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Shao S, Wang Y, Zhang N, Zhao Y, Zhang X, Sima Y, Wang P, Xu Y, Wang T, Bao S, Cao Y, Wang X, Zhang L, Bachert C. A prospective single-arm study on the efficacy and safety of short-course oral corticosteroids followed by topical corticosteroids in patients with severe chronic rhinosinusitis with nasal polyps. Expert Rev Clin Immunol 2023; 19:1029-1039. [PMID: 37119005 DOI: 10.1080/1744666x.2023.2209724] [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: 01/20/2023] [Accepted: 04/28/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Little evidence exists regarding an integrated multidimensional evaluation methodology to analyze the within-patient effects of medical treatment for chronic rhinosinusitis with nasal polyps (CRSwNP). We aimed to use an integrated evaluation model to analyze the effects of short-course oral corticosteroid (OCS) followed by intranasal corticosteroid spray (INCS) therapy in patients with severe CRSwNP. METHODS In all, 32 patients with severe CRSwNP received oral methylprednisolone for three weeks followed by intranasal budesonide spray for nine weeks in this prospective single-arm study. An evaluation model integrating the concepts of the core outcome set (COS), clinical control and minimum clinically important difference (MCID) was longitudinally evaluated. RESULTS All uncontrolled patients at baseline showed similar progressive improvements from baseline and more than 1 MCID response across core outcomes during the OCS period, with severe CRSwNP being partly controlled in 31 (96.9%) patients and uncontrolled in 1 (3.1%) patient at 3 weeks. During the subsequent INCS period, 14 (43.8%) patients gradually deteriorated to an uncontrolled status at 12 weeks, whereas 18 (56.2%) exhibited partly controlled CRSwNP until 12 weeks. CONCLUSIONS In more than half of the patients, severe CRSwNP was partly controlled with the initial OCS followed by INCS therapy. An integrated evaluation model was used to facilitate the comprehensive evaluation of within-patient response, especially in patients with different responses to the same treatment. TRIAL REGISTRATION ChiCTR1900024287.
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Affiliation(s)
- Shan Shao
- Department of Otorhinolaryngology Head and Neck Surgery, Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, China
- Department of Otolaryngology Head and Neck Surgery, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Yue Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, China
- Beijing Institute of Otolaryngology, Beijing Laboratory of Allergic Diseases (Beijing Municipal Education Commission), Beijing Key Laboratory of Nasal diseases, Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China) of Capital Medical University, Beijing 100005, China
| | - Nan Zhang
- Upper Airways Research Laboratory, Department of Oto-Rhino-Laryngology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Yan Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, China
- Beijing Institute of Otolaryngology, Beijing Laboratory of Allergic Diseases (Beijing Municipal Education Commission), Beijing Key Laboratory of Nasal diseases, Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China) of Capital Medical University, Beijing 100005, China
| | - Xuelian Zhang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing 10073, China
| | - Yutong Sima
- Department of Otorhinolaryngology Head and Neck Surgery, Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, China
- Beijing Institute of Otolaryngology, Beijing Laboratory of Allergic Diseases (Beijing Municipal Education Commission), Beijing Key Laboratory of Nasal diseases, Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China) of Capital Medical University, Beijing 100005, China
| | - Ping Wang
- Beijing Institute of Otolaryngology, Beijing Laboratory of Allergic Diseases (Beijing Municipal Education Commission), Beijing Key Laboratory of Nasal diseases, Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China) of Capital Medical University, Beijing 100005, China
| | - Yuan Xu
- Departments of Oncology, Community Health Sciences, and Surgery, Cumming School of Medicine, and The Center for Health Informatics, University of Calgary, Calgary, Alberta, Canada
| | - Tie Wang
- MIID Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shiping Bao
- Department of Otolaryngology Head and Neck Surgery, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Yu Cao
- Department of Epidemiology research, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Xiangdong Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, China
- Beijing Institute of Otolaryngology, Beijing Laboratory of Allergic Diseases (Beijing Municipal Education Commission), Beijing Key Laboratory of Nasal diseases, Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China) of Capital Medical University, Beijing 100005, China
| | - Luo Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing 100073, China
- Beijing Institute of Otolaryngology, Beijing Laboratory of Allergic Diseases (Beijing Municipal Education Commission), Beijing Key Laboratory of Nasal diseases, Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China) of Capital Medical University, Beijing 100005, China
| | - Claus Bachert
- Upper Airways Research Laboratory, Department of Oto-Rhino-Laryngology, Ghent University Hospital, 9000 Ghent, Belgium
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Münster, Münster, Germany
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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Gressler LE, Devlin V, Jung M, Marinac-Dabic D, Sedrakyan A, Paxton EW, Franklin P, Navarro R, Ibrahim S, Forsberg J, Voorhorst PE, Zusterzeel R, Vitale M, Marks MC, Newton PO, Peat R. Orthopedic Coordinated Registry Network (Ortho-CRN): advanced infrastructure for real-world evidence generation. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2022; 4:e000073. [PMID: 36393890 PMCID: PMC9660599 DOI: 10.1136/bmjsit-2020-000073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 09/06/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Laura Elisabeth Gressler
- Department of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Vincent Devlin
- Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - Mary Jung
- Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - Art Sedrakyan
- Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Elizabeth W Paxton
- Southern California Permanente Medical Group, Kaiser Permanente, Harbor City, California, USA
| | - Patricia Franklin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ronald Navarro
- Southern California Permanente Medical Group, Kaiser Permanente, Harbor City, California, USA
| | - Said Ibrahim
- Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Jonathan Forsberg
- Department of Defense Osseointegration, Murtha Cancer Center, Bethesda, MD, USA
- Orthopaedic Oncology, Sibley Memorial Hospital, Johns Hopkins University, Washington, DC, USA
| | | | - Robbert Zusterzeel
- Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - Michael Vitale
- Pediatric Spine and Scoliosis Service, Morgan Stanley Children's Hospital, New York, New York, USA
| | - Michelle C Marks
- Setting Scoliosis Straight Foundation, San Diego, California, USA
| | - Peter O Newton
- Orthopedics & Scoliosis, Rady Children's Hospital, San Diego, California, USA
| | - Raquel Peat
- Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, Maryland, USA
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Bertges DJ, White R, Cheng YC, Sun T, Ramkumar N, Goodney PP, Wilgus RW, Lottes AE, Smale JA, Drozda J, Raska M, Heise T, Jones WS, Tcheng JE, Eldrup-Jorgensen J, Sedrakyan A, Malone ML, Marinac-Dabic D, Thatcher R, Morales P, Krucoff MW, Cronenwett JL. Registry Assessment of Peripheral Interventional Devices objective performance goals for superficial femoral and popliteal artery peripheral vascular interventions. J Vasc Surg 2020; 73:1702-1714.e11. [PMID: 33080324 DOI: 10.1016/j.jvs.2020.09.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/10/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Superficial Femoral Artery-Popliteal EvidencE Development Study Group developed contemporary objective performance goals (OPGs) for peripheral vascular interventions (PVI) for superficial femoral artery (SFA)-popliteal artery disease using the Registry Assessment of Peripheral Interventional Devices. METHODS The Society for Vascular Surgery Vascular Quality Initiative PVI registry from January 2010 to October 2016 was used to develop OPGs based on SFA-popliteal procedures (n = 21,377) for intermittent claudication and critical limb ischemia (CLI). OPGs included 1-year rates for target lesion revascularization (TLR), major amputation, and 1 and 4-year survival rates. OPGs were calculated for the SFA and popliteal arteries and stratified by four treatments: angioplasty alone (percutaneous transluminal angioplasty [PTA]), self-expanding stenting, atherectomy, and any treatment type. Outcomes were illustrated by unadjusted Kaplan-Meier analyses. RESULTS Cohorts included PTA (n = 7505), stenting (n = 9217), atherectomy (n = 2510) and any treatment (n = 21,377). The mean age was 69 years, 58% were male, 79% were White, and 52% had CLI. The freedom from TLR OPGs at 1 year in the SFA were 80.3% (PTA), 83.2% (stenting), 83.9% (atherectomy), and 81.9% (any treatments). The freedom from TLR OPGs at 1 year in the popliteal were 81.3% (PTA), 81.3% (stenting), 80.2% (atherectomy), and 81.1% (any treatments). The freedom from major amputation OPGs at 1 year after SFA PVI were 93.4% (PTA), 95.7% (stenting), 95.1% (atherectomy), and 94.8% (any treatments). The freedom from major amputation OPG at 1 year after popliteal PVI were 90.5% (PTA), 93.7% (stenting), 91.8% (atherectomy), and 91.8%, (any treatments). The 4-year survival OPGs after SFA PVI were 76% (PTA), 80% (stenting), 82% (atherectomy), and 79% (any treatments), and for the popliteal artery were 72% (PTA), 77% (stenting), 82% (atherectomy), and 75% (any treatment). On a multivariable analysis, which included patient-level, leg-level, and lesion-level covariates, CLI was the single independent factor associated with increased TLR, amputation, and mortality. CONCLUSIONS The Superficial Femoral Artery-Popliteal EvidencE Development OPGs define a new, contemporary benchmark for SFA-popliteal interventions using a large subset of real-world evidence to inform more efficient peripheral device clinical trial designs to support regulatory and clinical decision-making. It is appropriate to discuss proposals intended for regulatory approval with the US Food and Drug Administration to refine the OPG to match the specific trial population. The OPGs may be updated using coordinated registry networks to assess long-term real-world device performance.
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Affiliation(s)
- Daniel J Bertges
- University of Vermont Medical Center, Division of Vascular Surgery, Burlington, VT.
| | | | | | - Tianyi Sun
- Departments of Cardiothoracic Surgery and Populations Health Sciences, Weill Cornell College of Medicine, New York, NY
| | - Niveditta Ramkumar
- Section of Vascular Surgery and the Dartmouth Institute, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Philip P Goodney
- Section of Vascular Surgery and the Dartmouth Institute, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Rebecca W Wilgus
- Department of Medicine and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | | | | | | | | | | | - W Schuyler Jones
- Department of Medicine and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - James E Tcheng
- Department of Medicine and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | | | - Art Sedrakyan
- Departments of Cardiothoracic Surgery and Populations Health Sciences, Weill Cornell College of Medicine, New York, NY
| | | | | | | | | | - Mitchell W Krucoff
- Department of Medicine and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Jack L Cronenwett
- Section of Vascular Surgery and the Dartmouth Institute, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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