A large prospective study of 215 patients with malignancy who had 317 total neutropenic episodes showed that 72.7% of patients with NE were on
antimetabolites, 72.7% were on anthracyclines, and 36.4% were on alkylating agents [3].
The recommended initial measure is the reduction of immunosuppression, which was performed in 100% of the patients we reported here and which consisted of anticalcineurin suspension in all of them, and
antimetabolite in the majority, with change to everolimus or sirolimus.
A successful case of trabeculectomy without adjunctive
antimetabolites performed with retrobulbar anesthesia has been reported in a pregnant patient.
Low-dose
antimetabolite therapy is often administered concomitantly to prevent antichimeric antibody production.
This study provides a new understanding of an unexplored
antimetabolite, L-CAV as an alternative of classical
antimetabolites, such as 5-fluoruracil and methotrexate.
Immunosuppressive therapy before and after RALP N = 12 Before RALP After RALP A: Calcineurin inhibitors 11/12 * (91.7%) 7/12 (58.3%) (Prograf, Advagraf) B: Corticosteroids 5/12 (41.7%) 4/12 (33.3%) C:
Antimetabolite 10/12 (83.3%) 6/12 (50%) (Cellcept) D: mTor inhibitors 0/12 (0%) 8/12 * (66.7%) (Rapamune, Certican) RALP: robot-assisted laparoscopic radical prostatectomy; mTOR: mammalian target of rapamycin.
However similar results may not be obtainable in higher risk eyes without the use of
antimetabolites as the only demonstrable risk factor for failure in our patients was the prior use of topical medications.
Bioisosteric replacement of carbonyl oxygen in hypoxanthine by S gives 6-mercaptopurine, a potent anticancer
antimetabolite [4, 45].
The first step is a 50% decrease in the dose of the
antimetabolite drug.
In this study, in which treatment with adalimumab was given for a mean of 2 years, at the end of the follow-up, only 4 patients remained on adalimumab monotherapy and the rest were on combined therapy with prednisone, methotrexate, cyclosporine A, or other
antimetabolite drugs.
The
antimetabolite 5FU is often linked with kidney damage (9).
Cytarabine is a cell cycle-specific (S phase)
antimetabolite that inhibits DNA synthesis.