<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_438"
                     title="Rituximab Shows Promise in Scleroderma (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/Rheumatology/GeneralRheumatology/tb/18352?impressionId=1265806775644"
                     
      &lt;p&gt;Rituximab (Rituxan) improved lung function in patients with scleroderma, a small proof-of-principle study found.&lt;/p&gt;
&lt;p&gt;At one year, patients randomized to receive rituximab had a median 10.25% increase in forced vital capacity (FVC) compared with baseline, while those who received standard treatment had a deterioration of 5.04% (&lt;em&gt;P&lt;/em&gt;=0.002), according to Dimitrios Daoussis, MD, and colleagues from the University of Patras in Greece.&lt;/p&gt;
&lt;p&gt;There also was a significant 19.46% increase in diffusing capacity of carbon monoxide (DL&lt;sub&gt;co&lt;/sub&gt;) in the rituximab-treated patients, while the controls showed deterioration of 7.5% (&lt;em&gt;P&lt;/em&gt;=0.023), the researchers reported in the February issue of &lt;em&gt;Rheumatology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Interstitial lung disease is a common manifestation of diffuse scleroderma and represents the disease component that dictates prognosis because it can be progressive and typically responds poorly to treatment. Animal and human studies have suggested a possible pathogenic role for B cells in the disease.&lt;/p&gt;
&lt;p&gt;There have been a few reports of clinical and histologic improvements in scleroderma and in graft-versus-host disease (which shares some features with scleroderma) after treatment with the B-cell depleting monoclonal antibody rituximab.&lt;/p&gt;
&lt;p&gt;These encouraging early findings led Daoussis and colleagues to undertake an open-label, controlled study that included 14 patients with diffuse disease.&lt;/p&gt;
&lt;p&gt;Median age was 55 and mean disease duration was seven years.&lt;/p&gt;
&lt;p&gt;All patients continued their standard medications, which included various agents such as prednisone, bosentan (Tracleer), mycophenolate mofetil (CellCept), and cyclophosphamide.&lt;/p&gt;
&lt;p&gt;Those randomized to rituximab treatment also underwent four weekly pulses of the drug (375 mg/m&lt;sup&gt;2&lt;/sup&gt;) at baseline and six months later.&lt;/p&gt;
&lt;p&gt;By one year, the mean FVC in the rituximab group had risen from 68.13% of normal predicted value based on age, sex, and height, to 75.63% (&lt;em&gt;P&lt;/em&gt;=0.0018), while FVC in the control group fell nonsignificantly from 86% of normal to 81.67%.&lt;/p&gt;
&lt;p&gt;In the rituximab group, DL&lt;sub&gt;co&lt;/sub&gt; increased from a mean of 52.25% of normal at baseline to 62% (&lt;em&gt;P&lt;/em&gt;=0.017) at one year, while the controls decreased nonsignificantly from 65.33% to 60.17%.&lt;/p&gt;
&lt;p&gt;None of the patients treated with rituximab experienced worsening of FVC or DL&lt;sub&gt;co&lt;/sub&gt;, whereas lung function deteriorated in five controls.&lt;/p&gt;
&lt;p&gt;&quot;We should note, however, that patients in the control group tended to have more early disease and better lung function parameters (although not statistically different from the [rituximab] group) making them more likely to deteriorate over the time of the study,&quot; the investigators commented.&lt;/p&gt;
&lt;p&gt;Skin manifestations of the disease also showed improvements in the rituximab group. Skin thickening, as measured by the Modified Rodnan Skin Score, improved by 39.25% in the rituximab group and by 20.80% in the control group, a difference that was not statistically significant.&lt;/p&gt;
&lt;p&gt;Skin fibrosis also improved by a median of 38.33%, while it worsened by 5.23% in controls.&lt;/p&gt;
&lt;p&gt;Histologic improvement was seen in four of the rituximab-treated patients, corresponding with clinical benefits. One patient in the active treatment group had a significant reduction of fibrosis in both the papillary and reticular dermis, accompanied by an almost complete resolution of skin lesions.&lt;/p&gt;
&lt;p&gt;Improvement in skin fibrosis was most common in patients who had evidence of B-cell depletion in the skin.&lt;/p&gt;
&lt;p&gt;Overall function, as evaluated by the Health Assessment Questionnaire, improved from a median baseline score of 0.687 to 0.312 at one year (&lt;em&gt;P&lt;/em&gt;=0.03), while no change was seen in controls.&lt;/p&gt;
&lt;p&gt;The pathogenesis of scleroderma is poorly understood, according to the authors, but this study adds support to a possible role for B cells.&lt;/p&gt;
&lt;p&gt;In addition, rituximab indirectly targets T cells, which also are thought to be implicated.&lt;/p&gt;
&lt;p&gt;The authors noted potential limitations, including the study&apos;s small size and the fact that most patients had longstanding disease, had been treated with multiple immunosuppressive agents in the past, and were receiving concurrent therapies during the study.&lt;/p&gt;
&lt;p&gt;&quot;This is a proof-of-principle study that was performed in order to obtain preliminary data regarding the effect of [rituximab] on a limited number of patients,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;Our data could serve as a good starting point for the design of larger scale, multicenter studies with longer evaluation periods and especially in earlier stages of the disease,&quot; they concluded.&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, Robert W. Simms, MD, and Robert Lafyatis, MD, of Boston University, echoed concerns about the small number of patients and the lack of blinding in the study.&lt;/p&gt;
&lt;p&gt;&quot;One cannot...on the basis of this study, recommend rituximab in the routine clinical care of patients with scleroderma,&quot; the editorialists wrote.&lt;/p&gt;
&lt;p&gt;The findings will need to be replicated in a multicenter randomized trial, but &quot;do provide some hope that B-cell depletion might enhance the currently restricted therapeutic armamentarium of this disease.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the Hellenic Rheumatology Society.&lt;/p&gt;&lt;p&gt;Funding to pay Open Access publication charges was provided by Roche Hellas.&lt;/p&gt;&lt;p&gt;Authors and editorialists declared to conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_261"
                     title="Scrubbing Away Germs Can Backfire on Backsides (CME/CE)"
                     score="0.001"
                     href="http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb/18121?impressionId=1265806775644"
                     
      Rashes from toilet seats are once again afflicting American children, and the rare condition is often misdiagnosed, which may delay proper treatment.&lt;br&gt;
&lt;br&gt;That&apos;s the conclusion from a report based of five-cases of toilet-seat contact dermatitis investigated by researchers at Johns Hopkins University School of Medicine and reported in the Jan. 25 issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;While toilet-seat dermatitis is commonly thought to result from allergies to wooden seats, the report concludes that another source is plastic toilet seats cleaned with harsh detergents.&lt;/p&gt;
&lt;p&gt;&quot;This case series and previous reports have documented that toilet-seat dermatitis is much more common than previously recognized in the U.S. and around the world,&quot; Bernard A. Cohen, MD, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;Furthermore, the incidence of this condition is rising in North America because of a resurgent popularity of exotic-wood toilet seats and frequent use of detergents that contain highly irritant/sensitizing compounds such as quaternary ammonium compounds, phenol, formaldehyde, etc. in public restrooms.&quot;&lt;/p&gt;
&lt;p&gt;Of the cases analyzed by the authors, two occurred in the U.S. and the other three occurred in India.&lt;/p&gt;
&lt;p&gt;Both U.S. cases were girls, a 6-year-old who had a rash for over two years before it was correctly diagnosed and a 10-year-old whose rash lasted for a year. In both cases, the rashes seemed to worsen during the school year when the girls were using school restrooms. The younger girl&apos;s dermatitis twice became infected with methicillin-resistant &lt;em&gt;Staphylococcus aureus &lt;/em&gt;and required treatment with antibiotics.&lt;/p&gt;
&lt;p&gt;After doctors determined the rashes were the result of contact with toilet seats and instructed the girls to use toilet-seat covers and apply moisturizers and topical steroids to the affected areas, the eruptions cleared up within a few weeks.&lt;/p&gt;
&lt;p&gt;The cases in India included a 14-month old boy and two girls, 12 and 10.&lt;/p&gt;
&lt;p&gt;The boy and the 12-year-old girl were both initially misdiagnosed with ringworm and unsuccessfully treated with clotrimazole cream. The other girl was unsuccessfully treated with ayurvedic and homeopathic topical medications before doctors diagnosed toilet-seat dermatitis. Two of the children were instructed to use soaps that only exacerbated the problem.&lt;/p&gt;
&lt;p&gt;In all three cases, the rashes cleared up with some combination of topical steroids, using toilet-seat covers, replacing the household toilet seat, and limiting time on the toilet.&lt;/p&gt;
&lt;p&gt;The authors distinguished between two types of toilet-seat dermatitis: allergic contact dermatitis, the better described form of the condition, in which a patient develops allergy to wooden toilet seats, and irritant contact dermatitis, in which the rashes result from contact with harsh detergents used on plastic toilet seats.&lt;/p&gt;
&lt;p&gt;They noted that detergents used in public restrooms and in hospitals are potentially more irritating to the skin than those used at home and that alkaline detergents are more likely to cause skin irritation than acidic detergents, because they perturb the body&apos;s natural acidic environment.&lt;/p&gt;
&lt;p&gt;Toilet-seat dermatitis was first identified as an external skin rash in 1927. Exposure to wooden toilet seats and associated varnish, lacquers, and paints led to sensitization and development of an allergic contact dermatitis.&lt;/p&gt;
&lt;p&gt;The condition nearly disappeared in the U.S. in 1980s and 1990s, after public facilities and homeowners in the U.S. changed from wooden to plastic toilet seats and sanitary seat covers became readily available.&lt;/p&gt;
&lt;p&gt;However, in recent years the number of cases has grown as a result of homeowners installing toilet seats made of exotic woods and the increased use of harsh toilet seat detergents.&lt;/p&gt;
&lt;p&gt;Most reports have focused on adults with rashes, but little previous attention has focused on the condition in children. &quot;In this case series we describe toilet-seat contact dermatitis in children and underscore a typical history and physical findings that we hope will aid clinicians in recognizing this disease,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;It is important to underscore that regular use of toilet-seat covers is the key to success in treatment,&quot; the authors wrote. &quot;Such seat covers can be purchased at any major retailer such as Walmart or online.&lt;/p&gt;
&lt;p&gt;As an alternative, newspaper cutouts could be used to provide barrier protection. Although it is possible to develop an allergy to toilet-seat covers, none have been reported thus far in the literature.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors reported no sources of funding or financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_494"
                     title="SDEF: Treatments for Rosacea Contribute to Growth of Antibiotic Resistance"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/SDEF/tb/12919?impressionId=1265806775644"
                     
      WAILEA, Hawaii, Feb. 17 -- Using antibiotics to treat rosacea -- a regimen that has no basis in evidence but a long history in daily clinical practice -- has contributed to antibiotic resistance, according to a review of the latest evidence.
              &lt;p&gt; 
              &lt;p&gt;The primary suspects in this case are the tetracyclines, particularly doxycycline, explained Hilary E. Baldwin, M.D., an associate professor and vice-chair of the department of dermatology at SUNYDownstate Medical Center in New York.
              &lt;p&gt; 
              &lt;p&gt;And, in a surprising finding, resistance to doxycycline can occur in a few days, with resistant bacteria in abundance after just seven days of treatment with 100 mg doxycyline daily, she said.
              &lt;p&gt; 
              &lt;p&gt;Dr. Baldwin reviewed rosacea treatments during a presentation at the Skin Disease Education Foundation Hawaii Dermatology Seminar.
              &lt;p&gt; 
              &lt;p&gt;She said that antibiotics became a standard rosacea treatment because of the mistaken belief that &quot;the etiology of rosacea was bacterial. But the best current evidence is that microbes are not involved.&quot;
              &lt;p&gt; 
              &lt;p&gt;Yet, antibiotics continue to be a standard course because they &quot;appear to be effective for treatment of papulopustular rosacea,&quot; she said.
              &lt;p&gt; 
              &lt;p&gt;But tetracyclines work, Dr. Baldwin explained, not because of their antibiotic properties but because &quot;they have anti-inflammatory activity.&quot;
              &lt;p&gt; 
              &lt;p&gt;Specifically, tetracyclines are involved in downregulation of proinflammatory cytokines, inhibition of angiogenesis, inhibition of neutrophil chemotaxis, inhibition of nitric oxide activity, and suppression of neutrophil-derived production of reactive oxygen species -- all of which help them take the red out of rosacea.
              &lt;p&gt; 
              &lt;p&gt;But doxycycycline at 40 mg controlled dose or 20 mg bid is an anti-inflammatory dose that has no antibiotic effect so it will not promote resistance. She cautioned, however, that simply cutting a 75 mg generic doxycycline pill in half does not achieve a guaranteed anti-inflammatory effect, she said. &quot;The low does must be administered in a dose specific pill at 40 mg or 20 mg,&quot; she said.
              &lt;p&gt; 
              &lt;p&gt;But she warned that &quot;giving 100 mg every other day, is not an anti-inflammatory dose.&quot;
              &lt;p&gt; 
              &lt;p&gt;The 100 mg every other day actually promotes antibiotic resistance because it is starting and stopping an antibiotic regimen.
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;Dr. Baldwin disclosed financial relationships with Allergan, Galderma, Glaxo Smith-Kline, Ortho-Neutrogena, Medicis, Ranbaxy, sanofi-aventis, and Steifel.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
            
    </recommendedItem>
    <recommendedItem id="20090101_19_450"
                     title="SDEF: Draft Guideline to Ease Methotrexate Liver Biopsy Recommendation"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/SDEF/tb/12846?impressionId=1265806775644"
                     
      WAILEA, Hawaii, Feb. 12 -- The American Academy of Dermatology is poised to loosen the decade-old guideline recommendation aimed at reducing liver damage from giving methotrexate for psoriasis.
              &lt;br&gt; 
              &lt;br&gt;John Y.M. Koo, M.D., vice chairman of dermatology at the University of California San Francisco, said that he and other members of the AAD guidelines committee have &quot;hashed out in a manuscript form&quot; an update that recommends periodic liver biopsies when patients reach a threshold of 3.5 g of methotrexate.
              &lt;br&gt; 
              &lt;br&gt;That recommendation, Dr. Koo said during a presentation at the Skin Disease Education Foundation (SDEF) Hawaii Dermatology Seminar, would cover only patients &quot;who have no risk factors whatever -- no fatty liver disease, no obesity, no diabetes.&quot;
              &lt;br&gt; 
              &lt;br&gt;Patients with such risk factors are not recommended for methotrexate therapy. 
              &lt;p&gt; 
              &lt;p&gt;Dr. Koo said the guideline must be approved by the AAD, but he said he expected that approval within the next few months. 
              &lt;p&gt; 
              &lt;p&gt;The current guidelines recommend periodic liver biopsies and cites a cumulative dose threshold of 1.5 g.
              &lt;p&gt; 
              &lt;p&gt;But in recent years several clinicians have questioned that threshold. 
              &lt;p&gt; 
              &lt;p&gt;Craig L. Leonardi, M.D., a dermatologist at Saint Louis University in St. Louis, said there was much controversy surrounding not only liver biopsies, but also the interpretation of the biopsy findings. 
              &lt;p&gt; 
              &lt;p&gt;He said he was &quot;trying to relax and wait until 3 g or 3.5 g before I&apos;m bothering my patients about liver biopsies.&quot;
              &lt;p&gt; 
              &lt;p&gt;Dr. Leonardi said the issue was complicated by a subset of patients &quot;who are very tolerant of the drug.&quot; 
              &lt;p&gt; 
              &lt;p&gt;To illustrate, he described a patient who was referred to him who had a history of 25 mg of methotrexate a week for 20 years. He said the patient had been poorly managed with liver function tests only every other year and the patient also &quot;drank a couple of fingers of Scotch every night.&quot;
              &lt;p&gt; 
              &lt;p&gt;Dr. Leonardi said when did a liver biopsy, the pathologist called to point out that the patient history must be incorrect because the liver was fine. 
              &lt;p&gt; 
              &lt;p&gt;Dr. Koo said he, too, had patients who appeared to be methotrexate tolerant, but he also had other patients who were in fulminant methotrexate-induced liver failure at relatively low doses. 
              &lt;p&gt; 
              &lt;p&gt;M. Shane Chapman, M.D., of Dartmouth-Hitchcock Medical Center in Lebanon, N.H., agreed that a guideline change was in order, but he said that if physicians believe that a patient may be harmed by methotrexate they should &quot;get the patient off the drug.&quot;
              &lt;p&gt; 
              &lt;p&gt;Henry H. Roenigk, Jr., M.D., professor emeritus at Northwestern, and chair of the SDEF psoriasis session, said methotrexate was the &quot;historic gold standard for psoriasis because it is so effective, with a 60% to 80% clear rate.&quot;
              &lt;p&gt; 
              &lt;p&gt;And, in the era of biologics that are noted for both their efficacy and price, &quot;methotrexate is cheap, and that&apos;s a key factor.&quot;
              &lt;p&gt; 
              &lt;p&gt;Dr. Roenigk noted, too, that rhematologists regularly use methotrexate &quot;with no biopsies.&quot; 
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; Dr. Roenigk said he was on the speakers&apos; bureaus for Amgen, Genentech, and Abbott.
              &lt;p&gt; 
              &lt;p&gt;Dr. Leonardi disclosed potential conflicts of interest with Abbott, Abgenix, Allergan, Amgen/Immunex, Biogen-IDEC, Boehringer-Ingelheim, Bristol-Myers Squibb, Connetics, Corixa, Celgene, Centocor, Fujisawa, Genentech, Isis, and Medimmune.
              &lt;p&gt; 
              &lt;p&gt;Dr. Chapman disclosed potential conflicts of interest with Genentech, Centocor, and Abbott.
              &lt;p&gt; 
              &lt;p&gt;Dr. Koo disclosed potential conflicts of interest with Abbot, Amgen, Biogen, Bristol Meyers Squibb, Centacor, Connetics, Eisai, Fujisawa, Galderma, Genentech, Novartis, Serono, Teikoku, Valeant, and Warner-Chilcott.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_456"
                     title="SDEF: Variety Key to Strategy for In-Office Infliximab for Psoriasis"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/SDEF/tb/12874?impressionId=1265806775644"
                     
      WAILEA, Hawaii, Feb.12 -- Long-term remission of even severe psoriasis is possible by modifying both the dose and frequency of infliximab (Remicade) following induction doses, a researcher said here.
              &lt;p&gt; 
              &lt;p&gt;In a series of 79 patients, 75% achieved PASI (psoriasis area and severity index) scores of 90% or better by varying dose and intervals following induction, according to results reported by Craig L. Leonardi, M.D., of Saint Louis University.
              &lt;p&gt; 
              &lt;p&gt;Patients were treated in an office setting from January 2005 through July 2007.
              &lt;p&gt; 
              &lt;p&gt;Among the patients, 68% received 5 mg/kg and 29% were dosed at 7.5 mg/kg; 71 of the patients were treated at intervals of six to eight weeks, including 22 patients who were infused at seven-week intervals.
              &lt;p&gt; 
              &lt;p&gt;Dr. Leonardi, who presented the findings at the Skin Disease Education Foundation (SDEF) Hawaii Dermatology Seminar, called his treatment paradigm &quot;a rational strategy&quot; for in-office infliximab infusions.  
              &lt;p&gt; 
              &lt;p&gt;He said the key to response was a strategy that reduced the likelihood that patients would form antibodies to the drug during therapy. 
              &lt;p&gt; 
              &lt;p&gt;&quot;Antibodies to infliximab are associated with both infusion reactions and loss of efficacy,&quot; Dr. Leonardi said. He said antibody formation was less likely when at least minimal infliximab levels are maintained. 
              &lt;p&gt; 
              &lt;p&gt;The recommended dosing regimen for infliximab is 5 mg/kg infusions at week 0, two, and six, with infusions very eight weeks thereafter. 
              &lt;p&gt; 
              &lt;p&gt;Dr. Leonardi changed that schedule to week 0, two, and six, with a follow-up infusion six weeks later. 
              &lt;p&gt; 
              &lt;p&gt;After those four infusions, he stratified patients by response: those with moderate to severe psoriasis had infusions every five weeks, those with mild psoriasis were maintained on an every-six-weeks schedule, and patients who achieved physicians global assessment (PGA) clear status had the infusion interval increased to every seven weeks. 
              &lt;p&gt; 
              &lt;p&gt;Doses were also adjusted with patients receiving doses as low as 2.5 mg/kg and as high as 12.5 mg/kg. A second immunosuppressant (methotrexate or azathioprine [Imuran]) was added to infliximab for nine patients to further reduce the risk of antibody formation.
              &lt;p&gt; 
              &lt;p&gt;Infusion reactions are a common side-effect of infliximab, but Dr. Leonardi said he was able to achieve a small reduction in reactions with a premedication strategy -- acetaminophen 1,000 mg and diphenhydramine 50 mg or acetaminophen 1,000 mg and loratadine 20 mg. 
              &lt;p&gt; 
              &lt;p&gt;Dr. Leonardi also said that slowing or suspending the infusion could reduce mild to moderate reactions. The infusion can then be resumed at a lower rate and antihistamines, acetaminophen, or corticosteroids can be given along with the infusion.
              &lt;p&gt; 
              &lt;p&gt;Of the 1,301 infusions given during the study period, 68 were administered before initiation of the premedication strategy. 
              &lt;p&gt; 
              &lt;p&gt;Before beginning the premedication regimen, the infusion reaction rate was 2.94% versus 2.43% following initiation of premedication. 
              &lt;p&gt; 
              &lt;p&gt;Only two patients had serious infusion reactions -- widespread uticaria in both cases. 
              &lt;p&gt; 
              &lt;p&gt;The overall adverse event rate was also low, but did include two MIs, one exacerbation of polyneuropathy, and one ovarian carcinoma. 
              &lt;p&gt; 
              &lt;p&gt;&quot;But there were zero cases of tuberculosis, histoplasmosis, opportunistic infections, demylination, or lymphoma,&quot; said Dr. Leonardi. 
              &lt;p&gt; 
              &lt;p&gt;The downside of an in-office infliximab infusion strategy is time and practice cost, he said. 
              &lt;p&gt; 
              &lt;p&gt;The total time per patient is three hours, which includes two-hour infusion time and a minimum of 30-minutes post-infusion observation.
              &lt;p&gt; 
              &lt;p&gt;Time is also required to obtain IV access and to reconstitute the drug. 
              &lt;p&gt; 
              &lt;p&gt;Dr. Leonardi cautioned that his presentation had several limitations -- the data were observational, all from a single center, and the fact that the regimen &quot;evolved&quot; over time.  
              &lt;p&gt; 
              &lt;p&gt;Also, he said, a number of external factors, including insurance, influenced patient selection.
              &lt;p&gt; 
              &lt;p&gt;That said, he concluded that in-office infliximab treatment can offer &quot;unsurpassed efficacy to patients, even difficult to treat patients. Hands down, this is the best we have.&quot;
              &lt;p&gt; 
              &lt;p&gt;For those considering offering in-office infliximab, Dr. Leonardi had one additional caution -- be sure to evaluate each patient before infusion.
              &lt;p&gt; 
              &lt;p&gt;Patients, he said, will frequently forget to mention a cold or other minor ailment. Any illness is a contraindication for infusion, &quot;so you need to look the patient in the face and make the clinical judgment that the patient is otherwise healthy.&quot;
              &lt;p&gt; 
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; Dr. Leonardi disclosed potential conflicts of interest with Abbott, Abgenix, Allergan, Amgen/Immunex, Biogen-IDEC, Boehringer-Ingelheim, Bristol-Myers Squibb, Connetics, Corixa, Celgene, Centocor, Fujisawa, Genentech, Isis, and Medimmune.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
</recommendedContent>