New Treatment Modalities for VitiligoKostovic, Kresimir; Pasic, Aida
doi: 10.2165/00003495-200565040-00002pmid: 15733009
The development of effective treatment modalities for vitiligo is dependent on an understanding of the events leading to depigmentation. However, the exact pathogenesis of vitiligo is still mostly unknown. Abnormalities in both humoral and cell-mediated immunity have been documented in vitiligo patients and they present a basis for using immunomodulating agents, such as corticosteroids and macrolide immunomodulators, in the treatment of vitiligo. Macrolide immunomodulators, such as tacrolimus and pimecrolimus, which can be used topically, are known as topical immunomodulators (TIMs). TIMs inhibit the action of calcineurin, and consequently inhibit T-cell activation and the production of various cytokines; this is considered the working mechanism of action of TIMs in vitiligo. Several small studies and case reports on the use of TIMs in vitiligo have been published so far. Tacrolimus achieves better results on the face and neck than on other body areas.
An Overview of Economic Evaluations for Drugs Used in Rheumatoid ArthritisBansback, Nick; Regier, Dean; Ara, Roberta; Brennan, Alan; Shojania, Kamran; Esdaile, John; Anis, Aslam; Marra, Carlo
doi: 10.2165/00003495-200565040-00004pmid: 15733011
Rheumatoid arthritis (RA) is a chronic, progressive, inflammatory disease that affects approximately 0.5–1% of the adult population. The introduction of new disease-modifying antirheumatic drugs (DMARDs) such as leflunomide, anakinra and the tumour necrosis factor (TNF)-α antagonists (infliximab, etanercept and adalimumab) have transformed the management of RA. In particular, the last class of agents has generated substantial controversy. Costing between $US16 000 and $US20 000 per patient-year (2001 values), the potential greater efficacy of treatment with TNFα antagonists comes at much higher drug costs, making these agents natural candidates for cost-effectiveness analyses (CEAs).
Management of Sight-Threatening UveitisBecker, Matthias; Smith, Justine; Max, Regina; Fiehn, Christoph
doi: 10.2165/00003495-200565040-00005pmid: 15733012
Over the past 2 decades therapy for the treatment of intraocular inflammation (uveitis) has developed into a highly differentiated approach with an increasing number of drug options. This paper primarily summarises literature from the past 5 years (2000 to May 2004), gives an update on systemic immunosuppressive therapy for non-infectious uveitis and speculates about new developments that could become relevant in the near future for the treatment of uveitis patients. The spectrum of immunosuppressive drugs has been notably expanded by tumor necrosis factor inhibitors, but with some limitations to uveitis. Behçet’s disease is an example of uveitis where a multisystem disorder can affect the eye very severely. This clinical example has been used to investigate the utility of many different types of immunosuppressive therapies and the clinical approach is extensively discussed in this review. An accompanying table summarises the proposed mode of action, standard dosage, common adverse effects, as well as estimated cost of current treatment options.