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Tarride JE, Blackhouse G, Lamarche L, Forsyth P, Oliver D, Carr T, Howard M, Thabane L, Datta J, Dolovich L, Clark R, Price D, Mangin D. Cost-effectiveness analysis of health tapestry, a complex primary care program for older adults: a post-hoc analysis. BMC PRIMARY CARE 2024; 25:235. [PMID: 38961340 PMCID: PMC11223344 DOI: 10.1186/s12875-024-02475-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 06/11/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND We initially reported on the cost-effectiveness of a 6-month randomized controlled implementation trial which evaluated Health TAPESTRY, a primary care program for older adults, at the McMaster Family Health Team (FHT) site and 5 other FHT sites in Ontario, Canada. While there were no statistically significant between-group differences in outcomes at month 6 post randomization, positive outcomes were observed at the McMaster FHT site, which recruited 40% (204/512) of the participants. The objective of this post-hoc study was to determine the cost-effectiveness of Health TAPESTRY based on data from the McMaster FHT site. METHODS Costs included the cost to implement Health TAPESTRY at McMaster as well as healthcare resource consumed, which were costed using publicly available sources. Health-related-quality-of-life was evaluated with the EQ-5L-5L at baseline and at month 6 post randomization. Quality-adjusted-life-years (QALYs) were calculated under an-area-under the curve approach. Unadjusted and adjusted regression analyses (two independent regression analyses on costs and QALYs, seemingly unrelated regression [SUR], net benefit regression) as well as difference-in-difference and propensity score matching (PSM) methods, were used to deal with the non-randomized nature of the trial. Sampling uncertainty inherent to the trial data was estimated using non-parametric bootstrapping. The return on investment (ROI) associated with Health TAPESTRY was calculated. All costs were reported in 2021 Canadian dollars. RESULTS With an intervention cost of $293/patient, Health TAPESTRY was the preferred strategy in the unadjusted and adjusted analyses. The results of our bootstrap analyses indicated that Health TAPESTRY was cost-effective compared to usual care at commonly accepted WTP thresholds. For example, if decision makers were willing to pay $50,000 per QALY gained, the probability of Health TAPESTRY to be cost effective compared to usual care varied from 0.72 (unadjusted analysis) to 0.96 (SUR) when using a WTP of $50,000/QALY gained. The DID and ROI analyses indicated that Health Tapestry generated a positive ROI. CONCLUSION Health TAPESTRY was the preferred strategy when implemented at the McMaster FHT. We caution care in interpreting the results because of the post-hoc nature of the analyses and limited sample size based on one site.
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Bandla M, Howard M, McNally A, Armstrong D, Simpson I, Mar A. Benralizumab: A novel treatment for the cutaneous features of paediatric eosinophilic granulomatosis with polyangiitis (pEGPA). Australas J Dermatol 2023; 64:404-407. [PMID: 37195732 DOI: 10.1111/ajd.14081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/18/2023]
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis presenting primarily with pulmonary and cutaneous features. The disease is typically seen in the fifth or sixth decade of life (1, 2). We report a case of EGPA in an adolescent who was successfully treated with the interleukin-5 (IL-5) receptor inhibitor, benralizumab.
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Vamvakas A, Lawn T, Veronese M, Williams S, Tsougos I, Howard M. CORRELATION OF ASL-MRI WITH PET AND MRNA EXPRESSIONS CAN REVEAL MOLECULAR SUBSTRATES OF CEREBRAL BLOOD FLOW IN CLINICAL ONGOING PAIN. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03119-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Vamvakas A, Lawn T, Veronese M, Williams S, Tsougos I, Howard M. CORRELATION OF ASL-MRI WITH PET AND MRNA EXPRESSIONS CAN REVEAL MOLECULAR SUBSTRATES OF CEREBRAL BLOOD FLOW IN CLINICAL ONGOING PAIN. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)03028-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Aden N, Shahid A, Howard M, Narayanamoorthi S, Khan T. 67 Does a National Lockdown Affect the Characteristics of Deep Vein Thromboses in Patients in the Community? Br J Surg 2022. [DOI: 10.1093/bjs/znac269.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Aim
Has lockdown and COVID-19 led to a change into the characteristics of DVT's and patients who have them alongside a review of the DVT service.
Method
Data was collected retrospectively from electronic patient records system for the following periods: 1st April until 30th June 2019 and 1st April until 30th June 2020. These were the key months during the first United Kingdom national lockdown. Data was analysed for patient demographics, risk factors, characteristics of the DVT, management and DVT reoccurrence. Statistical analyses were preformed using GraphPad Prism 8.
Results
227 patients sustained community DVT's in 2019 and 211 patients in 2020 during the study period. 13 of these patients in 2020 were COVID-19 positive. There was a difference in gender distribution (p= 0.0128) with 128 males and 99 females in 2019, 93 males and 118 females in 2020. No significant difference was noted for the incidence of thrombophilia with 9 in 2019 and 3 in 2020 (p=0.1437). Fewer long-haul journeys were made (p=0.012) with 16 in 2019 and only 2 in 2020. Fewer patients had immobility as a risk factor with 79 in 2019 and 55 in 2020 (p=0.0494). However, there were more patients using the contraceptive pill (p=0.0086) with 1 in 2019 and 9 in 2020.
Conclusion
There is no significant difference in the characteristics, extent, and management of DVT's prior to and during Lockdown during COVID-19. National Lockdowns do not affect community DVT's however it is important to highlight the surrounding inpatient numbers.
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Watson O, Pillai S, Howard M, Cezar-Zaldua J, Whitley J, Burgess B, Lawrence M, Hawkins K, Morris K, Evans PA. Impaired fibrinolysis in severe Covid-19 infection is detectable in early stages of the disease. Clin Hemorheol Microcirc 2022; 82:183-191. [PMID: 35694917 DOI: 10.3233/ch-221491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND A significant degree of mortality and morbidity in Covid-19 is due to thromboembolic disease. Coagulopathy has been well described in critically unwell patients on ICU. There is less clear evidence regarding these changes at the time of presentation to the Emergency Department and the progression of disease over time. OBJECTIVE We sought to investigate whether coagulation markers can predict severity and how they change over the disease course. METHODS Patients presenting to a single University Teaching Hospital were recruited and followed up if PCR was positive. Alongside routine blood testing, Rotational Thromboelastometry (ROTEM) was performed. Outcome data was recorded for all patients, and ROTEM values were compared across outcome groups. RESULTS Extem and Intem Maximum Lysis were significantly reduced in those who died or required an ICU admission, indicating a reduced ability to break down clot mass in the most critically unwell patients. CONCLUSION Comparisons between groups demonstrated that one distinguishing feature between those who require ICU admission or die of Covid-19 compared with those who survive a hospital stay to discharge was the extent to which fibrinolysis could occur. Mortality and morbidity in Covid-19 infection appears in part driven by an inability to break down clot mass.
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Makela A, Howard M. Chaos Unleashed: The impact of recreational drugs and COVID on young adults. Eur Psychiatry 2022. [PMCID: PMC9567418 DOI: 10.1192/j.eurpsy.2022.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction This case series reveals a number of young adults, whom after chronic use of recreational drugs, suffer the life-long consequence of severe chronic mental illness. Objectives • Review the illicit drugs that are commonly associated with psychotic symptoms. • Highlight exposures theorized to impact genetics associated with DSM 5 diseases. • Compare trends in illicit drug use during the worldwide COVID pandemic. Methods A literature review is used to examine the impact of COVID pandemic on illicit drug use in metropolitan cities in European countries and compare the trends with what is seen by the consult liaison psychiatry service at a metropolitan community hospital in the USA. Results In European Countries with data available, there were measurable differences in which illicit drugs were used most during the COVID 19 pandemic. In the US this data is not readily available at the time of submission for proper comparisson. Conclusions Although definitive comparrison is pending, the results of extensive illicit drug use demostrate a high comorbidity with psychotic spectrum disorders in the DSM 5. Disclosure No significant relationships.
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Howard M. The Importance of Cognitive Appraisal and Social Support in Pregnancy During COVID-19 from an Interdisciplinary View. Eur Psychiatry 2022. [PMCID: PMC9563831 DOI: 10.1192/j.eurpsy.2022.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: To describe how a US-based psychiatric Mother-Baby Unit adopted a virtual platform during the pandemic. Objectives: When the Covid-19 pandemic descended, mental health clinicians world-wide were faced with maintaining access and care delivery. Pregnant and newly postpartum women experienced the pandemic and lockdown through the lens of impending parenthood and new parenthood--amplifying distress, isolation, and lack of social and family support. The lockdown prevented those with most acute illness from accessing daily treatment in our structured, supportive intensive treatment setting. We acknowledged the urgency of developing a method to continue to treat our patients in a group environment that offered psychotherapy, psychopharmacology, dyadic and family intervention, and social support. Methods: The hospital purchased “Zoom for Health” platform to ensure compliance with regulatory guidelines. Cameras for individual computers were purchased with philanthropy funds, obtaining them quickly, compared to waiting for hospital funding. The clinical team designed a schedule of groups and individual sessions, each with their own zoom link. Each morning, a team member, sent the daily schedule through the patient portal of the EMR. Conclusion: Before the pandemic, the census was 12 pts per day. The full-day program paused for 7-10 days although individual sessions and medication management were conducted by phone as the virtual platform was constructed. Once established, census resumed normal levels. Challenges to running the Day Hospital virtually included: technology glitches, family demands and distractions, and privacy concerns. Overall, the program was a success wherein women requiring intensive treatment were able to receive treatment and social support.
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Martins DA, Mazibuko N, Zelaya F, Vasilakopoulou S, Loveridge J, Oates A, Maltezos S, Mehta M, Wastling S, Howard M, McAlonan G, Murphy D, Williams SCR, Fotopoulou A, Schuschnig U, Paloyelis Y. Author Correction: Effects of route of administration on oxytocin-induced changes in regional cerebral blood flow in humans. Nat Commun 2022; 13:1876. [PMID: 35361784 PMCID: PMC8971402 DOI: 10.1038/s41467-022-29419-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Howard M, Peppard S, O'Dwyer E, McLoughlin K, McLoughlin L, Carolan N, Walsh N, Chukwureh W, Russell E, Wilson L, Kottackal LM, Kelly M, Sheeran G, Maeri C. 147 ‘CHAMPIONING CONTINENCE’—ESTABLISHMENT OF A MULTIDISCIPLINARY CONTINENCE PROMOTION WORKING GROUP IN AN ACUTE TEACHING HOSPITAL. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
In line with the National Frailty Programme1, patients over the age of 75 admitted to hospital should have a comprehensive geriatric assessment including the assessment of current continence status and any history of incontinence. Up to 39% of adults are reported to develop new onset urinary incontinence during admission to hospital2,3, however studies show that is it a problem not always identified by staff members,4. In response to these observations within an acute teaching hospital, a continence working party was formed involving members of nursing, physiotherapy and occupational therapy colleagues to explore the current practice and culture relating to continence management.
Methods
The group established key objectives which were broken into four strands;
1. Audit of documentation of baseline continence on admission (therapy and nursing).
2. Obtaining access to additional types of continence wear.
3. Staff education.
4. Pre and post education survey.
Results
1. Audit of documentation demonstrated poor standards of documentation of baseline continence. This led to an amendment to questioning prompts on therapy initial assessment forms and a plan to further evaluate the nursing documentation.
2. A wider array of continence wear has been made available on the wards providing greater options for patients.
3. Staff education session was compiled by a specialist physiotherapist and is widely available for staff to access on the hospitals online training portal.
4. Pre-education surveys have been completed with a view to re-administering following education roll-out.
Conclusion
The aim of this multidisciplinary working group is to equip staff with the correct resources, knowledge, and confidence to ensure best practice promotion of continence on the targeted wards. This project is the first strand of a wider culture changed that is needed around continence promotion for older adults in the acute setting.
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Peppard S, Howard M. 146 INTRODUCTION OF A STANDARDISED SCREENING TOOL FOR REFERRAL TO OCCUPATIONAL THERAPY AND PHYSIOTHERAPY ON SPECIALIST GERIATRIC WARDS. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
The Occupational Therapists (OTs) and Physiotherapists (PTs) on the Specialist Geriatric Wards provide assessment, rehabilitation, and discharge planning for frail older adults. All patients are screened on admission by OT or PT to determine the need for therapy input. This rapid response eliminates delay in accessing therapy input and allows for proactive commencement of intervention and discharge planning without the delay of awaiting a referral.
It was identified that the existing process for screening patients lacked structure and clarity, leading to inefficient use of time and resources with the risk of duplication.
The aim of this local Quality Improvement (QI) initiative was to standardise the process for screening using a triage sticker containing set criteria for referral to OT/PT.
Methods
Following team consultation and review of frailty screening tools, a triage sticker was adapted and modified from the ‘Think Frailty’ tool1. QI methodology and PDSA cycles identified 6 blanket triggers for OT/PT assessment on the ward.
F—Functional impairment.
R—Resident in a care home.
A—Acute/chronic confusion.
I—Immobility/Instability.
L—Living at home with support.
S—Specialist seating or skin integrity issues.
Retrospective review of traditional triage vs the new sicker was performed to evaluate accuracy.
Results
Retrospective analysis found 83% accuracy between the new triage sticker and the traditional triage method. Of the patients who did not meet the criteria for referral, to date none have been subsequently referred during their admission, demonstrating its comprehensiveness as a tool.
Conclusion
Pro-active and early intervention from OT and PT is beneficial for ensuring optimum patient care and efficient discharge planning for frail older adults admitted to hospital. This local QI project demonstrated that standardising the screening process for referral to OT/PT could improve clarity and enable more efficient use of time and resources.
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Czeisler M, Wiley J, Czeisler C, Rajaratnam S, Howard M. Uncovering Survivorship Bias in Longitudinal Mental Health Surveys During the COVID-19 Pandemic. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 33564798 PMCID: PMC7872393 DOI: 10.1101/2021.01.28.21250694] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Aims Markedly elevated adverse mental health symptoms were widely observed early in the coronavirus disease 2019 (COVID-19) pandemic. Unlike the U.S., where cross-sectional data indicate anxiety and depression symptoms have remained elevated, such symptoms reportedly declined in the U.K., according to analysis of repeated measures from a largescale longitudinal study. However, nearly 40% of U.K. respondents (those who did not complete multiple follow-up surveys) were excluded from analysis, suggesting that survivorship bias might partially explain this discrepancy. We therefore sought to assess survivorship bias among participants in our longitudinal survey study as part of The COVID-19 Outbreak Public Evaluation (COPE) Initiative. Methods Survivorship bias was assessed 4,039 U.S. respondents who completed surveys including the assessment of mental health as part of The COPE Initiative in April 2020 and were invited to complete follow-up surveys. Participants completed validated screening instruments for symptoms of anxiety, depression, and insomnia. Survivorship bias was assessed for (1) demographic differences in follow-up survey participation, (2) differences in initial adverse mental health symptom prevalences adjusted for demographic factors, and (3) differences in follow-up survey participation based on mental health experiences adjusted for demographic factors. Results Adjusting for demographics, individuals who completed only one or two out of four surveys had higher prevalences of anxiety and depression symptoms in April 2020 (e.g., one-survey versus four-survey, anxiety symptoms, adjusted prevalence ratio [aPR]: 1.30, 95% confidence interval [CI]: 1.08–1.55, P=0.0045; depression symptoms, aPR: 1.43, 95% CI: 1.17–1.75, P=0.00052). Moreover, individuals who experienced incident anxiety or depression symptoms had higher odds of not completing follow-up surveys (adjusted odds ratio [aOR]: 1.68, 95% CI: 1.22–2.31, P=0.0015, aOR: 1.56, 95% CI: 1.15–2.12, P=0.0046, respectively). Conclusions Our findings revealed significant survivorship bias among longitudinal survey respondents, indicating that restricting analytic samples to only respondents who provide repeated assessments in longitudinal survey studies could lead to overly optimistic interpretations of mental health trends over time. Cross-sectional or planned missing data designs may provide more accurate estimates of population-level adverse mental health symptom prevalences than longitudinal surveys.
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Aryal K, Aryal K, Mowbray F, Gruneir A, Griffith L, Howard M, Jabbar A, Jones A, Costa AW. The Association Between Nursing Home Resident Characteristics and Transfers to the Emergency Department: A Population-Level Retrospective Cohort Study. J Am Med Dir Assoc 2021; 22:B23-B24. [PMID: 34287172 DOI: 10.1016/j.jamda.2021.01.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gevaert P, Saenz R, Corren J, Han J, Mullol J, Lee S, Zhao R, Howard M, Wong K, Islam L, Ligueros-Saylan M, Omachi T, Bachert C. D202 CONTINUED SAFETY/EFFICACY OF OMALIZUMAB IN CHRONIC RHINOSINUSITIS WITH NASAL POLYPS: AN OPEN-LABEL EXTENSION STUDY. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Thompson WH, Nair R, Oya H, Esteban O, Shine JM, Petkov CI, Poldrack RA, Howard M, Adolphs R. A data resource from concurrent intracranial stimulation and functional MRI of the human brain. Sci Data 2020; 7:258. [PMID: 32759965 PMCID: PMC7406507 DOI: 10.1038/s41597-020-00595-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/03/2020] [Indexed: 11/08/2022] Open
Abstract
Mapping the causal effects of one brain region on another is a challenging problem in neuroscience that we approached through invasive direct manipulation of brain function together with concurrent whole-brain measurement of the effects produced. Here we establish a unique resource and present data from 26 human patients who underwent electrical stimulation during functional magnetic resonance imaging (es-fMRI). The patients had medically refractory epilepsy requiring surgically implanted intracranial electrodes in cortical and subcortical locations. One or multiple contacts on these electrodes were stimulated while simultaneously recording BOLD-fMRI activity in a block design. Multiple runs exist for patients with different stimulation sites. We describe the resource, data collection process, preprocessing using the fMRIPrep analysis pipeline and management of artifacts, and provide end-user analyses to visualize distal brain activation produced by site-specific electrical stimulation. The data are organized according to the brain imaging data structure (BIDS) specification, and are available for analysis or future dataset contributions on openneuro.org including both raw and preprocessed data.
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Van Vollenhoven R, Takeuchi T, Rischmueller M, Blanco R, Xavier R, Howard M, Friedman A, Song Y, Strand V. THU0217 UPADACITINIB MONOTHERAPY IN METHOTREXATE-NAÏVE PATIENTS WITH RHEUMATOID ARTHRITIS: RESULTS AT 72 WEEKS FROM SELECT-EARLY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Upadacitinib (UPA), an oral JAK inhibitor, demonstrated significant improvements in signs, symptoms, and structural inhibition as monotherapy vs methotrexate (MTX) in a randomized, controlled trial (RCT) of MTX-naive RA patients (pts) through 48 weeks (wks).1Objectives:To present the safety and effectiveness of UPA through 72 wks in an ongoing long-term extension (LTE) of the SELECT-EARLY RCT.Methods:SELECT-EARLY included 2 study periods: (1) a 48-wk double-blind, active comparator-controlled, with pts randomized to UPA monotherapy 15 or 30 mg once daily or MTX (titrated to 20 mg/wk by Wk8); (2) an LTE, up to 4 years. Pts received open-label treatment once the last pt reached Wk48. Rescue therapy was added (MTX, for UPA groups; UPA, for MTX group) to pts not achieving CDAI remission (≤2.8) at Wk26. Non-responder imputation (NRI) was used for missing data as well as for pts receiving rescue therapy. Treatment-emergent adverse events (TEAEs) are summarized per 100 pt yrs (PY) through the cut-off date of 21 Feb 2019, when all pts had reached Wk72. Data are censored at the time of MTX or UPA addition among rescued patients.Results:Of 945 pts randomized and treated, 781 (83%) completed Period 1. Of these, 775 entered the LTE, including 57 rescued pts (MTX, 33; UPA 15 mg, 17; UPA 30 mg, 7). A total of 52 (7%) pts discontinued during the LTE through the cut-off date (primary reasons: AEs [n=16, 2.1%]; consent withdrawal [n=12, 1.5%]; lost to follow-up [n=10, 1.3%]). Cumulative exposures to monotherapy with MTX, UPA 15 mg, and UPA 30 mg were 350.6, 389.5, and 383.9 PYs, respectively. Both UPA 15 mg and 30 mg as monotherapy was associated with continued statistically significant improvements in disease activity measures vs MTX monotherapy through 72 wks (Table). The safety profiles of the UPA 15 and 30 mg groups were comparable for total TEAEs and numerically higher than MTX. Serious TEAEs and TEAEs leading to discontinuation of study drug were comparable across all groups (Figure). Most AEs of special interest were comparable across MTX and UPA groups, with the exception of higher rates of herpes zoster, opportunistic infections, and elevated creatine phosphokinase among the UPA groups. Two pts receiving MTX monotherapy experienced a venous thromboembolic event, with one event reported on UPA 30 mg and none on UPA 15 mg. There were 12 deaths (including 3 non-treatment-emergent) due to varied causes.Table.Proportion of Patients at Week 72 (NRI)Parameter (%)MTXMonotherapyUPA 15 mg QDMonotherapyUPA 30 mg QDMonotherapyACR20/50/7050/39/2671***/62***/47***72***/67***/54***DAS28(CRP) ≤3.2/<2.638/2863***/52***69***/61***CDAI ≤10/≤2.842/1960***/35***69***/44***Boolean Remission1329***33******,P<0.001 for differences between MTX and UPA 15 and UPA 30 mg groups.MTX, methotrexate; UPA, upadacitinib; QD, once daily; ACR, American College of Rheumatology; DAS28(CRP), 28-joint disease activity index based on C-reactive protein; CDAI, clinical disease activity index.Figure.Treatment-emergent Adverse Events Through ≥72 Weeks (E/100 PYs, 95% CI).Conclusion:Long-term UPA monotherapy was associated with continued improvements in RA signs and symptoms vs MTX monotherapy through 72 wks, and only a small proportion of pts required MTX addition at Wk26. Through 72 wks of treatment, the safety profile of UPA monotherapy remained consistent with data reported through 48 wks.1References:[1]van Vollenhoven R,et al.Ann Rheum Dis2019;78(S):376.Disclosure of Interests: :Ronald van Vollenhoven Grant/research support from: AbbVie, Arthrogen, Bristol-Myers Squibb, GlaxoSmithKline, Lilly, Pfizer, and UCB, Consultant of: AbbVie, AstraZeneca, Biotest, Bristol-Myers Squibb, Celgene, GSK, Janssen, Lilly, Medac, Merck, Novartis, Pfizer, Roche, and UCB, Tsutomu Takeuchi Grant/research support from: Eisai Co., Ltd, Astellas Pharma Inc., AbbVie GK, Asahi Kasei Pharma Corporation, Nippon Kayaku Co., Ltd, Takeda Pharmaceutical Company Ltd, UCB Pharma, Shionogi & Co., Ltd., Mitsubishi-Tanabe Pharma Corp., Daiichi Sankyo Co., Ltd., Chugai Pharmaceutical Co. Ltd., Consultant of: Chugai Pharmaceutical Co Ltd, Astellas Pharma Inc., Eli Lilly Japan KK, Speakers bureau: AbbVie GK, Eisai Co., Ltd, Mitsubishi-Tanabe Pharma Corporation, Chugai Pharmaceutical Co Ltd, Bristol-Myers Squibb Company, AYUMI Pharmaceutical Corp., Eisai Co., Ltd, Daiichi Sankyo Co., Ltd., Gilead Sciences, Inc., Novartis Pharma K.K., Pfizer Japan Inc., Sanofi K.K., Dainippon Sumitomo Co., Ltd., Maureen Rischmueller Consultant of: Abbvie, Bristol-Meyer-Squibb, Celgene, Glaxo Smith Kline, Hospira, Janssen Cilag, MSD, Novartis, Pfizer, Roche, Sanofi, UCB, Ricardo Blanco Grant/research support from: Abbvie, MSD and Roche, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD, Ricardo Xavier Consultant of: AbbVie, Pfizer, Novartis, Janssen, Eli Lilly, Roche, Mark Howard Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Alan Friedman Shareholder of: AbbVie Inc, Employee of: AbbVie Inc, Yanna Song Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Vibeke Strand Consultant of: AbbVie, Amgen, Biogen, Celltrion, Consortium of Rheumatology Researchers of North America, Crescendo Bioscience, Eli Lilly, Genentech/Roche, GlaxoSmithKline, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Sanofi, UCB
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Gottlieb EW, Egorova N, Khlif MS, Khan W, Werden E, Pase MP, Howard M, Brodtmann A. 0420 Fibre-Specific White Matter Neurodegeneration is Associated with Long Sleep Duration After Stroke. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Long sleep duration in aging populations has recently been proposed as a key modifiable risk factor and sequela of stroke. It is unclear whether the pathogenesis of post-stroke sleep-wake dysfunction is due to focal infarction to regional sleep-wake hubs in the brain, or to accelerated whole-brain neurodegeneration. We utilise a novel technique known as whole-brain fixel-based analyses (FBA) to characterize the first fibre-specific white-matter markers of long sleep duration after stroke.
Methods
We included 98 radiologically-confirmed ischemic stroke participants (67 male; mean age = 68) and 40 age-matched controls with no history of neurodegenerative disease imaged 3-months post-stroke. Sleep-wake was measured for one week using BodyMedia’s SenseWear armband. Diffusion-weighted MRI (DWI) were acquired using echoplanar imaging and preprocessed using MRtrix3. FBA were employed to identify tracts with altered white-matter fibre-density and fibre-bundle cross-section (FDC) in the long sleep duration (>8 hr, n=20) and normal sleep duration groups (between >6 hr and <8 hr, n=59) compared to controls. Statistical comparisons of FDC between groups were performed at each FDC fixel by a general linear model controlling for age, sex, and intracranial volume.
Results
Stroke participants with long sleep duration exhibited significant FDC reductions of up to 40% within the cortico-ponto-cerebellar tract when compared to healthy controls (family-wise-error-corrected p=<0.05). Bilateral pontine degeneration was observed at the decussation of the superior cerebellar peduncles. Stroke participants with normal sleep duration exhibited diffuse whole-brain degeneration most apparent along the corpus collosum and cingulum; however, the distribution was less extensive relative to long sleepers (i.e., no cortico-cerebellar projections) and percentage effect reductions did not exceed 20%.
Conclusion
Long sleep duration after stroke is associated with cortico-ponto-cerebellar degeneration when compared to controls or stroke-participants with normal sleep duration. Excessively long sleep may contribute to post-stroke neurodegeneration beyond the effects of direct infarction and may be a modifiable pharmacological target for abating brain volume loss after stroke.
Support
This work was supported by the National Health and Medical Research Council project grant (APP1020526), the Brain Foundation, Wicking Trust, Collie-Trust, and Sidney and Fiona Myer Family Foundation. NE was supported by the Australian Research Council DECRA award DE180100893.
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Martins DA, Mazibuko N, Zelaya F, Vasilakopoulou S, Loveridge J, Oates A, Maltezos S, Mehta M, Wastling S, Howard M, McAlonan G, Murphy D, Williams SCR, Fotopoulou A, Schuschnig U, Paloyelis Y. Effects of route of administration on oxytocin-induced changes in regional cerebral blood flow in humans. Nat Commun 2020; 11:1160. [PMID: 32127545 PMCID: PMC7054359 DOI: 10.1038/s41467-020-14845-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 02/04/2020] [Indexed: 11/17/2022] Open
Abstract
Could nose-to-brain pathways mediate the effects of peptides such as oxytocin (OT) on brain physiology when delivered intranasally? We address this question by contrasting two methods of intranasal administration (a standard nasal spray, and a nebulizer expected to improve OT deposition in nasal areas putatively involved in direct nose-to-brain transport) to intravenous administration in terms of effects on regional cerebral blood flow during two hours post-dosing. We demonstrate that OT-induced decreases in amygdala perfusion, a key hub of the OT central circuitry, are explained entirely by OT increases in systemic circulation following both intranasal and intravenous OT administration. Yet we also provide robust evidence confirming the validity of the intranasal route to target specific brain regions. Our work has important translational implications and demonstrates the need to carefully consider the method of administration in our efforts to engage specific central oxytocinergic targets for the treatment of neuropsychiatric disorders.
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Cori J, Turner S, Westlake J, Naqvi A, Ftouni S, Wilkinson V, Vakulin A, O'Donoghue F, Howard M. Sleepiness assessed via continuous ocular alertness measures in obstructive sleep apnoea patients during regular on road driving. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Boes A, Trapp N, Uitermarkt B, Gander P, Bruss J, Howard M, Oya H. Effects of transcranial magnetic stimulation on the human brain revealed by intracranial electrocorticography. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Sikic BI, Lakhani N, Patnaik A, Shah SA, Chandana SR, Rasco D, Colevas AD, O'Rourke T, Narayanan S, Papadopoulos K, Fisher GA, Villalobos V, Prohaska SS, Howard M, Beeram M, Chao MP, Agoram B, Chen JY, Huang J, Axt M, Liu J, Volkmer JP, Majeti R, Weissman IL, Takimoto CH, Supan D, Wakelee HA, Aoki R, Pegram MD, Padda SK. First-in-Human, First-in-Class Phase I Trial of the Anti-CD47 Antibody Hu5F9-G4 in Patients With Advanced Cancers. J Clin Oncol 2019; 37:946-953. [PMID: 30811285 DOI: 10.1200/jco.18.02018] [Citation(s) in RCA: 385] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To evaluate the safety, pharmacokinetics, and pharmacodynamics of Hu5F9-G4 (5F9), a humanized IgG4 antibody that targets CD47 to enable phagocytosis. PATIENTS AND METHODS Adult patients with solid tumors were treated in four cohorts: part A, to determine a priming dose; part B, to determine a weekly maintenance dose; part C, to study a loading dose in week 2; and a tumor biopsy cohort. RESULTS Sixty-two patients were treated: 11 in part A, 14 in B, 22 in C, and 15 in the biopsy cohort. Part A used doses that ranged from 0.1 to 3 mg/kg. On the basis of tolerability and receptor occupancy studies that showed 100% CD47 saturation on RBCs, 1 mg/kg was selected as the priming dose. In subsequent groups, patients were treated with maintenance doses that ranged from 3 to 45 mg/kg, and most toxicities were mild to moderate. These included transient anemia (57% of patients), hemagglutination on peripheral blood smear (36%), fatigue (64%), headaches (50%), fever (45%), chills (45%), hyperbilirubinemia (34%), lymphopenia (34%), infusion-related reactions (34%), and arthralgias (18%). No maximum tolerated dose was reached with maintenance doses up to 45 mg/kg. At doses of 10 mg/kg or more, the CD47 antigen sink was saturated by 5F9, and a 5F9 half-life of approximately 13 days was observed. Strong antibody staining of tumor tissue was observed in a patient at 30 mg/kg. Two patients with ovarian/fallopian tube cancers had partial remissions for 5.2 and 9.2 months. CONCLUSION 5F9 is well tolerated using a priming dose at 1 mg/kg on day 1 followed by maintenance doses of up to 45 mg/kg weekly.
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Livergant J, Howard M, Klein J. Barriers to Referral for Palliative Radiotherapy by Physicians: A Systematic Review. Clin Oncol (R Coll Radiol) 2019; 31:e75-e84. [DOI: 10.1016/j.clon.2018.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/02/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
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Ganesan S, Magee M, Stone JE, Mulhall MD, Collins A, Howard M, Lockley SW, Rajaratnam S, Sletten TL. 0175 Shift Work and its Impact on Sleep, Alertness and Performance in Intensive Care Health Workers. Sleep 2018. [DOI: 10.1093/sleep/zsy061.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rhodes M, Catenacci J, Howard M, La Lone B, Kostinski N, Perry D, Bennett C, Patterson J. Validating data analysis of broadband laser ranging. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2018; 89:035111. [PMID: 29604729 DOI: 10.1063/1.5019569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Broadband laser ranging combines spectral interferometry and a dispersive Fourier transform to achieve high-repetition-rate measurements of the position of a moving surface. Telecommunications fiber is a convenient tool for generating the large linear dispersions required for a dispersive Fourier transform, but standard fiber also has higher-order dispersion that distorts the Fourier transform. Imperfections in the dispersive Fourier transform significantly complicate the ranging signal and must be dealt with to make high-precision measurements. We describe in detail an analysis process for interpreting ranging data when standard telecommunications fiber is used to perform an imperfect dispersive Fourier transform. This analysis process is experimentally validated over a 27-cm scan of static positions, showing an accuracy of 50 μm and a root-mean-square precision of 4.7 μm.
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Cori J, Jackson M, Barnes M, Kennedy G, Howard M. The differential effects of regular shift work and obstructive sleep apnea on sleepiness, mood, vigilance and neurocognitive function. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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