Marshall Protocol Knowledge Base - home:othertreatments:immune_suppressants

Anti-TNF drugs

anonymous@undisclosed.example.com (Anonymous) — Wed, 14 Sep 2022 20:53:53 +0000

Corticosteroids

anonymous@undisclosed.example.com (Anonymous) — Wed, 14 Sep 2022 20:53:53 +0000

12.02.2018		current
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	The effects of steroids on the outcome of sepsis are dose dependent. Low doses appear to be beneficial, but high doses do not improve outcome for reasons that are insufficiently understood. The effects of steroids on systemic inflammation as a function of dose have not previously been studied in humans.		The effects of steroids on the outcome of sepsis are dose dependent. Low doses appear to be beneficial, but high doses do not improve outcome for reasons that are insufficiently understood. The effects of steroids on systemic inflammation as a function of dose have not previously been studied in humans.

-	These data indicate that prednisolone dose-dependently and differentially influences the systemic activation of different host response pathways during human endotoxemia. (({{pubmed>long:17237435}}))</blockquote>	+	These data indicate that prednisolone dose-dependently and differentially influences the systemic activation of different host response pathways during human endotoxemia.
		+	//de Kruif et al// (({{pmid>long:17237435}}))</blockquote>

-	A sudden and unprecedented increase in low dose naltrexone (LDN) prescribing in Norway. Patient and prescriber characteristics, and dispense patterns. A drug utilization cohort study	+	A sudden and unprecedented increase in low dose naltrexone (LDN) prescribing in Norway. Patient and prescriber characteristics, and dispense patterns. A drug utilization cohort study by Raknes G. and Småbrekke L.

-	<blockquote>We emphasize that we have neither examined indications, nor the efficacy or safety of LDN use. Many patients became persistent users of LDN, and this may be interpreted as a perceived acceptable effect and safety profile among these patients. This cannot be considered as a proof of LDN treatment efficacy for any condition. (({{pubmed>long:27670755}}))</blockquote>	+	<blockquote>We emphasize that we have neither examined indications, nor the efficacy or safety of LDN use. Many patients became persistent users of LDN, and this may be interpreted as a perceived acceptable effect and safety profile among these patients. This cannot be considered as a proof of LDN treatment efficacy for any condition. (({{pmid>long:27670755}}))</blockquote>

-	<blockquote>We found that LDN was associated with reduced plasma concentrations of interleukin (IL)-1β, IL-1Ra, IL-2, IL-4, IL-5, IL-6, IL-10, IL-12p40, IL-12p70, IL-15, IL-17A, IL-27, interferon (IFN)-α, transforming growth factor (TGF)-α, TGF-β, tumor necrosis factor (TNF)-α, and granulocyte-colony stimulating factor (G-CSF). We also found a 15% reduction of FM-associated pain and an 18% reduction in overall symptoms. (({{pubmed>long:28536359}}))</blockquote>	+	<blockquote>Parkitny L. and Younger J found that LDN was associated with reduced plasma concentrations of interleukin (IL)-1β, IL-1Ra, IL-2, IL-4, IL-5, IL-6, IL-10, IL-12p40, IL-12p70, IL-15, IL-17A, IL-27, interferon (IFN)-α, transforming growth factor (TGF)-α, TGF-β, tumor necrosis factor (TNF)-α, and granulocyte-colony stimulating factor (G-CSF). We also found a 15% reduction of FM-associated pain and an 18% reduction in overall symptoms. (({{pmid>long:28536359}}))</blockquote>

	==== Short-term palliative effect ====		==== Short-term palliative effect ====
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	===== Corticosteroids are ineffective ======		===== Corticosteroids are ineffective ======

-	There are no studies which show that steroids improve long-term prognosis in the treatment of illness. Van den Bosch and Grutters write(({{pubmed>long:16946094}})), "Remarkably, despite over 50 years of use, there is no proof of long-term (survival) benefit from corticosteroid treatment."	+	There are no studies which show that steroids improve long-term prognosis in the treatment of illness. Van den Bosch and Grutters write(({{pmid>long:16946094}})), "Remarkably, despite over 50 years of use, there is no proof of long-term (survival) benefit from corticosteroid treatment."

-	The 2003 NIH ACCESS study(({{pubmed>long:14620163}})), the largest and most ambitious to date, validates that these drugs are ineffective for sarcoidosis patients, even for a time period as short as two years.	+	The 2003 NIH ACCESS study(({{pmid>long:14620163}})), the largest and most ambitious to date, validates that these drugs are ineffective for sarcoidosis patients, even for a time period as short as two years.

	Table 3 in the paper shows how, for the majority of patients, markers of the disease process remained unchanged.		Table 3 in the paper shows how, for the majority of patients, markers of the disease process remained unchanged.
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	Latent pathogens grow slowly and accumulate over the course of decades. There is every reason to believe that a longer-term study as well as one looking at dose would further demonstrate how corticosteroids are worse than ineffective – they're dangerous. A more comprehensive paper would also have examined the range of negative side effects associated with coriticosteroid use.		Latent pathogens grow slowly and accumulate over the course of decades. There is every reason to believe that a longer-term study as well as one looking at dose would further demonstrate how corticosteroids are worse than ineffective – they're dangerous. A more comprehensive paper would also have examined the range of negative side effects associated with coriticosteroid use.

-	A systematic review(({{pubmed>long:15846612}})) of studies looking at the efficacy of inhaled and oral corticosteroids for pulmonary sarcoidosis concluded:	+	A systematic review(({{pmid>long:15846612}})) of studies looking at the efficacy of inhaled and oral corticosteroids for pulmonary sarcoidosis concluded:

	<blockquote>		<blockquote>
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	==== Corticosteroids cause relapse =====		==== Corticosteroids cause relapse =====

-	According to a comparative study(({{pubmed>long:9118698}})), 74% of patients relapse after trying to ease up their Prednisone dose, a significantly higher percentage of the time, and:	+	According to a comparative study(({{pmid>long:9118698}})), 74% of patients relapse after trying to ease up their Prednisone dose, a significantly higher percentage of the time, and:

	<blockquote>		<blockquote>
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	===== Side effects of corticosteroid therapy =====		===== Side effects of corticosteroid therapy =====

-	Corticosteroid therapy can produce a range of negative side effects in humans. Side effects tend to be dose- and duration-dependent. The table below summarizes some of the more common side effects. A more [[http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&term=%22Glucocorticoids%2Fadverse%20effects%22[MAJR]\|complete and up-to-date list]] of such studies is available at PubMed.	+	Corticosteroid therapy can produce a range of negative side effects in humans. Side effects tend to be dose- and duration-dependent. The table below summarizes some of the more common side effects. A more [[https://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&term=%22Glucocorticoids%2Fadverse%20effects%22[MAJR]\|complete and up-to-date list]] of such studies is available at PubMed.


	^System or function ^ Side effect^		^System or function ^ Side effect^
-	\|brain \|loss of brain tissue(({{pubmed>long:15882880}})) loss of cognition(({{pubmed>long:12013026}})) \|	+	\|brain \|loss of brain tissue(({{pmid>long:15882880}})) loss of cognition(({{pmid>long:12013026}})) \|
-	\|bone \|avascular necrosis of the bone(({{pubmed>long:11850924}})) (({{pubmed>long:10099819}})) osteoporosis(({{pubmed>long:15732231}})) osteonecrosis(({{pubmed>long:18757967}}))\|	+	\|bone \|avascular necrosis of the bone(({{pmid>long:11850924}})) (({{pmid>long:10099819}})) osteoporosis(({{pmid>long:15732231}})) osteonecrosis(({{pmid>long:18757967}}))\|
-	\|endocrine \|suppression of adrenal response(({{pubmed>long:10683005}})) (({{pubmed>long:9623166}})) widespread endocrine dysfunction(({{pubmed>long:2320881}})) Cushing's Syndrome(({{pubmed>long:15850848}})) \|	+	\|endocrine \|suppression of adrenal response(({{pmid>long:10683005}})) (({{pmid>long:9623166}})) widespread endocrine dysfunction(({{pmid>long:2320881}})) Cushing's Syndrome(({{pmid>long:15850848}})) \|
-	\|eyes \|cataracts(({{pubmed>long:3541262}})) glaucoma(({{pubmed>long:10641955}})) (({{pubmed>long:7701998}})) range of other side effects(({{pubmed>long:11820911}})) \|	+	\|eyes \|cataracts(({{pmid>long:3541262}})) glaucoma(({{pmid>long:10641955}})) (({{pmid>long:7701998}})) range of other side effects(({{pmid>long:11820911}})) \|
-	\|gastrointestinal \|gastrointestinal hemorrhage(({{pubmed>long:8927965}})) \|	+	\|gastrointestinal \|gastrointestinal hemorrhage(({{pmid>long:8927965}})) \|
-	\|muscle \|loss of skeletal muscle(({{pubmed>long: 12843161}})) myopathy (muscle weakness)(({{pubmed>long: 6851197}})) (({{pubmed>long: 9551512}})) (({{pubmed>long: 10939120}})) \|	+	\|muscle \|loss of skeletal muscle(({{pmid>long: 12843161}})) myopathy (muscle weakness)(({{pmid>long: 6851197}})) (({{pmid>long: 9551512}})) (({{pmid>long: 10939120}})) \|
-	\|psychological \|dementia(({{pubmed>long:15677408}})) \|	+	\|psychological \|dementia(({{pmid>long:15677408}})) \|
-	\|sexual, female \|menstruation disturbance(({{pubmed>long:2815743}}))\|	+	\|sexual, female \|menstruation disturbance(({{pmid>long:2815743}}))\|
-	\|sexual, male \|decrease testosterone(({{pubmed>long: 3083749}})) (({{pubmed>long: 7983641}})) \|	+	\|sexual, male \|decrease testosterone(({{pmid>long: 3083749}})) (({{pmid>long: 7983641}})) \|
-	\|skin \|skin atrophy(({{pubmed>long:11393207}})) \|	+	\|skin \|skin atrophy(({{pmid>long:11393207}})) \|


	==== Side effects in children ====		==== Side effects in children ====

-	Whether taking injectable or inhaled corticosteroids, children are particularly susceptible to the negative long-term effects of the drugs. The table below summarizes some of the more common side effects in children. A more [[http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=DetailsSearch&Term=%22Glucocorticoids%2Fadverse+effects%22[MAJR]+AND+%22Child%22[MeSH]\|complete and up-to-date list]] of such studies is available at PubMed.	+	Whether taking injectable or inhaled corticosteroids, children are particularly susceptible to the negative long-term effects of the drugs. The table below summarizes some of the more common side effects in children. A more [[https://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=DetailsSearch&Term=%22Glucocorticoids%2Fadverse+effects%22[MAJR]+AND+%22Child%22[MeSH]\|complete and up-to-date list]] of such studies is available at PubMed.

	^System or function ^ Side effect^		^System or function ^ Side effect^
-	\|bone \|higher risk of fractures(({{pubmed>long:12733732}})) loss of density(({{pubmed>long:18595975}})) \|	+	\|bone \|higher risk of fractures(({{pmid>long:12733732}})) loss of density(({{pmid>long:18595975}})) \|
-	\|dental \|eruption of permanent molars(({{pubmed>long:15470830}})) \|	+	\|dental \|eruption of permanent molars(({{pmid>long:15470830}})) \|
-	\|endocrine \|suppression of adrenal response(({{pubmed>long:15269067}})(({{pubmed>long:12904139}})) growth suppression(({{pubmed>long:1823076}})) (({{pubmed>long:9709954}})) (({{pubmed>long:11826253}})) Cushing's syndrome(({{pubmed>long:18183788}})) \|	+	\|endocrine \|suppression of adrenal response(({{pmid>long:15269067}})(({{pmid>long:12904139}})) growth suppression(({{pmid>long:1823076}})) (({{pmid>long:9709954}})) (({{pmid>long:11826253}})) Cushing's syndrome(({{pmid>long:18183788}})) \|
-	\|immunological \|allergies(({{pubmed>long:11456363}})) \|	+	\|immunological \|allergies(({{pmid>long:11456363}})) \|
-	\|psychological \|psychosis(({{pubmed>long:15851433}})) poor attention(({{pubmed>long:14577022}})) \|	+	\|psychological \|psychosis(({{pmid>long:15851433}})) poor attention(({{pmid>long:14577022}})) \|
-	\|skin \|skin death(({{pubmed>long:1806315}})) \|	+	\|skin \|skin death(({{pmid>long:1806315}})) \|
-	\|urinary \|kidney stones(({{pubmed>long:8576746}})) \|	+	\|urinary \|kidney stones(({{pmid>long:8576746}})) \|


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	==== Images of side effects ====		==== Images of side effects ====

-	Courtesy the [[http://vasculitis.med.jhu.edu/treatments/prednisone.html\|Johns Hopkins Vasculitis Center]], these images are of corticosteroid users. (Click for a larger image and description.)	+	Courtesy the [[https://vasculitis.med.jhu.edu/treatments/prednisone.html\|Johns Hopkins Vasculitis Center]], these images are of corticosteroid users. (Click for a larger image and description.)

	{{gallery>home:othertreatments:sideeffects?showtitle&150x150&3&lightbox&nodirect }}		{{gallery>home:othertreatments:sideeffects?showtitle&150x150&3&lightbox&nodirect }}
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	{{tag>Other_medication immunosuppressant }}		{{tag>Other_medication immunosuppressant }}
		+	<nodisp>
	===== Notes and comments =====		===== Notes and comments =====

	* Legacy content		* Legacy content
-	* http://www.marshallprotocol.com/forum2/12438.html	+	* https://www.marshallprotocol.com/forum2/12438.html


-	* SARS and mental health problems – In a 2009 study, many survivors of the severe acute respiratory syndrome (SARS) pandemic of 2003 suffer from persistent mental health problems and chronic fatigue years later.(({{pubmed>long:20008700}})) Over 40% of the respondents had active psychiatric illnesses, 40.3% reported a chronic fatigue problem, with 27.1% meeting the modified 1994 CDC criteria for chronic fatigue syndrome. Also, being a health care worker at the time of SARS infection more than tripled the risk of psychiatric morbidities at follow-up. This may be because corticoteroids were used heavily during the recent SARS outbreak.(({{pubmed>long:16172857}}))	+	* SARS and mental health problems – In a 2009 study, many survivors of the severe acute respiratory syndrome (SARS) pandemic of 2003 suffer from persistent mental health problems and chronic fatigue years later.(({{pmid>long:20008700}})) Over 40% of the respondents had active psychiatric illnesses, 40.3% reported a chronic fatigue problem, with 27.1% meeting the modified 1994 CDC criteria for chronic fatigue syndrome. Also, being a health care worker at the time of SARS infection more than tripled the risk of psychiatric morbidities at follow-up. This may be because corticoteroids were used heavily during the recent SARS outbreak.(({{pmid>long:16172857}}))


	<blockquote>Hip necrosis can occur with a single dose of just 30mg of prednisone:		<blockquote>Hip necrosis can occur with a single dose of just 30mg of prednisone:

-	http://www.ncbi.nlm.nih.gov/pubmed/12189457	+	https://www.ncbi.nlm.nih.gov/pubmed/12189457

	..Trevor..		..Trevor..
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	===== References =====		===== References =====
	Edit summary Minor Changes		Edit summary Minor Changes
		+	</nodisp>

Telmisartan

anonymous@undisclosed.example.com (Anonymous) — Wed, 14 Sep 2022 20:53:53 +0000

09.16.2017		current
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	==== Transcription of antimicrobial peptides ====		==== Transcription of antimicrobial peptides ====

-	One of the VDR's key functions is the transcription of naturally produced broad-spectrum antibacterials which target pathogens.(({{pubmed>long:15322146}})) (({{pubmed>long:15985530}}))	+	One of the VDR's key functions is the transcription of naturally produced broad-spectrum antibacterials which target pathogens.(({{pmid>long:15322146}})) (({{pmid>long:15985530}}))

	==== Telmisartan ====		==== Telmisartan ====
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-	{{tag>non-MP_therapies }}	+	{{tag>non-MP_therapies immunosuppressant }}


	===== References =====		===== References =====
-	===== Notes and comments =====	+	<nodisp>
		+	===== Notes and comments =====</nodisp>

09.16.2017		current
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-	Tumor necrosis factor-alpha or TNF-alpha is a cytokine critical for effective immune surveillance and is required for proper proliferation and function of natural killer cells, T cells, B cells, macrophages, and dendritic cells.(({{pubmed>long:16331857}})) Anti-TNF drugs, also known as TNF blockers, are drugs which interfere with the body's production of TNF-alpha.(({{pubmed>long: 18387510}}))	+	Tumor necrosis factor-alpha or TNF-alpha is a cytokine critical for effective immune surveillance and is required for proper proliferation and function of natural killer cells, T cells, B cells, macrophages, and dendritic cells.(({{pmid>long:16331857}})) Anti-TNF drugs, also known as TNF blockers, are drugs which interfere with the body's production of TNF-alpha.(({{pmid>long: 18387510}}))

	Anti-TNF drugs are expensive, ineffective at treating chronic disease and have a number of adverse effects. Also, anti-TNF inhibitors can make a patient feel temporarily less symptomatic, because they reduce immunopathology, the bacterial die-off reaction.		Anti-TNF drugs are expensive, ineffective at treating chronic disease and have a number of adverse effects. Also, anti-TNF inhibitors can make a patient feel temporarily less symptomatic, because they reduce immunopathology, the bacterial die-off reaction.
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	During immunopathology, cytokines, are elevated. Although cytokines are usually associated with an inflammatory process, it has been demonstrated that TNF, interleukin-6 (IL-6) and IL-8 are involved in the immunopathological reaction, each peaking at different times throughout the response: TNF elevates first, shortly after antibiotic administration, followed by IL-6 at the onset of symptoms and finally IL-8.		During immunopathology, cytokines, are elevated. Although cytokines are usually associated with an inflammatory process, it has been demonstrated that TNF, interleukin-6 (IL-6) and IL-8 are involved in the immunopathological reaction, each peaking at different times throughout the response: TNF elevates first, shortly after antibiotic administration, followed by IL-6 at the onset of symptoms and finally IL-8.

-	The release of cytokines appears to be essential for recovery after an infection. One study found that the cytokine TNF-alpha is necessary for the proper expression of acquired specific resistance following infection with //Mycobacterium tuberculosis//.(({{pubmed>long:18544042}})) (({{pubmed>long:12852719}})) (({{pubmed>long:15216471}})) Another effect of the use of TNF blockers is to break or reduce the formation of granuloma, one of the body's mechanisms to control bacterial pathogens.(({{pubmed>long:16322600}}))	+	The release of cytokines appears to be essential for recovery after an infection. One study found that the cytokine TNF-alpha is necessary for the proper expression of acquired specific resistance following infection with //Mycobacterium tuberculosis//.(({{pmid>long:18544042}})) (({{pmid>long:12852719}})) (({{pmid>long:15216471}})) Another effect of the use of TNF blockers is to break or reduce the formation of granuloma, one of the body's mechanisms to control bacterial pathogens.(({{pmid>long:16322600}}))

	For these reasons among others, TNF-alpha inhibitors, drugs which suppress the cytokine, are contraindicated for MP patients.		For these reasons among others, TNF-alpha inhibitors, drugs which suppress the cytokine, are contraindicated for MP patients.
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	===== Increased risk of infection =====		===== Increased risk of infection =====

-	One recent systematic review of the adverse effects of anti-TNF therapies as they were used in rheumatoid arthritis concluded that patients taking the drugs are at 2.0 times higher risk for serious infections.(({{pubmed>long:16705109}})) The study's authors concluded that these side effects were dose-dependent.	+	One recent systematic review of the adverse effects of anti-TNF therapies as they were used in rheumatoid arthritis concluded that patients taking the drugs are at 2.0 times higher risk for serious infections.(({{pmid>long:16705109}})) The study's authors concluded that these side effects were dose-dependent.


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	//U.S. Food and Drug Administration//, [[https://www.accessdata.fda.gov/drugsatfda_docs/label/2000/inflcen111099lb.pdf\|page 6 : Warnings]]</blockquote>		//U.S. Food and Drug Administration//, [[https://www.accessdata.fda.gov/drugsatfda_docs/label/2000/inflcen111099lb.pdf\|page 6 : Warnings]]</blockquote>

-	//M. tuberculosis// is one such infection.(({{pubmed>long:19565495}}))	+	//M. tuberculosis// is one such infection.(({{pmid>long:19565495}}))

	<blockquote>Cases of active tuberculosis have been reported worldwide with the use of therapeutic agents that inhibit tumour necrosis factor (TNF) alpha. TNF-alpha has a central role in mycobacterial infection and disease. Accordingly, progression of recently acquired tuberculosis infection or reactivation of remotely acquired infection //should be expected// with the use of anti-TNF agents.		<blockquote>Cases of active tuberculosis have been reported worldwide with the use of therapeutic agents that inhibit tumour necrosis factor (TNF) alpha. TNF-alpha has a central role in mycobacterial infection and disease. Accordingly, progression of recently acquired tuberculosis infection or reactivation of remotely acquired infection //should be expected// with the use of anti-TNF agents.

-	//Michael A. Gardam, et al.// (({{pubmed>long:12614731}}))</blockquote>	+	//Michael A. Gardam, et al.// (({{pmid>long:12614731}}))</blockquote>

-	To reduce the likelihood of contracting or exacerbating tuberculosis, prospective patients are routinely tested for infection via a skin test. However, as some researchers have noted, TB skin tests on patients treated with immunosupressants, which are routinely used on rheumatoid arthritis patients, are not reliable, because they result in false negatives.(({{pubmed>long:12614731}}))	+	To reduce the likelihood of contracting or exacerbating tuberculosis, prospective patients are routinely tested for infection via a skin test. However, as some researchers have noted, TB skin tests on patients treated with immunosupressants, which are routinely used on rheumatoid arthritis patients, are not reliable, because they result in false negatives.(({{pmid>long:12614731}}))

-	"Exaggerated //Borreliosis// infections" have been noted(({{pubmed>long:20184613}})) as have been fatal fungal infections. In 2008, the FDA ordered stronger warnings on Enbrel, Remicade, Humira and Cimzia due to increased risk of fungal infections.	+	"Exaggerated //Borreliosis// infections" have been noted(({{pmid>long:20184613}})) as have been fatal fungal infections. In 2008, the FDA ordered stronger warnings on Enbrel, Remicade, Humira and Cimzia due to increased risk of fungal infections.

	Researchers have also observed reactivation of latent viral infections, namely hepatitis B in patients who are chronic carriers of the virus.		Researchers have also observed reactivation of latent viral infections, namely hepatitis B in patients who are chronic carriers of the virus.

-	For these reasons, physicians are [[http://www.fda.gov/medwatch/SAFETY/2004/Remicade_12-22-04_PI.pdf\|strongly advised]] by the FDA not to prescribe TNF blockers to patients who suffer from active or latent infections and to discontinue therapy in the event of serious infection. Yet, this advisory is strikingly incomplete. In fact, all patients who suffer from diseases for which an anti-TNF agent could possibly indicated suffer from a chronic bacterial infection, a fact which underscores the importance of not taking such drugs.	+	For these reasons, physicians are [[https://www.fda.gov/medwatch/SAFETY/2004/Remicade_12-22-04_PI.pdf\|strongly advised]] by the FDA not to prescribe TNF blockers to patients who suffer from active or latent infections and to discontinue therapy in the event of serious infection. Yet, this advisory is strikingly incomplete. In fact, all patients who suffer from diseases for which an anti-TNF agent could possibly indicated suffer from a chronic bacterial infection, a fact which underscores the importance of not taking such drugs.

	===== Other adverse effects ======		===== Other adverse effects ======

-	* Allergic reaction – Some patients report an allergic response to Remicade. One possible reason may be that the [[http://cancerweb.ncl.ac.uk/cgi-bin/omd?chimeric+molecule\|chimeric monoclonal]] antibody in Remicade is part human, part mouse. Exposed to purely mouse (murine) antibodies, human immune systems naturally develop human antibodies to the foreign mouse proteins, a process which can trigger an allergic-like response.	+	* Allergic reaction – Some patients report an allergic response to Remicade. One possible reason may be that the [[https://cancerweb.ncl.ac.uk/cgi-bin/omd?chimeric+molecule\|chimeric monoclonal]] antibody in Remicade is part human, part mouse. Exposed to purely mouse (murine) antibodies, human immune systems naturally develop human antibodies to the foreign mouse proteins, a process which can trigger an allergic-like response.
	* Congestive heart failure – Exacerbation of CHF is a major side effect of Remicade use in patients with moderate to severe CHF. This is especially problematic in that many sarcoidosis patients do not know that they have cardiac involvement.		* Congestive heart failure – Exacerbation of CHF is a major side effect of Remicade use in patients with moderate to severe CHF. This is especially problematic in that many sarcoidosis patients do not know that they have cardiac involvement.
-	* Liver problems – [[http://www.fda.gov/medwatch/SAFETY/2004/Remicade_12-22-04_PI.pdf\|According to the FDA]], patients taking Remicade can (but rarely) experience severe hepatic reactions including acute liver failure, jaundice, hepatitis and cholestasis.	+	* Liver problems – [[https://www.fda.gov/medwatch/SAFETY/2004/Remicade_12-22-04_PI.pdf\|According to the FDA]], patients taking Remicade can (but rarely) experience severe hepatic reactions including acute liver failure, jaundice, hepatitis and cholestasis.
-	* Skin problems – In one prospective trial, 25% of patients on TNF-alpha-blocking therapy suffered from a dermatological condition that led them to visit a skin specialist. In a control group of patients who were not undergoing TNF-alpha blocking therapy and had less severe disease only 13% visited a dermatologist during the same period of time.(({{pubmed>long:15899052}}))	+	* Skin problems – In one prospective trial, 25% of patients on TNF-alpha-blocking therapy suffered from a dermatological condition that led them to visit a skin specialist. In a control group of patients who were not undergoing TNF-alpha blocking therapy and had less severe disease only 13% visited a dermatologist during the same period of time.(({{pmid>long:15899052}}))
-	* Cancer – One recent systematic review of the adverse effects of anti-TNF therapies as they were used in rheumatoid arthritis concluded that patients taking the drugs are at 3.3 times higher risk for "malignancies."(({{pubmed>long:16705109}})) The study's authors concluded that these side effects were dose-dependent. Since then, the FDA has issued [[http://www.fda.gov/CDER/drug/early_comm/TNF_blockers.htm\|an early communication]] about an ongoing investigation of approximately 30 reports of cancer in children and young adults. More recently, a study of over 20,000 US military veterans show that nonmelanoma skin cancer risk is about one third higher for patients with rheumatoid arthritis treated with TNF inhibitors than for similar patients treated with nonbiologic disease-modifying antirheumatic drugs (DMARDs).(({{pubmed>long:21415022}}))	+	* Cancer – One recent systematic review of the adverse effects of anti-TNF therapies as they were used in rheumatoid arthritis concluded that patients taking the drugs are at 3.3 times higher risk for "malignancies."(({{pmid>long:16705109}})) The study's authors concluded that these side effects were dose-dependent. Since then, the FDA has issued [[https://www.fda.gov/CDER/drug/early_comm/TNF_blockers.htm\|an early communication]] about an ongoing investigation of approximately 30 reports of cancer in children and young adults. More recently, a study of over 20,000 US military veterans show that nonmelanoma skin cancer risk is about one third higher for patients with rheumatoid arthritis treated with TNF inhibitors than for similar patients treated with nonbiologic disease-modifying antirheumatic drugs (DMARDs).(({{pmid>long:21415022}}))


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	Considering that Abbott’s Humira was the company’s best-selling product in 2007 with over $3 billion in sales, and Remicade also topped Schering-Plough’s portfolio with sales of $1.65 billion, there is minimal hope that such companies will be willing to embrace a true understanding of how their drugs foster the development of chronic disease.		Considering that Abbott’s Humira was the company’s best-selling product in 2007 with over $3 billion in sales, and Remicade also topped Schering-Plough’s portfolio with sales of $1.65 billion, there is minimal hope that such companies will be willing to embrace a true understanding of how their drugs foster the development of chronic disease.

-	Insurance coverage and baseline cost of anti-TNF drugs varies, but patients in the United States and Canada [[http://www.healingwell.com/community/default.aspx?f=38&m=1043934\|have reported]] being charged $4,600 or more for a single treatment of Remicade. According to one estimate, $1,000 of the $4,600 goes to pay the prescribing physician's clinical group.	+	Insurance coverage and baseline cost of anti-TNF drugs varies, but patients in the United States and Canada [[https://www.healingwell.com/community/default.aspx?f=38&m=1043934\|have reported]] being charged $4,600 or more for a single treatment of Remicade. According to one estimate, $1,000 of the $4,600 goes to pay the prescribing physician's clinical group.

-	One citizen watchdog group, the New Jersey Citizen Action (NJCA), [[http://www.prescriptionaccess.org/docs/remicade.pdf\|filed a lawsuit]] to stop Remicade from being promoted by promising doctors windfall profits when they prescribe the drug.	+	One citizen watchdog group, the New Jersey Citizen Action (NJCA), [[https://www.prescriptionaccess.org/docs/remicade.pdf\|filed a lawsuit]] to stop Remicade from being promoted by promising doctors windfall profits when they prescribe the drug.




-	{{tag> }}	+	{{tag>immunosuppressant }}

		+	<nodisp>
	===== Notes and comments =====		===== Notes and comments =====


	* Legacy content		* Legacy content
-	* http://www.marshallprotocol.com/view_topic.php?id=3094&forum_id=37&jump_to=28080#p28080 s32	+	* https://www.marshallprotocol.com/view_topic.php?id=3094&forum_id=37&jump_to=28080#p28080 s32
-	===== References =====	+	===== References =====</nodisp>