expert review of clinical immunology
pub_type: 杂志文章
doi:10.1080/1744666X.2020.1814145
更新日期:2020-09-01 00:00:00