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Payne RD, Ray P, Thomann MA. Bayesian model averaging of longitudinal dose-response models. J Biopharm Stat 2024; 34:349-365. [PMID: 38105583 DOI: 10.1080/10543406.2023.2292214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/02/2023] [Indexed: 12/19/2023]
Abstract
Selecting a safe and clinically beneficial dose can be difficult in drug development. Dose justification often relies on dose-response modeling where parametric assumptions are made in advance which may not adequately fit the data. This is especially problematic in longitudinal dose-response models, where additional parametric assumptions must be made. This paper proposes a class of longitudinal dose-response models to be used in the Bayesian model averaging paradigm which improve trial operating characteristics while maintaining flexibility a priori. A new longitudinal model for non-monotonic longitudinal profiles is proposed. The benefits and trade-offs of the proposed approach are demonstrated through a case study and simulation.
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Affiliation(s)
- Richard D Payne
- Global Statistical Sciences, Eli Lilly & Company, Indianapolis, IN, USA
| | - Pallavi Ray
- Global Statistical Sciences, Eli Lilly & Company, Indianapolis, IN, USA
| | - Mitchell A Thomann
- Department of Biostatistics and Data Science, Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT, USA
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Duan R, Chen K, Du Y, Kulkarni PM, Qu Y. Non-monotone Exponential Time (NEXT) Model for the Longitudinal Trend of a Continuous Outcome in Clinical Trials. Ther Innov Regul Sci 2024; 58:127-135. [PMID: 37751063 DOI: 10.1007/s43441-023-00576-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/21/2023] [Indexed: 09/27/2023]
Abstract
The dose-response curve has been studied extensively for decades. However, most of these methods ignore intermediate measurements of the response variable and only use the measurement at the endpoint. In early phase trials, it is crucial to utilize all available data due to the smaller sample size. Simulation studies have shown that the longitudinal dose-response surface model provides a more precise parameter estimation compared to the traditional dose response using only data from the primary time point. However, the current longitudinal models with parametric assumptions assume the treatment effect increases monotonically over time, which may be controversial to reality. We propose a parametric non-monotone exponential time (NEXT) model, an enhanced longitudinal dose-response model with greater flexibility, capable of accommodating non-monotonic treatment effects and making predictions for longer-term efficacy. In addition, the estimator for the time to maximum treatment effect and its asymptotic distribution have been derived from NEXT. Extensive simulation studies using known data-generating models and using real clinical data showed the NEXT model outperformed the existing monotone longitudinal models.
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Affiliation(s)
- Ran Duan
- Angitia Biopharmceutical, Inc., Woodland Hills, CA, USA
| | - Kaiyi Chen
- Department of Global Statistical Sciences, Lilly Corporate Center, Eli Lilly and Company, Indianapolis, IN, 46285, USA
| | - Yu Du
- Department of Global Statistical Sciences, Lilly Corporate Center, Eli Lilly and Company, Indianapolis, IN, 46285, USA
| | - Pandurang M Kulkarni
- Department of Global Statistical Sciences, Lilly Corporate Center, Eli Lilly and Company, Indianapolis, IN, 46285, USA
| | - Yongming Qu
- Department of Global Statistical Sciences, Lilly Corporate Center, Eli Lilly and Company, Indianapolis, IN, 46285, USA.
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Marso SP, Baeres FMM, Bain SC, Goldman B, Husain M, Nauck MA, Poulter NR, Pratley RE, Thomsen AB, Buse JB. Effects of Liraglutide on Cardiovascular Outcomes in Patients With Diabetes With or Without Heart Failure. J Am Coll Cardiol 2020; 75:1128-1141. [PMID: 32164886 DOI: 10.1016/j.jacc.2019.12.063] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/11/2019] [Accepted: 12/17/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND More data regarding effects of glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes (T2D) and heart failure (HF) are required. OBJECTIVES The purpose of this study was to investigate the effects of liraglutide on cardiovascular events and mortality in LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results) participants, by HF history. METHODS In the multinational, double-blind, randomized LEADER trial, 9,340 patients with T2D and high cardiovascular risk were assigned 1:1 to liraglutide (1.8 mg daily or maximum tolerated dose up to 1.8 mg daily) or placebo plus standard care, and followed for 3.5 to 5 years. New York Heart Association (NYHA) functional class IV HF was an exclusion criterion. The primary composite major adverse cardiovascular events outcome was time to first occurrence of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Post hoc Cox regression analyses of outcomes by baseline HF history were conducted. RESULTS At baseline, 18% of patients had a history of NYHA functional class I to III HF (liraglutide: n = 835 of 4,668; placebo: n = 832 of 4,672). Effects of liraglutide versus placebo on major adverse cardiovascular events were consistent in patients with (hazard ratio [HR]: 0.81 [95% confidence interval (CI): 0.65 to 1.02]) and without (HR: 0.88 [95% CI: 0.78 to 1.00]) a history of HF (p interaction = 0.53). In both subgroups, fewer deaths were observed with liraglutide (HR: 0.89 [95% CI: 0.70 to 1.14] with HF; HR: 0.83 [95% CI: 0.70 to 0.97] without HF; p interaction = 0.63) versus placebo. No increased risk of HF hospitalization was observed with liraglutide, regardless of HF history (HR: 0.98 [95% CI: 0.75 to 1.28] with HF; HR: 0.78 [95% CI: 0.61 to 1.00] without HF; p interaction = 0.22). Effects of liraglutide on the composite of HF hospitalization or cardiovascular death were consistent in patients with (HR: 0.92 [95% CI: 0.74 to 1.15]) and without (HR: 0.77 [95% CI: 0.65 to 0.91]) a history of HF (p interaction = 0.19). CONCLUSIONS Based on these findings, liraglutide should be considered suitable for patients with T2D with or without a history of NYHA functional class I to III HF. (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results [LEADER]; NCT01179048).
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Affiliation(s)
- Steven P Marso
- Midwest Heart and Vascular Institute, HCA Midwest Health, Overland Park, Kansas.
| | | | - Stephen C Bain
- Swansea University Medical School, Swansea, Wales, United Kingdom
| | | | - Mansoor Husain
- Ted Rogers Centre for Heart Research, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Michael A Nauck
- Diabetes Center Bochum-Hattingen, St. Josef-Hospital (Ruhr University), Bochum, Germany
| | - Neil R Poulter
- Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
| | - Richard E Pratley
- AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, Florida
| | | | - John B Buse
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Practical Considerations and Rationale for Glucagon-Like Peptide-1 Receptor Agonist Plus Sodium-Dependent Glucose Cotransporter-2 Inhibitor Combination Therapy in Type 2 Diabetes. Can J Diabetes 2020; 45:291-302. [PMID: 33189580 DOI: 10.1016/j.jcjd.2020.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 02/07/2023]
Abstract
Glucagon-like peptide-1 receptor agonists and sodium-dependent glucose cotransporter-2 inhibitors have demonstrated clinically significant benefits on glycated hemoglobin, weight, blood pressure and cardiorenal outcomes. The emerging evidence from clinical trials and meta-analyses that assessed the combination of these 2 classes of drugs has been promising. An expert forum that included individuals with expertise in endocrine, cardiology and nephrology issues was held in May 2020 to review the literature on the metabolic and cardiorenal benefits of these 2 classes, independently and in combination, in adults with type 2 diabetes mellitus. Although hard outcome data are not available, the group concluded that the combination of glucagon-like peptide-1 receptor agonists with sodium-dependent glucose cotransporter-2 inhibitors is an emerging option for managing adults with type 2 diabetes as long as cost is not a barrier. Ongoing research may offer further insights on hard cardiorenal outcomes for this therapeutic combination as well as provide direction on the potential of this approach in obesity, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis and populations without diabetes.
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Liakos A, Lambadiari V, Bargiota A, Kitsios K, Avramidis I, Kotsa K, Gerou S, Boura P, Tentolouris N, Dimitriadis G, Tsapas A. Effect of liraglutide on ambulatory blood pressure in patients with hypertension and type 2 diabetes: A randomized, double-blind, placebo-controlled trial. Diabetes Obes Metab 2019; 21:517-524. [PMID: 30242948 DOI: 10.1111/dom.13541] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/11/2018] [Accepted: 09/17/2018] [Indexed: 01/02/2023]
Abstract
AIMS To assess the effect of liraglutide on 24-hour ambulatory blood pressure and heart rate in patients with hypertension (pre- and stage 1 hypertension) and inadequately controlled Type 2 diabetes (glycated haemoglobin 7%-10% [53-86 mmol/mol]). MATERIALS AND METHODS Eligible patients for this investigator-initiated, parallel-group, randomized, double-blind trial were on stable background antihyperglycaemic therapy excluding insulin, glucagon-like peptide-1 receptor agonists and dipeptidyl-peptidase-4 inhibitors. Participants were centrally randomized in a 1:1 ratio to daily liraglutide 0.6 mg, titrated to 1.2 mg after the first week, or placebo for 5 weeks. The primary outcome was change in 24-hour ambulatory systolic blood pressure (SBP), and secondary outcomes included change in ambulatory diastolic blood pressure (DBP) and heart rate. We also assessed renal sodium handling. RESULTS Of 87 patients assessed for eligibility, 62 (66.1% men) with a mean age of 60.2 years were randomized to liraglutide (n = 31) or placebo (n = 31). All participants received background therapy with metformin, whilst 35.5% were treated concomitantly with sulphonylureas and 14.5% with pioglitazone. Compared with placebo, liraglutide reduced 24-hour SBP by -5.73 mm Hg (95% confidence interval [CI] -9.81 to -1.65) and had a neutral effect on 24-hour DBP (mean difference - 1.42 mm Hg; 95% CI -4.25 to 1.40), whilst increasing 24-hour heart rate by 6.16 beats/min (95% CI 3.25 to 9.07). Findings were consistent for daytime and night-time measurements. Liraglutide did not increase urine sodium excretion. CONCLUSION Based on 24-hour ambulatory measurements, short-term treatment with liraglutide had a favourable effect on SBP whilst increasing heart rate.
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Affiliation(s)
- Aris Liakos
- Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Vaia Lambadiari
- Research Institute and Diabetes Center, Second Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Bargiota
- Department of Endocrinology and Metabolic Diseases, University of Thessaly, Larisa, Greece
| | - Konstantinos Kitsios
- Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Iakovos Avramidis
- First Medical Department, G. Papanikolaou General Hospital, Thessaloniki, Greece
| | - Kalliopi Kotsa
- Division of Endocrinology-Diabetes, First Department of Internal Medicine, Aristotle University Thessaloniki, Thessaloniki, Greece
| | | | - Panagiota Boura
- Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Tentolouris
- First Department of Propedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George Dimitriadis
- Research Institute and Diabetes Center, Second Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Apostolos Tsapas
- Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
- Harris Manchester College, University of Oxford, Oxford, UK
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Heimbürger SM, Brønden A, Johansen NJ, Dejgaard TF, Vilsbøll T, Knop FK. The efficacy and safety of exenatide once weekly in patients with type 2 diabetes. Expert Opin Pharmacother 2019; 20:501-510. [DOI: 10.1080/14656566.2019.1571040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Andreas Brønden
- Clinical Metabolic Physiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicklas J. Johansen
- Clinical Metabolic Physiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Thomas F. Dejgaard
- Clinical Metabolic Physiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Tina Vilsbøll
- Clinical Metabolic Physiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Filip K. Knop
- Clinical Metabolic Physiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Chilton RJ, Gallegos KM, Silva-Cardoso J, Oliveros R, Pham S. The Evolving Role of the Cardiologist in the Management of Type 2 Diabetes. Curr Diab Rep 2018; 18:144. [PMID: 30406850 DOI: 10.1007/s11892-018-1114-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW To evaluate the treatment of type 2 diabetes from a cardiologist's view. RECENT FINDINGS A new era in the treatment of type 2 diabetes began for the cardiologist in 2015 with the publication of the EMPA-REG outcome trial finding a significant reduction in CV death with empagliflozin (oral sodium-glucose co-transporter-2 [SGLT2] inhibitor) in patients with type 2 diabetes at increased cardiovascular risk. Shortly thereafter, the injectable glucagon-like peptide agonists (GLP-1) liraglutide and semaglutide found a significant reduction in composite major cardiovascular events (CV death, non-fatal MI, or stroke). Both classes have demonstrated significant renal protection when added to usual care. Moreover, there may be some exciting new benefits of SGLT2 inhibitors for patients with heart failure. These research studies are underway. These two new classes of cardiovascular drugs for type 2 diabetes usher in a new era for the cardiologist who sees greater than 50% of patients with diabetes. The off-target effect of these agents is different as with all new cardiovascular compounds. While safety profiles in these populations are consistent with the known effects of these classes, new off-target effects have been seen with some agents in this class. Ongoing collaboration between cardiologists and other care providers remains important in the implementation of the evidence and care of patients with type 2 diabetes.
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Affiliation(s)
- Robert J Chilton
- Division of Cardiology, UT Health San Antonio, 7703 Floyd Curl Drive, Mail Code 7872, San Antonio, TX, 78229, USA.
| | - Kelly M Gallegos
- Division of Cardiology, UT Health San Antonio, 7703 Floyd Curl Drive, Mail Code 7872, San Antonio, TX, 78229, USA
| | | | - Rene Oliveros
- Division of Cardiology, UT Health San Antonio, 7703 Floyd Curl Drive, Mail Code 7872, San Antonio, TX, 78229, USA
| | - Son Pham
- Division of Cardiology, UT Health San Antonio, 7703 Floyd Curl Drive, Mail Code 7872, San Antonio, TX, 78229, USA
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