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All Journal Folia Medica Indonesiana Molecular and Cellular Biomedical Sciences (MCBS)
Utomo, Febriansyah Nur
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Biochemistry, Genetics & Molecular Biology Dentistry Immunology & microbiology Medicine & Pharmacology Neuroscience Other

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Mechanism of Actions, Efficacy, and Long-term Use of Steroids in Autoimmune Hemolytic Anemia (AIHA) Yulistiani, Yulistiani; Dwiyatna, Surya; Utomo, Febriansyah Nur
Molecular and Cellular Biomedical Sciences Vol 7, No 3 (2023)
Publisher : Cell and BioPharmaceutical Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21705/mcbs.v7i3.345

Abstract

Autoimmune hemolytic anemia (AIHA) is a rare condition in which autoantibodies cause the loss of red blood cells. Steroids have been used to treat several illnesses, including AIHA. For now, steroids remain as the first line of treatment for AIHA. In AIHA, especially warm AIHA (wAIHA), steroids suppress autoantibody production and downregulate Fcγ receptors' expression on monocytes to prevent hemolysis. The type of steroids chosen for first-line therapy for wAIHA in pediatrics and adults are Prednisone (Prednisolone) and Methylprednisolone. At the same time, Dexamethasone is used as an alternative treatment in AIHA. Steroids show better therapeutic outcomes in the first 2-3 weeks of administration, but the proportion of patients who remain in remission after steroid discontinuation are still quite low. Long-term administration of steroids may affect bone, blood glucose metabolism, and hypothalamic-pituitary-adrenal axis (HPAA). However, steroids which have a linear pharmacokinetic profile, intermediate-acting glucocorticoids such as Prednisone (Prednisolone) or Methylprednisolone, and also tapering dose of steroids after 2-4 weeks administration will be safe for long term use as AIHA treatment.Keywords: steroids, glucocorticoid, corticosteroid, autoimmune hemolytic anemia, AIHA, mechanism of action, efficacy
METHOTREXATE USE IS SAFE IN CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA Utomo, Febriansyah Nur; Yulistiani, Yulistiani; Zairina, Nun; Permono, Bambang
Folia Medica Indonesiana Vol. 53 No. 2 (2017): JUNE 2017
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (261.006 KB) | DOI: 10.20473/fmi.v53i2.6431

Abstract

Monitoring level of methotrexate is not only aimed at monitoring effectiveness, but also safety aspects of the administration of high-dose methotrexate because the use of high-dose methotrexate is one of the problems associated with toxicity in various organs.  In the use of high-dose methotrexate, measurement of methotrexate is important to identify patients with a high risk of toxicity, particularly nephrotoxicity as well as for dosing guidelines for leucovorin therapy. The aim of this study was to analyze the safety of high-dose methotrexate on kidney function during chemotherapy consolidation phase in children with acute lymphoblastic leukemia. This was a longitudinal, observational prospective study conducted to determine the safety profile of high-dose methotrexate on kidney function during chemotherapy consolidation phase in children with acute lymphoblastic leukemia. Patients who met the inclusion criteria were given high-dose methotrexate according to the 2013 Indonesian ALL Chemotherapy Protocol. Measurement of methotrexate level and kidney function was done 3 times on each cycle of chemotherapy consolidation phase. Measurements were made on the 0, 24 and 48 hours after the first drop of high-dose methotrexate. This study had been reviewed by Ethics Committee of Dr. Soetomo Hospital Surabaya. There were 12 patients who met inclusion criteria and 6 patients among them had finished their chemotherapy consolidation phase completely. There was no significant change in kidney function after the administration of high-dose methotrexate compared to baseline (p>0.05) and there was no significant correlation between serum level of methotrexate versus creatinine clearance. In conclusion, methotrexate was safe to use in children with acute lymphoblastic leukemia.
Co-Authors Bambang Permono Dwiyatna, Surya Nun Zairina, Nun Yulistiani Yulistiani, Yulistiani