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Knapen LM, Geurts SME, Ibragimova KIE, Croes S, Vriens BEPJ, van den Berkmortel FWPJ, Dercksen MW, van de Wouw AJ, Pepels MJAE, de Fallois AOJ, Lobbezoo DJA, de Boer M, Tjan-Heijnen VCG. A real-life study on the implementation and effectiveness of exemestane plus everolimus per hospital type in patients with advanced breast cancer. A study of the Southeast Netherlands Advanced Breast Cancer registry. Breast 2019; 44:46-51. [PMID: 30641299 DOI: 10.1016/j.breast.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/22/2018] [Accepted: 01/02/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We aimed to assess the implementation and effectiveness of exemestane plus everolimus treatment per hospital type in real-life, shortly after approval of everolimus. METHODS Advanced breast cancer patients treated with exemestane plus everolimus in 2012-2014 were included from the SONABRE registry. Progression-free survival (PFS) and a 12-week conditional PFS (post-hoc) were estimated by Kaplan-Meier method. The multivariable Cox proportional hazards model was performed by type of hospital and adjusted for patient, tumour and treatment characteristics. RESULTS We included 122 patients, comprising 48 patients treated in academic (N = 1), 56 in teaching (N = 4), and 18 in non-teaching (N = 2) hospitals. The median PFS was 6.3 months (95% Confidence Interval (CI) 4.0-8.6) overall, and 8.5 months (95% CI 7.7-9.3), 4.2 months (95% CI 2.0-6.3), and 5.5 months (95% CI 4.2-6.7) for the patients treated in academic, teaching and non-teaching hospitals, respectively. The adjusted Hazard Ratio (HR) for PFS-events was 1.5 (95% CI 1.0-2.2) and 1.0 (95% CI 0.5-1.9) respectively for patients treated at teaching and non-teaching hospitals versus the academic hospital. The adjusted HR for 12-week conditional PFS-events was not different between hospital types. In the first 12-week treatment period, treatment was discontinued due to early progression in one out of 48 patients in the academic versus nine out of 74 patients in the non-academic hospitals, confirmed by imaging in one and two patients, respectively. CONCLUSIONS In our study, the median PFS was borderline significantly different between hospital types, possibly the result of a different assessment approach in the first 12-week treatment period.
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Molimard M, Girodet PO, Van Ganse E. Interest of pharmacoepidemiology for the study of inhaled drugs. Therapie 2018; 74:233-237. [PMID: 30392699 DOI: 10.1016/j.therap.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 11/30/2022]
Abstract
Pharmacoepidemiology studies are of particular interest in the respiratory field and especially for inhaled drugs. In real-life, excessive use of rescue medications and under- or inappropriate-prescribing of preventer medications has been shown. In asthma and chronic obstructive pulmonary disease (COPD), the poor use of inhalation device is associated with uncontrolled diseases and occurrence of exacerbations. Inhalation treatments are directly delivered within the lung and are generally considered as safe. However, systemic adverse drug reactions that were not evidenced in clinical trials may be observed after a long-term treatment.
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Affiliation(s)
- Mathieu Molimard
- Service of medical pharmacology, university of Bordeaux, CHU de Bordeaux, 33076 Bordeaux, France; Inserm, UMR 1219, Bordeaux population health research center, team pharmacoepidemiology, 33000 Bordeaux, France.
| | - Pierre-Olivier Girodet
- Service of medical pharmacology, university of Bordeaux, CHU de Bordeaux, 33076 Bordeaux, France
| | - Eric Van Ganse
- EA 7425 HESPER health services and performance research, and PELyon, Claude-Bernard université, CIC 1401, 69424 Lyon, France; Respiratory medicine, Croix-Rousse hospital, 69317 Lyon, France
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Morice-Picard F, Taïeb C, Marti A, Gliksohn A, Bennani M, Bodemer C, Ezzedine K. Burden of albinism: development and validation of a burden assessment tool. Orphanet J Rare Dis 2018; 13:162. [PMID: 30227882 PMCID: PMC6145119 DOI: 10.1186/s13023-018-0894-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 08/20/2018] [Indexed: 11/22/2022] Open
Abstract
Background Albinism comprises a group of autosomal recessive diseases that are characterized by poor vision and a variable hypopigmentation phenotype. A comprehensive literature review showed that no tool can assess the burden experienced by individuals who present with albinism, although such a tool is needed and would be beneficial for clinicians and patients alike. Method The questionnaire was devised using standardized methodology for developing and validating questionnaires on the quality of life of subjects according to the following chronological structure: conceptual phase, development phase, and then validation phase. A multidisciplinary working group was assembled, including experts on questionnaire design and development, dermatologists specializing in care for patients with albinism, and representatives of the Genespoir association. Results Based on an initial verbatim report, the workgroup compiled a list of items that were transcribed and reformulated into questions. During the validation phase, principal component analysis (PCA) was conducted on the 24 items, which allowed the questionnaire to be reduced to 20 questions [Q]. The standardized regression coefficients were all greater than 0.5 for their corresponding factors. Based on their normalized regression coefficients, each group of questions was linked to one of the following four dimensions, with each dimension consisting of at least three questions: “Live with” (8 Q), “Daily life” (3 Q), “Resignation” (3 Q), and “Fear of the future” (6 Q). All dimensions correlated well with the overall BoA score. Cronbach’s α was 0.92 for the entire BoA scale, confirming excellent internal coherence. Intradimensional coherences all demonstrated excellent reliability (α > 0.65). The BoA questionnaire was highly correlated with the SF12, RSES and DLQI validated questionnaires. This outcome confirmed the external validity. Conclusion This questionnaire represents the first specific assessment tool for evaluating the burden of albinism. It is easy to use and relatively quick to complete, which will allow the burden to be evaluated over time with a reproducible questionnaire. To ensure that this questionnaire can be used by as many people as possible, cultural and linguistic validation in US English was conducted with the original French version. Electronic supplementary material The online version of this article (10.1186/s13023-018-0894-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Charles Taïeb
- FIMARAD, Hôpital Necker-Enfants Malades, APHP, Paris, France.
| | | | | | | | - Christine Bodemer
- MAGEC, CHU Necker-Enfants Malades, APHP, Paris, France.,Annimatrice, FIMARAD, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Khaled Ezzedine
- EA EpiDermE, UPE-Université Paris-Est, Créteil, France.,CHU H Mondor, APHP, Créteil, France
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Caro FM, Alberti ML, Campins F, Enghelmayer JI, Fernández ME, Lancellotti D, Papucci T, Sebastiani JA, Paulin F. Real-Life Experience with Pirfenidone in Idiopathic Pulmonary Fibrosis in Argentina. A Retrospective Multicenter Study. Arch Bronconeumol 2018; 55:75-80. [PMID: 30049557 DOI: 10.1016/j.arbres.2018.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/20/2018] [Accepted: 06/20/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Pirfenidone was the first antifibrotic drug approved in Argentina for idiopathic pulmonary fibrosis (IPF). Outcomes in real life may differ from the results of clinical trials. The primary endpoint was to study the tolerance of pirfenidone in real life. Secondary endpoints were to analyze effectiveness and reasons for discontinuation. MATERIALS AND METHODS Retrospective observational study conducted in 4 specialized centers in Argentina. We analyzed the medical records of patients with IPF who received pirfenidone between June 2013 and September 2016. Adverse events (AE) and the variables that could influence these results were analyzed. Forced vital capacity (FVC%) parameters were also compared between the pre-pirfenidone and post-pirfenidone periods. RESULTS Fifty patients were included, 38 (76%) men, with mean age (SD) 67.8 (8.36) years. Mean (SD) exposure to pirfenidone was 645.68 (428.19) days, with a mean daily dose (SD) of 2,064.56mg (301.49). Nineteen AEs in 15 patients (30%) were reported: nausea (14%), asthenia (10%) and skin rash (8%). A total of 18 patients (36%) interrupted treatment, only 1 definitively. The most frequent reason for discontinuation was failure of suppliers to provide the drug (9 subjects; 18%). We compared the evolution of FVC% between the pre-pirfenidone and post-pirfenidone periods, and found a mean (SD) FVC% decline of 4.03% (7.63) pre-pirfenidone and 2.64% (7.1) post-pirfenidone (P=.534). CONCLUSIONS In our study, pirfenidone was well tolerated and associated with a reduction in FVC decline, although without reaching statistical significance.
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Affiliation(s)
- Fabián Matías Caro
- Consultorio multidisciplinario de enfermedades pulmonares intersticiales, Hospital de Rehabilitación Respiratoria María Ferrer, Buenos Aires, Argentina.
| | - María Laura Alberti
- Consultorio multidisciplinario de enfermedades pulmonares intersticiales, Hospital de Rehabilitación Respiratoria María Ferrer, Buenos Aires, Argentina
| | | | | | - Martín Eduardo Fernández
- Consultorio multidisciplinario de enfermedades pulmonares intersticiales, Hospital de Rehabilitación Respiratoria María Ferrer, Buenos Aires, Argentina
| | | | - Tulio Papucci
- Laboratorio de Función Pulmonar de Alta Complejidad, Bahía Blanca, Argentina
| | | | - Francisco Paulin
- Consultorio multidisciplinario de enfermedades pulmonares intersticiales, Hospital de Rehabilitación Respiratoria María Ferrer, Buenos Aires, Argentina
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Zappasodi P, Marbello L, Borlenghi E, Fumagalli M, Bernardi M, Fracchiolla N, Mancini V, Da Vià M, Ravano E, Cerqui E, Ferretti VV, Rocca B, Calvello C, Cazzola M, Castagnola C, Rossi G. Molecular remission at the end of treatment is a necessary goal for a good outcome in ELN favorable-risk acute myeloid leukemia: a real-life analysis on 201 patients by the Rete Ematologica Lombarda network. Ann Hematol 2018; 97:2107-15. [PMID: 30009341 DOI: 10.1007/s00277-018-3424-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
Abstract
Favorable acute myeloid leukemia (AML) patients (pts.) demonstrate a relatively good outcome with standard induction; thus, pts. are generally not addressed to allogeneic transplant in first remission. However, it is not clear if also in a real-life setting, the outcome is homogeneous in the different favorable molecular groups and which are the parameters significantly associated to an increased relapse risk, useful to suggest the need of an intensified approach. In order to clarify this point, we collected clinical data on consecutive unselected AML pts. assigned to favorable category (modified ELN 2010 due to the inclusion of double-mutated CEBPA-positive cases), diagnosed and treated in six centers of the Italian network Rete Ematologica Lombarda (REL) from 2007 to 2015. We assessed response (CR, mCR), relapse rate (CIR), and outcome (OS, DFS) after first-line treatment. A total of 201 pts. was studied and the analysis was performed globally and in each molecular group: t(8;21)(q22;q22)/RUNX1-RUNX1T1 (30 pts., 14.9%), inv. (16)(p13q22) or t(16;16)(p13q22)/CBFB-MIH11 (35 pts., 17.4%), normal karyotype and mutated NPM1 and negative FLT3-ITD (116 pts., 57.7%) or double-mutated CEBPA (CEBPAdm) (20 pts., 10%). Complete remission (CR) was obtained in 188 pts. (93.5%), molecular CR (mCR) in 114 (67.5%); After a median follow-up of 2.4 years, cumulative incidence of relapse (CIR) was documented in 78 of 188 responding pts. (41%) after a median time of 11.3 months. CIR was higher in the CBFB-MIH11 group, in pts. achieving only a hematological response without mCR (72.1 vs 28.1%, p < 0.001), in older pts. and it resulted independently associated with a lower median cytarabine cumulative dose (CCD). Median OS was not reached: after 5 years it was 66.3%, and median DFS was 5.3 years, both without difference among groups. Molecular CR reached at any time, during or after the end of first-line treatment, was significantly associated with better DFS, and in particular, mCR assessed at the end of treatment was confirmed in multivariate analysis as an independent prognostic factor both for DFS and OS. In conclusion, the present study confirms in a real-life context the overall good prognosis of favorable-risk AML; the achievement of any molecular negativity during first-line treatment, particularly when assessed at the end of treatment, is associated with lower relapse and better survival. Increasing age at diagnosis has a negative prognostic impact, while CCD higher than 18 g/sqm is associated with better outcome.
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Bachert C, Bousquet J, Hellings P. Rapid onset of action and reduced nasal hyperreactivity: new targets in allergic rhinitis management. Clin Transl Allergy 2018; 8:25. [PMID: 29983907 PMCID: PMC6016145 DOI: 10.1186/s13601-018-0210-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/11/2018] [Indexed: 02/08/2023] Open
Abstract
Background This article summarizes a EUFOREA symposium, presented during the European Rhinology Research Forum in Brussels (9–10 November 2017; https://www.rhinologyresearch.eu/) which focused on novel pathways and therapeutic approaches in allergic rhinitis (AR). Main body AR remains under-diagnosed, under-estimated and under-treated. A key component in understanding the AR landscape has been the realization of a significant mismatch between how physicians instruct AR patients to manage their disease and what AR patients actually do in real life. Data from the Allergy Diary (developed by MACVIA ARIA) showed that AR patients take their medication prn, rapidly switch treatments, often experience poor control, use multiple therapies and stop treatment when symptoms are controlled. Better control of AR may be achievable by using an AR treatment which has a rapid onset of action and which effectively targets breakthrough symptoms. Indeed, AR patients report complete symptom relief, lack of breakthrough symptoms, rapid onset of action, safety and use on an ‘as needed’ basis as key targets for new nasal sprays. MP-AzeFlu comprises intranasal azelastine and fluticasone propionate (FP) in a novel formulation delivered in a single device. It is the first AR treatment to break the 5 min onset of action threshold and provides clinically relevant symptom relief in 15 min, much faster than that noted for FP + oral loratadine. MP-AzeFlu also significantly reduces nasal hyperresponsiveness (NHR) which may be responsible for the breakthrough symptoms frequently reported by AR patients. Mechanisms underlying MP-AzeFlu’s effect include inhibition of mast cell degranulation, stabilization of the mucosal barrier, synergistic inhibition of inflammatory cell recruitment and a unique desensitization of sensory neurons expressing the transient receptor potential A1 and V1 channels. Conclusion With the most rapid onset of action and onset of clinically-relevant effect of any AR medication currently available, and proven efficacy in the treatment of NHR, MP-AzeFlu is an AR treatment which provides what patients want, and fits how patients manage their AR in real life.
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Affiliation(s)
- C Bachert
- 1Ghent University Hospital, Ghent, Belgium.,2Upper Airways Research Laboratory, University of Ghent, Ghent, Belgium.,3Karolinska Institute, Stockholm, Sweden
| | - J Bousquet
- Fondation FMC VIA-LR, Montpellier, France.,5UMR-S 1168, INSERM U 1168, VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif, Université Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France.,European Forum for Research and Education in Allergy & airways diseases (EUFOREA), Brussels, Belgium
| | - P Hellings
- European Forum for Research and Education in Allergy & airways diseases (EUFOREA), Brussels, Belgium.,7Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Herestraat 49, Box 1030, 3000 Louvain, Belgium.,8Clinical Division of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Louvain, Belgium.,9Clinical Division of Otorhinolaryngology, Head and Neck Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Stefoni V, Pellegrini C, Broccoli A, Baldini L, Tani M, Cencini E, Figuera A, Ansuinelli M, Bernocco E, Cantonetti M, Cox MC, Ballerini F, Rusconi C, Visco C, Arcaini L, Fama A, Marasca R, Volpetti S, Castellino A, Califano C, Cavaliere M, Gini G, Liberati AM, Musuraca G, Lucania A, Ricciuti G, Argnani L, Zinzani PL. Lenalidomide in Pretreated Mantle Cell Lymphoma Patients: An Italian Observational Multicenter Retrospective Study in Daily Clinical Practice (the Lenamant Study). Oncologist 2018; 23:1033-1038. [PMID: 29674440 DOI: 10.1634/theoncologist.2017-0597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/06/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Mantle cell lymphoma (MCL) has the worst prognosis of B-cell subtypes owing to its aggressive clinical disease course and incurability with standard chemo-immunotherapy. Options for relapsed MCL are limited, although several single agents have been studied. Lenalidomide is available in Italy for patients with MCL based on a local disposition of the Italian Drug Agency. SUBJECTS, MATERIALS, AND METHODS An observational retrospective study was conducted in 24 Italian hematology centers with the aim to improve information on effectiveness and safety of lenalidomide use in real practice. RESULTS Seventy patients received lenalidomide for 21/28 days with a median of eight cycles. At the end of therapy, there were 22 complete responses (31.4%), 11 partial responses, 6 stable diseases, and 31 progressions, with an overall response rate of 47.1%. Eighteen patients (22.9%) received lenalidomide in combination with either dexamethasone (n = 13) or rituximab (n = 5). Median overall survival (OS) was reached at 33 months and median disease-free survival (DFS) at 20 months: 14/22 patients are in continuous complete response with a median of 26 months. Patients who received lenalidomide alone were compared with patients who received lenalidomide in combination: OS and DFS did not differ. Progression-free survivals are significantly different: at 56 months, 36% in the combination group versus 13% in patients who received lenalidomide alone. Toxicities were manageable, even if 17 of them led to an early drug discontinuation. CONCLUSION Lenalidomide therapy for relapsed MCL patients is effective and tolerable even in a real-life context. IMPLICATION FOR PRACTICE Several factors influence treatment choice in relapsed/refractory mantle cell lymphoma (rrMCL), and the therapeutic scenario is continuously evolving. In fact, rrMCL became the first lymphoma for which four novel agents have been approved: temsirolimus, lenalidomide, ibrutinib, and bortezomib. The rrMCL therapeutic algorithm is not so well established because data in the everyday clinical practice are still poor. Lenalidomide for rrMCL patients is effective and tolerable even in a real-life context.
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Affiliation(s)
| | | | | | - Luca Baldini
- Division of Hematology, Fondazione IRCCS Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Monica Tani
- Unit of Hematology, Santa Maria delle Croci Hospital, Ravenna, Italy
| | | | - Amalia Figuera
- Division of Hematology, AOU Policlinico-Vittorio Emanuele, Catania, Italy
| | - Michela Ansuinelli
- Hematology, Department of Cellular Biotechnologies and Hematology, 'Sapienza' University, Rome, Italy
| | - Elisa Bernocco
- Division of Hematology - SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | | | | | | | - Chiara Rusconi
- Division of Hematology, Niguarda Cancer Center, Milan, Italy
| | - Carlo Visco
- Department of Cell Therapy and Hematology, San Bortolo Hospital, Vicenza, Italy
| | - Luca Arcaini
- Department of Hematology-Oncology, Fondazione IRCCS Policlinico San Matteo & Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Angelo Fama
- Hematology-Arcispedale S.Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Roberto Marasca
- Department of Medical Sciences, Section of Hematology, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | | | - Guido Gini
- Affiliate Clinic of Hematology Ospedali Riuniti, Ancona, Italy
| | | | - Gerardo Musuraca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS, Meldola, Italy
| | - Anna Lucania
- Hematology Unit, ASL Napoli 1 Centro, Naples, Italy
| | - Giuseppina Ricciuti
- Department of Hematology, Lymphoma Unit, Spirito Santo Hospital, Pescara, Italy
| | - Lisa Argnani
- Institute of Hematology, University of Bologna, Bologna, Italy
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De Placido S, Giuliano M, Schettini F, Von Arx C, Buono G, Riccardi F, Cianniello D, Caputo R, Puglisi F, Bonotto M, Fabi A, Bilancia D, Ciccarese M, Lorusso V, Michelotti A, Bruzzese D, Veneziani BM, Locci M, De Laurentiis M, Arpino G. Human epidermal growth factor receptor 2 dual blockade with trastuzumab and pertuzumab in real life: Italian clinical practice versus the CLEOPATRA trial results. Breast 2018; 38:86-91. [PMID: 29287189 DOI: 10.1016/j.breast.2017.12.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/18/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Given their inclusion and exclusion criteria, randomized clinical trials (RCT) might not include a population that truly mirrors real life (RL). This raises concerns about the applicability of RCT results in clinical practice. We evaluated the efficacy of anti-HER2 treatment with pertuzumab combined with trastuzumab and a taxane as first-line treatment for HER2-positive metastatic breast cancer in a RL setting, and compared the safety results obtained in our population versus the experimental cohort of the CLEOPATRA RCT, which led to the approval of this therapy. MATERIALS AND METHODS Patients treated with trastuzumab, pertuzumab and a taxane were enrolled in this retrospective study. We compared the tumor features and the patients' characteristics of the RL cohort to those of the CLEOPATRA cohort. We also compared the median progression-free survival (PFS) in the RL population versus specific patients' subgroups. RESULTS RL patients were more frequently HR-positive, less likely to have visceral metastases (P < .001 for both) and had more frequently received (neo)adjuvant hormone therapy or trastuzumab than CLEOPATRA patients (P = .004 and P < .001, respectively). The median number of anti-HER2 cycles was 8 vs 24 and the median number of cycles was 7 vs 8 for docetaxel in the RL versus CLEOPATRA population, respectively. Adverse reactions of all grades were less frequent in RL. Median PFS was 27.8 months in the RL population and the treatment was equally effective in all patients' subgroups. CONCLUSION This study provides compelling evidence that pertuzumab, trastuzumab and a taxane are effective and safe also in a clinical scenario.
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Affiliation(s)
- Sabino De Placido
- Medical Oncology, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Mario Giuliano
- Medical Oncology, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Francesco Schettini
- Medical Oncology, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Claudia Von Arx
- Medical Oncology, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy; Department of Surgery and Cancer, Imperial College of London, London, UK
| | - Giuseppe Buono
- Medical Oncology, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | | | | | - Roberta Caputo
- National Cancer Institute Fondazione "G. Pascale", Naples, Italy
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Clinical Oncology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Marta Bonotto
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Alessandra Fabi
- Division of Medical Oncology, "Regina Elena" National Cancer Institute, Rome, Italy
| | | | | | - Vito Lorusso
- Operative Unit of Medical Oncology, Oncology Institute of Bari, Bari, Italy
| | | | - Dario Bruzzese
- Department of Epidemiology, University of Naples "Federico II", Naples, Italy
| | - Bianca Maria Veneziani
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II", Naples, Italy
| | - Mariavittoria Locci
- Department of Neuroscience, Reproductive Medicine, Odontostomatology, University of Naples "Federico II", Naples, Italy
| | | | - Grazia Arpino
- Medical Oncology, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
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Dudnik E, Moskovitz M, Daher S, Shamai S, Hanovich E, Grubstein A, Shochat T, Wollner M, Bar J, Merimsky O, Zer A, Goldstein DA, Hammerman A, Cyjon A, Shechtman Y, Abu-Amna M, Flex D, Roisman LC, Peled N; Israel Lung Cancer Group. Effectiveness and safety of nivolumab in advanced non-small cell lung cancer: The real-life data. Lung Cancer. 2018;126:217-223. [PMID: 29254746 DOI: 10.1016/j.lungcan.2017.11.015] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 04/12/2017] [Accepted: 11/17/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Nivolumab has recently received regulatory approval as a 2nd-line treatment of non-small cell lung cancer (NSCLC). The data regarding its effectiveness and safety in real life setting is lacking. MATERIALS AND METHODS 260 consecutive patients with advanced NSCLC treated with nivolumab at five Israeli cancer centers between January 2015 and March 2016 were evaluated for overall survival (OS) and toxicity. OS was analyzed by the Cox proportional-hazards regression model. Overall response rate (ORR) and progression-free survival (PFS) were assessed in 49 patients using RECIST, v.1.1. RESULTS Median age was 67y (41-99); males 68%; smokers 76%; ECOG PS ≥2 46%; non-squamous/squamous/other/NR 70%/23%/6%/1%; brain metastases 21%; liver metastases 21%; treatment line: 1st/2nd/3rd+-line/NR 6%/64%/26%/4%. With median survival follow-up of 18.5 months (range, 12.0-26.9), 155 (60%) patients died; median OS comprised 5.9 months (95% CI 4.7-7.4). In univariate and multivariate analysis, the only variable which significantly correlated with OS was ECOG PS. Median OS of patients with ECOG PS 0/1 and ECOG PS ≥2 comprised 9.5 months (95% CI, 6.7-NR) and 3.5 months (95% CI, 2.6-4.5), respectively. For 49 patients evaluable for response (median follow-up of 8.4 months (range, 2-16.8), ORR was 35%, median PFS was 2.8 months (95% CI, 1.8-7.7), incidence of pseudo-progression was 9%. The nivolumab safety profile was in accordance with the literature data, except for febrile neutropenia and pericarditis (observed in 1 case each). CONCLUSION In real life setting, the effectiveness of nivolumab is reasonable yet less prominent than it has been demonstrated in clinical trials. ECOG PS ≥2 is associated with poor prognosis.
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Schouten RD, Muller M, de Gooijer CJ, Baas P, van den Heuvel M. Real life experience with nivolumab for the treatment of non-small cell lung carcinoma: Data from the expanded access program and routine clinical care in a tertiary cancer centre-The Netherlands Cancer Institute. Lung Cancer 2017; 126:210-216. [PMID: 29179916 DOI: 10.1016/j.lungcan.2017.11.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 10/26/2017] [Accepted: 11/13/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Robert D Schouten
- Department of Thoracic Oncology, Netherlands Cancer Institute (NKI), Amsterdam
| | - Mirte Muller
- Department of Thoracic Oncology, Netherlands Cancer Institute (NKI), Amsterdam
| | | | - Paul Baas
- Department of Thoracic Oncology, Netherlands Cancer Institute (NKI), Amsterdam.
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Novakova SM, Staevska MT, Novakova PI, Yoncheva MD, Bratoycheva MS, Musurlieva NM, Tzekov VD, Nicolov DG. Quality of life improvement after a three-year course of sublingual immunotherapy in patients with house dust mite and grass pollen induced allergic rhinitis: results from real-life. Health Qual Life Outcomes 2017; 15:189. [PMID: 28962623 PMCID: PMC5622572 DOI: 10.1186/s12955-017-0764-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 09/24/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Along with its high prevalence, the burden of allergic rhinitis rests upon the serious impact on quality of life of patients. Allergic rhinitis is associated with impairments in daily activities, work and school performance, and practical problems. Patients suffer from sleep disorders and emotional problems. Тhe advantages of sublingual immunotherapy on quality of life have only recently begun to emerge. The objective of this prospective real-life study was to evaluate the effect of a three-year course of sublingual immunotherapy with house dust mite (HDM) and grass pollen extracts on quality of life in adults with allergic rhinitis. METHODS A total number of 191 adult patients [105 (54,979%) men; mean age 27.3 years (SD-6.14)] with moderate to severe allergic rhinitis and clinically relevant sensitization to house dust mites or grass pollen were prospectively evaluated in the course of management of their disease. Health-related quality of life was assessed by Rhinoconjunctivitis Quality of Life Questionnaire at baseline and after three-year course of sublingual immunotherapy. RESULTS The mean overall Qol score assessed at baseline and at the end of the third year of treatment decreased significantly in patients treated with HDM extract (from 2.95 to 0.76) as well as with Grass pollen extract (from 2.83 to 1.22) (р < 0.001). The improvements in treated with HDM extract were as followed: activities - 3.52 to 0.68; sleep- 2.48 to 0.31; general problems - 1.79 to 0.49; practical problems - 3.57 to 0.68; nasal symptoms - 3.91 to 0.74; eye symptoms - 2.92 to 0.39; emotions - 3.03 to 0.39. The improvements in grass pollen group were: activities - 3.68 to 1.69; sleep- 1.85 to 0.84; general problems - 1.74 to 0.97; practical problems - 3.52 to 1.37; nasal symptoms - 3.72 to 1.57; eye symptoms - 3.58 to 1.3; emotions - 2.48 to 1.19. CONCLUSION Our study conducted in real life provided evidence that a three-year course of SLIT with HDM extract as well as with grass pollen extract significantly increased QoL in patients with allergic rhinitis.
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Affiliation(s)
- Silviya Mihaylova Novakova
- Allergy Unit of Internal Consulting Department, University hospital St. George, “Peshtersko shosse” 66, Plovdiv, Bulgaria
| | | | | | - Manuela Dimitrova Yoncheva
- Internal Consulting Department, University hospital “St. George”, “Peshtersko shosse” 66, Plovdiv, Bulgaria
| | - Maria Stoykova Bratoycheva
- Faculty of Public Health, Department of Social Medicine and Public Health, Medical University-Plovdiv, “Vasil Aprilov”15A, Plovdiv, Bulgaria
| | - Nina Mihaylova Musurlieva
- Faculty of Public Health, Department of Social Medicine and Public Health, Medical University-Plovdiv, “Vasil Aprilov”15A, Plovdiv, Bulgaria
| | - Valeri Dimitrov Tzekov
- Medical Faculty, The Second Internal Department, Medical University-Plovdiv, “Vassil Aprilov”15A, Plovdiv, Bulgaria
| | - Dimitar Georgiev Nicolov
- Medical Faculty, The Second Internal Department, Medical University-Plovdiv, “Vassil Aprilov”15A, Plovdiv, Bulgaria
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Generali D, Montemurro F, Bordonaro R, Mafodda A, Romito S, Michelotti A, Piovano P, Ionta MT, Bighin C, Sartori D, Frassoldati A, Cazzaniga ME, Riccardi F, Testore F, Vici P, Barone CA, Schirone A, Piacentini F, Nolè F, Molino A, Latini L, Simoncini EL, Roila F, Cognetti F, Nuzzo F, Foglietta J, Minisini AM, Goffredo F, Portera G, Ascione G, Mariani G. Everolimus Plus Exemestane in Advanced Breast Cancer: Safety Results of the BALLET Study on Patients Previously Treated Without and with Chemotherapy in the Metastatic Setting. Oncologist 2017; 22:648-654. [PMID: 28432226 DOI: 10.1634/theoncologist.2016-0461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/10/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The BALLET study was an open-label, multicenter, expanded access study designed to allow treatment with everolimus plus exemestane in postmenopausal women with hormone receptor-positive metastatic breast cancer progressed following prior endocrine therapy. A post hoc analysis to evaluate if previous chemotherapy in the metastatic setting affects the safety profile of the combination regimen of everolimus and exemestane was conducted on the Italian subset, as it represented the major part of the patients enrolled (54%). PATIENTS AND METHODS One thousand one hundred and fifty-one Italian patients were included in the present post hoc analysis, which focused on two sets of patients: patients who never received chemotherapy in the metastatic setting (36.1%) and patients who received at least one chemotherapy treatment in the metastatic setting (63.9%). RESULTS One thousand one hundred and sixteen patients (97.0%) prematurely discontinued the study drug, and the main reasons reported were disease progression (39.1%), local reimbursement of everolimus (31.1%), and adverse events (AEs) (16.1%). The median duration of study treatment exposure was 139.5 days for exemestane and 135.0 days for everolimus. At least one AE was experienced by 92.5% of patients. The incidence of everolimus-related AEs was higher (83.9%) when compared with those that occurred with exemestane (29.1%), and the most commonly reported everolimus-related AE was stomatitis (51.3%). However, no significant difference in terms of safety related to the combination occurred between patients without and with chemotherapy in the metastatic setting. CONCLUSION Real-life data of the Italian patients BALLET-related cohort were an adequate setting to state that previous chemotherapy did not affect the safety profile of the combination regimen of everolimus and exemestane. IMPLICATIONS FOR PRACTICE With the advent of new targeted agents for advanced or metastatic breast cancer, multiple lines of therapy may be possible, and components of the combined regimens can overlap from one line to another. Thus, it is important to assess even the potential of cumulative and additive toxic effects among the drugs. Previous chemotherapy did not affect the safety profile of the combination regimen of everolimus and exemestane. The continuous monitoring of the safety signals of this drug combination from general clinical practice is important, in particular for stomatitis.
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Affiliation(s)
- Daniele Generali
- Breast Cancer Unit and Molecular Therapy Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Filippo Montemurro
- Divisione di Oncologia Clinica Investigativa dell'Istituto di Candiolo-IRCCS, Candiolo, Italy
| | | | - Antonino Mafodda
- Divisione Oncologia Medica, A.O. Bianchi Melarino Morelli, Reggio Calabria, Italy
| | - Sante Romito
- Reparto di Oncologia Medica, Ospedali Riuniti di Foggia, Foggia, Italy
| | | | - Pierluigi Piovano
- Divisione Oncologia Medica, Presidio Santi Antonio e Biagio, Alessandria, Italy
| | | | - Claudia Bighin
- Reparto Oncologia Medica A, Istituto Nazionale Ricerca sul Cancro, Genova, Italy
| | - Donata Sartori
- Divisione Oncologia Ematologia, Presidio Ospedaliero di Mirano, Venezia, Italy
| | | | | | | | - Franco Testore
- Day Hospital Oncologia, Ospedale Cardinale Guglielmo Massaia, Asti, Italy
| | - Patrizia Vici
- Divisione Oncologia Medica B, IRE IRCCS Regina Elena, Roma, Italy
| | | | - Alessio Schirone
- Day Hospital Oncoematologia, IRST Istituto Scientifico Romagnolo, Meldola, Italy
| | - Federico Piacentini
- Division of Medical Oncology Department of Medical and Surgical Sciences for Children & Adults University Hospital of Modena, Modena, Italy
| | - Franco Nolè
- Divisione Oncologia Medica Urogenitale, Istituto Europeo di Oncologia, Milano, Italy
| | | | - Luciano Latini
- Day Hospital Oncologia, Ospedale di Macerata, Macerata, Italy
| | | | - Fausto Roila
- Divisione Oncologia Medica, Ospedale Civile Santa Maria, Terni
| | | | - Francesco Nuzzo
- U.O.C. Oncologia Medica Senologica, Istituto Nazionale Tumori Fondazione Pascale, Napoli, Italy
| | - Jennifer Foglietta
- U.O. Oncologia Medica, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | | | | | | | | | - Gabriella Mariani
- Divisione Oncologia Medica 1, IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Ciprandi G, Natoli V, Puccinelli P, Incorvaia C. Allergic rhinitis: the eligible candidate to mite immunotherapy in the real world. Allergy Asthma Clin Immunol 2017; 13:11. [PMID: 28239397 PMCID: PMC5320802 DOI: 10.1186/s13223-017-0185-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 02/11/2017] [Indexed: 11/10/2022] Open
Abstract
As standard drug treatment of allergic rhinitis (AR) is not completely satisfactory, allergen immunotherapy (AIT) represents the only current treatment with the potential to modify the natural history. House dust mite (HDM) allergy is very common. The aim of the current experience was to describe the clinical profile of HDM-allergic patients with AR who received AIT in a real world model, such as allergy clinics. Globally, 239 patients (126 adults and 113 children; 107 females and 132 males; mean age 21 years, age range 6-56 years) were evaluated. AIT was prescribed in 59 patients (24.7%), 44 adults (35%) and 15 children (13.3%). The current findings deriving from this real world multicentre study are consistent with previous investigations on HDM-AIT and define some clinical characteristics of the eligible candidate to this treatment. In fact, severity of ocular-nasal symptoms and over-use of symptomatic medications may typify the ideal candidate to HDM-AIT and SLIT was the preferred choice.
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Affiliation(s)
- Giorgio Ciprandi
- Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.), Azienda Ospedaliera Universitaria San Martino-IST, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Valentina Natoli
- Scientific, Pharmacovigilance and Regulatory Department Stallergenes, Milan, Italy
| | - Paola Puccinelli
- Scientific, Pharmacovigilance and Regulatory Department Stallergenes, Milan, Italy
| | - Cristoforo Incorvaia
- Allergy/Pulmonary Rehabilitation Unit, Istituti Clinici di Perfezionamento Hospital, Milan, Italy
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Russo V, Di Napoli L, Bianchi V, Tavoletta V, De Vivo S, Cavallaro C, Vecchione F, Rago A, Sarubbi B, Calabrò P, Nigro G, D'Onofrio A. A new integrated strategy for direct current cardioversion in non-valvular atrial fibrillation patients using short term rivaroxaban administration: The MonaldiVert real life experience. Int J Cardiol 2016; 224:454-5. [PMID: 27716588 DOI: 10.1016/j.ijcard.2016.09.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 08/30/2016] [Accepted: 09/12/2016] [Indexed: 11/21/2022]
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Gandolfi L, Pellegrini C, Casadei B, Stefoni V, Broccoli A, Tonialini L, Morigi A, Argnani L, Zinzani PL. Long-Term Responders After Brentuximab Vedotin: Single-Center Experience on Relapsed and Refractory Hodgkin Lymphoma and Anaplastic Large Cell Lymphoma Patients. Oncologist 2016; 21:1436-1441. [PMID: 27486201 DOI: 10.1634/theoncologist.2016-0112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/22/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Brentuximab vedotin (BV) has shown high overall response rate in refractory/relapsed Hodgkin lymphoma (HL) and systemic anaplastic large cell lymphoma (sALCL) with reported long-term response duration in clinical trials, but few data are available regarding its role in long-term outcomes in real life. PATIENTS AND METHODS A single-center observational study was conducted on patients treated with BV in daily clinical practice to evaluate the long-term effectiveness of BV in HL and sALCL patients and to check whether clinical trial results are confirmed in a real-life context. RESULTS The best response rate in the treated 53 patients (43 HL and 10 sALCL) was 69.8% (with 46.5% complete response [CR]) in HL and 100% (80% CR) for sALCL, respectively. With a median patient follow-up of 36.8 months, the estimated median duration of response was 31.5 months for HL and 17.8 for sALCL, respectively. At the latest available follow-up, 75% of patients were still in response, with 43% without any consolidation. Toxicity was primarily neurological and it was rarely so serious to require dose reduction or interruption. In addition, it always reversed completely after the end of treatment. CONCLUSION Our data showed that 51% of patients treated with BV can be regarded as "long-term responders." Among these cases, for all patients who underwent stem cell transplantation immediately after BV, the procedure was consolidative. For patients who have remained in continuous CR without any consolidation after therapy, BV can induce prolonged disease control. IMPLICATIONS FOR PRACTICE Brentuximab vedotin (BV) has shown a high overall response rate in refractory/relapsed Hodgkin lymphoma and systemic anaplastic large cell lymphoma, with reported long-term response duration in clinical trials, whereas few data are available regarding its role in long-term outcomes in real life. The data reported in this study suggest that BV can induce the same results in daily clinical practice. The data showed that 51% of patients treated with BV can be regarded as "long-term responders." Among these cases, BV can induce prolonged disease control in patients who have remained in continuous complete response without any consolidation after the drug.
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Affiliation(s)
- Letizia Gandolfi
- Institute of Hematology "L. e A. Seràgnoli," University of Bologna, Bologna, Italy
| | - Cinzia Pellegrini
- Institute of Hematology "L. e A. Seràgnoli," University of Bologna, Bologna, Italy
| | - Beatrice Casadei
- Institute of Hematology "L. e A. Seràgnoli," University of Bologna, Bologna, Italy
| | - Vittorio Stefoni
- Institute of Hematology "L. e A. Seràgnoli," University of Bologna, Bologna, Italy
| | - Alessandro Broccoli
- Institute of Hematology "L. e A. Seràgnoli," University of Bologna, Bologna, Italy
| | - Lorenzo Tonialini
- Institute of Hematology "L. e A. Seràgnoli," University of Bologna, Bologna, Italy
| | - Alice Morigi
- Institute of Hematology "L. e A. Seràgnoli," University of Bologna, Bologna, Italy
| | - Lisa Argnani
- Institute of Hematology "L. e A. Seràgnoli," University of Bologna, Bologna, Italy
| | - Pier Luigi Zinzani
- Institute of Hematology "L. e A. Seràgnoli," University of Bologna, Bologna, Italy
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Norderud Lærum B, Telg G, Stratelis G. Need of education for dry powder inhaler storage and retention - a patient-reported survey. Multidiscip Respir Med 2016; 11:21. [PMID: 27280021 PMCID: PMC4897891 DOI: 10.1186/s40248-016-0057-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dry powder inhalers (DPIs) are the most commonly used devices in asthma treatment in the Nordic countries. As new DPIs become available, patients are likely to be exposed to more than one type of device, with variable optimal handling. The aim was to examine real life storage and retention of multidose DPIs in patients with asthma. METHODS This patient-reported survey on real life storage and retention of DPIs included asthma patients using multidose DPIs. Basic patient characteristics, information on inhaler use and storage, check of expiry date, and concurrent inhaler use was examined using an on line questionnaire. RESULTS A total of 738 patients were included with a median age of 41 years, out of which 83 % were women. Sixty-three per cent reported storage conditions pre-defined as risk locations for their maintenance inhaler and 38 % of the responding patients had more than one maintenance inhaler in use at the same time. Two thirds of the study population checked inhaler expiry date less than monthly or not at all. Use after expiry date was frequently reported. Two thirds of the patients had not received information on DPI storage, either from their doctor and/or nurse or at the pharmacy. CONCLUSIONS This patient reported survey indicates that two thirds of the patients store their inhaler devices in suboptimal conditions, and only a minority had received instruction regarding inhaler handling. Non awareness of inhalers' expiry dates and use of more than one maintenance inhaler simultaneously was common. As inhaler mishandling may impact device functionality, improved communication and patient education is needed.
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Affiliation(s)
- Birger Norderud Lærum
- Department of Clinical Science, University of Bergen, N-5020 Bergen, Norway ; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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Paolicelli D, Manni A, Iaffaldano A, Di Lecce V, D'Onghia M, Iaffaldano P, Trojano M. The role of neutralizing antibodies to interferon-β as a biomarker of persistent MRI activity in multiple sclerosis: a 7-year observational study. Eur J Clin Pharmacol 2016; 72:1025-9. [PMID: 27251359 DOI: 10.1007/s00228-016-2073-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE During interferon-β (IFN-β) therapy, up to 45 % of patients may develop neutralizing antibodies (NAbs), associated with a decreased efficacy of the drug. We investigated in a real-life setting the impact of NAbs on magnetic resonance imaging (MRI) outcomes in a population of 567 IFN-β-treated relapsing-remitting (RR) multiple sclerosis (MS) patients up to 7 years. We also evaluated NAbs' role as a biomarker of the persistence of MRI disease activity. METHODS Patients' sera were tested for NAbs' presence by cytopathic effect (CPE) assay every 6-12 months. MRI scans were performed every 12 months. Generalized hierarchical linear models accounting for within-patient correlation were used to analyze T1 gadolinium-enhancing and new T2 lesions. Moreover, further tests were carried out to assess the overall outcome difference from year 1 to year 7 according to NAb status and the possible interaction between NAb status and time of follow-up. RESULTS Seventy-five patients (13.2 %) became NAb positive (NAb+) during the follow-up. Considering T1 gadolinium-enhancing (GD+) lesions, we observed a significantly higher incidence in NAb+ patients (52 %, p = 0.0091). Also for new T2 lesions, we found a higher incidence in NAb+ patients (50 %, p = 0.0075). The negative impact of NAbs on the MRI outcomes considered did not change during the follow-up. CONCLUSIONS Our 7-year results show the negative effect of NAbs on MRI measures of disease activity and confirm their role as a surrogate marker of IFN-β treatment efficacy.
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Garrone O, Montemurro F, Saggia C, La Verde N, Vandone AM, Airoldi M, De Conciliis E, Donadio M, Lucio F, Polimeni MA, Oletti MV, Giacobino A, Merlano MC. Eribulin in pretreated metastatic breast cancer patients: results of the TROTTER trial-a multicenter retrospective study of eribulin in real life. Springerplus 2016; 5:59. [PMID: 26835238 PMCID: PMC4720621 DOI: 10.1186/s40064-016-1700-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 01/08/2016] [Indexed: 11/10/2022]
Abstract
This retrospective multicenter analysis was aimed to evaluate clinical activity and tolerability of eribulin in pretreated metastatic breast cancer patients in clinical practice. Patients treated with eribulin from January 2012 to July 2013 were enrolled in the observational study from 10 italian hospitals. Tumor and toxicity evaluation were performed according to Agenzia Italiana Farmaco. One-hundred and thirteen patients were included in the study. Median age 62 years old. 71.7 % of the patients had visceral involvement and the majority had a burden of disease involving two or more organs with a median number of 2 (1-6). The median number of previous chemotherapy regimens for advanced disease was 3 (1-10). Median number of eribulin cycles was 4 (1-27). Overall response rate was 24 % (95 % CI 16.0-31.8). Clinical benefit rate, was 35.4 % (95 % CI 26.6-44.2). At a median follow-up of 29.6 months (8.3-41.9) the median progression free survival was 3.3 months (0.6-26.7; 95 % CI 2.4-4.2), and the median overall survival 11.6 months (0.6-33.3; 95 % CI 8.7-14.5). No correlation was recorded between subtypes in terms of ORR and CBR. Toxicity was manageable. Main common grade 3-4 toxicities were neutropenia (19.4 %), febrile neutropenia (0.9 %), asthenia (3.5 %), abnormal liver function test (1.8 %), stomatitis (0.9 %). Our results confirm that treatment with eribulin is feasible and safe in real-world patients.
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Affiliation(s)
- Ornella Garrone
- Medical Oncology, A.O. Ospedale di Insegnamento S. Croce e Carle, V. M. Coppino, 26, 12100 Cuneo, Italy
| | - Filippo Montemurro
- Investigative Clinical Oncology, Fondazione del Piemonte per l'Oncologia, Candiolo Cancer Institute (IRCCS), Strada Provinciale 142, 10060 Candiolo, Turin, Italy
| | - Chiara Saggia
- Medical Oncology, A.O.U. Maggiore della Carità, C. G. Mazzini, 28, 28100 Novara, Italy
| | - Nicla La Verde
- Department of Oncology, A.O. Fatebenefratelli & Oftalmico, C. di Porta Nuova, 25, 20121 Milan, Italy
| | - Anna Maria Vandone
- Medical Oncology, A.O. Ospedale di Insegnamento S. Croce e Carle, V. M. Coppino, 26, 12100 Cuneo, Italy
| | - Mario Airoldi
- Department of Medical Oncology 2, A.O.U. Città della Salute e della Scienza, C. Bramante, 88, 10126 Turin, Italy
| | - Enrico De Conciliis
- Medical Oncology, Ospedale Cardinal Massaia, C. D. Alighieri, 201, 14100 Asti, Italy
| | - Michela Donadio
- Breast Unit, A.O.U. Città della Salute e della Scienza, C. Bramante, 88, 10126 Turin, Italy
| | - Francesco Lucio
- Radiotherapy Oncology, A.O. Ospedale di Insegnamento S. Croce e Carle, V. M. Coppino, 26, 12100 Cuneo, Italy
| | | | - Maria Vittoria Oletti
- Medical Oncology, Ospedale S. Spirito, V. G. Giolitti, 2, 15033 Casale Monferrato, Italy
| | - Alice Giacobino
- Department of Oncology, Ospedale degli Infermi, V. Ponderanesi, 2, 13875 Ponderano, Italy
| | - Marco Carlo Merlano
- Medical Oncology, A.O. Ospedale di Insegnamento S. Croce e Carle, V. M. Coppino, 26, 12100 Cuneo, Italy
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von Haaren B, Ottenbacher J, Muenz J, Neumann R, Boes K, Ebner-Priemer U. Does a 20-week aerobic exercise training programme increase our capabilities to buffer real-life stressors? A randomized, controlled trial using ambulatory assessment. Eur J Appl Physiol 2015; 116:383-94. [PMID: 26582310 DOI: 10.1007/s00421-015-3284-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 10/17/2015] [Indexed: 01/05/2023]
Abstract
PURPOSE The cross-stressor adaptation hypothesis suggests that regular exercise leads to adaptations in the stress response systems that induce decreased physiological responses to psychological stressors. Even though an exercise intervention to buffer the detrimental effects of psychological stressors on health might be of utmost importance, empirical evidence is mixed. This may be explained by the use of cross-sectional designs and non-personally relevant stressors. Using a randomized controlled trial, we hypothesized that a 20-week aerobic exercise training does reduce physiological stress responses to psychological real-life stressors in sedentary students. METHODS Sixty-one students were randomized to either a control group or an exercise training group. The academic examination period (end of the semester) served as a real-life stressor. We used ambulatory assessment methods to assess physiological stress reactivity of the autonomic nervous system (heart rate variability: LF/HF, RMSSD), physical activity and perceived stress during 2 days of everyday life and multilevel models for data analyses. Aerobic capacity (VO2max) was assessed pre- and post-intervention via cardiopulmonary exercise testing to analyze the effectiveness of the intervention. RESULTS During real-life stressors, the exercise training group showed significantly reduced LF/HF (β = -0.15, t = -2.59, p = .01) and increased RMSSD (β = 0.15, t = 2.34, p = .02) compared to the control group. CONCLUSIONS Using a randomized controlled trial and a real-life stressor, we could show that exercise appears to be a useful preventive strategy to buffer the effects of stress on the autonomic nervous system, which might result into detrimental health outcomes.
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Affiliation(s)
- Birte von Haaren
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany.
| | | | | | - Rainer Neumann
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
| | - Klaus Boes
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
| | - Ulrich Ebner-Priemer
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
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Khetta M, Benhamou Y, Tharasse C, Le Besnerais M, Miranda S, Cailleux-Talbot N, Girszyn N, Ngo S, Sauvêtre G, Lévesque H, Armengol G. [Which place for direct oral anticoagulants in routine hospital medical practice?]. Rev Med Interne 2015; 36:813-7. [PMID: 26320364 DOI: 10.1016/j.revmed.2015.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 05/06/2015] [Accepted: 06/05/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE More than one million patients received an oral anticoagulant treatment in France. This medication is the first aetiology of iatrogenic events. Recently, direct oral anticoagulant (DOA) provided efficacy and safety in the treatment of atrial fibrillation and venous thromboembolic events. Given the growing increase in the prescription of these molecules, with many advantages but also disadvantages, it seemed interesting to assess in routine hospital medical practice, the proportion of patients for which the initiation of AOD could be safe. METHODS This prospective, observational study was conducted in the department of internal medicine from October 2012 and September 2013. All inpatients receiving oral anticoagulant treatment have been included. Demographic data, indication of anticoagulant treatment, contraindications and interactions have been reported. From these information, we have established the percentage of patients who could benefit from DOA safely and securely. RESULTS Two hundred and ninety inpatients were included with a mean age of 76.3±15.2 years old. Atrial fibrillation and thromboembolic venous disease were the most prevalent indications of anticoagulant treatments (67.2% and 22.4% of cases respectively). Among all patients, 260 had an indication of DOA (89.7%), authorized by the French National health agency. Eighty percent had both indication and no contraindication for DOA. However, only 53.1% of patients neither had drug-drug interaction. Main contraindications were severe renal failure (clearance<30mL/min) in 10.7% of cases, and recent history of gastric ulcer in 15.3% of cases. The most frequent interactions with DOA were antiplatelet agent (14.5%) and amiodarone (11.6%). Almost two thirds of inpatients (65.1%) had at least one drug-drug interaction with VKA. CONCLUSION These results, coming from "real life", provide that only 53.1% of inpatients under anticoagulants could receive DOA safely. Caution is warranted, and VKA still have a preponderant role among anticoagulant drugs.
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Abstract
UNLABELLED Poorly controlled diabetes mellitus (DM) is associated with the development of long-term micro- and macro-vascular complications. The predominant focus of anti-diabetic therapy has been on lowering glycosylated haemoglobin levels, with a strong emphasis on fasting plasma glucose (particularly in Type 2 DM). There is considerable evidence indicating that post-meal hyperglycaemic levels are independently associated with higher risks of macro-vascular disease. Although some have identified mechanisms which may account for these observations, interventions which have specifically targeted postprandial glucose rises showed little or no effect in reducing cardiovascular risk. Clinical experience and some recent studies suggest acute hyperglycaemia affects cognition and other indicators of performance, equivalent to impairment seen during hypoglycaemia. In this brief report, we evaluated the published studies and argue that acute hyperglycaemia is worth investigating in relation to the real-life implications. In summary, evidence exists suggesting that acute hyperglycaemia may lead to impaired cognitive performance and productivity, but the relationship between these effects and daily activities remains poorly understood. Further research is required to enhance our understanding of acute hyperglycaemia in daily life. A better appreciation of clinically relevant effects of acute hyperglycaemia will allow us to determine whether it needs to be addressed by specific treatment. FUNDING Novo Nordisk A/S Søborg, Denmark.
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Seferina SC, Lobbezoo DJA, de Boer M, Dercksen MW, van den Berkmortel F, van Kampen RJW, van de Wouw AJ, de Vries B, Joore MA, Peer PGM, Voogd AC, Tjan-Heijnen VCG. Real-Life Use and Effectiveness of Adjuvant Trastuzumab in Early Breast Cancer Patients: A Study of the Southeast Netherlands Breast Cancer Consortium. Oncologist 2015; 20:856-63. [PMID: 26099745 DOI: 10.1634/theoncologist.2015-0006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/23/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The impact of drug prescriptions in real life as opposed to strict clinical trial prescription is only rarely assessed, although it is well recognized that incorrect use may harm patients and may have a significant impact on health care resources. We investigated the use and effectiveness of adjuvant trastuzumab in daily practice compared with the effectiveness in clinical trials. METHODS We included all patients with stage I-III invasive breast cancer, irrespective of human epidermal growth factor receptor 2 (HER2) status, diagnosed in five hospitals in the southeast of The Netherlands in 2005-2007. We aimed to assess the actual use of adjuvant trastuzumab in early HER2-positive breast and its efficacy in daily practice. RESULTS Of 2,684 patients included, 476 (17.7%) had a HER2-positive tumor. Of these, 251 (52.7%) patients had an indication for trastuzumab treatment of which 196 (78.1%) patients actually received it. Of the 225 patients without an indication, 34 (15.1%) received trastuzumab. Five-year disease-free survival was 80.7% for (n = 230) patients treated with versus 68.2% for (n = 246) patients not treated with trastuzumab (p = .0023), and 5-year overall survival rates were 90.7% and 77.4%, respectively (p = .0002). The hazard ratio for disease recurrence was 0.63 (95% confidence interval, 0.37-1.06) for trastuzumab when adjusting for potential confounders. CONCLUSION This study shows that in real life, patients treated with trastuzumab in early-stage HER2-positive breast cancer had a 5-year disease-free and overall survival comparable to prior randomized trials. For informative decision making, real-life data are of additional value, providing insight on outcome of patients considered ineligible for treatment.
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Affiliation(s)
- Shanly C Seferina
- Departments of Medical Oncology, Pathology, Clinical Epidemiology and Medical Technology Assessment, and Epidemiology and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Internal Medicine, Máxima Medical Centre, Veldhoven, The Netherlands; Department of Internal Medicine, Atrium Medical Centre Parkstad, Heerlen, The Netherlands; Department of Internal Medicine, Orbis Medical Centre, Sittard, The Netherlands; Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands; Biostatistics, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dorien J A Lobbezoo
- Departments of Medical Oncology, Pathology, Clinical Epidemiology and Medical Technology Assessment, and Epidemiology and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Internal Medicine, Máxima Medical Centre, Veldhoven, The Netherlands; Department of Internal Medicine, Atrium Medical Centre Parkstad, Heerlen, The Netherlands; Department of Internal Medicine, Orbis Medical Centre, Sittard, The Netherlands; Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands; Biostatistics, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maaike de Boer
- Departments of Medical Oncology, Pathology, Clinical Epidemiology and Medical Technology Assessment, and Epidemiology and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Internal Medicine, Máxima Medical Centre, Veldhoven, The Netherlands; Department of Internal Medicine, Atrium Medical Centre Parkstad, Heerlen, The Netherlands; Department of Internal Medicine, Orbis Medical Centre, Sittard, The Netherlands; Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands; Biostatistics, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M Wouter Dercksen
- Departments of Medical Oncology, Pathology, Clinical Epidemiology and Medical Technology Assessment, and Epidemiology and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Internal Medicine, Máxima Medical Centre, Veldhoven, The Netherlands; Department of Internal Medicine, Atrium Medical Centre Parkstad, Heerlen, The Netherlands; Department of Internal Medicine, Orbis Medical Centre, Sittard, The Netherlands; Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands; Biostatistics, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Franchette van den Berkmortel
- Departments of Medical Oncology, Pathology, Clinical Epidemiology and Medical Technology Assessment, and Epidemiology and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Internal Medicine, Máxima Medical Centre, Veldhoven, The Netherlands; Department of Internal Medicine, Atrium Medical Centre Parkstad, Heerlen, The Netherlands; Department of Internal Medicine, Orbis Medical Centre, Sittard, The Netherlands; Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands; Biostatistics, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roel J W van Kampen
- Departments of Medical Oncology, Pathology, Clinical Epidemiology and Medical Technology Assessment, and Epidemiology and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Internal Medicine, Máxima Medical Centre, Veldhoven, The Netherlands; Department of Internal Medicine, Atrium Medical Centre Parkstad, Heerlen, The Netherlands; Department of Internal Medicine, Orbis Medical Centre, Sittard, The Netherlands; Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands; Biostatistics, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Agnès J van de Wouw
- Departments of Medical Oncology, Pathology, Clinical Epidemiology and Medical Technology Assessment, and Epidemiology and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Internal Medicine, Máxima Medical Centre, Veldhoven, The Netherlands; Department of Internal Medicine, Atrium Medical Centre Parkstad, Heerlen, The Netherlands; Department of Internal Medicine, Orbis Medical Centre, Sittard, The Netherlands; Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands; Biostatistics, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart de Vries
- Departments of Medical Oncology, Pathology, Clinical Epidemiology and Medical Technology Assessment, and Epidemiology and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Internal Medicine, Máxima Medical Centre, Veldhoven, The Netherlands; Department of Internal Medicine, Atrium Medical Centre Parkstad, Heerlen, The Netherlands; Department of Internal Medicine, Orbis Medical Centre, Sittard, The Netherlands; Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands; Biostatistics, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Manuela A Joore
- Departments of Medical Oncology, Pathology, Clinical Epidemiology and Medical Technology Assessment, and Epidemiology and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Internal Medicine, Máxima Medical Centre, Veldhoven, The Netherlands; Department of Internal Medicine, Atrium Medical Centre Parkstad, Heerlen, The Netherlands; Department of Internal Medicine, Orbis Medical Centre, Sittard, The Netherlands; Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands; Biostatistics, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Petronella G M Peer
- Departments of Medical Oncology, Pathology, Clinical Epidemiology and Medical Technology Assessment, and Epidemiology and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Internal Medicine, Máxima Medical Centre, Veldhoven, The Netherlands; Department of Internal Medicine, Atrium Medical Centre Parkstad, Heerlen, The Netherlands; Department of Internal Medicine, Orbis Medical Centre, Sittard, The Netherlands; Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands; Biostatistics, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Adri C Voogd
- Departments of Medical Oncology, Pathology, Clinical Epidemiology and Medical Technology Assessment, and Epidemiology and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Internal Medicine, Máxima Medical Centre, Veldhoven, The Netherlands; Department of Internal Medicine, Atrium Medical Centre Parkstad, Heerlen, The Netherlands; Department of Internal Medicine, Orbis Medical Centre, Sittard, The Netherlands; Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands; Biostatistics, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Departments of Medical Oncology, Pathology, Clinical Epidemiology and Medical Technology Assessment, and Epidemiology and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Internal Medicine, Máxima Medical Centre, Veldhoven, The Netherlands; Department of Internal Medicine, Atrium Medical Centre Parkstad, Heerlen, The Netherlands; Department of Internal Medicine, Orbis Medical Centre, Sittard, The Netherlands; Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands; Biostatistics, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
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Baki E, Zwickel P, Zawierucha A, Ehehalt R, Gotthardt D, Stremmel W, Gauss A. Real-life outcome of anti-tumor necrosis factor α in the ambulatory treatment of ulcerative colitis. World J Gastroenterol 2015; 21:3282-3290. [PMID: 25805935 PMCID: PMC4363758 DOI: 10.3748/wjg.v21.i11.3282] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 10/24/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the outcome of anti-tumor necrosis factor alpha (anti-TNFα) therapy in outpatients with ulcerative colitis at a tertiary referral center.
METHODS: All patients with a confirmed diagnosis of ulcerative colitis undergoing therapy with infliximab and/or adalimumab at the outpatient clinic for inflammatory bowel diseases at the University Hospital Heidelberg between January 2011 and February 2014 were retrospectively enrolled. Patients with a follow-up period of less than 6 mo from start of anti-TNFα therapy were excluded. Medical records of all eligible individuals were carefully reviewed. Steroid-free clinical remission of a duration of at least 3 mo, colectomy rate, duration of anti-TNFα therapy, need for anti-TNFα dose escalation, and the occurrence of adverse events were evaluated as the main outcome parameters.
RESULTS: Seventy-two patients were included (35 treated with infliximab, 17 with adalimumab, 20 with both consecutively). Median follow-up was 27 mo (range: 6-87 mo). Steroid-free clinical remission was achieved by 22.2% of the patients (median duration: 21 mo until end of follow-up; range: 3-66 mo). Patients attaining steroid-free clinical remission displayed lower hemoglobin and albumin blood levels at the start of treatment than those who did not achieve remission. The overall colectomy rate was 20.8%. Nearly 50% of the patients underwent anti-TNFα dose escalation during the follow-up period. For both the infliximab and the adalimumab treated patients, non-response to anti-TNFα therapy was the major reason for treatment discontinuation. 18.2% of the infliximab-treated patients and 13.5% of the adalimumab-treated patients had to discontinue their therapy due to adverse events.
CONCLUSION: Real-life remission rates of ulcerative colitis under anti-TNFα are overall low, but some patients have a clear long-term benefit.
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Ridruejo E. Treatment of chronic hepatitis B in clinical practice with entecavir or tenofovir. World J Gastroenterol 2014; 20:7169-80. [PMID: 24966587 PMCID: PMC4064062 DOI: 10.3748/wjg.v20.i23.7169] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/20/2013] [Accepted: 01/02/2014] [Indexed: 02/07/2023] Open
Abstract
Results from phase III clinical trials clearly demonstrate the efficacy and safety of entecavir and tenofovir in the controlled environment of randomized clinical studies. There are several studies with both drugs performed in clinical practice (also called "real life studies"). Despite the pros and cons, studies performed in real life conditions represent everyday practice and add important information about long term treatment effectiveness and safety in this clinical setting. This review shows that patients treated with first line nucleos(t)ide analogs at referral centres, with good clinical follow-up and adherence to international guidelines, can achieve high treatment response rates with a very low rate of adverse events.
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Cacoub P, Ouzan D, Melin P, Lang JP, Rotily M, Fontanges T, Varastet M, Chousterman M, Marcellin P. Patient education improves adherence to peg-interferon and ribavirin in chronic genotype 2 or 3 hepatitis C virus infection: A prospective, real-life, observational study. World J Gastroenterol 2008; 14:6195-203. [PMID: 18985810 PMCID: PMC2761581 DOI: 10.3748/wjg.14.6195] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the impact of therapeutic education on adherence to antiviral treatment and sustained virological response (SVR) in a real-life setting in genotype 2/3 hepatitis C, as there are few adherence data in genotype 2/3 infection, even from randomized trials.
METHODS: This prospective survey included genotype 2/3 patients who received peg-interferon alfa-2b and ribavirin. There was no intervention. Adherence was self-reported over the past 4 wk (peg-interferon) or 7 d (ribavirin). Adherence to bitherapy was defined as adherence to the two drugs for ≥ 20 wk. SVR was defined as undetectable RNA ≥ 12wk after the end of treatment.
RESULTS: 370/674 patients received education during the first 3 mo of treatment. After 6 mo, adherence to bitherapy was higher in educated patients (61% vs 47%, P = 0.01). Adherence to peg-interferon was 78% vs 69% (P = 0.06). Adherence to ribavirin was 70% vs 56% (P = 0.006). The SVR (77% vs 70%, P = 0.05) and relapse (10% vs 16%, P = 0.09) rates tended to be improved. After adjustment for baseline differences, education improved adherence [Odds ratio (OR) 1.58, P = 0.04] but not the SVR (OR 1.54, P = 0.06).
CONCLUSION: In genotype 2/3 patients, therapeutic education helped maintain real-life adherence to bitherapy.
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