In patients with the adrenogenital syndrome, a single intramuscular injection of 40 mg every two weeks may be adequate. For maintenance of patients with rheumatoid arthritis , the weekly intramuscular dose will vary from 40 to 120 mg. The usual dosage for patients with dermatologic lesions benefited by systemic corticoid therapy is 40 to 120 mg of methylprednisolone acetate administered intramuscularly at weekly intervals for one to four weeks. In acute severe dermatitis due to poison ivy, relief may result within 8 to 12 hours following intramuscular administration of a single dose of 80 to 120 mg. In chronic contact dermatitis, repeated injections at 5 to 10 day intervals may be necessary. In seborrheic dermatitis, a weekly dose of 80 mg may be adequate to control the condition.
Bleomycin is a chemotherapeutic agent that inhibits DNA synthesis in cells and viruses. 9 It causes acute tissue necrosis that may stimulate an immune response. 10 There is no consistent evidence regarding the effectiveness of bleomycin for nongenital cutaneous warts. In five RCTs, cure rates ranged from 16 to 94 percent; one trial even showed higher cure rates in the placebo group. 2 , 7 Adverse effects of bleomycin include pain, swelling, and redness for one week after treatment. Necrosis in the skin may cause scarring, pigment change, or nail damage. Because treatment can lead to significant systemic drug exposure, bleomycin should be avoided in children, pregnant women, and patients with peripheral vascular disease or Raynaud disease. 27 Patients are usually referred to a dermatologist for this treatment.
T-VEC was compared with GM-CSF in the phase III OPTiM study in 436 stage IIIB/C and IV melanoma patients who had injectable and unresectable disease. Durable response (complete or partial), the primary endpoint, was defined as a response lasting continuously for at least 6 months and begun within 12 months of initiation of therapy. Patients were randomized 2:1 (295:141) to intralesional T-VEC (initially, ≤ 4 mL × 10 6 pfu/mL; then after 3 weeks, ≤ 4 mL × 10 8 pfu/mL every 2 weeks) or subcutaneous GM-CSF (125 µg/m 2 daily × 14 days every 28 days).