Itp steroid therapy

Ruiz-Delgado et al (2011) stated that thrombocytopenia ensuing during acute graft-versus-host disease (GVHD) is multi-factorial and may significantly compromise the prognosis of the patient; non-immune persistent thrombocytopenia has been considered as an adverse prognostic factor in GVHD.  These investigators described the case of a 10-year old girl who developed steroid-refractory thrombocytopenia and who responded promptly to the subcutaneous delivery of romiplostin.  The authors noted that to the best of their knowledge, this is the first description of the usefulness of the peptibody in the setting of GVHD.  However, UpToDate reviews on "Overview of immunosuppressive agents used for prevention and treatment of graft-versus-host disease" (Chao, 2012a),"Treatment of chronic graft-versus-host disease" (Chao, 2012b), and "Treatment of acute graft-versus-host disease: Clinical trials" (Chao, 2012c) do not mention the use of romiplostim as a therapeutic option.

Prednisolone.  Prednisolone (or prednisone) is the initial therapy for most patients with ITP who require treatment ( McMillan, 1981 ; Bussel, 1990 ; Warkentin & Kelton, 1990 ). Some two-thirds of patients will respond to prednisolone at 1 mg/kg body weight per day for 2–4 weeks, tapering off over several weeks ( Ben-Yehuda et al, 1994 ; George et al, 1994 ; Stasi et al, 1995 ). Reported response rates vary widely (from 3% to 50%) ( George et al, 1996 ). A single randomized trial showed no difference in response to low dose  mg/kg/d vs 1 mg/kg/d in 160 children and 223 adults ( Bellucci et al, 1988 ). Relapse of thrombocytopenia is common when the dose is reduced. Around one-third of patients can expect a long-term response ( Berchtold & McMillan, 1989 ; George et al, 1996 ; Manoharan, 1991 ; Blanchette et al, 1998 ). Corticosteroids should be rapidly tapered and stopped in patients who fail to respond to oral prednisolone after 4 weeks ( Pizzuto & Ambriz, 1984 ; Ben-Yehuda et al, 1994 ). Long-term remission is seen in only 10–20% of patients following cessation of prednisolone therapy ( Ben-Yehuda et al, 1994 ; Stasi et al, 1995 ). Patients who fail to respond to treatment with corticosteroids or require unacceptably high doses of corticosteroid in order to maintain a safe platelet count should be considered for splenectomy ( Ben-Yehuda et al, 1994 ; George et al, 1994 ).

60 mg/m2 orally daily on days 1, 2, 3, and 4; bortezomib mg/m2 subcutaneously twice weekly on weeks 1, 2, 4, and 5 of cycle 1 followed by bortezomib mg/m2 subcutaneously once weekly on weeks 1, 2, 4, and 5 of cycles 2 to 9; and melphalan 9 mg/m2 orally daily on days 1, 2, 3, and 4 repeated every 42 days for 9 cycles in combination with daratumumab 16 mg/kg IV every 3 weeks for 8 doses (starting on cycle 2) was evaluated in a randomized, phase III trial (the ALCYONE trial; n = 706). Treatment with daratumumab 16 mg/kg IV every 4 weeks was continued until disease progression or unacceptable toxicity.

A number of studies have revealed various health benefits of plant polyphenols and their importance in foods, beverages and natural medicine. In this context, polyphenols have some potential efficacy for preventing obesity. They inhibit enzymes related to fat metabolism including PL, lipoprotein lipase, and glycerophosphate dehydrogenase [74]. Polyphenol extracts are able to decrease the blood levels of glucose, triglycerides and LDL cholesterol, increase energy expenditure and fat oxidation, and reduce body weight and adiposity [75,76]. In fact, many polyphenols, including flavones, flavonols, tannins and chalcones, have shown an inhibitory activity of PL [9,22].
Flavonoids are a type of plant secondary metabolites which are characterized as containing two or more aromatic rings, each bearing at least one aromatic hydroxyl and connected with a carbon bridge [76]. Some of them are polymerized into large molecules, either by the plants themselves or as a result of food processing. These polymers are called tannins and three subclasses (condensed tannins, derived tannins and hydrolysable tannins) exhibit a variety of beneficial effects on health [76].

Itp steroid therapy

itp steroid therapy

A number of studies have revealed various health benefits of plant polyphenols and their importance in foods, beverages and natural medicine. In this context, polyphenols have some potential efficacy for preventing obesity. They inhibit enzymes related to fat metabolism including PL, lipoprotein lipase, and glycerophosphate dehydrogenase [74]. Polyphenol extracts are able to decrease the blood levels of glucose, triglycerides and LDL cholesterol, increase energy expenditure and fat oxidation, and reduce body weight and adiposity [75,76]. In fact, many polyphenols, including flavones, flavonols, tannins and chalcones, have shown an inhibitory activity of PL [9,22].
Flavonoids are a type of plant secondary metabolites which are characterized as containing two or more aromatic rings, each bearing at least one aromatic hydroxyl and connected with a carbon bridge [76]. Some of them are polymerized into large molecules, either by the plants themselves or as a result of food processing. These polymers are called tannins and three subclasses (condensed tannins, derived tannins and hydrolysable tannins) exhibit a variety of beneficial effects on health [76].

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