BIOLOGIC MEDICINES FOR MODERATE TO SEVERE PSORIASIS – A REVIEW OF CLINICAL EVIDENCE

A psoríase é uma doença autoimune, hiperproliferativa e crônica que se manifesta de várias maneiras, levando a alterações importantes principalmente na pele e nas articulações acometendo cerca de 0,1 a 3% da população mundial.  Os medicamentos biológicos surgem como alternativa terapêutica, apresentando resultados promissores de eficácia e segurança para o tratamento dessa doença. Trata-se de medicamentos que modificam sistemicamente a resposta imunológica na psoríase. Como a doença tem origem em processos inflamatórios de células T (notadamente células Th1 e Th17) que levam à hiperproliferação celular, os biológicos atuam mediando as interações específicas das células T com o antígeno, no bloqueio das interações intercelulares, no desvio da ativação do sistema imune, ou inibindo diretamente citocinas inflamatórias que desencadeiam ou exacerbam a resposta imunológica e proliferativa. Este artigo é uma revisão de literatura sobre eficácia e segurança de medicamentos imunobiológicos utilizados no tratamento da psoríase moderada a grave

Topical antiinflammatory activity and chemical composition of the epicuticular wax from the leaves of Eugenia beaurepaireana (Myrtaceae)

In order to verify the topical antiinflammatory effect of epicuticular wax from leaves of Eugenia beaurepaireana, it was tested in mice croton oil-induced inflammation. Our findings show that topical application of Eugenia beaurepaireana epicuticular wax was significantly active in inhibiting both oedema (Inhibitory dose 50 % (ID50) = 0.31 (0.26 - 0.39) mg.ear -1, inhibition = 79 ± 6 %) and tissue myeloperoxidase activity (indicative of polymorphonuclear leukocytes influx) (ID50 =0.34 (0.20 - 0.41) mg.ear -1, inhibition = 77 ± 4 %) in mice ear treated with croton oil. Two main compounds were detected on epicuticular wax of E. beaurepaireana. These compounds were identified as α- and β-amyrin by flame ionization detection (GC-FID) and spectroscopic methods (IR, NMR ¹H and 13C). In conclusion, the results indicate a topical antiinflammatory activity for the Eugenia specie studied and, that, at least in part, α- and β-amyrin are responsible for this activity.A atividade antiinflamatória tópica da cera epicuticular das folhas de Eugenia beaurepaireana foi avaliada pelo modelo do edema de orelha induzido pelo óleo de cróton em camundongos. Os resultados do estudo mostram que a aplicação tópica da cera epicuticular de Eugenia beaurepaireana inibiu significativamente a formação do edema (Dose inibitória 50 % (DI50) = 0,31 (0,26 - 0,39) mg.orelha-1, inibição = 79 ± 6 %) e a atividade da mieloperoxidase tissular (indicativo do influxo de leucócitos polimorfonucleares) (DI50 =0,34 (0,20 - 0,41) mg.orelha-1, inibição = 77 ± 4 %) em camundongos tratados com o óleo de cróton. Dois compostos majoritários foram detectados e isolados da cera epicuticular de E. beaurepaireana. Estes compostos foram identificados como os triterpenos α-amirina e β-amirina, através de técnicas cromatográficas (CG-FID) e espectroscópicas (IV, RMN ¹H e 13C). Em conclusão, os resultados indicam que a espécie E. beaurepaireana apresenta um efeito antiinflamatório tópico relevante, sendo os compostos α-amirina e β-amirina responsáveis, pelo menos em parte, por esta atividade

Combretum leprosum Mart. (Combretaceae): Potential as an antiproliferative and anti-inflammatory agent

AbstractEthnopharmacological relevanceCombretum leprosum is a species that is popularly used in Brazil as a healing agent to treat skin problems and lesions. In this study we investigated the possible potential of this extract to treat inflammatory and hyperproliferative skin conditions.Materials and methodsClassical models of skin inflammation such as TPA- and croton oil-induced mouse ear oedema were applied in order to verify the potential topical anti-inflammatory activity of the ethanolic extract from flowers of Combretum leprosum.ResultsTopical application of ethanolic extract promoted a dose-dependent inhibition of phorbol ester-induced ear oedema, reduced myeloperoxidase activity and IL-6 tissue levels with inhibition comparable to dexamethasone (positive control). Histological and immunohistochemical analysis revealed that ethanolic extract also suppressed cell infiltration. Ethanolic extract altered inflammatory parameters on a chronic skin inflammation model induced by repeated applications of croton oil, decreasing ear oedema, epidermal hyperproliferation and cell infiltration. In addition, immunohistochemical analysis showed that the extract decreased PCNA expression on the epidermis.ConclusionTaken together, these results suggest that the extract from flowers of Combretum leprosum could be considered as a new potential tool for the treatment of several skin inflammatory diseases since it reversed the skin inflammatory and hyperproliferative process in a very significant manner. Further investigations are needed in order to verify the cellular mechanism and safety of Combretum leprosum extract

Avaliação econômica das anticitocinas adalimumabe, etanercepte e infliximabe no tratamento da artrite reumatoide no Estado do Paraná = Economic evaluation of anticitokines adalimumab, etanercept and infliximab for treatment of rheumatoid arthritis in Paraná State, Brazil

This study aimed to perform an economic evaluation of anticytokines adalimumab (ADA), etanercept (ETA) and infliximab (IFX) for the treatment of rheumatoid arthritis in the State of Parana, in Brazil, in the perspective of the Brazilian Unified Health System. Data on efficacy and safety of treatment were collected in literature, and costs were calculated on the amounts spent by the Government for each treatment. A Markov model was performed to get the cost-effectiveness of each treatment. The incremental cost-effectiveness relationship (ICER) compared to a standard treatment was also calculated for each anticytokine. Sensitivity analysis and discount rates were applied. In assessing cost-effectiveness we found the following values (cost at R$per QALY): 511,633.00, 437,486.00 and 657,593.00 (respectively for ADA, ETA and IFX). The ICER (R$ per QALY) was 628,124.00, 509,974.00 and 965,927.00 (for ADA, ETA and IFX). In the sensitivity analysis, ETA and ADA showed similar values. It is for public managers and physicians the choice for each patient, among the treatments available

Analysis of the Potential Topical Anti-Inflammatory Activity of Averrhoa carambola L. in Mice

Inflammatory skin disorders, such as psoriasis and atopic dermatitis, are very common in the population; however, the treatments currently available are not well tolerated and are often ineffective. Averrhoa carambola L. (Oxalidaceae) is an Asian tree that has been used in traditional folk medicine in the treatment of several skin disorders. The present study evaluates the topical anti-inflammatory effects of the crude ethanolic extract of A. carambola leaves, its hexane, ethyl acetate, and butanol fractions and two isolated flavonoids on skin inflammation. Anti-inflammatory activity was measured using a croton oil-induced ear edema model of inflammation in mice. Topically applied ethanolic extract reduced edema in a dose-dependent manner, resulting in a maximum inhibition of 73 ± 3% and an ID50 value of 0.05 (range: 0.02–0.13) mg/ear. Myeloperoxidase (MPO) activity was also inhibited by the extract, resulting in a maximum inhibition of 60 ± 6% (0.6 mg/ear). All of the fractions tested caused inhibition of edema formation and of MPO activity. Treatment with the ethyl acetate fraction was the most effective, resulting in inhibition levels of 75 ± 5 and 54 ± 8% for edema formation and MPO activity, respectively. However, treatment of mice with isolated compounds [apigenin-6-C-β-l-fucopyranoside and apigenin-6-C-(2″-O-α-l-rhamnopyranosyl)-β-l-fucopyranoside] did not yield successful results. Apigenin-6-C-(2″-O-α-l-rhamnopyranosyl)-β-l-fucopyranoside caused only a mild reduction in edema formation (28 ± 11%). Taken together, these preliminary results support the popular use of A. carambola as an anti-inflammatory agent and open up new possibilities for its use in skin disorders

Simvastatin impairs murine melanoma growth

<p>Abstract</p> <p>Background</p> <p>Statins induces cell cycle arrest, apoptosis, reduction of angiogenic factors, inhibition of the endothelial growth factor, impairing tissue adhesion and attenuation of the resistance mechanisms. The aim of this study was evaluate the anti-tumoral activity of simvastatin in a B16F10 melanoma-mouse model.</p> <p>Methods</p> <p>Melanoma cells were treated with different concentrations of simvastatin and assessed by viability methods. Melanoma cells (5 × 10⁴) were implanted in two month old C57Bl6/J mice. Around 7 days after cells injection, the oral treatments were started with simvastatin (5 mg/kg/day, p.o.). Tumor size, hematological and biochemical analyses were evaluated.</p> <p>Results</p> <p>Simvastatin at a concentration of 0.8 μM, 1.2 μM and 1.6 μM had toxic effect. Concentration of 1.6 μM induced a massive death in the first 24 h of incubation. Simvastatin at 0.8 μM induces early cell cycle arrest in G0/G1, followed by increase of hypodiploidy. Tumor size were evaluated and the difference of treated group and control, after ten days, demonstrates that simvastatin inhibited the tumor expansion in 68%.</p> <p>Conclusion</p> <p>Simvastatin at 1.6 μM, presented cytototoxicity after 72 h of treatment, with an intense death. <it>In vivo</it>, simvastatin being potentially useful as an antiproliferative drug, with an impairment of growth after ten days.</p