Fifteen-year experience with natalizumab in the treatment of multiple sclerosis - a description of 15 clinical cases.

Natalizumab, a humanized anti-alpha4-integrin antibody, is a valuable therapeutic option for relapsing-remitting multiple sclerosis and has been widely used in this indication since 2006. The growing body of data on its high efficacy and safety profile, both from randomised trials and clinical practice, has allowed to identify risk factors for progressive multifocal leukoencephalopathy and to develop a preventive algorithm, which increased the therapeutic safety. Natalizumab also seems relatively safe in pregnant women as there is no indication in the available literature suggesting that exposure to this drug has a significant impact on pregnancy outcomes. However, adequate and well-controlled studies are still lacking and natalizumab should only be used in pregnancy if clearly needed. The mechanism of action of natalizumab also proved successful during the COVID-19 pandemic. Most patients receiving this therapy experienced only mild infection and developed normal vaccine-induced immunity after immunisation. We present a description of 15 patients with relapsing-remitting multiple sclerosis treated with natalizumab in 15 different centres throughout Poland. The drug was included both due to first-line treatment failure and in cases of rapidly progressing, severe form of multiple sclerosis. The patients differed in terms of disease duration, the length of natalizumab therapy, and JCV serological status. The described cases include patients from the natalizumab registration trial, women who became pregnant while on the therapy, and patients who developed COVID-19. The presented case reports summarise the experience to date with the use of natalizumab in the treatment of relapsing-remitting multiple sclerosis in PolandCopyright © 2022 Buchajewicz et al.

The Effect of Carriage of CYP3A5*3 and CYP3A4*22 Polymorphic Variants on the Safety of Remdesivir Therapy in Patients with COVID-19.

The aim of the study was to assess the association of polymorphic variants CYP3A5*3 6986 A>G rs776746 and CYP3A4*22 rs35599367 C>T with the safety parameters of remdesivir therapy in patients with COVID-19. Material and methods. The study included 156 patients admitted to the City Clinical Hospital No. 15 of the Moscow Health Department with COVID-19 diagnosis, who received remdesivir as an antiviral drug. The frequency of adverse reactions (bradycardia, dyspeptic disorders), as well as various laboratory parameters (ALT, AST, creatinine, ferritin, interleukin-6, and d-dimer levels) were compared between the carriers of wild-type and polymorphic variants of the studied genes. Results. Carriers of CYP3A5*3 polymorphic variants (GA+AA) had higher ALT levels after the treatment with remdesivir than carriers of the wild variant (GG). When comparing the level of interleukin-6 after therapy with remdesivir, carriers of the polymorphic variant of the CYP3A4*22 (CT) gene had a significantly higher level of this cytokine. Conclusion. An association between the carriage of polymorphic variants of CYP3A5*3 and an increase in the level of liver enzymes was found. Polymorphic variants of CYP3A4*22 were associated with higher levels of interleukin-6. Additional pharmacogenetic studies are required to assess the possibilities of personalizing antiviral therapy for COVID-19.Copyright © Team of Authors, 2022.

Using a Decision Tree with a Feedback Function to Select Therapeutic Tactis for Viral Infection of the Respiratory Tract in the Medical Expert System

The Electronic Clinical Pharmacologist (ECP) is a Medical Decision Support System (MDSS). This system is based on the Unified Medical Knowledge Base (UMKB), which is updated and updated as new medicines are released and specialized publications are published in peer-reviewed biomedical scientific journals. ECP helps to reduce the risks of medical errors and complications in clinical practice. When using ECP, the number of side effects from the use of medicines decreases, the patient's admission time is reduced, the quality of medical care is improved, the costs of the medical organization for the purchase of medicines are reduced, all this is carried out due to more rational prescriptions of the doctor. The ECP takes into account the personalized approach of drug therapy. Based on Stavropol State Medical University and medical universities of the North Caucasus Federal District, a questionnaire of students was conducted among students of 3-6 courses, as well as testing of the ECP application to compare treatment standards (clinical recommendations) according to the clinical recommendations of the Ministry of Health (outpatient, inpatient treatment) and self-treatment of students and their relatives. And patterns of changes in the course of treatment were also revealed when using MDSS ECP and without it. (C) 2022 INT TRANS J ENG MANAG SCI TECH.