Bromfenac-Xibrom in Japan

Addtional information on drugs and medications.

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ghoti
Posts: 8
Joined: Wed May 02, 2007 8:36 pm

Bromfenac-Xibrom in Japan

Post by ghoti » Wed May 02, 2007 8:48 pm

Hi, I am a first time poster, but an experienced iritis patient.

I am in Japan and got iritis just before the holidays here. I went to eye clinic and was prescribed what I thought was a Pred Forte equivalent, but was in fact a non-steroid eyedrop called Bromfenac 0.1%, or Xibrom (It's called BRONAC in Japan). That in additon to an anti-allergenic and an antibiotic eyedrop, which may or may not be useful - but they are commonly prescribed here.

He prescribed Bromfenac to be applied only twice per day.

I can't find anything that descibes this non-steroid being used to treat iritis. Has anybody used this stuff successfully for iritis? If so, what was the dosage?

Any suggestions would be appreciated. I have had some real problems with medical treatment in Japan before, and hope to stay ahead the curve this time.

Mike Bartolatz
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Joined: Fri Feb 06, 2004 9:58 pm

Post by Mike Bartolatz » Wed May 02, 2007 9:09 pm

generally, NSAID eyedrops won't treat uveitis; but, I don't know about Xibrom specifically. it can treat cystoid macular edema. I have asked Doctor Foster about this and will respond when I get further guidance.
If you can get to a University Medical School there in Japan, you might get better care. there are several opthalmologists that publish regularly. do a pub med search on Uveitis and look for articles translated from published medical journals there to find the best specialists as I don't have contact information for any of them. If you find one, post the contact information in our specialist list under the topic of Doctor in Japan.

Will get back as soon as I get a response from CSF.

Wish you the very best,
Mike
Mike Bartolatz
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Mike Bartolatz
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Post by Mike Bartolatz » Wed May 02, 2007 9:11 pm

JAPAN
Koki Aoki, MD
Shiroishi-Ku Tel: 81 11 864-4656
Hondori 6, Kita 2-1 FAX: 81 11 864-2344
Sapporo, 003
E-mail: aokimd@mail.rainbow.ne.jp

Hajime Inomata MD
Department of Ophthalmology Tel: 81-92-641-1151
Faculty of Medicine FAX: 81-92-633-4045
Kyushu University
Fukuoka 812
E-mail: inomata@eye.med.kyushu-u.ac.jp

Satoshi Kotake MD
Department of Ophthalmology
Hokkaido University School of Medicine
Kita-15, Nishi-7, Kita-ku
Sapporo 060-8638
Tel: 81-11-716-1161 Ext. 5944
FAX: 81-11-736-0952
E-mail: skotake@med.hokudai.ac.jp

Manabu Mochizuki MD
Dept. of Ophthalmology & Visual Science Tel: 81-3-5803-5296
Tokyo Medical & Dental University FAX: 81-3-5803-0145
1-5-45 Yushima, Bunkyo-ku
Tokyo 113-8519
E-mail: m.manabu.oph@tmd.ac.jp

Annabelle A. Okada, MD
Assistant Professor of Ophthalmology
Kyorin Eye Center
Kyorin University School of Medicine
6-20-2 Shinkawa, Mitaka
Tokyo 181-8611
Tel: 81-422-47-5511 Fax: 81-422-71-6836
E-mail: aokada@po.iijnit.or.jp

Shigeaka Ohno, MD
Dept. of Ophthalmology & Visual Science Tel: 81-11-716-1161
Hokkaido University FAX: 81-11-736-0952
Graduate School of Medicine
Kita-15, Nishi-7, Kita-Ku3-9
Sapporo 060-8638
E-mail: sohno@med.hokudai.ac.jp

Masahiko Usui, MD
Tokyo Medical University Tel: 81-333426111
Department of Ophthalmology FAX: 81-3-33469170,
6-7-1 Nishinjuku Shinjuku 81-3-33428430
Tokyo
E-mail: sopthal@tkk.att.ne.jp
Mike Bartolatz
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ghoti
Posts: 8
Joined: Wed May 02, 2007 8:36 pm

Xibrom

Post by ghoti » Wed May 02, 2007 11:32 pm

Wow. Thanks for a very quick response. I followed up a bit on the other drugs, and the Xibrom/Bromfenac is being used in combination with Rinderon, a Japanese steroid I have used in the past, not with great success. A couple of Japanese reports suggested that Bromfenac might potentially be used as a supplement to steroid treatment for iritis.

Dr. Inomata at Kyushu University, from the list you posted, is in my area. It can be quite hard to get in without an introduction, but I will shoot him an e-mail and hope for the best.

I used to have a supply of Pred Forte from the US, and a letter explaining treatment from a doctor at UCSF. But, it has been 9 years since my last outbreak, and I had hoped I was past it. I'll have to get another one of those letters, as it carries considerably more influence with local doctors than anything I might say.

This is a wonderful site, and a great source of support.

Thank you.

Mike Bartolatz
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Joined: Fri Feb 06, 2004 9:58 pm

Post by Mike Bartolatz » Wed May 02, 2007 11:41 pm

has anyone suggested a steroid sparing approach to treatment such as adding an NSAID to your daily routine such as Naprosyn, feldene, celebrex etc? your disease is systemic and systemic treatment is needed if you don't have a related environmental cause such as a virus, bacteria etc. do you have any form of arthritis showing up or other autoimmune disease process?

who did yousee in San Francisco, DR Ira Wong?

Iritis is quite common in Japan, often related to autoimmune disease suchas Vogt Koyanagi Harada disease, Behcet's disease and sometimes sarcoidosis as well as HLA B27 related uveitis.

Wish you the very best and I'm glad you have found our bulletin boards helpful
most sincerely,
Mike Bartolatz
Mike Bartolatz
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ghoti
Posts: 8
Joined: Wed May 02, 2007 8:36 pm

Related diseases

Post by ghoti » Thu May 03, 2007 12:08 am

Well, no such suggestions yet. It is systemic, but it only occurs every several years. It came back almost like clockwork, every 4-5 years until age 40, and then the long 9 year break. Maybe I'm wearing it down!

I was diagnosed with ankylosing spondylitis 30 years ago. My father suffered from arthritis and iritis as well, though his iritis only occurred once or twice when he was a young man.

I don't remember the name of the doctor at UCSF, but it wasn't Dr. Wong.
Thanks very much again.

Mike Bartolatz
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Joined: Fri Feb 06, 2004 9:58 pm

Post by Mike Bartolatz » Thu May 03, 2007 10:24 am

I got a response from Dr Foster indicating that Xibrom MAY be able to control very mild uveitis. He has a grant to study this coming up this summer.

your uveitis is most likely related to your ankylosing spondylitis. uveitis occurs in about 7 percent of individuals with this and is most often related to the HLA B27 haplotype.
this form of uveitis often responds very well to oral NSAID therapy. Celebrex and Dolobid work very well. other generic drugs in this class can work too such as naprosyn etc. you might want to get some blood work done to see if your liver and kidneys will tolerate NSAID therapy and ask to initiate such a treatment regimen.
a trial of about six months should tell if it will work for you. this will also help with your AS.

I hope your uveitis will respond to therapy quickly for you.

Wish you the very best,
Mike
Mike Bartolatz
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ghoti
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Post by ghoti » Thu May 03, 2007 10:49 pm

Just for your information, I found Rinderon is betamethasone 0.1%, and the strength seems about right. He started me with 4 applications per day, which I have bumped to 6, which I hope is enough.I know we are not supposed to do this, but doctors here commonly underprescribe for iritis and I end up suffering for it. It hasn't gotten worse anyway.

The bromfenac feels good going in, and it seems it might help as a supplement. No side effects at this point, and maybe it will help me to avoid the stronger treatments.

Thanks again. I feel informed enough to ask the right questions now, at least.

Mike Bartolatz
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Joined: Fri Feb 06, 2004 9:58 pm

Post by Mike Bartolatz » Fri May 04, 2007 12:37 am

Xibrom is most often prescribed to treat cystoid macular edema here in the USA.
do you know if you have developed this complication to long term uveitis?

Wish you the best,
Mike
Mike Bartolatz
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ghoti
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Joined: Wed May 02, 2007 8:36 pm

Post by ghoti » Fri May 04, 2007 2:15 am

No, I haven't. I avoid diseases of more than three syllables, and haven't had any unbearable symptoms (if any) of ankylosing spondylitis for years.

Bromfenac (Xibrom), from what I gather, is being pushed for all kinds of things in Japan, including iritis. Japanese doctors prefer Japanedse meds, and it's anyone's guess whether my prescription is for good reasons or because the doctor is helping the pharmaceutical company find new markets. Maybe he's a step ahead of Dr. Foster, and just trying it out.

I do intend to ask about it when I see him on Monday.

Mike Bartolatz
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Post by Mike Bartolatz » Fri May 04, 2007 10:10 am

Actually DR Foster's 'work' is a placebo controlled double blind study, not just anecdotal evidence used for much of the drugs to treat eye disease. a definitive answer needs to be arrived at so that harm isn't done by doctors who mean well but have no evidence in backing up their approach to treatment of ocular inflammatory disease processes.
it like the use of other NSAID eye drops, many doctors still try them even though the published studies have shown they don't work for uveitis. It is rather sad in my lay opinion as people can lose substantial vision to long term uveitis that isn't properly treated using a steroid sparing approach to treatment.

Take care,
Mike
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ghoti
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Post by ghoti » Sat May 05, 2007 7:35 am

I didn't intend any slight to Dr. Foster's work. I personally appreciate any seriouds research, but find it rather disheartening that many doctors don't bother learning from it.

Xibrom will probably turn out the same as the others. I wonder, do these tests research only the efficacy of NSAIDs alone, or do they also test them as supplements to actual streroids? In my case, they don't seem to have helped, and I went ahead and got an injection this morning.

Mike Bartolatz
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Post by Mike Bartolatz » Sat May 05, 2007 9:46 am

This would be an nsaid, xibrom only, test for very mild uveitis. I didn't take your comment as a sliight to Dr Foster's work but elaborated a bit on the trial.

yes it is sad that many doctors don't look to the research and try effective treatments. allot goes to old dogma regarding many of the medications now used to stop inflammation. early studies were done using transplant patients and much higher dose was required to control their immune systems. other factors weren't taken into consideration when used to control inflammatory response in autoimmune disease processes many of which have lymphoma as a long term component. it has now been found that early intervention usind Disease Modifying Arthritis Drugs actully preclude the development of Lymphoma and other consequences of the disease processes. Few doctors are aware of this continuing to tell their patients that 'that causes cancer so you don't want to use that.' they continue to use the biological, Enbrel as well and it won't work for uveitis. other biologicals such as Remicade and Humira will work in SOME individuals however so if they would keep up on the research much anguish and errosion of vision wouldn't occur.
I would think that xibrom wouldn't help you if you required a steroid injection since that is used for allot of inflammation. kinda like trying to put out a forest fire with a garden hose.

wish you the best,
Mike
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ghoti
Posts: 8
Joined: Wed May 02, 2007 8:36 pm

Follow up

Post by ghoti » Wed May 23, 2007 4:36 pm

In a couple days, when I find some time, I will write an intro. In the meantime, I just wanted to update you.

Your advice to find authors of medical papers on uveitis was very, very useful - and have since passed it on to friends with other medical problems. The Internet is a wonderful thing.
The doctor at my hospital was a bit reluctant to let me go , but he was clearly no expert on uveitis. The doctor I found is Dr. Sonoda at Kyushu University Hospital, and I left there feeling a great sense of relief that I finally had a doctor who knows more about uveitis than I do. He knows his stuff, and I feel in good hands.

Thanks again.

Mike Bartolatz
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Joined: Fri Feb 06, 2004 9:58 pm

Post by Mike Bartolatz » Thu May 24, 2007 3:53 pm

Some doctors are reluctant to let a patient see someone else because of their own inablitilites and word would then get out about their incompetence in my experience. Many think the are the 'best' when in reality they are just run of the mill doctors. the term 'expert' is used way too frequently in describing people within the medical community.
this stuff can blind a person pretty easily with improper care. if one has apprehension about care, move on. Don't look back. SAVE YOUR VISION,

Wish you the very best,
Mike
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