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Carroll KM, Kiluk BD, Nich C, DeVito EE, Decker S, LaPaglia D, Duffey D, Babuscio TA, Ball SA. Toward empirical identification of a clinically meaningful indicator of treatment outcome: features of candidate indicators and evaluation of sensitivity to treatment effects and relationship to one year follow up cocaine use outcomes. Drug Alcohol Depend 2014; 137:3-19. [PMID: 24556275 PMCID: PMC4042667 DOI: 10.1016/j.drugalcdep.2014.01.012] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/11/2014] [Accepted: 01/14/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Selection of an appropriate indictor of treatment response in clinical trials is complex, particularly for the various illicit drugs of abuse. Most widely used indicators have been selected based on expert group recommendation or convention rather than systematic empirical evaluation. Absence of an evidence-based, clinically meaningful index of treatment outcome hinders cross-study evaluations necessary for progress in addiction treatment science. METHOD Fifteen candidate indicators used in multiple clinical trials as well as some proposed recently are identified and discussed in terms of relative strengths and weaknesses (practicality, cost, verifiability, sensitivity to missing data). Using pooled data from five randomized controlled trials of cocaine dependence (N=434), the indicators were compared in terms of sensitivity to the effects of treatment and relationship to cocaine use and general functioning during follow-up. RESULTS Commonly used outcome measures (percent negative urine screens; percent days of abstinence) performed relatively well in that they were sensitive to the effects of the therapies evaluated. Others, including complete abstinence and reduction in frequency of use, were less sensitive to effects of specific therapies and were very weakly related to cocaine use or functioning during follow-up. Indicators more strongly related to cocaine use during follow-up were those that reflected achievement of sustained periods of abstinence, particularly at the end of treatment. CONCLUSIONS These analyses did not demonstrate overwhelming superiority of any single indicator, but did identify several that performed particularly poorly. Candidates for elimination included retention, complete abstinence, and indicators of reduced frequency of cocaine use.
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Affiliation(s)
- Kathleen M. Carroll
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516
| | - Brian D. Kiluk
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516
| | - Charla Nich
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516
| | - Elise E. DeVito
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516
| | - Suzanne Decker
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516,New England Mental Illness, Research Education and Clinical Center, VA Connecticut Healthcare System
| | - Donna LaPaglia
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516
| | - Dianne Duffey
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516
| | - Theresa A. Babuscio
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516
| | - Samuel A. Ball
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516,The APT Foundation, New Haven Connecticut, 1 Long Wharf, New Haven CT 06511
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102
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Servais S, Lengline E, Porcher R, Carmagnat M, Peffault de Latour R, Robin M, Sicre de Fontebrune F, Clave E, Maki G, Granier C, Xhaard A, Dhedin N, Molina JM, Toubert A, Moins-Teisserenc H, Socie G. Long-term immune reconstitution and infection burden after mismatched hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2014; 20:507-17. [PMID: 24406505 DOI: 10.1016/j.bbmt.2014.01.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/02/2014] [Indexed: 12/19/2022]
Abstract
Mismatched unrelated donor (MMUD) or umbilical cord blood (UCB) can be chosen as alternative donors for allogeneic stem cell transplantation but might be associated with long-lasting immune deficiency. Sixty-six patients who underwent a first transplantation from either UCB (n = 30) or 9/10 MMUD (n = 36) and who survived beyond 3 months were evaluated. Immune reconstitution was prospectively assessed at sequential time points after transplantation. NK, B, CD4(+), and CD8(+) T cells and their naïve and memory subsets, as well as regulatory T cells (Treg), were studied. Detailed analyses on infections occurring after 3 months were also assessed. The 18-month cumulative incidences of infection-related death were 8% and 3%, and of infections were 72% and 57% after MMUD and UCB transplantation, respectively. Rates of infection per 12 patient-month were roughly 2 overall (1 for bacterial, .9 for viral, and .3 for fungal infections). Memory, naïve CD4(+) and CD8(+)T cells, naïve B cells, and Treg cells reconstitution between the 2 sources were roughly similar. Absolute CD4(+)T cells hardly reached 500 per μL by 1 year after transplantation and most B cells were of naïve phenotype. Correlations between immune reconstitution and infection were then performed by multivariate analyses. Low CD4(+) and high CD8(+)T cells absolute counts at 3 months were linked to increased risks of overall and viral (but not bacterial) infections. When assessing for the naïve/memory phenotypes at 3 months among the CD4(+) T cell compartment, higher percentages of memory subsets were protective against late infections. Central memory CD4(+)T cells protected against overall and bacterial infections; late effector memory CD4(+)T cells protected against overall, bacterial, and viral infections. To the contrary, high percentage of effector- and late effector-memory subsets at 3 months among the CD8(+) T cell compartment predicted higher risks for viral infections. Patients who underwent transplantation from alternative donors represent a population with very high risk of infection. Detailed phenotypic analysis of immune reconstitution may help to evaluate infection risk and to adjust infection prophylaxis.
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Affiliation(s)
- Sophie Servais
- Service d'Hématologie Greffe, AP-HP Hôpital Saint Louis, Paris, France
| | - Etienne Lengline
- Service d'Hématologie Greffe, AP-HP Hôpital Saint Louis, Paris, France
| | | | | | | | - Marie Robin
- Service d'Hématologie Greffe, AP-HP Hôpital Saint Louis, Paris, France
| | | | - Emmanuel Clave
- Immunologie, AP-HP Hôpital Saint Louis, Paris, France; Inserm U 940, Hôpital Saint Louis, Paris, France
| | - Guitta Maki
- Immunologie, AP-HP Hôpital Saint Louis, Paris, France
| | | | - Alienor Xhaard
- Service d'Hématologie Greffe, AP-HP Hôpital Saint Louis, Paris, France
| | - Nathalie Dhedin
- Service d'Hématologie Greffe, AP-HP Hôpital Saint Louis, Paris, France
| | - Jean-Michel Molina
- Service des Maladies Infectieuses et Tropicales, AP-HP Hôpital Saint Louis, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, France
| | - Antoine Toubert
- Immunologie, AP-HP Hôpital Saint Louis, Paris, France; Inserm U 940, Hôpital Saint Louis, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, France
| | - Hélène Moins-Teisserenc
- Immunologie, AP-HP Hôpital Saint Louis, Paris, France; Inserm U 940, Hôpital Saint Louis, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, France
| | - Gérard Socie
- Service d'Hématologie Greffe, AP-HP Hôpital Saint Louis, Paris, France; Inserm U 940, Hôpital Saint Louis, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, France.
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103
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Durmuş B, Arends LR, Ay L, Hokken-Koelega AC, Raat H, Hofman A, Steegers EAP, Jaddoe VWV. Parental anthropometrics, early growth and the risk of overweight in pre-school children: the Generation R Study. Pediatr Obes 2013; 8:339-50. [PMID: 23239588 DOI: 10.1111/j.2047-6310.2012.00114.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 08/30/2012] [Accepted: 09/28/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are limited data regarding the associations of both maternal and paternal anthropometrics with longitudinally measured post-natal growth measures in early childhood. OBJECTIVE To assess the associations of maternal and paternal anthropometrics with growth characteristics and the risk of overweight in pre-school children. STUDY DESIGN Population-based prospective cohort study from early foetal life onwards in the Netherlands. METHODS Maternal pre-pregnancy anthropometrics and gestational weight gain, and paternal anthropometrics were related to foetal and post-natal growth measures and the risk of overweight until the age of 4 years. Analyses were based on 5674 mothers, fathers and their children. RESULTS Both pre-pregnancy maternal and paternal height, weight and body mass index were associated with corresponding foetal and post-natal anthropometric measures. Maternal body mass index had a significantly stronger effect on childhood body mass index than paternal body mass index. As compared to children from parents with normal body mass index, children from two obese parents had an increased risk of overweight at the age of 4 years (odds ratio 6.52 (95% confidence interval 3.44, 12.38). Maternal gestational weight gain was only among mothers with normal body mass index associated with body mass index and the risk of overweight in the children. CONCLUSION Maternal and paternal anthropometrics affect early growth in pre-school children differently. Gestational weight gain in mothers without overweight and obesity is related to the risk of overweight in early childhood.
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Affiliation(s)
- B Durmuş
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
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Peels DA, Bolman C, Golsteijn RHJ, de Vries H, Mudde AN, van Stralen MM, Lechner L. Long-term efficacy of a printed or a Web-based tailored physical activity intervention among older adults. Int J Behav Nutr Phys Act 2013; 10:104. [PMID: 24228862 PMCID: PMC3766084 DOI: 10.1186/1479-5868-10-104] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 08/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study provides insight into the long-term efficacy (i.e. 12 month results) of the Web-based or print-delivered tailored Active Plus intervention (with and without environmental approach) to promote physical activity (PA) among the over-fifties. Differences in effect among subgroups are studied as well. METHODS Intervention groups (i.e. print-delivered basic (PB; N = 439), print-delivered environmental (PE; N = 435), Web-based basic (WB; N = 423), Web-based environmental (WE; N = 432)) and a waiting list control group (N = 411) were studied in a clustered randomized controlled trial. Intervention participants received tailored advice three times within 4 months. Long-term effects (12 months after the intervention has started, i.e. 8 months after the intervention was completed) on PA (i.e. self-reported weekly minutes and days of sufficient PA) were tested using multilevel linear regression analyses. Participants' age, gender, BMI, educational level, PA intention and the presence of a chronic physical limitation were considered to be potential moderators of the effect. RESULTS Overall, the Active Plus intervention was effective in increasing weekly days of sufficient PA (B=0.49; p=.005), but ineffective in increasing weekly minutes of PA (B=84.59; p=.071). Per intervention condition analysis showed that the PB-intervention (B(days)=0.64; p=.002; B(min)=111.36; p=.017) and the PE-intervention (B(days)=0.70; p=.001; B(min)=157.41; p=.001) were effective in increasing days and minutes of PA. Neither Web-based conditions significantly increased PA, while the control group decreased their PA. In contrast to the intervention effect on minutes of PA, the effect on weekly days of PA was significantly moderated by the participants' baseline intention to be sufficiently physically active. CONCLUSIONS In general, after 12 months the print-delivered interventions resulted in stronger effects than the Web-based interventions. The participants' baseline intention was the only significant moderator of the intervention effect. All other assessed user characteristics did not significantly moderate the effect of the intervention, which might indicate that the intervention is sufficiently tailored to the different participant characteristics. Additional efforts should be taken to increase the sustainability of Web-based interventions. TRIAL REGISTRATION Dutch Trial Register: NTR2297.
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Affiliation(s)
- Denise Astrid Peels
- Department of Psychology, Open University of the Netherlands, PO Box 2960, 6401, DL Heerlen, the Netherlands.
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105
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Multiple imputation of missing values was not necessary before performing a longitudinal mixed-model analysis. J Clin Epidemiol 2013; 66:1022-8. [DOI: 10.1016/j.jclinepi.2013.03.017] [Citation(s) in RCA: 275] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 03/08/2013] [Accepted: 03/18/2013] [Indexed: 11/20/2022]
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106
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Thabane L, Mbuagbaw L, Zhang S, Samaan Z, Marcucci M, Ye C, Thabane M, Giangregorio L, Dennis B, Kosa D, Debono VB, Dillenburg R, Fruci V, Bawor M, Lee J, Wells G, Goldsmith CH. A tutorial on sensitivity analyses in clinical trials: the what, why, when and how. BMC Med Res Methodol 2013; 13:92. [PMID: 23855337 PMCID: PMC3720188 DOI: 10.1186/1471-2288-13-92] [Citation(s) in RCA: 465] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 07/10/2013] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Sensitivity analyses play a crucial role in assessing the robustness of the findings or conclusions based on primary analyses of data in clinical trials. They are a critical way to assess the impact, effect or influence of key assumptions or variations--such as different methods of analysis, definitions of outcomes, protocol deviations, missing data, and outliers--on the overall conclusions of a study.The current paper is the second in a series of tutorial-type manuscripts intended to discuss and clarify aspects related to key methodological issues in the design and analysis of clinical trials. DISCUSSION In this paper we will provide a detailed exploration of the key aspects of sensitivity analyses including: 1) what sensitivity analyses are, why they are needed, and how often they are used in practice; 2) the different types of sensitivity analyses that one can do, with examples from the literature; 3) some frequently asked questions about sensitivity analyses; and 4) some suggestions on how to report the results of sensitivity analyses in clinical trials. SUMMARY When reporting on a clinical trial, we recommend including planned or posthoc sensitivity analyses, the corresponding rationale and results along with the discussion of the consequences of these analyses on the overall findings of the study.
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Affiliation(s)
- Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Departments of Pediatrics and Anesthesia, McMaster University, Hamilton, ON, Canada
- Center for Evaluation of Medicine, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Center, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Center, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Shiyuan Zhang
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Center, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
- Population Genomics Program, McMaster University, Hamilton, ON, Canada
| | - Maura Marcucci
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Center, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Chenglin Ye
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Center, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Marroon Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- GSK, Mississauga, ON, Canada
| | - Lora Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Brittany Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Center, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Daisy Kosa
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Center, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Department of Nephrology, Toronto General Hospital, Toronto, ON, Canada
| | - Victoria Borg Debono
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Center, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | | | - Vincent Fruci
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Monica Bawor
- McMaster Integrative Neuroscience Discovery & Study (MiNDS) Program, McMaster University, Hamilton, ON, Canada
| | - Juneyoung Lee
- Department of Biostatistics, Korea University, Seoul, Korea
| | - George Wells
- Department of Clinical Epidemiology, University of Ottawa, Ottawa, ON, Canada
| | - Charles H Goldsmith
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Center, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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107
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Peters SAE, Bots ML. Carotid intima-media thickness studies: study design and data analysis. J Stroke 2013; 15:38-48. [PMID: 24324938 PMCID: PMC3779675 DOI: 10.5853/jos.2013.15.1.38] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 01/09/2013] [Accepted: 01/09/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Carotid intima-media thickness (CIMT) measurements have been widely used as primary endpoint in studies into the effects of new interventions as alternative for cardiovascular morbidity and mortality. There are no accepted standards on the use of CIMT measurements in intervention studies and choices in the design and analysis of a CIMT study are generally based on experience and expert opinion. In the present review, we provide an overview of the current evidence on several aspects in the design and analysis of a CIMT study on the early effects of new interventions. SUMMARY OF ISSUES A balanced evaluation of the carotid segments, carotid walls, and image view to be used as CIMT study endpoint; the reading method (manual or semi-automated and continuously or in batch) to be employed, the required sample size, and the frequency of ultrasound examinations is provided. We also discuss the preferred methods to analyse longitudinal CIMT data and address the possible impact of, and methods to deal with missing and biologically implausible CIMT values. CONCLUSIONS Linear mixed effects models are the preferred way to analyse CIMT data and do appropriately handle missing and biologically implausible CIMT values. Furthermore, we recommend to use extensive CIMT designs that measure CIMT at regular points during the multiple carotid sites as such approach is likely to increase the success rates of CIMT intervention studies designed to evaluate the effects of new interventions on atherosclerotic burden.
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Affiliation(s)
- Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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108
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Peters SAE, den Ruijter HM, Grobbee DE, Bots ML. Results From a Carotid Intima-Media Thickness Trial as a Decision Tool for Launching a Large-Scale Morbidity and Mortality Trial. Circ Cardiovasc Imaging 2013. [DOI: 10.1161/circimaging.112.978114] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Trials with carotid intima-media thickness (CIMT) as primary end point may improve the efficiency of the evaluation of new therapies targeting atherosclerosis considerably, and the results of CIMT trials may be used as a decision tool to help in the choice to launch or not to launch a large-scale morbidity and mortality (M&M) trial. We evaluated the literature to provide evidence to support or refute this proposition.
Methods and Results—
PubMed Medline was systematically searched on May 1, 2012, for randomized double-blind controlled CIMT trials. The agreement between the results from CIMT and M&M trials was assessed, and positive and negative predictive values were calculated. Forty-eight CIMT trials were included. CIMT trials (n=20) on lipid-level modifying therapies are all, except one, in agreement with the M&M trial findings. For blood pressure-lowering trials (n=13), 3 were not congruent with the M&M trial. The positive and negative predictive value (95% confidence interval) of a CIMT trial to predict the outcome of a M&M trial are 96% (80–99%) and 83% (64–93%), respectively. The predictive values are higher for lipid-level modifying therapies than for other therapies.
Conclusions—
A CIMT trial positioned before an M&M trial may considerably improve the efficiency of the evaluation of new drug therapies on atherosclerosis and cardiovascular disease risk. Hence, the results of a CIMT trial should be seen as a decision tool to support or refute the start of a large-scale M&M trial on drugs targeting atherosclerosis.
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Affiliation(s)
- Sanne A. E. Peters
- From the Julius Center for Health Sciences and Primary Care and University Medical Center Utrecht, Utrecht, The Netherlands (S.A.E.P., H.M.D.R., D.E.G., M.L.B.); and The Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (H.M.D.R.)
| | - Hester M. den Ruijter
- From the Julius Center for Health Sciences and Primary Care and University Medical Center Utrecht, Utrecht, The Netherlands (S.A.E.P., H.M.D.R., D.E.G., M.L.B.); and The Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (H.M.D.R.)
| | - Diederick E. Grobbee
- From the Julius Center for Health Sciences and Primary Care and University Medical Center Utrecht, Utrecht, The Netherlands (S.A.E.P., H.M.D.R., D.E.G., M.L.B.); and The Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (H.M.D.R.)
| | - Michiel L. Bots
- From the Julius Center for Health Sciences and Primary Care and University Medical Center Utrecht, Utrecht, The Netherlands (S.A.E.P., H.M.D.R., D.E.G., M.L.B.); and The Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (H.M.D.R.)
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109
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Mazairac AHA, de Wit GA, Grooteman MPC, Penne EL, van der Weerd NC, den Hoedt CH, Lévesque R, van den Dorpel MA, Nubé MJ, ter Wee PM, Bots ML, Blankestijn PJ. Effect of hemodiafiltration on quality of life over time. Clin J Am Soc Nephrol 2012; 8:82-9. [PMID: 23124783 DOI: 10.2215/cjn.00010112] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES It is unclear if hemodiafiltration leads to a better quality of life compared with hemodialysis. It was, therefore, the aim of this study to assess the effect of hemodiafiltration on quality of life compared with hemodialysis in patients with ESRD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This study analyzed the data of 714 patients with a median follow-up of 2 years from the Convective Transport Study. The patients were enrolled between June of 2004 and December of 2009. The Convective Transport Study is a randomized controlled trial on the effect of online hemodiafiltration versus low-flux hemodialysis on all-cause mortality. Quality of life was assessed with the Kidney Disease Quality of Life-Short Form. This questionnaire provides data for a physical and mental composite score and describes kidney disease-specific quality of life in 12 domains. The domains have scales from 0 to 100. RESULTS There were no significant differences in changes in health-related quality of life over time between patients treated with hemodialysis (n=358) or hemodiafiltration (n=356). The quality of life domain patient satisfaction declined over time in both dialysis modalities (hemodialysis: -2.5/yr, -3.4 to -1.5, P<0.001; hemodiafiltration: -1.4/yr, -2.4 to -0.5, P=0.004). CONCLUSIONS Compared with hemodialysis, hemodiafiltration had no significant effect on quality of life over time.
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Affiliation(s)
- Albert H A Mazairac
- Department of Nephrology and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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