Drug-induced immune haemolytic anaemia (DIIHA) is extremely rare. We herein report a case of life-threatening DIIHA due to levofloxacin. This is the second case reported in the literature. A 51-year-old woman presented with complaints of fatigue after 4-5 days of levofloxacin therapy for a lung infection. At presentation, she was found to have haemolysis with a positive Coombs test and IgG autoantibodies. Levofloxacin was identified as the probable culprit, using the Naranjo adverse drug reaction probability scale. Upon discontinuation of the drug and initiation of steroids, the patient's haematological parameters stabilised. Diagnosis of DIIHA is made through a history of intake of levofloxacin, clinical and laboratory features of haemolysis and a positive Coombs test. An autoantibody screen is most commonly positive for warm antibodies (IgG type). It is essential for clinicians to recognise this rare complication caused by a commonly prescribed medication, discontinue the offending drug and initiate treatment.
Anemia, Hemolytic ; chemically induced ; Anti-Bacterial Agents ; adverse effects ; therapeutic use ; Autoantibodies ; blood ; Female ; Fluoroquinolones ; adverse effects ; Hemolysis ; Humans ; Immunoglobulin G ; blood ; Levofloxacin ; adverse effects ; Male ; Middle Aged ; Steroids ; therapeutic use

There is no consensus on whether it is safe to re-administer tumor necrosis factor-alpha (TNFalpha) inhibitors in patients with rheumatoid arthritis (RA) or ankylosing spondylitis (AS) flared after withdrawal of TNFalpha inhibitors due to active tuberculosis (TB). We evaluated the safety of restarting anti-TNFalpha therapy in patients with TNFalpha-associated TB. We used data of 1,012 patients with RA or AS treated with TNFalpha inhibitors at Seoul St. Mary's Hospital between January 2003 and July 2013 to identify patients who developed active TB. Demographic and clinical data including the results of tuberculin skin tests (TST) and interferon-gamma releasing assays (IGRA) were collected. Fifteen patients developed active TB. Five cases were occurred in RA and 10 cases in AS. Nine of 15 patients had a negative TST or IGRA and 6 TST-positive patients had received prophylaxis prior to initiating anti-TNFalpha therapy. All patients discontinued TNFalpha inhibitors with starting the treatment of TB. Eight patients were re-administered TNFalpha inhibitors due to disease flares and promptly improved without recurrence of TB. TNFalpha inhibitors could be safely resumed after starting anti-TB regimen in patients with RA or AS.
Adult ; Aged ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects/therapeutic use ; Antibodies, Monoclonal/adverse effects/therapeutic use ; Antibodies, Monoclonal, Humanized/adverse effects/therapeutic use ; Antirheumatic Agents/adverse effects/therapeutic use ; Arthritis, Rheumatoid/*drug therapy ; Enzyme Inhibitors/adverse effects/therapeutic use ; Female ; Humans ; Hydroxychloroquine/adverse effects/therapeutic use ; Immunoglobulin G/adverse effects/therapeutic use ; Immunosuppressive Agents/adverse effects/*therapeutic use ; Interferon-gamma Release Tests ; Male ; Methotrexate/adverse effects/therapeutic use ; Middle Aged ; Mycobacterium tuberculosis/isolation & purification ; Receptors, Tumor Necrosis Factor/therapeutic use ; Retrospective Studies ; Spondylitis, Ankylosing/*drug therapy ; Tuberculin Test ; Tuberculosis/*chemically induced/microbiology ; Tumor Necrosis Factor-alpha/*antagonists & inhibitors

Glycosylation of the Fc region of IgG has a profound impact on the safety and clinical efficacy of therapeutic antibodies. While the biantennary complex-type oligosaccharide attached to Asn297 of the Fc is essential for antibody effector functions, fucose and outer-arm sugars attached to the core heptasaccharide that generate structural heterogeneity (glycoforms) exhibit unique biological activities. Hence, efficient and quantitative glycan analysis techniques have been increasingly important for the development and quality control of therapeutic antibodies, and glycan profiles of the Fc are recognized as critical quality attributes. In the past decade our understanding of the influence of glycosylation on the structure/function of IgG-Fc has grown rapidly through X-ray crystallographic and nuclear magnetic resonance studies, which provides possibilities for the design of novel antibody therapeutics. Furthermore, the chemoenzymatic glycoengineering approach using endoglycosidase-based glycosynthases may facilitate the development of homogeneous IgG glycoforms with desirable functionality as next-generation therapeutic antibodies. Thus, the Fc glycans are fertile ground for the improvement of the safety, functionality, and efficacy of therapeutic IgG antibodies in the era of precision medicine.
Animals ; Antibodies, Monoclonal ; adverse effects ; pharmacokinetics ; therapeutic use ; Glycosylation ; Humans ; Immunoglobulin G ; chemistry ; metabolism ; Protein Engineering ; methods ; Receptors, Fc ; chemistry ; metabolism ; Treatment Outcome

BACKGROUND/AIMS: The treatment for steroid-refractory acute graft versus host disease (GVHD) after allogeneic stem cell transplantation (allo-SCT) needs to be standardized. We report our clinical experience with etanercept for steroid-refractory acute GVHD. METHODS: Eighteen patients who underwent allo-SCT and presented with steroid-refractory acute GVHD at Ajou University Hospital were studied retrospectively. They were given 25 mg of etanercept subcutaneously twice weekly for 4 weeks. The clinical responses were evaluated with regard to the severity of acute GVHD. RESULTS: The median patient age was 43.5 years. Using nonparametric tests, etanercept had a down-grading effect on acute GVHD (p = 0.005), although no patient experienced complete remission. Partial responses were seen in 80%, 17%, and 57% of grade II to IV patients, respectively. Skin and gut GVHD were well controlled with etanercept, whereas hepatic GVHD was not. Four patients died of fatal infections. No factors affecting the clinical outcome of etanercept were identified. CONCLUSIONS: Etanercept has a modest effect on steroid-refractory acute GVHD after allo-SCT, with tolerable side effects.
Acute Disease ; Adult ; Aged ; Allografts ; Female ; Graft vs Host Disease/etiology/*therapy ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Humans ; Immunoglobulin G/adverse effects/*therapeutic use ; Immunosuppressive Agents/adverse effects/therapeutic use ; Male ; Middle Aged ; Receptors, Tumor Necrosis Factor/*therapeutic use ; Retrospective Studies ; Steroids/therapeutic use ; Young Adult

OBJECTIVETo observe the therapeutic effect of Yiqi Yangyin principle (YQYY, the treating principle in TCM to supplement Qi and nourish Yin) on corticosteroid withdrawal in patients with systemic lupus erythematosus (SLE) in remission stage and its influence on some immune parameters.

METHODSThe SLE patients were divided into two groups, 30 in the treated group and 10 in the control group, who were treated by conventional method with corticosteroids and/or immunosuppressant in acute progressive stage, and YQYY was added to the treated group in remission stage.

RESULTSThe total effective rate was 93.3% in the treated group and 90.0% in the control group, comparison between the two groups showed significant difference by Ridit test (P < 0.05). The immune parameters, IgG and C3 were significantly improved after treatment in the treated group (P < 0.01), but changed insignificantly in the control group. The maintaining dose of prednisone used in the two groups was 7.08 +/- 5.26 mg/d and 11.72 +/- 6.48 mg/d respectively, the amount used in the treated group was significantly lower than that in the control.

CONCLUSIONUsing mainly YQYY Principle to treat SLE in remission stage could withdraw the corticosteroid smoothly, relieve symptoms and improve immune function.

Adolescent ; Adult ; Child ; Complement C3 ; metabolism ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Immunoglobulin G ; blood ; Lupus Erythematosus, Systemic ; drug therapy ; Male ; Middle Aged ; Phytotherapy ; Prednisone ; adverse effects ; therapeutic use ; Substance Withdrawal Syndrome ; drug therapy

OBJECTIVETo explore the enhancing effect of compound Kusheg injection in chemotherapy for patients with stage III and IV non-small cell lung cancer (NSCLC).

METHODSA total of 286 patients with advanced NSCLC were enrolled in this study. The patients were treated with either compound Kusheng injection in combination with NP (NVB + CBP) chemotherapy (vinorelbine and carboplatin, n = 144), or with NP (NVB + CBP) chemotherapy alone (n = 142). The chemotherapy was performed for 4 cycles of 3 weeks, and the therapeutic efficacy was evaluated every 2 weeks. The following indicators were observed: levels of Hb, WBC, PLT and T cell subpopulations in blood, serum IgG level, short-term efficacy, adverse effects and quality of life.

RESULTSThe gastrointestinal reactions and the myelosuppression in the combination chemotherapy group were alleviated as compared with the chemotherapy alone group, showing a significant difference (P < 0.05). CD(8)(+) cells were markedly declined in the combination chemotherapy group, and the CD(4)(+)/CD(8)(+) ratio showed an elevation trend in the chemotherapy alone group. The KPS scores and serum IgM and IgG levels were higher in the combination chemotherapy group than those in the chemotherapy alone group (P < 0.01 and P < 0.05). The serum lgA levels were not significantly different in the two groups.

CONCLUSIONThe compound Kusheng injection plus NP chemotherapy regimen shows better therapeutic effect, reduces adverse effects of chemotherapy and improves the quality of life in patients with stage III and IV NSCLC.

Aged ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; CD4-CD8 Ratio ; Carboplatin ; administration & dosage ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; pathology ; Drugs, Chinese Herbal ; adverse effects ; therapeutic use ; Female ; Humans ; Immunoglobulin G ; blood ; Immunoglobulin M ; blood ; Leukopenia ; chemically induced ; Lung Neoplasms ; drug therapy ; pathology ; Male ; Middle Aged ; Nausea ; chemically induced ; Neoplasm Staging ; Phytotherapy ; Quality of Life ; Vinblastine ; administration & dosage ; analogs & derivatives

OBJECTIVETo observe the change of nephron damaged by chemotherapy and to evaluate the effect of Baoshen Mixture (, BSM) in protecting and treating damaged nephrons.

METHODSFour hundred tumor patients with normal renal function and ready to receive chemotherapy were randomly assigned to two groups. Both groups received one cycle of chemotherapy program of 28-30 days with conventional hydratization, alkalization and chloridization. To the 200 cases in the treated group BSM was given orally thrice a day, 150 mL every time for 15 successive days and the other 200 cases in the control group were treated by chemotherapy alone. The clinical efficacy was compared after treatment, and the changed condition of damaged nephrons were monitored dynamically and compared at different time points (the 3rd, 7th, 14th and 21st day after chemotherapy) by measuring the micro-globulin beta(2) (beta(2)-MG), albumin (Alb) and immunoglobulin G (IgG) levels in urine with radioimmunoassay (RIA).

RESULTS(1) The effective rates in the treated group at the 4 time points of observation were all higher than those in the control group respectively (P<0.05 or P<0.01); (2) Less occurrence of abnormal beta(2)-M, Alb and IgG levels on the 14th and 21st day in the treated group took place compared to that in the control group (P<0.01); (3) Urinary levels of beta(2)-MG, Alb and IgG reached the peak on the 7th day in both groups, and then, they came down gradually and returned to the normal level on the 21st day. However, comparison between the two groups showed that all the three parameters in the treated group on day 3, 14 and 21 were lower than the respective one at the corresponding time points in the control group (P<0.05 or P<0.01).

CONCLUSIONThe chemotherapy damage on nephron is regular in time, and reversible when treated suitably. TCM shows a marked effect in protecting and treating the damage on nephron caused by chemotherapy.

Adult ; Aged ; Albuminuria ; prevention & control ; Antineoplastic Agents ; adverse effects ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Immunoglobulin G ; urine ; Male ; Middle Aged ; Nephrons ; drug effects ; beta 2-Microglobulin ; urine

OBJECTIVETo evaluate of therapeutic efficacy of deoxyribouncleotidum on pulmonary tuberculosis.

METHODSEighty patients with pulmonary tuberculosis sustaining hepatic lesion after treatment with antituberculosis drugs were randomized into therapeutic group and control group. Patients in the control group received regular treatment and those in the therapeutic group had additional deoxyribouncleotidum injection.

RESULTSALT, AST, ALP and TBIL levels were significantly higher in the therapeutic group than in the control group 4 weeks after treatment. IgG, IgA, IgM levels, and CD3(+) and CD8(+) lymphocytes were significantly increased in the therapeutic group after treatment (P<0.05).

CONCLUSIONdeoxyribouncleotidum can improve hepatic function and immunity in patients with pulmonary tuberculosis.

Adjuvants, Immunologic ; administration & dosage ; therapeutic use ; Adult ; Alanine Transaminase ; metabolism ; Antitubercular Agents ; adverse effects ; therapeutic use ; Aspartate Aminotransferases ; metabolism ; CD3 Complex ; immunology ; CD8-Positive T-Lymphocytes ; cytology ; drug effects ; immunology ; Chemical and Drug Induced Liver Injury ; Deoxyribonucleotides ; administration & dosage ; therapeutic use ; Female ; Humans ; Immunoglobulin A ; blood ; Immunoglobulin G ; blood ; Immunoglobulin M ; blood ; Injections ; Liver Diseases ; blood ; drug therapy ; Male ; Middle Aged ; Treatment Outcome ; Tuberculosis, Pulmonary ; blood ; drug therapy

OBJECTIVETo observe the effect of Astragalus membranaceus efficacy enhancing and toxicity reducing on chemotherapy in patients of malignant tumor.

METHODSOne hundred and twenty tumor patients were randomly divided into the treated group and the control group. Both groups were treated with chemotherapy, but to the treated group, Astragalus injection was given additionally by intravenous dripping, 20 ml in 250 ml of normal saline once per day for 21 days as one course and 4 courses were given successively.

RESULTSCompared with the control group, the treated group showed a lower progressive incidence, lesser decrease of peripheral WBC and platelet count (P < 0.05), accompanied with CD8 significantly lowered (P < 0.05), CD4/CD8 ratio significantly increased (P < 0.01), IgG and IgM levels raised (P < 0.05) and Karnofsky scores elevated more than those in the control group. IgA level was unchanged in both groups.

CONCLUSIONAstragalus injection supplemented with chemotherapy could inhibit the development of tumor, decrease the toxic-adverse effect of chemotherapy, elevate the immune function of organism and improve the quality of life in patients.

Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; adverse effects ; therapeutic use ; Astragalus membranaceus ; chemistry ; CD4-CD8 Ratio ; Cisplatin ; administration & dosage ; Cyclophosphamide ; administration & dosage ; Doxorubicin ; administration & dosage ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Etoposide ; administration & dosage ; Female ; Fluorouracil ; administration & dosage ; Humans ; Immunoglobulin G ; blood ; Infusions, Intravenous ; Lung Neoplasms ; drug therapy ; immunology ; Male ; Middle Aged ; Mitomycin ; administration & dosage ; Phytotherapy ; Stomach Neoplasms ; drug therapy ; immunology