Print ISSN: 2706-6207

Online ISSN: 2664-3154

Keywords : efficacy

Efficacy, Safety and Predictors of Response to Rituximab in Treatment of Iraqi Patients with Active Rheumatoid Arthritis

Sarah Tareq Abdulazeez; Sami Salman; Faiq I. Goria

Al- Anbar Medical Journal, 2019, Volume 15, Issue 1, Pages 16-21

Background: Rituximab (RTX) is an anti-CD20 chimeric monoclonal antibody which effectively depletes B cells and is used for treating rheumatoid arthritis (RA). Objectives: To assess the efficacy and safety of RTX and to evaluate the predictors of response to RTX in the treatment of Iraqi patients with active RA. Materials and methods: An open-labeled single group study that was conducted over 13 months in 65 patients with RA diagnosed according to a 1987 American College of Rheumatology (ACR) criteria. All patients were given 4 doses RTX by intravenous infusion over 6 months 1gm/dose. Each patient was followed at each visit of disease activity, including the Clinical Disease Activity Index (CDAI) and functional class (F Class). Also, we assess 9 different patients’ characteristics (age, gender, disease duration, the presence of RF, presence of ACPA, smoking status, previous use of TNF-blocker, the use of methotrexate and BMI) as predictors to RTX. Results: Data analysis showed significant improvement in CDAI (P value=0.005) and functional disability (P-value =0.001), and ESR (P-value =0.005) with RTX use over 6 months. The analysis also showed that smoking has a negative correlation with response to treatment (p-value = 0.005). A better response was seen in RF-positive group. The other variables had no effects on the response to treatment. The patients who switched from TNF-blocker were (29), and the patients who started on RTX were 36 (either due to positive Purified Protein Derivative of a tuberculin test (PPD) or unavailability of TNF-blocker), results showed same RTX efficacy in both groups. Conclusion: RTX is effective both clinically (CDAI and F Class) and laboratory (ESR). It is more effective in patients who are not smokers, and in those who are seropositive for RF. RTX is relatively safe with few side effects, tolerable by most patients. The most common side effect is a transfusion reaction in the form of a sore throat.

Latanoprost Therapy In Primary Open-Angle Glaucoma Patients: A Three-Month Study In Al-Anbar Province

Majid A. K. Lafi

Al- Anbar Medical Journal, 2012, Volume 10, Issue 2, Pages 1-10

Background: Primary open angle glaucoma (POAG) is the most common form of glaucoma throughout world, accounting for about two-thirds of cases. Latanoprost is a prostaglandin (PG) F2α derivative and has a strong effect on lowering the intraocular pressure (IOP) in patients with POAG and in normal eyes.
Objectives: The aim of this study is to evaluate the IOP lowering effect and safety of latanoprost in POAG naïve patients and in patients on timolol exhibited insufficient response, in Al-Ramadi Teaching Hospital.
Patients and Methods: Forty-seven Iraqi patients (47 eyes) with POAG were enrolled in a single center (Al-Ramadi Teaching Hospital) in prospective uncontrolled observational cohort study. The mean age (± S.D) was 57.09±2.04. The baseline IOP of 38 naïve patients stratified into ≥ 21 ≤30 vs. ˃30mmHg. Nine patients who had been treated with timolol but exhibited insufficient response, they were shifted to latanoprost and enrolled in this study. All participants were treated with 0.005% latanoprost once daily (evening) for 3 months. IOP levels were measured at baseline and after 1, 2 and 3 months. The efficacy outcome was mean change and mean percent change in IOP from baseline to month 1, 2 and 3.
Results: At all follow-up visits there was a significant reduction in IOP compared with the baseline value in naïve patients treated by latanoprost as 1st line (P<0.0001) and in patients shifted from timolol to latanoprost (P<0.001). The baseline IOP was 26.69±3.22 (mean±SD) mmHg, 36.43 ±3.67 mmHg and 22.00 ±4.15 mmHg in ≥ 21 ≤30 mmHg group, ˃30mmHg group and in patients shifted from timolol to latanoprost respectively. After 3 months, the IOP was reduced by 12.31±3.22 mmHg (45.63±8.26%), 21.43±4.16 mmHg (58.40±6.33%) and 8.00±3.74 mmHg (34.88±10.02%) respectively. No evidence of an upward drift in the IOP was observed during the treatment period. The most frequently reported adverse ocular effects were mild conjunctival hyperemia. No adverse systemic effects were observed. Timolol has been added to latanoprost in five naïve patients (14.2%) to achieve the desired therapeutic objective. Three naïve patients were lost to follow up. None of the patients needed shifting from medical to surgical treatment.
Conclusion: It is highly justified to use latanoprost as 1st line monotherapy in POAG naive patients and in patients whose IOP is insufficiently controlled on β-blocker monotherapy (timolol) by shifting them to latanoprost.