1
|
Valentina M, Alessandro CL, Francesca C, Silvia R, Eleonora L, Claudia C, Jessica P, Ilaria M, Serena V, Lavinia F, Alessandra V, Gaetano M, Fabrizio C, Simone L, Emanuela C, Eugenia M, Raffaella L, Pierluca P, Enrico G, AnnaRosa G, Francesco V, Fabrizio M, Emanuele N, Andrea A. Viral load decrease in SARS-CoV-2 BA.1 and BA.2 Omicron sublineages infection after treatment with monoclonal antibodies and direct antiviral agents. J Med Virol 2022; 95:e28186. [PMID: 36184918 PMCID: PMC9539310 DOI: 10.1002/jmv.28186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/05/2022] [Accepted: 09/26/2022] [Indexed: 01/11/2023]
Abstract
The efficacy on the Omicron variant of the approved early coronavirus disease-2019 (COVID-19) therapies, especially monoclonal antibodies, has been challenged by in vitro neutralization data, while data on in vivo antiviral activity are lacking. We assessed potential decrease from Day 1 to Day 7 viral load (VL) in nasopharyngeal swabs of outpatients receiving Sotrovimab, Molnupiravir, Remdesivir, or Nirmatrelvir/ritonavir for mild-to-moderate COVID-19 due to sublineages BA.1 or BA.2, and average treatment effect by weighted marginal linear regression models. A total of 521 patients (378 BA.1 [73%], 143 [27%] BA.2) received treatments (Sotrovimab 202, Molnupiravir 117, Nirmatrelvir/ritonavir 84, and Remdesivir 118): median age 66 years, 90% vaccinated, median time from symptoms onset 3 days. Day 1 mean VL was 4.12 log2 (4.16 for BA.1 and 4.01 for BA.2). The adjusted analysis showed that Nirmatrelvir/ritonavir significantly reduced VL compared to all the other drugs, except versus Molnupiravir in BA.2. Molnupiravir was superior to Remdesivir in both BA.1 and BA.2, and to Sotrovimab in BA.2. Sotrovimab had better activity than Remdesivir only against BA.1. Nirmatrelvir/ritonavir showed the greatest antiviral activity against Omicron variant, comparable to Molnupiravir only in the BA.2 subgroup. VL decrease could be a valuable surrogate of drug activity in the context of the high prevalence of vaccinated people and low probability of hospital admission.
Collapse
Affiliation(s)
- Mazzotta Valentina
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly,PhD course in Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT)University of Rome Tor VergataRomeItaly
| | - Cozzi Lepri Alessandro
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME)Institute for Global HealthUCLLondonUK
| | - Colavita Francesca
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Rosati Silvia
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Lalle Eleonora
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Cimaglia Claudia
- Clinical Epidemiology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Paulicelli Jessica
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Mastrorosa Ilaria
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Vita Serena
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Fabeni Lavinia
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Vergori Alessandra
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Maffongelli Gaetano
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Carletti Fabrizio
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Lanini Simone
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Caraffa Emanuela
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Milozzi Eugenia
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Libertone Raffaella
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Piselli Pierluca
- Clinical Epidemiology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Girardi Enrico
- Scientific Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Garbuglia AnnaRosa
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Vaia Francesco
- General Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Maggi Fabrizio
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Nicastri Emanuele
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | - Antinori Andrea
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
| | | |
Collapse
|
2
|
Ma L, Yin Y, Liu L, Geng Z. On the individual surrogate paradox. Biostatistics 2021; 22:97-113. [PMID: 31215619 DOI: 10.1093/biostatistics/kxz019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/19/2019] [Accepted: 05/13/2019] [Indexed: 11/13/2022] Open
Abstract
When the primary outcome is difficult to collect, a surrogate endpoint is typically used as a substitute. It is possible that for every individual, the treatment has a positive effect on the surrogate, and the surrogate has a positive effect on the primary outcome, but for some individuals, the treatment has a negative effect on the primary outcome. For example, a treatment may be substantially effective in preventing the stroke for everyone, and lowering the risk of stroke is universally beneficial for life expectancy; however, the treatment may still cause death for some individuals. We define such paradoxical phenomenon as the individual surrogate paradox. The individual surrogate paradox is proposed to capture the treatment effect heterogeneity, which is unable to be described by either the surrogate paradox based on average causal effect or that based on distributional causal effect. We investigate the existing surrogate criteria in terms of whether the individual surrogate paradox could manifest. We find that only the strong binary surrogate can avoid such paradox without additional assumptions. Utilizing the sharp bounds, we propose novel criteria to exclude the individual surrogate paradox. Our methods are illustrated in an application to determine the effect of the intensive glycemia on the risk of development or progression of diabetic retinopathy.
Collapse
Affiliation(s)
- Linquan Ma
- University of Wisconsin-Madison, 1300 University Ave., Madison, WI, USA and School of Statistics, University of Minnesota at Twin Cities, 224 Church St., Minneapolis, MN, USA
| | - Yunjian Yin
- School of Mathematical Sciences, Peking University, Beijing, China
| | - Lan Liu
- School of Statistics, University of Minnesota at Twin Cities, Minneapolis, 224 Church St., MN, USA
| | - Zhi Geng
- School of Mathematical Sciences, Peking University, Beijing, China
| |
Collapse
|
3
|
Yin Y, Liu L, Geng Z, Luo P. Novel criteria to exclude the surrogate paradox and their optimalities. Scand Stat Theory Appl 2019. [DOI: 10.1111/sjos.12398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yunjian Yin
- School of Mathematical Sciences Peking University Beijing China
| | - Lan Liu
- School of Statistics University of Minnesota Minneapolis Minnesota
| | - Zhi Geng
- School of Mathematical Sciences Peking University Beijing China
| | - Peng Luo
- College of Mathematics and Statistics Shenzhen University Shenzhen China
| |
Collapse
|
4
|
Ensor H, Lee RJ, Sudlow C, Weir CJ. Statistical approaches for evaluating surrogate outcomes in clinical trials: A systematic review. J Biopharm Stat 2016; 26:859-79. [DOI: 10.1080/10543406.2015.1094811] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Hannah Ensor
- Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, UK
| | - Robert J. Lee
- Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, UK
| | - Cathie Sudlow
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Christopher J. Weir
- Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, UK
- Edinburgh Health Services Research Unit, University of Edinburgh, Western General Hospital, Edinburgh, UK
| |
Collapse
|
5
|
Gabriel EE, Follmann D. Augmented trial designs for evaluation of principal surrogates. Biostatistics 2016; 17:453-67. [PMID: 26825099 DOI: 10.1093/biostatistics/kxv055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 12/24/2015] [Indexed: 11/12/2022] Open
Abstract
Observation of counterfactual intermediate responses, and evaluation of them as candidate surrogates, is complicated in a standard randomized trial as half of the responses are systematically missing by design. Although some augmentation procedures exist for obtaining counterfactual responses, they are specific to vaccine trials. We outline extensions to the existing augmentations and suggest augmentations of three trial designs outside the setting of vaccines. We outline the assumptions needed to identify the causal estimands of interest under each augmented design, under which standard likelihood-based methods can be used to evaluate intermediate responses as principal surrogates. Two of these designs, crossover and individual stepped-wedge, allow for the observation of clinical endpoints under both treatment and control for some subset of subjects and can therefore improve efficiency over standard parallel trial designs. The third, the treatment run-in design, allows for the observation of a baseline measure that may be as useful a surrogate as the true counterfactual intermediate response. As the evaluation methods rely on several assumptions, we also outline a remediation analysis, which can be used to help overcome assumption violations. We illustrate our suggested methods in an example from a drug-resistant tuberculosis treatment trial.
Collapse
Affiliation(s)
- Erin E Gabriel
- Biostatistics Research Branch NIAID NIH, Bethesda, MD, USA
| | - Dean Follmann
- Biostatistics Research Branch NIAID NIH, Bethesda, MD, USA
| |
Collapse
|
6
|
MacCormick IJC, Czanner G, Faragher B. Developing retinal biomarkers of neurological disease: an analytical perspective. Biomark Med 2015; 9:691-701. [PMID: 26174843 PMCID: PMC4822679 DOI: 10.2217/bmm.15.17] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The inaccessibility of the brain poses a problem for neuroscience. Scientists have traditionally responded by developing biomarkers for brain physiology and disease. The retina is an attractive source of biomarkers since it shares many features with the brain. Some even describe the retina as a 'window' to the brain, implying that retinal signs are analogous to brain disease features. However, new analytical methods are needed to show whether or not retinal signs really are equivalent to brain abnormalities, since this requires greater evidence than direct associations between retina and brain. We, therefore propose a new way to think about, and test, how clearly one might see the brain through the retinal window, using cerebral malaria as a case study.
Collapse
Affiliation(s)
- Ian JC MacCormick
- Department of Eye & Vision Science, University of Liverpool, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Gabriela Czanner
- Department of Eye & Vision Science, University of Liverpool, Liverpool, UK
- Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | | |
Collapse
|
7
|
Conlon ASC, Taylor JMG, Elliott MR. Surrogacy assessment using principal stratification when surrogate and outcome measures are multivariate normal. Biostatistics 2013; 15:266-83. [PMID: 24285772 DOI: 10.1093/biostatistics/kxt051] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In clinical trials, a surrogate outcome variable (S) can be measured before the outcome of interest (T) and may provide early information regarding the treatment (Z) effect on T. Using the principal surrogacy framework introduced by Frangakis and Rubin (2002. Principal stratification in causal inference. Biometrics 58, 21-29), we consider an approach that has a causal interpretation and develop a Bayesian estimation strategy for surrogate validation when the joint distribution of potential surrogate and outcome measures is multivariate normal. From the joint conditional distribution of the potential outcomes of T, given the potential outcomes of S, we propose surrogacy validation measures from this model. As the model is not fully identifiable from the data, we propose some reasonable prior distributions and assumptions that can be placed on weakly identified parameters to aid in estimation. We explore the relationship between our surrogacy measures and the surrogacy measures proposed by Prentice (1989. Surrogate endpoints in clinical trials: definition and operational criteria. Statistics in Medicine 8, 431-440). The method is applied to data from a macular degeneration study and an ovarian cancer study.
Collapse
Affiliation(s)
- Anna S C Conlon
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA
| | | | | |
Collapse
|
8
|
Kuroki M. Sharp bounds on causal effects using a surrogate endpoint. Stat Med 2013; 32:4338-47. [DOI: 10.1002/sim.5873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 05/09/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Manabu Kuroki
- The Institute of Statistical Mathematics; 10-3, Midori-cho, Tachikawa Tokyo 190-8562 Japan
| |
Collapse
|
9
|
VanderWeele TJ. Rejoinder. Biometrics 2013; 69:577-81. [DOI: 10.1111/biom.12072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
10
|
Abstract
Surrogates which allow one to predict the effect of the treatment on the outcome of interest from the effect of the treatment on the surrogate are of importance when it is difficult or expensive to measure the primary outcome. Unfortunately, the use of such surrogates can give rise to paradoxical situations in which the effect of the treatment on the surrogate is positive, the surrogate and outcome are strongly positively correlated, but the effect of the treatment on the outcome is negative, a phenomenon sometimes referred to as the "surrogate paradox." New results are given for consistent surrogates that extend the existing literature on sufficient conditions that ensure the surrogate paradox is not manifest. Specifically, it is shown that for the surrogate paradox to be manifest it must be the case that either there is (i) a direct effect of treatment on the outcome not through the surrogate and in the opposite direction as that through the surrogate or (ii) confounding for the effect of the surrogate on the outcome, or (iii) a lack of transitivity so that treatment does not positively affect the surrogate for all the same individuals for whom the surrogate positively affects the outcome. The conditions for consistent surrogates and the results of the article are important because they allow investigators to predict the direction of the effect of the treatment on the outcome simply from the direction of the effect of the treatment on the surrogate. These results on consistent surrogates are then related to the four approaches to surrogate outcomes described by Joffe and Greene (2009, Biometrics 65, 530-538) to assess whether the standard criteria used by these approaches to assess whether a surrogate is "good" suffice to avoid the surrogate paradox.
Collapse
Affiliation(s)
- Tyler J. VanderWeele
- Departments of Epidemiology and Biostatistics, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, U.S.A.
| |
Collapse
|
11
|
Walter SD, Sun X, Heels-Ansdell D, Guyatt G. Treatment effects on patient-important outcomes can be small, even with large effects on surrogate markers. J Clin Epidemiol 2012; 65:940-5. [DOI: 10.1016/j.jclinepi.2012.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 02/15/2012] [Accepted: 02/19/2012] [Indexed: 11/28/2022]
|