51
|
Marino C, Bonanno E, Cavalli N, Borzì G, Brogna A, Costa R, D’Antoni V, Fazio I, Iacoviello G, Illari S, Mele S, Rabito A, Romeo N, Salamone V, Tonghi L. PO-1020 The Sicily Dosimetric Project: a multiinstitutional project on IMRT/VMAT lung treatment. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31440-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
52
|
Lees A, Ferreira J, Costa R, Santos A, Rocha J, Soares-Da-Silva P. 127EFFICACY AND SAFETY OF OPICAPONE IN PATIENTS OVER 70 YEARS WITH PARKINSON’S DISEASE AND MOTOR FLUCTUATIONS. Age Ageing 2019. [DOI: 10.1093/ageing/afy205.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
53
|
Fargeot G, Viala K, Theaudin M, Labeyrie MA, Costa R, Léger JM, Adams D, Vandendries C, Labeyrie C. Diagnostic usefulness of plexus magnetic resonance imaging in chronic inflammatory demyelinating polyradiculopathy without electrodiagnostic criteria of demyelination. Eur J Neurol 2018; 26:631-638. [PMID: 30431216 DOI: 10.1111/ene.13868] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/05/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE The usefulness of plexus magnetic resonance imaging (MRI) in the diagnosis of chronic inflammatory demyelinating polyradiculopathy (CIDP) without definite European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) electrodiagnostic criteria is currently unclear. METHODS Data from consecutive patients with clinical manifestations suggesting CIDP, with or without (CIDP-D and CIDP-ND, respectively) definite EFNS/PNS electrodiagnostic criteria, and referred for plexus MRI in our imaging centre were retrospectively analysed. An expert committee of neurologists compared the level of suspicion of CIDP in CIDP-ND patients to the blinded/unblinded MRI findings. Plexus MRI was reviewed by a neuroradiologist blinded to the final diagnosis. RESULTS In all, 38 patients were assessed with suspected CIDP-ND [7/38 (18%) probable; 13/38 (34%) possible; 18/38 (47%), no EFNS/PNS electrodiagnostic criteria], plus 10 with CIDP-D. Thirty-six of the 38 (95%) fulfilled clinical criteria of CIDP variants, including pure sensory neuropathy in 22/36 (61%). Plexus MRI showed abnormalities in 22/38 (58%) patients including increased nerve signal intensity on T2-weighted images in 22/22 (100%), nerve enlargement in 20/22 (91%) and contrast enhancement in 8/22 (36%). Plexus MRI enabled the expert committee's final diagnosis to be adjusted in 7/38 (18%) patients, and in conjunction with nerve conduction studies was a supportive criterion to classify 7/24 (29%) patients as definite CIDP. MRI abnormalities were more asymmetrical (P = 0.03) and less diffuse (P = 0.1) in CIDP-ND than in CIDP-D. CONCLUSIONS Our observations suggest that plexus MRI makes a valuable contribution to the diagnosis of CIDP-ND patients. Further studies are needed to investigate inter-rater reliability of clinical and imaging criteria of CIDP in these patients, and the impact on outcomes.
Collapse
|
54
|
Pereira S, Costa R, Castro Filho E, Almeida M, Rodrigues J, Bertoco J, Feliciano A, Barducci R, van Cleef E, Ezequiel J. PSXV-39 Soybean molasses improves texture of meat from feedlot lambs. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.1042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
55
|
Pereira S, Castro Filho E, Costa R, Feliciano A, Rodrigues J, Bertoco J, Barducci R, van Cleef E, Ezequiel J. PSXIII-39 Feed intake and in vitro digestibility of sheep fed high concentrations of soybean molasses. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
56
|
McCubbin A, Cox G, Costa R. Beliefs, information sources and intended practices regarding sodium intake in endurance athletes. J Sci Med Sport 2018. [DOI: 10.1016/j.jsams.2018.09.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
57
|
De Santis M, Ota C, Costa R, Doryab A, Alsafadi H, Bolukbas D, Konigshoff M, Wagner D. Development of a hybrid alginate-ECM hydrogel as a potential bioink for 3D bioprinting. Transplantation 2018. [DOI: 10.1183/13993003.congress-2018.lsc-1090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
58
|
Ferreira C, Oliveira-Santos M, Costa R, Milner J, Baptista R, Dias P, Moura J, Pego M. P5385Apoliprotein E genotypes and very long-term outcomes: an unexpected finding regarding diabetes incidence. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5385] [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: 11/14/2022] Open
|
59
|
Fontes Oliveira M, Baggen Santos R, Trepa M, Costa R, Barreira A, Fernandes P, Magalhaes S, Cabral S, Torres S. P1478Cardiac rehabilitation program for all: even after 80s? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1478] [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: 11/14/2022] Open
|
60
|
Blanco A, Resino E, Costa R. Clinical experience with PCSK-9 inhibitors in outpatients clinic for dyslipidemia in a tertiary hospital. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.741] [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: 12/01/2022]
|
61
|
Villa G, Agnese G, Bianchi P, Buffoni F, Costa R, Carli F, Peressini A, Solari N, Cafiero F, Mariani G. Mapping the Sentinel Lymph Node in Malignant Melanoma by Blue Dye, Lymphoscintigraphy and Intraoperative Gamma Probe. TUMORI JOURNAL 2018; 86:343-5. [PMID: 11016724 DOI: 10.1177/030089160008600425] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Eighty-eight consecutive patients (48 men and 40 women; mean age, 58.9 years; range, 16–84 years) with clinically localized cutaneous melanoma involving the trunk, extremities or head and neck underwent lymphatic mapping at our institution. The primary melanoma had a mean thickness of 2.74 mm (range, 0.95 to 9 mm). Patients were divided into two groups: group A (39 patients) underwent only vital blue dye (VBD) mapping, while group B (49 patients) underwent lymphatic mapping with VBD and radio-guided surgery (RGS) combined. In all patients 1-1.5 mL of VBD was injected subdermally around the biopsy scar 10–20 min before surgery. In group B 37 MBq in 150 μL of 99mTc-HSA nanocolloid was additionally injected intradermally 18 h before surgery (3–6 aliquots injected perilesionally). In all lymphatic basins where drainage was noted the sentinel lymph nodes (SNs) were identified and marked with a cutaneous marker. Final identification of the SN was then performed externally by a hand-held gamma probe. After the induction of anesthesia 0.5–1-0 mL of patent blue V dye was injected intradermally with a 25-gauge needle around the site of the primary melanoma. SNs were examined by routine hematoxylin and eosin (H&E) staining and immunohistochemistry. Patients with histologically positive SN(s) underwent standard lymph node dissection (SLND) in the involved lymph node basin. The SN was identified in 37/39 patients (94.9%) of group A and in 48/49 patients (98.0%) of group B. Blue dye mapping failed to identify the SN in 5 of the 88 patients (5.8%), while the radioisotope method failed in only 1 of 49 patients (2.0%). Similar results were obtained with the combined use of the two probes. The average number of SNs harvested was 1.9 per basin sampled, which does not differ significantly from the numbers reported by other authors114. The SN was histologically positive in 18 patients (20.5%). None of the 12 patients with a Breslow thickness less than 1.5 mm had positive SNs, whereas 18 of the 77 patients (23.4%) with a Breslow index exceeding 1.5 mm showed metastatic SNs with H&E or immunohistochemistry. The latter all underwent SLND of the affected basin. In 10 patients (55.6%) the SN was the only site of tumor invasion; eight patients (44.4%) with positive SNs had one or more metastatic lymph nodes in the draining basin.
Collapse
|
62
|
Facchinello N, Skobo T, Meneghetti G, Colletti E, Dinarello A, Tiso N, Costa R, Gioacchini G, Carnevali O, Argenton F, Colombo L, Valle LD. Author Correction: nr3c1 null mutant zebrafish are viable and reveal DNA-binding-independent activities of the glucocorticoid receptor. Sci Rep 2018. [PMID: 29520028 PMCID: PMC5843580 DOI: 10.1038/s41598-018-21745-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
63
|
Padrão E, Araújo D, Todo Bom A, Robalo Cordeiro C, Correia de Sousa J, Cardoso J, Morais-Almeida M, Costa R, Pavão F, Leite RB, Marques A. Asthma-COPD overlap: A Portuguese survey. Pulmonology 2018; 24:S2173-5115(17)30181-1. [PMID: 29338973 DOI: 10.1016/j.rppnen.2017.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/19/2017] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The overlap between asthma and chronic obstructive pulmonary disease (COPD) (ACO) has been discussed for many years but clinical recommendations for this entity have been diverse. This study is intended to reach a consensus on diagnosis, treatment and patient orientation for ACO, within the Portuguese medical community. METHODS This study was conducted by a multidisciplinary panel of experts from three distinct medical specialties (Pulmonology, Family Medicine and Immunoallergology). This panel selected a total of 190 clinicians, based on their expertise in obstructive airway diseases, to participate in a Delphi structured survey with three rounds of questionnaires. These results were ultimately discussed, in a meeting with the panel of experts and some of the study participants, and consensus was reached in terms of classification criteria, treatment and orientation of ACO patients. RESULTS The majority of clinicians (87.2%) considered relevant the definition of an overlap entity between asthma and COPD. A consensus was achieved on the diagnosis of ACO - presence of simultaneous clinical characteristics of asthma and COPD together with a fixed airflow obstruction (FEV1/FVC<0.7) associated with 2 major criteria (previous history of asthma; presence of a previous history of smoking exposure and/or exposure to biomass combustion; positive bronchodilation test (increase in FEV1 of at least 200mL and 12%) on more than 1 occasion) plus 1 minor criteria (history of atopy; age ≥40 years; peripheral eosinophilia (>300eosinophils/μL or >5% of leukocytes); elevation of specific IgEs or positive skin tests for common allergens). A combination of inhaled corticosteroid (ICS) with long-acting beta2-agonist (LABA) or long-acting muscarinic antagonist (LAMA) was considered as first line pharmacological treatment. Triple therapy with ICS plus LABA and LAMA should be used in more severe or symptomatic cases. Non-pharmacological treatment, similar to what is recommended for asthma and COPD, was also considered highly important. A hospital referral of ACO patients should be made in symptomatic or severe cases or when there is a lack of diagnostic resources. CONCLUSIONS This study highlights the relevance of defining ACO, within the Portuguese medical community, and establishes diagnostic criteria that are important for future interventional studies. Recommendations on treatment and patient's orientation were also achieved.
Collapse
|
64
|
Chambers H, Costa R, Konyer N, Nykamp S, Dobson H, Milgram N, Poma R. MRI measurement of the canine auditory pathways and relationship with brainstem auditory evoked responses. Vet Comp Orthop Traumatol 2018. [DOI: 10.1055/s-0037-1617367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryThe objective of this study was to determine direct measurements of auditory pathways by magnetic resonance imaging (MRI) during the growth period of healthy Beagles, and to discover how canine brainstem auditory evoked response (BAER) latencies vary in relation to these MRI measurements. Eighty healthy Beagles were tested at eight, 16 and 52 weeks of age (stages 1, 2, 3, respectively) with BAER and brain MRI. The BAER interpeak latency (IPL) II-V and brain MRI neural generators of BAER waves II and V were identified. A linear distance was calculated in millimeters in order to determine the approximate length of auditory pathways. Sensory nerve conduction velocity (SNCV) of the auditory pathway between peak II and peak V was calculated for each group. A significant difference was observed between brain MRI distances among the three stages. Mean BAER IPL II-V were not significantly different between the three stages. The progressive growth of the skull and brain witnessed by the progressive increased distance of the MRI auditory pathways between peak II and peak V was not associated with a progressive maturation of the BAER IPL II-V. The SNCV of the auditory pathway between peak II and peak V was 6.14 m/sec for group 1; 6.76 m/sec for group 2; and 7.32 m/sec for group 3.
Collapse
|
65
|
Costa R, Sousa C, Llorente M. Assessment of environmental enrichment for different primate species under low budget: A case study. J APPL ANIM WELF SCI 2018; 21:185-199. [DOI: 10.1080/10888705.2017.1414606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
66
|
Cellante L, Costa R, Monaco I, Cenacchi G, Locatelli E. One-step esterification of nanocellulose in a Brønsted acid ionic liquid for delivery to glioblastoma cancer cells. NEW J CHEM 2018. [DOI: 10.1039/c7nj04633b] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A Brønsted acid ionic liquid used as a solvent and a catalyst allows easy and mild esterification of nanocellulose with a chlorotoxin peptide.
Collapse
|
67
|
Chae Y, Iams W, Pai S, Costa R, Taxter T, Mohindra N, Villaflor V, Pro B, Giles F. P1.04-004 Phase I/Ib Study of Nivolumab and Veliparib in Advanced Solid Tumors and Lymphoma with and without Alterations in Selected DNA Repair Genes. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
68
|
Gomes J, Lopes A, Bednarczyk K, Gmurek M, Stelmachowski M, Zaleska-Medynska A, Quinta-Ferreira M, Costa R, Quinta-Ferreira R, Martins R. Environmental preservation of emerging parabens contamination: effect of Ag and Pt loading over the catalytic efficiency of TiO 2 during photocatalytic ozonation. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.egypro.2017.10.282] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
69
|
Costa R, Magalhães L, Gama H, Oliveira I, Moreira J, Rocha F, Ikedo F, Soares-da-Silva P. A pooled post-hoc analysis of change in depressive symptoms in patients with refractory partial-onset seizures treated with eslicarbazepine acetate as adjuntive therapy. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
70
|
Rodrigues M, Costa R, Brito S, Pissarra A, Lourenço A, Grenho F, Campos L. Ischemic stroke and cancer correlation: A stroke unit experience. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx363.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
71
|
Machado I, Silva K, Bassolli L, Martinelli Filho M, Costa R, Costa F. P5489Clinical effectiveness of cardiac ressincronization therapy in a cohort of patients with heart failure and chagas' disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5489] [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: 11/14/2022] Open
|
72
|
Castanho S, Califano G, Soares F, Costa R, Mata L, Pousão-Ferreira P, Ribeiro L. The effect of live feeds bathed with the red seaweed Asparagopsis armata on the survival, growth and physiology status of Sparus aurata larvae. FISH PHYSIOLOGY AND BIOCHEMISTRY 2017; 43:1043-1054. [PMID: 28315161 DOI: 10.1007/s10695-017-0351-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 02/05/2017] [Indexed: 06/06/2023]
Abstract
Larval rearing is affected by a wide range of microorganisms that thrive in larviculture systems. Some seaweed species have metabolites capable of reducing the bacterial load. However, no studies have yet tested whether including seaweed metabolites on larval rearing systems has any effects on the larvae development. This work assessed the development of Sparus aurata larvae fed preys treated with an Asparagopsis armata product. Live prey, Brachionus spp. and Artemia sp., were immersed in a solution containing 0.5% of a commercial extract of A. armata (Ysaline 100, YSA) for 30 min, before being fed to seabream larvae (n = 4 each). In the control, the live feed was immersed in clear water. Larval parameters such as growth, survival, digestive capacity (structural-histology and functional-enzymatic activity), stress level (cortisol content), non-specific immune response (lysozyme activity), anti-bacterial activity (disc-diffusion assay) and microbiota quantification (fish larvae gut and rearing water) were monitored. Fish larvae digestive capacity, stress level and non-specific immune response were not affected by the use of YSA. The number of Vibrionaceae was significantly reduced both in water and larval gut when using YSA. Growth was enhanced for YSA treatment, but higher mortality was also observed, especially until 10 days after hatching (DAH). The mortality peak observed at 8 DAH for both treatments, but higher for YSA, indicates larval higher susceptibility at this development stage, suggesting that lower concentrations of YSA should be used until 10 DAH. The application of YSA after 10 DAH onwards promotes a safer rearing environment.
Collapse
|
73
|
Costa R, Seth A, Chandra P, Bhal V, Nanjappa M, Rath P, Kalaricka M, Wander G, Mahajan A, Kumaran A, Koshy A, Goel P, Kumar V, Kaul U, Trehan V. 1968Quantitative angiographic analysis in patients with de novo native coronary artery lesions treated with novel poly-l-lactide based sirolimus-eluting bioresorbable vascular scaffold: MeRes-1 Trial. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.1968] [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: 11/13/2022] Open
|
74
|
Turco M, Biscontin A, Corrias M, Caccin L, Bano M, Chiaromanni F, Salamanca M, Mattei D, Salvoro C, Mazzotta G, De Pittà C, Middleton B, Skene DJ, Montagnese S, Costa R. Diurnal preference, mood and the response to morning light in relation to polymorphisms in the human clock gene PER3. Sci Rep 2017; 7:6967. [PMID: 28761043 PMCID: PMC5537342 DOI: 10.1038/s41598-017-06769-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/16/2017] [Indexed: 12/23/2022] Open
Abstract
PER3 gene polymorphisms have been associated with differences in human sleep-wake phenotypes, and sensitivity to light. The aims of this study were to assess: i) the frequency of allelic variants at two PER3 polymorphic sites (rs57875989 length polymorphism: PER3 4, PER3 5; rs228697 SNP: PER3 C, PER3 G) in relation to sleep-wake timing; ii) the effect of morning light on behavioural/circadian variables in PER3 4 /PER3 4 and PER3 5 /PER3 5 homozygotes. 786 Caucasian subjects living in Northern Italy donated buccal DNA and completed diurnal preference, sleep quality/timing and sleepiness/mood questionnaires. 19 PER3 4 /PER3 4 and 11 PER3 5 /PER3 5 homozygotes underwent morning light administration, whilst monitoring sleep-wake patterns and the urinary 6-sulphatoxymelatonin (aMT6s) rhythm. No significant relationship was observed between the length polymorphism and diurnal preference. By contrast, a significant association was observed between the PER3 G variant and morningness (OR = 2.10), and between the PER3 G-PER3 4 haplotype and morningness (OR = 2.19), for which a mechanistic hypothesis is suggested. No significant differences were observed in sleep timing/aMT6s rhythms between PER3 5 /PER3 5 and PER3 4 /PER3 4 subjects at baseline. After light administration, PER3 4 /PER3 4 subjects advanced their aMT6s acrophase (p < 0.05), and showed a trend of advanced sleep-wake timing. In conclusion, significant associations were observed between PER3 polymorphic variants/their combinations and both diurnal preference and the response to light.
Collapse
|
75
|
Costa R, Costa RB, Talamantes SM, Helenowski I, Peterson J, Kaplan J, Carneiro BA, Giles FJ, Gradishar WJ. Meta-analysis of selected toxicity endpoints of CDK4/6 inhibitors: Palbociclib and ribociclib. Breast 2017; 35:1-7. [PMID: 28618307 DOI: 10.1016/j.breast.2017.05.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors such as palbociclib and ribociclib are associated with distinct adverse effects (AEs) compared to other targeted therapies. This meta-analysis of clinical trials summarizes these agents' toxicity profile. METHODS A librarian-guided literature search was conducted in March of 2017. The trials needed to have at least one of the study arms consisting of palbociclib or ribociclib monotherapy at currently FDA approved dose regimens. Heterogeneity across studies was analyzed using I2 statistics. Data were analyzed using random effects meta-analysis for absolute risks. RESULTS Seven randomized trials and 1,332 patients were included in our meta-analysis. There was evidence of significant heterogeneity between studies for serious AEs but not for death. The pooled absolute risk (AR) for all-causality serious AEs and treatment-related death were 16% and 0%, respectively. Patients treated with CDK 4/6 inhibitors had an AR of grade 3/4 neutropenia of 61%; neutropenic fever and infections were rare (1% and 3%, respectively). Grade 3/4 nausea, vomiting, and rash were rare. There was no significant correlation between age of patients at study entry and the risk of grade 3/4 neutropenia. CONCLUSION Treatment with CDK 4/6 inhibitors is well tolerated and associated with a low risk of treatment-related deaths. There is an increased AR of grade 3/4 neutropenia but a low AR of associated infections.
Collapse
|