Conversion From Tacrolimus/Mycophenolic Acid to Tacrolimus/Leflunomide to Treat Cutaneous Warts in a Series of Four Pediatric Renal Allograft Recipients

Nguyen, Lieuko; McClellan, Robert B.; Chaudhuri, Abanti; Alexander, Steven R.; Chen, Sharon F.; Concepción, Waldo; Grimm, Paul

doi:10.1097/tp.0b013e318264351e

Cited by 8 publications

(13 citation statements)

References 26 publications

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“…88 The anti-viral efficacy of leflunomide has also been observed in transplant recipients infected with BK virus 89 and human papillomavirus (HPV). 90 In patients with polyomavirus type BK nephropathy, those that had blood A77 1726 concentrations higher than 40 μg/mL had either cleared the virus or showed progressive reductions of viral load in blood and urine. 89 In another study, 90 leflunomide successfully cleared verrucae vulgaris and molluscum lesions in four renal transplant patients with cutaneous warts, usually caused by HPV.…”

Section: Leflunomidementioning

confidence: 99%

“…90 In patients with polyomavirus type BK nephropathy, those that had blood A77 1726 concentrations higher than 40 μg/mL had either cleared the virus or showed progressive reductions of viral load in blood and urine. 89 In another study, 90 leflunomide successfully cleared verrucae vulgaris and molluscum lesions in four renal transplant patients with cutaneous warts, usually caused by HPV. However, it is worth noting that leflunomide has been associated with interstitial lung disease.…”

Section: Leflunomidementioning

confidence: 99%

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The immunology of COVID-19: is immune modulation an option for treatment?

Zhong

Tang

et al. 2020

The Lancet Rheumatology

227

238

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The coronavirus disease 2019 (COVID-19) pandemic caused by the new coronavirus (SARS-CoV-2) is currently responsible for over 500 thousand deaths in 216 countries across the world and is affecting over 10 million people. The absence of FDA approved drugs against the new SARS-CoV-2 virus has highlighted an urgent need to design new drugs. We developed an integrated model of the human cell and the SARS-CoV-2 virus to provide insight into the pathogenetic mechanism of the virus and to support current therapeutic strategies. We show the biochemical reactions required for the growth and general maintenance of the human cell, rst of all, in its healthy state. We then demonstrate how the entry of the SARS-CoV-2 virus into the human cell causes biochemical and structural changes, leading to a change of cell functions or cell death. We have completed a comparative analysis of our model and other previously generated cell type models and highlight 48 pathways and over 800 reactions hijacked by the virus for its replication and survival. We designed a new tool which predicts 15 unique reactions as drug targets from our models (the integrated human macrophage, human airway epithelial cells and the SARS-CoV2 virus) and provide a platform for future studies on viral entry inhibition and drug optimisation strategies.

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Section: Leflunomidementioning

confidence: 99%

Section: Leflunomidementioning

confidence: 99%

The immunology of COVID-19: is immune modulation an option for treatment?

Zhong

Tang

et al. 2020

The Lancet Rheumatology

227

238

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“…Multiple recalcitrant verrucae in three and molluscum in one of renal allograft recipients cleared after switching from MMF to leflunomide. 104 …”

Section: Part Ii: Dmards With Antiviral Potential Other Than Sars-covmentioning

confidence: 99%

Oral disease-modifying antirheumatic drugs and immunosuppressants with antiviral potential, including SARS-CoV-2 infection: a review

Tsai

2020

Therapeutic Advances in Musculoskeletal

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There have been several episodes of viral infection evolving into epidemics in recent decades, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the latest example. Its high infectivity and moderate mortality have resulted in an urgent need to find an effective treatment modality. Although the category of immunosuppressive drugs usually poses a risk of infection due to interference of the immune system, some of them have been found to exert antiviral properties and are already used in daily practice. Recently, hydroxychloroquine and baricitinib have been proposed as potential drugs for SARS-CoV-2. In fact, there are other immunosuppressants known with antiviral activities, including cyclosporine A, hydroxyurea, minocycline, mycophenolic acid, mycophenolate mofetil, leflunomide, tofacitinib, and thalidomide. The inherent antiviral activity could be a treatment choice for patients with coexisting rheumatological disorders and infections. Clinical evidence, their possible mode of actions and spectrum of antiviral activities are included in this review article. Lay summary Immunosuppressants often raise the concern of infection risks, especially for patients with underlying immune disorders. However, some disease-modifying antirheumatic drugs (DMARDs) with inherent antiviral activity would be a reasonable choice in the situation of concomitant viral infections and flare up of autoimmune diseases. This review covers DMARDs of treatment potential for SARS-CoV-2 in part I, and antiviral mechanisms plus trial evidence for viruses other than SARS-CoV-2 in part II.

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“…Acquiring an STI in a renal transplant recipient is concerning as the immunosuppression status may lead to a more fulminant presentation as seen with genital warts [29], or make it difficult to eradicate without prolonged treatment courses or alterations in the immunosuppression regimen [30]. STI treatment agents may have significant interactions with immunosuppressants metabolized by the hepatic cytochrome p450 pathways leading to complicated regimens and higher frequency of side effects.…”

Section: Burden and Relevance To Clinical Practicementioning

confidence: 99%

“…The serotypes included in the vaccine are responsible for about 75% of cervical cancer cases in females and about 90% of genital wart cases in both genders [47]. The prospect of using Gardasil ® for prevention is promising particularly since HPV-associated warts are a common occurrence in patients with chronic kidney disease [48] and may be resistant to standard topical therapy post transplantation [30]. Given the increased morbidity of HPV infection in immunocompromised individuals, the American College of Obstetricians and Gynecologists (ACOG) published exceptions to its Pap screening guideline in adolescents which now recommends screening six months apart after onset of sexual activity followed by annual screening in adolescent solid organ recipients [49].…”

Section: Vaccinationmentioning

confidence: 99%

Sexuality and Reproductive Health Counseling in Adolescent Renal Transplant Recipients

Isa

Ryan²

2014

TOUNJ

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Normal adolescence marks a period of significant physical, cognitive and psychosocial change. It is characterized by transition from concrete to abstract thought processes and concern for risk taking behaviors. Adolescents and young adults with chronic conditions are at a particular disadvantage and tend to be more vulnerable to risky behavior than their healthy peers. While there currently exists no information on the burden of sexually transmitted infections (STIs) in adolescent renal transplant recipients, they present a particularly worrisome population as they are likely to engage in risk taking behavior when they feel “normal” following transplantation to compensate for poor quality of life endured on dialysis. This is further compounded by adolescents’ false perception that they are unlikely to acquire such infections, and the likely improvement in libido and sexual functioning after transplantation. The potential for acquiring a sexually transmitted infection is concerning given their immunocompromised status, and complex treatment regimens which might have unfavorable interactions with STI treatments. Also, unintentional pregnancy is likely to have a significant impact on their overall medical condition and social functioning thereby impacting their long term allograft outcomes. As the pediatric nephrologist assumes a primary care provider role for these patients following their renal transplant, it becomes increasingly important to be familiar with basic reproductive health counseling techniques and available contraceptive methods on the market. Until consensus guidelines and specific recommendations for reproductive health counseling are developed for adolescent renal transplant recipients, this review provides a brief summary of available knowledge in those areas.

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Conversion From Tacrolimus/Mycophenolic Acid to Tacrolimus/Leflunomide to Treat Cutaneous Warts in a Series of Four Pediatric Renal Allograft Recipients

Cited by 8 publications

References 26 publications

The immunology of COVID-19: is immune modulation an option for treatment?

The immunology of COVID-19: is immune modulation an option for treatment?

Oral disease-modifying antirheumatic drugs and immunosuppressants with antiviral potential, including SARS-CoV-2 infection: a review

Sexuality and Reproductive Health Counseling in Adolescent Renal Transplant Recipients

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