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Bissonnette R, Eichenfield LF, Simpson E, Thaçi D, Kabashima K, Thyssen JP, Guttman-Yassky E, Nunes FP, Gamalo M, Ahmad F, Kuligowski M, Sun K, Pipper C, Christensen AW, D'Angelo P, Milutinovic M, Guettner A, Silverberg JI. Estimands for atopic dermatitis clinical trials: Expert opinion on the importance of intercurrent events. J Eur Acad Dermatol Venereol 2023; 37:976-983. [PMID: 36652273 DOI: 10.1111/jdv.18881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/05/2023] [Indexed: 01/19/2023]
Abstract
Despite the emergence of novel targeted treatments for atopic dermatitis (AD), there is a lack of guidelines on standardizing analysis of clinical trial data. To define and estimate meaningful treatment comparisons, several factors, including intercurrent events, must be taken into account. Intercurrent events are defined as events occurring after treatment initiation that affect either the interpretation or existence of the measurements associated with clinical questions of interest. Due to the relapsing, unpredictable nature of AD, intercurrent events frequently occur in AD trials, such as use of rescue therapy for intense itch and sleep deprivation. Despite the impact of intercurrent events in AD, they are often handled in an inconsistent manner across trials, which limits results interpretation. The estimand framework is increasingly used to estimate treatment effects while accounting for intercurrent events. This review explores how guidance from the International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH) on the use of estimands can be applied to support AD clinical trial design and analysis. We propose that estimands are used in AD trials and defined early during trial design. The use of estimands can provide clinicians with interventional trial results that are more reflective of clinical practice, help facilitate comparisons across clinical trials, and are more informative to enable improved treatment selection for patients.
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Paller A, Blauvelt A, Soong W, Hong C, Schuttelaar M, Schneider S, Moerch M, Simpson E. MEANINGFUL RESPONSES IN TRALOKINUMAB-TREATED ADOLESCENTS WITH ATOPIC DERMATITIS NOT ACHIEVING IGA 0/1 AT WEEK-16. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Grimbly C, Escagedo PD, Jaremko JL, Bruce A, Alos N, Robinson ME, Konji VN, Page M, Scharke M, Simpson E, Pastore YD, Girgis R, Alexander RT, Ward LM. Sickle cell bone disease and response to intravenous bisphosphonates in children. Osteoporos Int 2022; 33:2397-2408. [PMID: 35904681 PMCID: PMC9568449 DOI: 10.1007/s00198-022-06455-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/28/2022] [Indexed: 11/30/2022]
Abstract
UNLABELLED Children with sickle cell disease (SCD) have the potential for extensive and early-onset bone morbidity. This study reports on the diversity of bone morbidity seen in children with SCD followed at three tertiary centers. IV bisphosphonates were effective for bone pain analgesia and did not trigger sickle cell complications. INTRODUCTION To evaluate bone morbidity and the response to intravenous (IV) bisphosphonate therapy in children with SCD. METHODS We conducted a retrospective review of patient records from 2003 to 2019 at three Canadian pediatric tertiary care centers. Radiographs, magnetic resonance images, and computed tomography scans were reviewed for the presence of avascular necrosis (AVN), bone infarcts, and myositis. IV bisphosphonates were offered for bone pain management. Bone mineral density was assessed by dual-energy X-ray absorptiometry (DXA). RESULTS Forty-six children (20 girls, 43%) had bone morbidity at a mean age of 11.8 years (SD 3.9) including AVN of the femoral (17/46, 37%) and humeral (8/46, 17%) heads, H-shaped vertebral body deformities due to endplate infarcts (35/46, 76%), and non-vertebral body skeletal infarcts (15/46, 32%). Five children (5/26, 19%) had myositis overlying areas of AVN or bone infarcts visualized on magnetic resonance imaging. Twenty-three children (8/23 girls) received IV bisphosphonate therapy. They all reported significant or complete resolution of bone pain. There were no reports of sickle cell hemolytic crises, pain crises, or stroke attributed to IV bisphosphonate therapy. CONCLUSION Children with SCD have the potential for extensive and early-onset bone morbidity. In this series, IV bisphosphonates were effective for bone pain analgesia and did not trigger sickle cell complications.
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Becksfort J, Lucas J, Hsu C, Vajapeyam S, Wang C, Simpson E, Chiang J, Armstrong J, Soike M, Young M, Kann B, Li Y, Li C, Lu Z, Kline C, Meuller S, Gajjar A, Merchant T, Baker S, Patay Z, Wright K, Poussaint T, Tinkle C. Conventional and Cross-Channel MR Radiomic Features do Not Predict Histone H3 Status in DIPG: Genomic and Clinical Evaluation of a Multi-Institutional Cohort. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Baghoomian W, Simpson E. 381 Assessing the ease of use and adherence of topical corticosteroid drug delivery devices in caregivers of pediatric patients with atopic dermatitis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Baghoomian W, Jacobson M, Kastala A, Thibau I, Simpson E, Smith Begolka W. LB909 Understanding the motivating factors and barriers to participation in eczema clinical trials among patients and caregivers. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Calco G, Baghoomian W, Jacoby D, Simpson E. 405 Atopic dermatitis patients have decreased epidermal innervation but increased neuronal substance p expression. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Berdyshev E, Simpson E, Bronova I, Pavel A, Soong W, Antaya R, Imafuku S, Røpke M, Jiang L, Guttman-Yassky E, Leung D. 399 Tralokinumab treatment modifies stratum corneum lipid composition in skin of adolescents with atopic dermatitis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Beck L, Boguniewicz M, Hata T, Fuxench Z, Simpson E, De Benedetto A, Ko J, Ong P, Yoshida T, Gallo R, Lussier S, David G, Schlievert P, Gill S, Rudman Spergel A, Leung D. 519 Rapid reduction in S. aureus & cytotoxins in dupilumab treated atopic dermatitis subjects. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Baghoomian W, Dunlap R, Chang A, Foster E, Simpson E. 335 Developing a treatment decision aid for patients with moderate to severe atopic dermatitis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bauman M, Hellinger A, Pluym CV, Bhat R, Simpson E, Mehegan M, Knox P, Massicotte M. Online KidClot education for patients and families initiating warfarin therapy: The eKITE study. Thromb Res 2022; 215:14-18. [PMID: 35594736 PMCID: PMC9755220 DOI: 10.1016/j.thromres.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 01/12/2023]
Abstract
Anticoagulation with Vitamin K antagonists (VKA) has always posed challenges in terms of monitoring requirements. These challenges were further exacerbated in the setting of the COVID-19 pandemic, with limited access to and/or avoidance of laboratory testing. The importance of utilizing point of care (POC) health technology for individualized patient management is salient. The foundation of effective home INR monitoring is establishing patient knowledge about their therapy and INR testing proficiency. The eKITE series was developed to support patients in establishing foundational knowledge required for VKA (warfarin) management and INR monitoring. The primary objectives were to evaluate eKITE, a patient-oriented innovative online education program for warfarin therapy, participant learning stress, and patient preference for online learning. This multi-center prospective study provided patients access to warfarin online education. Participants were required to complete written quizzes assessing warfarin knowledge of key concepts proficiency and identifying knowledge deficits. Patient preference, evaluating calm (lack of anxiety) while learning, and an INR on a home meter was completed. Participants performed INR tests at home and reported INRs by telephone. The analysis included 144 children and caregivers enrolled at five US and CDN sites. Most indications for anticoagulation were cardiac (congenital or acquired heart disease) with varied INR target ranges. Mean knowledge scores for warfarin and INR self-testing modules were 97%, with low anxiety with TTR of 84%. Patient preferred online learning. eKITE is an effective teaching modality for warfarin/home INR monitoring with safe INR testing and warfarin management that is appropriate for pediatrics and adults alike. PROLOGUE: The whir in the hallways is deafening. Lights bright, alarms are ringing in a chorus of unsynchronized beeps and screeches. It has been more than a week since I have slept. Snuggled beside me is my precious child, whining and equally irritated with the asynchronous symphony, further compounded by anxiety, procedures, and pain. The sun has broken. The staff smiles are welcoming and incessant, as one after one, they approach hurried, urgent, assiduous, their need to coach me for our upcoming departure to the warmth of home. Each provides essential information that I will require to keep my child, my treasure, safe and healthy. Yet, my eyes are heavy, blurred, and my brain foggy, trapped in a dark heavy cloud. How am I to follow? Comprehend? and retain anything? As they instruct, my precious child yearns for loving arms, compassion and love, whining, crying in disquiet. Overwhelmed does not adequately describe my ineffable exhaustion. Amidst this, how am I to learn about warfarin? Such a challenging medication, with so much to know. Concentrate, I tell myself, focus; now is my only opportunity to learn. I must be alert. It seems to be nonsensical.
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Lanfranchi V, Jones N, Read J, Fegan C, Field B, Simpson E, Revitt C, Cudd P, Ciravegna F. User attitudes towards virtual home assessment technologies. J Med Eng Technol 2022; 46:536-546. [PMID: 35730495 DOI: 10.1080/03091902.2022.2089250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Telehealth has long been highlighted as a way to solve issues of efficiency and effectiveness in healthcare and to improve patients' care and has become fundamental to address patients' needs during the COVID-19 pandemic; however previous studies have shown mixed results in the user acceptance of such technologies. Whilst many previous studies have focussed on clinical application of telehealth, we focus on the adoption of telehealth for virtual assessments visits aimed to evaluate the suitability of a property where a patient is discharged, and eventual adaptations needed. We present a study of stakeholders' attitudes towards such virtual assessment visits. The study has been carried out with healthcare professionals and patients and allowed us to identify user attitudes, barriers and facilitators for the success of virtual assessment visits from the point of view of healthcare professionals and patients. Finally, we discuss implications for designers of telehealth services and guidelines that can be derived from our study.
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Hadjigeorgiou E, Clark B, Simpson E, Coles D, Comber R, Fischer A, Meijer N, Marvin H, Frewer L. A systematic review into expert knowledge elicitation methods for emerging food and feed risk identification. Food Control 2022. [DOI: 10.1016/j.foodcont.2022.108848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Simpson E, Lacour J, Beck L, Zhang H, Aamodt K, ROSSI A. P196 PATIENT PERCEPTION OF TREATMENT WITH LONG-TERM DUPILUMAB MONOTHERAPY IN ADULTS WITH MODERATE-TO-SEVERE ATOPIC DERMATITIS. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Simpson E, Cork M, Arkwright P, Deleuran M, Chen Z, Rodriguez Marco A, Cyr S, Harel S. P193 DUPILUMAB DECREASES TOTAL AND ALLERGEN-SPECIFIC IGE IN ADOLESCENTS WITH MODERATE-TO-SEVERE ATOPIC DERMATITIS (AD). Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Silverberg J, Simpson E, Gooderham M, Lebwohl M, Fargnoli M, Tsianakas A, Kerkmann U, Valdez H, Biswas P, Levenberg M. P152 CHARACTERIZING THE EFFECTIVENESS OF ABROCITINIB IN SUBTHRESHOLD RESPONDERS IN THE MAINTENANCE PHASE OF JADE REGIMEN. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Papp K, Szepietowski J, Kircik L, Toth D, Eichenfield L, Forman S, Kuligowski M, Venturanza M, Sun K, Simpson E. 208 Long-Term Safety and Disease Control With Ruxolitinib Cream in Atopic Dermatitis: Results From Two Phase 3 Studies. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Reich K, Simpson E, Wollenberg A, Bissonnette R, Abe M, Cardillo T, Janes J, Sun L, Chen S, Silverberg J. 041 Efficacy with continuous dosing, down-titration, or treatment withdrawal after successful treatment with baricitinib in patients with moderate-to-severe atopic dermatitis. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Guttman E, Nosbaum A, Simpson E, Weidinger S. Pioneering Global Best Practices in Atopic Dermatitis: Results from the Atopic Dermatitis Quality of Care Initiative. Clin Exp Dermatol 2021; 47:303-311. [PMID: 34382243 DOI: 10.1111/ced.14880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/12/2021] [Accepted: 08/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by unrelenting pruritus and recurrent eczematous lesions. It affects up to 15% of children and adolescents and up to 5% of adults and confers a high and multifactorial burden to patients, families, and society. With increasing awareness of this substantial burden, AD has become a priority for healthcare systems. OBJECTIVE The Atopic Dermatitis Quality of Care (ADQoC) Initiative set out to describe good practices for addressing the challenges that impede the management of AD. METHODS The Initiative carried out a literature review and surveyed 32 expert care centres, catalogued findings, and analysed and elucidated global challenges to AD care along with good practice implementations that can address them. RESULTS The four challenges to quality care for AD are: misconceptions about AD; delayed referral and access to AD specialists; poor patient access to AD treatments and poor adherence to medications; and managing the complexity of atopic dermatitis and its comorbidities. The Initiative highlighted five of ten good practice implementations as high priority for any AD care centre to focus: clinical assessment and diagnosis; a structured multidisciplinary care team; monitoring and evaluating care quality; patient education and communication; and collaboration and exchange with patient groups. CONCLUSIONS These implementations can provide benefits for patients, healthcare providers, and the healthcare system. They directly contribute to the efficacy of treatment; improved healthcare provider efficiency; improved education; and improved costs to healthcare systems. The Initiative was launched on https://atopicdermatitiscare.kpmg.co.uk/ to provide an easy-to-use educational platform.
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Hopkins A, Lerner K, Grinich E, Ahn J, Choi Y, Simpson E. 321 The frequency and utility of drug cessation trials in older adults with chronic eczematous dermatitis of unknown etiology. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Simpson E, Lee M, Brar K, Kuligowski M, Venturanza M, Sun K, Toth D. 329 Efficacy of ruxolitinib cream in adults and adolescents with atopic comorbidities. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Forman J, Yoshida T, Lillis J, Gill A, Corbett A, Cahill M, Lockhart A, Simpson E, Boguniewicz M, Hanifin J, De Benedetto A, David G, Leung D, Schlievert P, Gill S, Beck L. 189 Microbial expression of lantibiotics may explain discrepancies between S. aureus culturability and metagenomics in atopic dermatitis subjects and healthy controls. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Beck L, Boguniewicz M, Hatta T, Chiesa Fuxench Z, Simpson E, De Benedetto A, Ko J, Ong P, Yoshida T, Gallo R, Schlievert P, Gill S, Mosmann T, Berdyshev E, David G, Lussier S, Rudman Spergel A, Leung D. 666 Effect of dupilumab on the host-microbe interface in atopic dermatitis. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Blauvelt A, Szepietowski J, Papp K, Simpson E, Silverberg J, Kim B, Kwatra S, Kuligowski M, Venturanza M, Sun K, Kircik L. 313 Itch-free state in patients with atopic dermatitis treated with ruxolitinib cream. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Simpson E, Bissonnette R, Kuligowski M, Venturanza M, Sun K, Silverberg J. 311 Effects of ruxolitinib cream in patients with atopic dermatitis with head and/or neck involvement. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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