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Wikoff DS, Urban JD, Ring C, Britt J, Fitch S, Budinsky R, Haws LC. Development of a Range of Plausible Noncancer Toxicity Values for 2,3,7,8-Tetrachlorodibenzo-p-Dioxin Based on Effects on Sperm Count: Application of Systematic Review Methods and Quantitative Integration of Dose Response Using Meta-Regression. Toxicol Sci 2021; 179:162-182. [PMID: 33306106 DOI: 10.1093/toxsci/kfaa171] [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] [Indexed: 11/14/2022] Open
Abstract
Regulatory agencies have derived noncancer toxicity values for 2,3,7,8-tetrachlorodibenzo-p-dioxin based on reduced sperm counts relying on single studies from a large body of evidence. Techniques such as meta-regression allow for greater use of the available data while simultaneously providing important information regarding the uncertainty associated with the underlying evidence base when conducting risk assessments. The objective herein was to apply systematic review methods and meta-regression to characterize the dose-response relationship of gestational exposure and epididymal sperm count. Twenty-three publications (20 animal studies consisting of 29 separate rat experimental data sets, and 3 epidemiology studies) met inclusion criteria. Risk of bias evaluation was performed to critically appraise study validity. Low to very low confidence precluded use of available epidemiological data as candidate studies for dose-response due to inconsistencies across the evidence base, high risk of bias, and general lack of biological coherence, including lack of clinical relevance and dose-response concordance. Experimental animal studies, which were found to have higher confidence following the structured assessment of confidence (eg, controlled exposure, biological consistency), were used as the basis of a meta-regression. Multiple models were fit; points of departure were identified and converted to human equivalent doses. The resulting reference dose estimates ranged from approximately 4 to 70 pg/kg/day, depending on model, benchmark response level, and study validity integration approach. This range of reference doses can be used either qualitatively or quantitatively to enhance understanding of human health risk estimates for dioxin-like compounds.
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Wikoff D, Lewis RJ, Erraguntla N, Franzen A, Foreman J. Facilitation of risk assessment with evidence-based methods - A framework for use of systematic mapping and systematic reviews in determining hazard, developing toxicity values, and characterizing uncertainty. Regul Toxicol Pharmacol 2020; 118:104790. [PMID: 33038430 DOI: 10.1016/j.yrtph.2020.104790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/17/2020] [Accepted: 10/04/2020] [Indexed: 01/08/2023]
Abstract
Systematic review tools and approaches developed for clinical medicine are often difficult to apply "off the shelf" in order to meet the needs of chemical risk assessments. To address such, we propose an approach that can be used by practitioners for using evidence-based methods to facilitate the risk assessment process. The framework builds on and combines efforts conducted to date by a number of agencies and researchers; the novelty is in combining these efforts with a practical understanding of risk assessment, and translating such into a 'step-by-step' guide. The approach relies on three key components: problem formulation, systematic evidence mapping, and systematic review, applied using a stepwise approach. Unique to this framework is the consideration of exposure in selecting, prioritizing, and evaluating data (e.g., dose-relevance, routes of exposure, etc.). Using the proposed step-by-step process, critical appraisal of individual studies (e.g., formal and structured assessment of both relevance and reliability) and integration efforts are considered in context of specified risk assessment objectives (e.g., mode of action, dose-response) as well as chemical-specific considerations. The resulting framework provides a logical approach of how evidence-based methods can be used to facilitate risk assessment, and elevates the use of systematic methods beyond hazard identification to directly facilitating transparent and objective selection of candidate studies and/or datasets used to quantitatively characterize risk, and to better use the underlying process to inform the approaches used to develop toxicity values.
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Affiliation(s)
- Daniele Wikoff
- 31 College Place, Suite B118, Asheville, NC, 28801, USA.
| | - R Jeffrey Lewis
- ExxonMobil Biomedical Sciences, Inc., 1545 US Highway 22 East, Room CC291, Annandale, NJ, 08801-3059, USA.
| | | | - Allison Franzen
- ToxStrategies, Inc, 1800 Forsythe Ave., Suite 2 #148, Monroe, LA, 71201, USA.
| | - Jennifer Foreman
- ExxonMobil Chemical Company, Energy 4, E4.3A.478 22777 Springwoods Village Parkway, Spring, TX, 77389, USA.
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Brozek JL, Canelo-Aybar C, Akl EA, Bowen JM, Bucher J, Chiu WA, Cronin M, Djulbegovic B, Falavigna M, Guyatt GH, Gordon AA, Hilton Boon M, Hutubessy RCW, Joore MA, Katikireddi V, LaKind J, Langendam M, Manja V, Magnuson K, Mathioudakis AG, Meerpohl J, Mertz D, Mezencev R, Morgan R, Morgano GP, Mustafa R, O'Flaherty M, Patlewicz G, Riva JJ, Posso M, Rooney A, Schlosser PM, Schwartz L, Shemilt I, Tarride JE, Thayer KA, Tsaioun K, Vale L, Wambaugh J, Wignall J, Williams A, Xie F, Zhang Y, Schünemann HJ. GRADE Guidelines 30: the GRADE approach to assessing the certainty of modeled evidence-An overview in the context of health decision-making. J Clin Epidemiol 2020; 129:138-150. [PMID: 32980429 DOI: 10.1016/j.jclinepi.2020.09.018] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The objective of the study is to present the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) conceptual approach to the assessment of certainty of evidence from modeling studies (i.e., certainty associated with model outputs). STUDY DESIGN AND SETTING Expert consultations and an international multidisciplinary workshop informed development of a conceptual approach to assessing the certainty of evidence from models within the context of systematic reviews, health technology assessments, and health care decisions. The discussions also clarified selected concepts and terminology used in the GRADE approach and by the modeling community. Feedback from experts in a broad range of modeling and health care disciplines addressed the content validity of the approach. RESULTS Workshop participants agreed that the domains determining the certainty of evidence previously identified in the GRADE approach (risk of bias, indirectness, inconsistency, imprecision, reporting bias, magnitude of an effect, dose-response relation, and the direction of residual confounding) also apply when assessing the certainty of evidence from models. The assessment depends on the nature of model inputs and the model itself and on whether one is evaluating evidence from a single model or multiple models. We propose a framework for selecting the best available evidence from models: 1) developing de novo, a model specific to the situation of interest, 2) identifying an existing model, the outputs of which provide the highest certainty evidence for the situation of interest, either "off-the-shelf" or after adaptation, and 3) using outputs from multiple models. We also present a summary of preferred terminology to facilitate communication among modeling and health care disciplines. CONCLUSION This conceptual GRADE approach provides a framework for using evidence from models in health decision-making and the assessment of certainty of evidence from a model or models. The GRADE Working Group and the modeling community are currently developing the detailed methods and related guidance for assessing specific domains determining the certainty of evidence from models across health care-related disciplines (e.g., therapeutic decision-making, toxicology, environmental health, and health economics).
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Affiliation(s)
- Jan L Brozek
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; McMaster GRADE Centre & Michael DeGroote Cochrane Canada Centre, McMaster University, Hamilton, Ontario, Canada
| | - Carlos Canelo-Aybar
- Department of Paediatrics, Obstetrics and Gynaecology, Preventive Medicine, and Public Health. PhD Programme in Methodology of Biomedical Research and Public Health. Universitat Autònoma de Barcelona, Bellaterra, Spain; Iberoamerican Cochrane Center, Biomedical Research Institute (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - James M Bowen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Ontario, Canada
| | - John Bucher
- National Toxicology Program, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Weihsueh A Chiu
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, USA
| | - Mark Cronin
- School of Pharmacy and Chemistry, Liverpool John Moores University, Liverpool, UK
| | - Benjamin Djulbegovic
- Center for Evidence-Based Medicine and Health Outcome Research, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Maicon Falavigna
- Institute for Education and Research, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; McMaster GRADE Centre & Michael DeGroote Cochrane Canada Centre, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Raymond C W Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Manuela A Joore
- Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | | | - Judy LaKind
- LaKind Associates, LLC, Catonsville, MD, USA; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Miranda Langendam
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Veena Manja
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, University of California Davis, Sacramento, CA, USA; Department of Medicine, Department of Veterans Affairs, Northern California Health Care System, Mather, CA, USA
| | | | - Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, University Hospital of South Manchester, University of Manchester, Manchester, UK
| | - Joerg Meerpohl
- Institute for Evidence in Medicine, Medical Center, University of Freiburg, Freiburg-am-Breisgau, Germany; Cochrane Germany, Freiburg-am-Breisgau, Germany
| | - Dominik Mertz
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Roman Mezencev
- National Center for Environmental Assessment, U.S. Environmental Protection Agency, Washington, DC, USA
| | - Rebecca Morgan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gian Paolo Morgano
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; McMaster GRADE Centre & Michael DeGroote Cochrane Canada Centre, McMaster University, Hamilton, Ontario, Canada
| | - Reem Mustafa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Martin O'Flaherty
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Grace Patlewicz
- National Center for Computational Toxicology, U.S. Environmental Protection Agency, Durham, NC, USA
| | - John J Riva
- McMaster GRADE Centre & Michael DeGroote Cochrane Canada Centre, McMaster University, Hamilton, Ontario, Canada; Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Margarita Posso
- Iberoamerican Cochrane Center, Biomedical Research Institute (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Andrew Rooney
- National Toxicology Program, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Paul M Schlosser
- National Center for Environmental Assessment, U.S. Environmental Protection Agency, Washington, DC, USA
| | - Lisa Schwartz
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ian Shemilt
- EPPI-Centre, Institute of Education, University College London, London, UK
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Programs for Assessment of Technology in Health, McMaster University, Hamilton, Ontario, Canada
| | - Kristina A Thayer
- Department of Medicine, Department of Veterans Affairs, Northern California Health Care System, Mather, CA, USA
| | - Katya Tsaioun
- Evidence-Based Toxicology Collaboration, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - John Wambaugh
- National Center for Computational Toxicology, U.S. Environmental Protection Agency, Durham, NC, USA
| | | | | | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yuan Zhang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Health Quality Ontario, Toronto, Ontario, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; McMaster GRADE Centre & Michael DeGroote Cochrane Canada Centre, McMaster University, Hamilton, Ontario, Canada
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