ABSTRACT
INTRODUCTION: Desmoteplase is an investigational plasminogen activator found in the saliva of the vampire bat, Desmodus rotundus. It has been of scientific interest for over 25 years as it exhibits pharmacological properties that have led to the hypothesis that desmoteplase may be safer and more effective than recombinant tissue plasminogen activator (rtPA) in arterial thromboembolic disease, and in particular, acute ischaemic stroke (AIS). AREAS COVERED: In this review, the authors cover the pharmacological properties of desmoteplase, focussing on how this translates into a theoretical advantage over rtPA in AIS. The authors further present preclinical studies and clinical data on the use of desmoteplase in AIS. EXPERT OPINION: In contrast to rtPA, and despite a similar structure, desmoteplase has demonstrated high selectivity for fibrin and an absence of neurotoxicity in experimental models. Demonstrating such properties in animal models, one would have expected an ambitious clinical study future. Phase II and Phase III clinical studies in patients with AIS demonstrated an excellent safety profile with low risk of symptomatic intracranial haemorrhage compared to rtPA. However, data on clinical and radiological efficacy end points of desmoteplase in AIS are inconclusive. Further Phase III trials are currently underway and their results are eagerly awaited.
Subject(s)
Brain Ischemia/drug therapy , Plasminogen Activators/pharmacology , Plasminogen Activators/therapeutic use , Animals , Clinical Trials, Phase II as Topic , Clinical Trials, Phase III as Topic , Drug Evaluation, Preclinical , Fibrinolytic Agents/pharmacology , Fibrinolytic Agents/therapeutic use , Humans , Stroke/drug therapyABSTRACT
BACKGROUND: Current guidelines do not recommend G-CSF for patients with risk factors for neutropenia. MATERIAL/METHODS: One-hundred patients undergoing chemotherapy were randomized to treatment with G-CSF at 5 Kg/kg for established febrile neutropenia (ANC <1000/microl) (Group A) or G-CSF at 263 Kg/day if ANC was 1500/microl or less on the day of the expected nadir, with the duration of treatment determined by the severity of neutropenia (Group B). RESULTS: The number of doses of G-CSF was similar in the two groups. There were 34 cases of febrile neutropenia in Group A, but none in Group B (p=0.0001). Hospital admission for febrile neutropenia, antibiotic use and delays in chemotherapy were all significantly more common in Group A. Total direct costs were estimated to be 66, 646 for Group A and 47, 119 for Group B. CONCLUSIONS: Tailoring treatment does not increase G-CSF use, but significantly reduces febrile neutropenia and treatment delays and lowers direct costs.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Fever/drug therapy , Granulocyte Colony-Stimulating Factor/administration & dosage , Neoplasms/drug therapy , Neutropenia/drug therapy , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/economics , Drug Administration Schedule , Female , Fever/blood , Fever/complications , Granulocyte Colony-Stimulating Factor/economics , Humans , Leukocyte Count , Male , Middle Aged , Neoplasms/blood , Neoplasms/complications , Neutropenia/blood , Neutropenia/complications , Neutrophils/cytology , Neutrophils/drug effectsABSTRACT
We report a rare case of actinomycetoma of the foot (madura foot) due to Actinomadura madurae in a patient living in a Temperate Zone country. Plain radiographs and MRI imaging were useful in establishing the diagnosis.
