ABSTRACT
The clinical manifestation of myasthenia gravis is due to the acetylcholine transmission defect of neuromuscular junction caused by autoimmune disturbance. With the intensive understanding of the pathogenesis and the emerging of specific immunological targeting therapy, therapeutic investigations are widely expanding. A multi-target therapy pattern is now available based on treatments primed to distinct immunopathological processes and improving neuromuscular junction transmission. We will comment the status and problems in this article.
ABSTRACT
Objective The treatment of anti-neutrophil cytoplasmic antibodies ( ANCA) associated vasculitis ( AVV) such as mycophenolate mofetil ( MMF ) can improve the remission rate, however, it also results in high recurrence rate and high incidence of adverse reaction related to the treatment.The article was to observe the clinical efficacy and safety of multi-target therapy ( MT ) in the treatment of AAV with renal involvement. Methods Retrospective observation was made on 7 AVV patients treated with multi-target therapy in our department from June 2009 to October 2013.The pa-tients (1 male, 6 females) aged from 21 to 54 years were accompa-nied with renal damage and serum creatinine (SCr≤3 mg/dL).All patients had positive myelopeeroxidase-ANCA (MPO-ANCA), high-grade proteinuria and hematuria.4 patients had elevated SCr (1.47-2.94 mg/dL) with EGFR90 mL/min in 2 patients and EGFR60 mL/min) .At the end of follow-up, the EGFR expres-sion was normal in 4 patients, 60-90 mL/min in 1 patient and less than 60 mL/min in 2 patients, without end stage renal disease. ANCA level turned to normal in 3 patients and significantly decreased in 4 patients.No patients had adverse reaction, died, or re-lapsed during the follow-up. Conclusion MT is effective in the control of renal activities of AVV patients with mild or moderate re-nal function damage.It attributes to great improvement of renal function and urine protein, as well as good tolerance.However, pro-spective study is required to confirm the efficacy of this new therapy.
ABSTRACT
Objective To explore the efficacy of multiple target therapy in treatment of patients with chronic moderate and severe IgA nephropathy with hyperuricemia.Methods Seventy-six patients with chronic progressive moderate and severe IgA nephropathy with hyperuricemia were enrolled the current study and randomly divided into observation group and control group.Patients in control group were treated with allopurinol,prednisone,benner pury and valsartan,while those in observation group were treated with urokinase,mycophenolate mofetil besides the basis of control group for 6 months.The blood uric acid (UA),24 h urine protein,mean arterial pressure (MAP) and creatinine clearance rate (Ccr) were determined and analyzed.Results The levels of UA,24 h urinary protein,MAP and Ccr in observation group and control group were same before treatment (P ＞ 0.05).After 6 months treatment,the levels of UA,24 h urine protein,MAP and Ccr in observation group were (413.7 ± 90.7) μmol/L,(1.15 ± 0.57) g/L,(87.7 ± 10.6) mmHg and (81.9 ± 3.7) ml/min respectively,significantly different from those of the control group ((369.6 ± 67.2) μ mol/L,(0.77 ±0.51) g/L,(81.6 ±12.3) mmHg and (86.4 ±6.8) ml/min;t =2.219,2.802,2.132,3.230;P ＜0.05).The rate of adverse reactions in two groups was not significantly differnent(9.7％ (3/31) vs 9.1％ (3/33) ; x2 =0.006,P =0.936).Conclusion Multiply target therapy is effective and safe in terms of treating chronic progressive moderate and severe IgA nephropathy with hyperuricemia.