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Results for “adjunct therapy”

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PubMed1994

Hyperbaric oxygen therapy following radical vulvectomy: an adjunctive therapy to improve wound healing.

The objective of the study was to evaluate the effect of postoperative hyperbaric oxygen (HBO) therapy on wound breakdown following radical vulvectomy. A prospective, observational study was performed on patients undergoing radical vulvectomy from October 1990 to March 1993 at Scott and White Memorial Hospital, Temple, Texas. HBO therapy was initiated in the postoperative period. Retrospective review of all patients coded as radical vulvectomy from 1987 to 1990 provides for a historical comparison. Eight patients were enrolled in the study. Six patients had radical vulvectomies with lymph node dissections (LND) and two did not. One wound breakdown was observed in the HBO-treated patients. Retrospective review identified 22 patients as having undergone radical vulvectomy with or without LND. Seven of 9 patients with LND and 3 of 13 without LND had wound breakdowns. A significant difference (P = 0.035) was found comparing patients treated with LND and HBO to retrospective controls with LND. Hospitalization was shorter in the HBO-treated patients. This small study showed a reduction in wound breakdown for patients undergoing radical vulvectomy with LND and HBO therapy compared to similar patients not treated with HBO. This observation supports the need for randomized studies examining the efficacy of HBO therapy in this group of patients.

Adolescent↗

PubMed2000

Efficacy of gabapentin as adjunctive therapy in a large, multicenter study. The Steps Study Group.

The objective of this study was to determine the efficacy of gabapentin as adjunctive therapy in doses required to achieve the most effective seizure control. There were 2016 patients with partial seizures requiring adjunctive therapy who received gabapentin at doses up to 3600 mg/day in this open-label, multicenter, 16-week study. Of the 1055 patients evaluable for efficacy, 573 received gabapentin < or =1800 mg/day and 482 received > 1800 mg/day as the highest dose received. For the overall efficacy evaluable population, the percentage of patients achieving at least a 50% reduction in seizure frequency was 76.0%; 46.4% of the patients were seizure free. Patients whose highest gabapentin dose did not require > 1800 mg/day had, at baseline, fewer seizures and were receiving fewer concomitant antiepileptic drugs (AEDs) at baseline than those patients requiring > 1800 mg/day. This suggests that patients requiring higher doses of gabapentin were more refractory to drug treatment at the start of the study. Gabapentin was well tolerated at all doses in this study. The results of the study demonstrate that gabapentin is effective as adjunctive therapy in patients with partial seizures whose seizures are inadequately controlled by traditional AEDs.

Acetates↗

PubMed2004

Pregabalin as adjunctive therapy for partial seizures.

The efficacy and safety of pregabalin as adjunctive therapy for patients with partial epilepsy with or without secondary generalization has been studied in three randomized, double-blind, placebo-controlled trials involving 1,052 patients. Patients (> or =12 years of age) participating in the trials were highly refractory to treatment, experiencing at least six seizures and no 4-week seizure-free period during the 8-week baseline phase, even though 73% received at least two antiepileptic drugs and 23% received three. Each fixed-dose study was 12 weeks in duration. In Study 1, patients received pregabalin 50, 150, 300, or 600 mg/day given two times daily with no titration period. Studies 2 and 3 had a 1-week titration to dose levels of 150 and 600 mg/day given three times daily (Study 2), 600 mg/day given two times daily, and 600 mg/day given three times daily (Study 3). Pregabalin, at 150, 300, and 600 mg/day, was significantly superior to placebo in reducing seizure frequency with a clear dose-response relationship. Responder rates, defined as the percentage of patients with > or =50% reduction in seizure frequency from baseline, approached 50% at 600 mg/day. In the effective dose range (150-600 mg/day), seizure freedom in the last 28 days of treatment was 3-17%. There was no difference between two times daily and three times daily dosing regimens. Efficacy was apparent as early as week one. The most commonly reported adverse events were CNS related, and either mild or moderate in intensity and generally self limiting. Few patients (< or =5% in any treatment group) discontinued due to lack of efficacy. These results indicate that pregabalin is highly effective as adjunctive therapy in the treatment of patients with partial seizures with or without secondary generalization.

Adolescent↗

PubMed2004

Potential adjunctive therapies in adolescents with type 1 diabetes mellitus.

Appropriate insulin therapy is central to the management of all individuals with type 1 diabetes mellitus. The potential role of adjunctive therapy in type 1 diabetes is to improve insulin action, and facilitate the ability of all individuals with type 1 diabetes to achieve and maintain 'better' metabolic control. The landmark clinical trial in type 1 diabetes is the Diabetes Control and Complications Trial (DCCT). The DCCT showed that there is no threshold below which a reduction in glycemia would not provide further benefit against diabetes-related microvascular complications. This study in particular provides the rationale for attempting to achieve as near normoglycemia as possible. We review the use of recognized pharmacologic agents as potential insulin adjunctives in children and adolescents with type 1 diabetes. Adjunctive therapies can be grouped into the following categories based on their putative mechanism of action: enhancement of insulin action (e.g. the biguanides and thiazolidinediones), alteration of gastrointestinal nutrient delivery (e.g. acarbose and amylin), and other targets of action (e.g. pirenzepine and insulin-like growth factor-1 [IGF-1], which reduce growth hormone secretion, and glucagon-like peptide-1, which acts to stimulate insulin secretion). Many of these agents have been found to be effective in short-term studies with decreases in glycosylated hemoglobin of 0.5-1.0%, lowered postprandial blood glucose levels, and decreased daily insulin doses. Adverse effects such as poor gastrointestinal tolerability (metformin, acarbose) or potential acceleration of retinopathy (IGF-1) indicates the need for further studies of efficacy, safety, and patient selection before these adjunctive therapies can be widely recommended in type 1 diabetes.

Adolescent↗

PubMed1993

A selective approach to adjunctive therapy for cancer of the rectum.

PURPOSE: To present results of a selective approach to adjunctive therapy and surgery based on a new model of clinical staging for rectal cancer. METHODS AND MATERIALS: Three hundred and sixty-two patients with rectal cancer treated with adjunctive radiation therapy and surgery have been analyzed to define patient selection criteria based on clinical assessment of disease. Clinical prognostic features of tumor mobility and level of lesion in the rectum with reference to the anorectal junction were used. Mobile, early fixed (partial), advanced fixed (total) and frozen pelvis are defined as clinical Stages I, II, III, and IV. Tumors above 6 cm (middle valve), 3-6 cm (inferior to middle valve), 0-3 cm (anorectum to inferior valve), and into the anal canal are defined as levels a, b, c, d, respectively. Based on this model, patients with mobile tumors of the proximal rectum (CS Ia, b) are treated with 500 cGy preoperative radiation and selective postoperative radiation (4500 cGy) for Stages B2 and C cancer. All other patients are treated with escalating doses of preoperative radiation. Follow-up in these patients ranges from 1 year to 14 years with a median of 5 years. RESULTS: Overall 5-year survival of the total group of patients is 69%. Survival by pathological stage is 82% for O, A, B1, 67% for B2, 74% for C1, and 51% for C2. Survival by clinical stages is 77% for CS I, 67% for CS II, 57% for CS III, and 21% for CS IV. Overall local recurrence is 43/362 (12%). L.R. by pathological stages is 5% for O, A, B1, 18% for B2, 10% for C1, and 17% for C2. L.R. by clinical stages is 9% for CS I, 14% for CS II, 17% for CS III, and 50% for CS IV. CONCLUSION: An integrated adjunctive therapy and selective surgical approach based on careful clinical staging of rectal cancer results in a global improvement in overall local control and survival of patients.

Adenocarcinoma↗

PubMed2006

[Evaluation of the efficacy of long-acting somatostatin analog as adjunctive therapy in patients with active acromegaly].

UNLABELLED: Transsphenoidal surgery is the first-line therapy for patients with acromegaly, but can achieve biochemical control with normalization of somatomedin C in 40-80% of cases. All patients with continued growth hormone hypersecretion after neurosurgery require adjunctive therapy to prevent morbidity and premature mortality. The aim of our study was to evaluate the efficacy of long-acting somatostatin analog--octreotide LAR (OCT-LAR) as adjunctive therapy for patients with persistent disease. 14 adult subjects (age 45 +/- 15 years) were included into the study. All patients were diagnosed as having growth hormone secreting pituitary tumor and underwent transsphenoidal surgery (TSS). Radiotherapy (RT) was used as adjunctive therapy in 7 of investigated persons. In all subjects elevated level of somatomedin C was found, 9 have increased level of growth hormone (hGH) as well. After 6 months therapy with OCT-LAR we noticed drop in somatomedin C and hGH levels in all patients. Mean drop in somatomedin C level was 42.3% (p=0.001), in GH level was 52.3% (p=0.001). We found entire normalization of GH in 12 (85.7%) patients, nearly normalization of somatomedin C (level lower than 110% of normal upper limit) in 8 (57%) patients. We found no significant correlation between decrease in somatomedin C and its level prior to the treatment (p=0.8), but high positive correlation between decrease in hGh level and its initial value (R=0.75, p=0.002). Decreases in both somatomedin C (p=0.7) and hGH (p=0.6) levels were not correlated with patients' age. The therapeutic outcome defined as decrease in somatomedin C level was not significantly different between patients with or without adjunctive radiotherapy in the past (p=0.08) and between patients with intensive or weak isotope collection in the pituitary in 99mTc-octreotide scintiscan (p=0.2). CONCLUSIONS: Octreotide-LAR efficiently reduces somatomedin C and GH levels in patients with active acromegaly. Initial values of somatomedin C as well as age and isotopic imaging findings are not valuable predictor factors for therapeutic outcome.

Acromegaly↗

PubMed2001

Celecoxib as adjunctive therapy for treatment of colorectal cancer.

OBJECTIVE: To describe the role of celecoxib as adjunctive therapy in the treatment of familial adenomatous polyposis (FAP), an inherited autosomal dominant predisposition syndrome for colorectal cancer. DATA SOURCES: Literature was evaluated through MEDLINE search (1995-March 2000) and through secondary sources, using the search terms celecoxib, cyclooxygenase-2 inhibitors, and familial adenomatous polyps. DATA SYNTHESIS: Observational studies have found a decreased rate of colorectal cancer in people who regularly took aspirin or other nonsteroidal antiinflammatory drugs (NSAIDs). The Food and Drug Administration granted accelerated approval in December 1999 for the NSAID celecoxib, a selective cyclooxygenase-2 (COX-2) inhibitor, for adjunctive therapy in patients with FAP, based on a six-month, randomized, controlled clinical trial. CONCLUSIONS: Aspirin and other NSAIDs reduce the incidence of colorectal cancer in the general population. Limited clinical studies in patients with FAP using nonaspirin NSAIDs have shown a reduction in polyp burden. A current clinical trial using celecoxib has also shown a reduction in polyp burden in patients with FAP. The long-term clinical impact of using a selective COX-2 inhibitor is not known, since celecoxib has not been studied beyond six months in patients with FAP. By reducing the polyp burden in FAP patients, celecoxib may be useful as adjunctive chemotherapy, in addition to routine endoscopic surveillance and surgery.

Adenomatous Polyposis Coli↗

PubMed1978

The logic of adjunctive therapy in surgical patients with resectable cancer.

The principles and rationale of using multiple modalities (surgery, chemotherapy, radiotherapy, and immunotherapy) to treat solid malignancies is reviewed. Animal models of human tumors have clearly demonstrated the superiority of combining local treatment (eg, surgery) with systemic treatment (eg, chemotherapy). Although the results of many trials of adjunctive therapy in man are still preliminary, they warrant the caustious generalization that multiple modality therapy will increasingly become more effective than surgery alone for most types of solid tumors. Although the strategy of employing adjunctive therapy is rational, it must be emphasized that the therapeutic efficacy of specific drugs or agents for particular patients or tumor types has not always been satisfactory. Clinical trials now in progress may demonstrate more effective regimens. In the meantime, physicians should be cautious about using adjunctive therapy as standard treatment until long-term benefits and safety have been demonstrated. Participation in clinical trials is encouraged to verify the validity and application of this therapeutic approach.

Animals↗

PubMed2006

Cognitive dysfunctions in schizophrenia: potential benefits of cholinesterase inhibitor adjunctive therapy.

OBJECTIVE: In schizophrenia, cognitive dysfunctions commonly affect attention, memory and executive function, interfere with functional outcome and remain difficult to treat. Previous studies have implicated the cholinergic system in cognitive functioning. In Alzheimer's disease, cholinergic agonists have shown modest clinical benefits on cognitive and behavioural symptoms. Impaired cholinergic activity might also be involved in schizophrenia. Hence the role of cholinesterase inhibitors (ChEI) as adjunctive therapy is under study. We aimed to review the literature and evaluate the overall effectiveness of ChEI adjunctive therapy for the management of cognitive dysfunctions in schizophrenia. METHODS: We conducted a computer-based search using PubMed (up to February 15, 2006) and ISI Web of Science (conference proceeding abstracts from January 2003 to December 2005) databases. We used the search terms "schizophrenia," "cognition or memory" and "tacrine or donepezil or rivastigmine or galantamine." Studies included were critically analyzed for allocation, blindness, duration and study design, demographic data, and clinical and neuropsychological outcome assessments. We excluded studies that involved patients with psychiatric disorders other than schizophrenia-spectrum or if they involved animals or molecular investigations. We also excluded conference proceeding abstracts with no explicit neuropsychological battery and/or results. RESULTS: Data on ChEI as adjunctive therapy for the cognitive impairments in schizophrenia are sparse and so far derived from small samples and mostly open uncontrolled studies. ChEI's potential in long-term management has barely been documented and remains to be fully explored. CONCLUSION: There is insufficient evidence on whether ChEI should be used for the treatment of cognitive dysfunctions in schizophrenia. Nevertheless, further studies with appropriate trial designs and outcome measures in homogenous schizophrenia populations are warranted.

Cholinesterase Inhibitors↗

PubMed1997

Azelastine nasal spray as adjunctive therapy to azelastine tablets in the management of seasonal allergic rhinitis.

BACKGROUND: Azelastine rhinitis medications (nasal spray and tablets) have been shown to relieve the symptoms of allergic rhinitis. Nevertheless, many rhinitic subjects suffer from acute exacerbations of symptoms that sometimes require additional treatment. OBJECTIVE: To assess the efficacy and safety of azelastine nasal spray as adjunctive therapy to azelastine tablets in the management of symptomatic seasonal allergic rhinitis in subjects who remain symptomatic despite the oral medication. METHODS: A 2-day, randomized, multicenter, double-blind, placebo-controlled, parallel-group study. Two hundred thirty-three subjects with symptomatic allergic rhinitis received azelastine tablets (0.5 mg bid) for a minimum of seven days prior to receiving either azelastine nasal spray (2 sprays per nostril bid) or placebo nasal spray as adjunctive therapy. Efficacy was determined by improvement in rhinitis symptoms that were grouped according to total and major symptom complex severity scores. RESULTS: Mean percent improvements in the total symptom complex severity scores for azelastine were statistically significant (P < or = .05) or showed a trend toward statistical significance (.05 < or = P < .10) versus placebo from the second through the first ten hours after the initial dose and for each of the last five hours of the second day, demonstrating a rapid onset of action and sustained efficacy over the 2-day study period. Azelastine was well tolerated, and no subject discontinued therapy with azelastine due to an adverse experience. CONCLUSION: Azelastine nasal spray can be effectively administered as adjunctive therapy, in an outdoor environment in which subjects are exposed to pollen and other aeroallergens.

Administration, Inhalation↗

PubMed2006

Drug Insight: adjunctive therapies in adults with bacterial meningitis.

Despite the availability of effective antibiotics, mortality and morbidity rates associated with bacterial meningitis are high. Studies in animals have shown that bacterial lysis, induced by treatment with antibiotics, leads to inflammation in the subarachnoid space, which might contribute to an unfavorable outcome. The management of adults with bacterial meningitis can be complex, and common complications include meningoencephalitis, systemic compromise, stroke and raised intracranial pressure. Various adjunctive therapies have been described to improve outcome in such patients, including anti-inflammatory agents, anticoagulant therapies, and strategies to reduce intracranial pressure. Although a recent randomized trial provided evidence in favor of dexamethasone treatment, few randomized clinical studies are available for other adjunctive therapies in adults with bacterial meningitis. This review briefly summarizes the pathogenesis and pathophysiology of bacterial meningitis, and focuses on the evidence for and against use of the available adjunctive therapies in clinical practice.

Adult↗

PubMed2005

Rofecoxib as adjunctive therapy for haemophilic arthropathy.

Joint haemorrhage and subsequent haemophilic arthropathy are significant complications in haemophilia. The pathophysiology involves inflammation and angiogenesis. Cyclooxygenase-2 (COX-2) inhibitors are anti-inflammatory agents, which have potent anti-inflammatory, anti-angiogenic and analgesic properties yet do not affect platelet function in the manner of traditional non-steroidal anti-inflammatory drugs. These properties make such agents potentially useful as adjunctive therapy in haemophilia. There is only one prior report describing rofecoxib treatment in a single haemophilia patient. Our objectives were to determine the safety and efficacy of rofecoxib in treating acute haemarthrosis, chronic synovitis, target joints and pain. We conducted a retrospective medical record review of patients treated with rofecoxib for acute haemarthrosis, chronic synovitis, target joint or pain. The safety and efficacy of rofecoxib treatment were determined based on subjective patient reports and physical examinations during follow-up clinic visits. A total of 28 patients between 3 and 37 years of age were treated for a total of 42 courses of rofecoxib treatment. All courses were evaluated for safety and 31 for efficacy. Rofecoxib was used for eight acute haemarthrosis, four target joints, seven cases of synovitis and 12 episodes of pain. Efficacy was demonstrated particularly for chronic synovitis and pain and no serious adverse events occurred. This is the largest study to date evaluating COX-2 inhibitors as adjunctive therapy in haemophilia and suggests that these agents may be an important adjunctive therapy in the management of haemophilia.

Acute Disease↗

PubMed1995

Wound healing with noncontact therapeutic touch used as an adjunct therapy.

Noncontact therapeutic touch is an effective adjunct therapy for wound healing that furthers the theoretic principle of therapeutic touch. The ET nurse's scientific-based, skilled experience could, if combined with sensitivity and compassion, escalate the patient's recovery through the intentionality of healing through the hands. Synoptic explanations of noncontact therapeutic touch and wound healing are followed by citations from published research.

Complementary Therapies↗

PubMed1994

Prevention of rethrombosis after coronary thrombolysis in a chronic canine model. II. Adjunctive therapy with r-hirudin.

We examined the effectiveness of the direct-acting thrombin inhibitor, recombinant hirudin (r-hirudin), for prevention of coronary rethrombosis after thrombolysis with recombinant tissue plasminogen activator (rt-PA) in a canine model of coronary artery thrombosis. The reocclusion rate of 15-30% associated with thrombolytic therapy emphasizes the need for adjunctive therapy to prevent rethrombosis. We studied r-hirudin for its potential to prevent reocclusion in a model of coronary artery thrombosis/thrombolysis. The circumflex coronary arteries of anesthetized dogs were instrumented with a flow probe, an intraluminal electrode, and a ligature stenosis. The dogs were reanesthetized on the ninth postoperative day, and intimal injury was induced with an anodal current. After occlusive thrombus formation, tissue plasminogen activator (rt-PA) was administered. The animals were allocated to receive either placebo, r-hirudin [5 mg/kg intravenously (i.v.) bolus, 2 mg/kg/h i.v., for 3.5 h] or r-hirudin (5 mg/kg i.v., bolus, 1 mg/kg/h i.v., for 12 h). Neither aspirin nor heparin was used. Ex vivo platelet function and coronary artery blood flow velocity were recorded on each of 5 consecutive days. Infarct size and residual thrombus weight were determined at the end of the protocol. r-Hirudin infusion (3.5 and 12 h) provided little benefit over rt-PA alone. Ex vivo platelet aggregation was not affected by r-hirudin. Little improvement in the incidence of reocclusion and mortality in a model of coronary artery thrombosis/thrombolysis resulted from adjunctive treatment with r-hirudin.

Animals↗

PubMed1999

Efficacy of brimonidine 0.2% as adjunctive therapy for patients with glaucoma inadequately controlled with otherwise maximal medical therapy.

PURPOSE: To evaluate the clinical efficacy and tolerability of brimonidine tartrate 0.2% twice daily as adjunctive therapy for glaucoma patients inadequately controlled with otherwise maximal tolerated medical therapy. DESIGN: Retrospective, noncomparative, case series. PARTICIPANTS: Ninety-six patients were identified from the authors' tertiary glaucoma practice who were treated with brimonidine. Their glaucoma was uncontrolled despite maximal tolerated medical therapy before receiving brimonidine, and some had previously undergone argon laser trabeculoplasty or filtration surgery. The patients were subdivided according to their glaucoma diagnosis: open-angle (OAG), angle-closure (ACG), mixed mechanism, and congenital glaucoma. Both the short- (about 2 weeks) and long-term results were evaluated. Twenty-two patients were excluded because additional medication changes were made at the time of introduction of brimonidine. INTERVENTION: Brimonidine was added to the existing regimen of glaucoma medication. MAIN OUTCOME MEASURES: Intraocular pressure (IOP) was recorded at all follow-up dates, together with visual field examination and optic disc evaluation twice yearly. RESULTS: There were 44 OAG, 20 ACG, 6 mixed mechanism, and 4 congenital glaucoma patients. Mean pretreatment IOP, mean short-term post-treatment IOP, and mean short-term IOP reduction (percentage) were 23.10 +/- 5.21 mmHg, 18.49 +/- 4.77 mmHg, and 4.6 mmHg (20%) for OAG; 22.80 +/- 5.70 mmHg, 18.65 +/- 5.75 mmHg, and 4.15 mmHg (18%) for ACG; 25.00 +/- 10.32 mmHg, 21.00 +/- 12.12 mmHg, and 4.0 mmHg (16%) for mixed mechanism; and 26.00 +/- 4.97 mmHg, 17.75 +/- 4.57 mmHg, and 8.25 mmHg (32%) for congenital glaucoma, respectively. Mean long-term follow-up was 204 days for OAG and 213 days for ACG. Of the initially controlled OAG and ACG patients, at 3 months 96% and 100%, at 6 months 80% and 77%, and at 9 months 58% and 44%, respectively, were still controlled. Six patients discontinued brimonidine, three of these owing to allergy. CONCLUSION: As adjunctive therapy, brimonidine achieved a short-term IOP reduction of 16%-32% in this patient population; 77%-80% of initially controlled patients were still controlled after 6 months. Brimonidine was well tolerated.

Adolescent↗

PubMed2006

Pelvic floor muscle training and adjunctive therapies for the treatment of stress urinary incontinence in women: a systematic review.

BACKGROUND: Stress urinary incontinence (SUI) is a prevalent and costly condition which may be treated surgically or by physical therapy. The aim of this review was to systematically assess the literature and present the best available evidence for the efficacy and effectiveness of pelvic floor muscle training (PFMT) performed alone and together with adjunctive therapies (eg biofeedback, electrical stimulation, vaginal cones) for the treatment of female SUI. METHODS: All major electronic sources of relevant information were systematically searched to identify peer-reviewed English language abstracts or papers published between 1995 and 2005. Randomised controlled trials (RCTs) and other study designs eg non-randomised trials, cohort studies, case series, were considered for this review in order to source all the available evidence relevant to clinical practice. Studies of adult women with a urodynamic or clinical diagnosis of SUI were eligible for inclusion. Excluded were studies of women who were pregnant, immediately post-partum or with a diagnosis of mixed or urge incontinence. Studies with a PFMT protocol alone and in combination with adjunctive physical therapies were considered. Two independent reviewers assessed the eligibility of each study, its level of evidence and the methodological quality. Due to the heterogeneity of study designs, the results are presented in narrative format. RESULTS: Twenty four studies, including 17 RCTs and seven non-RCTs, met the inclusion criteria. The methodological quality of the studies varied but lower quality scores did not necessarily indicate studies from lower levels of evidence. This review found consistent evidence from a number of high quality RCTs that PFMT alone and in combination with adjunctive therapies is effective treatment for women with SUI with rates of 'cure' and 'cure/improvement' up to 73% and 97% respectively. The contribution of adjunctive therapies is unclear and there is limited evidence about treatment outcomes in primary care settings. CONCLUSION: There is strong evidence for the efficacy of physical therapy for the treatment for SUI in women but further high quality studies are needed to evaluate the optimal treatment programs and training protocols in subgroups of women and their effectiveness in clinical practice.

Journal Article↗

PubMed2001

Plasmapheresis: an adjunct therapy in severe progressive neuropsychiatric lupus.

OBJECTIVE: We report our experience with use of plasmapheresis (PP) as an adjunct therapy in severe progressive neuropsychiatric systemic lupus erythematosus (NPSLE). METHOD: Three patients of NPSLE (including 2 with status epilepticus) who were progressively worsening on steroids or combination of pulse cyclophosphamide (CPM) and steroids were treated with PP followed by synchronized CPM. Pre and post treatment SLE Disease Activity Index (SLEDAI) and laboratory tests were carried out. RESULTS: Significant clinical improvement with decrease in SLEDAI occurred immediately following PP. Mean SLEDAI before and after PP were 33 and 11. Mean erythrocyte sedimentation rate decreased from 121 to 31. Rebound flare of disease activity noted in two patients between 7th-10th day requiring additional immunosuppressants or steroids. CONCLUSIONS: PP used as an adjunct therapy in severe, progressive NPSLE is well tolerated and can turn the patient around. PP should be followed by synchronized pulse CPM to prevent disease flare.

Adolescent↗

PubMed2006

Pilot study of imiquimod 5% cream as adjunctive therapy to curettage and electrodesiccation for nodular basal cell carcinoma.

BACKGROUND: Curettage and electrodesiccation (C&D) is a widely used method to treat nodular basal cell carcinoma (BCC). However, residual tumor is present immediately after the procedure in approximately 20 to 40% of cases. Imiquimod, a topical immune response modifier that targets Toll-like receptor 7, is currently approved for superficial BCC. OBJECTIVE: In a double-blind, vehicle-controlled study, the administration of imiquimod after C&D was investigated to determine if the combination regimen would reduce the frequency of residual tumor compared with C&D alone in patients with nodular BCC. METHODS: Twenty patients received three cycles of C&D followed by imiquimod 5% or vehicle cream once daily for 1 month as adjunctive therapy. The primary end point was the frequency of residual tumor. The secondary end points included the time to heal and cosmetic appearance. RESULTS: Twenty patients were randomized to the imiquimod (n = 10) or vehicle (n = 10) treatment group. At 8 weeks, the proportion of patients with residual tumor was substantially decreased with imiquimod therapy (10%) compared with vehicle (40%). Wounds in the vehicle group healed more quickly than those in the imiquimod group, although by 8 weeks, all excision sites were healed. The majority of scars in the control group were atrophic and hypopigmented, whereas most scars in the imiquimod group were flat and slightly pink. CONCLUSION: Imiquimod 5% cream once daily for 1 month as adjunctive therapy after C&D substantially reduced the frequency of residual tumor and improved the cosmetic appearance compared with C&D alone. These preliminary results suggest that further studies to investigate imiquimod adjunctive therapy are warranted.

Adult↗