Secondary amyloidosis medical therapy: Difference between revisions

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==Medical Therapy==
==Medical Therapy==


* Medical or surgical treatment of the underlying chronic infection or inflammatory disease is recommended among all patients who develop AA amyloidosis.
* Medical or surgical treatment of the underlying chronic infection or inflammatory disease is recommended among all patients who develop AA amyloidosis.<ref name="pmid22909024">{{cite journal| author=Desport E, Bridoux F, Sirac C, Delbes S, Bender S, Fernandez B et al.| title=Al amyloidosis. | journal=Orphanet J Rare Dis | year= 2012 | volume= 7 | issue=  | pages= 54 | pmid=22909024 | doi=10.1186/1750-1172-7-54 | pmc=3495844 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22909024  }}</ref>
* Aggressively treating the disease that is causing the excess [[amyloid]] protein can improve [[symptoms]] and slow down or halt the progression of the disease.  
* Aggressively treating the disease that is causing the excess [[amyloid]] protein can improve [[symptoms]] and slow down or halt the progression of the disease.  
* Complications such as [[heart failure]], [[renal failure]], and other problems can sometimes be treated, when needed.
* Complications such as [[heart failure]], [[renal failure]], and other problems can sometimes be treated, when needed.
*Although the choice of therapy depends on the underlying cause of chronic inflammation, the aim is always to suppress production of SAA to within the normal range.
*Although the choice of therapy depends on the underlying cause of chronic inflammation, the aim is always to suppress production of SAA to within the normal range.
*Examples of treatments for the commonest disorders underlying AA amyloidosis:<ref name="pmid30274625">{{cite journal| author=Papa R, Lachmann HJ| title=Secondary, AA, Amyloidosis. | journal=Rheum Dis Clin North Am | year= 2018 | volume= 44 | issue= 4 | pages= 585-603 | pmid=30274625 | doi=10.1016/j.rdc.2018.06.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30274625  }} </ref>
*Examples of treatments for the commonest disorders underlying AA amyloidosis, adapted from Rheumatic Diseases Clinics of North America:<ref name="pmid30274625">{{cite journal| author=Papa R, Lachmann HJ| title=Secondary, AA, Amyloidosis. | journal=Rheum Dis Clin North Am | year= 2018 | volume= 44 | issue= 4 | pages= 585-603 | pmid=30274625 | doi=10.1016/j.rdc.2018.06.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30274625  }} </ref>


{|
{|
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| style="padding: 5px 5px; background: #F5F5F5;" | Conventional disease-modifying agents
| style="padding: 5px 5px; background: #F5F5F5;" | Conventional disease-modifying agents
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Gold
*[[Gold]]
*Hydroxychloroquine sulfasalazine
*[[Hydroxychloroquine]] [[sulfasalazine]]
*Azathioprine
*[[Azathioprine]]
*Methotrexate
*[[Methotrexate]]
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
Other immunosuppressant agents
Other immunosuppressant agents
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Cyclosporine
*[[Cyclosporine]]
*Cyclophosphamide
*[[Cyclophosphamide]]
*Mycophenolate
*[[Mycophenolate]]
*Leflunomide
*[[Leflunomide]]
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
Biologic agents
Biologic agents
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Infliximab
*[[Infliximab]]
*Etanercept
*[[Etanercept]]
*Adalimumab
*[[Adalimumab]]
*Tocilizumab
*[[Tocilizumab]]
*Rituximab
*[[Rituximab]]
|-
|-
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" |Periodic fevers
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" |Periodic fevers
| style="padding: 5px 5px; background: #F5F5F5;" | On-demand agents
| style="padding: 5px 5px; background: #F5F5F5;" | On-demand agents
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Nonsteroidal anti-inflammatory drugs
*[[Nonsteroidal anti-inflammatory drugs]]
*Prednisone
*[[Prednisone]]
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
Colchicine (for familial mediterranean fever)
Colchicine (for familial mediterranean fever)
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
Colchicine
* [[Colchicine]]
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
Biologic agents
Biologic agents
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Anakinra
*[[Anakinra]]
*Canakinumab
*[[Canakinumab]]
|-
|-
| rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" |Inflammatory bowel disease
| rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" |Inflammatory bowel disease
| style="padding: 5px 5px; background: #F5F5F5;" | Conventional disease-modifying agents
| style="padding: 5px 5px; background: #F5F5F5;" | Conventional disease-modifying agents
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Sulfasalazine
*[[Sulfasalazine]]
*Mesalazine
*[[Mesalazine]]
*Azathioprine
*[[Azathioprine]]
*Methotrexate
*[[Methotrexate toxicity|Methotrexate]]
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
Biologic agents
Biologic agents
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Infliximab
*[[Infliximab]]
*Adalimumab
*[[Adalimumab]]
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
Antibiotics
Antibiotics
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Metronidazole
*[[Metronidazole]]
*Ciprofloxacin
*[[Ciprofloxacin]]
*Azithromycin
*[[Azithromycin]]
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
Biologic agents
Biologic agents
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Infliximab
*[[Infliximab]]
*Adalimumab
*[[Adalimumab]]
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
Surgery
Surgery
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
ileo-cecal resection and primary reconstruction
* ileo-cecal resection and primary reconstruction
|-
|-
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" | Immunodeficiency
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" | Immunodeficiency
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Antibiotics
Antibiotics
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Cotrimoxazole
*[[Cotrimoxazole]]
*Miconazole
*[[Miconazole]]
|-
|-
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" | Chronic infections
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" | Chronic infections
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Antibiotics
Antibiotics
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Cotrimoxazole
*[[Cotrimoxazole]]
*Miconazole
*[[Miconazole]]
|-
|-
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" | Neoplasia
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" | Neoplasia
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Biologic agents (in Castleman disease)
Biologic agents (in Castleman disease)
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Tocilizumab
*[[Tocilizumab]]
|-
|-
|}
|}


* Long-term inflammatory control can be accompanied by gradual regression of amyloid deposits and improvement in renal function.
* Long-term inflammatory control can be accompanied by gradual regression of amyloid deposits and improvement in renal function.
*Currently a second clinical trial is in progress in order to evaluate a targeted inhibitor molecule, Kiacta, in the management of secondary amyloidosis.
*Currently a second clinical trial is in progress in order to evaluate a targeted inhibitor molecule, Kiacta, in the management of secondary amyloidosis.<ref name="pmid17577686">{{cite journal| author=Hazenberg BP, Bijzet J, Limburg PC, Skinner M, Hawkins PN, Butrimiene I et al.| title=Diagnostic performance of amyloid A protein quantification in fat tissue of patients with clinical AA amyloidosis. | journal=Amyloid | year= 2007 | volume= 14 | issue= 2 | pages= 133-40 | pmid=17577686 | doi=10.1080/13506120701260224 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17577686  }}</ref>
*Novel therapies aimed at promoting clearance of existing amyloid deposits soon may be an effective treatment approach.
*Novel therapies aimed at promoting clearance of existing amyloid deposits soon may be an effective treatment approach.



Latest revision as of 20:18, 1 November 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Roukoz A. Karam, M.D.[2]

Overview

Medical or surgical treatment of the underlying chronic infection or inflammatory disease is recommended among all patients who develop AA amyloidosis.

Medical Therapy

  • Medical or surgical treatment of the underlying chronic infection or inflammatory disease is recommended among all patients who develop AA amyloidosis.[1]
  • Aggressively treating the disease that is causing the excess amyloid protein can improve symptoms and slow down or halt the progression of the disease.
  • Complications such as heart failure, renal failure, and other problems can sometimes be treated, when needed.
  • Although the choice of therapy depends on the underlying cause of chronic inflammation, the aim is always to suppress production of SAA to within the normal range.
  • Examples of treatments for the commonest disorders underlying AA amyloidosis, adapted from Rheumatic Diseases Clinics of North America:[2]
Underlying Condition Treatment Options Examples
Inflammatory arthritis Conventional disease-modifying agents

Other immunosuppressant agents

Biologic agents

Periodic fevers On-demand agents

Colchicine (for familial mediterranean fever)

Biologic agents

Inflammatory bowel disease Conventional disease-modifying agents

Biologic agents

Antibiotics

Biologic agents

Surgery

  • ileo-cecal resection and primary reconstruction
Immunodeficiency Immunoglobulins

Antibiotics

Chronic infections Antibiotics and surgery

Physiotherapy (in case of bronchiectasis)

Immunodeficiency Immunoglobulins

Antibiotics

Neoplasia Chemotherapy and surgery

Varies according to type of cancer

Biologic agents (in Castleman disease)

  • Long-term inflammatory control can be accompanied by gradual regression of amyloid deposits and improvement in renal function.
  • Currently a second clinical trial is in progress in order to evaluate a targeted inhibitor molecule, Kiacta, in the management of secondary amyloidosis.[3]
  • Novel therapies aimed at promoting clearance of existing amyloid deposits soon may be an effective treatment approach.


References

  1. Desport E, Bridoux F, Sirac C, Delbes S, Bender S, Fernandez B; et al. (2012). "Al amyloidosis". Orphanet J Rare Dis. 7: 54. doi:10.1186/1750-1172-7-54. PMC 3495844. PMID 22909024.
  2. Papa R, Lachmann HJ (2018). "Secondary, AA, Amyloidosis". Rheum Dis Clin North Am. 44 (4): 585–603. doi:10.1016/j.rdc.2018.06.004. PMID 30274625.
  3. Hazenberg BP, Bijzet J, Limburg PC, Skinner M, Hawkins PN, Butrimiene I; et al. (2007). "Diagnostic performance of amyloid A protein quantification in fat tissue of patients with clinical AA amyloidosis". Amyloid. 14 (2): 133–40. doi:10.1080/13506120701260224. PMID 17577686.

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