In Japan, adjuvant chemotherapy using DTIC, ACNU, VCR, and/or interferon beta (DAVFeron) has been widely accepted for stage II and III melanoma patients. Other adjuvant therapies such as daily dermal injection of interferon beta (feron therapy) and once in 2 to 4 weeks injection of interferon beta (feron maintenance therapy) are also utilized; however, no clear analysis of their efficacy has been performed thus far. In this study, we evaluated the efficacy of adjuvant therapies from the data in patients’ databases collected by the Japanese Melanoma Study Group by using Cox proportional hazards regression model. The results showed that feron maintenance therapy improved survival in both stage II and III melanoma but that DAVFeron and feron therapy failed to have any significant effect. Although this study involves a retrospective cohort, we suggest that decisions to apply adjuvant therapy should consider this result.
We added mizoribine (MZR) to the usual steroid therapy in 12 cases of refractory autoimmune bullous disease (6 cases of pemphigus vulgaris, 3 of pemphigus foliaceus, and 3 of bullous pemphigoid) which had not been controlled by steroid therapy alone or had a relapse of blisters during tapering of the steroid. The patients took MZR once in the morning at a dose of 100–200 mg, and the drug reached a peak concentration in the serum 3 h after administration. Ten out of the 12 cases showed improvement, 3 of whom had excellent responses, but MZR was discontinued in 2 cases because of side effects. In 8 patients, the anti-BP180 antibody or anti-desmoglein 1 and 3 antibodies were decreased. When prescribing an MZR and oral steroid combination, it is recommended that the MZR be administered once in the morning in order to maintain as high a concentration of the drug as long as possible. A peak MZR concentration over 1.2 μg/dl is recommended to be efficacious. Because of the peak concentration of MZR will differ among individuals depending upon their age, gender, and renal function, we recommend that the peak MZR concentration be measured for each patient in order to administer the drug safely and effectively.
A 58-year-old man with refractory psoriatic uveitis was successfully treated with infliximab therapy. The patient was diagnosed with chronic plaque psoriasis at the age of 25 years; he then developed non-granulomatous anterior uveitis, which manifested as nephelopsia, at the age of 33 years. He was treated with cyclosporin and topical corticosteroids, but the treatment was not sufficiently effective. At the age of 58 years, he developed pustular psoriasis and had a high risk of blindness attributable to recurrent uveitis and glaucoma caused by treatment with topical corticosteroids. Six weeks after infliximab was administered, both the skin eruptions and the uveitis improved rapidly and remarkably. We investigated the clinical characteristics of psoriatic uveitis in 4 of our cases and in 27 other cases reported in Japan. In most of these cases, psoriatic uveitis initially manifested as visual impairment and was followed in sequence by nephelopsia, conjunctival hyperemia, and ophthalmalgia. Of the psoriatic patients, 92% and 96% had articular symptoms and the HLA-A2 allele, respectively. In 90% of the patients, skin manifestations of psoriatic uveitis were observed prior to the ocular symptoms, which developed much later. The findings suggest that psoriatic uveitis is related to both the articular symptoms and the HLA-A2 allele.