How chronic inflammation may drive down dopamine and motivation

A new computational method will allow scientists to measure the effects of chronic inflammation on energy availability and effort-based decision-making. The method may yield insights into how chronic, low-grade inflammation contributes to motivational impairments in some cases of depression, schizophrenia and other medical disorders.  Click here to read further.

New NIHR Signal Prescribing anti-inflammatories for urine infection reduces antibiotic use but increases complication risk

New NIHR Signal Prescribing anti-inflammatories for urine infection reduces antibiotic use but increases complication risk
Published on 5 June 2018


Urinary tract infection symptoms resolved by three days for 80% of women given antibiotics compared with 54% given anti-inflammatories. Anti-inflammatories reduced antibiotic use, but 5% of women developed more severe infection of the kidneys.
From the NIHR Dissemination centre
https://discover.dc.nihr.ac.uk/content/signal-000598/anti-inflammatories-for-urine-infection-reduces-antibiotic-use-but-increases-complication-risk

Pirfenidone for treating idiopathic pulmonary fibrosis [TA 504]

New: Technology appraisal guidance




https://www.nice.org.uk/guidance/ta504Pirfenidone is recommended as an option for treating idiopathic pulmonary fibrosis in adults only if:

• the person has a forced vital capacity (FVC) between 50% and 80% predicted
• the company provides pirfenidone with the discount agreed in the patient access scheme and
• treatment is stopped if there is evidence of disease progression (an absolute decline of 10% or more in predicted FVC within any 12‑month period).
• 
  

Pirfenidone (Esbriet, Roche) is an oral immunosuppressant with anti-inflammatory and antifibrotic effects.

Point-of-care and home faecal calprotectin tests for monitoring treatment response in inflammatory bowel disease [MIB132]

New medtech innovation briefing from NICE:

Elevated faecal calprotectin (FC) is a marker of intestinal inflammation, including that caused by inflammatory bowel disease (IBD). NICE diagnostics guidance recommends FC testing for the diagnosis of IBD; this briefing summarises the available information on the use of FC to monitor treatment response in patients with IBD.

There are 3 types of FC test available: point of care (used by healthcare professionals), home use (used by patients or carers) and laboratory (used by laboratory scientists). This briefing includes only point‑of‑care and home‑use tests because laboratory tests are widely available in the NHS, although their usage varies.

Guideline for the prescription and monitoring of non-biologic Disease-Modifying Anti-Rheumatic Drugs

The mainstay of treatment for inflammatory rheumatic disease involves DMARDs. The last 30 years have seen enormous shifts in the use of DMARDs, with earlier initiation in disease course as well as combination strategies. Many of the drugs used have potential for harm as well as benefit. Appropriate screening prior to DMARD initiation, as well as vigilant monitoring during therapy, are required to minimize the risk of harm. This current guideline supersedes the previous 2008 BSR/BHPR guideline.

Assessing, managing and monitoring biologic therapies for inflammatory arthritis

RCN's updated fourth edition of the RCN’s guidance on assessing, managing and monitoring biologic therapies for inflammatory arthritis which provides a best practice framework for rheumatology specialist practitioners and the wider health care team involved in supporting the administration, monitoring and delivery of care to patients in a variety of settings.

Anti-inflammatory drug may help prevent heart attacks

"Anti-inflammatory drug 'cuts heart attack risk'," BBC News reports. A major study found canakinumab – an anti-inflammatory drug originally designed to treat rheumatoid arthritis – could also reduce the risk of having another heart attack in people who have already had one.

The study included more than 10,000 people who'd already had a heart attack. They were assigned to receive either injections of the drug canakinumab or a placebo.

Canakinumab is an engineered antibody designed to modify the immune system. It turns off the process of inflammation, making it useful for serious inflammatory conditions like rheumatoid arthritis.

Not everyone who has a heart attack has raised cholesterol levels, so it's unclear whether giving statins to these groups of patients would reduce the risk of another heart attack. The researchers wanted to see if a drug that reduces inflammation would be of more use.

After four years, researchers found people who received the higher doses of canakinumab (150mg or 300mg) were significantly less likely to have had another heart attack or a stroke, or to have died from cardiovascular disease.

But people taking the drug had a higher risk of developing fatal infections. Though this outcome was rare, it's a serious risk that needs investigation.

Ustekinumab for moderately to severely active Crohn’s disease after previous treatment - guidance (TA456)

New NICE technology appraisal guidance on using ustekinumab (Stelara) for previously treated moderately to severely active Crohn’s disease in adults.

Ustekinumab is recommended, within its marketing authorisation, as an option for treating moderately to severely active Crohn's disease, that is, for adults who have had an inadequate response with, lost response to, or were intolerant to either conventional therapy or a TNF‑alpha inhibitor or have medical contraindications to such therapies.

The choice of treatment between ustekinumab or another biological therapy should be made on an individual basis after discussion between the patient and their clinician about the advantages and disadvantages of the treatments available. If more than 1 treatment is suitable, the least expensive should be chosen (taking into account administration costs, dosage and price per dose).

Ustekinumab should be given until treatment failure (including the need for surgery) or until 12 months after the start of treatment, whichever is shorter.

Spondyloarthritis in over 16s: diagnosis and management

This new guideline from NICE covers diagnosing and managing spondyloarthritis that is suspected or confirmed in adults who are 16 years or older. It aims to raise awareness of the features of spondyloarthritis and provide clear advice on what action to take when people with signs and symptoms first present in healthcare settings. It also provides advice on the range of treatments available.

In June 2017, we updated recommendation 1.2.7 to clarify the advice on what imaging should be done.

Preventive Care in Inflammatory Bowel Disease

New guidance on preventative care in inflammatory bowel disease from the American College of Gastroenterology.

One group of drugs used to treat Crohn’s disease is unlikely to prevent relapse

Anti-inflammatory drugs called 5-aminosalicylic acids (5-ASAs) do not prevent relapses of Crohn’s disease when compared to placebo at one year.

From the NIHR Dissemination Centre

Pertuzumab for the neoadjuvant treatment of HER2-positive breast cancer

New NICE Technology Appraisal Guidance on pertuzumab (Perjeta) for treating HER2-positive breast cancer that is locally advanced, inflammatory, or early-stage with a high risk of recurrence, in adults.

Neuromyelitis Optica in HIV: A Case Report and Literature Review

J Neurol Neurosurg Psychiatry 2016 87:e1. doi:10.1136/jnnp-2016-315106.122

Neuromyelitis optica (NMO) is a rare autoimmune condition that preferentially causes inflammation of the optic nerves and spinal cord. There are scanty reports of NMO occurring in the setting of patients with Human immunodeficiency virus (HIV). We present a case and review the literature.

UHCW Research: Jason P Appleton and Anthony Kenton

An inducer of glyoxalase 1 down regulates inflammatory gene expression in overweight and obese non-diabetic subjects

Diabetologia (2016) 59 (Suppl 1):S1–S581  Abstracts of 52nd EASD Annual Meeting No. 631

Glo1 deficiency was identified as a driver of cardiovascular disease in a large integrative genomics study. Induction of glyoxalase 1 (Glo1) expression is a novel strategy to prevent inflammatory signalling and decrease risk of cardiovascular disease in overweight and obese populations. Increasing Glo1 expression is unaddressed by current therapy. Glo1 is part of the glyoxalase metabolic pathway which catalyses the metabolism of the reactive metabolite and glycating agent, methylglyoxal (MG), and thereby prevents formation of advanced glycation endproducts (AGEs). We previously described a regulatory antioxidant response element in the GLO1 gene which, when bound by transcription factor Nrf2, increases basal and inducible expression of Glo1. We screened dietary bioactive compounds for Glo1 inducer activity, confirmed hits and improvement of cell function in human cell primary cultures. The aim of this study was to validate target pharmacology of an optimised Glo1 inducer formulation in Phase 1 clinical trial in overweight and obese subjects and assess inflammatory gene expression in peripheral blood mononuclear cells (PBMCs)

UHCW Research: M. O. Weickert and S Qureshi

CTAS: a CT score to quantify disease activity in pulmonary sarcoidosis

Thorax. 2016 Jul 27. pii: thoraxjnl-2016-208833. doi: 10.1136/thoraxjnl-2016-208833. [Epub ahead of print]

CTAS provides a concept for an objective and reproducible CT scoring method to quantify disease activity in sarcoidosis. The score can potentially be used to stratify patients according to disease activity, determine response to treatment and establish if fibrotic sarcoidosis is active.

UHCW Research: Cole SL

Secukinumab for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors

New NICE Technology Appraisal Guidance:

This guidance recommends secukinumab for treating active ankylosing spondylitis that has not responded well enough to conventional therapy.

Belimumab for treating active autoantibody-positive systemic lupus erythematosus

New NICE technology appraisal guidance:

Evidence-based recommendations on belimumab (Benlysta) as an add-on treatment for active autoantibody-positive systemic lupus erythematosus in adults.