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Wu F, Dai C, Zhou Y, Deng Z, Wang Z, Li X, Chen S, Guan W, Zhong N, Ran P. Tiotropium reduces clinically important deterioration in patients with mild-to-moderate chronic obstructive pulmonary disease: A post hoc analysis of the Tie-COPD study. Respir Med 2024; 222:107527. [PMID: 38199288 DOI: 10.1016/j.rmed.2024.107527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/20/2023] [Accepted: 01/07/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Clinically important deterioration (CID) is a composite endpoint used to holistically assess the complex progression of chronic obstructive pulmonary disease (COPD). Tiotropium improves lung function and reduces the rate of COPD exacerbations in patients with COPD of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1 (mild) or 2 (moderate). However, whether tiotropium reduces CID risk in patients with mild-to-moderate COPD remains unclear. METHODS This was a post hoc analysis of the 24-month Tie-COPD study comparing 18 μg tiotropium with placebo in patients with mild-to-moderate COPD. CID was defined as a decrease of ≥100 mL in trough forced expiratory volume in 1 s, an increase of ≥2 unit in COPD Assessment Test (CAT) score, or moderate-to-severe exacerbation. The time to the first occurrence of one of these events was recorded as the time to the first CID. Subgroup analyses were conducted among patients stratified by CAT score, modified Medical Research Council (mMRC) dyspnea score, and GOLD stage at baseline. RESULTS Of the 841 randomized patients, 771 were included in the full analysis set. Overall, 643 patients (83.4 %) experienced at least one CID event. Tiotropium significantly reduced the CID risk and delayed the time to first CID compared with placebo (adjusted hazard ratio = 0.58, 95 % confidence interval = 0.49-0.68, P < 0.001). Significant reductions in CID risk were also observed in various subgroups, including patients with a CAT score <10, mMRC score <2, and mild COPD. CONCLUSIONS Tiotropium reduced CID risk in patients with mild-to-moderate COPD, even in patients with fewer respiratory symptoms or mild disease, which highlights tiotropium's effectiveness in treating COPD patients with mild disease. TRIAL REGISTRATION This study is registered at ClinicalTrials.gov (Tie-COPD, NCT01455129).
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Affiliation(s)
- Fan Wu
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou National Laboratory, Guangzhou, China
| | - Cuiqiong Dai
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yumin Zhou
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou National Laboratory, Guangzhou, China
| | - Zhishan Deng
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zihui Wang
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaochen Li
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shuyun Chen
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weijie Guan
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou National Laboratory, Guangzhou, China
| | - Pixin Ran
- State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou National Laboratory, Guangzhou, China.
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Papi A, Hughes R, del Olmo R, Agusti A, Chipps BE, Make B, Tomaszewski E, Peres Da Costa K, Srivastava D, Vestbo J, Janson C, Burgel PR, Price D. Relationships between symptoms and lung function in asthma and/or chronic obstructive pulmonary disease in a real-life setting: the NOVEL observational longiTudinal studY. Ther Adv Respir Dis 2024; 18:17534666241254212. [PMID: 38841799 PMCID: PMC11155362 DOI: 10.1177/17534666241254212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 04/22/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The relationships between spirometric assessment of lung function and symptoms (including exacerbations) in patients with asthma and/or chronic obstructive pulmonary disease (COPD) in a real-life setting are uncertain. OBJECTIVES To assess the relationships between baseline post-bronchodilator (post-BD) spirometry measures of lung function and symptoms and exacerbations in patients with a physician-assigned diagnosis of asthma and/or COPD. DESIGN The NOVEL observational longiTudinal studY (NOVELTY) is a global, prospective, 3-year observational study. METHODS Logistic regression analysis was used to evaluate relationships. Spirometry measures were assessed as percent predicted (%pred). Symptoms were assessed at baseline, and exacerbations were assessed at baseline and Year 1. RESULTS A total of 11,181 patients in NOVELTY had spirometry data (asthma, n = 5903; COPD, n = 3881; asthma + COPD, n = 1397). A 10% lower post-BD %pred forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) - adjusted for age and sex - were significantly associated with dyspnea (modified Medical Research Council ⩾ grade 2), frequent breathlessness [St George's Respiratory Questionnaire (SGRQ)], frequent wheeze attacks (SGRQ), nocturnal awakening (Respiratory Symptoms Questionnaire; ⩾1 night/week), and frequent productive cough (SGRQ). Lower post-BD %pred FEV1 and, to a lesser extent, lower post-BD %pred FVC were significantly associated with ⩾1 physician-reported exacerbation at baseline or Year 1. This association was stronger in patients with COPD than in those with asthma. CONCLUSION In a real-life setting, reduced lung function is consistently associated with symptoms in patients with asthma, COPD, or asthma + COPD. The relationship with exacerbations is stronger in COPD only than in asthma. TRAIL REGISTRATION clinicaltrials.gov identifier: NCT02760329 (www.clinicaltrials.gov).
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Affiliation(s)
- Alberto Papi
- Respiratory Unit, Emergency Department, Research Centre on Asthma and COPD, University of Ferrara, University Hospital S. Anna, Ferrara 44124, Italy
| | - Rod Hughes
- Research and Early Development, Respiratory and Immunology, AstraZeneca, Cambridge, UK
| | - Ricardo del Olmo
- Diagnostic and Treatment Department, Hospital de Rehabilitación Respiratoria ‘Maria Ferrer’ and IDIM CR, Buenos Aires, Argentina
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, Cátedra de Salud Respiratoria, University of Barcelona, IDIBAPS, and CIBERES, Barcelona, Spain
| | | | - Barry Make
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health and University of Colorado Denver, Denver, CO, USA
| | - Erin Tomaszewski
- BioPharmaceuticals Medical, Patient-Centered Science, AstraZeneca, Gaithersburg, MD, USA
| | | | | | - Jørgen Vestbo
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Pierre-Régis Burgel
- Service de Pneumologie, Hôpital Cochin, Assistance Publique Hôpitaux de Paris
- Institut Cochin, Inserm U1016, Université Paris Cité, Paris, France
| | - David Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Thomas M, Beasley R. The treatable traits approach to adults with obstructive airways disease in primary and secondary care. Respirology 2023; 28:1101-1116. [PMID: 37877554 DOI: 10.1111/resp.14610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023]
Abstract
The treatable traits approach is based on the recognition that the different clinical phenotypes of asthma and chronic obstructive airways disease (COPD) are a heterogeneous group of conditions with different underlying mechanisms and clinical manifestations, and that the identification and treatment of the specific clinical features or traits facilitates a personalised approach to management. Fundamentally, it recognises two important concepts. Firstly, that treatment for obstructive lung disease can achieve better outcomes if guided by specific clinical characteristics. Secondly, that in patients with a diagnosis of asthma, and/or COPD, poor respiratory health may also be due to numerous overlapping disorders that can present with symptoms that may be indistinguishable from asthma and/or COPD, comorbidities that might require treatment in their own right, and lifestyle or environmental factors that, if addressed, might lead to better control rather than simply increasing airways directed treatment. While these concepts are well accepted, how best to implement this personalised medicine approach in primary and secondary care within existing resource constraints remains uncertain. In this review, we consider the evidence base for this management approach and propose that the priority now is to assess different prototype templates for the identification and management of treatable traits in both asthma and COPD, in primary, secondary and tertiary care, to provide the evidence that will guide their use in clinical practice in different health care systems.
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Affiliation(s)
- Mike Thomas
- Primary Care Research, School of Primary Care, Population Sciences and Medical Education (PPM), Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Richard Beasley
- Medicine, Medical Research Institute of New Zealand, Wellington, New Zealand
- Victoria University of Wellington, Wellington, New Zealand
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Gale RP, Zhang MJ, Lazarus HM. The role of randomized controlled trials, registries, observational databases in evaluating new interventions. Best Pract Res Clin Haematol 2023; 36:101523. [PMID: 38092482 DOI: 10.1016/j.beha.2023.101523] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/17/2023] [Indexed: 12/18/2023]
Abstract
Approaches to comparing safety and efficacy of interventions include analyzing data from randomized controlled trials (RCTs), registries and observational databases (ODBs). RCTs are regarded as the gold standard but data from such trials are sometimes unavailable because a disease is uncommon, because the intervention is uncommon, because of structural limitations or because randomization cannot be done for practical or (seemingly) ethical reasons. There are many examples of an unproved intervention being so widely-believed to be effective that clinical trialists and potential subjects decline randomization. Often, when a RCT is finally done the intervention is proved ineffective or even harmful. These situations are termed medical reversals and are not uncommon [1,2]. There is also the dilemma of when seemingly similar RCTs report discordant conclisions Data from high-quality registries, especially ODBs can be used when data from RCTs are unavailable but also have limitations. Biases and confounding co-variates may be unknown, difficult or impossible to identify and/or difficult to adjust for adequately. However, ODBs sometimes have large numbers of diverse subjects and often give answers more useful to clinicians than RCTs. Side-by-side comparisons suggest analyses from high-quality ODBs often give similar conclusions from high quality RCTs. Meta-analyses combining data from RCTs, registries and ODBs are sometimes appropriate. We suggest increased use of registries and ODBs to compare efficacy of interventions.
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Affiliation(s)
- Robert Peter Gale
- Centre for Haematology, Department of Immunology and Inflammation, Imperial College of Science, Technology and Medicine, London, UK.
| | - Mei-Jie Zhang
- Center for International Blood and Marrow Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA
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Feldman WB, Avorn J, Kesselheim AS, Gagne JJ. Chronic Obstructive Pulmonary Disease Exacerbations and Pneumonia Hospitalizations Among New Users of Combination Maintenance Inhalers. JAMA Intern Med 2023; 183:685-695. [PMID: 37213116 PMCID: PMC10203971 DOI: 10.1001/jamainternmed.2023.1245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/07/2023] [Indexed: 05/23/2023]
Abstract
Importance Clinical guidelines on chronic obstructive pulmonary disease (COPD) recommend inhalers containing long-acting muscarinic antagonists (LAMAs) and long-acting β-agonists (LABAs) over inhalers containing inhaled corticosteroids (ICSs) and LABAs. However, data from randomized clinical trials comparing these combination inhalers (LAMA-LABAs vs ICS-LABAs) have been conflicting and raised concerns of generalizability. Objective To assess whether LAMA-LABA therapy is associated with reduced COPD exacerbations and pneumonia hospitalizations compared with ICS-LABA therapy in routine clinical practice. Design, Setting, and Participants This was a 1:1 propensity score-matched cohort study using Optum's Clinformatics Data Mart, a large commercial insurance-claims database. Patients must have had a diagnosis of COPD and filled a new prescription for a combination LAMA-LABA or ICS-LABA inhaler between January 1, 2014, and December 31, 2019. Patients younger than 40 years were excluded, as were those with a prior diagnosis of asthma. The current analysis was performed from February 2021 to March 2023. Exposures Combination LAMA-LABA inhalers (aclidinium-formoterol, glycopyrronium-formoterol, glycopyrronium-indacaterol, tiotropium-olodaterol, or umeclidinium-vilanterol) and combination ICS-LABA inhalers (budesonide-formoterol, fluticasone-salmeterol, fluticasone-vilanterol, or mometasone-formoterol). Main Outcome The primary effectiveness outcome was first moderate or severe COPD exacerbation, and the primary safety outcome was first pneumonia hospitalization. Propensity score matching was used to control for confounding between the 2 groups. Logistic regression analysis was used to estimate propensity scores. Hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards models stratified on matched pairs. Results Among 137 833 patients (mean [SD] age, 70.2 [9.9] years; 69 530 [50.4%] female) (107 004 new ICS-LABA users and 30 829 new LAMA-LABA users), 30 216 matched pairs were identified for the primary analysis. Compared with ICS-LABA use, LAMA-LABA use was associated with an 8% reduction in the rate of first moderate or severe COPD exacerbation (HR, 0.92; 95% CI, 0.89-0.96) and a 20% reduction in the rate of first pneumonia hospitalization (HR, 0.80; 95% CI, 0.75-0.86). These findings were robust across a range of prespecified subgroup and sensitivity analyses. Conclusion In this cohort study, LAMA-LABA therapy was associated with improved clinical outcomes compared with ICS-LABA therapy, suggesting that LAMA-LABA therapy should be preferred for patients with COPD.
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Affiliation(s)
- William B. Feldman
- Program on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jerry Avorn
- Program on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Aaron S. Kesselheim
- Program on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Joshua J. Gagne
- Program on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Now with Johnson & Johnson, Cambridge, Massachusetts
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Papi A, Qasuri M, Chung E, Abdelbaset M, Aly Moussa M, Backer V, Schmidt O, Usmani O. Fixed-dose combination fluticasone/formoterol for asthma treatment in a real-world setting: meta-analysis of exacerbation rates and asthma control. Eur Clin Respir J 2023; 10:2174642. [PMID: 36815940 PMCID: PMC9930770 DOI: 10.1080/20018525.2023.2174642] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Treatment guidelines for asthma management are derived almost exclusively from the results of controlled clinical trials undertaken in carefully selected patient populations; meaning that their outcomes may not reflect the true performance of treatments when used in general daily medical practice. The aim of this meta-analysis was to combine the results of observational studies investigating the fluticasone propionate/formoterol (FP/FORM) fixed-dose combination in real-world asthma patients. METHODS A systemic literature review was completed in March 2019 using the PubMed database. We identified 394 studies. Five studies, which included a total of 4756 patients treated with FP/FORM, were judged eligible and included in the meta-analysis. RESULTS The estimated severe asthma exacerbation rate was 11.47% (95% CI, 5.8 to 18.72%), calculated from the random effect model. A sensitivity analysis excluding 2 studies (one was an outlier, and the exacerbation rate for the studied treatment alone could not be determined in the other) showed a 7.04% rate of severe asthma exacerbations. The estimated relative risk of the incidence of severe asthma exacerbations was 0.323 (95% CI, 0.159 to 0.658). The estimated asthma control rate was 60.6% (95% CI, 55.7% to 65.6%). The odds of achieving asthma control significantly increased by FP/FORM compared with pre-study conditions (estimated odds ratio: 2.214 [95% CI, 1.292 to 3.795]; p < 0.001). CONCLUSIONS The findings of this meta-analysis confirm the effectiveness of FP/FORM for the treatment of asthma patients in a real-world setting beyond the limitations of RCTs.
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Affiliation(s)
- Alberto Papi
- Chair of Respiratory Medicine, University of Ferrara, Ferrara, Italy,CONTACT Alberto Papi ; Chair of Respiratory Medicine, University of Ferrara, Via Savonarola, 9, 44121 Ferrara FE, Italy
| | - Murtaza Qasuri
- Regional Therapeutic Leadership Team, Zuellig Pharma Therapeutics, Singapore, Singapore
| | - Ernestine Chung
- Respiratory & Ophthalmology, Mundipharma, Asia Pacific, Singapore
| | - Mohamed Abdelbaset
- Head of Medical Affairs & Compliance, Mundipharma Saudi Arabia, Riyadh, Saudi Arabia
| | - Mohamed Aly Moussa
- Medical Specialist, Clinical Ops & Research, Medical Information, Mundipharma GCC, Dubai, United Arab Emirates
| | - Vibeke Backer
- Department of Respiratory Medicine, University Hospital of Copenhagen, Copenhagen, Denmark
| | | | - Omar Usmani
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
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Magnan A, Nicolas JF, Caimmi D, Vocanson M, Haddad T, Colas L, Scurati S, Mascarell L, Shamji MH. Deciphering Differential Behavior of Immune Responses as the Foundation for Precision Dosing in Allergen Immunotherapy. J Pers Med 2023; 13:jpm13020324. [PMID: 36836557 PMCID: PMC9964800 DOI: 10.3390/jpm13020324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
Like in many fields of medicine, the concept of precision dosing has re-emerged in routine practice in allergology. Only one retrospective study on French physicians' practice has addressed this topic so far and generated preliminary data supporting dose adaptation, mainly based on experience, patient profile understanding and response to treatment. Both intrinsic and extrinsic factors shape the individual immune system response to allergen immunotherapy (AIT). Herein, we focus on key immune cells (i.e., dendritic cells, innate lymphoid cells, B and T cells, basophils and mast cells) involved in allergic disease and its resolution to further understand the effect of AIT on the phenotype, frequency or polarization of these cells. We strive to discriminate differences in immune responses between responders and non-responders to AIT, and discuss the eligibility of a non/low-responder subset for dose adaptation. A differential behavior in immune cells is clearly observed in responders, highlighting the importance of conducting clinical trials with large cohorts of well-characterized subjects to decipher the immune mechanism of AIT. We conclude that there is a need for designing new clinical and mechanistic studies to support the scientific rationale of dose adaptation in the interest of patients who do not properly respond to AIT.
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Affiliation(s)
- Antoine Magnan
- INRAe UMR 0892, Hôpital Foch, Université de Versailles Saint Quentin, Paris-Saclay, 92150 Suresnes, France
| | - Jean-François Nicolas
- CIRI-International Center for Infectiology Research, INSERM U1111, Lyon1 University, Ecole Normale Supérieure de Lyon, CNRS, UMR 5308, 69007 Lyon, France
| | - Davide Caimmi
- Allergy Unit, Department Respiratory Medicine and Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, 34090 Montpellier, France
| | - Marc Vocanson
- CIRI-International Center for Infectiology Research, INSERM U1111, Lyon1 University, Ecole Normale Supérieure de Lyon, CNRS, UMR 5308, 69007 Lyon, France
| | - Thierry Haddad
- Dermatology, Allergology and Vascular Medicine, Tenon Hospital, 75020 Paris, France
| | - Luc Colas
- Plateforme Transversale d’Allergologie, Clinique Dermatologique, CHU de Nantes, 44093 Nantes, France
- UMR 1064, Center for Research in Transplantation and Translational Immunology, INSERM, Nantes Université, 44093 Nantes, France
| | - Silvia Scurati
- Stallergenes Greer, 92160 Antony, France
- Correspondence: ; Tel.: +33-(0)-6-12-88-40-93
| | | | - Mohamed H. Shamji
- National Heart & Lung Institute, Imperial College London, London SW7 2AZ, UK
- NIHR Imperial Biomedical Research Centre, London W2 1NY, UK
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Terada K, Tanabe N, Shiraishi Y, Hamakawa Y, Shima H, Maetani T, Terada S, Sato S, Kanezaki M, Hirai T. Chronic obstructive pulmonary disease features in patients visiting primary respiratory clinic and tertiary hospital in Japan. Respir Investig 2023; 61:40-44. [PMID: 36470802 DOI: 10.1016/j.resinv.2022.10.010] [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: 06/13/2022] [Revised: 09/23/2022] [Accepted: 10/31/2022] [Indexed: 12/05/2022]
Abstract
Pulmonologists in primary care clinics are positioned between those in tertiary hospitals and general practitioners in clinics and are anticipated to promote hospital-clinic collaboration for patients with chronic obstructive pulmonary disease (COPD). However, the clinical features of patients in primary respiratory clinics are unclear. This multicenter study cross-sectionally compared the characteristics of patients with COPD in a respiratory clinic (n = 69) with those in a university hospital (n = 124). More patients visited the clinic for symptom relief without a referral, whereas more visited the hospital for consultation of abnormal spirometry/computed tomography (CT). The patients in the clinic showed female predilection, higher prevalence of current smokers, severe dyspnea, and concomitant heart failure, and higher CT-measured cross-sectional area ratio of pectoralis muscle to adjacent subcutaneous adipose tissue compared to those in the hospital (all p < 0.05). The observed differences between the two groups suggest the need to establish the role of primary pulmonologists in hospital-clinic collaboration for better COPD management.
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Affiliation(s)
- Kunihiko Terada
- Terada Clinic, Respiratory Medicine and General Practice, Himeji, Hyogo, Japan.
| | - Naoya Tanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Yusuke Shiraishi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Yoko Hamakawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Hiroshi Shima
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Tomoki Maetani
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Satoru Terada
- Terada Clinic, Respiratory Medicine and General Practice, Himeji, Hyogo, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Susumu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan; Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Masashi Kanezaki
- Department of Physical Therapy, School of Health Sciences, Tokyo International University, 1-13-1 Matobakita, Kawagoe, Saitama 350-1197, Japan.
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
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Andersen IC, Siersma V, Marsaa K, Preisel N, Høegholm A, Brodersen J, Bodtger U. Is it okay to choose to receive bad news by telephone? An observational study on psychosocial consequences of diagnostic workup for lung cancer suspicion. Acta Oncol 2022; 61:1446-1453. [PMID: 36394954 DOI: 10.1080/0284186x.2022.2143280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND In-person meeting is considered the gold standard in current communication protocols regarding sensitive information, yet one size may not fit all, and patients increasingly demand or are offered disclosure of bad news by, e.g., telephone. It is unknown how patients' active preference for communication modality affect psychosocial consequences of receiving potentially bad news. AIM To explore psychosocial consequences in patients, who themselves chose to have results of lung cancer workup delivered either in-person or by telephone compared with patients randomly assigned to either delivery in a recently published randomised controlled trial (RCT). METHODS An observational study prospectively including patients referred for invasive workup for suspected lung cancer stratified in those declining (Patient's Own Choice, POC group) and those participating in the RCT. On the day of invasive workup and five weeks later, patients completed a validated, nine-dimension, condition-specific questionnaire, Consequences of Screening in Lung Cancer (COS-LC). Primary outcome: difference in change in COS-LC dimensions between POC and RCT groups. RESULTS In total, 151 patients were included in the POC group versus 255 in the RCT. Most (70%) in the POC group chose to have results by telephone. Baseline characteristics and diagnostic outcomes were comparable between POC and RCT groups, and in telephone and in-person subgroups too. We observed no statistically significant between-groups differences in any COS-LC score between POC and RCT groups, or between telephone and in-person subgroups in the POC group. CONCLUSION Continually informed patients' choice between in-person or telephone disclosure of results of lung cancer workup is not associated with differences in psychosocial outcomes. The present article supports further use of a simple model for how to prepare the patient for potential bad news.
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Affiliation(s)
- Ingrid C Andersen
- Department of Respiratory Medicine, Respiratory Research Unit PLUZ, Zealand University Hospital Naestved, Naestved, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Medicine, Naestved, Slagelse and Ringsted Hospitals, Næstved, Denmark
| | - Volkert Siersma
- Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Nikolaj Preisel
- Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Asbjørn Høegholm
- Department of Respiratory Medicine, Respiratory Research Unit PLUZ, Zealand University Hospital Naestved, Naestved, Denmark
| | - John Brodersen
- Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The Primary Health Care Research Unit, Region Zealand, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Respiratory Research Unit PLUZ, Zealand University Hospital Naestved, Naestved, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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10
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Hahn DL. Does the asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) exist? A narrative review from epidemiology and practice. Allergol Immunopathol (Madr) 2022; 50:100-106. [PMID: 36335452 DOI: 10.15586/aei.v50i6.678] [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: 05/21/2022] [Accepted: 08/21/2022] [Indexed: 06/16/2023]
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) have traditionally been approached as separate entities that must be researched and treated separately. There is growing recognition, however, that a substantial proportion of patients with obstructive lung disease have characteristics of both asthma and COPD (termed the asthma-COPD overlap syndrome (ACOS)). Lung disease experts have difficulty defining ACOS, and many still resist accepting the possibility that asthma and COPD may be linked. It is likely that practicing clinicians may be equally confused about how to identify and treat ACOS. This narrative review aims to clarify concepts of ACOS definition, argues that the best way to understand ACOS is to view the chronic lung disease process longitudinally rather than cross-sectionally, and presents evidence that ACOS can be the end result of the natural history of severe asthma. The review also points out the serious gaps in knowledge regarding therapy for ACOS and presents emerging data supporting the intracellular respiratory pathogen Chlamydia pneumoniae as a possible common etiologic agent in severe asthma and ACOS.
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Affiliation(s)
- David L Hahn
- Intracell Research Group, Town of Wake Forest, NC, United States;
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11
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Agustí A, Rapsomaniki E, Beasley R, Hughes R, Müllerová H, Papi A, Pavord ID, van den Berge M, Faner R. Treatable traits in the NOVELTY study. Respirology 2022; 27:929-940. [PMID: 35861464 PMCID: PMC9795904 DOI: 10.1111/resp.14325] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/08/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Asthma and chronic obstructive pulmonary disease (COPD) are two prevalent and complex diseases that require personalized management. Although a strategy based on treatable traits (TTs) has been proposed, the prevalence and relationship of TTs to the diagnostic label and disease severity established by the attending physician in a real-world setting are unknown. We assessed how the presence/absence of specific TTs relate to the diagnosis and severity of 'asthma', 'COPD' or 'asthma + COPD'. METHODS The authors selected 30 frequently occurring TTs from the NOVELTY study cohort (NOVEL observational longiTudinal studY; NCT02760329), a large (n = 11,226), global study that systematically collects data in a real-world setting, both in primary care clinics and specialized centres, for patients with 'asthma' (n = 5932, 52.8%), 'COPD' (n = 3898, 34.7%) or both ('asthma + COPD'; n = 1396, 12.4%). RESULTS The results indicate that (1) the prevalence of the 30 TTs evaluated varied widely, with a mean ± SD of 4.6 ± 2.6, 5.4 ± 2.6 and 6.4 ± 2.8 TTs/patient in those with 'asthma', 'COPD' and 'asthma + COPD', respectively (p < 0.0001); (2) there were no large global geographical variations, but the prevalence of TTs was different in primary versus specialized clinics; (3) several TTs were specific to the diagnosis and severity of disease, but many were not; and (4) both the presence and absence of TTs formed a pattern that is recognized by clinicians to establish a diagnosis and grade its severity. CONCLUSION These results provide the largest and most granular characterization of TTs in patients with airway diseases in a real-world setting to date.
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Affiliation(s)
- Alvar Agustí
- Càtedra Salut RespiratoriaUniversitat BarcelonaBarcelonaSpain,Servei Pneumologia, Respiratory InstituteHospital ClinicBarcelonaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain,CIBER Enfermedades RespiratoriasBarcelonaSpain
| | | | - Richard Beasley
- Medical Research Institute of New ZealandWellingtonNew Zealand
| | - Rod Hughes
- External Scientific Engagement, BioPharmaceuticals MedicalAstraZenecaCambridgeUK
| | - Hana Müllerová
- Respiratory & Immunology, Medical and Payer Evidence Strategy, BioPharmaceuticals MedicalAstraZenecaCambridgeUK
| | - Alberto Papi
- Department of Respiratory MedicineMedical School, University of FerraraFerraraItaly,Respiratory Unit, Emergency DepartmentUniversity HospitalFerraraItaly
| | - Ian D. Pavord
- Oxford Respiratory NIHR BRC and Respiratory Medicine Unit, Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | | | - Rosa Faner
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain,CIBER Enfermedades RespiratoriasBarcelonaSpain
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12
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Bakerly ND, Nikitin K, Snowise NG, Cardwell G, Freeman D, Saggu R, De Soyza A. Pragmatic randomised controlled trials in COPD and asthma: how to guide clinical practice. BMJ Open Respir Res 2022; 9:9/1/e001303. [PMID: 36180103 PMCID: PMC9528570 DOI: 10.1136/bmjresp-2022-001303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/27/2022] [Indexed: 11/17/2022] Open
Abstract
The use of real-world evidence (RWE) studies, including pragmatic randomised controlled trials (RCTs; randomised RWE studies), to aid the development of treatment guidelines, is gradually becoming a mainstay within clinical practice. RWE is an integral part of patient-driven decision-making and offers important value to add complimentary evidence to traditional RCTs; these provide a more well-rounded view of the benefits to patient-reported outcomes and improve the external validity of a given treatment versus findings from traditional RCTs alone. Discussions in recent scientific workshops explored the importance of pragmatic RCTs in optimising guideline development and patient care in chronic obstructive pulmonary disease (COPD) and asthma. The Salford Lung Study in patients with COPD (NCT01551758) and asthma (NCT01706198) were the world’s first prelicence pragmatic RCTs that compared novel investigational treatments with existing COPD and asthma treatments and, more recently (2021), RWE studies have been used by the American Thoracic Society and the US Food and Drug Administration to support the approval of an immunosuppressant drug in patients receiving lung transplants. This highlights the importance of RWE data in supporting clinical guideline development and emphasises the advantages for the use of pragmatic RCTs in guiding clinical practice.
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Affiliation(s)
- Nawar Diar Bakerly
- School of Biological Sciences, Manchester Metropolitan University, Manchester, UK.,Salford Royal, NHS Foundation Trust, Salford, UK
| | | | - Neil G Snowise
- Institute of Pharmaceutical Science, Faculty of Life Sciences and Medicine, King's College, London, UK
| | | | - Daryl Freeman
- Norfolk Community Health and Care, Woodlands House, Norwich, UK
| | - Ravijyot Saggu
- Pharmacy Department, University College Hospital, NHS Foundation Trust, London, UK
| | - Anthony De Soyza
- Population and Health Sciences Institute, Newcastle University, Newcastle, UK
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13
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Çolak Y, Nordestgaard BG, Lange P, Vestbo J, Afzal S. Prognosis of Patients with Chronic Obstructive Pulmonary Disease Not Eligible for Major Clinical Trials. Am J Respir Crit Care Med 2022; 206:271-280. [PMID: 35438616 PMCID: PMC9890252 DOI: 10.1164/rccm.202110-2441oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Rationale: Randomized controlled trials only include a subset of patients with chronic obstructive pulmonary disease (COPD) fulfilling strict inclusion criteria. Thus, most patients with COPD in a real-world setting do not have the necessary evidence to support treatment effectiveness. Objectives: To test the hypotheses that most individuals with COPD in the general population are not represented in major clinical trials despite clinically significant disease with exacerbations and early death. Methods: In 105,630 adults from a Danish contemporary population-based cohort, we defined COPD as age 40 or more years, chronic respiratory symptoms, history of smoking exposure, and airflow limitation with FEV1/FVC < 0.70. Outcomes included acute exacerbations and all-cause mortality. Symptomatic smokers without COPD were used as a reference group. Measurements and Main Results: Of all, 7,516 (7%) and 16,079 (15%) were symptomatic smokers with and without COPD. Only 44% of those with COPD were eligible for major clinical trials when applying FEV1 < 80% predicted, smoking history of 10 or more pack-years, and no comorbid asthma as common inclusion criteria. During the median 8.9 years of follow-up, we observed 2,130 acute exacerbations and 3,973 deaths in symptomatic smokers. Compared with symptomatic smokers without COPD, multivariable-adjusted hazard ratios for exacerbations were 7.45 (95% confidence interval, 5.41-10.3) and 29.0 (21.1-39.8) in those with COPD, respectively, excluded and eligible for clinical trials. Corresponding hazard ratios for all-cause mortality were 1.21 (1.11-1.31) and 1.67 (1.54-1.81), respectively. Conclusions: More than half of individuals with COPD in the general population are excluded from major clinical trials; however, these individuals have a clinically significant disease with exacerbations and early death compared with symptomatic smokers without COPD.
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Affiliation(s)
- Yunus Çolak
- Department of Respiratory Medicine,,The Copenhagen General Population Study, and,Department of Clinical Medicine, Faculty of Health and Medical Sciences, and
| | - Børge G. Nordestgaard
- The Copenhagen General Population Study, and,Department of Clinical Biochemistry, Copenhagen University Hospital – Herlev and Gentofte, Copenhagen, Denmark;,Department of Clinical Medicine, Faculty of Health and Medical Sciences, and
| | - Peter Lange
- Department of Respiratory Medicine,,The Copenhagen General Population Study, and,Department of Clinical Medicine, Faculty of Health and Medical Sciences, and,Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; and
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, and Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Shoaib Afzal
- The Copenhagen General Population Study, and,Department of Clinical Biochemistry, Copenhagen University Hospital – Herlev and Gentofte, Copenhagen, Denmark;,Department of Clinical Medicine, Faculty of Health and Medical Sciences, and
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14
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Mohammadi Jouabadi S, Nekouei Shahraki M, Peymani P, Stricker BH, Ahmadizar F. Utilization of Pharmacokinetic/Pharmacodynamic Modeling in Pharmacoepidemiological Studies: A Systematic Review on Antiarrhythmic and Glucose-Lowering Medicines. Front Pharmacol 2022; 13:908538. [PMID: 35795566 PMCID: PMC9251370 DOI: 10.3389/fphar.2022.908538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/04/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction: In human pharmacology, there are two important scientific branches: clinical pharmacology and pharmacoepidemiology. Pharmacokinetic/pharmacodynamic (PK/PD) modeling is important in preclinical studies and randomized control trials. However, it is rarely used in pharmacoepidemiological studies on the effectiveness and medication safety where the target population is heterogeneous and followed for longer periods. The objective of this literature review was to investigate how far PK/PD modeling is utilized in observational studies on glucose-lowering and antiarrhythmic drugs. Method: A systematic literature search of MEDLINE, Embase, and Web of Science was conducted from January 2010 to 21 February 2020. To calculate the utilization of PK/PD modeling in observational studies, we followed two search strategies. In the first strategy, we screened a 1% random set from 95,672 studies on glucose-lowering and antiarrhythmic drugs on inclusion criteria. In the second strategy, we evaluated the percentage of studies in which PK/PD modeling techniques were utilized. Subsequently, we divided the total number of included studies in the second search strategy by the total number of eligible studies in the first search strategy. Results: The comprehensive search of databases and the manual search of included references yielded a total of 29 studies included in the qualitative synthesis of our systematic review. Nearly all 29 studies had utilized a PK model, whereas only two studies developed a PD model to evaluate the effectiveness of medications. In total, 16 out of 29 studies (55.1%) used a PK/PD model in the observational setting to study effect modification. The utilization of PK/PD modeling in observational studies was calculated as 0.42%. Conclusion: PK/PD modeling techniques were substantially underutilized in observational studies of antiarrhythmic and glucose-lowering drugs during the past decade.
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Affiliation(s)
- Soroush Mohammadi Jouabadi
- Department of Epidemiology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
- Division of Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Mitra Nekouei Shahraki
- Department of Epidemiology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Payam Peymani
- Department of Epidemiology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Bruno H. Stricker
- Department of Epidemiology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
- *Correspondence: Bruno H. Stricker,
| | - Fariba Ahmadizar
- Department of Epidemiology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
- Julius Global Health, University Medical Center Utrecht, Utrecht, Netherlands
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15
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Cazzola M, Ora J, Calzetta L, Rogliani P, Matera MG. Advances in inhaled corticosteroids for the treatment of chronic obstructive pulmonary disease: what is their value today? Expert Opin Pharmacother 2022; 23:917-927. [PMID: 35575510 DOI: 10.1080/14656566.2022.2076592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION As of today, there is still a need to determine which COPD patients may benefit from ICS therapy, whether ICSs are useful in COPD patients without chronic bronchitis, and whether long-acting bronchodilators can reduce the risk of exacerbations in frequent exacerbators even if ICSs are not used, and whether combination therapy including ICSs is helpful in infrequent exacerbators to optimise the use of ICSs in COPD. Nevertheless, in recent years, a fair amount of evidence has been produced that, at least in part, can help define the role of ICSs in COPD better. AREAS COVERED Herein, the authors provide an overview of current use of ICS in COPD and discuss their value to the current treatment armamentarium. The article includes discussion of which patients will benefit best from the use of ICSs, their potential uses and adverse effects. EXPERT OPINION There is growing agreement on why, in whom, and when ICS therapy can be used in COPD, although the consensus is still lacking because of the heterogeneity of COPD. The use of blood eosinophil counts (BECs) is only helpful in T2 inflammation, while there is a lack of biomarkers indicating the presence of T1 and T17 immunity, which is poorly responsive to ICS. Identifying ICS-sensitive endotypes using specific biomarkers that have yet to be identified and validated is likely to demonstrate that ICSs can influence the natural course of COPD in at least a subset of patients.
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Affiliation(s)
- Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Josuel Ora
- Unit of Respiratory Medicine, "Tor Vergata" Hospital Foundation, Rome, Italy
| | - Luigino Calzetta
- Unit of Respiratory Diseases and Lung Function, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.,Unit of Respiratory Medicine, "Tor Vergata" Hospital Foundation, Rome, Italy
| | - Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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16
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Dalin DA, Løkke A, Kristiansen P, Jensen C, Birkefoss K, Christensen HR, Godtfredsen NS, Hilberg O, Rohde JF, Ussing A, Vermehren C, Handel MN. A systematic review of blood eosinophils and continued treatment with inhaled corticosteroids in patients with COPD. Respir Med 2022; 198:106880. [DOI: 10.1016/j.rmed.2022.106880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 12/15/2022]
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17
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Reynor A, McArdle N, Shenoy B, Dhaliwal SS, Rea SC, Walsh J, Eastwood PR, Maddison K, Hillman DR, Ling I, Keenan BT, Maislin G, Magalang U, Pack AI, Mazzotti DR, Lee CH, Singh B. Continuous positive airway pressure and adverse cardiovascular events in obstructive sleep apnea: are participants of randomized trials representative of sleep clinic patients? Sleep 2022; 45:zsab264. [PMID: 34739082 PMCID: PMC9891109 DOI: 10.1093/sleep/zsab264] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/26/2021] [Indexed: 02/04/2023] Open
Abstract
STUDY OBJECTIVES Randomized controlled trials (RCTs) have shown no reduction in adverse cardiovascular (CV) events in patients randomized to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA). This study examined whether randomized study populations were representative of OSA patients attending a sleep clinic. METHODS Sleep clinic patients were 3,965 consecutive adults diagnosed with OSA by in-laboratory polysomnography from 2006 to 2010 at a tertiary hospital sleep clinic. Characteristics of these patients were compared with participants of five recent RCTs examining the effect of CPAP on adverse CV events in OSA. The percentage of patients with severe (apnea-hypopnea index, [AHI] ≥ 30 events/h) or any OSA (AHI ≥ 5 events/h) who met the eligibility criteria of each RCT was determined, and those criteria that excluded the most patients identified. RESULTS Compared to RCT participants, sleep clinic OSA patients were younger, sleepier, more likely to be female and less likely to have established CV disease. The percentage of patients with severe or any OSA who met the RCT eligibility criteria ranged from 1.2% to 20.9% and 0.8% to 21.9%, respectively. The eligibility criteria that excluded most patients were preexisting CV disease, symptoms of excessive sleepiness, nocturnal hypoxemia and co-morbidities. CONCLUSIONS A minority of sleep clinic patients diagnosed with OSA meet the eligibility criteria of RCTs of CPAP on adverse CV events in OSA. OSA populations in these RCTs differ considerably from typical sleep clinic OSA patients. This suggests that the findings of such OSA treatment-related RCTs are not generalizable to sleep clinic OSA patients.Randomized Intervention with Continuous Positive Airway Pressure in CAD and OSA (RICCADSA) trial, https://clinicaltrials.gov/ct2/show/NCT00519597, ClinicalTrials.gov number, NCT00519597.Usefulness of Nasal Continuous Positive Airway Pressure (CPAP) Treatment in Patients with a First Ever Stroke and Sleep Apnea Syndrome, https://clinicaltrials.gov/ct2/show/NCT00202501, ClinicalTrials.gov number, NCT00202501.Effect of Continuous Positive Airway Pressure (CPAP) on Hypertension and Cardiovascular Morbidity-Mortality in Patients with Sleep Apnea and no Daytime Sleepiness, https://clinicaltrials.gov/ct2/show/NCT00127348, ClinicalTrials.gov number, NCT00127348.Continuous Positive Airway Pressure (CPAP) in Patients with Acute Coronary Syndrome and Obstructive Sleep Apnea (OSA) (ISAACC), https://clinicaltrials.gov/ct2/show/NCT01335087, ClinicalTrials.gov number, NCT01335087.
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Affiliation(s)
- Ayesha Reynor
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Nigel McArdle
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- West Australian Sleep Disorders Research Institute, Nedlands, WA, Australia
| | - Bindiya Shenoy
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Satvinder S Dhaliwal
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, B305, Curtin University, Bentley, WA, Australia
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Duke-NUS Medical School, National University of Singapore, Singapore
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Minden, Pulau Pinang, Malaysia
| | - Siobhan C Rea
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Jennifer Walsh
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- West Australian Sleep Disorders Research Institute, Nedlands, WA, Australia
| | - Peter R Eastwood
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Kathleen Maddison
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- West Australian Sleep Disorders Research Institute, Nedlands, WA, Australia
| | - David R Hillman
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia
- West Australian Sleep Disorders Research Institute, Nedlands, WA, Australia
| | - Ivan Ling
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- West Australian Sleep Disorders Research Institute, Nedlands, WA, Australia
| | - Brendan T Keenan
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Greg Maislin
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ulysses Magalang
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Allan I Pack
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Chi-Hang Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore
| | - Bhajan Singh
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- West Australian Sleep Disorders Research Institute, Nedlands, WA, Australia
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18
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Martinez-Garcia MA, Oscullo G, Gomez-Olivas JD. Representativeness of randomized controlled trials participants on the effect of continuous positive airway pressure on cardiovascular outcomes: caution is needed. Sleep 2022; 45:6510875. [DOI: 10.1093/sleep/zsac021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Miguel Angel Martinez-Garcia
- Pneumology Department, University and Polytechnic la Fe Hospital, Valencia, Spain
- CIBERES in Pulmonary Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Grace Oscullo
- Pneumology Department, University and Polytechnic la Fe Hospital, Valencia, Spain
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19
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Park SY, Kang SY, Song WJ, Kim JH. Evolving Concept of Severe Asthma: Transition From Diagnosis to Treatable Traits. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 14:447-464. [PMID: 36174989 PMCID: PMC9523415 DOI: 10.4168/aair.2022.14.5.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/28/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022]
Abstract
In recent decades, the concept of severe asthma has evolved from an umbrella term encompassing patients with high-intensity treatment needs to a clinical syndrome with heterogeneous, albeit distinct, pathophysiological processes. Biased and unbiased cluster approaches have been used to identify several clinical phenotypes. In parallel, cellular and molecular approaches allow for the development of biological therapies, especially targeting type 2 (T2) cytokine pathways. Although T2-biologics have significantly improved clinical outcomes for patients with severe asthma in real-world practice, questions on the proper use of biologics remain open. Furthermore, a subset of severe asthma patients remains poorly controlled. The unmet needs require a new approach. The “treatable traits” concept has been suggested to address a diversity of pathophysiological factors in severe asthma and overcome the limitations of existing treatment strategies. With a tailored therapy that targets the treatable traits in individual patients, better personalized medical care and outcomes should be achieved.
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Affiliation(s)
- So-Young Park
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Chung-Ang University Gwangmyeong Medical Center, Gwangmyeong, Korea
| | - Sung-Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo-Hee Kim
- Department of Internal Medicine, Hallym University College of Medicine, Anyang, Korea
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20
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Ashdown HF, Smith M, McFadden E, Pavord ID, Butler CC, Bafadhel M. Blood eosinophils to guide inhaled maintenance therapy in a primary care COPD population. ERJ Open Res 2021; 8:00606-2021. [PMID: 35141324 PMCID: PMC8819252 DOI: 10.1183/23120541.00606-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 12/27/2022] Open
Abstract
Blood eosinophils are a potentially useful biomarker for guiding inhaled corticosteroid (ICS) treatment decisions in COPD. We investigated whether existing blood eosinophil counts predict benefit from initiation of ICS compared to bronchodilator therapy.We used routinely collected data from UK primary care in the Clinical Practice Research Datalink. Participants were aged ≥40 years with COPD, were ICS-naïve and starting a new inhaled maintenance medication (intervention group: ICS; comparator group: long-acting bronchodilator, non-ICS). Primary outcome was time to first exacerbation, compared between ICS and non-ICS groups, stratified by blood eosinophils (“high” ≥150 cells·µL−1 and “low” <150 cells·µL−1).Out of 9475 eligible patients, 53.9% initiated ICS and 46.1% non-ICS treatment with no difference in eosinophils between treatment groups (p=0.71). Exacerbation risk was higher in patients prescribed ICS than those prescribed non-ICS treatment, but with a lower risk in those with high eosinophils (hazard ratio (HR) 1.04, 95% CI 0.98–1.10) than low eosinophils (HR 1.19, 95% CI 1.09–1.31) (p-value for interaction 0.01). Risk of pneumonia hospitalisation with ICS was greatest in those with low eosinophils (HR 1.26, 95% CI 1.05–1.50; p-value for interaction 0.04). Results were similar whether the most recent blood eosinophil count or the mean of blood eosinophil counts was used.In a primary care population, the most recent blood eosinophil count could be used to guide initiation of ICS in COPD patients. We suggest that ICS should be considered in those with higher eosinophils and avoided in those with lower eosinophils (<150 cells·µL−1).
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Zhu HH, Ma YF, Yu K, Ouyang GF, Luo WD, Pei RZ, Xu WQ, Hu HX, Mo SP, Xu XH, Lan JP, Shen JP, Shou LH, Qian SX, Feng WY, Zhao P, Jiang JH, Hu BL, Zhang J, Qian SY, Wu GQ, Wu WP, Qiu L, Li LJ, Lang XH, Chen S, Chen LL, Guo JB, Cao LH, Jiang HF, Xia YM, Le J, Zhao JZ, Huang J, Zhang YF, Lv YL, Hua JS, Hong YW, Zheng CP, Wang JX, Hu BF, Chen XH, Zhang LM, Tao S, Xie BS, Kuang YM, Luo WJ, Su P, Guo J, Wu X, Jiang W, Zhang HQ, Zhang Y, Chen CM, Xu XF, Guo Y, Tu JM, Hu S, Yan XY, Yao C, Lou YJ, Jin J. Early Death and Survival of Patients With Acute Promyelocytic Leukemia in ATRA Plus Arsenic Era: A Population-Based Study. Front Oncol 2021; 11:762653. [PMID: 34868978 PMCID: PMC8637823 DOI: 10.3389/fonc.2021.762653] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022] Open
Abstract
Most randomized trials for acute promyelocytic leukemia (APL) have investigated highly selected patients under idealized conditions, and the findings need to be validated in the real world. We conducted a population-based study of all APL patients in Zhejiang Province, China, with a total population of 82 million people, to assess the generalization of all-trans retinoic acid (ATRA) and arsenic as front-line treatment. The outcomes of APL patients were also analyzed. Between January 2015 and December 2019, 1,233 eligible patients were included in the final analysis. The rate of ATRA and arsenic as front-line treatment increased steadily from 66.2% in 2015 to 83.3% in 2019, with no difference among the size of the center (≥5 or <5 patients per year, p = 0.12) or age (≥60 or <60 years, p = 0.35). The early death (ED) rate, defined as death within 30 days after diagnosis, was 8.2%, and the 3-year overall survival (OS) was 87.9% in the whole patient population. Age (≥60 years) and white blood cell count (>10 × 109/L) were independent risk factors for ED and OS in the multivariate analysis. This population-based study showed that ATRA and arsenic as front-line treatment are widely used under real-world conditions and yield a low ED rate and a high survival rate, which mimic the results from clinical trials, thereby supporting the wider application of APL guidelines in the future.
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Affiliation(s)
- Hong-Hu Zhu
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Hematologic Malignancies, Diagnosis and Treatment, Hangzhou, China.,Zhejiang University Cancer Center, Hangzhou, China.,Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou, China
| | - Ya-Fang Ma
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Kang Yu
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Hangzhou, China
| | - Gui-Fang Ouyang
- Department of Hematology, Ningbo First Hospital, Ningbo, China
| | - Wen-Da Luo
- Department of Hematology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, China
| | - Ren-Zhi Pei
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, China
| | - Wei-Qun Xu
- Department of Hematology, The Children's Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Hui-Xian Hu
- Department of Hematology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Shu-Ping Mo
- Department of Hematology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Xiao-Hua Xu
- Department of Hematology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jian-Ping Lan
- Department of Hematology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Jian-Ping Shen
- Department of Hematology, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China
| | - Li-Hong Shou
- Department of Hematology, Huzhou Central Hospital, Huzhou, China
| | - Shen-Xian Qian
- Department of Hematology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei-Ying Feng
- Department of Hematology, Shaoxing People's Hospital, Wenzhou, China
| | - Pu Zhao
- Department of Hematology, Ruian People's Hospital, Wenzhou, China
| | - Jin-Hong Jiang
- Department of Hematology, Lishui City People's Hospital, Lishui, China
| | - Bei-Li Hu
- Department of Hematology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jin Zhang
- Department of Hematology, Sir Run Run Shaw Hospital (SRRSH) Affiliated with the Zhejiang University School of Medicine, Hangzhou, China
| | - Su-Ying Qian
- Department of Hematology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Gong-Qiang Wu
- Department of Hematology, Dongyang Hospital Affiliated to Wenzhou Medical University, Jinhua, China
| | - Wen-Ping Wu
- Department of Hematology, People's Hospital of Quzhou, Quzhou, China
| | - Lei Qiu
- Department of Hematology, Zhoushan Hospital, Zhoushan, China
| | - Lin-Jie Li
- Department of Hematology, Lishui Municipal Central Hospital, Jinhua, China
| | - Xiang-Hua Lang
- Department of Hematology, The First People's Hospital of Yongkang, Jinhua, China
| | - Sai Chen
- Department of Hematology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Li-Li Chen
- Department of Hematology and Oncology, Taizhou First People's Hospital (Huangyan Hospital of Wenzhou Medical University), Taizhou, China
| | - Jun-Bin Guo
- Department of Hematology and Oncology, The First People's Hospital of Wenling, Taizhou, China
| | - Li-Hong Cao
- Department of Hematology, Shulan Hospital, Hangzhou, China
| | - Hui-Fang Jiang
- Department of Hematology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Yong-Ming Xia
- Department of Hematology, Rheumatology and Nephrology, Yuyao People's Hospital, Ningbo University Yangming Affiliated Hospital, Ningbo, China
| | - Jing Le
- Department of Hematology and Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Jian-Zhi Zhao
- Department of Hematology, Shaoxing Central Hospital, Shaoxing, China
| | - Jian Huang
- Department of Hematology, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Jinhua, China
| | - Yue-Feng Zhang
- Department of Hematology, The First People's Hospital of Yuhang District, Hangzhou, China
| | - Ya-Li Lv
- Department of Hematology, Xinchang People's Hospital, Shaoxing, China
| | - Jing-Sheng Hua
- Department of Hematology and Oncology, Taizhou Municipal Hospital, Taizhou, China
| | - Yong-Wei Hong
- Department of Hematology, Ningbo Yinzhou No. 2 Hospital, Ningbo, China
| | - Cui-Ping Zheng
- Department of Hematotherapeutic, Wenzhou Central Hospital Medical Group, Wenzhou, China
| | - Ju-Xiang Wang
- Department of Hematology and Oncology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bin-Fei Hu
- Department of Pediatric Hematology, Ningbo Women and Children's Hospital, Ningbo, China
| | - Xiao-Hui Chen
- Department of Hematology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Li-Ming Zhang
- Department of Hematology, Zhuji People's Hospital, Shaoxing, China
| | - Shi Tao
- Department of Hematology, Shaoxing Second Hospital, Shaoxing, China
| | - Bing-Shou Xie
- Department of Hematology, Wenzhou People's Hospital, Wenzhou, China
| | - Yue-Min Kuang
- Department of Hematology, Jinhua People's Hospital, Jinhua, China
| | - Wen-Ji Luo
- Department of Hematology, The First People's Hospital of Xiaoshan District, Hangzhou, China
| | - Ping Su
- Department of Hematology, Zhejiang Xiaoshan Hospital, Hangzhou, China
| | - Jun Guo
- Department of Hematology and Oncology, The Sencond Affiliated Hospital of Zhejiang University, SAHZU Changxing Branch, Huzhou, China
| | - Xiao Wu
- Department of Oncology and Hematology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Wei Jiang
- Department of Hematology, Shangyu People's Hospital, Shaoxing, China
| | - Hui-Qi Zhang
- Department of Hematology, The First People's Hospital of Huzhou, Huzhou, China
| | - Yun Zhang
- Department of Hematotherapeutic, Yueqing People's Hospital, Wenzhou, China
| | - Chun-Mei Chen
- Department of Hematotherapeutic, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiao-Feng Xu
- Department of Oncology and Hematology, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Yan Guo
- Department of Hematology, The First People's Hospital of Pinghu, Jiaxing, China
| | - Jin-Ming Tu
- Department of Gastroenterology and Hematology, Longyou People's Hospital, Quzhou, China
| | - Shao Hu
- Department of Hematology and Oncology, The First Hospital of Ninghai County, Ningbo, China
| | - Xiao-Yan Yan
- Department of Biostatistics, Peking University Clinical Research Institute, Beijing, China
| | - Chen Yao
- Department of Biostatistics, Peking University Clinical Research Institute, Beijing, China
| | - Yin-Jun Lou
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Hematologic Malignancies, Diagnosis and Treatment, Hangzhou, China.,Zhejiang University Cancer Center, Hangzhou, China.,Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou, China
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22
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Louis R, Louis G, Bonhomme O. NOVELTY: a landmark study in phenotyping and endotyping chronic obstructive airway diseases in real clinical practice. Eur Respir J 2021; 58:58/3/2100627. [PMID: 34556532 DOI: 10.1183/13993003.00627-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 11/05/2022]
Affiliation(s)
| | - Gilles Louis
- Dept of Public Health, University of Liege, Liege, Belgium
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23
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Abstract
PURPOSE OF REVIEW Real-life (or real-world) studies can provide information that cannot be derived from randomized controlled trials. This approach is currently becoming of relevance for many treatments. In recent years, the real-life method has been applied also to allergen immunotherapy, providing new insights on it. We reviewed herein the available literature on the argument. RECENT FINDINGS Several prospective and retrospective studies on allergen immunotherapy in the real-world setting have been published, mostly in the last 5 years. Most of them focused on adverse events, compliance, and the long term/preventive effects, and evidenced an overall favorable profile for different products and different allergens. SUMMARY Real life study provided novel information and evidenced those aspects of immunotherapy that worth a more detailed approach, without the strict limitations usually imposed by controlled randomized trials.
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Affiliation(s)
- Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
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24
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Wagshul FA, Brown DT, Schultek NM, Hahn DL. Outcomes of Antibiotics in Adults with "Difficult to Treat" Asthma or the Overlap Syndrome. J Asthma Allergy 2021; 14:703-712. [PMID: 34163182 PMCID: PMC8216074 DOI: 10.2147/jaa.s313480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/26/2021] [Indexed: 01/10/2023] Open
Abstract
Purpose Macrolides are a recommended treatment option for severe asthma, but data for “difficult-to-treat” asthma, the asthma-COPD “overlap” syndrome, and treatment duration beyond one year are lacking. We present long-term data from community practice experience providing insights for practice and research. Methods We report data from (1) baseline (pre-treatment) chart review of antibiotic-treated asthma patients and (2) follow-up telephone interviews documenting severe exacerbations (NIH criteria), Asthma Control Test (ACT) scores, and asthma controller use at baseline and follow-up, analyzed using a “before-after” model. Results A total of 101 patients (mean age 55.6 years (Sd 16.8), 66 females) were included. None had ever taken high dose inhaled corticosteroids and 79 (78.2%) were severely uncontrolled (ACT score ≤15) before treatment. Coexisting COPD was present in 62 (61.4%) patients. Azithromycin or azithromycin plus doxycycline was primarily prescribed with a median treatment duration of 12 months and median follow-up duration of 22 months. Severe exacerbations in the month before treatment occurred in 50.5% vs 17.8% at follow-up (P<0.0001). Mean ACT score increased from 12.2 to 20.6 (P<0.0001). The number of patients taking controller medications decreased (P<0.0001 for inhaled corticosteroids; P<0.001 for long-acting beta agonist/long-acting muscarinic antagonist; P<0.05 for leukotriene receptor antagonists). Of the 79 severely uncontrolled patients, 51 (64.6%) became controlled at follow-up, and of these 51, 27 (52.9%) continued to take antibiotics while 24 (47.1%) had discontinued antibiotics earlier yet remained controlled. Conclusion Antibiotic treatment may be beneficial in a significant proportion of “difficult to treat” asthma patients beyond one year, including some patients with the overlap syndrome and/or who fail to meet criteria for refractoriness. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/0vF55ewkTVc
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25
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Shantakumar S, Ho YF, Beale J, Gribben B. Burden of illness in blood eosinophilic phenotype COPD patients in New Zealand. Respir Investig 2021; 59:487-497. [PMID: 33994346 DOI: 10.1016/j.resinv.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Real-world data on eosinophilic chronic obstructive pulmonary disease (COPD)'s clinical burden, in exacerbating/stable states, and the stability of blood eosinophil count (BEC) measurements are limited. We described measured BEC distributions among general practice COPD patients in New Zealand (NZ). METHODS This retrospective cohort study utilized the NZ-HealthStat primary care database. Participants were aged ≥40 years, with ≥1 BEC 6 months following a COPD diagnosis code during 2011-2012. Descriptive analyses included examinations of BEC stability and association with COPD exacerbations/treatments/comorbidities. RESULTS The most frequent COPD comorbidity was asthma (n = 1180/2909, 40.56%). Among COPD patients: 65% had BECs >150 cells/μL; 35% had BECs >300 cells/μL (non-mutually exclusive threshold categories). Treatment patterns were similar, except for more frequent inhaled corticosteroid (ICS)/long-acting beta2-agonist use in COPD patients with asthma history (51%) than those without (31%). Factors associated with BECs >150 cells/μL in participants without ICS treatment included Māori/Pacific ethnicity, obesity, oral corticosteroid (OCS) use, and exacerbation history. When stratified by asthma history, ICS treatment, and neutrophil count above/below 5000 cells/μL, geometric mean BECs ranged from 136.70 to 398.52 cells/μL. Exploratory analyses showed a fair-good COPD/BEC measurement stability over 12 months. CONCLUSIONS Asthma was a common COPD comorbidity in NZ, particularly in Māori/Pacific patients. No overall relationship was observed between BEC/COPD exacerbations, which may reflect background ICS confounding. However, analyses in non-ICS treated participants suggested that Māori/Pacific patients with obesity and COPD, OCS treatment, exacerbation history, and/or elevated BECs are at the highest risk of COPD exacerbations. One BEC measurement appears a good indicator of a patient's BECs over time.
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Affiliation(s)
- Sumitra Shantakumar
- Epidemiology, GlaxoSmithKline, 50 Beach Road, #21-00 Gateway West, Singapore, 189720, Singapore
| | - Yu-Fan Ho
- Epidemiology, GlaxoSmithKline, 50 Beach Road, #21-00 Gateway West, Singapore, 189720, Singapore
| | - Janine Beale
- Medical Affairs, GlaxoSmithKline, Zurich House, 21 Queen Street, Auckland, 1010, New Zealand
| | - Barry Gribben
- Public Sector Surveying, CBG Health Research, Auckland, New Zealand.
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26
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Chlamydia pneumoniae and chronic asthma: Updated systematic review and meta-analysis of population attributable risk. PLoS One 2021; 16:e0250034. [PMID: 33872336 PMCID: PMC8055030 DOI: 10.1371/journal.pone.0250034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/24/2021] [Indexed: 12/02/2022] Open
Abstract
Background Chlamydia pneumoniae (Cp) is an obligate intracellular human respiratory pathogen producing persisting lung infection with a plausible link to asthma pathogenesis. The population attributable risk of potentially treatable Cp infection in asthma has not been reported. Methods The author searched from 2000 to 2020 inclusive for previously un-reviewed and new cross sectional and prospective controlled studies of Cp biomarkers and chronic asthma in both children and adults. Qualitative descriptive results and quantitative estimates of population attributable risk for selected biomarkers (specific IgG, IgA and IgE) are presented. Findings No large, long-term prospective population-based studies of Cp infection and asthma were identified. About half of case-control studies reported one or more significant associations of Cp biomarkers and chronic asthma. Heterogeneity of results by age group (pediatric v adult asthma), severity category (severe/uncontrolled, moderate/partly controlled, mild/controlled) and antibody isotype (specific IgG, IgA, IgE) were suggested by the qualitative results and confirmed by meta-analyses. The population attributable risks for Cp-specific IgG and IgA were nul in children and were 6% (95% confidence interval 2%-10%, p = 0.002) and 13% (9%-18%, p<0.00001) respectively in adults. In contrast to the nul or small population attributable risks for Cp-specific IgG and IgA, the population attributable risk for C. pneumoniae-specific IgE (children and adults combined) was 47% (39%-55%, p<0.00001). In the subset of studies that reported on asthma severity categories, Cp biomarkers were positively and significantly (P<0.00001) associated with asthma severity. Interpretation C. pneumoniae-specific IgE is strongly associated with asthma and asthma severity, suggesting a possible mechanism linking chronic Cp infection with asthma in a subset of individuals with asthma. Infection biomarkers should be included in future macrolide treatment trials for severe and uncontrolled asthma.
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27
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Harvey C, Woodcock A, Vestbo J, Crim C, Frith L, Bakerly ND, New JP, Williams C, Elkhenini H, Majeed N, Cardwell G, Collier S, Jacques L, Fletcher J. Safety data in randomised real-world evidence studies: Salford Lung Study learnings. ERJ Open Res 2021; 7:00966-2020. [PMID: 34084785 PMCID: PMC8165374 DOI: 10.1183/23120541.00966-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/01/2021] [Indexed: 11/05/2022] Open
Abstract
Evidence to support clinical decision making must be based on safety data that have been captured, analysed and interpreted in a robust and reliable way. Randomised real-world evidence (RRWE) studies provide the opportunity to evaluate the use of medicines in patients and settings representative of routine clinical practice. However, elements that underpin the design of RRWE studies can have a significant impact upon the analysis, interpretation and implications of safety data. In this narrative review, we use data from the Salford Lung Study; two prospective, 12-month, open-label, parallel-group, phase III randomised controlled trials conducted in primary care in the UK; to highlight the importance of capturing treatment modifications when attempting to evaluate safety events according to actual treatment exposure. We demonstrate that analysing safety data by actual treatment received (i.e. accounting for the treatment modifications that occur routinely in the primary care setting) provides additional insight beyond analysing according to randomised treatment strategy only. It is therefore proposed that understanding of safety data from RRWE trials can be optimised by analysing both by randomised group and by actual treatment received.
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Affiliation(s)
| | - Ashley Woodcock
- Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Jørgen Vestbo
- Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Courtney Crim
- GlaxoSmithKline plc, Research Triangle Park, NC, USA
| | - Lucy Frith
- GlaxoSmithKline plc, Uxbridge, Middlesex, UK
| | - Nawar Diar Bakerly
- Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
| | - John P. New
- Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
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28
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Incorvaia C, Al‐Ahmad M, Ansotegui IJ, Arasi S, Bachert C, Bos C, Bousquet J, Bozek A, Caimmi D, Calderón MA, Casale T, Custovic A, De Blay F, Demoly P, Devillier P, Didier A, Fiocchi A, Fox AT, Gevaert P, Gomez M, Heffler E, Ilina N, Irani C, Jutel M, Karagiannis E, Klimek L, Kuna P, O'Hehir R, Kurbacheva O, Matricardi PM, Morais‐Almeida M, Mosges R, Novak N, Okamoto Y, Panzner P, Papadopoulos NG, Park H, Passalacqua G, Pawankar R, Pfaar O, Schmid‐Grendelmeier P, Scurati S, Tortajada‐Girbés M, Vidal C, Virchow JC, Wahn U, Worm M, Zieglmayer P, Canonica GW. Personalized medicine for allergy treatment: Allergen immunotherapy still a unique and unmatched model. Allergy 2021; 76:1041-1052. [PMID: 32869882 DOI: 10.1111/all.14575] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 12/17/2022]
Abstract
The introduction of personalized medicine (PM) has been a milestone in the history of medical therapy, because it has revolutionized the previous approach of treating the disease with that of treating the patient. It is known today that diseases can occur in different genetic variants, making specific treatments of proven efficacy necessary for a given endotype. Allergic diseases are particularly suitable for PM, because they meet the therapeutic success requirements, including a known molecular mechanism of the disease, a diagnostic tool for such disease, and a treatment blocking the mechanism. The stakes of PM in allergic patients are molecular diagnostics, to detect specific IgE to single-allergen molecules and to distinguish the causative molecules from those merely cross-reactive, pursuit of patient's treatable traits addressing genetic, phenotypic, and psychosocial features, and omics, such as proteomics, epi-genomics, metabolomics, and breathomics, to forecast patient's responsiveness to therapies, to detect biomarker and mediators, and to verify the disease control. This new approach has already improved the precision of allergy diagnosis and is likely to significantly increase, through the higher performance achieved with the personalized treatment, the effectiveness of allergen immunotherapy by enhancing its already known and unique characteristics of treatment that acts on the causes.
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Affiliation(s)
| | - Mona Al‐Ahmad
- Microbiology Department Faculty of Medicine Kuwait University Kuwait
- Drug Allergy Unit Department of Allergy Al‐Rashed Allergy Center Kuwait
| | | | - Stefania Arasi
- Department of Allergy Bambino Gesu' Childrens' Hospital IRCCS Rome Italy
| | - Claus Bachert
- Upper Airways Research Laboratory ENT Dept Ghent University Hospital Ghent Belgium
- Karolinska Institutet Stockholm Sweden
- Department of ENT Diseases Karolinska University Hospital Stockholm Sweden
| | - Catherine Bos
- Stallergenes Greer Medical Affairs Department Antony France
| | - Jean Bousquet
- University Hospital Montpellier France – MACVIA‐France Montpellier France
| | - Andrzéj Bozek
- Clinical Department of Internal Disease, Dermatology and Allergology Medical University of Silesia Katowice Poland
| | - Davide Caimmi
- Department of Pulmonology and Addictology Arnaud de Villeneuve Hospital Montpellier University Montpellier France
| | - Moises A. Calderón
- Imperial College London – National Heart and Lung Institute Royal Brompton Hospital NHS London UK
| | - Thomas Casale
- Division of Allergy/Immunology University of South Florida Tampa FL USA
| | - Adnan Custovic
- Centre for Respiratory Medicine and Allergy Institute of Inflammation and Repair University of Manchester and University Hospital of South Manchester Manchester UK
| | - Frédéric De Blay
- Allergy Division Chest Diseases Department Strasbourg University Hospital Strasbourg France
| | - Pascal Demoly
- Department of Pulmonology and Addictology Arnaud de Villeneuve Hospital Montpellier University Montpellier France
- Sorbonne Université UMR‐S 1136 INSERM IPLESP EPAR Team Paris France
| | - Philippe Devillier
- Laboratoire de Recherche en Pharmacologie Respiratoire Pôle des Maladies des Voies Respiratoires Hôpital Foch Université Paris‐Saclay Suresnes France
| | - Alain Didier
- Respiratory Disease Dept Larrey Hospital University Hospital of Toulouse Paul Sabatier University Toulouse France
| | - Alessandro Fiocchi
- Department of Allergy Bambino Gesu' Childrens' Hospital IRCCS Rome Italy
| | - Adam T. Fox
- Department of Paediatric Allergy Guy's & St Thomas' Hospitals NHS Foundation Trust London UK
| | - Philippe Gevaert
- Upper Airways Research Laboratory ENT Dept Ghent University Hospital Ghent Belgium
| | | | - Enrico Heffler
- Personalized Medicine, Asthma & Allergy – Humanitas Clinical and Research Center IRCCS Rozzano Italy
- Department of Biomedical Science Humanitas University Pieve Emanuele Italy
| | - Natalia Ilina
- Federal Institute of Immunology of Russia Moscow Russia
| | - Carla Irani
- Department of Internal Medicine and Clinical Immunology Faculty of Medicine Hotel Dieu de France Hospital Saint Joseph University Beirut Lebanon
| | - Marek Jutel
- Department of Clinical Immunology Wrocław Medical University Wrocław Poland
| | | | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy Barlicki University Hospital Medical University of Lodz Lodz Poland
| | - Robin O'Hehir
- Alfred Hospital and Monash University Melbourne Australia
| | - Oxana Kurbacheva
- National Research Center – Institute of Immunology Federal Medical‐Biological Agency of Russia Moscow Russia
| | - Paolo M. Matricardi
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine Charité – University Medicine Berlin Berlin Germany
| | - Mario Morais‐Almeida
- Immunoallergy Department of CUF‐Descobertas Hospital Lisbon Portugal
- CUF‐Infante Santo Hospital Lisbon Portugal
| | - Ralph Mosges
- Faculty of Medicine Institute of Medical Statistics and Computational Biology University of Cologne Cologne Germany
- CRI – Clinical Research International Ltd. Cologne Germany
| | - Natalija Novak
- Department of Dermatology and Allergy University Hospital Bonn Bonn Germany
| | - Yoshitaka Okamoto
- Department of Otorhinolaryngology Chiba University Hospital Chiba Japan
| | - Petr Panzner
- Department of Immunology and Allergology Faculty of Medicine in Pilsen Charles University in Prague Pilsen Czech Republic
| | - Nikolaos G. Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine Royal Manchester Children's Hospital University of Manchester Manchester UK
- Allergy Department 2nd Pediatric Clinic Athens General Children's Hospital "P&A Kyriakou" University of Athens Athens Greece
| | - Hae‐Sim Park
- Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon South Korea
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases Ospedale Policlino San Martino – University of Genoa Genoa Italy
| | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | | | - Silvia Scurati
- Stallergenes Greer Medical Affairs Department Antony France
| | - Miguel Tortajada‐Girbés
- Pediatric Pulmonology and Allergy Unit Department of Pediatrics Dr. Peset University Hospital Valencia Spain
- Department of Pediatrics, Obstetrics and Gynecology University of Valencia Valencia Spain
- IVI Foundation Valencia Spain
| | - Carmen Vidal
- Allergy Service Complejo Hospitalario Universitario de Santiago Santiago de Compostela Spain
| | - J. Christian Virchow
- Department of Pneumology/Intensive Care Medicine University of Rostock Rostock Germany
| | - Ulrich Wahn
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine Charité – University Medicine Berlin Berlin Germany
| | - Margitta Worm
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine Charité – University Medicine Berlin Berlin Germany
| | | | - Giorgio W. Canonica
- Personalized Medicine, Asthma & Allergy – Humanitas Clinical and Research Center IRCCS Rozzano Italy
- Department of Biomedical Science Humanitas University Pieve Emanuele Italy
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van Zelst CM, Kasteleyn MJ, van Noort EMJ, Rutten-van Molken MPMH, Braunstahl GJ, Chavannes NH, In 't Veen JCCM. The impact of the involvement of a healthcare professional on the usage of an eHealth platform: a retrospective observational COPD study. Respir Res 2021; 22:88. [PMID: 33743686 PMCID: PMC7981385 DOI: 10.1186/s12931-021-01685-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Ehealth platforms, since the outbreak of COVID-19 more important than ever, can support self-management in patients with Chronic Obstructive Pulmonary Disease (COPD). The aim of this observational study is to explore the impact of healthcare professional involvement on the adherence of patients to an eHealth platform. We evaluated the usage of an eHealth platform by patients who used the platform individually compared with patients in a blended setting, where healthcare professionals were involved. Methods In this observational cohort study, log data from September 2011 until January 2018 were extracted from the eHealth platform Curavista. Patients with COPD who completed at least one Clinical COPD Questionnaire (CCQ) were included for analyses (n = 299). In 57% (n = 171) of the patients, the eHealth platform was used in a blended setting, either in hospital (n = 128) or primary care (n = 29). To compare usage of the platform between patients who used the platform independently or with a healthcare professional, we applied propensity score matching and performed adjusted Poisson regression analysis on CCQ-submission rate. Results Using the eHealth platform in a blended setting was associated with a 3.25 higher CCQ-submission rate compared to patients using the eHealth platform independently. Within the blended setting, the CCQ-submission rate was 1.83 higher in the hospital care group than in the primary care group. Conclusion It is shown that COPD patients used the platform more frequently in a blended care setting compared to patients who used the eHealth platform independently, adjusted for age, sex and disease burden. Blended care seems essential for adherence to eHealth programs in COPD, which in turn may improve self-management.
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Affiliation(s)
- Cathelijne M van Zelst
- Department of Pulmonology, Franciscus Gasthuis en Vlietland, Kleiweg 500, Rotterdam, 3045 PM, The Netherlands. .,Department of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Marise J Kasteleyn
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands.,Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther M J van Noort
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Gert-Jan Braunstahl
- Department of Pulmonology, Franciscus Gasthuis en Vlietland, Kleiweg 500, Rotterdam, 3045 PM, The Netherlands.,Department of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
| | - Johannes C C M In 't Veen
- Department of Pulmonology, Franciscus Gasthuis en Vlietland, Kleiweg 500, Rotterdam, 3045 PM, The Netherlands
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Abstract
PURPOSE To evaluate the real-life efficacy and safety of the intravitreal dexamethasone implant in uveitis. METHODS This retrospective observational multicentric study included 152 eyes treated exclusively by 358 dexamethasone implant injections. The main outcome measures included change in the best-corrected visual acuity, central macular thickness, and vitreous haze score. RESULTS Patients were treated with dexamethasone implant for macular edema (51.3%), vitritis with macular edema (40.1%), vitritis (5.3%), and other causes (3.3%). The mean duration of follow-up was 19.0 months. The mean gain in best-corrected visual acuity during follow-up was +12.1 letters. An improvement in best-corrected visual acuity ≥5, 10, and 15 letters was found in 64.5, 50.7, and 35.5% of cases, respectively. 59.7% of eyes with macular edema at baseline were found to be anatomical responders. Vitritis resolution (vitreous haze = 0+) was obtained in 81.4% of cases. Ocular hypertension (intraocular pressure ≥25 mmHg and/or gain ≥10 mmHg from baseline) occurred in 28.3% of patients. No filtering surgery/laser therapy was required. A total of 40.2% of phakic subjects underwent cataract surgery on average 11.2 months after the first injection. CONCLUSION This study confirms the efficacy and safety of the dexamethasone implant in noninfectious uveitis. Cataract and ocular hypertension were not uncommon but easily manageable.
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Rates of Major Cardiovascular Events in Severe Asthma: US Real-World and Clinical Trial-Eligible Populations. Ann Am Thorac Soc 2021; 18:1580-1584. [PMID: 33606957 PMCID: PMC8489874 DOI: 10.1513/annalsats.202010-1349rl] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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32
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Janson C, Lisspers K, Ställberg B, Johansson G, Gutzwiller FS, Mezzi K, Mindeholm L, Bjerregaard BK, Jorgensen L, Larsson K. Osteoporosis and fracture risk associated with inhaled corticosteroid use among Swedish COPD patients: the ARCTIC study. Eur Respir J 2021; 57:13993003.00515-2020. [PMID: 32972982 DOI: 10.1183/13993003.00515-2020] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023]
Abstract
The effect of inhaled corticosteroids (ICS) on the risk of osteoporosis and fracture in patients with chronic obstructive pulmonary disease (COPD) remains uncertain. The aim of this study was to assess this risk in patients with COPD.Electronic medical record data linked to National Health Registries were collected from COPD patients and matched reference controls at 52 Swedish primary care centres from 2000 to 2014. The outcomes analysed were the effect of ICS on all fractures, fractures typically related to osteoporosis, recorded osteoporosis diagnosis, prescriptions of drugs for osteoporosis and a combined measure of any osteoporosis-related event. The COPD patients were stratified by the level of ICS exposure.A total of 9651 patients with COPD and 59 454 matched reference controls were analysed. During the follow-up, 19.9% of COPD patients had at least one osteoporosis-related event compared with 12.9% of reference controls (p<0.0001). Multivariate analysis in the COPD population demonstrated a dose-effect relationship, with high-dose ICS being significantly associated with any osteoporosis-related event (risk ratio 1.52 (95% CI 1.24-1.62)), while the corresponding estimate for low-dose ICS was 1.27 (95% CI 1.13-1.56) compared with COPD patients not using ICS. A similar dose-related adverse effect was found for all four of the specific osteoporosis-related events: all fractures, fractures typically related to osteoporosis, prescriptions of drugs for osteoporosis and diagnosis of osteoporosis.We conclude that patients with COPD have a greater risk of bone fractures and osteoporosis, and high-dose ICS use increased this risk further.
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Affiliation(s)
- Christer Janson
- Respiratory, Allergy and Sleep Research, Dept of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Karin Lisspers
- Family Medicine and Preventive Medicine, Dept of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Björn Ställberg
- Family Medicine and Preventive Medicine, Dept of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Gunnar Johansson
- Family Medicine and Preventive Medicine, Dept of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | | | | | - Linda Mindeholm
- Novartis Institutes for Biomedical Research (NIBR), Cambridge, MA, USA.,Novartis Institutes for Biomedical Research (NIBR), Basel, Switzerland
| | | | | | - Kjell Larsson
- Intergrative Toxicology, National Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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Israel E, Cardet JC, Carroll JK, Fuhlbrigge AL, Pace WD, Maher NE, She L, Rockhold FW, Fagan M, Forth VE, Hernandez PA, Manning BK, Rodriguez-Louis J, Shields JB, Coyne-Beasley T, Kaplan BM, Rand CS, Morales-Cosme W, Wechsler ME, Wisnivesky JP, White M, Yawn BP, McKee MD, Busse PJ, Kaelber DC, Nazario S, Hernandez ML, Apter AJ, Chang KL, Pinto-Plata V, Stranges PM, Hurley LP, Trevor J, Casale TB, Chupp G, Riley IL, Shenoy K, Pasarica M, Calderon-Candelario RA, Tapp H, Baydur A. A randomized, open-label, pragmatic study to assess reliever-triggered inhaled corticosteroid in African American/Black and Hispanic/Latinx adults with asthma: Design and methods of the PREPARE trial. Contemp Clin Trials 2021; 101:106246. [PMID: 33316456 PMCID: PMC8130188 DOI: 10.1016/j.cct.2020.106246] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Asthma prevalence, morbidity, and mortality disproportionately impact African American/Black (AA/B) and Hispanic/Latinx (H/L) communities. Adherence to daily inhaled corticosteroid (ICS), recommended by asthma guidelines in all but the mildest cases of asthma, is generally poor. As-needed ICS has shown promise as a patient-empowering asthma management strategy, but it has not been rigorously studied in AA/B or H/L patients or in a real-world setting. Design and Aim The PeRson EmPowered Asthma RElief (PREPARE) Study is a randomized, open-label, pragmatic study which aims to assess whether a patient-guided, reliever-triggered ICS strategy called PARTICS (Patient-Activated Reliever-Triggered Inhaled CorticoSteroid) can improve asthma outcomes in AA/B and H/L adult patient populations. In designing and implementing the study, the PREPARE research team has relied heavily on advice from AA/B and H/L Patient Partners and other stakeholders. Methods PREPARE is enrolling 1200 adult participants (600 AA/Bs, 600H/Ls) with asthma. Participants are randomized to PARTICS + Usual Care (intervention) versus Usual Care (control). Following a single in-person enrollment visit, participants complete monthly questionnaires for 15 months. The primary endpoint is annualized asthma exacerbation rate. Secondary endpoints include asthma control; preference-based quality of life; and days lost from work, school, or usual activities. Discussion The PREPARE study features a pragmatic design allowing for the real-world assessment of a patient-centered, reliever-triggered ICS strategy in AA/B and H/L patients. Outcomes of this study have the potential to offer powerful evidence supporting PARTICS as an effective asthma management strategy in patient populations that suffer disproportionately from asthma morbidity and mortality.
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Affiliation(s)
- Elliot Israel
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, United States of America.
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Morsani College of Medicine, University of South Florida, 12908 Bruce B Downs Boulevard, Suite 4128, Tampa, FL, United States of America.
| | - Jennifer K Carroll
- American Academy of Family Physicians National Research Network, 11400 Tomahawk Creek Parkway, Leawood, KS 66211, United States of America; CU Anschutz Department of Family Medicine, University of Colorado, 12631 East 17th Avenue, Box F496, Aurora, CO 80045, United States of America.
| | - Anne L Fuhlbrigge
- Department of Medicine, Pulmonary Science and Critical Care Medicine, University of Colorado School of Medicine, Fitzsimons Building, 13001 E 17th Place, Box C290, Aurora, CO, United States of America.
| | - Wilson D Pace
- American Academy of Family Physicians National Research Network, 11400 Tomahawk Creek Parkway, Leawood, KS 66211, United States of America; DARTNet Institute, 12635 East Montview Boulevard, Mail Stop 3, Suite 129, Aurora, CO, United States of America.
| | - Nancy E Maher
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, United States of America.
| | - Lilin She
- Duke Clinical Research Institute, Duke University Medical Center, P.O. Box 17969, Durham, NC, United States of America.
| | - Frank W Rockhold
- Duke Clinical Research Institute, Duke University Medical Center, 200 Morris Street, Office 6428, Durham, NC, United States of America.
| | - Maureen Fagan
- University of Miami Health System, 1150 NW 14th Street, Don Soffer Clinical Research Building, Suite 360-H, Miami, FL, United States of America.
| | - Victoria E Forth
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, United States of America
| | - Paulina Arias Hernandez
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, United States of America
| | - Brian K Manning
- American Academy of Family Physicians National Research Network, 11400 Tomahawk Creek Parkway, Leawood, KS, United States of America.
| | - Jacqueline Rodriguez-Louis
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, United States of America.
| | - Joel B Shields
- American Academy of Family Physicians National Research Network, 11400 Tomahawk Creek Parkway, Leawood, KS, United States of America.
| | - Tamera Coyne-Beasley
- Division of Adolescent Medicine, University of Alabama at Birmingham, Children's of Alabama, 1600 7th Avenue South, Birmingham, AL, United States of America.
| | - Barbara M Kaplan
- American Lung Association, 1331 Pennsylvania Avenue NW, 1425N, Washington, DC, United States of America.
| | - Cynthia S Rand
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, 1830 Building, 1830 E Monument Street, Baltimore, MD, United States of America.
| | - Wilfredo Morales-Cosme
- University of Puerto Rico: Medical Sciences Campus, P.O. Box 365067, San Juan, Puerto Rico.
| | - Michael E Wechsler
- Department of Medicine, NJH Cohen Family Asthma Institute, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, United States of America.
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States of America; Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States of America.
| | - Mary White
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, United States of America
| | - Barbara P Yawn
- Department of Family and Community Health, University of Minnesota, 516 Delaware Street SE, Minneapolis, MN, United States of America
| | - M Diane McKee
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, The Bronx, NY 10461, United States of America; Department of Family Medicine and Community Health, University of Massachusetts Medical School, UMass Memorial Health Care, 55 Lake Avenue North, Worcester, MA, United States of America.
| | - Paula J Busse
- Division of Clinical Immunology and Allergy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, Room 11-20, New York, NY, United States of America.
| | - David C Kaelber
- Center for Clinical Informatics Research and Education, Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, The MetroHealth System, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, United States of America.
| | - Sylvette Nazario
- Department of Internal Medicine, Allergy/Immunology Section, University of Puerto Rico: Medical Sciences Campus, P.O. Box 365067, San Juan, Puerto Rico.
| | - Michelle L Hernandez
- Division of Allergy, Immunology, & Rheumatology, University of North Carolina School of Medicine, 5008C Mary Ellen Jones Building, 116 Manning Drive, CB #7231, Chapel Hill, NC, United States of America.
| | - Andrea J Apter
- Division of Pulmonary, Allergy, Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, 829 Gates Building, Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA, United States of America.
| | - Ku-Lang Chang
- Department of Community Health and Family Medicine, University of Florida College of Medicine, 4197 NW 86th Terrace, Gainesville, FL, United States of America.
| | - Victor Pinto-Plata
- Division of Critical Care/Pulmonary, Baystate Health, Tolosky Center, 3300 Main Street, Suite 2B, Springfield, MA, United States of America.
| | - Paul M Stranges
- University of Illinois at Chicago College of Pharmacy, 833 S Wood Street, Chicago, IL, United States of America.
| | - Laura P Hurley
- Denver Health and Hospital Authority, 301 W 6th Avenue, MC 3251, Denver, CO, United States of America.
| | - Jennifer Trevor
- Department of Medicine, UAB Lung Health Center, University of Alabama, 526 20th Street South, Birmingham, AL, United States of America.
| | - Thomas B Casale
- Division of Allergy and Immunology, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Boulevard, MDC 19, Tampa, FL, United States of America.
| | - Geoffrey Chupp
- Pulmonary, Critical Care & Sleep Medicine, Yale School of Medicine, PO Box 208057, 300 Cedar Street, New Haven, CT, United States of America.
| | - Isaretta L Riley
- Division of Pulmonary, Allergy & Critical Care Medicine, Duke University School of Medicine, Box 102355, 247 Hanes House, Durham, NC, United States of America.
| | - Kartik Shenoy
- Temple Lung Center, Lewis Katz School of Medicine at Temple University, 3401 N. Broad Street, Suite 710C, Philadelphia, PA, United States of America.
| | - Magdalena Pasarica
- University of Central Florida, College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL, United States of America.
| | - Rafael A Calderon-Candelario
- Miller School of Medicine, University of Miami, 1600 NW 10 Ave (Loc# R-47), 7th floor, Room 7052, Miami, FL, United States of America.
| | - Hazel Tapp
- Department of Family Medicine, Atrium Health, 2001 Vail Street, Suite 400B, Charlotte, NC, United States of America.
| | - Ahmet Baydur
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, 2020 Zonal Avenue, IRD 725, Los Angeles, CA, United States of America.
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Tabyshova A, Hurst JR, Soriano JB, Checkley W, Wan-Chun Huang E, Trofor AC, Flores-Flores O, Alupo P, Gianella G, Ferdous T, Meharg D, Alison J, Correia de Sousa J, Postma MJ, Chavannes NH, van Boven JFM. Gaps in COPD Guidelines of Low- and Middle-Income Countries: A Systematic Scoping Review. Chest 2021; 159:575-584. [PMID: 33038390 PMCID: PMC7856534 DOI: 10.1016/j.chest.2020.09.260] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/19/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Guidelines are critical for facilitating cost-effective COPD care. Development and implementation in low-and middle-income countries (LMICs) is challenging. To guide future strategy, an overview of current global COPD guidelines is required. RESEARCH QUESTION We systematically reviewed national COPD guidelines, focusing on worldwide availability and identification of potential development, content, context, and quality gaps that may hamper effective implementation. STUDY DESIGN AND METHODS Scoping review of national COPD management guidelines. We assessed: (1) global guideline coverage; (2) guideline information (authors, target audience, dissemination plans); (3) content (prevention, diagnosis, treatments); (4) ethical, legal, and socio-economic aspects; and (5) compliance with the eight Institute of Medicine (IOM) guideline standards. LMICs guidelines were compared with those from high-income countries (HICs). RESULTS Of the 61 national COPD guidelines identified, 30 were from LMICs. Guidelines did not cover 1.93 billion (30.2%) people living in LMICs, whereas only 0.02 billion (1.9%) in HICs were without national guidelines. Compared with HICs, LMIC guidelines targeted fewer health-care professional groups and less often addressed case finding and co-morbidities. More than 90% of all guidelines included smoking cessation advice. Air pollution reduction strategies were less frequently mentioned in both LMICs (47%) and HICs (42%). LMIC guidelines fulfilled on average 3.37 (42%) of IOM standards, compared with 5.29 (66%) in HICs (P < .05). LMICs scored significantly lower compared with HICs regarding conflicts of interest management, updates, articulation of recommendations, and funding transparency (all, P < .05). INTERPRETATION Several development, content, context, and quality gaps exist in COPD guidelines from LMICs that may hamper effective implementation. Overall, COPD guidelines in LMICs should be more widely available and should be transparently developed and updated. Guidelines may be further enhanced by better inclusion of local risk factors, case findings, and co-morbidity management, preferably tailored to available financial and staff resources.
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Affiliation(s)
- Aizhamal Tabyshova
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, the Netherlands; Department of Pulmonary Diseases, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - John R Hurst
- UCL Respiratory, University College London, United Kingdom
| | - Joan B Soriano
- Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD
| | - Erick Wan-Chun Huang
- Woolcock Institute of Medical Research, Sydney, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, Australia; Division of Thoracic Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Antigona C Trofor
- University of Medicine and Pharmacy 'Grigore T. Popa' Iasi (UMF Iasi), Iasi, Romania
| | - Oscar Flores-Flores
- Biomedical Research Unit, A.B. PRISMA, Lima, Peru; Universidad de San Martin de Porres, Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Lima, Peru; and the Universidad Cientifica del Sur, Facultad de Ciencias de la Salud, Lima, Peru
| | - Patricia Alupo
- Department of Medicine, Makerere Lung Institute, Kampala, Uganda
| | - Gonzalo Gianella
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - David Meharg
- University of Sydney, Faculty of Medicine and Health, Australia
| | - Jennifer Alison
- University of Sydney, Faculty of Medicine and Health, Australia
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Maarten J Postma
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Unit of Global Health, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Job F M van Boven
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, the Netherlands.
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Bakerly ND, Browning D, Boucot I, Crawford J, McCorkindale S, Stein N, New JP. The impact of fluticasone furoate/vilanterol on healthcare resource utilisation in the Salford Lung Study in chronic obstructive pulmonary disease. Ther Adv Respir Dis 2021; 15:17534666211001013. [PMID: 33781142 PMCID: PMC8013671 DOI: 10.1177/17534666211001013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/27/2021] [Indexed: 11/15/2022] Open
Abstract
AIM The Salford Lung Study (SLS) in chronic obstructive pulmonary disease (COPD) was a randomised controlled trial evaluating the effectiveness and safety of initiating fluticasone furoate/vilanterol (FF/VI) 100/25 µg versus continuing usual care (UC) in patients with COPD and a history of exacerbations. Here, we investigate the impact of initiating FF/VI on healthcare resource utilisation (HRU) in SLS COPD. METHODS HRU and interventions were determined from patients' electronic health records. Annual rates of on-treatment all-cause and COPD-related secondary care contacts (SCCs) and primary care contacts (PCCs) for FF/VI versus UC were analysed using a general linear model. Costs were derived from national data sources. RESULTS Least-squares (LS) mean annual rates of all-cause (9.81 versus 9.36) and COPD-related (1.57 versus 1.48) SCCs were similar for FF/VI and UC, as were rates of all-cause hospitalisations (0.87 versus 0.82). Mean duration of hospital stay/patient was 4.5 and 4.2 days, respectively. COPD-related SCC mean total cost/patient was £484 FF/VI and £475 UC. LS mean annual rates of all-cause PCCs were significantly higher for FF/VI (21.20 versus 18.88 UC; p < 0.001). LS mean annual rates of COPD-related PCCs were similar for FF/VI and UC (2.42 versus 2.46). All-cause PCC mean total cost/patient was £900 FF/VI versus £811 UC, but COPD-related PCC costs were similar (£116 versus £114). Direct COPD-related total medical costs/patient were significantly lower for FF/VI (LS geometric mean £806 versus £963 UC; p < 0.001). DISCUSSION In patients with COPD and exacerbation history, FF/VI may represent a less costly alternative to current therapies.GlaxoSmithKline plc. study HZC115151; ClinicalTrials.gov NCT01551758.The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Nawar Diar Bakerly
- Department of Respiratory Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK
- Manchester Academic Health Sciences Centre, University of Manchester, Citylabs 1.0, Nelson Street, Manchester M13 9NQ, UK
| | - Dominy Browning
- Respiratory Research and Development, GlaxoSmithKline plc., Brentford, Middlesex, UK
| | - Isabelle Boucot
- Global Respiratory Therapy Area, GlaxoSmithKline plc., Brentford, Middlesex, UK
| | - Jodie Crawford
- Clinical Statistics, GlaxoSmithKline plc., Stockley Park West, Uxbridge, Middlesex, UK
| | - Sheila McCorkindale
- NIHR Clinical Research Network Greater Manchester, Citylabs 1.0, Manchester, UK
| | - Norman Stein
- Manchester Academic Health Sciences Centre, University of Manchester, Citylabs 1.0, Manchester
- NorthWest EHealth, Manchester Science Park, Manchester, UK
| | - John P. New
- Department of Respiratory Medicine, Salford Royal NHS Foundation Trust, Salford, UK
- Manchester Academic Health Sciences Centre, University of Manchester, Citylabs 1.0, Manchester, UK
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Veit C, Herrera R, Weinmayr G, Genuneit J, Windstetter D, Vogelberg C, von Mutius E, Nowak D, Radon K, Gerlich J, Weinmann T. Long-term effects of asthma medication on asthma symptoms: an application of the targeted maximum likelihood estimation. BMC Med Res Methodol 2020; 20:307. [PMID: 33327942 PMCID: PMC7739451 DOI: 10.1186/s12874-020-01175-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background Long-term effectiveness of asthma control medication has been shown in clinical trials but results from observational studies with children and adolescents are lacking. Marginal structural models estimated using targeted maximum likelihood methods are a novel statistiscal approach for such studies as it allows to account for time-varying confounders and time-varying treatment. Therefore, we aimed to calculate the long-term risk of reporting asthma symptoms in relation to control medication use in a real-life setting from childhood to adulthood applying targeted maximum likelihood estimation. Methods In the prospective cohort study SOLAR (Study on Occupational Allergy Risks) we followed a German subsample of 121 asthmatic children (9–11 years old) of the ISAAC II cohort (International Study of Asthma and Allergies in Childhood) until the age of 19 to 24. We obtained self-reported questionnaire data on asthma control medication use at baseline (1995–1996) and first follow-up (2002–2003) as well as self-reported asthma symptoms at baseline, first and second follow-up (2007–2009). Three hypothetical treatment scenarios were defined: early sustained intervention, early unsustained intervention and no treatment at all. We performed longitudinal targeted maximum likelihood estimation combined with Super Learner algorithm to estimate the relative risk (RR) to report asthma symptoms at SOLAR I and SOLAR II in relation to the different hypothetical scenarios. Results A hypothetical intervention of early sustained treatment was associated with a statistically significant risk increment of asthma symptoms at second follow-up when compared to no treatment at all (RR: 1.51, 95% CI: 1.19–1.83) or early unsustained intervention (RR:1.38, 95% CI: 1.11–1.65). Conclusions While we could confirm the tagerted maximum likelihood estimation to be a usable and robust statistical tool, we did not observe a beneficial effect of asthma control medication on asthma symptoms. Because of potential due to the small sample size, lack of data on disease severity and reverse causation our results should, however, be interpreted with caution.
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Affiliation(s)
- Carolin Veit
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital Munich, Munich, Germany.,Department of Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilian University Munich (LMU), Munich, Germany.,Comprehensive Pneumology Center CPC LMU Munich, member of the German Center for Lung Research (DZL), Munich, Germany
| | - Ronald Herrera
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital Munich, Munich, Germany.,Comprehensive Pneumology Center CPC LMU Munich, member of the German Center for Lung Research (DZL), Munich, Germany
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Paediatric Epidemiology, Hospital for Children and Adolescents, University of Leipzig Medical Center, Leipzig, Germany
| | - Doris Windstetter
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital Munich, Munich, Germany.,Comprehensive Pneumology Center CPC LMU Munich, member of the German Center for Lung Research (DZL), Munich, Germany
| | - Christian Vogelberg
- Paediatric Department, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Erika von Mutius
- Comprehensive Pneumology Center CPC LMU Munich, member of the German Center for Lung Research (DZL), Munich, Germany.,Dr. v. Haunersches Kinderspital, LMU University Hospital Munich, Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital Munich, Munich, Germany.,Comprehensive Pneumology Center CPC LMU Munich, member of the German Center for Lung Research (DZL), Munich, Germany
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital Munich, Munich, Germany.,Comprehensive Pneumology Center CPC LMU Munich, member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jessica Gerlich
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital Munich, Munich, Germany.,Comprehensive Pneumology Center CPC LMU Munich, member of the German Center for Lung Research (DZL), Munich, Germany
| | - Tobias Weinmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital Munich, Munich, Germany. .,Comprehensive Pneumology Center CPC LMU Munich, member of the German Center for Lung Research (DZL), Munich, Germany.
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37
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van 't Hul AJ, Koolen EH, Antons JC, de Man M, Djamin RS, In 't Veen JCCM, Simons SO, van den Heuvel M, van den Borst B, Spruit MA. Treatable traits qualifying for nonpharmacological interventions in COPD patients upon first referral to a pulmonologist: the COPD sTRAITosphere. ERJ Open Res 2020; 6:00438-2020. [PMID: 33263050 PMCID: PMC7682701 DOI: 10.1183/23120541.00438-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/26/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction The present study assessed the prevalence of nine treatable traits (TTs) pinpointing nonpharmacological interventions in patients with COPD upon first referral to a pulmonologist, how these TTs co-occurred and whether and to what extent the TTs increased the odds having a severely impaired health status. Methods Data were collected from a sample of 402 COPD patients. A second sample of 381 patients with COPD was used for validation. Nine TTs were assessed: current smoking status, activity-related dyspnoea, frequent exacerbations <12 months, severe fatigue, depressed mood, poor physical capacity, low physical activity, poor nutritional status and a low level of self-management activation. For each TT the odds ratio (OR) of having a severe health status impairment was calculated. Furthermore, a graphic representation was created, the COPD sTRAITosphere, to visualise TTs prevalence and OR. Results On average 3.9±2.0 TTs per patient were observed. These TTs occurred relatively independently of each other and coexisted in 151 unique combinations. A significant positive correlation was found between the number of TTs and Clinical COPD Questionnaire total score (r=0.58; p<0.001). Patients with severe fatigue (OR: 8.8), severe activity-related dyspnoea (OR: 5.8) or depressed mood (OR: 4.2) had the highest likelihood of having a severely impaired health status. The validation sample corroborated these findings. Conclusions Upon first referral to a pulmonologist, COPD patients show multiple TTs indicating them to several nonpharmacological interventions. These TTs coexist in many different combinations, are relatively independent and increase the likelihood of having a severely impaired health status.
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Affiliation(s)
- Alex J van 't Hul
- Radboud University Medical Center, Radboud Institute for Health Sciences, Dept of Respiratory Diseases, Nijmegen, The Netherlands
| | - Eleonore H Koolen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Dept of Respiratory Diseases, Nijmegen, The Netherlands
| | - Jeanine C Antons
- Radboud University Medical Center, Radboud Institute for Health Sciences, Dept of Respiratory Diseases, Nijmegen, The Netherlands
| | - Marianne de Man
- Bernhoven, Dept of Respiratory Diseases, Uden, The Netherlands
| | - Remco S Djamin
- Dept of Respiratory Diseases, Amphia Hospital, Breda, The Netherlands
| | - Johannes C C M In 't Veen
- Dept of Respiratory Diseases, STZ Centre of Excellence for Asthma & COPD, Franciscus Gasthuis & Vlietland Hospital, Rotterdam, The Netherlands
| | - Sami O Simons
- Dept of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Michel van den Heuvel
- Radboud University Medical Center, Radboud Institute for Health Sciences, Dept of Respiratory Diseases, Nijmegen, The Netherlands
| | - Bram van den Borst
- Radboud University Medical Center, Radboud Institute for Health Sciences, Dept of Respiratory Diseases, Nijmegen, The Netherlands
| | - Martijn A Spruit
- Dept of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,Dept of Research and Development, CIRO+, Horn, The Netherlands.,REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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38
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Buhl R, Dreher M, Korn S, Taube C, Stock C, Zehendner CM, Kondla A, Vogelmeier CF. A Non-Interventional Study of Tiotropium/Olodaterol versus Any Triple Combination Therapy for Chronic Obstructive Pulmonary Disease: The EVELUT ® Study Protocol. Int J Chron Obstruct Pulmon Dis 2020; 15:2601-2608. [PMID: 33122898 PMCID: PMC7591229 DOI: 10.2147/copd.s262746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/23/2020] [Indexed: 12/03/2022] Open
Abstract
Background The Global Initiative for Chronic Obstructive Lung Disease 2020 report recommends that patients with chronic obstructive pulmonary disease (COPD) suffering from persistent dyspnea, despite long-acting β2-agonist (LABA)/inhaled corticosteroid (ICS) maintenance therapy, are switched to either a long-acting muscarinic antagonist (LAMA)/LABA combination regimen or LAMA/LABA/ICS triple therapy. However, to date, no studies have investigated the direct switch from LABA/ICS to LAMA/LABA therapy—instead of switching to triple therapy—in a prospective, real-world, non-interventional setting. Methods EVELUT® (NCT03954132) is an ongoing, prospective, open-label, multicenter, non-interventional study comparing the once-daily fixed-dose combination of tiotropium and olodaterol (tio/olo) versus any triple therapy (LAMA/LABA/ICS) in patients with COPD who are symptomatic despite LABA/ICS maintenance therapy. Patients with acute or frequent COPD exacerbations are excluded from the study. Participants will receive LABA/ICS maintenance treatment until Visit 1, followed by switching of treatment to tio/olo or LAMA/LABA/ICS. The primary endpoints are changes in modified Medical Research Council (mMRC) and COPD Assessment Test (CAT®) scores after approximately 12 weeks of treatment. Secondary endpoints are change in the patients’ general condition according to the Physician’s Global Evaluation score, the proportion of responders with a change in mMRC score of ≥1 and in CAT® score of ≥2, and patient satisfaction with the inhaler and therapy. The study is expected to enroll approximately 900 patients. Conclusion EVELUT results are expected to add to the current real-world evidence informing therapeutic decisions for COPD in everyday clinical practice. Trial Registration The European Union electronic Register of Post-authorisation Studies (EU PAS Register): EUPAS29784; the Federal Institute for Drugs and Medical Devices (BfArM): NIS Study No 7305; Clinicaltrials.gov: NCT03954132.
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Affiliation(s)
- Roland Buhl
- Pulmonary Department, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michael Dreher
- Clinic of Cardiology, Pneumology, Angiology and Internal Medicine Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Stephanie Korn
- Pulmonary Department, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christian Taube
- Clinic for Pneumonology, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Christian Stock
- Biostatistics + Data Sciences Corp, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
| | - Christoph M Zehendner
- HP Country Medical Affairs, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
| | - Anke Kondla
- HP Country Medical Affairs, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
| | - Claus F Vogelmeier
- Department of Pneumology, University Hospital of Giessen and Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
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Vestbo J, Janson C, Nuevo J, Price D. Observational studies assessing the pharmacological treatment of obstructive lung disease: strengths, challenges and considerations for study design. ERJ Open Res 2020; 6:00044-2020. [PMID: 33083435 PMCID: PMC7553106 DOI: 10.1183/23120541.00044-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/01/2020] [Indexed: 11/05/2022] Open
Abstract
Randomised controlled trials (RCTs) are the gold standard for evaluating treatment efficacy in patients with obstructive lung disease. However, due to strict inclusion criteria and the conditions required for ascertaining statistical significance, the patients included typically represent as little as 5% of the general obstructive lung disease population. Thus, studies in broader patient populations are becoming increasingly important. These can be randomised effectiveness trials or observational studies providing data on real-world treatment effectiveness and safety data that complement efficacy RCTs. In this review we describe the features associated with the diagnosis of asthma and chronic obstructive pulmonary disease (COPD) in the real-world clinical practice setting. We also discuss how RCTs and observational studies have reported opposing outcomes with several treatments and inhaler devices due to differences in study design and the variations in patients recruited by different study types. Whilst observational studies are not without weaknesses, we outline recently developed tools for defining markers of quality of observational studies. We also examine how observational studies are capable of providing valuable insights into disease mechanisms and management and how they are a vital component of research into obstructive lung disease. As we move into an era of personalised medicine, recent observational studies, such as the NOVEL observational longiTudinal studY (NOVELTY), have the capacity to provide a greater understanding of the value of a personalised healthcare approach in patients in clinical practice by focussing on standardised outcome measures of patient-reported outcomes, physician assessments, airway physiology, and blood and airway biomarkers across both primary and specialist care.
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Affiliation(s)
- Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Christer Janson
- Dept of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | | | - David Price
- Observational and Pragmatic Research Institute, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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40
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Gemzoe K, Crawford R, Caress A, McCorkindale S, Conroy R, Collier S, Doward L, Vekaria RM, Worsley S, Leather DA, Irving E. Patient and healthcare professional experiences of the Salford Lung Studies: qualitative insights for future effectiveness trials. Trials 2020; 21:798. [PMID: 32943093 PMCID: PMC7499906 DOI: 10.1186/s13063-020-04655-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/05/2020] [Indexed: 01/09/2023] Open
Abstract
Background Randomized controlled trials (RCTs) conducted in the routine care setting provide the opportunity to better understand the effectiveness of new medicines but can present recruitment difficulties. An improved understanding of the challenges/opportunities for patient and healthcare professional (HCP) engagement in clinical research is needed to enhance participation and trial experience. In this study, we explored patient and HCP drivers for, and experiences of, participation in the Salford Lung Studies (SLS), and their views on future trial participation and the overall value of such trials. Methods This was a qualitative study set in Salford, UK, comprising patient telephone interviews (N = 10) and HCP advisory boards (one with general practitioners [GPs], one with practice managers [PMs]); all individuals had participated in the SLS. Semi-structured telephone interviews were recorded, transcribed and analysed thematically. Advisory board meetings were analysed based on transcriptions of audio recordings and field notes. Results For patients, key positive aspects of the SLS were the ease/convenience of study assessments and excellent relationships with study nurses. GPs and PMs considered the SLS to be well-organized and highlighted the value of research nurse support; they also described minor challenges relating to trial systems, initial financial strain on practices and staff turnover. All participants indicated that they were very likely to participate in future trials, citing a design closely aligned with routine care practice as essential. Several strategies to encourage trial participation were suggested, such as clearly communicating benefits to patients and ensuring flexible study assessments. Conclusions Patients and HCPs had positive experiences of the SLS. The study design, closely aligned with routine care, was considered important to their high likelihood of participating in future trials. The experiences of patients and HCPs in the SLS provide valuable insights that will help inform future best practice in the design and conduct of future real-world effectiveness RCTs in primary care. The detailed first-hand experiences of HCPs will be of significant value to others considering engaging in clinical research and participating in effectiveness RCTs.
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Affiliation(s)
- Kim Gemzoe
- Real World Study Delivery, Value Evidence and Outcomes, GlaxoSmithKline plc., Research & Development Ltd., Stockley Park West, 1-3 Ironbridge Road, Uxbridge, Middlesex, UB11 1BT, UK.
| | | | - Ann Caress
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK
| | | | | | - Susan Collier
- UK Medical, GlaxoSmithKline plc, Uxbridge, UB11 1BT, UK
| | | | | | - Sally Worsley
- Real World Study Delivery, Value Evidence and Outcomes, GlaxoSmithKline plc., Research & Development Ltd., Stevenage, SG1 2NY, UK
| | - David A Leather
- Global Respiratory Franchise, GlaxoSmithKline plc., Brentford, TW8 9GS, UK
| | - Elaine Irving
- Real World Study Delivery, Value Evidence and Outcomes, GlaxoSmithKline plc., Research & Development Ltd., Stevenage, SG1 2NY, UK
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41
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Kerkhof M, Voorham J, Dorinsky P, Cabrera C, Darken P, Kocks JWH, Sadatsafavi M, Sin DD, Carter V, Price DB. The Long-Term Burden of COPD Exacerbations During Maintenance Therapy and Lung Function Decline. Int J Chron Obstruct Pulmon Dis 2020; 15:1909-1918. [PMID: 32821093 PMCID: PMC7418151 DOI: 10.2147/copd.s253812] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/15/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Early identification of preventable risk factors of COPD progression is important. Whether exacerbations have a negative impact on disease progression is largely unknown. We investigated whether the long-term occurrence of exacerbations is associated with lung function decline at early stages of COPD. Methods Patients diagnosed with mild/moderate COPD (obstruction and FEV1% predicted 50–90%), aged ≥35 years, and a smoking history, who had ≥6 years of UK electronic medical records after initiation of maintenance therapy were studied. Multilevel mixed-effect linear regression was performed to determine the association between the count of any year in which the patient had ≥1 exacerbation over a 6-year period and FEV1 decline, adjusted for sex, age, anthropometrics and smoking habits. Exacerbations were defined as any prescription for an acute oral corticosteroid course and/or lower respiratory-related antibiotics and/or any COPD-related emergency or inpatient hospitalization. Results Of 11,337 patients included (mean age 65 years; 49% female) 31.6%, 23.3%, 16.6%, 11.6%, 8.1%, 5.3% and 3.4% had 0, 1, 2, 3, 4, 5 and 6 years with ≥1 exacerbation. The mean annual FEV1 decline accelerated by 1.50 mL/year (95% Confidence Interval 1.02; 1.98) with every additional year with ≥1 exacerbation from 31.0 mL/year in subjects without any exacerbation to 40.0 mL/year in patients experiencing ≥1 exacerbation every year. Patients with more years with ≥1 exacerbation had a lower mean FEV1 at first diagnosis: 14.7 mL (11.7; 17.8) lower with every additional year with exacerbations. When counting years with ≥2 exacerbations, greater effects were observed (2.19 [1.50; 2.88] mL/year excess decline per year with ≥2 exacerbations; 16.5 mL [12.1; 20.8] lower FEV1 at diagnosis). Conclusion Patients who experienced a greater exacerbation burden after initiation of maintenance therapy had worse lung function at diagnosis and a more rapid lung function decline thereafter, which emphasizes the need for better treatment strategies.
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Affiliation(s)
- Marjan Kerkhof
- Observational & Pragmatic Research Institute Pte Ltd, Singapore, Singapore
| | - Jaco Voorham
- Observational & Pragmatic Research Institute Pte Ltd, Singapore, Singapore
| | | | - Claudia Cabrera
- AstraZeneca, Mölndal, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | | | - Janwillem W H Kocks
- Observational & Pragmatic Research Institute Pte Ltd, Singapore, Singapore.,General Practitioners Research Institute, Groningen, The Netherlands
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, BC, Canada.,Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Don D Sin
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, BC, Canada.,Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Victoria Carter
- Observational & Pragmatic Research Institute Pte Ltd, Singapore, Singapore
| | - David B Price
- Observational & Pragmatic Research Institute Pte Ltd, Singapore, Singapore.,Academic Primary Care, University of Aberdeen, Aberdeen, UK
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Oishi K, Matsunaga K, Shirai T, Hirai K, Gon Y. Role of Type2 Inflammatory Biomarkers in Chronic Obstructive Pulmonary Disease. J Clin Med 2020; 9:jcm9082670. [PMID: 32824775 PMCID: PMC7464674 DOI: 10.3390/jcm9082670] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023] Open
Abstract
Airway inflammation in chronic obstructive pulmonary disease (COPD) is typically thought to be driven by Type1 immune responses, while Type2 inflammation appears to be present in definite proportions in the stable state and during exacerbations. In fact, some COPD patients showed gene expression of Type2 inflammation in the airway, and this subset was associated with the inhaled corticosteroid (ICS) response. Interestingly enough, the relationship between COPD and diseases associated with Type2 inflammation from the perspective of impaired lung development is increasingly highlighted by recent epidemiologic studies on the origin of COPD. Therefore, many researchers have shown an interest in the prevalence and the role of existent Type2 biomarkers such as sputum and blood eosinophils, exhaled nitric oxide fraction, and atopy, not only in asthma but also in COPD. Although the evidence about Type2 biomarkers in COPD is inconsistent and less robust, Type2 biomarkers have shown some potential when analyzing various clinical outcomes or therapeutic response to ICS. In this article, we review the existent and emerging Type2 biomarkers with clinically higher applicability in the management of COPD.
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Affiliation(s)
- Keiji Oishi
- Department of Medicine and Clinical Science, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan
- Correspondence: ; Tel.: +81-836-22-2248
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan;
| | - Toshihiro Shirai
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka 420-8527, Japan;
| | - Keita Hirai
- Department of Clinical Pharmacology and Genetics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka 422-8526, Japan;
- Laboratory of Clinical Pharmacogenomics, Shizuoka General Hospital, Shizuoka 420-8527, Japan
| | - Yasuhiro Gon
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Tokyo 173-8601, Japan;
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Noibi S, Mohy A, Gouhar R, Shaker F, Lukic T, Al-Jahdali H. Asthma control factors in the Gulf Cooperation Council (GCC) countries and the effectiveness of ICS/LABA fixed dose combinations: a dual rapid literature review. BMC Public Health 2020; 20:1211. [PMID: 32770967 PMCID: PMC7414753 DOI: 10.1186/s12889-020-09259-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/14/2020] [Indexed: 01/08/2023] Open
Abstract
Background Asthma control is influenced by multiple factors. These factors must be considered when appraising asthma interventions and their effectiveness in the Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates [UAE]). Based on published studies, the most prevalent asthma treatment in these countries are fixed dose combinations (FDC) of inhaled corticosteroid and long-acting beta-agonist (ICS/LABA). This study is a rapid review of the literature on: (a) factors associated with asthma control in the GCC countries and (b) generalisability of ICS/LABA FDC effectiveness studies. Methods To review local factors associated with asthma control and, generalisability of published ICS/LABA FDC studies, two rapid reviews were conducted. Review 1 targeted literature pertaining to asthma control factors in GCC countries. Eligible studies were appraised, and clustering methodology used to summarise factors. Review 2 assessed ICS/LABA FDC studies in conditions close to actual clinical practice (i.e. effectiveness studies). Eligibility was determined by reviewing study characteristics. Evaluation of studies focused on randomised controlled trials (RCTs). In both reviews, initial (January 2018) and updated (November 2019) searches were conducted in EMBASE and PubMed databases. Eligible studies were appraised using the Critical Appraisal Skills Program (CASP) checklists. Results We identified 51 publications reporting factors associated with asthma control. These publications reported studies conducted in Saudi Arabia (35), Qatar (5), Kuwait (5), UAE (3), Oman (1) and multiple countries (2). The most common factors associated with asthma control were: asthma-related education (13 articles), demographics (11articles), comorbidities (11 articles) and environmental exposures (11 articles). Review 2 identified 61 articles reporting ICS/LABA FDC effectiveness studies from countries outside of the GCC. Of these, six RCTs were critically appraised. The adequacy of RCTs in informing clinical practice varied when appraised against previously published criteria. Conclusions Asthma-related education was the most recurring factor associated with asthma control in the GCC countries. Moreover, the generalisability of ICS/LABA FDC studies to this region is variable. Hence, asthma patients in the region, particularly those on ICS/LABA FDC, will continue to require physician review and oversight. While our findings provide evidence for local treatment guidelines, further research is required in GCC countries to establish the causal pathways through which asthma-related education influence asthma control for patients on ICS/LABA FDC therapy.
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Affiliation(s)
- Saeed Noibi
- Medical Affairs Department, GSK Saudi Arabia, 22nd Floor Head Quarters Business Park, Jeddah, Kingdom of Saudi Arabia.
| | - Ahmed Mohy
- Medical Affairs Department, GSK Saudi Arabia, 22nd Floor Head Quarters Business Park, Jeddah, Kingdom of Saudi Arabia
| | - Raef Gouhar
- Medical Affairs Department, GSK Gulf Countries, Arenco Towers, Dubai Medial City, Dubai, United Arab Emirates
| | - Fadel Shaker
- Medical Affairs Department, GSK Saudi Arabia, 22nd Floor Head Quarters Business Park, Jeddah, Kingdom of Saudi Arabia
| | - Tamara Lukic
- Medical Affairs Department, GSK Gulf Countries, Arenco Towers, Dubai Medial City, Dubai, United Arab Emirates
| | - Hamdan Al-Jahdali
- King Saud bin Abdulaziz University for Health Sciences I KSAU-HS, College of Medicine, Riyadh, Kingdom of Saudi Arabia
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Shimizu Y, Shiobara T, Arai R, Chibana K, Takemasa A. Real-life effectiveness of fluticasone furoate/vilanterol after switching from fluticasone/salmeterol or budesonide/formoterol therapy in patients with symptomatic asthma: Relvar Ellipta for Real Asthma Control Study (RERACS study). J Thorac Dis 2020; 12:1877-1883. [PMID: 32642091 PMCID: PMC7330400 DOI: 10.21037/jtd-19-3913] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/08/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study evaluated the efficacy of switching therapy from fluticasone propionate/salmeterol (FP/SM) or budesonide/formoterol (BD/FM) to fluticasone furoate and vilanterol (FF/VI) at the equivalent corticosteroid dose in a real-world setting. METHODS A prospective, 3-month, open-label, parallel group, switching therapy trial was performed in symptomatic asthma patients under routine management. Patients using 1 puff of FP 250 µg/SM 50 µg b.i.d or 2 puffs of BD 160 µg/FM 4.5 µg b.i.d were switched to FF 100 µg/VI 25 µg once daily, while patients using 1 puff of FP 500 µg/SM 50 µg b.i.d or 4 puffs of BD 160/FM b.i.d was switched to FF 200 µg/VI 25 µg once daily. The primary outcome was improvement of the predicted forced expiratory volume in 1 second % (%FEV1), while secondary outcomes were improvement of asthma symptoms evaluated by the asthma control test (ACT) and fractional exhaled nitric oxide (FeNO). RESULTS The %FEV1 was improved at 4 weeks after switching, and the improvement was maintained until 12 weeks. ACT also improved after switching. Patients with ACT <20 before switching showed greater improvement of symptoms at 4 weeks and 62% had an ACT score >20. FeNO decreased from 8 weeks. CONCLUSIONS In symptomatic asthma patients showing insufficient control, improvement of asthma was obtained by switching to FF/VI at the equivalent corticosteroid dose accompanied with the improvement of biomarkers. FF/VI can be a useful option for better control of asthma because of its high efficacy, long duration of action, and delivery via a single-action device.
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Affiliation(s)
- Yasuo Shimizu
- Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Taichi Shiobara
- Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Ryo Arai
- Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Kazuyuki Chibana
- Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Akihiro Takemasa
- Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
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45
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Chorostowska-Wynimko J, Wencker M, Horváth I. The importance of effective registries in pulmonary diseases and how to optimize their output. Chron Respir Dis 2020; 16:1479973119881777. [PMID: 31645111 PMCID: PMC6811757 DOI: 10.1177/1479973119881777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Randomized controlled trials (RCTs) are essential for the approval of new
therapies; however, because of their design, they provide little insight
concerning disease epidemiology/etiology and current clinical practice.
Particularly, in lung disease, rigid inclusion/exclusion criteria can limit the
generalizability of pivotal trial data. Noninterventional studies (NIS),
conducted through the well-established mechanism of patient registries, are
undervalued as a means to close data gaps left by RCTs by providing essential
data that can guide patient care at different levels from clinical
decision-making to health-care policy. While NIS contribute valuable data in all
disease areas, their importance in rare diseases cannot be underestimated. In
respiratory disease, registries have been essential in understanding the natural
history and different phenotypes of rare conditions, such as alpha 1 antitrypsin
deficiency, cystic fibrosis, and idiopathic pulmonary fibrosis. Importantly,
additional therapeutic outcome data were generated. While measures for enhancing
data quality in RCTs have evolved significantly, the approach and effectiveness
of registries is variable. Within this article, we review the contribution of
registries to pulmonary disease and make recommendations for their effective
management. Additionally, we assess limitations of registry data as well as
challenges to registry operation, including the impact of the European Union
General Data Protection Regulation.
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Affiliation(s)
- Joanna Chorostowska-Wynimko
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | | | - Ildikó Horváth
- Department of XIV, National Koranyi Institute for Pulmonology, Budapest, Hungary.,Department of Public Health, Semmelweis University, Budapest, Hungary
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46
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Backer V, Klein DK, Bodtger U, Romberg K, Porsbjerg C, Erjefält JS, Kristiansen K, Xu R, Silberbrandt A, Frøssing L, Hvidtfeldt M, Obling N, Jarenbäck L, Nasr A, Tufvesson E, Mori M, Winther-Jensen M, Karlsson L, Nihlén U, Veje Flintegaard T, Bjermer L. Clinical characteristics of the BREATHE cohort - a real-life study on patients with asthma and COPD. Eur Clin Respir J 2020; 7:1736934. [PMID: 32284828 PMCID: PMC7144315 DOI: 10.1080/20018525.2020.1736934] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/24/2020] [Indexed: 01/06/2023] Open
Abstract
Background: The BREATHE study is a cross-sectional study of real-life patients with asthma and/or COPD in Denmark and Sweden aiming to increase the knowledge across severities and combinations of obstructive airway disease. Design: Patients with suspicion of asthma and/or COPD and healthy controls were invited to participate in the study and had a standard evaluation performed consisting of questionnaires, physical examination, FeNO and lung function, mannitol provocation test, allergy test, and collection of sputum and blood samples. A subgroup of patients and healthy controls had a bronchoscopy performed with a collection of airway samples. Results: The study population consisted of 1403 patients with obstructive airway disease (859 with asthma, 271 with COPD, 126 with concurrent asthma and COPD, 147 with other), and 89 healthy controls (smokers and non-smokers). Of patients with asthma, 54% had moderate-to-severe disease and 46% had mild disease. In patients with COPD, 82% had groups A and B, whereas 18% had groups C and D classified disease. Patients with asthma more frequently had childhood asthma, atopic dermatitis, and allergic rhinitis, compared to patients with COPD, asthma + COPD and Other, whereas FeNO levels were higher in patients with asthma and asthma + COPD compared to COPD and Other (18 ppb and 16 ppb vs 12.5 ppb and 14 ppb, p < 0.001). Patients with asthma, asthma + COPD and Other had higher sputum eosinophilia (1.5%, 1.5%, 1.2% vs 0.75%, respectively, p < 0.001) but lower sputum neutrophilia (39.3, 43.5%, 40.8% vs 66.8%, p < 0.001) compared to patients with COPD. Conclusions: The BREATHE study provides a unique database and biobank with clinical information and samples from 1403 real-life patients with asthma, COPD, and overlap representing different severities of the diseases. This research platform is highly relevant for disease phenotype- and biomarker studies aiming to describe a broad spectrum of obstructive airway diseases.
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Affiliation(s)
- Vibeke Backer
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Ditte K Klein
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Respiratory and Internal Medicine, Naestved Hospital, Naestved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Kerstin Romberg
- Health Care Centre, Näsets Läkargrupp, Höllviken, Sweden.,Respiratory Medicine and Allergology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Celeste Porsbjerg
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | | | - Karsten Kristiansen
- Laboratory of Genomics and Molecular Biomedicine, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Ruiqi Xu
- North Europe Regional Department, BGI-Europe, Copenhagen, Denmark
| | - Alexander Silberbrandt
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Laurits Frøssing
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Morten Hvidtfeldt
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Nicolai Obling
- Department of Respiratory and Internal Medicine, Naestved Hospital, Naestved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Linnea Jarenbäck
- Respiratory Medicine and Allergology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Abir Nasr
- Respiratory Medicine and Allergology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ellen Tufvesson
- Respiratory Medicine and Allergology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Michiko Mori
- Unit of Airway Inflammation, Lund University, Lund, Sweden
| | - Matilde Winther-Jensen
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Lisa Karlsson
- Unit of Airway Inflammation, Lund University, Lund, Sweden
| | - Ulf Nihlén
- Respiratory Medicine and Allergology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Thomas Veje Flintegaard
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Clinical Sciences Lund, Lund University, Lund, Sweden
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47
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Jones R, Nicholls A, Browning D, Diar Bakerly N, Woodcock A, Vestbo J, Leather DA, Jacques L, Lay-Flurrie J, Svedsater H, Collier S. Impact of socioeconomic status on participation and outcomes in the Salford Lung Studies. ERJ Open Res 2020; 6:00193-2019. [PMID: 32201688 PMCID: PMC7073415 DOI: 10.1183/23120541.00193-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/11/2019] [Indexed: 11/05/2022] Open
Abstract
COPD and asthma prevalence is associated with socioeconomic status (or "deprivation"), yet deprivation is rarely considered in typical large-scale efficacy randomised controlled trials that recruit highly selected patient populations. In this post hoc analysis of the Salford Lung Studies in COPD and asthma (two 12-month, open-label, effectiveness randomised controlled trials conducted in UK primary care), we evaluated the impact of patient deprivation on clinical outcomes with initiating fluticasone furoate/vilanterol versus continuing usual care. Patients were categorised into deprivation quintiles based on postcode and a countrywide database of indices of deprivation, and trial outcomes by quintile were assessed. 52% of patients in the COPD study were included in the most deprived quintile, contrasting with 20% in the asthma study. Greater deprivation was associated with higher rates of primary/secondary healthcare contacts and costs. However, the treatment effect of fluticasone furoate/vilanterol versus usual care for primary (COPD: moderate/severe exacerbations; asthma: Asthma Control Test responders at week 24) and secondary/other (healthcare consumption, adherence, treatment modifications, study withdrawals, exacerbations, serious adverse events) outcomes was similar across deprivation quintiles. Our findings support the recruitment of participants from all socioeconomic strata to allow assessment of data generalisability to routine clinical practice.
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Affiliation(s)
- Rupert Jones
- Community and Primary Health Care, Faculty of Health, Plymouth University, Plymouth, UK
| | - Andy Nicholls
- Clinical Statistics, GlaxoSmithKline plc., Uxbridge, UK
| | - Dominy Browning
- Respiratory Research and Development, GlaxoSmithKline plc., Brentford, UK
| | - Nawar Diar Bakerly
- Salford Royal NHS Foundation Trust, Salford, UK.,Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Ashley Woodcock
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK
| | - David A Leather
- Global Respiratory Franchise, GlaxoSmithKline plc., Brentford, UK
| | | | | | - Henrik Svedsater
- Value Evidence and Outcomes, GlaxoSmithKline plc., Brentford, UK
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48
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Duarte-de-Araújo A, Teixeira P, Hespanhol V, Correia-de-Sousa J. COPD: How can evidence from randomised controlled trials apply to patients treated in everyday clinical practice? Pulmonology 2020; 28:431-439. [PMID: 32169297 DOI: 10.1016/j.pulmoe.2020.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES To evaluate the degree to which evidence from large clinical trials can be applied to patients treated in a local hospital cohort of COPD outpatients. METHODS The authors selected seventeen RCTs identified in a systematic way from GOLD 2019 consensus document, and applied their inclusion and exclusion criteria to a real-world cohort of a previous cross-sectional study of 303 COPD outpatients included consecutively. RESULTS When the inclusion criteria of the 17 RCTs were applied to a real-world cohort of COPD outpatients, only a small portion of them were eligible to participate in the referred trials, from 4.29% to 60.07%. However, when both the inclusion and the exclusion criteria were applied, only as little as 3.63% to as much as 40.59% of patients were eligible to participate. Hence, only a small fraction of patients from this cohort could benefit from the findings of these RCTs. CONCLUSIONS There is a need to complement the efficacy evidence provided by large RCTs according to the extent to which their results, designed to target significant patient populations, can be applied to typical patients treated in routine clinical practice.
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Affiliation(s)
- António Duarte-de-Araújo
- Respiratory Department, H. Sª Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - Pedro Teixeira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Venceslau Hespanhol
- Respiratory Department, Centro Hospitalar de S. João, Porto, Portugal; Faculty of Medicine (FMUP), University of Porto, Portugal
| | - Jaime Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; Horizonte Family Health Unit, Matosinhos, Portugal
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49
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Devillier P, Demoly P, Molimard M. Allergen immunotherapy: what is the added value of real-world evidence from retrospective claims database studies? Expert Rev Respir Med 2020; 14:445-452. [PMID: 32131649 DOI: 10.1080/17476348.2020.1733417] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Randomized controlled trials (RCTs) show that allergen immunotherapy (AIT) has proven long-term efficacy in patients with allergic rhinitis (AR). However, RCTs have limited generalizability and there is growing recognition that real-world evidence (RWE) is necessary to provide complementary data to those of RCTs, and corroborate their findings. Until recently, data from the real-world setting investigating the benefits of AIT for the treatment of patients with grass and birch pollen-associated AR were sparse, but new retrospective claims database studies from France and Germany have confirmed the sustained benefits of grass and birch pollen AIT in terms of significantly reduced progression of AR and asthma, and a significantly decreased risk of new-onset asthma.Areas covered: Here, we review the value of RWE used alongside data from traditional RCTs, and its potential strengths and limitations, and summarize the findings of the recent RWE studies investigating the benefits of AIT for the management of patients with grass and birch pollen-associated AR.Expert opinion: There is growing recognition of the necessity and value of RWE as a complement to data acquired in RCTs, to better understand the effects of AIT treatments in a broader, more representative patient population, and to help guide clinical decision-making.
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Affiliation(s)
- Philippe Devillier
- UPRES EA 220, Department of Airway Diseases, Hôpital Foch, University of Versailles Saint Quentin, University Paris-Saclay, Suresnes, France
| | - Pascal Demoly
- Department of Pulmonology, Division of Allergy, Hôpital Arnaud De Villeneuve, University Hospital of Montpellier, Montpellier, France and Equipe EPAR - IPLESP, Sorbonne Université, Paris, France
| | - Mathieu Molimard
- Pharmacology Department, University of Bordeaux, INSERM Unit CR1219, Bordeaux, France
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50
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Leather DA, Jones R, Woodcock A, Vestbo J, Jacques L, Thomas M. Real-World Data and Randomised Controlled Trials: The Salford Lung Study. Adv Ther 2020; 37:977-997. [PMID: 31927698 PMCID: PMC7147238 DOI: 10.1007/s12325-019-01192-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Indexed: 01/31/2023]
Abstract
Traditional efficacy double-blind randomised controlled trials (DBRCTs) measure the benefit a treatment produces under near-ideal test conditions in highly selected patient populations; however, the behaviour of patients and investigators in such trials is highly controlled, highly compliant and adherent, and non-representative of routine clinical practice. Pragmatic effectiveness trials measure the benefit a treatment produces in patients in everyday "real-world" practice. Ideally, effectiveness trials should recruit patients as similar as possible to those who will ultimately be prescribed the medicine, and create freedom within the study design to allow normal behaviours of patients and healthcare professionals (HCPs) to be expressed. The Salford Lung Study (SLS) was a world-first, prospective, phase III, pragmatic randomised controlled trial (RCT) programme in patients with chronic obstructive pulmonary disease and asthma to evaluate the effectiveness of a pre-licensed medication (fluticasone furoate/vilanterol) in real-world practice using electronic health records and through collaboratively engaging general practitioners and community pharmacists in clinical research. The real-world aspect of SLS was unique, requiring careful planning and attention to the goals of maximising the external validity of the trials while maintaining scientific rigour and securing suitable electronic processes for proper interpretation of safety data. Key learnings from SLS that may inform the design of future pragmatic effectiveness RCTs include: (1) ensuring the trial setting and operational infrastructure are aligned with routine clinical care; (2) recruiting a broad patient population with characteristics as close as possible to patients in routine clinical practice, to maximise the generalisability and applicability of trial results; (3) ensuring that patients and HCPs are suitably engaged in the trial, to maximise the chances of successful trial delivery; and (4) careful study design, incorporating outcomes of value to patients, HCPs, policymakers and payers, and using pre-planned analyses to address scientifically valid research hypotheses to ensure robustness of the trial data.
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Affiliation(s)
- David A Leather
- Global Respiratory Franchise, GlaxoSmithKline plc., Brentford, Middlesex, UK.
| | - Rupert Jones
- Community and Primary Health Care, Faculty of Health, Plymouth University, Plymouth, UK
| | - Ashley Woodcock
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre, The University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre, The University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - Loretta Jacques
- Clinical Sciences, GlaxoSmithKline plc., Uxbridge, Middlesex, UK
| | - Mike Thomas
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
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