Evaluation of frequency and the attacks features of patients with colchicine resistance in FMF

Introduction: Colchicine is the mainstay for the treatment of FMF, which is an auto-inflammatory disease mainly with relapsing polyserositis. Despite daily doses of 2 mg ormore each day, approximately 5% to 10% of the patients continue to suffer from its attacks. In this study, we aimed to investigate the depression and attack features in patients withFMF who have colchicine resistance (CR).Patients e Methods: CR was defined for FMF patients with 2 or more attacks within the last6 months period while using 2 mg/day colchicine. Eighteen patients (9 Female/9 Male) wereenrolled into the CR group and 41 patients were enrolled into the control group (12 Male/29Female). Demographic, clinical e laboratory findings, treatment adherence, and the BeckDepression Inventory (BDI) scores were evaluated. Results: The age of onset of FMF was significantly lower in the CR group (12.3 yrs vs. 16.9 yrs, P = 0.03). Disease duration was longer in the CR group (P = 0.01). Abdominal and leg pain dueto exercise were significantly more frequent in the CR group versus controls (83% vs. 51%;P = 0.02 e 88% vs. 60%; P = 0.04, respectively). Patients with BDI scores over 17 points weremore frequent in the CR group compared to controls (50% vs. 34.1%; P < 0.001).Discussion: We found that: (1) the age of disease onset was lower and (2) the disease durationwas longer in CR group. Pleuritic attacks, hematuria e proteinuria were more frequent in CRpatients. We propose that depression is an important factor to consider in the susceptibilityto CR. © 2014 Elsevier Editora Ltda

Secukinumab, an Interleukin-17A Inhibitor, in Ankylosing Spondylitis

Background Secukinumab is an anti–interleukin-17A monoclonal antibody that has been shown to control the symptoms of ankylosing spondylitis in a phase 2 trial. We conducted two phase 3 trials of secukinumab in patients with active ankylosing spondylitis. Methods In two double-blind trials, we randomly assigned patients to receive secukinumab or placebo. In MEASURE 1, a total of 371 patients received intravenous secukinumab (10 mg per kilogram of body weight) or matched placebo at weeks 0, 2, and 4, followed by subcutaneous secukinumab (150 mg or 75 mg) or matched placebo every 4 weeks starting at week 8. In MEASURE 2, a total of 219 patients received subcutaneous secukinumab (150 mg or 75 mg) or matched placebo at baseline; at weeks 1, 2, and 3; and every 4 weeks starting at week 4. At week 16, patients in the placebo group were randomly reassigned to subcutaneous secukinumab at a dose of 150 mg or 75 mg. The primary end point was the proportion of patients with at least 20% improvement in Assessment of Spondyloarthritis International Society (ASAS20) response criteria at week 16. Results In MEASURE 1, the ASAS20 response rates at week 16 were 61%, 60%, and 29% for subcutaneous secukinumab at doses of 150 mg and 75 mg and for placebo, respectively (P<0.001 for both comparisons with placebo); in MEASURE 2, the rates were 61%, 41%, and 28% for subcutaneous secukinumab at doses of 150 mg and 75 mg and for placebo, respectively (P<0.001 for the 150-mg dose and P=0.10 for the 75-mg dose). The significant improvements were sustained through 52 weeks. Infections, including candidiasis, were more common with secukinumab than with placebo during the placebo-controlled period of MEASURE 1. During the entire treatment period, pooled exposure-adjusted incidence rates of grade 3 or 4 neutropenia, candida infections, and Crohn’s disease were 0.7, 0.9, and 0.7 cases per 100 patient-years, respectively, in secukinumab-treated patients. Conclusions Secukinumab at a subcutaneous dose of 150 mg, with either subcutaneous or intravenous loading, provided significant reductions in the signs and symptoms of ankylosing spondylitis at week 16. Secukinumab at a subcutaneous dose of 75 mg resulted in significant improvement only with a higher intravenous loading dose. (Funded by Novartis Pharma; ClinicalTrials.gov numbers, NCT01358175 and NCT01649375.

Flutamide-induced acute renal failure in a patient with metastatic prostate cancer

Androgen blockage, with either orchiectomy or luteinizing hormone releasing hormone (LHRH) analogs combined with an antiandrogen drug, is the standard treatment for metastatic prostate cancer. Flutatr ide is a nonsteroidal antiandrogen drug that is frequently used for total androgen blockage. We report on a 54-yr-old man with metastatic prostate cancer who developed nonoliguric acute renal failure (ARF) during treatment with flutamide. Following discontinuation of flutamide therapy, his renal functions returned to normal limits within 4 wk. After a rechallenge with flutamide, serum levels of BUN and creatinine increased again. His renal function recovered completely after the cessation of the drug for the second time. This observation confirm that ARF may be clearly attributed to flutamide therapy. Although very rare, flutamide-induced ARF should be considered

Persisting fever in a patient with brucella endocarditis: occult splenic abscess

Brucella endocarditis, despite its high mortality rate with combined medical and surgical treatment, has a low occurrence rate in cases of brucellosis and has been endemic in regions surrounding Turkey. Rarely, patients with infective endocarditis with common microorganisms develop a splenic abscess. A patient is reported on with brucella endocarditis and persistent fever. An occult splenic abscess was found. This is the second reported case in the literature of brucella endocarditis with splenic abscess