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Androsavich JR. Frameworks for transformational breakthroughs in RNA-based medicines. Nat Rev Drug Discov 2024; 23:421-444. [PMID: 38740953 DOI: 10.1038/s41573-024-00943-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 05/16/2024]
Abstract
RNA has sparked a revolution in modern medicine, with the potential to transform the way we treat diseases. Recent regulatory approvals, hundreds of new clinical trials, the emergence of CRISPR gene editing, and the effectiveness of mRNA vaccines in dramatic response to the COVID-19 pandemic have converged to create tremendous momentum and expectation. However, challenges with this relatively new class of drugs persist and require specialized knowledge and expertise to overcome. This Review explores shared strategies for developing RNA drug platforms, including layering technologies, addressing common biases and identifying gaps in understanding. It discusses the potential of RNA-based therapeutics to transform medicine, as well as the challenges associated with improving applicability, efficacy and safety profiles. Insights gained from RNA modalities such as antisense oligonucleotides (ASOs) and small interfering RNAs are used to identify important next steps for mRNA and gene editing technologies.
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Affiliation(s)
- John R Androsavich
- RNA Accelerator, Pfizer Inc, Cambridge, MA, USA.
- Ginkgo Bioworks, Boston, MA, USA.
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Dannehl D, von Au A, Engler T, Volmer LL, Gutsfeld R, Englisch JF, Hahn M, Hawighorst-Knapstein S, Chaudhuri A, Bauer A, Wallwiener M, Taran FA, Wallwiener D, Brucker SY, Wallwiener S, Hartkopf AD, Dijkstra TMH. Implementation and Evaluation of a Breast Cancer Disease Model Using Real-World Claims Data in Germany from 2010 to 2020. Cancers (Basel) 2024; 16:1490. [PMID: 38672572 PMCID: PMC11049278 DOI: 10.3390/cancers16081490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Breast cancer is the leading cause of cancer-related mortality among women in Germany and worldwide. This retrospective claims data analysis utilizing data from AOK Baden-Wuerttemberg, a major statutory German health insurance provider, aimed to construct and assess a real-world data breast cancer disease model. The study included 27,869 female breast cancer patients and 55,738 age-matched controls, analyzing data from 2010 to 2020. Three distinct breast cancer stages were analyzed: Stage A (early breast cancer without lymph node involvement), Stage B (early breast cancer with lymph node involvement), and Stage C (primary distant metastatic breast cancer). Tumor subtypes were estimated based on the prescription of antihormonal or HER2-targeted therapy. The study established that 77.9% of patients had HR+ breast cancer and 9.8% HER2+; HR+/HER2- was the most common subtype (70.9%). Overall survival (OS) analysis demonstrated significantly lower survival rates for stages B and C than for controls, with 5-year OS rates ranging from 79.3% for stage B to 35.4% for stage C. OS rates were further stratified by tumor subtype and stage, revealing varying prognoses. Distant recurrence-free survival (DRFS) analysis showed higher recurrence rates in stage B than in stage A, with HR-/HER2- displaying the worst DRFS. This study, the first to model breast cancer subtypes, stages, and outcomes using German claims data, provides valuable insights into real-world breast cancer epidemiology and demonstrates that this breast cancer disease model has the potential to be representative of treatment outcomes.
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Affiliation(s)
- Dominik Dannehl
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Alexandra von Au
- Department of Gynecology and Obstetrics, Heidelberg University, 69120 Heidelberg, Germany;
| | - Tobias Engler
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Léa Louise Volmer
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Raphael Gutsfeld
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Johannes Felix Englisch
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Markus Hahn
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | | | - Ariane Chaudhuri
- AOK Baden-Wuerttemberg, 70188 Stuttgart, Germany; (S.H.-K.); (A.C.)
| | - Armin Bauer
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | | | - Florin-Andrei Taran
- Department of Gynecology and Obstetrics, Freiburg University, 79106 Freiburg im Breisgau, Germany;
| | - Diethelm Wallwiener
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Sara Yvonne Brucker
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Stephanie Wallwiener
- Department of Obstetrics and Perinatal Medicine, Halle University, 06120 Halle, Germany;
| | - Andreas Daniel Hartkopf
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Tjeerd Maarten Hein Dijkstra
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
- Institute for Translational Bioinformatics, University Hospital Tübingen, 72076 Tübingen, Germany
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Beyeler M, Pohle F, Weber L, Mueller M, Kurmann CC, Mujanovic A, Clénin L, Piechowiak EI, Meinel TR, Bücke P, Jung S, Seiffge D, Pilgram-Pastor SM, Dobrocky T, Arnold M, Gralla J, Fischer U, Mordasini P, Kaesmacher J. Long-Term Effect of Mechanical Thrombectomy in Stroke Patients According to Advanced Imaging Characteristics. Clin Neuroradiol 2024; 34:105-114. [PMID: 37642685 PMCID: PMC10881753 DOI: 10.1007/s00062-023-01337-4] [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: 03/05/2023] [Accepted: 07/13/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Data on long-term effect of mechanical thrombectomy (MT) in patients with large ischemic cores (≥ 70 ml) are scarce. Our study aimed to assess the long-term outcomes in MT-patients according to baseline advanced imaging parameters. METHODS We performed a single-centre retrospective cohort study of stroke patients receiving MT between January 1, 2010 and December 31, 2018. We assessed baseline imaging to determine core and mismatch volumes and hypoperfusion intensity ratio (with low ratio reflecting good collateral status) using RAPID automated post-processing software. Main outcomes were cross-sectional long-term mortality, functional outcome and quality of life by May 2020. Analysis were stratified by the final reperfusion status. RESULTS In total 519 patients were included of whom 288 (55.5%) have deceased at follow-up (median follow-up time 28 months, interquartile range 1-55). Successful reperfusion was associated with lower long-term mortality in patients with ischemic core volumes ≥ 70 ml (adjusted hazard ratio (aHR) 0.20; 95% confidence interval (95% CI) 0.10-0.44) and ≥ 100 ml (aHR 0.26; 95% CI 0.08-0.87). The effect of successful reperfusion on long-term mortality was significant only in the presence of relevant mismatch (aHR 0.17; 95% CI 0.01-0.44). Increasing reperfusion grade was associated with a higher rate of favorable outcomes (mRS 0-3) also in patients with ischemic core volume ≥ 70 ml (aOR 3.58, 95% CI 1.64-7.83). CONCLUSION Our study demonstrated a sustainable benefit of better reperfusion status in patients with large ischemic core volumes. Our results suggest that patient deselection based on large ischemic cores alone is not advisable.
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Affiliation(s)
- Morin Beyeler
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
| | - Fabienne Pohle
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Loris Weber
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Madlaine Mueller
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Christoph C Kurmann
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Adnan Mujanovic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Leander Clénin
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Eike Immo Piechowiak
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Thomas Raphael Meinel
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Philipp Bücke
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - David Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Sara M Pilgram-Pastor
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Tomas Dobrocky
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Jan Gralla
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
- Neurology Department, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Pasquale Mordasini
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Johannes Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland.
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Rasmussen LA, Jensen H, Pedersen AF, Vedsted P. Healthcare use and fear of recurrence in adult cancer survivors at 2.5 years after a cancer diagnosis: a nationwide register study in Denmark. J Cancer Surviv 2023:10.1007/s11764-023-01459-1. [PMID: 37704918 DOI: 10.1007/s11764-023-01459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/24/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE To investigate the association between fear of cancer recurrence (FCR) and healthcare use in general practice among cancer survivors. METHODS We linked nationwide register data to survey data on FCR in cancer survivors at 2.5 years after a cancer diagnosis. Multiple regression models were used to analyse the association between high FCR level and quartiles of healthcare use at 18-30 months before the cancer diagnosis (habitual healthcare use) and between high FCR level and healthcare use at 18-30 months after the cancer diagnosis (survivorship healthcare use). RESULTS We included 1538 cancer survivors in the study. High habitual healthcare use was associated with a high level of FCR (odds ratio = 2.07 (95% confidence interval (CI): 1.36-3.15)) for the 4th quartile of healthcare use compared to the 1st quartile. A high FCR score was also associated with higher healthcare use during cancer survivorship (incidence rate ratio (IRR) = 1.26 (95% CI: 1.14-1.40)). This association remained statistically significant when adjusting for habitual healthcare use (IRR = 1.20 (95% CI: 1.09-1.33)). CONCLUSION High healthcare use before the cancer diagnosis was associated with high FCR during survivorship. This indicates that FCR is partly explained by a general (pre-diagnostic) health concern. High FCR predicted high healthcare use during cancer survivorship, even when adjusting for habitual healthcare use. IMPLICATIONS FOR CANCER SURVIVORS Our results suggest that FCR in cancer survivors is triggered by a general high level of health concern, and the cancer diagnosis may further exacerbate this concern.
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Affiliation(s)
| | - Henry Jensen
- Research Unit for General Practice, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | | | - Peter Vedsted
- Research Unit for General Practice, Bartholins Allé 2, 8000, Aarhus C, Denmark
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Aydin E, Torlak N, Haberman B, Lim FY, Peiro JL. The Survivorship Bias in Congenital Diaphragmatic Hernia. CHILDREN 2022; 9:children9020218. [PMID: 35204938 PMCID: PMC8869836 DOI: 10.3390/children9020218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/16/2022] [Accepted: 01/29/2022] [Indexed: 11/16/2022]
Abstract
Current literature for congenital diaphragmatic hernia (CDH) focuses on the comparison of the overall mortality in CDH patients. Only a few studies concentrate on analyzing the unstable patients who could not achieve surgical repair, as well as those who could but did not survive after. Hence, this study aimed to analyze the effects of various parameters on the timing of death. A retrospective analysis was performed by using the data of all CDH patients from 2003 to 2016 at a single tertiary center. Patients who were diagnosed with left-sided CDH and expired were included in the study regardless of the cause. Of the 66 expired patients, 5 were excluded due to right-sided CDH. The study population constituted a total of 61 patients, of which 31 patients expired prior to CDH repair, and 30 patients expired at different times after CDH repair. Multinomial regression analysis identified that the ECMO need (B = 20.257, p = 0.000, OR: 62.756, 95% CI 10.600–371.384) and O/E LHR (B = 20.376, p = 0.000, OR: 70.663, 95% CI 48.716–102.415) values were the independent predictors that influenced mortality in this cohort. Prenatal pulmonary measurements are the major predictors determining the severity of the disease in patients with CDH.
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Affiliation(s)
- Emrah Aydin
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (F.-Y.L.); (J.L.P.)
- Department of Pediatric Surgery, Tekirdağ Namık Kemal University School of Medicine, 59030 Tekirdağ, Turkey
- Correspondence:
| | - Nilhan Torlak
- Cellular and Molecular Medicine, Koç University Graduate School of Health Sciences, 34450 Istanbul, Turkey;
| | - Beth Haberman
- Division of Neonatology, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Foong-Yen Lim
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (F.-Y.L.); (J.L.P.)
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Jose L. Peiro
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (F.-Y.L.); (J.L.P.)
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
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