He has the answer. “First of all the answer is, the treatment is not needed at this point in time and has been very helpful in the past, so we are not yet ready to declare it useless.” He went on to say, “The best decision would be to just take the drug. There are several similar drugs that have met with success with the treatment of HFpEF. The problem is: Do they work? Most of them do not, and a large reason is that, although there are two different kinds of HFpEF (in essence a diffuse and diffuse hypersensitivity), there is only one type of HFpEF (i.e., HFpEF with and without conduction abnormalities). Some of these drugs can reduce inflammation, and this is important, but not all of them. They can reduce the levels of inflammation, but can they reach the levels of inflammation that could potentially be needed? And then we have the non-inflammatory HFpE, which can lead to a much greater amount of inflammatory cells, so that there is a potential increase in the risk of developing HFpEF in the future. As long as you have a disease that increases the amount of inflammatory cells, any new medication that goes down the same road is likely to lead to a higher risk for developing the disease.” Here is a list of the most effective drugs for HFpEF, using numbers from the Food and Drug Administration (FDA). The most well known and easily accessible is rt-alpha-lipoic acid, which is manufactured by Merck & Co. The primary problems associated with this medication are the following: 1) it is difficult to find , requiring either multiple trips, or the rare discovery of an isolated agent. 2) there are multiple forms; 1) the more common form, rutinib that has “sensitivity” to one of several lipoproteins (e.g., S100). This form also requires that the patient have a high degree of hepatic lipase production. It is also, and unfortunately, very expensive (around $10,000-$20,000 per year). 3) it can take time to produce; the active ingredient in this form of rt-alpha-lipoic acid is used for its lipoprotein and apolipoprotein effects, and can stay in the body for years after its use is over. 4) it can induce oxidative stress; this form of rt-alpha-lipoic acid affects the same lipoprotein. It has to be stored in the liver, so that its lipoprotein effects can be sustained for weeks at a time. 5) rt-alpha-lipoic acid is toxic to the liver; this may be relevant in those people who take multiple forms. The most common side effects include a low grade fever, nausea, stomach cramps, and nausea with diarrhea. These are somewhat more common in younger patients, and are often resolved within 7 days. The FDA has recently come out in support of increased screening and testing of patients who are diagnosed with HFpEF. The goal of these tests is to identify and treat patients with or at risk of developing HFpEF. In terms of the cost, it is important to remember that as the frequency of HFpEF increases from years to decades, a drug that doesn’t work in that age group will likely be more expensive than one that does. This all speaks to the need for new drug treatment for HFpEF, because the FDA has indicated that many of these drugs are not effective in the first place. Dr. Mandrola added, “As for rt-alpha- lipoic acid, it can’t be prescribed because it does not seem to be effective in one form of HFpEF, making it a lot more expensive than the other drugs that we’ve tried. Rituximab is an inexpensive therapy, and it is likely the cost will need to be lower to reach similar outcomes.”
NF-kappaB is important for T cells and T cells and B cells for a host of diseases. It is part of the cell cycle, but also participates in immune regulation, and even development. I would just call it a “myth” - it seems to behave differently in different circumstances. My own views are that it does indeed have anti-inflammatory effects, but the fact that it is also a cytokine and has many other effects makes it worth a look. I would say, even if it needs an effective anti-tension drug, it is worth at least considering. The first drug that is tested for NF-kappaB is rituximab (Metacel). If your doctor is familiar with it, then I would say no risk for severe liver toxicity, and it is much easier to take.
Rituximabdoes not interact with a lot of