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Aleyadeh W, Verna EC, Elbeshbeshy H, Sulkowski MS, Smith C, Darling J, Sterling RK, Muir A, Akushevich L, La D, Terrault N, Fried MW, Feld JJ. Outcomes of early vs late treatment initiation in solid organ transplantation from hepatitis C virus nucleic acid test-positive donors to hepatitis C virus-uninfected recipients: Results from the HCV-TARGET study. Am J Transplant 2024; 24:468-478. [PMID: 37871798 DOI: 10.1016/j.ajt.2023.10.006] [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: 05/30/2023] [Revised: 09/14/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023]
Abstract
Curative hepatitis C virus (HCV) therapy has increased transplantation from HCV-infected nucleic acid test-positive donors to HCV-uninfected recipients (D+/R-). We evaluated outcomes of early and late HCV treatment among D+/R- nonliver organ transplants. Patients received HCV regimens per local standard (n = 10 sites). Outcomes were compared between early and late treatments. Early treatment regimens (ETR) (n = 56) were initiated pretransplantation to day 7 posttransplant. Late treatment regimens (LTRs) (n = 102) began median 31 (range, 8-114) days posttransplant. There were 79 kidney, 50 lung, 23 heart, and 6 mixed transplants, similar between groups. HCV RNA was quantifiable in 98% of LTR versus 44.6% of ETR recipients (P < .001). Mean (range) days on treatment were 28 (7-93) ETR and 81 (51-111) LTR (P < .0001). There were no virological failures with ETR, but relapse (n = 3) and nonresponse (n = 2) in LTR (P = .16), including fibrosing cholestatic hepatitis postrelapse (n = 1). Sustained virological response was 100% (95% confidence interval, 93.4-100.0) in ETR (n = 54) and 94.9% (95% confidence interval, 88.5-98.3) in LTR (n = 98). Acute rejection occurred in 11 (19.6%) ETR and 25 (24.5%) LTR. In total, 11 HCV-unrelated deaths occurred: 8 ETR and 3 LTR. Organ transplantation from HCV-infected nucleic acid test-positive donors to HCV-uninfected recipients was safe. ETR led to fewer virological failures with shorter treatment duration, supporting recommendations to initiate treatment promptly posttransplant.
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Affiliation(s)
- Wesam Aleyadeh
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
| | - Elizabeth C Verna
- Transplant Hepatology, Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, New York, USA
| | - Hany Elbeshbeshy
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Mark S Sulkowski
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Coleman Smith
- Department of Transplant Hepatology, MedStar Georgetown University Transplant Institute, Washington, District of Columbia, USA
| | - Jama Darling
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Richard K Sterling
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, VCU Medical Center, Richmond, Virginia, USA
| | - Andrew Muir
- Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lucy Akushevich
- Biometrics and Data Quality HCV-TARGET Data Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Danie La
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Norah Terrault
- Division of Gastroenterology and Liver Disease, Keck School of Medicine at University of Southern California, Los Angeles, California, USA
| | - Michael W Fried
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
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Lutz M, Caldera F, Schroeder K, Gazis D, Crawford JM, Long MD, Barnes EL. Prevalence of Immunomodulator Use as Combination Therapy With Vedolizumab or Ustekinumab in Inflammatory Bowel Disease. Clin Transl Gastroenterol 2023; 14:e00620. [PMID: 37450671 PMCID: PMC10684180 DOI: 10.14309/ctg.0000000000000620] [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: 03/09/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION The benefit of adding an immunomodulator to vedolizumab and ustekinumab remains unclear and may compromise the safety of these biologics. We evaluated the prevalence and predictors of immunomodulator use with vedolizumab or ustekinumab in patients with inflammatory bowel disease in a large longitudinal cohort. METHODS Clinical information was ascertained from electronic medical records of patients enrolled in TARGET-IBD, a prospective longitudinal observational cohort of patients with inflammatory bowel disease (IBD) at 34 sites. The prevalence of immunomodulator use with vedolizumab, ustekinumab, and antitumor necrosis factor therapies and predictors of immunomodulator use with vedolizumab and ustekinumab were estimated. Rates of combination therapy were additionally stratified by time from drug approval. RESULTS Four thousand thirty-nine adults with IBD were identified, of whom 18.8% were treated with vedolizumab and 13.0% were treated with ustekinumab. Combination therapy with vedolizumab and ustekinumab exceeded 30% (30.7% and 36.2%, respectively) and was more likely in those with perianal disease or previous biologic exposure. Age and presence of extraintestinal manifestations did not consistently predict the use of an immunomodulator. Combination therapy decreased in the years after drug approval. DISCUSSION Combination therapy with vedolizumab or ustekinumab was common and was associated with perianal disease and greater exposure to other biologics, although the practice is decreasing with time. Further data are needed to determine the efficacy and safety of combination therapy in patients initiating vedolizumab or ustekinumab for IBD.
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Affiliation(s)
- Megan Lutz
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin—Madison, School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Freddy Caldera
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin—Madison, School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Katie Schroeder
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Derek Gazis
- TARGET RWE, Inc., Durham, North Carolina, USA
| | | | - Millie D. Long
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Edward L. Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Lok AS, Moon J, Sherman KE, Khalili M, Fishbein D, Reddy KR. Long-term Follow-up of Hepatitis C Patients Who Achieved Sustained Virologic Response in the Pragmatic PRIORITIZE Study. Clin Gastroenterol Hepatol 2023; 21:546-548.e4. [PMID: 35182741 PMCID: PMC9503088 DOI: 10.1016/j.cgh.2022.01.059] [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: 12/03/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 02/07/2023]
Abstract
Multiple real-world studies have confirmed the safety and efficacy of hepatitis C (HCV) direct-acting antivirals (DAAs); however, few studies have provided data on long-term outcomes of patients without cirrhosis after achieving sustained virologic response (SVR).1-3 The aims of this analysis were to describe, among individuals in the PRIORITIZE Study achieving SVR: (1) the frequency of laboratory testing and imaging during long-term follow-up (LTFU), (2) changes in liver tests, (3) occurrence of hepatic decompensation or hepatocellular carcinoma (HCC) and deaths, and (4) durability of SVR.
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Affiliation(s)
- Anna S Lok
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, MI.
| | - Juhi Moon
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Mandana Khalili
- University of California San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
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Evaluation of machine learning algorithms for predicting direct-acting antiviral treatment failure among patients with chronic hepatitis C infection. Sci Rep 2022; 12:18094. [PMID: 36302828 PMCID: PMC9613877 DOI: 10.1038/s41598-022-22819-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/19/2022] [Indexed: 12/30/2022] Open
Abstract
Despite the availability of efficacious direct-acting antiviral (DAA) therapy, the number of people infected with hepatitis C virus (HCV) continues to rise, and HCV remains a leading cause of liver-related morbidity, liver transplantation, and mortality. We developed and validated machine learning (ML) algorithms to predict DAA treatment failure. Using the HCV-TARGET registry of adults who initiated all-oral DAA treatment, we developed elastic net (EN), random forest (RF), gradient boosting machine (GBM), and feedforward neural network (FNN) ML algorithms. Model performances were compared with multivariable logistic regression (MLR) by assessing C statistics and other prediction evaluation metrics. Among 6525 HCV-infected adults, 308 patients (4.7%) experienced DAA treatment failure. ML models performed similarly in predicting DAA treatment failure (C statistic [95% CI]: EN, 0.74 [0.69-0.79]; RF, 0.74 [0.69-0.80]; GBM, 0.72 [0.67-0.78]; FNN, 0.75 [0.70-0.80]), and all 4 outperformed MLR (C statistic [95% CI]: 0.51 [0.46-0.57]), and EN used the fewest predictors (n = 27). With Youden index, the EN had 58.4% sensitivity and 77.8% specificity, and nine patients were needed to evaluate to identify 1 DAA treatment failure. Over 60% treatment failure were classified in top three risk decile subgroups. EN-identified predictors included male sex, treatment < 8 weeks, treatment discontinuation due to adverse events, albumin level < 3.5 g/dL, total bilirubin level > 1.2 g/dL, advanced liver disease, and use of tobacco, alcohol, or vitamins. Addressing modifiable factors of DAA treatment failure may reduce the burden of retreatment. Machine learning algorithms have the potential to inform public health policies regarding curative treatment of HCV.
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Park H, Lo-Ciganic WH, Huang J, Wu Y, Henry L, Peter J, Sulkowski M, Nelson DR. Machine learning algorithms for predicting direct-acting antiviral treatment failure in chronic hepatitis C: An HCV-TARGET analysis. Hepatology 2022; 76:483-491. [PMID: 35034373 PMCID: PMC9287493 DOI: 10.1002/hep.32347] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS We aimed to develop and validate machine learning algorithms to predict direct-acting antiviral (DAA) treatment failure among patients with HCV infection. APPROACH AND RESULTS We used HCV-TARGET registry data to identify HCV-infected adults receiving all-oral DAA treatment and having virologic outcome. Potential pretreatment predictors (n = 179) included sociodemographic, clinical characteristics, and virologic data. We applied multivariable logistic regression as well as elastic net, random forest, gradient boosting machine (GBM), and feedforward neural network machine learning algorithms to predict DAA treatment failure. Training (n = 4894) and validation (n = 1631) patient samples had similar sociodemographic and clinical characteristics (mean age, 57 years; 60% male; 66% White; 36% with cirrhosis). Of 6525 HCV-infected adults, 95.3% achieved sustained virologic response, whereas 4.7% experienced DAA treatment failure. In the validation sample, machine learning approaches performed similarly in predicting DAA treatment failure (C statistic [95% CI]: GBM, 0.69 [0.64-0.74]; random forest, 0.68 [0.63-0.73]; feedforward neural network, 0.66 [0.60-0.71]; elastic net, 0.64 [0.59-0.70]), and all four outperformed multivariable logistic regression (0.51 [0.46-0.57]). Using the Youden index to identify the balanced risk score threshold, GBM had 66.2% sensitivity and 65.1% specificity, and 12 individuals were needed to evaluate to identify 1 DAA treatment failure. Over 55% of patients with treatment failure were classified by the GBM in the top three risk decile subgroups (positive predictive value: 6%-14%). The top 10 GBM-identified predictors included albumin, liver enzymes (aspartate aminotransferase, alkaline phosphatase), total bilirubin levels, sex, HCV viral loads, sodium level, HCC, platelet levels, and tobacco use. CONCLUSIONS Machine learning algorithms performed effectively for risk prediction and stratification of DAA treatment failure.
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Affiliation(s)
- Haesuk Park
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Wei-Hsuan Lo-Ciganic
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - James Huang
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Yonghui Wu
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Linda Henry
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Joy Peter
- Department of Medicine, University of Florida, Gainesville, Florida
| | | | - David R. Nelson
- Department of Medicine, University of Florida, Gainesville, Florida
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Sulkowski MS, Moon JS, Sherman KE, Morelli G, Darling JM, Muir AJ, Khalili M, Fishbein DA, Hinestrosa F, Shiffman ML, Di Bisceglie A, Rajender Reddy K, Pearlman B, Lok AS, Fried MW, Stewart PW, Peter J, Wadsworth S, Kixmiller S, Sloan A, Vainorius M, Horne PM, Michael L, Dong M, Evon DM, Segal JB, Nelson DR. A Pragmatic, Randomized Controlled Trial of Oral Antivirals for the Treatment of Chronic Hepatitis C: The PRIORITIZE Study. Hepatology 2021; 74:2952-2964. [PMID: 34255381 PMCID: PMC8639765 DOI: 10.1002/hep.32053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/15/2021] [Accepted: 07/04/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Multiple direct-acting antiviral (DAA) regimens are available to treat HCV genotype 1 infection. However, comparative effectiveness from randomized controlled trials of DAA regimens is unavailable. APPROACH AND RESULTS We conducted a pragmatic randomized controlled trial (NCT02786537) to compare the effectiveness of DAAs for HCV genotype 1a or 1b on viral response, safety, tolerability, and medication nonadherence. Adults with compensated liver disease, HCV genotype 1, not pregnant or breastfeeding, and with health insurance likely to cover ledipasvir/sofosbuvir (LDV/SOF) were recruited from 34 US viral hepatitis clinics. Participants were randomized (± ribavirin) to LDV/SOF, elbasvir/grazoprevir (EBR/GZR), and paritaprevir/ritonavir/ombitasvir+dasabuvir (PrOD; treatment arm stopped early). Primary outcomes included sustained viral response at 12 weeks (SVR12), clinician-recorded adverse events, patient-reported symptoms, and medication nonadherence. Between June 2016 and March 2018, 1,609 participants were randomized. Among 1,128 participants who received ≥1 dose of EBR/GZR or LDV/SOF (± ribavirin), SVR12 was 95.2% (95% CI, 92.8%-97.6%) and 97.4% (95% CI, 95.5%-99.2%), respectively, with a difference estimate of 2.2% (-0.5% to 4.7%), falling within the "equivalence" interval (-5% to 5%). While most (56%) participants experienced adverse events, few were serious (4.2%) or severe (1.8%). In the absence of ribavirin, discontinuations due to adverse events were rare. Patient-reported symptoms and medication nonadherence were similar. Study limitations were dropout due to insurance denial and loss to follow-up after treatment, limiting the ability to measure SVR12. CONCLUSIONS This pragmatic trial demonstrated high SVR12 for participants treated with EBR/GZR and LDV/SOF with few adverse effects. Overall, the two regimens were equivalent in effectiveness. The results support current HCV guidelines that do not distinguish between ribavirin-free EBR/GZR and LDV/SOF.
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Affiliation(s)
- Mark S Sulkowski
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Juhi S Moon
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kenneth E Sherman
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Giuseppe Morelli
- Department of Gastroenterology, Hepatology & Nutrition, University of Florida, Gainesville, FL
| | - Jama M Darling
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew J Muir
- Division of Gastroenterology, Duke University, Durham, NC
| | - Mandana Khalili
- Department of Medicine, University of California San Francisco, Zuckerberg San Francisco General, Hospital and Trauma Center, San Francisco, CA
| | - Dawn A Fishbein
- Infectious Disease, Medstar Health Research Institute, Washington, DC
| | | | | | - Adrian Di Bisceglie
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - K Rajender Reddy
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brian Pearlman
- Department of Internal Medicine, Wellstar Health System, Atlanta, GA
| | - Anna S Lok
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Michael W Fried
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Paul W Stewart
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Joy Peter
- Department of Gastroenterology, Hepatology & Nutrition, University of Florida, Gainesville, FL
| | | | - Scott Kixmiller
- PRIORITIZE Patient Engagement Group consultant, Greensboro, NC
| | | | - Monika Vainorius
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Patrick M Horne
- Department of Gastroenterology, Hepatology & Nutrition, University of Florida, Gainesville, FL
| | - Larry Michael
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Meichen Dong
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Donna M Evon
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jodi B Segal
- Division of Internal Medicne, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David R Nelson
- Department of Gastroenterology, Hepatology & Nutrition, University of Florida, Gainesville, FL
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Mospan AR, Morris HL, Fried MW. Real-world evidence in hepatocellular carcinoma. Liver Int 2021; 41 Suppl 1:61-67. [PMID: 34155788 DOI: 10.1111/liv.14864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 02/28/2021] [Indexed: 12/19/2022]
Abstract
Real-world evidence includes all health-related information, such as electronic health records, insurance claims, pharmacy records and wearables that are obtained outside of clinical trials. These data can provide critical insights into the natural history of disease and evaluate the safety and effectiveness of treatment regimens used in clinical practice. Real-world data have been applied to varying degrees by global regulatory agencies to inform and expedite many phases of drug development and help refine the use of therapeutic regimens after marketing, especially in populations that are under-represented in registration trials. For the management of hepatocellular carcinoma, early detection provides the best chance for curative therapies, whose success has been evaluated in numerous cohorts. The availability of novel systemic therapies, including kinase inhibitors and immunotherapies, has provided new treatment options and improved survival in patients with advanced stage hepatocellular carcinoma. Real-world longitudinal observational studies can help understand the long-term safety and effectiveness of these agents.
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Affiliation(s)
| | | | - Michael W Fried
- Target RWE, Durham, NC, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
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Li M, Chen S, Lai Y, Liang Z, Wang J, Shi J, Lin H, Yao D, Hu H, Ung COL. Integrating Real-World Evidence in the Regulatory Decision-Making Process: A Systematic Analysis of Experiences in the US, EU, and China Using a Logic Model. Front Med (Lausanne) 2021; 8:669509. [PMID: 34136505 PMCID: PMC8200400 DOI: 10.3389/fmed.2021.669509] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/04/2021] [Indexed: 12/11/2022] Open
Abstract
Real world evidence (RWE) and real-world data (RWD) are drawing ever-increasing attention in the pharmaceutical industry and drug regulatory authorities (DRAs) all over the world due to their paramount role in supporting drug development and regulatory decision making. However, there is little systematic documentary analysis about how RWE was integrated for the use by the DRAs in evaluating new treatment approaches and monitoring post-market safety. This study aimed to analyze and discuss the integration of RWE into regulatory decision-making process from the perspective of DRAs. Different development strategies to develop and adopt RWE by the DRAs in the US, Europe, and China were reviewed and compared, and the challenges encountered were discussed. It was found that different strategies on development of RWE were applied by FDA, EMA, and NMPA. The extent to which RWE was adopted in China was relatively limited compared to that in the US and EU, which was highly related to the national pharmaceutical environment and development stages. A better understanding of the overall goals, inputs, activities, outputs, and outcomes in developing RWE will help inform actions to harness RWD and leverage RWE for better health care decisions.
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Affiliation(s)
- Meng Li
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Shengqi Chen
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Yunfeng Lai
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Zuanji Liang
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Jiaqi Wang
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Junnan Shi
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Haojie Lin
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Dongning Yao
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Hao Hu
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Carolina Oi Lam Ung
- State Key Laboratory in Quality Research of Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
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Click B, Barnes EL, Cohen BL, Sands BE, Hanson JS, Regueiro M, Rubin DT, Dubinsky MC, Gazis DR, Dalfonso L, Hildebrand JS, Crawford JM, Long MD. Methodology and Initial Results From a Real-World Observational Cohort of Patients With Inflammatory Bowel Disease: TARGET-IBD. CROHN'S & COLITIS 360 2021; 3:otab023. [PMID: 36776639 PMCID: PMC9802086 DOI: 10.1093/crocol/otab023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Indexed: 12/13/2022] Open
Abstract
Background Data on care patterns for inflammatory bowel disease (IBD) from large-scale, diverse clinical cohorts in real-world practice are sparse. We developed a real-world cohort of patients receiving care at academic and community sites, for comparative study of therapies and natural history of IBD. Methods We describe novel methodology of central abstraction of clinical data into a real-world IBD registry with patient reported outcomes (PROs). Baseline demographics, clinical characteristics, healthcare utilization, and disease metrics were assessed. Bivariate statistics were used to compare demographic and clinical data by Crohn disease (CD) or ulcerative colitis (UC) and site of care (academic, community). Results In 1 year, 1343 IBD patients (60.1% CD, 38.9% UC) were recruited from 27 academic (49.5%) and community (50.5%) sites, exceeding expectations (110% enrolled). Most participants also consented to provide PROs (59.5%) or biosamples (85.7%). Overall, 48.7% of the cohort provided a baseline PRO, and 62.6% provided a biosample. Compared to UC, CD subjects had higher prior (34.1% CD vs 7.7% UC; P < 0.001) and current (72.1% vs 47.9%; P < 0.001) biologic utilization. CD participants from academic sites had more complicated disease than those from community sites (62.5% vs 46.8% stricturing/penetrating; 33.5% vs 27% perianal; 36.8% vs 14.5% prior biologic, respectively). Nearly all (90.4%) participants had endoscopic data of whom 37.7% were in remission. One-year retention was 98.4%. Conclusions Centralized data abstraction and electronic PRO capture provided efficient recruitment into a large real-world observational cohort. This novel platform provides a resource for clinical outcomes and comparative effectiveness research in IBD.
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Affiliation(s)
- Benjamin Click
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA,Address correspondence to: Benjamin Click, MD, MS, Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA ()
| | - Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Benjamin L Cohen
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - Bruce E Sands
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John S Hanson
- Atrium Health Gastroenterology and Hepatology, Charlotte, NC, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA
| | - David T Rubin
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
| | - Marla C Dubinsky
- Division of Pediatric Gastroenterology, The Susan & Leonard Feinstein IBD Clinical Center at Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | - Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Abuabara K, Silverberg JI, Simpson EL, Paller AS, Eichenfield LF, Bissonnette R, Krueger J, Harris JE, Dalfonso L, Watkins SE, Crawford JM, Thaçi D, Guttman-Yassky E. International observational atopic dermatitis cohort to follow natural history and treatment course: TARGET-DERM AD study design and rationale. BMJ Open 2020; 10:e039928. [PMID: 33247014 PMCID: PMC7703415 DOI: 10.1136/bmjopen-2020-039928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION As new topical and systemic treatments become available for atopic dermatitis (AD), there is a need to understand how treatments are being used in routine clinical practice, their comparative effectiveness and their long-term safety in diverse clinical settings. METHODS AND ANALYSIS The TARGET-DERM AD cohort is a longitudinal, observational study of patients with AD of all ages, designed to provide practical information on long-term effectiveness and safety unobtainable in traditional registration trials. Patients with physician-diagnosed AD receiving prescription treatment (topical or systemic) will be enrolled at academic and community clinical centres. Up to 3 years of retrospective medical records, 5 years of prospective medical records, and optional biological samples and patient-reported outcomes will be collected. The primary aims include characterisation of AD treatment regimens, evaluation of response to therapy, and description of adverse events. ETHICS AND DISSEMINATION TARGET-DERM has been approved by a central IRB (Copernicus Group IRB, 5000 Centregreen Way Suite 200, Cary, North Carolina 27513) as well as local and institutional IRBs. No additional Ethics Committee reviews. Results will be reviewed by a publications committee and submitted to peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03661866, pre-results.
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Affiliation(s)
- Katrina Abuabara
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | | | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Amy S Paller
- Department of Dermatology, Northwestern University, Chicago, Illinois, USA
| | - Lawrence F Eichenfield
- Department of Dermatology, University of California, San Diego School, La Jolla, California, USA
| | | | - James Krueger
- Department of Immunology, Virology and Microbiology, Rockefeller Institute for Medical Research, New York, New York, USA
| | - John E Harris
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Laura Dalfonso
- Clinical Operations, TARGET PharmaSolutions, Durham, North Carolina, USA
| | - Stephanie E Watkins
- Scientific and Medical Affairs, TARGET PharmaSolutions, Durham, North Carolina, USA
| | - Julie M Crawford
- Scientific and Medical Affairs, TARGET PharmaSolutions, Durham, North Carolina, USA
| | - D Thaçi
- Comprehensive Center for Inflammation Medicine, University of Lubeck, Lubeck, Schleswig-Holstein, Germany
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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11
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Verna EC, Serper M, Chu J, Corey K, Fix OK, Hoyt K, Page KA, Loomba R, Li M, Everson GT, Fried MW, Garcia‐Tsao G, Terrault N, Lok AS, Chung RT, Reddy KR. Clinical Research in Hepatology in the COVID-19 Pandemic and Post-Pandemic Era: Challenges and the Need for Innovation. Hepatology 2020; 72:1819-1837. [PMID: 32740969 PMCID: PMC7435542 DOI: 10.1002/hep.31491] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 12/14/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 pandemic has drastically altered all facets of clinical care and research. Clinical research in hepatology has had a rich tradition in several domains, including the discovery and therapeutic development for diseases such as hepatitis B and C and studying the natural history of many forms of chronic liver disease. National Institutes of Health, foundation, and industry funding have provided important opportunities to advance the academic careers of young investigators while they strived to make contributions to the field. Instantaneously, however, all nonessential research activities were halted when the pandemic started, forcing those involved in clinical research to rethink their research strategy, including a shift to coronavirus disease 2019 research while endeavoring to maintain their preexisting agenda. Strategies to maintain the integrity of ongoing studies, including patient follow-up, safety assessments, and continuation of investigational products, have included a shift to telemedicine, remote safety laboratory monitoring, and shipping of investigational products to study subjects. As a revamp of research is being planned, unique issues that face the research community include maintenance of infrastructure, funding, completion of studies in the predetermined time frame, and the need to reprogram career path timelines. Real-world databases, biomarker and long-term follow up studies, and research involving special groups (children, the homeless, and other marginalized populations) are likely to face unique challenges. The implementation of telemedicine has been dramatically accelerated and will serve as a backbone for the future of clinical research. As we move forward, innovation in clinical trial design will be essential for conducting optimized clinical research.
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Affiliation(s)
- Elizabeth C. Verna
- Center for Liver Disease and TransplantationColumbia University Irving Medical CenterNew YorkNY
| | - Marina Serper
- Division of Gastroenterology and HepatologyUniversity of PennsylvaniaPhiladelphiaPA
| | - Jaime Chu
- Division of Pediatric HepatologyMt. Sinai School of MedicineNew YorkNY
| | | | - Oren K. Fix
- Organ Transplant and Liver CenterSwedish Medical CenterSeattleWA
| | | | - Kimberly A. Page
- Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal MedicineUniversity of New Mexico School of MedicineAlbuquerqueNM
| | - Rohit Loomba
- Division of GastroenterologyUC San Diego School of MedicineSan DiegoCA
| | - Ming Li
- Keck School of Medicine of USCLos AngelesCA
| | - Gregory T. Everson
- Division of Gastroenterology and Hepatology, Department of Internal MedicineUniversity of Colorado Denver School of MedicineAuroraCO,HepQuant LLCGreenwood VillageCO
| | - Michael W. Fried
- Division of Gastroenterology and HepatologyUniversity of North Carolina School of MedicineChapel HillNC
| | | | | | - Anna S. Lok
- Division of GastroenterologyUniversity of Michigan Medical SchoolAnn ArborMI
| | | | - K. Rajender Reddy
- Division of Gastroenterology and HepatologyUniversity of PennsylvaniaPhiladelphiaPA
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12
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Lok AS, Sulkowski MS, Kort JJ, Willner I, Reddy KR, Shiffman ML, Hassan MA, Pearlman BL, Hinestrosa F, Jacobson IM, Morelli G, Peter JA, Vainorius M, Michael LC, Fried MW, Wang GP, Lu W, Larsen L, Nelson DR. Efficacy of Glecaprevir and Pibrentasvir in Patients With Genotype 1 Hepatitis C Virus Infection With Treatment Failure After NS5A Inhibitor Plus Sofosbuvir Therapy. Gastroenterology 2019; 157:1506-1517.e1. [PMID: 31401140 DOI: 10.1053/j.gastro.2019.08.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Treatment options are limited for patients with hepatitis C (HCV) infection with treatment failure after sofosbuvir plus an NS5A inhibitor. There are some data for the efficacy of glecaprevir/pibrentasvir (G/P) in these patients. We performed a randomized trial of the safety and efficacy of 12 and 16 weeks of G/P, with or without ribavirin, in patients with HCV genotype 1 infection with treatment failure after sofosbuvir and an NS5A inhibitor. METHODS We performed a phase 3b, open-label study of patients with chronic HCV genotype 1 infection who received previous treatment with sofosbuvir plus an NS5A inhibitor. Patients without cirrhosis were randomly assigned to groups that received G/P for 12 weeks (n = 78, group A) or 16 weeks (n = 49, group B). Patients with compensated cirrhosis were randomly assigned to groups that received G/P and ribavirin for 12 weeks (n = 21, group C) or G/P for 16 weeks (n = 29, group D). The primary end point was a sustained virologic response 12 weeks after treatment. Samples collected at baseline and at time of treatment failure were sequenced for resistance-associated substitutions in NS3 and NS5A. RESULTS Of the 177 patients in the 4 groups, 81% were men, 79% had HCV genotype 1a infection, and 44% were black. Proportions of patients with sustained virologic response 12 weeks after treatment in groups A, B, C, and D were 90%, 94%, 86%, and 97%, respectively. The treatment failed in 13 (7.3%) patients with HCV genotype 1a infection, 6 (7.9%) in group A, 3 (6.1%) in group B, 3 (6.1%) in group C (6.1%), and 1 (3.4%) in group D. Most patients had baseline resistance-associated substitutions in NS5A. Treatment-emergent resistance-associated substitutions in NS3 and NS5A were observed in 9 and 10 patients with treatment failure, respectively. G/P was well tolerated. Ribavirin increased adverse events but did not increase efficacy. CONCLUSIONS In a randomized study of patients with chronic HCV genotype 1 infection who received previous treatment with sofosbuvir plus an NS5A inhibitor, 16 weeks treatment with G/P produced sustained virologic response 12 weeks after treatment in >90% of patients, including those with compensated cirrhosis. ClinicalTrials.gov, Number: NCT03092375.
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Affiliation(s)
- Anna S Lok
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan.
| | - Mark S Sulkowski
- Divisions of Infectious Diseases and Gastroenterology/Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ira Willner
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Mohamed A Hassan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota
| | - Brian L Pearlman
- Center for Hepatitis C, Wellstar Health System, Atlanta, Georgia
| | | | - Ira M Jacobson
- Department of Hepatology, New York University Langone Health, New York, New York
| | - Giuseppe Morelli
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida
| | - Joy A Peter
- Hepatology Research, University of Florida, Gainesville, Florida
| | - Monika Vainorius
- HCV-TARGET Data Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Larry C Michael
- HCV-TARGET Data Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael W Fried
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gary P Wang
- Division of Infectious Diseases and Global Medicine, University of Florida, Gainesville, Florida
| | | | | | - David R Nelson
- Department of Medicine, University of Florida, Gainesville, Florida
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13
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Pariente A, Arpurt JP, Rémy AJ, Rosa-Hézode I, Causse X, Heluwaert F, Macaigne G, Henrion J, Renou C, Schnee M, Salloum H, Hommel S, Pilette C, Arotcarena R, Barjonet G, Lison H, Bourhis F, Jouannaud V, Pauwels A, Le eaBricquir Y, Geagea E, Condat B, Ripault MP, Zanditenas D, de Montigny-Lenhardt S, Labadie H, Tissot B, Maringe E, Cadranel JF, Hagège H, Lesgourgues B. Hepatitis C treatment with all-oral direct-acting antivirals: Effectiveness and tolerance in a multicenter, prospective, observational study from French general hospitals (APROVVIE, ANGH). Presse Med 2019; 48:e101-e110. [PMID: 30853287 DOI: 10.1016/j.lpm.2018.06.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/29/2018] [Accepted: 06/21/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND AIMS According to clinical trials, the treatment of patients with chronic hepatitis C (CHC) with second-generation direct acting antiviral agents (DAAs) is highly efficient and well tolerated. The goal of this study was to investigate the effectiveness and safety of various combinations of these drugs during their first 2 years of use in the real-world practice of French general hospitals. METHODS Data from patients treated with all-oral DAAs in 24 French non-academic hospital centers from March 1, 2014 to January 1, 2016, were prospectively recorded. The sustained virological response 12-24 weeks after treatment (SVR 12-24) was estimated and severe adverse events (SAE) were evaluated and their predictive factors were determined using logistic regression. RESULTS Data from 1123 patients were analyzed. The population was 69% genotype (G) 1, 13% G3, 11.5% G4, 5% G2, 49% with cirrhosis and 55% treatment-experienced. The treatment regimens were sofosbuvir/ledipasvir (38%), sofosbuvir/daclatasvir (32%), sofosbuvir/simeprevir (17%), ombitasvir+paritaprevir+ritonavir (5%) (with dasabuvir 3.5%), and sofosbuvir/ribavirin (8%). Ribavirin was given to 24% of patients. The SVR 12-24 was 91.0% (95% CI: 89.2-92.5%). Sofosbuvir-ribavirin was less effective than other regimens. The independent predictors of SVR 12-24 by logistic regression were body weight, albumin, previous hepatocellular carcinoma and treatment regimen (sofosbuvir/ribavirin vs. others). Sixty-four severe adverse events (SAE) were observed in 59 [5.6%] patients, and were independently predicted by cirrhosis and baseline hemoglobin. Serum creatinine increased during treatment (mean 8.5%, [P<10-5]), satisfying criteria for acute kidney injury in 62 patients (7.3%). Patient-reported overall tolerance was excellent, and patient-reported fatigue decreased during and after treatment. CONCLUSIONS Second generation DAAs combinations are as effective and well tolerated in a « real-world » population as in clinical trials. Further studies are needed on renal tolerance.
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Affiliation(s)
- Alexandre Pariente
- Service d'hépatogastroentérologie, centre hospitalier de Pau, 528, route de la Coustète, Calotis, 40240 Mauvezin d' Armagnac, France.
| | - Jean-Pierre Arpurt
- Service d'hépatogastroentérologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - André-Jean Rémy
- Service d'hépatogastroentérologie, centre hospitalier de Perpignan, Perpignan, 66000 France
| | - Isabelle Rosa-Hézode
- Service d'hépatogastroentérologie, centre hospitalier intercommunal de Créteil, 94100 Créteil, France
| | - Xavier Causse
- Service d'hépatogastroentérologie, centre hospitalier régional d'Orléans, 45000 Orléans, France
| | - Frédéric Heluwaert
- Service d'hépatogastroentérologie, centre hospitalier d'Annecy, 74000 Annecy, France
| | - Gilles Macaigne
- Service d'hépatogastroentérologie. centre hospitalier du grand Est parisien, 77600 Jossigny, France
| | - Jean Henrion
- Service d'hépatogastroentérologie, centre hospitalier d'Haine-Saint-Paul, 7100 Haine-Saint-Paul, Belgium
| | - Christophe Renou
- Service d'hépatogastroentérologie, centre hospitalier d'Hyères, 83400 Hyères, France
| | - Matthieu Schnee
- Service d'hépatogastroentérologie, centre hospitalier de La-Roche-sur-Yon, 85000 La-Roche-sur-Yon, France
| | - Hatem Salloum
- Service d'hépatogastroentérologie, centre hospitalier de Meaux, Meaux, 77100 France
| | - Séverine Hommel
- Service d'hépatogastroentérologie, centre hospitalier d'Aix-en-Provence, 13100 Aix-en-Provence, France
| | - Christophe Pilette
- Service d'hépatogastroentérologie, centre hospitalier du Mans, 72000 Le Mans, France
| | - Ramuntxo Arotcarena
- Service d'hépatogastroentérologie, centre hospitalier de Pau, 528, route de la Coustète, Calotis, 40240 Mauvezin d' Armagnac, France
| | - Georges Barjonet
- Service d'hépatogastroentérologie, centre hospitalier de Montélimar, 26200 Montélimar, France
| | - Hortensia Lison
- Service d'hépatogastroentérologie, centre hospitalier de Creil, 60100 Creil, France
| | - François Bourhis
- Service d'hépatogastroentérologie, centre hospitalier de Chambéry, 73000 Chambéry, France
| | - Vincent Jouannaud
- Service d'hépatogastroentérologie, centre hospitalier de Montfermeil, 93370 Montfermeil, France
| | - Arnaud Pauwels
- Service d'hépatogastroentérologie, centre hospitalier de Gonesse, 95500 Gonesse, France
| | - Yann Le eaBricquir
- Service d'hépatogastroentérologie, centre hospitalier de Béziers, 34500 Béziers, France
| | - Edmond Geagea
- Service d'hépatogastroentérologie, centre hospitalier de Cholet, 49280 Cholet, France
| | - Bertrand Condat
- Service d'hépatogastroentérologie, centre hospitalier de Bry-sur-Marne, 94360 Bry-sur-Marne, France
| | - Marie-Pierre Ripault
- Service d'hépatogastroentérologie, centre hospitalier de Béziers, 34500 Béziers, France
| | - David Zanditenas
- Service d'hépatogastroentérologie, centre hospitalier de Bry-sur-Marne, 94360 Bry-sur-Marne, France
| | | | - Hélène Labadie
- Service d'hépatogastroentérologie, centre hospitalier de Saint-Denis, 93200 Saint-Denis, France
| | - Bertrand Tissot
- Service d'hépatogastroentérologie, centre hospitalier du Mans, 72000 Le Mans, France
| | - Eric Maringe
- Service d'hépatogastroentérologie, centre hospitalier de Beaune, 21200 Beaune, France
| | | | - Hervé Hagège
- Service d'hépatogastroentérologie, centre hospitalier intercommunal de Créteil, 94100 Créteil, France
| | - Bruno Lesgourgues
- Service d'hépatogastroentérologie, centre hospitalier de Montfermeil, 93370 Montfermeil, France
| | -
- Service d'hépatogastroentérologie, centre hospitalier de Pau, 528, route de la Coustète, Calotis, 40240 Mauvezin d' Armagnac, France; Service d'hépatogastroentérologie, centre hospitalier d'Avignon, 84000 Avignon, France; Service d'hépatogastroentérologie, centre hospitalier de Perpignan, Perpignan, 66000 France; Service d'hépatogastroentérologie, centre hospitalier intercommunal de Créteil, 94100 Créteil, France; Service d'hépatogastroentérologie, centre hospitalier régional d'Orléans, 45000 Orléans, France; Service d'hépatogastroentérologie, centre hospitalier d'Annecy, 74000 Annecy, France; Service d'hépatogastroentérologie. centre hospitalier du grand Est parisien, 77600 Jossigny, France; Service d'hépatogastroentérologie, centre hospitalier d'Haine-Saint-Paul, 7100 Haine-Saint-Paul, Belgium; Service d'hépatogastroentérologie, centre hospitalier d'Hyères, 83400 Hyères, France; Service d'hépatogastroentérologie, centre hospitalier de La-Roche-sur-Yon, 85000 La-Roche-sur-Yon, France; Service d'hépatogastroentérologie, centre hospitalier de Meaux, Meaux, 77100 France; Service d'hépatogastroentérologie, centre hospitalier d'Aix-en-Provence, 13100 Aix-en-Provence, France; Service d'hépatogastroentérologie, centre hospitalier du Mans, 72000 Le Mans, France; Service d'hépatogastroentérologie, centre hospitalier de Montélimar, 26200 Montélimar, France; Service d'hépatogastroentérologie, centre hospitalier de Creil, 60100 Creil, France; Service d'hépatogastroentérologie, centre hospitalier de Chambéry, 73000 Chambéry, France; Service d'hépatogastroentérologie, centre hospitalier de Montfermeil, 93370 Montfermeil, France; Service d'hépatogastroentérologie, centre hospitalier de Gonesse, 95500 Gonesse, France; Service d'hépatogastroentérologie, centre hospitalier de Béziers, 34500 Béziers, France; Service d'hépatogastroentérologie, centre hospitalier de Cholet, 49280 Cholet, France; Service d'hépatogastroentérologie, centre hospitalier de Bry-sur-Marne, 94360 Bry-sur-Marne, France; Service d'hépatogastroentérologie, centre hospitalier d'Aubagne, 13400 Aubagne, France; Service d'hépatogastroentérologie, centre hospitalier de Saint-Denis, 93200 Saint-Denis, France; Service d'hépatogastroentérologie, centre hospitalier de Beaune, 21200 Beaune, France
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14
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Levy C, Bowlus CL, Carey E, Crawford JM, Deane K, Mayo MJ, Kim WR, Fried MW. A real-world observational cohort of patients with primary biliary cholangitis: TARGET-primary biliary cholangitis study design and rationale. Hepatol Commun 2018; 2:484-491. [PMID: 29761165 PMCID: PMC5944592 DOI: 10.1002/hep4.1173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 02/08/2018] [Accepted: 02/08/2018] [Indexed: 12/13/2022] Open
Abstract
Primary biliary cholangitis (PBC) is a rare chronic cholestatic liver disease that may progress to biliary cirrhosis if left untreated. The first‐line therapy for PBC is ursodeoxycholic acid (UDCA). Unfortunately, 1 of 3 patients does not respond to UDCA. These patients are at risk for developing clinical events, including cirrhosis, complications of portal hypertension, hepatocellular carcinoma, liver transplant, or death. Recently, the U.S. Food and Drug Administration approved obeticholic acid to be used in certain patients with PBC. Off‐label therapies are also used, and several other therapies are currently under evaluation. Real‐world effectiveness of newly approved and off‐label therapies remains unknown. TARGET‐PBC is a 5‐year, longitudinal, observational study of patients with PBC that will evaluate the effectiveness of clinical practice interventions and provide practical information unobtainable in registration trials. Enrollment will take place at both academic and community sites. In addition to consenting to medical records review, participants will be asked to provide an annual blood sample and complete patient reported outcome surveys at predetermined intervals. Any available liver biopsies will be digitally preserved. Conclusion: Key study outcomes will be the evaluation of the safety and effectiveness of PBC interventions and the assessment of disease progression under real‐world conditions. (Hepatology Communications 2018;2:484‐491)
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Affiliation(s)
- Cynthia Levy
- Department of Medicine University of Miami Miami FL
| | | | | | | | | | - Marlyn J Mayo
- University of Texas Southwestern Medical Center Dallas TX
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15
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Barritt AS, Gitlin N, Klein S, Lok AS, Loomba R, Malahias L, Powell M, Vos MB, Weiss LM, Cusi K, Neuschwander-Tetri BA, Sanyal A. Design and rationale for a real-world observational cohort of patients with nonalcoholic fatty liver disease: The TARGET-NASH study. Contemp Clin Trials 2017; 61:33-38. [PMID: 28735109 DOI: 10.1016/j.cct.2017.07.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/11/2017] [Accepted: 07/17/2017] [Indexed: 12/20/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is highly prevalent and can lead to cirrhosis, hepatocellular carcinoma, and end-stage liver disease. NAFLD comprises the spectrum from simple steatosis (nonalcoholic fatty liver, NAFL), to steatosis with inflammation (nonalcoholic steatohepatitis, NASH). Current primary therapy recommended for NAFLD is weight loss induced by lifestyle modification. The difficulty in achieving this has led to robust pharmacological therapy development. While new drugs may show efficacy in selected phase II/III clinical trial populations, their real-world effectiveness is unknown. TARGET-NASH is a 5-year, longitudinal, observational study of patients with NAFLD designed to evaluate the effectiveness of clinical practice interventions and provide practical information unobtainable in registration trials. A biological specimen repository is included in TARGET-NASH for translational studies of genomics and biomarkers of disease activity. Patients are enrolling at adult and pediatric sites representing multiple specialties. All patients being managed for NAFLD are eligible, whereas those in other NASH registries or clinical trials will be excluded. Enrolled patients range in age from 6 and up and will have 3years of clinical data reviewed. Patient comorbidities, concomitant medications, disease progression and off-label interventions will be assessed, and adverse outcomes, monitored. Confirming the use, safety and effectiveness of NAFLD interventions in children and adults and establishing pragmatic methods of assessing disease progression under real-world conditions are key study outcomes. Ultimately, TARGET-NASH will establish a large, diverse registry of NAFLD patients at academic and community practices to be leveraged to improve health and reduce development of cirrhosis and hepatocellular carcinoma.
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Affiliation(s)
- A S Barritt
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, UNC Liver Center, C.B.7584, Chapel Hill, NC 27599, United States.
| | - Norman Gitlin
- Atlanta Gastroenterology Associates, 550 Peachtree Street NE, Suite 1720, Atlanta, GA 30308, United States
| | - Samuel Klein
- Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine, Washington University School of Medicine, 507 S. Euclid Ave., West Building, 2nd Floor, St. Louis, MO 63110, United States
| | - Anna S Lok
- Division of Gastroenterology and Hepatology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States
| | - Rohit Loomba
- Division of Gastroenterology, Department of Medicine, University of California at San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Laura Malahias
- TARGET PharmaSolutions, Inc., 1450 Raleigh Road, Suite 212, Chapel Hill, NC 27517, United States
| | - Margaret Powell
- TARGET PharmaSolutions, Inc., 1450 Raleigh Road, Suite 212, Chapel Hill, NC 27517, United States
| | - Miriam B Vos
- School of Medicine, Emory University and Children's Healthcare of Atlanta, 1405 Clifton Road, Atlanta, GA 30329, United States
| | - L Michael Weiss
- Gastro Florida, 3001 Executive Drive Ste 130, Clearwater, FL 33762, United States
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610, United States
| | - Brent A Neuschwander-Tetri
- Division of Gastroenterology and Hepatology, 3635 Vista Avenue, Saint Louis University, St. Louis, MO 63110, United States
| | - Arun Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, VCU Medical Center-MCV Campus, West Hospital, 14th Floor, 1200 E. Broad Street, P.O. Box 980341, Richmond, VA 23298, United States
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