Médecine sciences : M/S
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Médecine sciences : M/S · Dec 2009
Review[Monoclonal antibodies targeting VEGF in ophthalmology: the case of exudative age-related macular degeneration].
Age-related macular degeneration (AMD) is the main cause of vision loss in the elderly in developed countries. The exudative AMD is the most frequent and severe form of the disease, leading to a rapid loss of vision. The results of MARINA and ANCHOR studies, two multicentric clinical trials analyzing the efficacy of anti-VEGF in exudative AMD, have showed that this modality of treatment results in a stabilisation of the visual acuity in most cases (70%), and in visual improvement in 30 % of the cases. Up till now, the anti-VEGF approach represents a major step in the therapeutic strategy of this disease.
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Rituximab, a chimeric monoclonal anti-CD20 antibody, was introduced into clinical practice in 1997, and has proven to be highly effective in the treatment of B-lymphoproliferative disorders and autoimmune diseases. Despite such success, in vivo mechanisms of action of anti-CD20 have only recently began to be unraveled, pointing to the crucial role of antibody-dependent cellular cytotoxicity response mediated through Fcg receptor signalling. ⋯ However these antibodies are used in combination with standard chemotherapy and cannot substitute for cytotoxic drugs. This review summarizes the knowledge acquired through our clinical use of anti-CD20 and authorized monoclonal antibodies in oncohematology and proposes some news areas that will lead to the development of new and more effective therapeutic strategies.
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Stroke unit care is effective to reduce mortality and handicap in all types of strokes. In ischaemic strokes t-PA within 3 hours is the standard therapy, replaced by aspirin 300 mg when not appropriate. ⋯ Vascular risk factors should be treated to prevent stroke, especially high blood pressure, high blood cholesterol, and cigarette smoking. To reduce the risk of any new vascular events after a first stroke or TIA, the 3 complementary strategies are: an optimal management of risk factors for stroke (for all types of strokes and TIA), an antithrombotic therapy (in ischaemic stroke and TIA only), and carotid surgery in severe symptomatic stenosis.