fumarates and Autoimmune-Diseases

Long-term management of psoriasis requires an individualized approach. Some treatments such as calcipotriol, methotrexate and acitretin may be used as maintenance treatment for many months. However, most anti-psoriasis treatments should be prescribed for restricted periods of time. Rotational treatment is a practical approach to reduce the cumulative toxicity of anti-psoriasis treatments. The selection of a treatment is based on the clinical presentation of psoriasis and whether contraindications might exist. Combination treatment is another approach, which is used by the majority of patients. Useful combinations are calcipotriol-acitretin, calcipotriol-cyclosporin, calcipotriol-PUVA, calcipotriol-topical corticosteroids, dithranol-UVB, dithranol-tar, coaltar-UVB, acitretin-UVB and acitretin-PUVA. Combinations which are contraindicated are coaltar-PUVA, UVB-cyclosporin, PUVA-cyclosporin and methotrexate-acitretin. Combined use of UVB-methotrexate, UVB-PUVA; PUVA-methotrexate; methotrexate-cyclosporin and cyclosporin-acitretin require careful monitoring and might be helpful in patients with severe and recalcitrant psoriasis. Depending on the individual presentation of psoriasis, previous anti-psoriatic treatments and side-effects, treatment adjustments are made.

Topics: Acitretin; Administration, Topical; Anti-Inflammatory Agents; Autoimmune Diseases; Calcitriol; Dermatologic Agents; Drug Administration Schedule; Drug Therapy, Combination; Fumarates; Glucocorticoids; Humans; Immunosuppressive Agents; Keratolytic Agents; Methotrexate; Phototherapy; Psoriasis; PUVA Therapy

Severe cases of psoriasis and psoriasis arthritis require systemic treatment. Although a number of established drugs are in clinical use, there is a need for new compounds with an improved risk-benefit ratio with a major emphasis on long-term safety. Furthermore, patients with moderate psoriasis ask for systemic drugs to make therapy easier and to avoid excessive local treatments. This article aims to give a brief overview about new drugs or groups of compounds together with an evaluation of their present status in the treatment of psoriasis and their future role with particular respect to efficacy, tolerability, safety and usability.

Topics: Antibodies, Monoclonal; Anticarcinogenic Agents; Antigen-Presenting Cells; Arthritis, Psoriatic; Autoimmune Diseases; Dermatologic Agents; Fumarates; Humans; Immunosuppressive Agents; Immunotherapy; Keratolytic Agents; Platelet Aggregation Inhibitors; Psoriasis; Receptors, Cytoplasmic and Nuclear; Transcription Factors

Topics: Administration, Oral; Alopecia Areata; Autoimmune Diseases; Biological Availability; Clinical Trials as Topic; Comorbidity; Dermatologic Agents; Dimethyl Fumarate; Dose-Response Relationship, Drug; Drug Administration Schedule; Education; Etanercept; Follow-Up Studies; Fumarates; Humans; Immunoglobulin G; Metabolic Clearance Rate; Pilot Projects; Prospective Studies; Psoriasis; PUVA Therapy; Quality of Life; Receptors, Tumor Necrosis Factor; Registries; Sick Role

Fumaric acid esters (FAE) have been proven to be effective for the systemic treatment of psoriasis and multiple sclerosis, Th1 cell-mediated chronic inflammatory diseases, but their effect on autoimmune myocarditis has not yet been addressed. We investigated the effect of dimethyl fumarate (DMF) on myosin-induced experimental autoimmune myocarditis (EAM).. Dark Agouti (DA) rats immunized with porcine cardiac myosin were orally treated with 5 and 15 mg/kg body weight (bw) DMF either from days 0-10 (early treatment groups) or from days 10-21 (late treatment groups) after induction of EAM. All rats were sacrificed on day 21 after immunization and hearts were evaluated macroscopically and microscopically. Levels of TNF-alpha and IL-10 in serum and lymph node cells culture supernatants were detected by ELISA.. Both early and late treatment with 15 mg/kg body weight (bw) DMF markedly reduced the severity of myocarditis by comparing the incidence, heart weight/bw ratio, macroscopic and microscopic scores, and number of OX-6+ cells in the myocardium. Further, levels of tumor necrosis factor-alpha (TNF-alpha) in serum and culture supernatants of lymph node cells stimulated with ConA or myosin were significantly lower in DMF-treated EAM animals compared with vehicle-treated EAM rats. There was no significant difference in serum levels of interleukin-10 between DMF- and vehicle-treated EAM rats.. These results show for the first time that DMF ameliorates experimental autoimmune myocarditis and may be acted, at least in part, by interfering with the production of TNF-alpha.

Topics: Animals; Autoimmune Diseases; Dimethyl Fumarate; Disease Models, Animal; Fumarates; Immunosuppressive Agents; Interleukin-10; Lymphocytes; Male; Myocarditis; Myocardium; Myosins; Rats; Tumor Necrosis Factor-alpha