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Uçkay I, Wirth S, Zörner B, Fucentese S, Wieser K, Schweizer A, Müller D, Zingg P, Farshad M. Study protocol: short against long antibiotic therapy for infected orthopedic sites - the randomized-controlled SALATIO trials. Trials 2023; 24:117. [PMID: 36803837 PMCID: PMC9938993 DOI: 10.1186/s13063-023-07141-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 02/07/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Few studies address the appropriate duration of post-surgical antibiotic therapy for orthopedic infections; with or without infected residual implants. We perform two similar randomized-clinical trials (RCT) to reduce the antibiotic use and associated adverse events. METHODS Two unblinded RCTs in adult patients (non-inferiority with a margin of 10%, a power of 80%) with the primary outcomes "remission" and "microbiologically-identical recurrences" after a combined surgical and antibiotic therapy. The main secondary outcome is antibiotic-related adverse events. The RCTs allocate the participants between 3 vs. 6 weeks of post-surgical systemic antibiotic therapy for implant-free infections and between 6 vs. 12 weeks for residual implant-related infections. We need a total of 280 episodes (randomization schemes 1:1) with a minimal follow-up of 12 months. We perform two interim analyses starting approximately after 1 and 2 years. The study approximatively lasts 3 years. DISCUSSION Both parallel RCTs will enable to prescribe less antibiotics for future orthopedic infections in adult patients. TRIAL REGISTRATION ClinicalTrial.gov NCT05499481. Registered on 12 August 2022. PROTOCOL VERSION 2 (19 May 2022).
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Affiliation(s)
- Ilker Uçkay
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland. .,Unit for Clinical and Applied Research, Balgrist University Hospital, University of Zurich, Zurich, Switzerland. .,Infectiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Stephan Wirth
- grid.7400.30000 0004 1937 0650Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Björn Zörner
- grid.7400.30000 0004 1937 0650Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Sandro Fucentese
- grid.7400.30000 0004 1937 0650Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- grid.7400.30000 0004 1937 0650Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Andreas Schweizer
- grid.7400.30000 0004 1937 0650Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Hand Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Daniel Müller
- grid.7400.30000 0004 1937 0650Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick Zingg
- grid.7400.30000 0004 1937 0650Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- grid.7400.30000 0004 1937 0650Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Medical Direction, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Khabbazi A, Gadakchi L, Moslemi M, Khalaji A, Esalatmanesh K, Ziarati Yazdeli A, Hajialilo M, Malek Mahdavi A. Prevalence and predictors of long-term remission in rheumatoid arthritis in real-world practice: a longitudinal study. Clin Rheumatol 2023; 42:1537-1544. [PMID: 36800137 DOI: 10.1007/s10067-023-06548-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/14/2022] [Revised: 01/14/2023] [Accepted: 02/09/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVES The aim of the present study was to provide real-world evidence for factors predicting long-term remission in a longitudinal study of rheumatoid arthritis (RA) patients. METHODS Long-term remission was defined by meeting American Rheumatism Association (ARA) criteria for remission and prednisolone dose ≤ 5 mg/d for at least 5 years. Patients in this cohort were treated by tight control strategy using step-up combination therapy with conventional synthetic DMARDs (csDMARDs), biologic DMARDs. The parameters associated with long-term remission were subjected to univariate analysis, and parameters with P-values of < 0.1 in univariate analysis were included in a multivariate regression analysis. RESULTS One thousand two hundred and eighty-six RA subjects were considered for eligibility, and finally, 499 patients were included in the study. Median duration of follow-up was 108 months. Long-term remission occurred in 157 (31.5%) patients. Median time to long-term remission was 8 (5, 41) months. Predictors of long-term remission were absence of flare during the course of disease, occurrence of sustained remission during 6 months after starting therapy, age at the disease onset > 60, being anti-citrullinated protein antibodies (ACPA) negative, and Disease Activity Score-28 (DAS28) at cohort entry ≤ 5.1. CONCLUSION In real-world practice, long-term remission occurs in 31.5% of patients treated with a tight control strategy. Absence of flare during the course of disease, occurrence of sustained remission during 6 months after starting therapy, age at the disease onset > 60, being ACPA negative, and DAS28 at baseline ≤ 5.1 are independent predictors of long-term remission. Key Points • In real-world practice, long-term remission occurs in 31.5% of patients treated with a tight control strategy. • Median time to long-term remission was 8 months. • Absence of flare during the course of disease, occurrence of sustained remission during 6 months after starting therapy, age at the disease onset >60, being ACPA negative, and DAS28 at baseline ≤ 5.1 are independent predictors of long-term remission.
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Affiliation(s)
- Alireza Khabbazi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Golgasht St., P.O Box 5166614756, Tabriz, Iran
| | - Leyla Gadakchi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Golgasht St., P.O Box 5166614756, Tabriz, Iran
| | - Mohammadreza Moslemi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Golgasht St., P.O Box 5166614756, Tabriz, Iran
| | - Amirreza Khalaji
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Golgasht St., P.O Box 5166614756, Tabriz, Iran
| | - Kamal Esalatmanesh
- Internal Medicine Department, Kashan University of Medical Sciences, Kashan, Iran
| | - Asma Ziarati Yazdeli
- Internal Medicine Department, Kashan University of Medical Sciences, Kashan, Iran
| | - Mehrzad Hajialilo
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Golgasht St., P.O Box 5166614756, Tabriz, Iran
| | - Aida Malek Mahdavi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Golgasht St., P.O Box 5166614756, Tabriz, Iran. .,Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. .,Rahat Breathe and Sleep Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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153
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Lapidos A, Lopez-Vives D, Sera CE, Ahearn E, Vest E, Senic I, Vande Voort JL, Frye M, Goes FS, Achtyes E, Greden J, Parikh SV. Patients' recovery and non-recovery narratives after intravenous ketamine for treatment-resistant depression. J Affect Disord 2023; 323:534-539. [PMID: 36481228 DOI: 10.1016/j.jad.2022.11.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/31/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intravenous (IV) ketamine is an effective therapy for treatment-resistant depression. A large data base is confirmatory and steadily expanding. Qualitative studies can inform best practices and suggest new research directions. As part of a clinical trial designed to identify biomarkers of ketamine response, a qualitative study was conducted to characterize experiences with: receiving infusions; recovering or not recovering from depression; and beliefs about why ketamine worked or did not work. METHODS Adults with treatment-resistant depression received three IV ketamine infusions in a two-week period and were characterized as remitters or non-remitters via symptom reduction 24 h after the third infusion. Qualitative interviews of a subset of participants were audio recorded, transcribed verbatim, and coded using deductive and inductive methods. Themes were derived and compared across a broader construct of recovery status. RESULTS Of the 21 participants, nine (43 %) were characterized as having experienced remission and 12 (57 %) non-remission. Of the 12 non-remitters, five were characterized as having experienced partial recovery based on their subjective experiences, reporting substantial benefit from ketamine infusions despite non-remission status based on scale measurements. Attributions for ketamine's effects included biological and experiential mechanisms. Among non-remitters there was risk of disappointment when adding another failed treatment. LIMITATIONS A more diverse sample may have yielded different themes. Different patients had different amounts of time elapsed between ketamine infusions and qualitative interview. CONCLUSIONS Qualitative methods may enhance researchers' characterization of IV ketamine's impact on treatment-resistant depression. While requiring confirmation, patients may benefit from a preparatory milieu that prepares them for multiple recovery pathways; decouples the psychedelic experience from clinical outcomes; and addresses potential risks of another failed treatment.
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Affiliation(s)
- Adrienne Lapidos
- Department of Psychiatry, University of Michigan Medical School, USA.
| | | | - Cortney E Sera
- Department of Psychiatry, University of Michigan Medical School, USA
| | - Elizabeth Ahearn
- Department of Psychiatry, University of Michigan Medical School, USA
| | - Erica Vest
- Department of Psychiatry, University of Michigan Medical School, USA
| | - Ivana Senic
- Department of Psychiatry, University of Michigan Medical School, USA
| | | | - Mark Frye
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, USA
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Eric Achtyes
- Pine Rest Christian Mental Health Services, USA; Division of Psychiatry & Behavioral Medicine, Michigan State University College of Human Medicine, USA
| | - John Greden
- Department of Psychiatry, University of Michigan Medical School, USA; Eisenberg Family Depression Center
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan Medical School, USA; Eisenberg Family Depression Center
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154
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Cooper SM, Fusar-Poli P, Uhlhaas PJ. Characteristics and clinical correlates of risk symptoms in individuals at clinical high-risk for psychosis: A systematic review and meta-analysis. Schizophr Res 2023; 254:54-61. [PMID: 36801514 DOI: 10.1016/j.schres.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 01/19/2023] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Abstract
Emerging evidence suggests that the duration of risk symptoms (DUR) may have an impact on clinical outcomes in clinical high-risk for psychosis (CHRP) participants. To explore this hypothesis, we performed a meta-analysis on studies that examined DUR in CHR-P individuals in relation to their clinical outcomes. This review was conducted in accordance with the PRISMA guidelines and the protocol was registered with PROSPERO on 16th April 2021 (ID no. CRD42021249443). Literature searches were conducted using PsycINFO and Web of Science in March and November 2021, for studies reporting on DUR in CHR-P populations, in relation to transition to psychosis or symptomatic, functional, or cognitive outcomes. The primary outcome was transition to psychosis, while the secondary outcomes were remission from CHR-P status and functioning at baseline. Thirteen independent studies relating to 2506 CHR-P individuals were included in the meta-analysis. The mean age was 19.88 years (SD = 1.61) and 1194 individuals (47.65 %) were females. The mean length of DUR was 23.61 months (SD = 13.18). There was no meta-analytic effect of DUR on transition to psychosis at 12-month follow-up (OR = 1.000, 95%CI = 0.999-1.000, k = 8, p = .98), while DUR was related to remission (Hedge's g = 0.236, 95%CI = 0.014-0.458, k = 4, p = .037). DUR was not related to baseline GAF scores (beta = -0.004, 95%CI = -0.025-0.017, k = 3, p = .71). The current findings suggest that DUR is not associated with transition to psychosis at 12 months, but may impact remission. However, the database was small and further research in this area is required.
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Affiliation(s)
- Saskia M Cooper
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; OASIS service, South London and Maudsley NHS Foundation Trust, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; National Institute for Health Research Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
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155
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Chin Fatt CR, Minhajuddin A, Jha MK, Mayes T, Rush AJ, Trivedi MH. Data driven clusters derived from resting state functional connectivity: Findings from the EMBARC study. J Psychiatr Res 2023; 158:150-156. [PMID: 36586213 PMCID: PMC10177663 DOI: 10.1016/j.jpsychires.2022.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/14/2022] [Accepted: 12/10/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND To address the clinical heterogeneity of Major Depressive Disorder (MDD), this investigation determined whether resting state functional magnetic resonance imaging (fMRI) could be deployed to identify circuit based homogeneous subgroups, and whether subgroups identified show differential treatment outcomes. METHODS Pretreatment resting state fMRIs obtained from 278 outpatients with nonpsychotic MDD from Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care for Depression Study were used to create data-driven subgroups using CLICK clustering. These subgroups were then compared using baseline clinical data, as well as baseline-to-week 8 changes in depression severity measured using the 17-item Hamilton Rating Scale for Depression (HAMD17) and response/remission rates by treatment group. RESULTS Three subgroups were identified. Cluster-1 was characterized by overallhyperconnectivity coupled with profound hypoconnectivity between the supramarginal gyrus (executive control network; ECN) and the superior frontal cortex (dorsal attention network; DAN). Cluster-2 was characterized by overall hypoconnectivity coupled with hyperconnectivity between supramarginal gyrus (ECN) and superior frontal cortex (DAN). Cluster-3 showed hypoconnectivity, especially profound between the angular cortex (default mode network; DMN) and middle frontal cortex (ECN). While baseline clinical measures did not differentiate the three clusters, Cluster-3 had the remission rate (51.6%) compared to Cluster-1 and Cluster-2 (32.7% and 31.9%) when treated with sertraline. LIMITATIONS Due to the exploratory nature of these analyses, there were no adjustments for multiple comparisons. CONCLUSIONS Baseline functional connectivity can be used to subgroup patients with MDD that differ in acute phase treatment outcomes. Measures of connectivity may address the heterogeneity of MDD.
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Affiliation(s)
- Cherise R Chin Fatt
- Center for Depression Research and Clinical Care, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Abu Minhajuddin
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Manish K Jha
- Center for Depression Research and Clinical Care, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Taryn Mayes
- Center for Depression Research and Clinical Care, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - A John Rush
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Duke-National University of Singapore, Singapore
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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156
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Li B, Li G, Song Z, Zhang Z. Serum Calprotectin as a Promising Inflammatory Biomarker in Psoriatic Arthritis: a 1-Year Longitudinal Study. Rheumatol Ther 2023; 10:149-160. [PMID: 36271188 PMCID: PMC9931953 DOI: 10.1007/s40744-022-00501-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/29/2022] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION There are few biomarkers correlated with psoriatic arthritis (PsA). We aimed to explore the clinical value of calprotectin (CLP) in PsA in disease activity and treatment targets. METHODS Serum CLP was detected by enzyme-linked immunosorbent assay (ELISA) in 71 patients with PsA, 55 patients with psoriasis (PsO), and 10 healthy controls. The association of serum CLP with disease activity index at baseline and follow-up was analyzed. Cox regression and receiver operating characteristic (ROC) analysis were used to evaluate the potential of CLP for predicting the achievement of treatment targets, including low disease activity (LDA), remission, and minimal disease activity (MDA). RESULTS Serum CLP levels (μg/ml) were significantly increased in patients with PsA/PsO compared with healthy controls (p < 0.001). Serum CLP levels were positively associated with psoriasis area and severity index (PASI), disease activity in psoriatic arthritis (DAPSA), and its components [including tender joint count (TJC), swollen joint count (SJC), patient's global assessment (PGA), and visual analog scale (VAS)-pain, r 0.290-0.601, all p value < 0.05]. After 1-year follow-up, the number of patients with PsA in remission and MDA increased [17 (23.9%) versus 47 (66.1%) and 21 (29.5%) versus 52 (73.2%) respectively, all p value < 0.001]. Cox regression and Kaplan-Meier survival analysis indicated that patients with lower CLP obtain LDA, MDA, and remission earlier, including remission and MDA within a year (all p-value < 0.05). ROC analysis showed the ability of serum at baseline to predict the achievement of the treatment target in 3 months [area under the curve (AUC) 0.663-0.691, all p-values < 0.05]. CONCLUSIONS Serum CLP level was correlated with disease activity in PsA. It also possessed the ability to predict the achievement of the therapeutic target. These features of CLP would make it a useful tool in clinical work.
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Affiliation(s)
- Borui Li
- Rheumatology and Clinical Immunology Department, Peking University First Hospital, Beijing, 100034, China
| | - Guangtao Li
- Rheumatology and Clinical Immunology Department, Peking University First Hospital, Beijing, 100034, China
| | - Zhibo Song
- Rheumatology and Clinical Immunology Department, Peking University First Hospital, Beijing, 100034, China
| | - Zhuoli Zhang
- Rheumatology and Clinical Immunology Department, Peking University First Hospital, Beijing, 100034, China.
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Hasegawa K, Wei AH, Garcia-Manero G, Daver NG, Rajakumaraswamy N, Iqbal S, Chan RJ, Hu H, Tse P, Yan J, Zoratti MJ, Xie F, Sallman DA. Azacitidine Monotherapy in Patients With Treatment-Naïve Higher-risk Myelodysplastic Syndrome: A Systematic Literature Review and Meta-analysis. Clin Lymphoma Myeloma Leuk 2023; 23:127-137. [PMID: 36428152 DOI: 10.1016/j.clml.2022.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The global incidence of myelodysplastic syndromes (MDS) has been estimated as 0.06 to 0.26/100,000. Since their introduction, hypomethylating agents have played a central role in the treatment of MDS, with heterogeneous real-world outcomes. MATERIALS AND METHODS We assessed and synthesized clinical outcomes of azacitidine (AZA) monotherapy in treatment-naïve patients with higher-risk MDS. A systematic literature review was conducted by searching MEDLINE, Embase, and CENTRAL to identify randomized clinical trials (RCTs) and observational studies, both prospective and retrospective, reporting complete remission (CR), partial remission (PR), overall survival (OS), duration of response (DOR), time-to-response (TTR), and myelosuppressive adverse events (AEs) for patients treated with AZA monotherapy. Noncomparative meta-analyses were used to summarize effects. RESULTS The search identified 3250 abstracts, of which 34 publications describing 16 studies (5 RCTs, 3 prospective, and 8 retrospective observational) were included. Across all studies, pooled CR was 16%; PR was 6%; Median OS was 16.4 months; median DOR was 10.1 months; median TTR was 4.6 months. Proportions of grade 3/4 anemia and thrombocytopenia AEs were 10% and 30%. CONCLUSIONS The effectiveness and efficacy of AZA monotherapy-as measured by CR and median OS-was limited. These findings highlight a significant unmet medical need for effective treatments for patients with higher-risk MDS.
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Affiliation(s)
| | - Andrew H Wei
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC
| | | | - Naval G Daver
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Hao Hu
- Gilead Sciences, Inc., Foster City, CA
| | | | - Jiajun Yan
- McMaster University, Hamilton, ON, Canada
| | | | - Feng Xie
- McMaster University, Hamilton, ON, Canada
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Sattar N, Welsh P, Leslie WS, Thom G, McCombie L, Brosnahan N, Richardson J, Gill JM, Crawford L, Lean ME. Dietary weight-management for type 2 diabetes remissions in South Asians: the South Asian diabetes remission randomised trial for proof-of-concept and feasibility (STANDby). Lancet Reg Health Southeast Asia 2023; 9:100111. [PMID: 36777452 PMCID: PMC9904218 DOI: 10.1016/j.lansea.2022.100111] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022]
Abstract
Background We aimed to assess whether a structured weight management programme incorporating a total diet replacement (TDR) (3-5 months ∼850 kcal/day formula diet) weight loss phase is acceptable to people of South Asian ethnicity and can achieve type 2 diabetes (T2D) remissions similarly to other populations. Methods Adults of South Asian ethnicity, aged 18-65 years, with T2D for ≤4 years, and BMI 25-45 kg/m2 were recruited from primary care and social media, and randomised to commence TDR either immediately (iTDR), or delayed (dTDR) for 3-5 months as a usual care control arm during this period. Intervention effects were tested in randomised comparisons powered to detect significant weight loss, and in an expanded observational analysis to determine remission effect size, including both iTDR and dTDR groups. Acceptability in those recruited was explored by questionnaire and weight change. Trial registration Current Controlled Trials, ISRCTN10720065. Date of Registration 27/09/2017. Findings Twenty-five eligible individuals were recruited. Mean baseline (SD) age was 45.8 (11.1) years, weight 88.2 (13.7) kg, BMI 32.1 (3.8) kg/m2, HbA1c 60.4 (11.3) mmol/mol, liver fat by MRI 15.6 (9.4)%. In the RCT, mean(SD) weight change after TDR was -7.7 (7.2)% in the intervention group (n = 13), and -1.2 (1.4)% in the usual-care control group (n = 12) (p = 0.005), with T2D remission achieved by 5/13, compared to 0/12 respectively (p = 0.039). In the observational study, 23/25 started TDR and 19/23 participants completed the TDR phase. Median time spent in TDR was 105 days (IQR 77-134 days). T2D remission was achieved in 10/23 (43%), and weight changes were concordant with the RCT. Overall, 8/23 (35%) lost over 10% bodyweight. Absolute liver fat proportion near halved from 15.3% at the start of TDR to 8.6% (p < 0.001). Interpretation In UK-based South Asians, TDR-led weight loss and T2D remission rates are comparable to those observed in white cohorts, and the intervention was acceptable in most of those recruited. There is potential to further improve outcomes, but one-third lost >10% body weight, and the mechanism underpinning T2D remission appears similar, driven by weight change with loss of excess ectopic body-fat. Funding We gratefully acknowledge funding for the MRI scans from the, Miss MJM Smith Trust (registered charity: SC040586). No other external funds were provided for this trial. NS is supported by the British Heart Foundation Research Excellence Award (RE/18/6/34217).
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Affiliation(s)
- Naveed Sattar
- School of Cardiovascular and Metabolic Health, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
- Corresponding author.
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Wilma S. Leslie
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G31 2ER, UK
| | - George Thom
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G31 2ER, UK
| | - Louise McCombie
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G31 2ER, UK
| | - Naomi Brosnahan
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G31 2ER, UK
- Counterweight Ltd, London, UK
| | - Janice Richardson
- School of Cardiovascular and Metabolic Health, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Jason M.R. Gill
- School of Cardiovascular and Metabolic Health, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Luisa Crawford
- NHS Forth Valley, Stirling Community Hospital, Livilands Gate, Stirling, FK8 2AU, UK
| | - Michael E.J. Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G31 2ER, UK
- Corresponding author. Human Nutrition, School of Medicine, Dentistry and Nursing, R2.19, Level 2, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
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Portacci A, Dragonieri S, Carpagnano GE. Super-Responders to Biologic Treatment in Type 2-High Severe Asthma: Passing Fad or a Meaningful Phenotype? J Allergy Clin Immunol Pract 2023:S2213-2198(23)00091-0. [PMID: 36720387 DOI: 10.1016/j.jaip.2023.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 01/31/2023]
Abstract
Defining super-response to biologic treatment is a major concern in severe asthma. Although many definitions have been proposed, there is still a gap between the clinical perception of the super-response and a standardized classification. The current definition of super-response mainly relies on several clinical features, while many aspects of severe asthma inflammation and lung function are still poorly considered. Furthermore, many criteria of severe asthma super-response overlap with those of the clinical remission, leaving room for possible misclassifications. In this context, identifying the correct trajectory linking these 2 aspects of type 2-high severe asthma could help clinicians to understand which factors can predict a greater response to biologic therapies. In this paper, we review various aspects of super-response assessment, proposing some new criteria for its definition as well as new perspectives on its relationship with severe asthma clinical remission.
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Gooday C, Game F, Woodburn J, Poland F, Sims E, Dhatariya K, Shepstone L, Barton G, Hardeman W. A randomised feasibility study of serial magnetic resonance imaging to reduce treatment times in Charcot neuroarthropathy in people with diabetes (CADOM). J Foot Ankle Res 2023; 16:2. [PMID: 36703174 PMCID: PMC9878485 DOI: 10.1186/s13047-023-00601-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/04/2023] [Indexed: 01/27/2023] Open
Abstract
AIM This study aims to explore the feasibility of using serial MRI without contrast in the monitoring of Charcot neuroarthropathy to reduce duration of immobilisation of the foot, in order to decide whether a large-scale trial is warranted. METHODS A multicentre, randomised, prospective, two arm, open, feasibility study (CADOM) of people with diabetes with a suspected or confirmed diagnosis of Charcot neuroarthropathy. Participants were randomised (1:1) to 'standard care plus', including repeated foot temperature measurements and X-rays, or the intervention arm, with additional three-monthly MRI, until remission of Charcot neuroarthropathy or a maximum 12 months (active phase). Participants were then followed-up for a further 6 months, post remission to monitor for relapse of the Charcot neuroarthropathy (follow-up phase). Feasibility outcomes were recruitment, retention, data completeness, adherence to study procedures and safety of the intervention MRI. We also collected clinical efficacy outcomes, this included time in cast/off-loading device which will be the primary outcome of a future definitive trial. Finally, we collected patient reported outcomes, and data on health and social care usage. RESULTS One-hundred and five people were assessed for eligibility at five sites. 64/105 potential participants meet the eligibility criteria to participate in the study. Forty-three participants were randomised: 20 to standard care plus and 23 to MRI intervention. The main reason for ineligibility was a previous episode of Charcot neuroarthropathy. Thirteen participants were withdrawn post-randomisation due to an alternative diagnosis being made. Of the remaining 30 participants, 19 achieved remission, 6 had not gone into remission at the end of the 12 month active phase so exited the study. Five participants were lost to follow-up. Of the MRIs that were not disrupted by COVID-19 pandemic 26/31 (84%) were completed. For the visits that were conducted face-to-face, completion rates of patient-reported outcome measures were between 71 and 100%. There were no safety incidents associated with the intervention MRI. As this was a feasibility study it was not designed to test the effectiveness of serial MRI in diagnosing remission. The time in cast/off-loading device was 235 (±108.3) days for the standard care plus arm compared to 292 (±177.4) days for the intervention arm. There was no statistical difference in the time in cast/off-loading device between the two arms of the study: Hazard Ratio (HR) 0.405 (95% CI 0.140-1.172), p = 0.096. DISCUSSION The findings support a definitive randomised controlled trial to evaluate the effectiveness of MRI in diagnosing remission in Charcot neuroarthropathy. The rates of recruitment, retention, data, and MRI completeness show that a definitive study is feasible. STUDY REGISTRATION ISRCTN, 74101606 . Registered on 6 November 2017.
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Affiliation(s)
- Catherine Gooday
- grid.8273.e0000 0001 1092 7967School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ UK ,grid.240367.40000 0004 0445 7876Elsie Bertram Diabetes Centre, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, NR4 7UY UK
| | - Frances Game
- grid.508499.9Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, DE22 3NE UK
| | - Jim Woodburn
- grid.1022.10000 0004 0437 5432School of Health Sciences and Social Work, Griffith University, Southport, QLD 4222 Australia
| | - Fiona Poland
- grid.8273.e0000 0001 1092 7967Institute for Volunteering Research, Faculty of Medicine and Health Science, University of East Anglia, Norwich, NR4 7TJ UK
| | - Erika Sims
- grid.8273.e0000 0001 1092 7967Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK
| | - Ketan Dhatariya
- grid.240367.40000 0004 0445 7876Elsie Bertram Diabetes Centre, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, NR4 7UY UK ,grid.8273.e0000 0001 1092 7967Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK
| | - Lee Shepstone
- grid.8273.e0000 0001 1092 7967Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK
| | - Garry Barton
- grid.8273.e0000 0001 1092 7967Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK
| | - Wendy Hardeman
- grid.8273.e0000 0001 1092 7967School of Health Sciences - Behavioural and Implementation Science Group, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ UK
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Ebadinejad A, Shahshahani M, Hosseinpanah F, Ghazy F, Khalaj A, Mahdavi M, Valizadeh M, Barzin M. Comparison of hypertension remission and relapse after sleeve gastrectomy and one-anastomosis gastric bypass: a prospective cohort study. Hypertens Res 2023; 46:1287-1296. [PMID: 36670229 DOI: 10.1038/s41440-023-01180-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/11/2022] [Revised: 11/27/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023]
Abstract
This study aimed to assess the remission and relapse of hypertension (HTN) in hypertensive individuals who underwent sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB) and identify the predictors of HTN remission and relapse following bariatric surgery. A prospective cohort study with a follow-up of 3 years was conducted on severely obese patients between 2013 and 2018. Hypertension remission was defined as the normalization of blood pressure (BP) with the discontinuation of medical treatment, and HTN relapse was defined as the need for the onset of antihypertensive drugs or the occurrence of BP impairment. A total of 787 hypertensive patients were included in this study. The cumulative incidence of HTN remission and relapse were 83.9% (95% CI: 81.6-86.5) and 31.4% (95% CI: 25.6-38.2), respectively. Remission and relapse were not significantly different among the patients undergoing either surgery (SG or OAGB). A higher remission rate was linked to a younger age and the use of fewer antihypertensive medications pre-operation. However, failure to successfully lose weight during the first year postoperative and weight regain predicted a higher risk of HTN relapse after 3 years. Following bariatric surgery, BP drops initially but then gradually rises. These alterations are responsible for about 31% relapse after 3 years in those who initially achieve remission. Patients who are younger and use less antihypertensive medications before surgery may benefit the most from bariatric surgery in terms of HTN. First-year successful weight loss and control of weight regain may prevent HTN relapse in the following years.
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Affiliation(s)
- Amir Ebadinejad
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahbod Shahshahani
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faranak Ghazy
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Khalaj
- Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Maryam Mahdavi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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162
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Attri B, Goyal A, Kalaivani M, Kandasamy D, Gupta Y, Agarwal S, Shamim SA, Damle N, Dhingra A, Jyotsna VP, Suri A, Tandon N. Clinical profile and treatment outcomes of patients with ectopic ACTH syndrome compared to Cushing disease: a single-center experience. Endocrine 2023; 80:408-418. [PMID: 36609908 DOI: 10.1007/s12020-022-03298-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE We aimed to evaluate and compare the clinical, biochemical and radiological profile and outcomes of patients with ectopic ACTH syndrome (EAS) and Cushing disease (CD) treated over a period of 10 years (2013-2022). METHODS In this ambispective observational study, we collected data for 146 patients with ACTH-dependent CS (EAS, n = 23; CD, n = 94; occult ACTH source, n = 29). Relevant details were filled in a predesigned proforma and outcomes were ascertained at the most recent visit. RESULTS EAS was more common in males (65.2 vs. 27.6%, p < 0.001). Patients with EAS had a shorter duration of symptoms [12 (6-12) vs. 31.5 (15-48) months, p < 0.001] and were more likely to have hypokalemia (82.6 vs. 21.0%, p = 0.001), pedal edema (65.2 vs. 34.2%, p = 0.015), weight loss (34.8 vs. 4.0%, p < 0.001) and systemic infection (30.4 vs. 6.5%, p = 0.006). They also had significantly higher 8 a.m. serum cortisol, midnight serum and salivary cortisol and 8 a.m. plasma ACTH levels. Bronchial carcinoid (n = 10, 43.5%) was the most common etiology of EAS. Bilateral adrenalectomy was performed in 11 (47.8%) patients with EAS. Eight patients (34.8%) with EAS died at the last follow-up, of whom 7 (87.5%) had metastatic disease. In CD group, overall remission rate was 69.4% (56.1%, early and 13.3%, delayed) and 26.3% of patients with an initial remission had recurrence. CONCLUSIONS Bronchial carcinoid was the most common cause of EAS in our cohort. Bilateral adrenalectomy was performed in approximately every 1 in 2 patients with EAS and approximately every 1 in 3 patients expired till the last follow-up.
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Affiliation(s)
- Bhawna Attri
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Alpesh Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Yashdeep Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Shamim A Shamim
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nishikant Damle
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Dhingra
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Viveka P Jyotsna
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Boyle JG, Lean MEJ. Type 2 diabetes remission: achieving calorie restriction and weight loss by any which way? J Clin Endocrinol Metab 2023; 108:e352-e353. [PMID: 36611260 DOI: 10.1210/clinem/dgac755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023]
Affiliation(s)
- James G Boyle
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER, Scotland
| | - Michael E J Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER, Scotland
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Ratheesh A, Hett D, Ramain J, Wong E, Berk L, Conus P, Fristad MA, Goldstein T, Hillegers M, Jauhar S, Kessing LV, Miklowitz DJ, Murray G, Scott J, Tohen M, Yatham LN, Young AH, Berk M, Marwaha S. A systematic review of interventions in the early course of bipolar disorder I or II: a report of the International Society for Bipolar Disorders Taskforce on early intervention. Int J Bipolar Disord 2023; 11:1. [PMID: 36595095 PMCID: PMC9810772 DOI: 10.1186/s40345-022-00275-3] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/14/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Given the likelihood of progressive illness in bipolar disorder (BD), it is important to understand the benefits and risks of interventions administered early in illness course. We conducted a systematic review of the effectiveness of interventions in the early course of BD I or II. METHODS We completed a systematic search on MEDLINE, PsycINFO, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL and Google Scholar from 1/1/1979 till 14/9/2022. We included controlled trials examining intervention effects on symptomatic, course, functional and tolerability outcomes of patients in the 'early course' of BD I or II. We classified patients to be in early course if they (a) were seeking help for the first time for a manic episode, (b) had a lifetime history of up to 3 manic episodes, or (c) had up to 6 lifetime mood episodes. Evidence quality was assessed using the GRADE approach. RESULTS From 4135 unique publications we included 25 reports representing 2212 participants in 16 randomized studies, and 17,714 participants from nine non-randomized studies. Available evidence suggested that in early illness course, lithium use was associated with lower recurrence risk compared with other mood stabilizers. Mood stabilizers were also associated with better global functioning, compared with the use of antipsychotics in the medium term. While summative findings regarding psychological therapies were limited by heterogeneity, family-focused and cognitive-behavioral interventions were associated with reduced recurrence risk or improved symptomatic outcomes. There was some evidence that the same pharmacological interventions were more efficacious in preventing recurrences when utilized in earlier rather than later illness course. CONCLUSIONS AND RECOMMENDATIONS While there are promising initial findings, there is a need for more adequately powered trials to examine the efficacy and tolerability of interventions in youth and adults in early illness course. Specifically, there is a compelling need to compare the relative benefits of lithium with other pharmacological agents in preventing recurrences. In addition to symptomatic outcomes, there should be a greater focus on functional impact and tolerability. Effective pharmacological and psychological interventions should be offered to those in early course of BD, balancing potential risks using shared decision-making approaches.
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Affiliation(s)
- A. Ratheesh
- grid.488501.00000 0004 8032 6923Orygen, 35 Poplar Road, Parkville, VIC Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - D. Hett
- grid.6572.60000 0004 1936 7486Institute for Mental Health, University of Birmingham, Birmingham, UK ,Birmingham and Solihull Mental Health NHS Trust, Birmingham, UK
| | - J. Ramain
- grid.8515.90000 0001 0423 4662TIPP Program, Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - E. Wong
- grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - L. Berk
- grid.414257.10000 0004 0540 0062IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - P. Conus
- grid.8515.90000 0001 0423 4662TIPP Program, Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - M. A. Fristad
- grid.261331.40000 0001 2285 7943Nationwide Children’s Hospital, The Ohio State University, Columbus, USA
| | - T. Goldstein
- grid.21925.3d0000 0004 1936 9000Department of Psychiatry, University of Pittsburgh, Pittsburgh, USA
| | - M. Hillegers
- grid.5645.2000000040459992XDepartment of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - S. Jauhar
- grid.13097.3c0000 0001 2322 6764Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.415717.10000 0001 2324 5535South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX UK
| | - L. V. Kessing
- grid.475435.4Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - D. J. Miklowitz
- grid.19006.3e0000 0000 9632 6718Semel Institute for Neuroscience and Human Behavior, Los Angeles School of Medicine, University of California, Los Angeles, USA
| | - G. Murray
- grid.1027.40000 0004 0409 2862Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - J. Scott
- grid.1006.70000 0001 0462 7212Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - M. Tohen
- grid.266832.b0000 0001 2188 8502Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM USA
| | - L. N. Yatham
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - A. H. Young
- grid.13097.3c0000 0001 2322 6764Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.415717.10000 0001 2324 5535South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX UK
| | - M. Berk
- grid.414257.10000 0004 0540 0062IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - S. Marwaha
- grid.6572.60000 0004 1936 7486Institute for Mental Health, University of Birmingham, Birmingham, UK ,Birmingham and Solihull Mental Health NHS Trust, Birmingham, UK
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Adewuya AO, Oladipo OE, Imarah T, Asmal L, Emsley R. The 3-year progression of clinically significant psychotic-like experiences in a general adult population in Lagos, Nigeria. Soc Psychiatry Psychiatr Epidemiol 2023; 58:91-103. [PMID: 36098756 DOI: 10.1007/s00127-022-02358-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/24/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE The study assessed the 3-year progression of clinically significant psychotic-like experience (CS-PLE) symptoms in an adult general population in terms of stability or remission of symptoms and transition to psychosis. METHODS Participants (n = 1292) aged 18-65 years with CS-PLE were assessed at baseline for sociodemographic details, family history of mental illness, functioning status, common mental disorders, alcohol, and substance use disorders. Three years later they were reassessed for diagnosis of psychosis, presence or remission of PLE symptoms, and contact with mental health services. RESULTS The mean age of the participants at baseline in years was 36.56 (SD = 11.66) and there were 855 (66.2%) females. By the 3rd year follow-up, 95 (7.3%) had transited to psychosis, while 850 (65.5%) had persistent CS-PLE symptoms and the rest 347 (27.2%) were in remission. Only history of mental illness in the immediate family (HR 4.81, 95% CI 1.40-16.47, P = 0.013) and regular use of cannabis at less than 18 years of age (HR 0.65, 95% CI 0.55-0.77, P < 0.001) were the independent predictors of conversion to psychosis at 3 years. CONCLUSION The rate of TTP in the non-clinical population with elevated risk may be lower than that earlier reported in the western literature. Interventions aimed at preventing transition to psychosis in high risk groups must pay attention to early onset users of cannabis and those with family history of mental illness.
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Affiliation(s)
- Abiodun O Adewuya
- Department of Behavioral Medicine, Lagos State University College of Medicine, 1-5, Oba Akinjobi Way, GRA, Ikeja, Lagos, Nigeria.
- Centre for Mental Health Research and Initiative, Lagos, Nigeria.
| | | | - Tomilola Imarah
- Centre for Mental Health Research and Initiative, Lagos, Nigeria
| | - Laila Asmal
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Robin Emsley
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
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Dalal RS, McClure EL, Marcus J, Allegretti JR. Comparative Long-Term Drug Survival of Vedolizumab, Adalimumab, and Infliximab in Biologic-Naïve Patients with Ulcerative Colitis. Dig Dis Sci 2023; 68:223-32. [PMID: 35415826 DOI: 10.1007/s10620-022-07472-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/01/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The comparative long-term survival of first-line biologics for UC and reasons for drug discontinuation are poorly understood. We sought to compare the long-term drug survival related to non-response (NR) and adverse effects (AEs) for vedolizumab, adalimumab, and infliximab among biologic-naïve patients with UC. METHODS This was a retrospective cohort study of adult biologic-naïve patients with moderate-to-severe UC initiating vedolizumab, adalimumab, or infliximab 6/1/14-12/31/20 at a large academic medical center. The primary outcome was time to biologic discontinuation for primary or secondary NR (including colectomy). The secondary outcome was time to biologic discontinuation due to AEs. Inverse probability of treatment-weighted (IPTW) Cox regression was used to perform three pair-wise comparisons of drug survival. RESULTS The cohort included 805 patients with UC who initiated vedolizumab (n = 195), adalimumab (n = 278), or infliximab (n = 332). The adjusted hazard of biologic discontinuation for NR was significantly lower for vedolizumab vs adalimumab (HR 0.51, 95% CI 0.34-0.75), similar for vedolizumab vs infliximab (HR 1.32, 95% CI 0.79-2.18), and greater for adalimumab vs infliximab (HR 2.07, 95% CI 1.51-2.86). The adjusted hazard of discontinuation for AEs was significantly lower for vedolizumab vs adalimumab (HR 0.25, 95% CI 0.09-0.64), lower for vedolizumab vs infliximab (HR 0.21, 95% CI 0.10-0.46), and similar for adalimumab vs infliximab (HR 0.85, 95% CI 0.53-1.35). CONCLUSIONS There was greater survival of vedolizumab compared to adalimumab for clinical response and greater survival of vedolizumab compared to both adalimumab and infliximab for AEs. These long-term data support the use of vedolizumab as a first-line biologic over adalimumab for biologic-naïve patients with UC.
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Otsuka Y, Kaneita Y, Tanaka K, Itani O, Matsumoto Y, Kuriyama K. Longitudinal assessment of lifestyle factors associated with nonrestorative sleep in Japan. Sleep Med 2023; 101:99-105. [PMID: 36368075 DOI: 10.1016/j.sleep.2022.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/19/2022] [Accepted: 10/23/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Nonrestorative sleep (NRS) is common in the general global population. This study surveyed the incident/remission rate of NRS and identified related lifestyle factors in a general Japanese adult cohort. METHODS Data from a Japanese health check-based cohort between the fiscal years 2011 and 2018 were obtained. NRS was assessed through a single item question, and socio-demographic and clinical data were assessed through self-reports. To identify potential correlates of NRS incidence/remission, Cox regression analysis (or survival analysis) was performed. RESULTS Among the 135 609 individuals surveyed at baseline, data from 93 548 were considered for analysis. NRS exhibited incidence and remission rates of 11.3% and 15.4%, respectively. New NRS incidence was predicted by eating fast (hazard ratio [HR]: 1.07, 95% confidence interval [CI]: 1.04-1.10), dining close to bedtime (HR: 1.33, 95% CI: 1.27-1.38), midnight snacking (HR: 1.09, 95% CI: 1.04-1.13), skipping breakfast (HR: 1.16, 95% CI: 1.10-1.22), non-regular exercise (HR: 1.12, 95% CI: 1.07-1.17), lower levels of physical activity (HR: 1.19, 95% CI: 1.14-1.24), and slow walking speed (HR: 1.34, 95% CI: 1.29-1.39), while heavy drinking was less predictive of NRS. However, the same factors (except for heavy drinking) were found to predict NRS remission. CONCLUSIONS We found that unhealthy lifestyle behaviors, particularly dining close to bedtime and slow walking speed, were positively associated with NRS incidence, while they were negatively associated with NRS remission. These results can be useful in developing more effective health promotion policies to achieve good sleep.
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Affiliation(s)
- Yuichiro Otsuka
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yoshitaka Kaneita
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Katsutoshi Tanaka
- Department of Occupational Mental Health, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, 252-0374, Japan
| | - Osamu Itani
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yuuki Matsumoto
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kenichi Kuriyama
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
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168
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Ramanan R, Tiong IS, Ivey A, Ong DM, Brown FC, Chua C, Das T, Curtis DJ. Cellular distribution of IDH mutations in AML during morphologic remission. Leuk Res 2023; 124:106993. [PMID: 36459762 DOI: 10.1016/j.leukres.2022.106993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 11/27/2022]
Abstract
Limited information exists about the cellular distribution of mutations which persist in remission in acute myeloid leukemia (AML) (variably considered pre-leukemic mutations). We hypothesized that mutations detectable in all cell compartments may be less pathogenic than those that are myeloid-restricted. Here, we describe the cellular compartments that have IDH mutations in five patients with IDH-mutated AML in morphologic remission. Unlike pre-leukemic clones harboring the more common DNMT3A, TET2 and ASXL1 (DTA) mutations, we show that IDH mutations are myeloid-restricted. This finding provides an explanation for the reports that IDH mutations carry a higher risk for relapse than DTA mutations. Detailed analysis of one case also shows acquisition of additional mutations in distinct cellular compartments, illustrating subclonal complexity associated with therapeutics.
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169
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Kubo K, Sakurai H, Tani H, Watanabe K, Mimura M, Uchida H. Predicting relapse from the time to remission during the acute treatment of depression: A re-analysis of the STAR*D data. J Affect Disord 2023; 320:710-715. [PMID: 36208688 DOI: 10.1016/j.jad.2022.09.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Predicting relapse during maintenance treatment for depression is challenging. The objective of this analysis was to investigate the association between the time taken to achieve remission in the acute phase, and the subsequent relapse rate or time to relapse using the Sequenced Treatment Alternatives to Relieve Depression dataset. METHOD Data of 1296 outpatients with nonpsychotic depression who entered a 12-month naturalistic follow-up period after achieving remission with citalopram for up to 14 weeks were analyzed. One-way analysis of variance and the Jonckheere-Terpstra trend test were performed to compare the relapse rates and days to relapse during the follow-up period among those who achieved remission at weeks 2, 4, 6, 9, 12, and 14. Remission and relapse were defined as scores of ≤5 and ≥11, respectively, on the 16-Item Quick Inventory of Depressive Symptomatology and Self-Report. RESULTS The relapse rates were significantly different among those who achieved remission each week (F(5, 1087) = 4.995, p < 0.001). The lowest and highest relapse rates were observed in those who achieved remission at weeks 4 (25.7 %) and 12 (42.4 %), respectively, with a significant difference (p = 0.006). There was also a significant negative trend between the weeks taken to achieve remission and the days to relapse (z = -6.13, p < 0.001). CONCLUSIONS Patients with depression who show a faster response to antidepressant treatment are more likely to maintain remission in the long term. This finding suggests that, to prevent relapse, close attention should be paid to patients who require a relatively long time to achieve remission.
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Affiliation(s)
- Kaoruhiko Kubo
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hitoshi Sakurai
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan.
| | - Hideaki Tani
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
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170
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Law C, Kamarsu S, Obisie-Orlu IC, Belli GM, Mancebo M, Eisen J, Rasmussen S, Boisseau CL. Personality traits as predictors of OCD remission: A longitudinal study. J Affect Disord 2023; 320:196-200. [PMID: 36183822 DOI: 10.1016/j.jad.2022.09.121] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/19/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Personality traits may confer vulnerability to psychopathology. However, few studies have examined the association between personality traits and obsessive-compulsive disorder (OCD) course. The present study investigates personality traits, OCD symptom severity, and illness duration as a predictor of OCD remission. METHODS 166 treatment-seeking adults with OCD, recruited as part of the Brown Longitudinal Obsessive-Compulsive Study, completed the NEO Five-Factor Inventory 3 (NEO-FFI) and were in episode for OCD at time of NEO-FFI completion. Participants were followed for up to 3 years. RESULTS Results suggest individuals with OCD had a 21 % likelihood of reaching remission over the course of 3 years. Greater OCD symptom severity and longer illness duration were associated with a decreased likelihood of remission. Among the five factors of personality, only low extraversion was associated with a decreased rate of remission. Neuroticism, openness, agreeableness, and conscientiousness were not associated with remission. LIMITATIONS As this was an observational study, treatment was not controlled precluding examination of treatment on course. Further, data collected on age of onset and symptom severity during follow up were retrospective and therefore are also subject to recall bias. CONCLUSIONS Our findings provide preliminary support that personality traits are potential factors impacting course and symptom presentation. Future research is necessary to determine the mechanisms in which personality traits may influence the presentation and course of OCD.
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Affiliation(s)
- Clara Law
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Snigdha Kamarsu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Immanuela C Obisie-Orlu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gina M Belli
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maria Mancebo
- Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jane Eisen
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Steven Rasmussen
- Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Christina L Boisseau
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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171
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Zhu XQ, Mayes TL, Qi N, Feng L, Feng Y, Wu WY, Hu YD, Xiao L, Wang G. The effect of the time to remission on residual symptoms and functioning among depressive patients. J Affect Disord 2023; 320:667-673. [PMID: 36209781 DOI: 10.1016/j.jad.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To explore the effect of time to remission on residual symptoms, functioning and quality of life (QOL) of the patients with major depressive disorder (MDD). METHOD A total of 434 patients were enrolled from 16 sites of China. The Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR) and self-rating scales were assessed at baseline, and months 1, 3 and 6. Baseline remitters were defined as those subjects with a QIDS-SR score ≤ 5 at baseline. Later remitters was defined as those reaching remission one month (Month 1 remitters) or three month (Month 3 remitters) after baseline. Persistent non-remitters were defined as those with QIDS-SR score > 5 at all 3 assessments. A follow-up assessment was done at month 6 to examine outcomes. Cross-lagged models indicated QIDS-SR predicted social functioning and QOL. RESULTS Totally, 179 patients at baseline achieved remission. An additional 141 participants remitted at month 1 (n = 94) or month 3 (n = 47), and 63 patients were persistent non-remitters. There were significant differences between all groups on depression severity at baseline. QOL was similar for both late remitter groups, which was better than non-remitters, but lower than early-remitters. Late remitters and non-remitters showed significant differences on change of functioning and QOL (P < 0.001) at each visit. By 6 months, all remitting groups showed lower depression severity and better social functioning and QOL than persistent non-remitters. Cross-lagged models indicated QIDS-SR predicted social functioning and QOL. CONCLUSION We confirmed the association of earlier remission with a better quality of remission at early stage; but the time to remission does not affect future functioning and QOL.
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Affiliation(s)
- Xue-Quan Zhu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Taryn L Mayes
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Na Qi
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Lei Feng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yuan Feng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Wen-Yuan Wu
- Department of Psychiatry, Tongji Hospital of Tongji University, Shanghai, China
| | - Yong-Dong Hu
- Department of Clinical Psychology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Le Xiao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Gang Wang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
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Seidl E, Venz J, Ollmann TM, Voss C, Hoyer J, Pieper L, Beesdo-Baum K. Dynamics of affect, cognition and behavior in a general population sample of adolescents and young adults with current and remitted anxiety disorders: An Ecological Momentary Assessment study. J Anxiety Disord 2023; 93:102646. [PMID: 36427380 DOI: 10.1016/j.janxdis.2022.102646] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 10/24/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Measures of dynamic changes in affect/emotions (variability, instability, inertia) have been linked to anxiety disorders (AD). We examine dynamics in affect, cognition and behavior in youth with current and remitted AD. METHODS Mental disorders were assessed in a general population sample (N = 1180, age 14-21; Dresden, Germany) using standardized interview. Ecological Momentary Assessment of real-life affect, cognition and behavior took place eight times/day for four days. RESULTS Individuals with current AD (n = 65) compared to healthy controls (HC, n = 531) revealed heightened variability of anxious and manic symptomatology, experiential avoidance, optimism and positive thoughts. Remitted AD (n = 52) showed lower variability of anxious and manic symptomatology and positive thoughts compared to current AD, while no differences were found compared to HC. Current AD and HC differed significantly in instability. Remitted AD showed lower instability of all constructs except for anger than current AD, and higher instability on all constructs except for positive and negative thoughts compared to HC. Current AD showed higher inertia of anger and negative thoughts than HC, and less inertia of positive thoughts than remitted AD. DISCUSSION AD in youths is particularly linked to higher variability and instability of intertwined emotion-related experiences that partly persist after remission, informing emotion regulation models and interventions.
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Affiliation(s)
- Esther Seidl
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Research Group Security and Privacy, Faculty of Computer Science, University of Vienna, Austria
| | - John Venz
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Theresa Magdalena Ollmann
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Catharina Voss
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Jana Hoyer
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Lars Pieper
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Katja Beesdo-Baum
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
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173
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Lautenbach A, Wernecke M, Mann O, Wagner J, Wolter S, Stoll F, Aberle J. Low-Grade Hepatic Steatosis Is Associated with Long-term Remission of Type 2 Diabetes Independent of Type of Bariatric-Metabolic Surgery. Obes Surg 2023; 33:530-538. [PMID: 36508157 PMCID: PMC9889466 DOI: 10.1007/s11695-022-06406-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Bariatric-metabolic surgery (BS) decreases the grade of steatosis, hepatic inflammation, and fibrosis in patients with severe obesity and non-alcoholic fatty liver disease (NAFLD). Mechanisms include substantial weight loss, but also simultaneous effects on glucose homeostasis. Therefore, we aimed to investigate the association between NAFLD and remission of type 2 diabetes (T2D) up to 8 years following different types of BS. METHODS In a retrospective cohort study including 107 patients with obesity and T2D at baseline, the association between biopsy-proven NAFLD defined as steatosis in > 5% of hepatocytes at the time of surgery and T2D remission up to 8 years following different surgical procedures was investigated. Univariate regression analysis was used to examine the association between NAFLD and remission of T2D. RESULTS Long-term remission of T2D was present in 56% of patients (n = 60). The presence of low-grade liver steatosis (grade 1) was associated with remission of T2D. Patients with a liver steatosis score ≥ 2 showed higher HbA1c levels at baseline. There were no significant differences in preoperative presence of lobular inflammation, hepatocyte ballooning, or fibrosis between patients who achieved T2D remission compared with those with no remission. Type of surgery did not affect remission of T2D. CONCLUSION Our results suggest that the presence of low-grade liver steatosis is associated with remission of T2D following sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Therefore, BS should be considered at an early NAFLD stage in patients with T2D.
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Affiliation(s)
- Anne Lautenbach
- III Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
| | - Marie Wernecke
- III Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Oliver Mann
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Jonas Wagner
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Stefan Wolter
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Fabian Stoll
- III Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Jens Aberle
- III Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
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174
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Kahn RM, Ragupathi G, Zhou QC, Iasonos A, Kravetz S, Hensley ML, Konner JA, Makker V, Tew WP, Aghajanian C, Sabbatini PJ, O'Cearbhaill RE. Long-term outcomes of patients with recurrent ovarian cancer treated with a polyvalent vaccine with bevacizumab combination. Cancer Immunol Immunother 2023; 72:183-191. [PMID: 35779095 PMCID: PMC10123530 DOI: 10.1007/s00262-022-03225-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/17/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND To characterize the safety, immunogenicity, and outcomes of patients with high-grade serous ovarian cancer (HGSOC) in second or greater remission treated with a polyvalent antigen-KLH plus OPT-821 vaccine construct and bevacizumab. METHODS Patients with recurrent HGSOC were treated with the vaccine plus bevacizumab at our institution from 01/05/2011 to 03/20/2012. Follow-up continued until 03/2021. Blood/urine samples were collected. "Responders" had an immunogenic response to ≥ 3 antigens; "non-responders" to ≤ 2 antigens. RESULTS Twenty-one patients were treated on study. One developed a dose-limiting toxicity (grade 4 fever). Two (10%) experienced bevacizumab-related grade 3 hypertension. Thirteen (68%) and 16 (84%) of 19 responded to ≥ 3 and ≥ 2 antigens, respectively (Globo-H, GM2, TF cluster Tn, MUC-1). Four of 21 patients were alive > 5 years post-treatment. Responders and non-responders had a median PFS of 4.9 months (95% CI: 2.8-8.1) and 5.0 months (95% CI: 0.7-cannot estimate), respectively; median OS was 30.7 months (95% CI: 16.9-52.0) and 34.2 months (95% CI: 12.8-cannot estimate), respectively. On two-timepoint analysis (baseline, week 17), increased IL-8 exhibited improved PFS (HR as 10-unit increase, 0.43; p = 0.04); increased PDGF exhibited worse OS (HR as 10-unit increase, 1.01; p = 0.02). CONCLUSIONS This is the longest follow-up of vaccine administration with bevacizumab in patients with ovarian cancer. The vaccine was well tolerated with bevacizumab. Response was not associated with improved survival. On two-timepoint analysis, increased IL-8 was associated with significant improvement in PFS; increased PDGF with significantly worse OS. For all timepoint measurements, cytokine levels were not significantly associated with survival. TRIAL REGISTRATION NCT01223235.
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Affiliation(s)
- Ryan M Kahn
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Govind Ragupathi
- Melanoma and Immunotherapeutics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qin C Zhou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sara Kravetz
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Martee L Hensley
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Jason A Konner
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Vicky Makker
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - William P Tew
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Carol Aghajanian
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Paul J Sabbatini
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Roisin E O'Cearbhaill
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
- National University of Ireland, Galway, Ireland.
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175
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Yee AMF. Durable medication-free remission of sarcoidosis following discontinuation of anti-tumor necrosis factor-α therapy. Respir Med 2023; 206:107055. [PMID: 36459954 DOI: 10.1016/j.rmed.2022.107055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Monoclonal antibodies against tumor necrosis factor-alpha (TNF-α) have been used successfully in the treatment of sarcoidosis, but optimal duration of their use is unclear. Published studies have consistently suggested that withdrawal of therapy typically results in prompt disease relapse. The aim of this study is to identify and characterize patients with sarcoidosis in whom medication-free disease remissions were induced and sustained following treatment with and subsequent discontinuation of anti-TNF-α antibodies. METHODS A retrospective chart review was conducted to identify patients satisfying three criteria: (1) histopathological documentation of sarcoidosis; (2) disease remission induced by anti-TNF-α antibodies, since discontinued; and (3) subsequent maintained clinical, radiological, and laboratory remission for at least one year without ongoing immunomodulatory medications. RESULTS Eight patients whose sarcoidosis remained in medication-free remissions were identified. The duration of remissions ranged from 22 to 132 months. All patients had previously had inadequate response to corticosteroid therapy and at least one steroid-sparing agent, prompting the use of anti-TNF-α antibodies. Before anti-TNF-α therapy was discontinued, all eight patients had been able to remain off systemic corticosteroid therapy for at least a year (range 12-130 months). CONCLUSIONS These observations suggest that in select sarcoidosis patients, anti-TNF-α antibodies may induce prolonged medication-free remissions. The sustained capacity to remain off corticosteroids during anti-TNF-α therapy may be a favorable prognostic indicator for maintained disease remission. These findings may help to develop principles for optimal utilization of these agents and to shed light onto the potential pathogenic role of TNF-α in this disease.
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Affiliation(s)
- Arthur M F Yee
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery and Weill Cornell Medicine, 535 East 70th Street, New York, NY, USA.
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176
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von Koch L, Kathmann N, Reuter B. Lack of speeded disengagement from facial expressions of disgust in remitted major depressive disorder: Evidence from an eye-movement study. Behav Res Ther 2023; 160:104231. [PMID: 36463834 DOI: 10.1016/j.brat.2022.104231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/06/2022] [Revised: 10/30/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022]
Abstract
Acute major depression is characterized by specific abnormalities in the way emotional material is attended to. In late stages of stimulus processing, clinically depressed and dysphoric individuals show difficulties to disengage attention from emotionally negative material. It is unclear, however, whether aberrant disengagement is a transitory attentional phenomenon tied to depressive symptoms, or whether it constitutes a more stable disposition that outlast the symptomatic episode. To address this issue, the current study examined 39 currently euthymic individuals previously affected by major depression (RMD) and 40 healthy control participants reporting no lifetime psychopathology (ND). We used a gaze-contingent eye tracking paradigm designed to separately assess the attentional components of engagement and disengagement when viewing facial expressions of sadness, disgust and happiness. Never-depressed healthy participants, but not remitted euthymic individuals, showed speeded disengagement from facial expressions of disgust. We propose that the lack of this distinct acceleration in previously depressed but fully remitted individuals might reflect an attentional disposition that carries over to euthymic phases of the disease. On the other hand, a tendency to disengage quickly from areas in the visual field that convey social disdain could potentially act as a protective, possibly mood-stabilizing bias in resilient individuals.
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Affiliation(s)
- Lara von Koch
- Department of Psychology, Humboldt-Universität zu Berlin, Germany.
| | - Norbert Kathmann
- Department of Psychology, Humboldt-Universität zu Berlin, Germany
| | - Benedikt Reuter
- Department of Psychology, Humboldt-Universität zu Berlin, Germany; Department of Medicine, MSB Medical School Berlin, Germany
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177
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Nagase H, Suzukawa M, Oishi K, Matsunaga K. Biologics for severe asthma: The real-world evidence, effectiveness of switching, and prediction factors for the efficacy. Allergol Int 2023; 72:11-23. [PMID: 36543689 DOI: 10.1016/j.alit.2022.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [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: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022] Open
Abstract
Biologics have been a key component of severe asthma treatment, and there are currently biologics available that target IgE, IL-5, IL-4/IL-13, and TSLP. Randomized controlled trials have established clinical evidence, but a significant portion of patients with severe asthma in real-life settings would have been excluded from those trials. Therefore, real-world research is necessary, and there is a growing body of information about the long-term efficacy and safety of biologics. Multiple clinical phenotypes of severe asthma exist, and it is crucial to choose patients based on their phenotypes. Blood eosinophil count is an important biomarker for anti-IL-5 therapies, and FeNO and eosinophil counts serve as prediction markers for dupilumab. Reliable markers for predicting response, however, have not yet been fully established for omalizumab. Identification of clinical or biological prediction factors is crucial for the path toward clinical remission because the current treatment goal includes clinical remission, which is defined as a realistic goal for remission off treatment. Additionally, since there are now multiple biologic options and overlaps in eligibility for biologics in clinical practice, the evidence regarding the effectiveness of switching the biologics is crucial. Investigations into the clinical trajectory following the cessation of biologics are another important issue. Recent research on omalizumab, mepolizumab, benralizumab and dupilumab's real-world effectiveness, the prediction factor for the efficacy, and the impact of switching or discontinuation will be reviewed and discussed in this review.
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Affiliation(s)
- Hiroyuki Nagase
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
| | - Maho Suzukawa
- Asthma Allergy and Rheumatology Center, Clinical Research Center, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
| | - Keiji Oishi
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan.
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Schupack DA, Johnson K, Akambase JA, Geno D, Lavey C, Lennon RJ, Ravi K, Snyder DL, Katzka DA, Alexander JA. Histologic response to steroids in eosinophilic esophagitis is dependent on delivery compound. Dis Esophagus 2022; 36:6627605. [PMID: 35780320 DOI: 10.1093/dote/doac040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/04/2022] [Accepted: 05/30/2022] [Indexed: 01/11/2023]
Abstract
Topical steroids are commonly used in treatment of eosinophilic esophagitis (EoE), but currently there is lack of data to clarify most effective regimen. We aimed to study the achievement of histologic remission using the same dose of budesonide in two different delivery formulations. Patients with established EoE treated with pharmacy compounded budesonide capsule or budesonide Rincinol gel (both 3 mg twice daily) were studied retrospectively. Those with pre-treatment and post-treatment histologic assessment were included with main endpoint being histologic remission. 103 patients (62 gel, 41 capsule) were included, with higher rate of histologic remission with gel (84 vs. 59%, P=0.004). A subset of patients in both groups had lack of steroid response (<50% drop in eosinophils) (15% for gel, 32% for capsule). Formulation/delivery vehicle of steroid treatments to esophageal mucosa in EoE appears important for treatment efficacy, with budesonide gel having higher likelihood of histologic remission compared to budesonide capsules in our population. A truly steroid refractory group appears likely in our population. Larger, prospective studies may help clarify best regimen of topical steroids in EoE and may work to identify patients likely to benefit from alternative therapies.
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Affiliation(s)
- Daniel A Schupack
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | - Joseph A Akambase
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Debra Geno
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Crystal Lavey
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Ryan J Lennon
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Karthik Ravi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Diana L Snyder
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - David A Katzka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey A Alexander
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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Liu Y, Lin L, Yuan C, Shen S, Tang Y, Liu Z, Zhu Y, Zhou L. Recovery from diabetes mellitus in primary aldosteronism patients after adrenalectomy. BMC Endocr Disord 2022; 22:331. [PMID: 36572916 PMCID: PMC9793683 DOI: 10.1186/s12902-022-01254-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The prevalence of diabetes mellitus (DM) was higher in primary aldosteronism (PA) patients. We aimed to evaluate the outcome of DM after adrenalectomy and determine the factors associated with that in PA patients. METHODS PA patients with DM (PA + DM patients) who received adrenalectomy were recruited into the study. The patients were classified into 3 groups based on their DM conditions after treatment, including "remission", "improved" and "unchanged" groups. Univariate and multivariate logistic regression analysis was conducted to uncover the preoperative factors affecting the outcome of DM after adrenalectomy. RESULTS A total of 54 PA + DM patients received adrenalectomy. After adrenalectomy, 16.7%, 33.3% and 50.0% of patients were classified into the "remission", "improved" and "unchanged" groups, respectively. The factors negatively associated with remission or improvement from DM after adrenalectomy were longer duration of hypertension (P = 0.029). Higher concentration of urinary magnesium (P = 0.031) and higher 24 h urinary potassium (P = 0.049) were factors negatively associated with the "remission" from DM after adrenalectomy. CONCLUSIONS Adrenalectomy was beneficial for the remission and improvement from DM in the half of PA patients with DM. Longer duration of hypertension, higher concentration of urinary magnesium and higher 24 h urinary potassium may prevent the remission and improvement from DM after adrenalectomy in PA patients. Examination of urinary electrolyte could be considered in PA patients with DM for predicting the outcome of DM after adrenalectomy.
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Affiliation(s)
- Yu Liu
- 1Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan, P.R. China
| | - Lede Lin
- 1Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan, P.R. China
| | - Chi Yuan
- 1Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan, P.R. China
| | - Sikui Shen
- 1Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan, P.R. China
| | - Yin Tang
- 1Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan, P.R. China
| | - Zhihong Liu
- 1Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan, P.R. China
| | - Yuchun Zhu
- 1Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan, P.R. China.
| | - Liang Zhou
- 1Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan, P.R. China.
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Lee SD, Lee HJ, Kim HR, Kang MG, Kim K, Park JR. Development of dilated cardiomyopathy with a long latent period followed by viral fulminant myocarditis: A case report. World J Clin Cases 2022; 10:13451-13457. [PMID: 36683618 PMCID: PMC9850995 DOI: 10.12998/wjcc.v10.i36.13451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/10/2022] [Accepted: 12/05/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The clinical course of acute myocarditis ranges from the occurrence of a few symptoms to the development of fatal fulminant myocarditis. Specifically, fulminant myocarditis causes clinical deterioration very rapidly and aggressively. The long-term prognosis of myocarditis is varied, and it fully recovers without leaving any special complications. However, even after recovery, heart failure may occur and eventually progress to dilated cardiomyopathy (DCM), which causes serious left ventricular dysfunction. In the case of follow-up observation, no clear guidelines have been established.
CASE SUMMARY We report the case of a 21-year-old woman who presented with dyspnea. She became hemodynamically unstable and showed sustained fatal arrhythmias with decreased heart function. She was clinically diagnosed with fulminant myocarditis based on her echocardiogram and cardiac magnetic resonance results. After 2 d, she was readmitted to the emergency department under cardiopulmonary resuscitation and received mechanical ventilation and extracorporeal membrane oxygenation. An implantable cardioverter defibrillator was inserted for secondary prevention. She recovered and was discharged. Prior to being hospitalized for sudden cardiac function decline and arrhythmia, she had been well for 7 years without any complications. She was finally diagnosed with dilated cardiomyopathy.
CONCLUSION DCM may develop unexpectedly in patients who have been cured of acute fulminant myocarditis and have been stable with a long period of remission. Therefore, they should be carefully and regularly observed clinically throughout long-term follow-up.
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Affiliation(s)
- Seung Do Lee
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Hyo Jin Lee
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Hye Ree Kim
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Min Gyu Kang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Kyehwan Kim
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Jeong Rang Park
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, South Korea
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181
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Kanokwongnuwat W, Penpong N, Sangsri C. Incidence and treatment outcomes of Graves' disease in Thailand: a single-center retrospective observational study. Thyroid Res 2022; 15:24. [PMID: 36529758 PMCID: PMC9761999 DOI: 10.1186/s13044-022-00142-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Treatment patterns and outcomes of Graves' disease (GD) are variable around the world. However, studies on treatment outcomes of GD from the Asian populations are limited. We aimed to evaluate treatment outcomes of GD in Thailand. METHODS Patients with new diagnoses of GD in a single center between 2014-2018 were retrospectively reviewed. The diagnosis of GD was based on clinical features, which included diffuse goiter, Graves' orbitopathy (GO), pretibial myxedema and acropachy. RESULTS The age-adjusted incidence of GD was 26.57 per 100,000 per year. The study included 355 patients aged 15 years or above with a follow-up period of at least 24 months. Antithyroid drug (ATD) was the most popular first-line treatment modality with 98.7% patients receiving the treatment, followed by radioactive iodine (RAI) treatment in 1.3% patients. The most effective treatment modality was surgery with a remission rate of 100%. ATD had a lowest remission rate of 23.8%. Multivariable Cox regression analysis showed GO (HR 1.76, 95% CI 1.08-2.88) and initial TSH < 0.01 uIU/ml (HR 1.61, 95% CI 1.14-2.28) were significant factors associated with an increased treatment failure rate. CONCLUSION Treatment failure with ATD in patients with GD was frequent in this population. The diagnosis of GD based solely on clinical features may explain the high treatment failure rate in this study. More definitive treatment could be used to prevent relapse and complications of the disease.
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Affiliation(s)
- Wasit Kanokwongnuwat
- grid.415153.70000 0004 0576 179XDivision of Nuclear Medicine, Department of Radiology, Prapokklao Hospital, 38 Leab Neon Road, Muang, Chanthaburi, 22000 Thailand
| | - Nawarat Penpong
- grid.415153.70000 0004 0576 179XDivision of Endocrinology, Department of Medicine, Prapokklao Hospital, Chanthaburi, Thailand
| | - Chaninporn Sangsri
- grid.415153.70000 0004 0576 179XDivision of Head Neck and Breast Surgery, Department of Surgery, Prapokklao Hospital, Chanthaburi, Thailand
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Zhou J, Jiang X, Zhou Y, Zhu Y, Jia L, Sun T, Liu L, Sun Q, Ren L, Guo Y, Wu F, Kong L, Tang Y. Distinguishing major depressive disorder from bipolar disorder in remission: A brain structural network analysis. J Affect Disord 2022; 319:8-14. [PMID: 36058360 DOI: 10.1016/j.jad.2022.08.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 05/18/2022] [Accepted: 08/26/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND It is challenging to differentiate major depressive disorder (MDD) from bipolar disorder (BD) in depression and remission. To exclude the potential influence of depressive episodes, we compared the white matter (WM) network between MDD and BD patients in remission to find disease-specific alterations in MDD and BD, and then distinguish these two affective disorders. METHODS We recruited 33 patients with remitted MDD (rMDD), 54 patients with remitted BD (rBD), and 60 healthy controls (HCs). Diffusion tensor imaging and high-resolution 3D T1-weighted image were acquired. Global and nodal topological parameters were used to depict the alterations of the whole-brain WM network. RESULTS We found that rMDD displayed increased global network efficiency (Eglob) and local network efficiency (Eloc) compared with HCs, whereas we found no significance between rBD and HCs. Compared with rBD and HCs, patients in the rMDD group showed increased nodal degree and nodal efficiency, and decreased nodal shortest path length in the four cerebral regions, including the right calcarine fissure (CAL.R), right cuneus (CUN.R), left lingual gyrus (LING.L), and left middle occipital gyrus (MOG.L). We did not find any rBD specific changes of nodal topological metrics. LIMITATIONS The main limitation is the possible effects of medication and BD subtypes on the results. CONCLUSIONS Our findings indicate that rMDD exhibited elevated global properties compared with HCs group, and increased nodal properties in the CAL.R, CUN.R, LING.L, and MOG.L specifically compared with rBD and HCs, which may underlie the distinction of the two affective disorders in remission.
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Affiliation(s)
- Jian Zhou
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Xiaowei Jiang
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Yifang Zhou
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Yue Zhu
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Linna Jia
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Ting Sun
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Linzi Liu
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Qikun Sun
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Luyu Ren
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Yanan Guo
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Feng Wu
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Lingtao Kong
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Brain Function Research Section, The First Hospital of China Medical University, Shenyang, China
| | - Yanqing Tang
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China; Department of Geriatric Medicine, The First Hospital of China Medical University, Shenyang, China.
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183
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Snijders RJALM, Stoelinga AEC, Gevers TJG, Pape S, Biewenga M, Verdonk RC, de Jonge HJM, Vrolijk JM, Bakker SF, Vanwolleghem T, de Boer YS, Pronk MAMCB, Beuers UHW, van der Meer AJ, van Gerven NMF, Sijtsma MGM, Verwer BJ, Gisbertz IAM, Bartelink M, van den Brand FF, Sebib Korkmaz K, van den Berg AP, Guichelaar MMJ, Soufidi K, Levens AD, van Hoek B, Drenth JPH. Assessing the efficacy and safety of mycophenolate mofetil versus azathioprine in patients with autoimmune hepatitis (CAMARO trial): study protocol for a randomised controlled trial. Trials 2022; 23:1012. [PMID: 36514163 PMCID: PMC9745715 DOI: 10.1186/s13063-022-06890-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/05/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Currently, the standard therapy for autoimmune hepatitis (AIH) consists of a combination of prednisolone and azathioprine. However, 15% of patients are intolerant to azathioprine which necessitates cessation of azathioprine or changes in therapy. In addition, not all patients achieve complete biochemical response (CR). Uncontrolled data indicate that mycophenolate mofetil (MMF) can induce CR in a majority of patients. Better understanding of first-line treatment and robust evidence from randomised clinical trials are needed. The aim of this study was to explore the potential benefits of MMF as compared to azathioprine, both combined with prednisolone, as induction therapy in a randomised controlled trial in patients with treatment-naive AIH. METHODS CAMARO is a randomised (1:1), open-label, parallel-group, multicentre superiority trial. All patients with AIH are screened for eligibility. Seventy adult patients with AIH from fourteen centres in the Netherlands and Belgium will be randomised to receive MMF or azathioprine. Both treatment arms will start with prednisolone as induction therapy. The primary outcome is biochemical remission, defined as serum levels of alanine aminotransferase and immunoglobulin G below the upper limit of normal. Secondary outcomes include safety and tolerability of MMF and azathioprine, time to remission, changes in Model For End-Stage Liver Disease (MELD)-score, adverse events, and aspects of quality of life. The study period will last for 24 weeks. DISCUSSION The CAMARO trial investigates whether treatment with MMF and prednisolone increases the proportion of patients in remission compared with azathioprine and prednisolone as the current standard treatment strategy. In addition, we reflect on the challenges of conducting a randomized trial in rare diseases. TRIAL REGISTRATION EudraCT 2016-001038-91 . Prospectively registered on 18 April 2016.
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Affiliation(s)
- Romée J. A. L. M. Snijders
- grid.10417.330000 0004 0444 9382Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands ,European Reference Network RARE-LIVER, Hamburg, Germany
| | - Anna E. C. Stoelinga
- grid.10419.3d0000000089452978Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom J. G. Gevers
- grid.10417.330000 0004 0444 9382Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands ,European Reference Network RARE-LIVER, Hamburg, Germany ,grid.412966.e0000 0004 0480 1382Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099Nutrim School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Simon Pape
- grid.10417.330000 0004 0444 9382Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands ,European Reference Network RARE-LIVER, Hamburg, Germany
| | - Maaike Biewenga
- grid.10419.3d0000000089452978Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert C. Verdonk
- grid.415960.f0000 0004 0622 1269Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Hendrik J. M. de Jonge
- grid.413508.b0000 0004 0501 9798Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, ‘s Hertogenbosch, The Netherlands
| | - Jan Maarten Vrolijk
- grid.415930.aDepartment of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Sjoerd F. Bakker
- grid.416373.40000 0004 0472 8381Department of Gastroenterology and Hepatology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Thomas Vanwolleghem
- grid.411414.50000 0004 0626 3418Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium
| | - Ynto S. de Boer
- European Reference Network RARE-LIVER, Hamburg, Germany ,grid.509540.d0000 0004 6880 3010Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, The Netherlands
| | - Martine A. M. C. Baven Pronk
- grid.413370.20000 0004 0405 8883Department of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, The Netherlands
| | - Ulrich H. W. Beuers
- European Reference Network RARE-LIVER, Hamburg, Germany ,grid.509540.d0000 0004 6880 3010Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| | - Adriaan J. van der Meer
- grid.5645.2000000040459992XDepartment of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nicole M. F. van Gerven
- Department of Gastroenterology and Hepatology, Rode Kruis Hospital, Beverwijk, The Netherlands
| | - Marijn G. M. Sijtsma
- Department of Gastroenterology and Hepatology, St. Jansdal Hospital, Harderwijk, The Netherlands
| | - Bart J. Verwer
- grid.416219.90000 0004 0568 6419Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Ingrid A. M. Gisbertz
- Department of Gastroenterology and Hepatology, Hospital Bernhoven, Uden, The Netherlands
| | - Maartje Bartelink
- grid.413649.d0000 0004 0396 5908Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands
| | - Floris F. van den Brand
- grid.440209.b0000 0004 0501 8269Department of Gastroenterology and Hepatology, OLVG Oost, Amsterdam, The Netherlands
| | - Kerem Sebib Korkmaz
- Department of Gastroenterology and Hepatology, IJselland Hospital, Capelle aan den Ijssel, The Netherlands
| | - Aad P. van den Berg
- grid.4494.d0000 0000 9558 4598Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Maureen M. J. Guichelaar
- grid.415214.70000 0004 0399 8347Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Khalida Soufidi
- grid.416905.fDepartment of Gastroenterology and Hepatology, Zuyderland, Heerlen, The Netherlands
| | - Amar D. Levens
- grid.10419.3d0000000089452978Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bart van Hoek
- grid.10419.3d0000000089452978Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joost P. H. Drenth
- grid.10417.330000 0004 0444 9382Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands ,European Reference Network RARE-LIVER, Hamburg, Germany
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Limmer S, Nerschbach V, Eberle N, Teske E, Simon Betz D. Efficacy and tolerability of a 12-week combination chemotherapy followed by lomustine consolidation treatment in canine B- and T-cell lymphoma. Acta Vet Scand 2022; 64:36. [PMID: 36503518 PMCID: PMC9743771 DOI: 10.1186/s13028-022-00660-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND High-grade lymphoma in dogs is a chemotherapy-responsive neoplasia with remission rates exceeding 80% under combination chemotherapy protocols. Usually these protocols are intensive and 24 + weeks. The objective of the present study was to investigate if a shorter protocol combined with an oral lomustine maintenance treatment (3 × in 8 weeks) would present an acceptable result, both for B- and T-cell lymphomas, and for the different types of lymphomas normally encountered in private veterinary practice. RESULTS 144 dogs entered the study. Lymphoma types included multicentric (n = 123), alimentary (n = 13), miscellaneous (n = 7), and mediastinal lymphoma (n = 1). Overall response rate was 83.3% (B-cell: 86.6%, T-cell: 79.4%). Complete remission (CR) was achieved in 72.2% (B-cell: 77.3%, T-cell: 67.6%) and partial remission (PR) in 11.1% (B-cell: 9.3%, T-cell: 11.8%) of the dogs. Median duration of first CR amounted to 242 days (B-cell: 263 d, T-cell: 161 d). Median survival in dogs with CR was 374 days (B-cell: 436 d, T-cell: 252 d), and median overall survival time was 291 days (B-cell: 357d, T-cell: 210d). Immunophenotype demonstrated an independent significant influence on duration of remission and survival in the whole group. Findings of splenic and hepatic cytology were not significant associated with patient outcome. Treatment was well tolerated; the majority of adverse events were classified as grade 1 or 2. CONCLUSIONS Short-term chemotherapy followed by lomustine consolidation leads to compara-ble remission and survival times compared to conventional protocols with cyclophosphamide, doxorubicin, vincristine and prednisolone with acceptable toxicosis in dogs with both B-cell and T-cell lymphoma.
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Affiliation(s)
- Stefanie Limmer
- grid.412970.90000 0001 0126 6191Small Animal Hospital, University of Veterinary Medicine Hannover, Bünteweg 9, Gebäude 280, 30559 Hannover, Germany
| | - Verena Nerschbach
- grid.412970.90000 0001 0126 6191Small Animal Hospital, University of Veterinary Medicine Hannover, Bünteweg 9, Gebäude 280, 30559 Hannover, Germany
| | - Nina Eberle
- Center for Small Animal Medicine, VetSpezial, Im Kornfeld 7, 31275 Lehrte, Germany
| | - Erik Teske
- grid.5477.10000000120346234Department of Clinical Sciences, Veterinary Faculty, Utrecht University, P.O. Box 80.154, 3508TD Utrecht, The Netherlands
| | - Daniela Simon Betz
- grid.412970.90000 0001 0126 6191Small Animal Hospital, University of Veterinary Medicine Hannover, Bünteweg 9, Gebäude 280, 30559 Hannover, Germany ,Independent Scientific Writing, Translation & Consultancy Clinical Oncology, Bünteweg 9, Gebäude 280, 30559 Hannover, Germany
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Jairath V, Cohen RD, Loftus EV, Candela N, Lasch K, Schultz BG. Evaluating cost per remission and cost of serious adverse events of advanced therapies for ulcerative colitis. BMC Gastroenterol 2022; 22:501. [PMID: 36474165 PMCID: PMC9724317 DOI: 10.1186/s12876-022-02590-6] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Determining the relative cost-effectiveness between advanced therapeutic options for ulcerative colitis (UC) may optimize resource utilization. We evaluated total cost per response, cost per remission, and cost of safety events for patients with moderately-to-severely active UC after 52 weeks of treatment with advanced therapies at standard dosing. METHODS An analytic model was developed to estimate costs from the US healthcare system perspective associated with achieving efficacy outcomes and managing safety outcomes for advanced therapies approved for the treatment of UC. Numbers needed to treat (NNT) for response and remission, and numbers needed to harm (NNH) for serious adverse events (SAEs) and serious infections (SIs) were derived from a network meta-analysis of pivotal trials. NNT for induction and maintenance were combined with drug regimen costs to calculate cost per clinical remission. Cost of managing AEs was calculated using NNH for safety outcomes and published costs of treating respective AEs. RESULTS Costs per remission were $205,240, $249,417, $267,463, $365,050, $579,622, $750,200, and $787,998 for tofacitinib 10 mg, tofacitinib 5 mg, infliximab, vedolizumab, golimumab, adalimumab, and ustekinumab, respectively. Incremental costs of SAEs and SIs collectively were $136,390, $90,333, $31,888, $31,061, $20,049, $12,059, and $0 for tofacitinib 5 mg, golimumab, adalimumab, tofacitinib 10 mg, infliximab, ustekinumab, and vedolizumab (reference), respectively. CONCLUSIONS Tofacitinib was associated with the lowest cost per response and cost per remission, while vedolizumab had the lowest costs related to SAEs and SIs. Balancing efficacy versus safety is important when evaluating the costs associated with treatment of moderate-to-severe UC.
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Affiliation(s)
- Vipul Jairath
- grid.39381.300000 0004 1936 8884Western University Schulich School of Medicine, London, ON Canada
| | - Russell D. Cohen
- grid.170205.10000 0004 1936 7822University of Chicago Pritzker School of Medicine, Chicago, IL USA
| | - Edward V. Loftus
- grid.66875.3a0000 0004 0459 167XMayo Clinic College of Medicine and Science, Rochester, MN USA
| | - Ninfa Candela
- grid.419849.90000 0004 0447 7762Takeda Pharmaceuticals U.S.A., Inc., 95 Hayden Ave., Lexington, MA 02421 USA
| | - Karen Lasch
- grid.419849.90000 0004 0447 7762Takeda Pharmaceuticals U.S.A., Inc., 95 Hayden Ave., Lexington, MA 02421 USA
| | - Bob G. Schultz
- grid.419849.90000 0004 0447 7762Takeda Pharmaceuticals U.S.A., Inc., 95 Hayden Ave., Lexington, MA 02421 USA ,grid.185648.60000 0001 2175 0319University of Illinois at Chicago College of Pharmacy, Chicago, IL USA
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186
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Khader Y, Beran A, Ghazaleh S, Lee-Smith W, Altorok N. Predictors of remission in rheumatoid arthritis patients treated with biologics: a systematic review and meta-analysis. Clin Rheumatol 2022; 41:3615-3627. [PMID: 35974226 PMCID: PMC9652218 DOI: 10.1007/s10067-022-06307-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 06/22/2022] [Revised: 07/04/2022] [Accepted: 07/17/2022] [Indexed: 01/10/2023]
Abstract
Biologics have emerged as an effective treatment of rheumatoid arthritis (RA). However, there is a significant proportion of patients who fail to respond to biologics. Identifying the predictors that affect the response to biologics remains challenging. A comprehensive literature search of PubMed, Embase, and Web of Science databases was conducted through May 1, 2022. We included all studies that used a multivariate model to assess for the predictors of remission in RA patients treated with biologics. We calculated pooled odds ratios (OR) with 95% confidence intervals (CI) for risk factors reported in ≥ 3 studies using a random-effects model. A total of 16,934 patients with RA who were treated with biologics were included in twenty-one studies. Our study showed that old age (OR 0.98 (0.97, 0.99), P < 0.00001), female gender (OR 0.66 (0.56, 0.77), P < 0.00001), smoking history (OR 0.86 (0.75, 0.99), P 0.04), obesity (OR 0.95 (0.91, 0.99), P 0.02), poor functional status (OR 0.62 (0.48, 1.27), P < 0.00001), high disease activity (OR 0.90 (0.85, 0.96), P 0.0005), and elevated erythrocyte sedimentation rate (OR 0.99 (0.98, 1.00), P 0.009) were poor predictors of remission. On the other hand, positive anti-citrullinated protein antibodies (OR 2.52 (1.53, 4.12), P 0.0003) was associated with high remission rate. Old age, female gender, obesity, smoking history, poor functional status, high disease activity, and elevated ESR at the time of diagnosis have been associated with poor response to biologics. Our findings could help establish a risk stratification model for predicting the remission rate in RA patients receiving biologics.
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Affiliation(s)
- Yasmin Khader
- Department of Internal Medicine, University of Toledo, 2100 West Central Ave, Toledo, OH 43606 USA
| | - Azizullah Beran
- Department of Internal Medicine, University of Toledo, 2100 West Central Ave, Toledo, OH 43606 USA
| | - Sami Ghazaleh
- Department of Internal Medicine, University of Toledo, 2100 West Central Ave, Toledo, OH 43606 USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, OH USA
| | - Nezam Altorok
- Department of Rheumatology, University of Toledo, Toledo, OH USA
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187
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Marsal Barril S, Martin-Martinez MA, Blanco-Garcia FJ, Fernández-Nebro A, García de Vicuña R, Tornero-Molina J, Sánchez-Alonso F, Novella-Navarro M, Escudero-Contreras A, Alegre-Sancho JJ, Urruticoechea-Arana A, Bustabad-Reyes MS, Trenor-Larraz P, Pérez-Sandoval T, Tevar-Sánchez MI, Sánchez-Costa JT, Raya-Álvarez E. Effectiveness and safety of tocilizumab in monotherapy in biologic-naïve and non-naïve patients with rheumatoid arthritis in a real-world setting. Reumatol Clin (Engl Ed) 2022; 18:567-573. [PMID: 36435554 DOI: 10.1016/j.reumae.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 12/09/2021] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of tocilizumab (TCZ) monotherapy in biologic-naïve patients with rheumatoid arthritis (RA) versus patients with previous biologic exposure in a real-world setting. MATERIALS AND METHODS Non-controlled clinical-trial, 32-week prospective multicenter study including RA patients with moderate-severe disease activity starting TCZ in monotherapy who had a prior inadequate response or were intolerant to methotrexate (MTX). Effectiveness according to EULAR response evaluated at 24-week and safety at 32-weekwere assessed. RESULTS Of the 93 were enrolled of whom 84 (90%) were eligible for the effectiveness analysis. Biologic-naïve patients (n=46, 54.8%) were younger (51.5 versus 57.9) with shorter disease duration (6.4 versus 13.3) but presented similar comorbidities in comparison with non-naïve patients. DAS28 remission was achieved in a higher percentage in the group of patients with prior biological treatment. 89 adverse events (AE) were recorded in 50 patients, most of them non-serious AE (non-SAE) (86.3%). CONCLUSIONS In a real world setting, TCZ exhibit similar effectiveness and safety in monotherapy in patients with RA regardless previous exposure to other biologic therapies. This study provides additional and valuable real-world findings on the use of TCZ in patients with RA.
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Affiliation(s)
- Sara Marsal Barril
- Rheumatology Department, Hospital Universitario Vall d'Hebron, Passeig de la Vall d'Hebron, 119, 129, 08035 Barcelona, Spain
| | | | | | - Antonio Fernández-Nebro
- Rheumatology Department, Biomedical Research Institute of Málaga (IBIMA), Hospital Universitario Regional de Málaga, Av. de Carlos Haya, 84, 29010 Málaga, Spain
| | - Rosario García de Vicuña
- Rheumatology Department, Hospital Universitario La Princesa, Calle de Diego de León, 62, 28006, Madrid, Spain
| | - Jesús Tornero-Molina
- Rheumatology Department, Hospital Universitario de Guadalajara, Calle Donante de Sangre, S/N, 19002 Guadalajara, Spain; Medicine and Medical Specialties Departament, University of Alcalá, Campus Universitario - C/ 19, Av. de Madrid, Km 33,600, 28871 Alcalá de Henares, Madrid, Spain
| | - Fernando Sánchez-Alonso
- Research Unit of Spanish Society of Rheumatology, Calle Marqués del Duero, 5 Primero A, 28001 Madrid, Spain
| | - Marta Novella-Navarro
- Rheumatology Department, Hospital Universitario de Torrejón, Calle Mateo Inurria, s/n, 28850 Torrejón de Ardoz, Madrid, Spain
| | - Alejandro Escudero-Contreras
- Rheumatology Department, Hospital Universitario Reina Sofia, Córdoba. Av. Menéndez Pidal, s/n, 14004, Córdoba, Spain
| | - Juan José Alegre-Sancho
- Rheumatology Department, Hospital Universitario Doctor Peset, Valencia, Av. de Gaspar Aguilar, 90, 46017 Valencia, Spain
| | - Ana Urruticoechea-Arana
- Rheumatology Department, Hospital Can Misses, Carrer de Corona, s/n, 07800 Ibiza, Islas Baleares, Spain
| | - Maria Sagrario Bustabad-Reyes
- Rheumatology Department, Hospital Universitario de Canarias, Carretera Cuesta Taco, 0, 38320 Santa Cruz de Tenerife, Islas Canarias, Spain
| | - Pilar Trenor-Larraz
- Rheumatology Department, Hospital Clínico Universitario de Valencia, Av. de Blasco Ibáñez, 17, 46010 Valencia, Spain
| | - Trinidad Pérez-Sandoval
- Rheumatoloy Department, Complejo Asistencial Universitario de León, Calle Altos de nava, s/n, 24001 León, Spain
| | - Maria Isabel Tevar-Sánchez
- Rheumatoloy Department, Hospital Vega Baja, Ctra. Orihuela - Almoradí S/N, 03314 San Bartolomé, Orihuela, Spain
| | - Jesús T Sánchez-Costa
- Research Unit of Spanish Society of Rheumatology, Calle Marqués del Duero, 5 Primero A, 28001 Madrid, Spain
| | - Enrique Raya-Álvarez
- Rheumatoloy Department(,) Hospital Universitario San Cecilio, Av. de la Investigación, s/n, 18016 Granada, Spain
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Yoshii I, Chijiwa T, Sawada N. Clinical Advantage of Attaining Index-Based Remission Prior to Composite Remission in Treating Rheumatoid Arthritis. Reumatol Clin (Engl Ed) 2022; 18:574-579. [PMID: 36435555 DOI: 10.1016/j.reumae.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/09/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVES The clinical advantage of targeting index-based remission prior to Boolean remission was evaluated retrospectively. MATERIALS AND METHODS A total of 578 patients with rheumatoid arthritis (RA), who were treated for more than three years, were recruited. Patients who were treated to targeted index-based remission and composite measure remission criteria such as Boolean remission from the first consultation were divided according to the turn of attaining Boolean remission and index-based remission: G-IBR, a group that matched index-based remission at the same time Boolean remission is attained or earlier; G-BR_IF, a group that attained Boolean remission followed by index-based remission or failed; G-IR_BF, a group that could not attain Boolean remission despite attaining index-based remission; G-BothF, a group that failed to attain either Boolean remission or index-based remission. Background factors were statistically compared among groups. The Boolean remission rate in patients who attained index-based remission (BRR) and the rate of failure to attain index-based remission in patients who failed to attain Boolean remission (BFR) were statistically evaluated. RESULTS Groups comprising 225, 231, and 482 in G-IBR; 160, 154, and 8 in G-BR_IF; 18, 18, and 75 in G-IR_BF; and 175, 175, and 13 in G-BothF when indexing the clinical disease activity index (CDAI), simplified disease activity index (SDAI), and 28-joints disease activity score with C-reactive protein (DAS28-CRP), respectively. Disease activity indices' scores after Boolean remission were demonstrated to be significantly higher in the G-BR_IF group than in the G-IBR group. BRR was 92.6%, 92.8%, and 86.5%, while BFR was 71.3%, 71.3%, and 13.8% when indexing CDAI, SDAI, and DAS28-CRP, respectively. CONCLUSIONS Targeting CDAI and SDAI remission prior to Boolean remission contributes to a stable clinical course.
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Affiliation(s)
- Ichiro Yoshii
- Department of Rheumatology and Musculoskeletal Medicine, Yoshii Hospital, Shimanto City, Kochi Prefecture, Japan.
| | - Tatsumi Chijiwa
- Department of Rheumatology, Kochi Memorial Hospital, Kochi, Kochi, Japan
| | - Naoya Sawada
- Department of Rheumatology, Dohgo Onsen Hospital, Matsuyama, Ehime Prefecture, Japan
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189
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Kong L, Wang X, Chen H, Shi Z, Lang Y, Zhang Y, Zhou H. Relapses after SARS-CoV-2 vaccination in patients with neuromyelitis optica spectrum disorder and multiple sclerosis. Mult Scler Relat Disord 2022; 68:104167. [PMID: 36170773 PMCID: PMC9472679 DOI: 10.1016/j.msard.2022.104167] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/19/2022] [Accepted: 09/08/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic outbreak raises the question of whether immunization is recommended for patients with CNS demyelinating diseases. On the one hand, existing studies suggested that SARS-CoV-2 vaccinations are not associated with increased risk of relapse activity. On the other hand, case reports with acute CNS demyelinating disease post vaccination were emerging and raising clinicians' attention. METHODS In this longitudinal observational study, we included 556 patients with neuromyelitis optica spectrum disorder (NMOSD) and 280 patients with relapsing-remitting multiple sclerosis (RRMS). Each vaccinated patient was matched to two unvaccinated patients according to age, gender, ARR and immunotherapy status, based on propensity score matching model (PSM). The primary outcome is the short- and medium-term risk of relapse, which were evaluated by Kaplan-Meier analysis between groups. RESULTS In our cohort, 649 patients (77.6%) have not yet been vaccinated, mainly due to their concerns about relapse. After PSM, 109 vaccinated patients with NMOSD, 218 PS-matched unvaccinated patients with NMOSD, 78 vaccinated patients with RRMS, and 156 PS-matched unvaccinated patients with RRMS were included in the survival analysis to explore the safety of vaccines, with a median of 9-month follow-up. Following the first vaccination dose, 10 patients with NMOSD (9.2%) and four with RRMS (5.1%) experienced an acute relapse. Meanwhile, in the PS-matched unvaccinated group, 15 patients with NMOSD (6.9%) and 12 patients with RRMS (7.7%) presented with an acute relapse. There was no significant difference between the two curves in both NMOSD and RRMS groups over the course of the observation period. There were no significant differences in demographic characteristics, clinical characteristics, and symptoms of relapses between the vaccinated and PS-matched unvaccinated groups. Post vaccination adverse events (ADE) were reported in 39 individuals (20.9%). CONCLUSION Our results indicate that inactivated SARS-CoV-2 vaccines appear safe for patients with CNS demyelinating diseases.
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190
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Mataix-Cols D, Andersson E, Aspvall K, Boberg J, Crowley JJ, de Schipper E, Fernández de la Cruz L, Flygare O, Ivanova E, Lenhard F, Lundström L, Rück C, Serlachius E, Cervin M. Operational Definitions of Treatment Response and Remission in Obsessive-Compulsive Disorder Capture Meaningful Improvements in Everyday Life. Psychother Psychosom 2022; 91:424-430. [PMID: 36382651 PMCID: PMC9838085 DOI: 10.1159/000527115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/08/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The operational definitions of treatment response, partial response, and remission in obsessive-compulsive disorder (OCD) are widely used in clinical trials and regular practice. However, the clinimetric sensitivity of these definitions, that is, whether they identify patients that experience meaningful changes in their everyday life, remains unexplored. OBJECTIVE The objective was to examine the clinimetric sensitivity of the operational definitions of treatment response, partial response, and remission in children and adults with OCD. METHODS Pre- and post-treatment data from five clinical trials and three cohort studies of children and adults with OCD (n = 1,528; 55.3% children, 61.1% female) were pooled. We compared (1) responders, partial responders, and non-responders and (2) remitters and non-remitters on self-reported OCD symptoms, clinician-rated general functioning, and self-reported quality of life. Remission was also evaluated against post-treatment diagnostic interviews. RESULTS Responders and remitters experienced large improvements across validators. Responders had greater improvements than partial responders and non-responders on self-reported OCD symptoms (Cohen's d 0.65-1.13), clinician-rated functioning (Cohen's d 0.53-1.03), and self-reported quality of life (Cohen's d 0.63-0.73). Few meaningful differences emerged between partial responders and non-responders. Remitters had better outcomes across most validators than non-remitters. Remission criteria corresponded well with absence of post-treatment diagnosis (sensitivity/specificity: 93%/83%). Using both the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Clinical Global Impression Scale yielded more conservative results and more robust changes across validators, compared to only using the Y-BOCS. CONCLUSIONS The current definitions of treatment response and remission capture meaningful improvements in the everyday life of individuals with OCD, whereas the concept of partial response has dubious clinimetric sensitivity.
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Affiliation(s)
- David Mataix-Cols
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden,*David Mataix-Cols,
| | - Erik Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Kristina Aspvall
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Julia Boberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - James J. Crowley
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Department of Genetics at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Department of Psychiatry at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elles de Schipper
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Oskar Flygare
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Ekaterina Ivanova
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Fabian Lenhard
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lina Lundström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Eva Serlachius
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Matti Cervin
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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191
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Mahmoud R, Schultheiss HP, Louwers J, van der Kaaij M, van Hellemondt B, Mahmmod N, van Boeckel P, Jharap B, Fidder H, Oldenburg B. Immunomodulator Withdrawal From Anti-TNF Therapy Is Not Associated With Loss of Response in Inflammatory Bowel Disease. Clin Gastroenterol Hepatol 2022; 20:2577-2587.e6. [PMID: 35101632 DOI: 10.1016/j.cgh.2022.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The benefit of concomitant immunomodulators (thiopurines or methotrexate) in patients with inflammatory bowel disease (IBD) on anti-tumor necrosis factor α (anti-TNF) (infliximab or adalimumab) maintenance therapy is debated. We compared outcomes after immunomodulator withdrawal vs continuation of combination therapy. METHODS This was a retrospective cohort study in a general hospital and a tertiary referral center. We included adult IBD patients, receiving anti-TNF therapy for ≥4 months, plus an immunomodulator at baseline, between January 1, 2011, and January 1, 2019. The primary endpoints were loss of response (LOR) (ie, anti-TNF discontinuation because of disease activity) and anti-drug antibodies. Adjusted hazard ratios (aHRs) were calculated by mixed-effects Cox regression analysis. RESULTS We included 614 treatment episodes of combination therapy in 543 individuals, yielding 1664 patient-years of follow-up. The immunomodulator was withdrawn in 296 (48.2%) episodes after 0.9 (interquartile range, 0.6-2.1) years, which was not associated with a higher risk of LOR (aHR, 1.08; 95% confidence interval [CI], 0.72-1.61), although anti-drug antibodies were detected more frequently (aHR, 2.14; 95% CI, 1.17-3.94), compared with continuation. Clinical remission at the time of withdrawal reduced the risk of LOR (aHR, 0.48; 95% CI, 0.25-0.93), while longer duration of combination therapy before withdrawal decreased the risk of anti-drug antibodies (HR per year, 0.56; 95% CI, 0.32-0.91). Higher prewithdrawal infliximab trough levels reduced the subsequent risks of anti-drug antibodies and LOR. Infliximab trough levels were lower after immunomodulator withdrawal (P = .01). CONCLUSIONS Patients who withdrew the immunomodulator in this retrospective cohort were not at increased risk of LOR within the following 1-2 years, but an increase in anti-drug antibodies was observed. Our findings require prospective validation, preferably in adequately powered randomized controlled trials.
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Affiliation(s)
- Remi Mahmoud
- Division of Internal Medicine and Dermatology, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hans-Paul Schultheiss
- Division of Internal Medicine and Dermatology, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jonas Louwers
- Division of Internal Medicine and Dermatology, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michiel van der Kaaij
- Division of Internal Medicine and Dermatology, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Boris van Hellemondt
- Division of Internal Medicine and Dermatology, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nofel Mahmmod
- Division of Internal Medicine, Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Petra van Boeckel
- Division of Internal Medicine, Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Bindia Jharap
- Division of Internal Medicine, Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, the Netherlands
| | - Herma Fidder
- Division of Internal Medicine and Dermatology, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bas Oldenburg
- Division of Internal Medicine and Dermatology, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.
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192
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Stevelink R, Al-Toma D, Jansen FE, Lamberink HJ, Asadi-Pooya AA, Farazdaghi M, Cação G, Jayalakshmi S, Patil A, Özkara Ç, Aydın Ş, Gesche J, Beier CP, Stephen LJ, Brodie MJ, Unnithan G, Radhakrishnan A, Höfler J, Trinka E, Krause R, Irelli EC, Di Bonaventura C, Szaflarski JP, Hernández-Vanegas LE, Moya-Alfaro ML, Zhang Y, Zhou D, Pietrafusa N, Specchio N, Japaridze G, Beniczky S, Janmohamed M, Kwan P, Syvertsen M, Selmer KK, Vorderwülbecke BJ, Holtkamp M, Viswanathan LG, Sinha S, Baykan B, Altindag E, von Podewils F, Schulz J, Seneviratne U, Viloria-Alebesque A, Karakis I, D'Souza WJ, Sander JW, Koeleman BP, Otte WM, Braun KP. Individualised prediction of drug resistance and seizure recurrence after medication withdrawal in people with juvenile myoclonic epilepsy: A systematic review and individual participant data meta-analysis. EClinicalMedicine 2022; 53:101732. [PMID: 36467455 PMCID: PMC9716332 DOI: 10.1016/j.eclinm.2022.101732] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A third of people with juvenile myoclonic epilepsy (JME) are drug-resistant. Three-quarters have a seizure relapse when attempting to withdraw anti-seizure medication (ASM) after achieving seizure-freedom. It is currently impossible to predict who is likely to become drug-resistant and safely withdraw treatment. We aimed to identify predictors of drug resistance and seizure recurrence to allow for individualised prediction of treatment outcomes in people with JME. METHODS We performed an individual participant data (IPD) meta-analysis based on a systematic search in EMBASE and PubMed - last updated on March 11, 2021 - including prospective and retrospective observational studies reporting on treatment outcomes of people diagnosed with JME and available seizure outcome data after a minimum one-year follow-up. We invited authors to share standardised IPD to identify predictors of drug resistance using multivariable logistic regression. We excluded pseudo-resistant individuals. A subset who attempted to withdraw ASM was included in a multivariable proportional hazards analysis on seizure recurrence after ASM withdrawal. The study was registered at the Open Science Framework (OSF; https://osf.io/b9zjc/). FINDINGS Our search yielded 1641 articles; 53 were eligible, of which the authors of 24 studies agreed to collaborate by sharing IPD. Using data from 2518 people with JME, we found nine independent predictors of drug resistance: three seizure types, psychiatric comorbidities, catamenial epilepsy, epileptiform focality, ethnicity, history of CAE, family history of epilepsy, status epilepticus, and febrile seizures. Internal-external cross-validation of our multivariable model showed an area under the receiver operating characteristic curve of 0·70 (95%CI 0·68-0·72). Recurrence of seizures after ASM withdrawal (n = 368) was predicted by an earlier age at the start of withdrawal, shorter seizure-free interval and more currently used ASMs, resulting in an average internal-external cross-validation concordance-statistic of 0·70 (95%CI 0·68-0·73). INTERPRETATION We were able to predict and validate clinically relevant personalised treatment outcomes for people with JME. Individualised predictions are accessible as nomograms and web-based tools. FUNDING MING fonds.
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Affiliation(s)
- Remi Stevelink
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
- Corresponding author. Department of Child Neurology, University Medical Center Utrecht, 3584 CX, Utrecht, Netherlands.
| | - Dania Al-Toma
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Floor E. Jansen
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Herm J. Lamberink
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Ali A. Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Zand, Shiraz, Iran
- Department of Neurology, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA, 19107, USA
| | - Mohsen Farazdaghi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Zand, Shiraz, Iran
| | - Gonçalo Cação
- Department of Neurology, Unidade Local de Saude do Alto Minho, Estrada de Santa Luzia, Viana do Castelo, 4904-858, Portugal
| | - Sita Jayalakshmi
- Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad, 500003, India
| | - Anuja Patil
- Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad, 500003, India
| | - Çiğdem Özkara
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Kocamustafapaşa caddesi, Istanbul, 34098, Turkey
| | - Şenay Aydın
- Department of Neurology, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, University of Health Sciences, Belgrat Kapı yolu, Istanbul, 34020, Turkey
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, J.B. Winsløws Vej 4, Odense, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 4, Odense, 5000, Denmark
| | - Christoph P. Beier
- Department of Neurology, Odense University Hospital, J.B. Winsløws Vej 4, Odense, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 4, Odense, 5000, Denmark
| | - Linda J. Stephen
- Epilepsy Unit, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - Martin J. Brodie
- Epilepsy Unit, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - Gopeekrishnan Unnithan
- Department of Neurology, R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Chalakkuzhi, Medical College Road, Trivandrum, 695011, India
| | - Ashalatha Radhakrishnan
- Department of Neurology, R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Chalakkuzhi, Medical College Road, Trivandrum, 695011, India
| | - Julia Höfler
- Department of Neurology and Neuroscience Institute, Christian Doppler Medical Centre, Paracelsus Medical University and Centre for Cognitive Neuroscience, European Reference Network EpiCARE, Ignaz-Harrer Straße 79, Salzburg, 5020, Austria
| | - Eugen Trinka
- Department of Neurology and Neuroscience Institute, Christian Doppler Medical Centre, Paracelsus Medical University and Centre for Cognitive Neuroscience, European Reference Network EpiCARE, Ignaz-Harrer Straße 79, Salzburg, 5020, Austria
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Hellbrunner Straße 34, Salzburg, 3100, Austria
- Department of Public Health, University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnöfer-Zentrum 1, Hall in Tirol, 6060, Austria
| | - Roland Krause
- Bioinformatics Core Facility, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, 6 Ave du Swing, Belvaux, 4367, Luxembourg
| | | | - Emanuele Cerulli Irelli
- Department of Human Neurosciences, Epilepsy Unit, Sapienza, University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Epilepsy Unit, Sapienza, University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| | - Jerzy P. Szaflarski
- Departments of Neurology, Neurosurgery, and Neurobiology, UAB Epilepsy Center, University of Alabama at Birmingham Heersink School of Medicine, 1670 University Blvd, Birmingham, AL, 35294, USA
| | - Laura E. Hernández-Vanegas
- Department of Clinical Research, Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, Mexico, 14269, Mexico
| | - Monica L. Moya-Alfaro
- Department of Clinical Research, Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, Mexico, 14269, Mexico
| | - Yingying Zhang
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
| | - Nicola Pietrafusa
- Department of Neuroscience, Division of Neurology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome, 00165, Italy
| | - Nicola Specchio
- Department of Neuroscience, Division of Neurology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome, 00165, Italy
| | - Giorgi Japaridze
- Department of Clinical Neurophysiology, Institute of Neurology and Neuropsychology, 83/11 Vazha-Pshavela Ave., Tbilisi, 186, Georgia
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Filadelfia, Visby Allé 5, Dianalund, 4293, Denmark
- Department of Clinical Neurophysiology, Aarhus University Hospital and Aarhus University, Palle Juul-Jensens Blvd. 99, Aarhus, 8200, Denmark
| | - Mubeen Janmohamed
- Department of Neurosciences, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Patrick Kwan
- Department of Neurosciences, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
- Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, Victoria, Australia
| | - Marte Syvertsen
- Department of Neurology, Vestre Viken Hospital Trust, Dronninggata 28, Drammen, 3004, Norway
| | - Kaja K. Selmer
- National Centre for Epilepsy & Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, G. F. Henriksens vei 29, Sandvika, 1337, Norway
| | - Bernd J. Vorderwülbecke
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Martin Holtkamp
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | | | - Sanjib Sinha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, 560029, India
| | - Betül Baykan
- Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Millet Cad, Istanbul, 34390, Turkey
| | - Ebru Altindag
- Department of Neurology, Istanbul Florence Nightingale Hospital, Abide-i Hürriyet Cad, Istanbul, 34381, Turkey
| | - Felix von Podewils
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Sauerbruchstraße, Greifswald, 17489, Germany
| | - Juliane Schulz
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Sauerbruchstraße, Greifswald, 17489, Germany
| | - Udaya Seneviratne
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 55 Victoria Parade, Melbourne, Victoria, 3065, Australia
- Department of Medicine, The School of Clinical Sciences at Monash Health, Monash University, Clayton Road, Melbourne, Victoria, 3168, Australia
| | - Alejandro Viloria-Alebesque
- Department of Neurology, Hospital General de la Defensa, Vía Ibérica 1, Zaragoza, 50009, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, Avda. San Juan Bosco 13, Zaragoza, 50009, Spain
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE, Office 335, Atlanta, GA, 30303, USA
| | - Wendyl J. D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 55 Victoria Parade, Melbourne, Victoria, 3065, Australia
| | - Josemir W. Sander
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
- Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 7, Heemstede, Netherlands
- UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Bobby P.C. Koeleman
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Willem M. Otte
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Kees P.J. Braun
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
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Jensen S, Mortensen EL, Skarphedinsson G, Højgaard DR, Hybel KA, Nissen JB, Tord Ivarsson, Weidle B, Torp NC, Thomsen PH. Long- term remission status in pediatric obsessive-compulsive disorder: Evaluating the predictive value of symptom severity after treatment. Psychiatry Res 2022; 317:114906. [PMID: 36265194 DOI: 10.1016/j.psychres.2022.114906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/30/2022] [Accepted: 10/12/2022] [Indexed: 11/15/2022]
Abstract
It is unknown if long-term remission for pediatric obsessive-compulsive disorder (OCD) patients is associated with post-treatment OCD symptom severity. The aim of the present study was to evaluate if post-treatment symptom severity cut-offs can discriminate remitters from non-remitters in pediatric OCD patients during three years of follow-up. All participants (N = 269) from the Nordic Long-term OCD Treatment Study (NordLOTS) undergoing stepped-care treatment were included. Patients were rated with the Clinical Global Impression - Severity Scale (CGI-S) one (n = 186), two (n = 167), and three years (n = 166) after first-line cognitive-behavioral therapy. Post-treatment symptom severity scores as well as percentage reductions during treatment evaluated with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) were analyzed using receiver operating characteristics according to the CGI-S remission scores (< 2) at follow-up. Post-treatment CY-BOCS severity scores acceptably discriminated remitters from non-remitters at one-year follow-up, but poorly for the two- and three-year follow-up. Severity percentage reduction during treatment did not discriminate remission status acceptably at any follow-up point. Post-treatment OCD symptom severity status seems to have little discriminative value for long-term remission status in pediatric patients. Further research is warranted to detect post-treatment factors of prognostic value.
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Affiliation(s)
- Sanne Jensen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - Erik L Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Denmark
| | | | - David Rma Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Katja A Hybel
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Judith B Nissen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Tord Ivarsson
- Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Norwegian University of Science and Technology, Trondheim, Norway; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bernhard Weidle
- Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nor C Torp
- Division of Mental Health and Addiction, Vestre Viken Hospital, Drammen, Norway; Akershus University Hospital, Oslo, Norway
| | - Per H Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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Chen J, Liu L, Ma R, Pang A, Yang D, Chen X, Wei J, He Y, Zhang R, Zhai W, Ma Q, Jiang E, Han M, Zhou J, Feng S. Outcome of autologous stem cell transplantation in patients with favorable-risk acute myeloid leukemia in first remission. Cancer Cell Int 2022; 22:332. [PMID: 36316734 PMCID: PMC9623918 DOI: 10.1186/s12935-022-02750-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/18/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of autologous hematopoietic stem cell transplantation (auto-HSCT) in patients with favorable-risk acute myeloid leukemia in first remission. METHOD Twenty patients who received auto-HSCT at our center between January 2014 and January 2021 were retrospectively reviewed. RESULTS Until last follow-up, three patients in the cohort were dead due to relapse. The estimated 1-year and 5-year overall survival were 95.00% ± 4.87% and 83.82% ± 8.58%, respectively. The estimated 5-year RFS and CIR (cumulative incidence of relapse) were 85.00% ± 7.98% and 15.00% ±7.98%, respectively. CONCLUSION The outcome of auto-HSCT in patients with favorable-risk acute myeloid leukemia in first remission was excellent and auto-HSCT could be an effective treatment for these patients.
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Affiliation(s)
- Juan Chen
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, 300020 Tianjin, China ,grid.429222.d0000 0004 1798 0228Department of Hematology, The First Affiliated Hospital of Soochow University, National Clinical Research Center for Hematologic Diseases, Soochow University, 215006 Suzhou, China ,grid.429222.d0000 0004 1798 0228Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Collaborative Innovation Center of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, 215006 Suzhou, China
| | - Li Liu
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, 300020 Tianjin, China
| | - Runzhi Ma
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, 300020 Tianjin, China
| | - Aiming Pang
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, 300020 Tianjin, China
| | - Donglin Yang
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, 300020 Tianjin, China
| | - Xin Chen
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, 300020 Tianjin, China
| | - Jialin Wei
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, 300020 Tianjin, China
| | - Yi He
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, 300020 Tianjin, China
| | - Rongli Zhang
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, 300020 Tianjin, China
| | - Weihua Zhai
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, 300020 Tianjin, China
| | - Qiaoling Ma
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, 300020 Tianjin, China
| | - Erlie Jiang
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, 300020 Tianjin, China
| | - Mingzhe Han
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, 300020 Tianjin, China
| | - Jiaxi Zhou
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, 300020 Tianjin, China
| | - Sizhou Feng
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, 300020 Tianjin, China
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Tahedl M, Levine SM, Weissert R, Kohl Z, Lee DH, Linker RA, Schwarzbach JV. Early remission in multiple sclerosis is linked to altered coherence of the Cerebellar Network. J Transl Med 2022; 20:488. [PMID: 36303221 PMCID: PMC9615296 DOI: 10.1186/s12967-022-03576-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/06/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The development of permanent disability in multiple sclerosis (MS) is highly variable among patients, and the exact mechanisms that contribute to this disability remain unknown. METHODS Following the idea that the brain has intrinsic network organization, we investigated changes of functional networks in MS patients to identify possible links between network reorganization and remission from clinical episodes in MS. Eighteen relapsing-remitting MS patients (RRMS) in their first clinical manifestation underwent resting-state functional MRI and again during remission. We used ten template networks, identified from independent component analysis, to compare changes in network coherence for each patient compared to those of 44 healthy controls from the Human Connectome Project test-retest dataset (two-sample t-test of pre-post differences). Combining a binomial test with Monte Carlo procedures, we tested four models of how functional coherence might change between the first clinical episode and remission: a network can change its coherence (a) with itself ("one-with-self"), (b) with another network ("one-with-other"), or (c) with a set of other networks ("one-with-many"), or (d) multiple networks can change their coherence with respect to one common network ("many-with-one"). RESULTS We found evidence supporting two of these hypotheses: coherence decreased between the Executive Control Network and several other networks ("one-with-many" hypothesis), and a set of networks altered their coherence with the Cerebellar Network ("many-with-one" hypothesis). CONCLUSION Given the unexpected commonality of the Cerebellar Network's altered coherence with other networks (a finding present in more than 70% of the patients, despite their clinical heterogeneity), we conclude that remission in MS may result from learning processes mediated by the Cerebellar Network.
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Affiliation(s)
- Marlene Tahedl
- grid.7727.50000 0001 2190 5763Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany ,grid.7727.50000 0001 2190 5763Institute for Psychology, University of Regensburg, 93053 Regensburg, Germany
| | - Seth M. Levine
- grid.5252.00000 0004 1936 973XDepartment of Psychology, LMU Munich, 80802 Munich, Germany ,grid.411095.80000 0004 0477 2585NeuroImaging Core Unit Munich (NICUM), University Hospital LMU, 80336 Munich, Germany
| | - Robert Weissert
- grid.7727.50000 0001 2190 5763Department of Neurology, University of Regensburg, 93053 Regensburg, Germany
| | - Zacharias Kohl
- grid.7727.50000 0001 2190 5763Department of Neurology, University of Regensburg, 93053 Regensburg, Germany
| | - De-Hyung Lee
- grid.7727.50000 0001 2190 5763Department of Neurology, University of Regensburg, 93053 Regensburg, Germany
| | - Ralf A. Linker
- grid.7727.50000 0001 2190 5763Department of Neurology, University of Regensburg, 93053 Regensburg, Germany
| | - Jens V. Schwarzbach
- grid.7727.50000 0001 2190 5763Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
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Moradi M, Kabir A, Khalili D, Lakeh MM, Dodaran MS, Pazouki A, Kermansaravi M, Alibeigi P, Moazenzadeh H, Abdolhosseini MR, Eghbali F, Baradaran HR. Type 2 diabetes remission after Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and one anastomosis gastric bypass (OAGB): results of the longitudinal assessment of bariatric surgery study. BMC Endocr Disord 2022; 22:260. [PMID: 36289529 PMCID: PMC9598002 DOI: 10.1186/s12902-022-01171-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/12/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Several studies on various bariatric surgeries involving patients with type 2 diabetes mellitus (T2DM) showed an overall rate of remission of hyperglycemia. However, there is little known about predictive factors on remission after different types of surgeries. The aim of this study was to identify the T2DM remission rate and to determine the effects of preoperative factors characteristics of remission of type 2 diabetes in Iran. METHODS We conducted a retrospective analysis of 1351 patients with T2DM operated by three different types of surgeries (Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and One Anastomosis Gastric Bypass (OAGB)). Diabetes remission was defined according to the American Diabetes Association (ADA) criteria. Binary logistic regression analyses were employed. RESULTS A total of 1351 patients, 675 patients (50.0%) undergoing OAGB, 475 (35.2%) RYGB, and 201 (14.9%) SG. 80.6%, 84.2% of OAGB, 81.7%, 82.6% of RYGB, and 77.1%, 81.5% of SG participants were in T2DM remission after 1 and 3 years, respectively. 1- and 3-year remission were associated with preoperative age, duration of T2DM, FBS and HbA1c, BMI, insulin therapy, and a family history of obesity (p < 0.05). CONCLUSION The remission of T2DM after RYGB, SG, and OAGB surgery is dependent on various preoperative factors. Patients with younger age, shorter duration of T2DM, lower preoperative HbA1c and FBS, higher BMI, who were not on insulin therapy, and not having a family history of obesity were the best candidates to achieve a prolonged diabetes remission.
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Affiliation(s)
- Marziyeh Moradi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maziar Moradi Lakeh
- Preventive Medicine and Public Health Research Center, Department of Community and Family Medicine, School of Medicine, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Solaymani Dodaran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Peyman Alibeigi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram and Nikan Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Reza Abdolhosseini
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Foolad Eghbali
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, AB25 2ZD Aberdeen, Scotland, UK
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
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De Craemer AS, Łukasik Z, Carron P. Use of Imaging in Axial Spondyloarthritis for Diagnosis and Assessment of Disease Remission in the Year 2022. Curr Rheumatol Rep 2022. [PMID: 36242738 DOI: 10.1007/s11926-022-01091-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
Medical imaging remains the cornerstone of diagnostics and follow-up of axial spondyloarthritis (axSpA) patients. With the lack of specific biomarkers allowing monitoring of disease activity and progression, clinicians refer to imaging modalities for accurate evaluation of the axSpA burden. Technological advances and increasing availability of modern imaging techniques such as MRI have enabled faster diagnosis of the disease, hence dramatically changed the diagnostic delay and improved the prognosis and functional outcomes for axSpA patients.Active sacroiliitis as visualized by MRI has been widely accepted as a diagnostic tool, and definitions of inflammatory and structural lesions within the axial skeleton have been developed. Recently, it has been acknowledged that bone marrow edema, suggestive of sacroiliitis, is a common finding among non-SpA patients, and could be attributed to mechanical loading or accumulate with age in healthy individuals. Therefore, it is crucial to distinguish between true pathological and concealing imaging findings, not only for diagnostic but also for disease remission purposes. New imaging modalities, aimed for in vivo visualization of specific molecular processes, could be employed to cross-validate findings from techniques used in daily clinical practice. This review critically evaluates the use of different imaging modalities for diagnosis and assessment of disease remission in axSpA in the year 2022.
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Beliveau V, Hedeboe E, Fisher PM, Dam VH, Jørgensen MB, Frokjaer VG, Knudsen GM, Ganz M. Generalizability of treatment outcome prediction in major depressive disorder using structural MRI: A NeuroPharm study. Neuroimage Clin 2022; 36:103224. [PMID: 36252556 PMCID: PMC9668596 DOI: 10.1016/j.nicl.2022.103224] [Citation(s) in RCA: 3] [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: 04/22/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/11/2022]
Abstract
Brain morphology has been suggested to be predictive of drug treatment outcome in major depressive disorders (MDD). The current study aims at evaluating the performance of pretreatment structural brain magnetic resonance imaging (MRI) measures in predicting the outcome of a drug treatment of MDD in a large single-site cohort, and, importantly, to assess the generalizability of these findings in an independent cohort. The random forest, boosted trees, support vector machines and elastic net classifiers were evaluated in predicting treatment response and remission following an eight week drug treatment of MDD using structural brain measures derived with FastSurfer (FreeSurfer). Models were trained and tested within a nested cross-validation framework using the NeuroPharm dataset (n = 79, treatment: escitalopram); their generalizability was assessed using an independent clinical dataset, EMBARC (n = 64, treatment: sertraline). Prediction of antidepressant treatment response in the Neuropharm cohort was statistically significant for the random forest (p = 0.048), whereas none of the models could significantly predict remission. Furthermore, none of the models trained using the entire NeuroPharm dataset could significantly predict treatment outcome in the EMBARC dataset. Although our primary findings in the NeuroPharm cohort support some, but limited value in using pretreatment structural brain MRI to predict drug treatment outcome in MDD, the models did not generalize to an independent cohort suggesting limited clinical applicability. This study emphasizes the importance of assessing model generalizability for establishing clinical utility.
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Affiliation(s)
- Vincent Beliveau
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark,Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria,Corresponding author at: Neurobiology Research Unit, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Ella Hedeboe
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Patrick M. Fisher
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Vibeke H. Dam
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Martin B. Jørgensen
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Vibe G. Frokjaer
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Gitte M. Knudsen
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Melanie Ganz
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark,Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
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Sánchez J, Álvarez L, Cardona R. Prospective analysis of clinical evolution in chronic urticaria: Persistence, remission, recurrence, and pruritus alone. World Allergy Organ J 2022; 15:100705. [PMID: 36267098 DOI: 10.1016/j.waojou.2022.100705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/25/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Population and study's methodology heterogenicity became clinical evolution of chronic spontaneous urticaria (CSU) highly variable. Objective In a prospective cohort, we evaluated the different pathways of clinical evolution of CSU and identified possible risk factors. Methods A total of 685 CSU patients (>12 years) were prospectively followed over 5 years. Diagnosis and follow-up of urticaria were based on medical evaluation and photographic records. Remission was defined as at least 6 months without symptoms (hives, angioedema, or pruritus) and medication. The follow-up included at least 2 visits per year, with photographic registration and clinical evaluation. Predefined clinical and paraclinical variables were included in the regression analyses. Results We identified four clinical evolution pathways; The cumulative prevalence of remission at 5 years was 59.1%, recurrence was 17.1%, persistence was 11.6%, and chronic pruritus without hives or angioedema was 12.2%. The probability of persistence increased with hypothyroidism diagnosis (HR 0.425, 95% CI 0.290-0.621) and each point in the UAS7 (HR 0.931 95% CI 0.918-0.945). Conclusion Chronic urticaria has different evolutions. Disease activity and hypothyroidism predict persistence and remission. Recurrence and chronic pruritus phenotypes require further study to evaluate their causality and prognosis.
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Trimpou P, Backlund E, Ragnarsson O, Skoglund T, Hallén T, Gudnadottir G, Carlqvist J, Farahmand D. Long-Term Outcomes and Complications from Endoscopic Versus Microscopic Transsphenoidal Surgery for Cushing's Disease: A 15-Year Single-Center Study. World Neurosurg 2022; 166:e427-e434. [PMID: 35840092 DOI: 10.1016/j.wneu.2022.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/14/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Endoscopic endonasal surgery is the main transsphenoidal approach for pituitary surgery in many centers; however, few studies compare the endoscopic and microscopic surgical approaches with regard to long-term follow-up. This single-center study aimed to compare the 2 techniques over 15 years. METHODS Medical records and magnetic resonance images from 40 patients with primary transsphenoidal surgery for Cushing's disease at Sahlgrenska University Hospital between 2003 and 2018 were reviewed. 14 patients who underwent microscopic surgery and 26 patients who underwent endoscopic surgery were included in this study. RESULTS In the microscopic group, 12 of 14 patients achieved endocrine remission, compared to 19 of 26 patients in the endoscopic group (n. s.). Three patients in each group developed a late recurrence. Complications were seen in 5 patients in the microscopic group and in 8 patients in the endoscopic group (n. s.). No serious complications, such as carotid artery damage, cerebrovascular fluid leakage, epistaxis, or meningitis, occurred in any group. The postoperative hospital stay was shorter in the endoscopic than in the microscopic group. CONCLUSIONS Endoscopic endonasal surgery for Cushing's disease showed no difference in remission, recurrence, and complication rates compared to the microscopic approach. The endoscopic group had a shorter postoperative hospital stay than the microscopic group, which in part may be due to the minimal invasiveness of the endoscopic approach.
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Affiliation(s)
- Penelope Trimpou
- Section for Endocrinology, Sahlgrenska University Hospital, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Erika Backlund
- Department of Neurosurgery, Sahlgrenska University Hospital, Institution of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Oskar Ragnarsson
- Section for Endocrinology, Sahlgrenska University Hospital, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Skoglund
- Department of Neurosurgery, Sahlgrenska University Hospital, Institution of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tobias Hallén
- Department of Neurosurgery, Sahlgrenska University Hospital, Institution of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunnhildur Gudnadottir
- Department of Otorhinolaryngology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jeanette Carlqvist
- Department of Radiology, Neuroradiology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dan Farahmand
- Department of Neurosurgery, Sahlgrenska University Hospital, Institution of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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