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+ | ====== Anti-TNF drugs ====== | ||
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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, | ||
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+ | Anti-TNF drugs are expensive, ineffective at treating chronic disease and have a number of adverse effects. | ||
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+ | Anti-TNF drugs can make a patient feel temporarily less symptomatic, | ||
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+ | ===== Types of anti-TNF drugs ===== | ||
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+ | * adalimumab (Humira) | ||
+ | * etanercept (Enbrel) | ||
+ | * infliximab (Remicade) | ||
+ | * pentoxyfyllene (Trental) | ||
+ | ===== Molecular actions ===== | ||
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+ | During immunopathology, | ||
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+ | 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 // | ||
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+ | For these reasons among others, TNF-alpha inhibitors, drugs which suppress the cytokine, are contraindicated for MP patients. | ||
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+ | ==== Olmesartan (Benicar) vs. TNF-alpha blockers ==== | ||
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+ | While the Marshall Protocol medication olmesartan also reduces levels of TNF-alpha, it does so by blocking the generation of the substance in the first place. This is in contrast to TNF-alpha blockers, which bind and disable free-floating TNF-alpha after the cytokine has been produced. This distinction is significant enough to be responsible for the vastly different safety profiles between olmesartan and the anti-TNF drugs. In contrast to drugs like Remicade, olmesartan enjoys one of the safest reputations of any prescription medication. | ||
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+ | ===== Weaning from infliximab (Remicade) ===== | ||
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+ | The half life of Remicade is 9.5 days. The excretion rate is unknown. Patients who are starting the Marshall Protocol may take olmesartan (Benicar) to dampen inflammatory symptoms that may flare as Remicade leaves the system. Wait three weeks to begin minocycline so the body will be accustomed to the absence of Remicade' | ||
+ | ===== Increased risk of infection ===== | ||
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+ | 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> | ||
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+ | [[http:// | ||
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+ | //**U.S. Food and Drug Administration**//, | ||
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+ | //M. tuberculosis// | ||
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+ | //**Michael A. Gardam,** et al.// (({{pubmed> | ||
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+ | To reduce the likelihood of contracting or exacerbating tuberculosis, | ||
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+ | " | ||
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+ | Researchers have also observed reactivation of latent viral infections, namely hepatitis B in patients who are chronic carriers of the virus. | ||
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+ | For these reasons, physicians are [[http:// | ||
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+ | ===== Other adverse effects ====== | ||
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+ | * **Allergic reaction** – Some patients report an allergic response to Remicade. One possible reason may be that the [[http:// | ||
+ | * **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:// | ||
+ | * **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> | ||
+ | * **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 " | ||
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+ | ===== Economic motives for ongoing use ===== | ||
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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. | ||
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+ | Insurance coverage and baseline cost of anti-TNF drugs varies, but patients in the United States and Canada [[http:// | ||
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+ | One citizen watchdog group, the New Jersey Citizen Action (NJCA), [[http:// | ||
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+ | {{tag> }} | ||
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+ | ===== Notes and comments ===== | ||
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+ | * Legacy content | ||
+ | * http:// | ||
+ | ===== References ===== |