RESUMEN
BACKGROUND/AIMS: We examined the effectiveness of escalating the dose of interferon-alpha-2b in subjects with chronic hepatitis C who did not respond to usual treatment with 3,000,000 units 3 times a week. METHODOLOGY: Treatment was started with 3,000,000 units of interferon-alpha-2b 3 times a week. If serum alanine aminotransferase activity was not normal at 12 weeks, the dose was increased to 3,000,000 units daily. If serum alanine aminotransferase activity was not normal after 12 weeks, the dose was increased to 5,000,000 units daily. RESULTS: Fifty-one subjects started treatment. Twenty-nine subjects had their dose increased to 3,000,000 units daily and only 1 responded (3%, 95% confidence interval 0-10.9%) while 41% (95% confidence interval 21.4-60.6%) had to discontinue treatment at this dose because of adverse events or intolerance. Of 14 subjects who had their dose increased to 5,000,000 units daily, none (95% confidence interval 0-3.6%) responded, while 43% (95% confidence interval 13.5-72.5%) had to discontinue treatment. CONCLUSIONS: Escalating doses of interferon-alpha-2b are not effective and are associated with increased toxicity and intolerance in patients with chronic hepatitis who do not respond to initial treatment with 3,000,000 units 2 times a week.
Asunto(s)
Hepatitis C Crónica/terapia , Interferón-alfa/administración & dosificación , Adulto , Anciano , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Estudios de Seguimiento , Hepacivirus/efectos de los fármacos , Humanos , Interferón alfa-2 , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , ARN Viral/sangre , Proteínas Recombinantes , Resultado del Tratamiento , Replicación Viral/efectos de los fármacosRESUMEN
Left ventricular assist devices effectively improve hemodynamic function and reverse renal and hepatic dysfunction; however, their effects upon the gastrointestinal (Gl) system have not been addressed. We evaluated Gl function in 27 left ventricular assist device recipients using interviews, Gl contrast studies, endoscopy, and 99mTc sulfur colloid studies of esophageal transit and gastric emptying. While on left ventricular assist device support (mean duration of 84 days), 19 patients reported early satiety and/or nausea, and 1 was unable to tolerate oral intake. Esophageal transit time (normal, < 10 sec) was borderline slow at 14 +/- 4 (mean +/- standard error of the mean) and gastric emptying (normal < 90 min) was prolonged (range of 106-506 min, mean = 283 +/- 69 min). In a 1-38 month follow-up, gastric function subjectively improved in all. Six patients had intraperitoneal device placement. One died of aspiration pneumonia secondary to small bowel obstruction, and one had prolonged inability to tolerate oral intake, which required feeding jejunostomy tube placement. The 21 patients with pre peritoneal placement of the device did not require Gl operative interventions and had no catastrophic Gl events; they had mild to no Gl complaints. Pre peritoneal placement may mitigate early satiety and obviate serious Gl complications.
Asunto(s)
Vaciamiento Gástrico/fisiología , Enfermedades Gastrointestinales/etiología , Tránsito Gastrointestinal/fisiología , Corazón Auxiliar/efectos adversos , Fenómenos Fisiológicos del Sistema Digestivo , Endoscopía Gastrointestinal , Corazón Auxiliar/normas , Hemodinámica/fisiología , Humanos , Marcaje Isotópico , Complicaciones Posoperatorias , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , TecnecioRESUMEN
A conjugate of 4-desacetylvinblastine-3-carboxyhydrazide (DAVLBHY) and the glioma-reactive monoclonal antibody (mAb) 9.2.27 induced long-term suppression of tumor growth in athymic nude mice engrafted with U87MG human glioma cells. In vitro, DAVLBHY had the strongest antiproliferative activity (inhibitory concentration at which incorporation of [3H]thymidine is at 50% of untreated control is 2.0 x 10(-9) M) of seven cytotoxic drugs tested and so was chosen for conjugation to mAb 9.2.27, which reacts specifically with the core protein of chondroitin sulfate proteoglycans found in human glioblastomas. After conjugation of DAVLBHY to the carbohydrate residues of mAb 9.2.27 it retained its full binding capacity. For in vivo studies, DAVLBHY and several conjugate derivatives were evaluated by using two dosages of i.v. injections, each starting 2 days after s.c. tumor inoculation. The control tumors reached a volume of nearly 3000 mm3 within 30 days. Tumor growth was delayed by about 20 days with four i.v. injections of 0.5 mg/kg 9.2.27-DAVLBHY, which was slightly superior to the unconjugated drug. Moreover, 9.2.27-DAVLBHY produced a highly significant suppression of growth so that the average tumor volume was only 3% of that observed in untreated controls after 28 days. Four injections of this conjugate at a larger dose, 2.0 mg/kg, prevented recurrence of the tumors for 130 days in all animals tested, thus demonstrating a significant increase in the therapeutic index, since the unconjugated drug provided limited inhibition of tumor growth for only 40 days. The specificity of the antitumor effect was demonstrated in a comparison with the control conjugate, KS1/4-DAVLBHY, which despite partial tumor suppression had only a transient effect. The specific antitumor effect of 9.2.27-DAVLBHY was unexpected, since the target antigen is expressed at a relatively low density (40,000 sites/cell) on U87MG glioma cells.