161,728 research outputs found
AIT (allergen immunotherapy): a model for the “precision medicine”
No full textThe interpretation of medical approaches, especially therapy, evolved rapidly in the last century. Starting from the simple description of symptoms, we moved to the pathophysiological descriptions, to the evidence-based medicine, until the so-called "precision medicine". This latter can be defined as a structural model aimed at customizing healthcare, with medical decisions/products tailored on an individual patient at a highly detailed level. In this sense, allergen immunotherapy represents an optimal model of "precision medicine", since we know and describe symptoms, function, aetiological agents at molecular level, and we have the possibility to intervene on the natural history of the disease. If considered under the point of view of pharmaco-economy, that is prescribing the optimal treatment to the right patient, allergen immunotherapy represents an almost-ideal model of precision medicine
Allergen immunotherapy as add-on to biologic agents
No full textPurpose of review: In this review, we sought to outline many of the recent evidences about the available clinical trials in which
biologic agents [i.e. omalizumab (OMA)] were associated as add-on to allergen-specific immunotherapy (AIT).
Recent findings: The available literature shows that OMA may be a valuable option as add-on to AIT for respiratory allergy,
or food desensitization, especially in the escalation or build-up phases, in which adverse events are more
commonly expected. The encouraging data for hymenoptera venom allergy remain limited to case reports,
and no structured clinical trial is available.
Summary: Over the past decade, studies of OMA used with AIT have shown promising results. Today, big
randomized, double-blind, placebo-controlled trials are needed to better select those patients who would
benefit from the addition of OMA (or other biologic agents) to AIT, as well as optimal dosing schedules,
optimal duration of treatments and, finally, adequate evaluation about pharmacoeconomic aspect
Patient-reported outcomes in asthma clinical trials
No full textPurpose of review The review provides an overview of the results of asthma clinical trials published in peer review journals in the last 18 months that evaluated patient-reported outcomes (PROs). Recent findings In the last 10 years, health care moved toward a patient-centered approach, which includes patients' perspectives reflecting the impact of a disease and its treatment. Summary Surprisingly, among the almost 300 clinical trials published in the last one and a half year, PRO evaluation was performed in only 20 studies, and none of them held in a real-life setting. The effort of applying the scientific methods of PRO investigations in asthma clinical trials following a rigorous and systematic approach needs to be highly improved to allow better understanding of patient reported factors. Some recommendations are drawn particularly about PRO assessment in personalized medicine research. The ability of an individual PRO to evaluate choice of treatment and its effectiveness remains to be achieved
From "blockbusters" to "biosimilars": An opportunity for patients, medical specialists and health care providers
No full textAdvances in basic research and research and development plans of pharmaceutical companies are radically changing the kind of available drugs and therapeutic targets. We are switching from predominantly chemical molecules, aimed at treating large populations of patients (blockbuster drugs), to a new generation of products, mostly biotech, aimed at modifying a specific pathogenetic mechanism. In other word we are moving fast to targeted therapy, which represents the first step toward personalized therapy, where the right drug at the right dose is administered to the right person, at the right time. Like the patent expiration of chemical products has corresponded to the development of generic drugs, the expiration of new biotech products will witness the appearance of biosimilars. The latter are biologic products that are highly similar but not identical to the reference medical products in terms of quality, safety and efficacy. This implies specific research, clinical monitoring, physicians updating of knowledge for a safe and appropriate use of these products. We are the beginning of a devolution in patient's care and physicians' practice. © 2012 Elsevier Ltd
Le funzioni della forma canonica nel sistema matrimoniale canonico
No full textLa celebrazione dei matrimonio e un atto che supera la sfera privata dei coniugi e convolge la communita. Gli ordinamenti giuridici hanno pertanto regolato il modo di scambiarsi il consenso matrimoniale. Con il decreto Tametsi il Concilio di Trento impose per la validita del matrimonio l’obbligo di una forma speciale, cioè la forma canonica.
L’analisi svolta in questo articolo ha dimostrato che la forma canonica compie nel sistema matrimoniale canonico una triplice funzione, cioè: l’intergrazione della sostanza dei matrimonio, la ricezione dellatto consensuale e la certezza per quanto riguarda la manifestazione dei consenso
Strategies to reduce corticosteroid-related adverse events in asthma
No full textPurpose of review Severe asthmatics, despite the chronic use of high inhaled corticosteroids (ICS) doses and frequent intake of systemic corticosteroids, remains clinically and/or functionally uncontrolled. These patients are also often affected by rhinitis or chronic rhinosinusitis requiring frequent use of intranasal corticosteroids. Therefore, severe asthmatics are exposed to an overload of corticosteroids that is frequently associated with relevant and costly adverse events. This clinical problem and the strategies to overcome it are here summarized. Recent findings Different therapeutic options may help in reducing the corticosteroid load in asthmatics, ranging from allergy immunotherapy (nonsuitable for severe uncontrolled patients), immunosuppressant agents like methotrexate or cyclosporine, novel biologic drugs (mainly anti-IgE, anti-IL5 and anti-IL4-receptor-alpha), and aspirin desensitization (for patients with anti-inflammatory drugs exacerbated respiratory disease). Summary The evidence of even serious corticosteroid-related adverse events associated with consistent health-care costs, should prompt the entire scientific community and health regulatory authorities to promote actions to increase the use of well tolerated and effective strategies to reduce the corticosteroid need in asthmatics; the most promising option seems to be the add-on use of biologic agents
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