Annual review of medicine
-
Annual review of medicine · Jan 2007
ReviewUse of stents to treat intracranial cerebrovascular disease.
Intracranial atherosclerosis is a common cause of stroke. Although it has been recognized for decades, the lack of successful treatment strategies has limited clinical interest until recently. We review the natural history and pathophysiology of intracranial atherosclerosis. ⋯ Identification of appropriate candidates for treatment also remains a challenge, and our knowledge about the natural history of the disease is limited. At this time, patients with significant intracranial stenosis should receive information on the benefits and risks of revascularization therapy. Determining which patients should undergo revascularization procedures will require carefully planned, randomized clinical trials.
-
Annual review of medicine · Jan 2007
ReviewDoes anti-IgE therapy help in asthma? Efficacy and controversies.
Omalizumab, a humanized monoclonal antibody against IgE, is clinically efficacious when it neutralizes almost all free IgE and reduces IgE receptors on basophils and mast cells. Asthmatic subjects on inhaled corticosteroids who are treated with omalizumab as an add-on therapy experience only modest benefits in symptoms and perhaps in quality of life, but the most significant effects are reductions in airway inflammation and in exacerbation rate. Airway obstruction and hyperresponsiveness do not change significantly. ⋯ The safety profile of omalizumab is very encouraging, although phase IV studies are ongoing to clarify the incidence of neoplasias. Because of its cost, omalizumab therapy may be most cost-effective in patients with severe and refractory asthma, particularly those with frequent exacerbations requiring hospital care. Further clinical studies are now evaluating the best place for omalizumab in the algorithm of asthma management.