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Attia J, Weaver N, Peel R, Fleming K, Holliday E, Rissel C, Bauman A, Wiggers J, Acharya S, Luu J, Reeves P, McEvoy M, Hure A. Effectiveness of NSW health get healthy telephone coaching in adults screened from general practices. BMC Public Health 2024; 24:2372. [PMID: 39223517 PMCID: PMC11368026 DOI: 10.1186/s12889-024-19849-0] [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: 05/23/2023] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The effectiveness of the NSW Health "Get Healthy Information and Coaching Service®"(Get Healthy) to facilitate weight loss on a population scale has been documented, but this was based on self-reported measures. Our study aims to test the effectiveness of the Get Healthy Service on objectively measured weight, BMI, waist circumference, and changes in other health behaviours, including nutrition, physical activity and alcohol intake. METHODS Men and women aged 40-70 years (n = 154) with pre-diabetes (5.7% < HbA1c < 6.5%) were referred from GP Practices to the Get Healthy Service, NSW Health. A subset (n = 98) participated in the "Zinc In Preventing the Progression of pre-Diabetes" (ZIPPeD) trial (ACTRN12618001120268). RESULTS The self-reported outcomes showed a statistically significant improvement from baseline to 12 months in weight (mean 2.7 kg loss, p < 0.001), BMI (mean 1 unit reduction, p < 0.001), and waist circumference (mean 4.3 cm reduction, p < 0.001). However, in the objectively measured outcomes from ZIPPeD, the differences were more modest, with point estimates of 0.8 kg mean weight loss (p = 0.1), 0.4 unit reduction in BMI (p = 0.03), and 1.8 cm reduction in waist circumference (p = 0.04). Bland-Altman plots indicated that discrepancies were due to a small number of participants who dramatically underestimated their weight or BMI. There were minimal changes in nutrition, physical activity, and alcohol. CONCLUSIONS The potential benefits of Get Healthy should be interpreted with caution as we have shown significant differences between self-reported and objectively measured values. More valid and objective evidence is needed to determine the program's effectiveness and cost-effectiveness.
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Affiliation(s)
- John Attia
- School of Medicine and Public Health, University of Newcastle, NSW, Australia.
- Division of Medicine, Hunter New England Local Health District, NSW, Australia.
| | - Natasha Weaver
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - Roseanne Peel
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - Kerry Fleming
- Diabetes Service and Diabetes Alliance Hunter New England Local Health District, NSW, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - Chris Rissel
- Flinders University, Adelaide SA, and The University of Sydney, Sydney NSW, Australia
| | - Adrian Bauman
- School of Public Health, and the Charles Perkins Centre, University of Sydney, Sydney, 2006, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
- Health Research and Translation and Population Health, Hunter New England Local Health District, NSW, Australia
| | - Shamasunder Acharya
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
- Division of Medicine, Hunter New England Local Health District, NSW, Australia
- Diabetes Service and Diabetes Alliance Hunter New England Local Health District, NSW, Australia
| | - Judy Luu
- Division of Medicine, Hunter New England Local Health District, NSW, Australia
- Diabetes Service and Diabetes Alliance Hunter New England Local Health District, NSW, Australia
| | - Penny Reeves
- Health Research Economics, Hunter Medical Research Institute, NSW, Australia
| | - Mark McEvoy
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
- Department of Rural Health, LaTrobe University, Bendigo, Australia
| | - Alexis Hure
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
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Anand P, Zhang Y, Ngan K, Mahesri M, Brill G, Kim DH, Lin KJ. Identifying Dementia Severity Among People Living With Dementia Using Administrative Claims Data. J Am Med Dir Assoc 2024; 25:105129. [PMID: 38977199 PMCID: PMC11368613 DOI: 10.1016/j.jamda.2024.105129] [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: 12/27/2023] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVES There is currently no reliable tool for classifying dementia severity level based on administrative claims data. We aimed to develop a claims-based model to identify patients with severe dementia among a cohort of patients with dementia. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS We identified people living with dementia (PLWD) in US Medicare claims data linked with the Minimum Data Set (MDS) and Outcome and Assessment Information Set (OASIS). METHODS Severe dementia was defined based on cognitive and functional status data available in the MDS and OASIS. The dataset was randomly divided into training (70%) and validation (30%) sets, and a logistic regression model was developed to predict severe dementia using baseline (assessed in the prior year) features selected by generalized linear mixed models (GLMMs) with least absolute shrinkage and selection operator (LASSO) regression. We assessed model performance by area under the receiver operating characteristic curve (AUROC), area under precision-recall curve (AUPRC), and precision and recall at various cutoff points, including Youden Index. We compared the model performance with and without using Synthetic Minority Oversampling Technique (SMOTE) to reduce the imbalance of the dataset. RESULTS Our study cohort included 254,410 PLWD with 17,907 (7.0%) classified as having severe dementia. The AUROC of our primary model, without SMOTE, was 0.81 in the training and 0.80 in the validation set. In the validation set at the optimized Youden Index, the model had a sensitivity of 0.77 and specificity of 0.70. Using a SMOTE-balanced validation set, the model had an AUROC of 0.83, AUPRC of 0.80, sensitivity of 0.79, specificity of 0.74, positive predictive value of 0.75, and negative predictive value of 0.78 when at the optimized Youden Index. CONCLUSIONS AND IMPLICATIONS Our claims-based algorithm to identify patients living with severe dementia can be useful for claims-based pharmacoepidemiologic and health services research.
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Affiliation(s)
- Priyanka Anand
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ye Zhang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Kerry Ngan
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mufaddal Mahesri
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory Brill
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dae H Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA
| | - Kueiyiu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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3
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Roy JM, Schupper AJ, Majidi S. Reporting of Participant Race and Ethnicity in Cerebrovascular Randomized Controlled Trials. World Neurosurg 2024; 189:e825-e831. [PMID: 38986939 DOI: 10.1016/j.wneu.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/30/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Randomized controlled trials (RCTs) provide information on appropriate management protocols in patients with cerebrovascular diseases. Despite growing evidence of race and ethnicity being independent predictors of outcomes, recent literature has drawn attention to inadequate reporting of these demographic profiles across RCTs. To our knowledge, the adherence to reporting race and/or ethnicity in cerebrovascular RCTs remains undescribed. Our study describes trends in the reporting of race and/or ethnicity across cerebrovascular RCTs. METHODS Web of Science was searched to identify the top 100-cited cerebrovascular RCTs. Additional articles were retrieved from guidelines issued by the American Heart Association for the management of ischemic stroke, intracerebral hemorrhage, and aneurysmal subarachnoid hemorrhage. Univariate and multivariate analyses were performed to assess for factors influencing reporting of race/ethnicity. RESULTS Sixty-five percent of cerebrovascular RCTs lacked reporting of participant race and/or ethnicity. Multivariate regression revealed that studies from North America had a 14.74- fold higher odds (95% CI: 4.574-47.519) of reporting race/ethnicity. Impact factor of the journal was associated with 1.007-fold odds of reporting race/ethnicity (95% CI: 1.000-1.013). Reporting of race and/or ethnicity did not increase with time, or vary according to the number of participating centers, median number of study participants, source of funding, or category of RCT. Among RCTs that reported race, Blacks and Asians were underrepresented compared to Whites. CONCLUSIONS Sixty-five percent of prominent cerebrovascular RCTs lack adequate reporting of participant race/ethnicity. Reasons for inadequate reporting of these variables remain unclear and warrant additional investigation.
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Affiliation(s)
- Joanna M Roy
- Topiwala National Medical College, Mumbai, India
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Shahram Majidi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Gräf DD, Westphal L, Hallgreen CE. The life cycle of vaccines evaluated by the European Medicines Agency. Vaccine 2024; 42:126186. [PMID: 39121512 DOI: 10.1016/j.vaccine.2024.126186] [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: 05/10/2024] [Revised: 06/28/2024] [Accepted: 07/26/2024] [Indexed: 08/11/2024]
Abstract
BACKGROUND vaccines are complex products used in healthy populations. They should be carefully regulated, and benefits should clearly outweigh risks. OBJECTIVES To describe the evidence used to support benefit-risk evaluations of vaccines centrally assessed by the European Medicines Agency (EMA), and to identify if real-world data (RWD) was used throughout the vaccine life cycle. METHODS Cohort study of vaccines approved in the European Union. Inclusion criteria comprised having ATC code J07 and being centrally approved between 2012 and 2022. We collected data from regulatory documents, study protocols, and, when necessary, from scientific publications. Vaccines were followed from initial approval up to March 2023. RESULTS We included 31 vaccines addressing 17 therapeutic areas. More than 390 studies were used in the process of initial marketing authorisation (MA) and monitoring, and 174 studies were listed in initial risk management plans. We also identified 93 studies in the EU PAS register. At MA, all vaccines had at least one pivotal trial and 27 vaccines had at least one supportive study. Most pivotal trials were randomized, double-blinded and active-controlled, with immunogenicity endpoints as primary outcome. RWD was used for extension of indications and monitoring of at least 4 vaccines, and the undertaking of RWE studies was foreseen in the RMP of at least 17 vaccines. DISCUSSION Our study revealed an important reliance on randomized controlled trials with individual-level randomization, and a significant focus on immunogenicity endpoints. The use of RWD in vaccine assessments so far has been restricted to COVID-19, and despite its challenges and limitations, we believe that efforts to expand adoption of RWE in continuous benefit-risk assessments should be made. We further highlight the need to enhance data transparency and reporting standards since heterogeneity among regulatory documents made it difficult to identify all the studies considered in vaccine evaluations.
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Affiliation(s)
- Débora D Gräf
- Copenhagen Centre for Regulatory Science (CORS), Department of Pharmacy, University of Copenhagen, Denmark.
| | - Lukas Westphal
- Copenhagen Centre for Regulatory Science (CORS), Department of Pharmacy, University of Copenhagen, Denmark
| | - Christine E Hallgreen
- Copenhagen Centre for Regulatory Science (CORS), Department of Pharmacy, University of Copenhagen, Denmark
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5
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Wang SM, Li Y, Nash A, Ren Y, Thomas SM, Francescatti AB, Barber A, Lynch T, Frank ES, Grimm LJ, Thompson AM, Partridge AH, Hyslop T, Hwang ES, Ryser MD. Disease-specific survival outcomes for patients after locoregional treatment for ductal carcinoma in situ: observational cohort study. Br J Surg 2024; 111:znae198. [PMID: 39213131 DOI: 10.1093/bjs/znae198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/29/2024] [Accepted: 07/11/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Breast-conserving surgery alone, breast-conserving surgery with adjuvant radiation treatment, and mastectomy are guideline-concordant treatments for ductal carcinoma in situ. The aim of this study was to compare survival outcomes between these treatment options. METHODS A stratified random sample of patients diagnosed with pure ductal carcinoma in situ between 2008 and 2014 was selected from 1330 sites in the USA. Data on diagnosis, treatment, and follow-up were abstracted by local cancer registrars. Population-averaged marginal estimates of disease-specific survival and overall survival for breast-conserving surgery alone, breast-conserving surgery with radiation treatment, and mastectomy were obtained by combining sampling and overlap weights. RESULTS A total of 18 442 women were included, with a median follow-up of 67.8 (interquartile range 46.1-93.5) months. A total of 35 women died from breast cancer, at a median age of 62 (interquartile range 50-74) years. Population-averaged 8-year rates of disease-specific survival were 99.6% or higher for all treatment groups, with no significant differences between groups (breast-conserving surgery alone versus breast-conserving surgery with radiation treatment, HR 1.19 (95% c.i. 0.29 to 4.85); and mastectomy versus breast-conserving surgery with radiation treatment, HR 1.74 (95% c.i. 0.53 to 5.72). There was no difference in overall survival between the patients who underwent a mastectomy and the patients who underwent breast-conserving surgery with radiation treatment (HR 1.09 (95% c.i. 0.83 to 1.43)). Patients who underwent breast-conserving surgery alone had lower overall survival compared with the patients who underwent breast-conserving surgery with radiation treatment (HR 1.29 (95% c.i. 1.00 to 1.67)). This survival difference vanished for all but one subgroup, namely patients less than 65 years (HR 1.86 (95% c.i. 1.15 to 3.00)). CONCLUSION There was no statistically significant difference in disease-specific survival between women operated with breast-conserving surgery alone, breast-conserving surgery with radiation treatment, or mastectomy for ductal carcinoma in situ. Given the low absolute risk of disease-specific mortality, these results provide confidence in offering individualized locoregional treatment without fear of compromising survival.
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MESH Headings
- Humans
- Female
- Breast Neoplasms/mortality
- Breast Neoplasms/therapy
- Breast Neoplasms/surgery
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/pathology
- Middle Aged
- Aged
- Mastectomy, Segmental/mortality
- Carcinoma, Intraductal, Noninfiltrating/mortality
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Intraductal, Noninfiltrating/therapy
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Mastectomy/mortality
- Radiotherapy, Adjuvant
- United States/epidemiology
- Treatment Outcome
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Affiliation(s)
- Sabrina M Wang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Yan Li
- Duke Cancer Institute Biostatistics Shared Resource, Duke University Medical Center, Durham, North Carolina, USA
| | - Amanda Nash
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Yi Ren
- Duke Cancer Institute Biostatistics Shared Resource, Duke University Medical Center, Durham, North Carolina, USA
| | - Samantha M Thomas
- Duke Cancer Institute Biostatistics Shared Resource, Duke University Medical Center, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Anne Barber
- Cancer Programs, American College of Surgeons, Chicago, Illinois, USA
| | - Thomas Lynch
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Elizabeth S Frank
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lars J Grimm
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Terry Hyslop
- Division of Biostatistics & Bioinformatics, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Marc D Ryser
- Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina, USA
- Department of Mathematics, Duke University, Durham North Carolina, USA
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Aymerich C, Salazar de Pablo G, Pacho M, Pérez-Rodríguez V, Bilbao A, Andrés L, Pedruzo B, Castillo-Sintes I, Aranguren N, Fusar-Poli P, Zorrilla I, González-Pinto A, González-Torres MÁ, Catalán A. All-cause mortality risk in long-acting injectable versus oral antipsychotics in schizophrenia: a systematic review and meta-analysis. Mol Psychiatry 2024:10.1038/s41380-024-02694-3. [PMID: 39174648 DOI: 10.1038/s41380-024-02694-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 08/01/2024] [Accepted: 08/05/2024] [Indexed: 08/24/2024]
Abstract
Patients with schizophrenia receiving antipsychotic treatment present lower mortality rates than those who do not. However, the non-adherence rate is high, which can be partially addressed using long-acting injectable (LAI) antipsychotics. The impact of LAI treatments on all-cause mortality compared to oral antipsychotics remains unclear. To fill that gap, a random effects meta-analysis was conducted to analyze the odds ratio (OR) of all-cause, suicidal, and non-suicidal mortality among patients taking LAI antipsychotics compared to oral antipsychotics (PROSPERO:CRD42023391352). Individual and pooled LAI antipsychotics were analyzed against pooled oral antipsychotics. Sensitivity analyses were performed for study design, setting, and industry sponsorship. Meta-regressions were conducted for gender, age, antipsychotic dose, and race. Seventeen articles, total sample 12,042 patients (N = 5795 oral, N = 6247 LAI) were included. Lower risk of all-cause mortality for patients receiving LAI antipsychotics vs receiving oral antipsychotics was found (OR = 0.79; 95%CI = 0.66-0.95). Statistical significance was maintained when only studies comparing the same LAI and oral antipsychotic were included (OR = 0.79; 95%CI = 0.66-0.95; p = <0.01), as well as for non-suicidal mortality (OR = 0.77: 95%CI = 0.63-0.94; p = 0.01), but not for suicidal mortality (OR = 0.86; 95%CI = 0.59-1.26; p = 0.44). Mortality reduction was more pronounced for LAI antipsychotics in first-episode psychosis (FEP) (OR = 0.79; 95%CI = 0.66-0.96) compared to chronic psychosis. No individual LAI reported statistically significant differences against all pooled oral antipsychotics. LAI antipsychotics are associated with a lower risk of all-cause and non-suicidal mortality in individuals with schizophrenia compared to oral antipsychotics. Better adherence to the medication and health services may explain this difference. Whenever possible, the use of LAIs should be considered from the FEP.
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Affiliation(s)
- Claudia Aymerich
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain.
- Biobizkaia Health Research Institute, Barakaldo, Spain.
- CIBERSAM. Centro Investigación Biomédica en Red de Salud Mental, Madrid, Spain.
- University of the Basque Country, UPV/EHU, Leioa, Spain.
| | - Gonzalo Salazar de Pablo
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Madrid, Spain
| | - Malein Pacho
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | | | - Amaia Bilbao
- Osakidetza Basque Health Service, Basurto University Hospital, Research and Innovation Unit, Bilbao, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Bilbao, Spain
| | - Lucía Andrés
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | - Borja Pedruzo
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
- Biobizkaia Health Research Institute, Barakaldo, Spain
- CIBERSAM. Centro Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- Kronikgune Health Services Research Institute, Barakaldo, Spain
| | - Idoia Castillo-Sintes
- Osakidetza Basque Health Service, Basurto University Hospital, Research and Innovation Unit, Bilbao, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Bilbao, Spain
- Kronikgune Health Services Research Institute, Barakaldo, Spain
| | - Nerea Aranguren
- Osakidetza Basque Health Service, Basurto University Hospital, Research and Innovation Unit, Bilbao, Spain
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), London, UK
- Outreach and Support in South London (OASIS) service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Iñaki Zorrilla
- CIBERSAM. Centro Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- University of the Basque Country, UPV/EHU, Leioa, Spain
- Bioaraba, Mental Health and Childhood Research Group, Vitoria-Gasteiz, Spain
- Osakidetza Basque Health Service, Araba University Hospital, Psychiatry Department, Vitoria-Gasteiz, Spain
| | - Ana González-Pinto
- CIBERSAM. Centro Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- University of the Basque Country, UPV/EHU, Leioa, Spain
- Bioaraba, Mental Health and Childhood Research Group, Vitoria-Gasteiz, Spain
- Osakidetza Basque Health Service, Araba University Hospital, Psychiatry Department, Vitoria-Gasteiz, Spain
| | - Miguel Ángel González-Torres
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
- Biobizkaia Health Research Institute, Barakaldo, Spain
- CIBERSAM. Centro Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- University of the Basque Country, UPV/EHU, Leioa, Spain
| | - Ana Catalán
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
- Biobizkaia Health Research Institute, Barakaldo, Spain
- CIBERSAM. Centro Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- University of the Basque Country, UPV/EHU, Leioa, Spain
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Ramonfaur D, Gasperetti A, Blake VE, Rivers B, Kassamali AA, Kasper EK, Barouch LA, Wu KC, Madrazo JA, Carrick RT. Eighteen-Month Real-World Experience Using Mavacamten for Treatment of Obstructive Hypertrophic Cardiomyopathy in a Racially Diverse Population. J Am Heart Assoc 2024; 13:e034069. [PMID: 39082420 DOI: 10.1161/jaha.123.034069] [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: 12/18/2023] [Accepted: 06/26/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Patients with obstructive hypertrophic cardiomyopathy have increased symptomatic burden. Mavacamten was recently approved for treatment of obstructive hypertrophic cardiomyopathy based on 2 randomized controlled trials. However, its use under real-world conditions and in diverse populations is under-studied. METHODS AND RESULTS This was a prospective observational cohort study of patients seen at the Johns Hopkins HCM center and prescribed mavacamten for obstructive hypertrophic cardiomyopathy between July 7, 2022 and January 6, 2024. Patients were followed longitudinally, with serial echocardiography and clinical evaluation as mandated by the risk evaluation and mitigation strategy program. Sixty-six patients received mavacamten (mean age 59 years, 47% male, 29% non-White [Black, Hispanic/Latino, Asian, Native Hawaiian or Pacific Islander], 47% obese). Before treatment, all patients had New York Heart Association class II (51.5%) or III (48.5%) heart failure symptoms. Initial maximum peak left ventricular outflow tract gradient was 107±46 mm Hg. Median treatment duration was 9 months. For patients on mavacamten after ≥6 months (n=43), symptoms improved by ≥1 New York Heart Association class in 72% of patients, and peak left ventricular outflow tract gradient decreased by 80±46 mm Hg, eliminating hemodynamically significant left ventricular outflow tract obstruction in 79.1% of patients. Mavacamten was temporarily discontinued in 3 patients due to left ventricular ejection fraction decrease <50%. There were no medication-related adverse events. Effectiveness and safety were similar between White and non-White patients, but symptomatic relief was attenuated in patients with body-mass index ≥35 kg/m2. CONCLUSIONS Mavacamten was effective and safe when used under real-world conditions in a racially diverse population of symptomatic patients with obstructive hypertrophic cardiomyopathy. Patients with comorbid obesity were less likely to experience symptomatic improvement while on mavacamten.
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Affiliation(s)
- Diego Ramonfaur
- Division of Cardiology, Department of Medicine Johns Hopkins University Baltimore MD
| | - Alessio Gasperetti
- Division of Cardiology, Department of Medicine Johns Hopkins University Baltimore MD
| | - Victoria E Blake
- Division of Cardiology, Department of Medicine Johns Hopkins University Baltimore MD
| | - Bryana Rivers
- Division of Cardiology, Department of Medicine Johns Hopkins University Baltimore MD
| | - Ali A Kassamali
- Division of Cardiology, Department of Medicine Johns Hopkins University Baltimore MD
| | - Edward K Kasper
- Division of Cardiology, Department of Medicine Johns Hopkins University Baltimore MD
| | - Lili A Barouch
- Division of Cardiology, Department of Medicine Johns Hopkins University Baltimore MD
| | - Katherine C Wu
- Division of Cardiology, Department of Medicine Johns Hopkins University Baltimore MD
| | - Jose A Madrazo
- Division of Cardiology, Department of Medicine Johns Hopkins University Baltimore MD
| | - Richard T Carrick
- Division of Cardiology, Department of Medicine Johns Hopkins University Baltimore MD
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8
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Wagenaar LP, van Vugt WLJ, Huppelschoten AG, Radder CM, Peters LW, Weyers S, van Wessel S, Schoot BC, Hamerlynck TWO, van Vliet HA. Reproductive and obstetrical outcomes after treatment of retained products of conception: hysteroscopic removal vs ultrasound-guided electric vacuum aspiration, a prospective follow-up study. Am J Obstet Gynecol 2024; 231:233.e1-233.e8. [PMID: 38521232 DOI: 10.1016/j.ajog.2024.03.017] [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: 12/18/2023] [Revised: 02/25/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Traditionally, curettage has been the most widely performed surgical intervention for removing retained products of conception. However, hysteroscopic removal is increasingly performed as an alternative because of the potentially lower risk of intrauterine adhesions and higher rates of complete removal. Until recently, studies comparing curettage with hysteroscopic removal regarding reproductive and obstetrical outcomes were limited, and data conflicting. OBJECTIVE This study aimed to assess reproductive and obstetrical outcomes in women wishing to conceive after removal of retained products of conception by hysteroscopy or ultrasound-guided electric vacuum aspiration. STUDY DESIGN This was a prospective long-term follow-up study, conducted in 3 teaching hospitals and 1 university hospital. Patients were included from April 2015 until June 2022 for follow-up, either in a randomized controlled, nonblinded trial on the risk of intrauterine adhesions after removal of retained products of conception, or in a cohort alongside the randomized trial. Women with an ultrasonographic image suggestive of retained products of conception ranging from 1 to 4 cm were eligible. Surgical procedures in the randomized controlled trial were hysteroscopic morcellation or ultrasound-guided electric vacuum aspiration. In the cohort study, hysteroscopic treatment included hysteroscopic morcellation or cold loop resection compared with ultrasound-guided electric vacuum aspiration. RESULTS A total of 261 out of 305 patients (85.6%) were available for follow-up after removal of retained products of conception, resulting in a cohort of 171 women after hysteroscopic removal and 90 women after removal by ultrasound-guided vacuum aspiration. Respectively, 92 of 171 women (53.8%) in the hysteroscopic removal group and 56 of 90 (62.2%) in the electric vacuum aspiration group wished to conceive (P=.192). Subsequent pregnancy rates were 88 of 91 (96.7%) after hysteroscopic removal and 52 of 56 (92.9%) after electric vacuum aspiration (P=.428). The live birth rates were 61 of 80 (76.3%) and 37 of 48 (77.1%) after hysteroscopic removal and electric vacuum aspiration, respectively (P=.914), with 8 of 88 pregnancies (9.1%) in the hysteroscopic removal group and 4 of 52 (7.7%) in the electric vacuum aspiration group still ongoing at follow-up (P=1.00). The median time to conception was 8.2 weeks (interquartile range, 5.0-17.2) in the hysteroscopic removal group and 6.9 weeks (interquartile range, 5.0-12.1) in the electric vacuum aspiration group (P=.262). The overall placental complication rate was 13 of 80 (16.3%) in the hysteroscopic removal group and 11 of 48 (22.9%) in the electric vacuum aspiration group (P=.350). CONCLUSION Hysteroscopic removal and ultrasound-guided electric vacuum aspiration of retained products of conception seem to have no significantly different effects on subsequent live birth rate, pregnancy rate, time to conception, or pregnancy complications. Reproductive and obstetrical outcomes after removal of retained products of conception are reassuring, albeit with a high risk of placental complications.
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Affiliation(s)
- Liselot P Wagenaar
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, the Netherlands.
| | - Wouter L J van Vugt
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Celine M Radder
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, the Netherlands
| | - Louisette W Peters
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, the Netherlands
| | - Steven Weyers
- Women's Clinic, Ghent University Hospital, Ghent, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | | | - Benedictus C Schoot
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Tjalina W O Hamerlynck
- Women's Clinic, Ghent University Hospital, Ghent, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Huib A van Vliet
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, the Netherlands; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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9
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Smeets MJR, Cannegieter SC. Using real-world evidence to complement evidence from randomized controlled trials on oral anticoagulants for stroke prevention. PLoS Med 2024; 21:e1004449. [PMID: 39207949 PMCID: PMC11361432 DOI: 10.1371/journal.pmed.1004449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Mark J. R. Smeets and Suzanne C. Cannegieter discuss the use of real world data to complement data generated by clinical trials of systemic anticoagulants.
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Affiliation(s)
- Mark J. R. Smeets
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Suzanne C. Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Internal Medicine, section Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
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10
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Reynolds SA, O'Connor L, McGee A, Kilcoyne AQ, Connolly A, Mockler D, Guinan E, O'Neill L. Recruitment rates and strategies in exercise trials in cancer survivorship: a systematic review. J Cancer Surviv 2024; 18:1233-1242. [PMID: 37022641 PMCID: PMC11324688 DOI: 10.1007/s11764-023-01363-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/14/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE Despite clear evidence-based supporting a benefit to exercise on physical and psychological metrics in patients with cancer, recruitment to exercise trials amongst cancer survivors is suboptimal. We explore current recruitment rates, strategies, and common barriers to participation in exercise oncology trials in cancer survivorship. METHODS A systematic review was conducted using a pre-defined search strategy in EMBASE, CINAHL, Medline, Cochrane Library, and Web of Science. The search was performed up to 28/02/2022. Screening of titles and abstracts, full-text review, and data extraction was completed in duplicate. RESULTS Of the 3204 identified studies, 87 papers corresponding to 86 trials were included. Recruitment rates were highly variable with a median rate of 38% (range 0.52-100%). Trials recruiting prostate cancer patients only had the highest median recruitment rate (45.9%) vs trials recruiting colorectal cancer patients only which had the lowest (31.25%). Active recruitment strategies such as direct recruitment via a healthcare professional were associated with higher recruitment rates (rho = 0.201, p = 0.064). Common reasons for non-participation included lack of interest (46.51%, n (number of studies) = 40); distance and transport (45.3%, n = 39); and failure to contact (44.2%, n = 38). CONCLUSIONS Recruitment of cancer survivors to exercise interventions is suboptimal with barriers being predominantly patient-oriented. This paper provides the benchmark for current recruitment rates to exercise oncology trials, providing data for trialists planning future trial design and implementation, optimise future recruitment strategies, and evaluate their own recruitment success against current practice. IMPLICATIONS FOR CANCER SURVIVORS Enhanced recruitment to cancer survivorship exercise trials is necessary in facilitating the publication of definitive exercise guidelines, generalisable to varying cancer cohorts. PROSPERO REGISTRATION NUMBER CRD42020185968.
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Affiliation(s)
- Sophie A Reynolds
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Louise O'Connor
- Trinity St James's Cancer Institute, Dublin, Ireland
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Anna McGee
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Anna Quinn Kilcoyne
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Archie Connolly
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - David Mockler
- John Stearne Library, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
| | - Emer Guinan
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Linda O'Neill
- Trinity St James's Cancer Institute, Dublin, Ireland.
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland.
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11
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Tesfaye H, Wang KM, Zabotka LE, Wexler DJ, Schmedt N, Koeneman L, Seman L, Paik JM, Patorno E. Empagliflozin and Risk of Incident Gout: Analysis from the EMPagliflozin Comparative Effectiveness and SafEty (EMPRISE) Cohort Study. J Gen Intern Med 2024; 39:1870-1879. [PMID: 38710868 PMCID: PMC11282041 DOI: 10.1007/s11606-024-08793-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Hyperuricemia is frequently observed in patients with type 2 diabetes (T2D) and is associated with increased risk of gout and cardiovascular disease (CVD). Empagliflozin lowers serum urate levels by enhancing its urinary excretion. OBJECTIVE To compare initiators of empagliflozin vs dipeptidyl peptidase-4 inhibitor (DPP4i) and initiators of empagliflozin vs glucagon-like peptide-1 receptor agonist (GLP-1RA) with respect to the risk of incident gout events. DESIGN AND PARTICIPANTS Using three claims-based datasets from 08/2014 to 09/2019, we generated two cohorts (cohort 1: empagliflozin vs DPP4i; cohort 2: empagliflozin vs GLP-1RA) of adult patients with T2D and without prior history of gout or gout-specific medication dispensing separately in each dataset. To assess the risk of incident gout, we estimated hazard ratios (HR) and rate differences (RD) per 1000 person-years (PY) with their 95% confidence intervals (CI) before and after 1:1 propensity score (PS) matching adjusting for 141 baseline covariates. KEY RESULTS We identified 102,262 pairs of 1:1 propensity score-matched adults in cohort 1 and 131,216 pairs in cohort 2. Over a mean follow-up period of 8 months on treatment, the risk of gout was lower in patients initiating empagliflozin compared to DPP4i (HR = 0.69: 95% CI (0.60-0.79); RD = - 2.27: 95% CI (- 3.08, 1.46)) or GLP-1RA (HR = 0.83: 95% CI (0.73-0.94); RD = - 0.99: 95% CI (- 1.66, - 0.32)). Results were consistent across subgroups (sex, age, body mass index, chronic kidney disease, heart failure, cardiovascular disease, and concurrent diuretic use) and sensitivity analyses. CONCLUSIONS Among adults with T2D, the initiation of empagliflozin vs a DPP4i or GLP-1RA was associated with lower risk of incident gout, complementing results from a post hoc analysis of the EMPA-REG OUTCOME trial and previously published observational research focusing on the sodium-glucose co-transporter-2 inhibitor class in more narrowly defined study populations.
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Affiliation(s)
- Helen Tesfaye
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Katherine M Wang
- Division of Renal (Kidney) Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Center for Healthcare Organization & Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
| | - Luke E Zabotka
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Deborah J Wexler
- MGH Diabetes Center, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Niklas Schmedt
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | | | - Leo Seman
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA
| | - Julie M Paik
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Renal (Kidney) Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Center for Healthcare Organization & Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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12
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Bin WJJ, Chow A, Smith HE, Lee ES. Demographic diversity of participants in clinical trials conducted in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2024; 53:446-453. [PMID: 39132961 DOI: 10.47102/annals-acadmedsg.2023252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Introduction The under-representativeness of participants in clinical trials limits the generalisability of results. This review evaluates the representative-ness within pharmaceutical randomised controlled trials (RCTs) in Singapore. Method Four bibliographic databases were searched for papers on pharmaceutical RCTs which included Singapore adults (≥18 years old), published between 2017 and 2022. The demographic characteristics of study participants were compared against the population in the 2020 Singapore census. Recruitment strategies and authors' comments on the generalisa-bility of their findings were reviewed. Results Thirty-three publications were included (19 Singapore-only studies and 14 multiregional trials which included Singapore). Where data were available, we found that females and Indians were under-represented compared to the census (41.3% versus [vs] 51.1%, P<0.05; 7.3% vs 9.0%, P<0.05). Ethnic diversity varied between individual studies, and almost half (46.2%) of Singapore-only studies achieved census levels. However, more than one-third of the trials provided no data (31.6%) or partial data (5.3%) on ethnicity. Half of the multiregional publications stated the number of participants recruited from Singapore, but only 1 reported any detail beyond Asian participants. Recruitment strategies were mentioned in fewer than half (42.4%), and less than a quarter (24.2%) commented on sample representative-ness or the external validity of the evidence generated. Conclusion There is room for improvement regarding the recruitment of RCT participants in Singapore, with particular attention to female gender and Indian ethnicity. Demographic data should also be presented in full. RCTs should be designed and reported such that clinicians can ascertain the generalisability to the Singapore population and the potential benefits from the studied interventions in clinical practice.
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Affiliation(s)
- Wen Jun Jerome Bin
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Singapore
| | - Aloysius Chow
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Singapore
| | | | - Eng Sing Lee
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Singapore
- National Healthcare Group Polyclinics, Singapore
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13
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Faraj KS, Oerline M, Kaufman SR, Dall C, Srivastava A, Caram MEV, Shahinian VB, Hollenbeck BK. Adverse events in men with advanced prostate cancer treated with androgen biosynthesis inhibitors and androgen receptor inhibitors. J Natl Cancer Inst 2024:djae155. [PMID: 39049442 DOI: 10.1093/jnci/djae155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/04/2024] [Accepted: 06/20/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The use of androgen biosynthesis and second-generation androgen receptor inhibitors for advanced prostate cancer is increasing. Because these therapies alter the androgen pathway, they have been associated with cardiometabolic and neurocognitive toxicities. Although their safety profiles have been assessed in clinical trials, real-world data are limited. METHODS A 20% sample of national Medicare claims was used to perform a retrospective cohort study of Medicare beneficiaries with advanced prostate cancer treated with androgen biosynthesis (ie, abiraterone) and second-generation androgen receptor inhibitors between 2012 and 2019. Outcomes were assessed after the first fill of either class of drug for the 12-month period after starting therapy. The primary outcome was a hospital admission or emergency department visit for a cardiometabolic event. Secondary outcomes included neurocognitive events and fractures. Multivariable regression was used to assess the association between the class of drug and occurrence of an adverse event. RESULTS There were 3488 (60%) men started on an androgen biosynthesis inhibitor and 2361 (40%) started on an androgen receptor inhibitor for the first time. Cardiometabolic adverse events were more common in men managed with androgen biosynthesis inhibitor (9.2% vs 7.5%, P = .027). No difference between androgen biosynthesis and androgen receptor inhibitors was observed for neurocognitive events (3.3% vs 3.4%, respectively; P = .71) or fractures (4.2% vs 3.6%, respectively; P = .26). CONCLUSIONS Men with advanced prostate cancer initiating an androgen biosynthesis inhibitor for the first time more commonly had cardiometabolic events than those started on androgen receptor inhibitors. Neurocognitive events and fractures did not differ by drug class.
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Affiliation(s)
- Kassem S Faraj
- Dow Division of Health Services Research, Department of Urology, University of Michigan, MI, USA
| | - Mary Oerline
- Dow Division of Health Services Research, Department of Urology, University of Michigan, MI, USA
| | - Samuel R Kaufman
- Dow Division of Health Services Research, Department of Urology, University of Michigan, MI, USA
| | - Christopher Dall
- Department of Urology, Massachusetts General Hospital, Boston, MA, USA
| | - Arnav Srivastava
- Dow Division of Health Services Research, Department of Urology, University of Michigan, MI, USA
| | - Megan E V Caram
- VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Vahakn B Shahinian
- Division of Nephrology, Department of Internal Medicine, University of Michigan, MI, USA
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14
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Granda P, Villamañán E, Laorden D, Carpio C, Collada V, Domínguez-Ortega J, de las Vecillas L, Romero-Ribate D, Chaparro-Díaz OF, Lázaro Miguel-Sin T, Alloca-Álvarez DJ, Correa-Borit JM, Losantos I, Mir-Ihara P, Narváez-Fernández EJ, Quirce S, Álvarez-Sala R. Cardiovascular Events in Patients with Severe Asthma-A Retrospective Study of Two Cohorts: Asthma Type T2 Treated with Biologics and Non-Type T2. J Clin Med 2024; 13:4299. [PMID: 39124568 PMCID: PMC11313306 DOI: 10.3390/jcm13154299] [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: 06/24/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 08/12/2024] Open
Abstract
Background: The prevalence of cardiovascular events (CVEs) in patients with asthma varies amongst studies, with little evidence as to their prevalence in patients treated with monoclonal antibodies (mAbs). In this retrospective, observational study, we aimed to evaluate the prevalence of CVEs in patients with T2 and non-T2 asthma and to identify risk factors associated with CVEs. Methods: A total of 206 patients with severe asthma were included. Demographic variables, respiratory comorbidities and cardiovascular risk factors were collected, along with respiratory function, laboratory parameters and respiratory pharmacotherapy, including treatment with mAbs. Results: A total of 10.7% of the patients had any CVE from the date of asthma diagnosis, with a higher risk in those patients with chronic obstructive pulmonary disease (odds ratio [OR] = 5.36, 95% CI 1.76-16.31; p = 0.003), arterial hypertension (OR = 2.71, 95% CI 1.13-6.55; p = 0.026) and dyslipidaemia (OR = 9.34, 95% CI 3.57-24.44; p < 0.001). No association between mAb treatment and a CVE or between time of mAb treatment and the event was found. No significant differences were observed between the T2 and non-T2 cohort. After a multivariate analysis, dyslipidaemia was identified as an independent risk factor (OR = 13.33, 95% CI 4.49-39.58; p < 0.001), whereas regular use of inhaled corticosteroids was associated with a reduced risk of a CVE (OR = 0.103, 95% CI 0.021-0.499; p = 0.005). Further research is needed to fully understand the relationship between severe asthma and CVEs. Conclusions: This study suggests that patients with severe asthma experience a higher percentage of CVEs compared with the general population.
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Affiliation(s)
- Paula Granda
- Pharmacy Department, Gómez Ulla Military Hospital, 28047 Madrid, Spain
| | - Elena Villamañán
- Pharmacy Department, La Paz University Hospital, IdiPAZ, 28029 Madrid, Spain; (E.V.); (V.C.)
- Medicine Department, Autonomous University of Madrid, 28049 Madrid, Spain; (C.C.); (R.Á.-S.)
| | - Daniel Laorden
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
| | - Carlos Carpio
- Medicine Department, Autonomous University of Madrid, 28049 Madrid, Spain; (C.C.); (R.Á.-S.)
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
| | - Victoria Collada
- Pharmacy Department, La Paz University Hospital, IdiPAZ, 28029 Madrid, Spain; (E.V.); (V.C.)
| | - Javier Domínguez-Ortega
- Allergy Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (J.D.-O.); (L.d.l.V.); (J.M.C.-B.); (P.M.-I.); (E.J.N.-F.); (S.Q.)
| | - Leticia de las Vecillas
- Allergy Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (J.D.-O.); (L.d.l.V.); (J.M.C.-B.); (P.M.-I.); (E.J.N.-F.); (S.Q.)
| | - David Romero-Ribate
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
| | - Omar Fabián Chaparro-Díaz
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
| | - Teresa Lázaro Miguel-Sin
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
| | - Daniela Jose Alloca-Álvarez
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
| | - Jorge Mauricio Correa-Borit
- Allergy Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (J.D.-O.); (L.d.l.V.); (J.M.C.-B.); (P.M.-I.); (E.J.N.-F.); (S.Q.)
| | - Itsaso Losantos
- Biostatistics Department, La Paz University Hospital, 28046 Madrid, Spain;
| | - Patricia Mir-Ihara
- Allergy Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (J.D.-O.); (L.d.l.V.); (J.M.C.-B.); (P.M.-I.); (E.J.N.-F.); (S.Q.)
| | - Emilio José Narváez-Fernández
- Allergy Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (J.D.-O.); (L.d.l.V.); (J.M.C.-B.); (P.M.-I.); (E.J.N.-F.); (S.Q.)
| | - Santiago Quirce
- Allergy Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (J.D.-O.); (L.d.l.V.); (J.M.C.-B.); (P.M.-I.); (E.J.N.-F.); (S.Q.)
| | - Rodolfo Álvarez-Sala
- Medicine Department, Autonomous University of Madrid, 28049 Madrid, Spain; (C.C.); (R.Á.-S.)
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
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15
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Tao BK, Xie JS, Kohly RP, Margolin E. Disease burden descriptions in trial protocols. Lancet 2024; 404:238-239. [PMID: 39033000 DOI: 10.1016/s0140-6736(24)00881-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/26/2024] [Indexed: 07/23/2024]
Affiliation(s)
- Brendan K Tao
- The University of British Columbia, Vancouver, BC, Canada
| | - Jim S Xie
- Department of Ophthalmology & Vision Science, Mount Sinai Hospital, University of Toronto, Toronto, ON M5T 3A9, Canada
| | - Radha P Kohly
- Department of Ophthalmology & Vision Science, Mount Sinai Hospital, University of Toronto, Toronto, ON M5T 3A9, Canada
| | - Edward Margolin
- Department of Ophthalmology & Vision Science, Mount Sinai Hospital, University of Toronto, Toronto, ON M5T 3A9, Canada.
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Nicmanis M, Chur-Hansen A, Oxlad M. The psychological, social, and quality of life outcomes of people with a cardiac implantable electronic device: an umbrella review. Eur J Cardiovasc Nurs 2024; 23:441-451. [PMID: 38126134 DOI: 10.1093/eurjcn/zvad133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
AIMS To synthesize the psychological, social, and quality of life outcomes of people with a cardiac implantable electronic device. METHODS AND RESULTS An umbrella review of systematic reviews that reported the psychological, social, or quality of life outcomes of adults with a cardiac implantable electronic device was conducted. This umbrella review was pre-registered with PROSPERO (CRD42023437078) and adhered to JBI and PRISMA guidelines. Seven databases (CINAHL, Cochrane Library, Embase, EmCare, PsycINFO, PubMed, and the Web of Science) were searched alongside citation and bibliographic searches. Methodological quality was assessed using the JBI Checklist of Systematic Reviews and Research Syntheses. Due to the heterogeneity of the included reviews, the findings were reported narratively. A total of 14 systematic reviews met the inclusion criteria; 11 considered quality of life outcomes, and 3 considered psychological outcomes. Little difference in quality of life was found between people with an implantable cardioverter-defibrillator and controls; however, a high prevalence of psychological disorders was present. Cardiac resynchronization therapy devices demonstrated improvements in quality of life compared with control groups, alongside possible cognitive benefits. Quality of life did not differ between subcutaneous and transvenous implantable cardioverter-defibrillators. Pacemakers were associated with improved post-implantation quality of life. CONCLUSION Research on the psychosocial and quality of life outcomes of people with a cardiac implantable electronic device is limited and inconsistent. Given the heterogeneity of the current research, conclusions are uncertain. Nevertheless, some recipients may experience adverse psychosocial complications. Further research employing rigorous methodologies is needed, and healthcare practitioners should provide care that acknowledges the potential for adverse psychosocial experiences. REGISTRATION PROSPERO: CRD42023437078.
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Affiliation(s)
- Mitchell Nicmanis
- Faculty of Health and Medical Sciences, School of Psychology, The University of Adelaide, Level 5, Hughes building North Terrace campus, Adelaide 5000, Australia
| | - Anna Chur-Hansen
- Faculty of Health and Medical Sciences, School of Psychology, The University of Adelaide, Level 5, Hughes building North Terrace campus, Adelaide 5000, Australia
| | - Melissa Oxlad
- Faculty of Health and Medical Sciences, School of Psychology, The University of Adelaide, Level 5, Hughes building North Terrace campus, Adelaide 5000, Australia
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Smith AM, Prom MC, Ng LC. A Qualitative Investigation of Characteristics Impacting Clinical Decision-Making in Integrated Behavioral Health Care. J Behav Health Serv Res 2024:10.1007/s11414-024-09891-6. [PMID: 38982024 DOI: 10.1007/s11414-024-09891-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/11/2024]
Abstract
To support implementation of integrated behavioral health care (IBHC) models in local settings, providers may benefit from clinical decision-making support. The present analysis examines perspectives on patient characteristics appropriate or inappropriate for, and currently managed within, IBHC at a large medical center to inform recommendations for provider decision-making. Twenty-four participants (n = 13 primary care providers; n = 6 behavioral health providers; n = 5 administrators) in an IBHC setting were interviewed. Thematic analysis was conducted with acceptable interrater reliability (κ = 0.75). Responses indicated behavioral health symptom and patient characteristics that impact perceptions of appropriateness for management in IBHC, with high variability between providers. Many patients with characteristics identified as inappropriate for IBHC were nonetheless currently managed in IBHC. Interactions between patient ability to engage in care and provider ability to manage patient needs guided decisions to refer a patient to IBHC or specialty care. A heuristic representing this dimensional approach to clinical decision-making is presented to suggest provider decision-making guidance informed by both patient and provider ability.
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Affiliation(s)
- Ash M Smith
- Boston Medical Center, 720 Harrison Ave, Boston, MA, 02118, USA
- Psychology Department, The Graduate Center, City University of New York, New York, NY, USA
| | - Maria C Prom
- Boston Medical Center, 720 Harrison Ave, Boston, MA, 02118, USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Lauren C Ng
- Boston Medical Center, 720 Harrison Ave, Boston, MA, 02118, USA.
- Psychiatry Department, Boston University School of Medicine, Boston, MA, USA.
- Department of Psychology, University of California Los Angeles, Psychology Building 1285, Box 951563, Los Angeles, CA, 90095, USA.
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18
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Näher A, Kopka M, Balzer F, Schulte‐Althoff M. Generalizability in real-world trials. Clin Transl Sci 2024; 17:e13886. [PMID: 39046315 PMCID: PMC11267629 DOI: 10.1111/cts.13886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 06/27/2024] [Indexed: 07/25/2024] Open
Abstract
Real-world evidence (RWE) trials have a key advantage over conventional randomized controlled trials (RCTs) due to their potentially better generalizability. High generalizability of study results facilitates new biological insights and enables targeted therapeutic strategies. Random sampling of RWE trial participants is regarded as the gold standard for generalizability. Additionally, the use of sample correction procedures can increase the generalizability of trial results, even when using nonrandomly sampled real-world data (RWD). This study presents descriptive evidence on the extent to which the design of currently planned or already conducted RWE trials takes sampling into account. It also examines whether random sampling or procedures for correcting nonrandom samples are considered. Based on text mining of publicly available metadata provided during registrations of RWE trials on clinicaltrials.gov, EU-PAS, and the OSF-RWE registry, it is shown that the share of RWE trial registrations with information on sampling increased from 65.27% in 2002 to 97.43% in 2022, with a corresponding increase from 14.79% to 28.30% for trials with random samples. For RWE trials with nonrandom samples, there is an increase from 0.00% to 0.95% of trials in which sample correction procedures are used. We conclude that the potential benefits of RWD in terms of generalizing trial results are not yet being fully realized.
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Affiliation(s)
- Anatol‐Fiete Näher
- Digital Global Public Health, Hasso Plattner Institute for Digital EngineeringUniversity of PotsdamPotsdamGermany
- Institute of Medical InformaticsCharité – Universitätsmedizin BerlinBerlinGermany
| | - Marvin Kopka
- Institute of Medical InformaticsCharité – Universitätsmedizin BerlinBerlinGermany
- Institute of Psychology and Ergonomics (IPA), Division of ErgonomicsTechnische Universität BerlinBerlinGermany
| | - Felix Balzer
- Institute of Medical InformaticsCharité – Universitätsmedizin BerlinBerlinGermany
| | - Matthias Schulte‐Althoff
- Institute of Medical InformaticsCharité – Universitätsmedizin BerlinBerlinGermany
- Department of Information SystemsFreie Universität BerlinBerlinGermany
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19
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Nguyen Y, Mariette X, Gottenberg JE, Iudici M, Morel J, Vittecoq O, Constantin A, Flipo RM, Schaeverbeke T, Sibilia J, Ravaud P, Porcher R, Seror R. Can efficacy and safety data from clinical trials of rituximab in RA be extrapolated? Insights from 1984 patients from the AIR-PR Registry. Rheumatology (Oxford) 2024; 63:1893-1901. [PMID: 37725356 DOI: 10.1093/rheumatology/kead495] [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] [Revised: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVES To investigate whether the efficacy and safety data from drug-registration trials can be extrapolated to real-life RA patients receiving RTX. METHODS The 'AutoImmunity and Rituximab' (AIR-PR) registry is a French multicentre, prospective cohort of RA patients treated with RTX in a real-life setting. We compared treatment responses at 12 months and serious adverse events (AEs) between eligible and non-eligible patients, by retrieving the eligibility criteria of the three rituximab-registration trials. We determined critical eligibility criteria and modelled the benefit-risk ratio according to the number of fulfilled critical eligibility criteria. RESULTS Among 1984 RA patients, only 9-12% fulfilled all eligibility criteria. Non-eligible patients had fewer EULAR responses at 12 months (40.3% vs 46.9%, P = 0.044). Critical inclusion criteria included swollen joints count ≥4, tender joints count ≥4, CRP ≥15 mg/l and RF positivity. Critical exclusion criteria were age >80 years, RA-associated systemic diseases, ACR functional class IV, DMARD other than MTX and prednisone >10 mg/day. Only 20.8% fulfilled those critical eligibility criteria. During the first year, serious AEs occurred for 182 (9.2%) patients (70.3% serious infections) and patients with ≥1 critical exclusion criterion were at higher risk (hazard ratio 3.03; 95% CI 2.25-4.06; for ≥3 criteria vs 0). The incremental risk-benefit ratio decreased with the number of unmet critical inclusion criteria and of fulfilled exclusion criteria. CONCLUSION Few real-life RA patients were eligible for the drug-registration trials. Non-eligible patients had lower chance of response, and higher risk of serious AEs. Efficacy and safety data obtained from those trials may not be generalizable to RA patients receiving RTX in real-world clinical practice.
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Affiliation(s)
- Yann Nguyen
- Department of Rheumatology, Hôpital Bicêtre Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Center for Immunology of Viral Infections and Auto-immune Diseases (IMVA), Université Paris-Saclay, Institut pour la Santé et la Recherche Médicale (INSERM) UMR 1184, Le Kremlin Bicêtre, France
| | - Xavier Mariette
- Department of Rheumatology, Hôpital Bicêtre Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Center for Immunology of Viral Infections and Auto-immune Diseases (IMVA), Université Paris-Saclay, Institut pour la Santé et la Recherche Médicale (INSERM) UMR 1184, Le Kremlin Bicêtre, France
| | - Jacques E Gottenberg
- Rheumatology Department, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Michele Iudici
- INSERM, UMR1153 Epidemiology and Statistics Sorbonne Paris Cité Research Centre (CRESS), Team METHODS, Paris, France
- Division of Rheumatology, Department of Internal Medicine Specialties, Geneva University Hospitals, Geneva, Switzerland
| | - Jacques Morel
- Rheumatology Department, CHU and University of Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Olivier Vittecoq
- Department of Rheumatology, Rouen University Hospital & Inserm U905, Rouen, France
| | - Arnaud Constantin
- Rheumatology Department, Purpan University Hospital, Paul Sabatier Toulouse III University, INSERM U1291 Infinity, Toulouse, France
| | - Rene-Marc Flipo
- Rheumatology Department, CHRU de Lille, Université de Lille, Lille, France
| | | | - Jean Sibilia
- Rheumatology Department, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Philippe Ravaud
- INSERM, UMR1153 Epidemiology and Statistics Sorbonne Paris Cité Research Centre (CRESS), Team METHODS, Paris, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Hôtel-Dieu, Center for Clinical Epidemiology, Paris, France
| | - Raphaël Porcher
- INSERM, UMR1153 Epidemiology and Statistics Sorbonne Paris Cité Research Centre (CRESS), Team METHODS, Paris, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Hôtel-Dieu, Center for Clinical Epidemiology, Paris, France
| | - Raphaèle Seror
- Department of Rheumatology, Hôpital Bicêtre Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Center for Immunology of Viral Infections and Auto-immune Diseases (IMVA), Université Paris-Saclay, Institut pour la Santé et la Recherche Médicale (INSERM) UMR 1184, Le Kremlin Bicêtre, France
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20
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Ju JW, Lee HJ, Nam K, Kim S, Hong H, Yoo SH, Lee S, Cho YJ, Jeon Y. Volatile Anesthetic Use Versus Total Intravenous Anesthesia for Patients Undergoing Heart Valve Surgery: A Nationwide Population-Based Study. Anesth Analg 2024; 139:114-123. [PMID: 38885399 DOI: 10.1213/ane.0000000000006760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
BACKGROUND Many studies have suggested that volatile anesthetic use may improve postoperative outcomes after cardiac surgery compared to total intravenous anesthesia (TIVA) owing to its potential cardioprotective effect. However, the results were inconclusive, and few studies have included patients undergoing heart valve surgery. METHODS This nationwide population-based study included all adult patients who underwent heart valve surgery between 2010 and 2019 in Korea based on data from a health insurance claim database. Patients were divided based on the use of volatile anesthetics: the volatile anesthetics or TIVA groups. After stabilized inverse probability of treatment weighting (IPTW), the association between the use of volatile anesthetics and the risk of cumulative 1-year all-cause mortality (the primary outcome) and cumulative long-term (beyond 1 year) mortality were assessed using Cox regression analysis. RESULTS Of the 30,755 patients included in this study, the overall incidence of 1-year mortality was 8.5%. After stabilized IPTW, the risk of cumulative 1-year mortality did not differ in the volatile anesthetics group compared to the TIVA group (hazard ratio, 0.98; 95% confidence interval, 0.90-1.07; P = .602), nor did the risk of cumulative long-term mortality (hazard ratio, 0.98; 95% confidence interval, 0.93-1.04; P = .579) at a median (interquartile range) follow-up duration of 4.8 (2.6-7.6) years. CONCLUSIONS Compared with TIVA, volatile anesthetic use was not associated with reduced postoperative mortality risk in patients undergoing heart valve surgery. Our findings indicate that the use of volatile anesthetics does not have a significant impact on mortality after heart valve surgery. Therefore, the choice of anesthesia type can be based on the anesthesiologists' or institutional preference and experience.
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Affiliation(s)
- Jae-Woo Ju
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho-Jin Lee
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Karam Nam
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | - Hyunsook Hong
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Ho Yoo
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seohee Lee
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youn Joung Cho
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yunseok Jeon
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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21
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Wilson BE, Eisenhauer EA, Booth CM. Study Participants, Future Patients, and Outcomes That Matter in Cancer Clinical Trials. JAMA 2024; 331:2081-2083. [PMID: 38767591 DOI: 10.1001/jama.2024.1281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Brooke E Wilson
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Canada
- School of Population Health, Faculty of Medicine and Health, Sydney, Australia
| | | | - Christopher M Booth
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Canada
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22
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Bettega F, Mendelson M, Leyrat C, Bailly S. Use and reporting of inverse-probability-of-treatment weighting for multicategory treatments in medical research: a systematic review. J Clin Epidemiol 2024; 170:111338. [PMID: 38556101 DOI: 10.1016/j.jclinepi.2024.111338] [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: 08/09/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES Causal inference methods for observational data represent an alternative to randomised controlled trials when they are not feasible or when real-world evidence is sought. Inverse-probability-of-treatment weighting (IPTW) is one of the most popular approaches to account for confounding in observational studies. In medical research, IPTW is mainly applied to estimate the causal effect of a binary treatment, even when the treatment has in fact multiple categories, despite the availability of IPTW estimators for multiple treatment categories. This raises questions about the appropriateness of the use of IPTW in this context. Therefore, we conducted a systematic review of medical publications reporting the use of IPTW in the presence of a multi-category treatment. Our objectives were to investigate the frequency of use and the implementation of these methods in practice, and to assess the quality of their reporting. STUDY DESIGN AND SETTING Using Pubmed, Embase and Web of Science, we screened 5660 articles and retained 106 articles in the final analysis that were from 17 different medical areas. This systematic review is registered on PROSPERO (CRD42022352669). RESULTS The number of treatment groups varied between 3 and 9, with a large majority of articles (90 [84.9%]) including 3 or 4 groups. The most commonly used method for estimating the weights was multinomial regression (51 [48.1%]) and generalized boosted models (48 [45.3%]). The covariates of the weight model were reported in 91 articles (85.9 %). Twenty-six articles (24.5 %) did not discuss the balance of covariates after weighting, and only 16 articles (15.1 %) referred to the assumptions needed to obtain correct inferences. CONCLUSION The results of this systematic review illustrate that medical publications scarcely use IPTW methods for more than two treatment categories. Among the publications that did, the quality of reporting was suboptimal, in particular in regard to the assumptions and model building. IPTW for multi-category treatments could be applied more broadly in medical research, and the application of the proposed guidelines in this context will help researchers to report their results and to ensure reproducibility of their research.
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Affiliation(s)
- François Bettega
- University Grenoble Alpes, Inserm, Grenoble Alpes University Hospital, HP2, 38000 Grenoble, France
| | - Monique Mendelson
- University Grenoble Alpes, Inserm, Grenoble Alpes University Hospital, HP2, 38000 Grenoble, France
| | - Clémence Leyrat
- Department of Medical Statistics, Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, London, UK
| | - Sébastien Bailly
- University Grenoble Alpes, Inserm, Grenoble Alpes University Hospital, HP2, 38000 Grenoble, France.
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23
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Gandaglia G, Pellegrino F, De Meulder B, Hijazy A, Abbott T, Golozar A, Nicoletti R, Gomez-Rivas J, Steinbeisser C, Evans-Axelsson S, Briganti A, N’Dow J. Research protocol for an observational health data analysis to assess the applicability of randomized controlled trials focusing on newly diagnosed metastatic prostate cancer using real-world data: PIONEER IMI's "big data for better outcomes" program. Int J Surg Protoc 2024; 28:64-72. [PMID: 38854711 PMCID: PMC11161292 DOI: 10.1097/sp9.0000000000000024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 03/16/2024] [Indexed: 06/11/2024] Open
Abstract
Background Metastatic prostate cancer (PCa) constitutes ~5% of all new PCa diagnoses in Western countries. For most cases, primary consideration should be given to systemic therapies as the first-line approach based on evidence from randomized controlled trials (RCTs). Despite the importance of RCTs as the pinnacle of evidence in modern medicine, concerns have been raised about their applicability to real-life scenarios. These trials often feature participants who are younger with better performance statuses and prognoses compared to their real-world counterparts. The PIONEER project falls under the Innovative Medicine Initiative's (IMI) "Big Data for Better Outcomes" initiative, aimed at revolutionizing PCa care in Europe. The central focus lies in improving cancer-related outcomes, enhancing health system efficiency, and elevating the quality of health and social care. This study endeavours to evaluate the generalizability of RCT findings concerning newly diagnosed metastatic PCa. Methods A systematic review of the literature will be conducted to compile patient characteristics from RCTs addressing this subject within the past decade. To create a real-world benchmark, patients with recently diagnosed metastatic PCa from a network of population-based databases will serve as a comparison group. The objective is to assess the applicability of RCT results in two ways. First, a comparison will be made between the characteristics of patients with newly diagnosed metastatic PCa enroled in RCTs and those with the same condition included in our databases which might represent the real-world setting. Second, an evaluation will be undertaken to determine the proportion of real-world patients with newly diagnosed metastatic PCa who meet the criteria for RCT enrolment. This study will rely on extensive observational data, primarily sourced from population-based registries, electronic health records, and insurance claims data. The study cohort is established upon routinely gathered healthcare data, meticulously mapped to the Observational Medical Outcomes Partnership Common Data Model.
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Affiliation(s)
- Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan
| | - Francesco Pellegrino
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan
| | | | | | | | | | - Rossella Nicoletti
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - Juan Gomez-Rivas
- Department of Urology, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Alberto Briganti
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan
| | - James N’Dow
- Academic Urology Unit, University of Aberdeen, Scotland, UK
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24
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Jent S, Bez NS, Haddad J, Catalano L, Egger KS, Raia M, Tedde GS, Rogler G. The efficacy and real-world effectiveness of a diet low in fermentable oligo-, di-, monosaccharides and polyols in irritable bowel syndrome: A systematic review and meta-analysis. Clin Nutr 2024; 43:1551-1562. [PMID: 38754307 DOI: 10.1016/j.clnu.2024.05.014] [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: 12/20/2023] [Revised: 04/02/2024] [Accepted: 05/05/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND & AIMS A diet low in fermentable oligo-, di-, monosaccharides, and polyols (LFD) has been shown to effectively reduce irritable bowel syndrome (IBS) symptoms. Effects resulting from real-world studies may differ from those seen in efficacy studies because of the diversity of patients in real-world settings. This systematic review and meta-analysis aimed to compare the effect of the LFD on reducing IBS symptoms and improving the quality of life (QoL) in efficacy trials and real-world studies. METHODS Major databases, trial registries, dissertations, and journals were systematically searched for studies on the LFD in adults with IBS. Meta-analysis was conducted using a random effects model with standardized mean differences (SMD) and 95% confidence intervals (CI). Outcomes of interest were all patient-reported: stool consistency, stool frequency, abdominal pain, overall symptoms, adequate symptom relief, IBS-specific QoL and adherence to the LFD. RESULTS Eleven efficacy and 19 real-world studies were reviewed. The meta-analysis results for abdominal pain (SMD 0.35, 95% CI 0.16 to 0.54) and QoL (SMD 0.23, 95% CI -0.05 to 0.50) showed the LFD was beneficial in efficacy studies with no statistically significant results for stool frequency (SMD 0.71, 95% CI 0.34 to 1.07). Real-world studies found improvements in abdominal pain and QoL. Due to heterogeneity, no meta-analysis was done for stool consistency and overall symptoms. In these outcomes, results were mostly supportive of the LFD, but they were not always statistically significant. CONCLUSIONS The results of this systematic review and meta-analysis suggest the LFD improves outcomes compared to a control diet (efficacy studies) or baseline data (real-world studies). Because of diverse study designs and heterogeneity of results, a clear superiority of the LFD over control diets could not be concluded. There are no indications of an efficacy-effectiveness gap for the LFD in adults with IBS.
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Affiliation(s)
- Sandra Jent
- Bern University of Applied Sciences, Department of Health Professions, Murtenstrasse 10, 3011 Bern, Switzerland.
| | - Natalie Sara Bez
- Bern University of Applied Sciences, Department of Health Professions, Murtenstrasse 10, 3011 Bern, Switzerland
| | - Joyce Haddad
- Bern University of Applied Sciences, Department of Health Professions, Murtenstrasse 10, 3011 Bern, Switzerland
| | - Loan Catalano
- Bern University of Applied Sciences, Department of Health Professions, Murtenstrasse 10, 3011 Bern, Switzerland
| | - Kim Stefanie Egger
- Bern University of Applied Sciences, Department of Health Professions, Murtenstrasse 10, 3011 Bern, Switzerland
| | - Michela Raia
- Bern University of Applied Sciences, Department of Health Professions, Murtenstrasse 10, 3011 Bern, Switzerland
| | - Giulia Simona Tedde
- Bern University of Applied Sciences, Department of Health Professions, Murtenstrasse 10, 3011 Bern, Switzerland
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
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25
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Thokagevistk K, Coppo C, Rey L, Carelli A, Díez V, Vaselenak S, Oliveira L, Patel A, Sicari E, Ramos T, Schach S, Schirghuber E, Simpson A, Choquet R, Le Lay K. Real-World Evidence to Reinforce Clinical Trial Evidence in Health Technology Assessment: A Critical Review of Real-World Evidence Requirements from Seven Countries and Recommendations to Improve Acceptance. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2024; 12:105-117. [PMID: 38808313 PMCID: PMC11130860 DOI: 10.3390/jmahp12020009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/22/2024] [Accepted: 04/18/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Real-world evidence (RWE) can reinforce clinical trial evidence in health technology assessment (HTA). OBJECTIVES Review HTA bodies' (HTAbs) requirements for RWE, real uses, and acceptance across seven countries (Brazil, Canada, France, Germany, Italy, Spain, and the United Kingdom) and outline recommendations that may improve acceptance of RWE in efficacy/effectiveness assessments and appraisals processes. METHODS RWE requirements were summarized based on HTAbs' guidelines. Acceptance by HTAbs was evaluated based on industry experience and case studies. RESULTS As of June 2022, RWE methodological guidelines were in place in three of the seven countries. HTAbs typically requested analyses based on local data sources, but the preferred study design and data sources differed. HTAbs had individual submission, assessment, and appraisal processes; some allowed early meetings for the protocol and/or results validation, though few involved external experts or medical societies to provide input to assessment and appraisal. The extent of submission, assessment, and appraisal requirements did not necessarily reflect the degree of acceptance. CONCLUSION All the countries reviewed face common challenges regarding the use of RWE. Our proposals address the need to facilitate collaboration and communication with industry and regulatory agencies and the need for specific guidelines describing RWE design and criteria of acceptance throughout the assessment and appraisal processes.
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Affiliation(s)
| | - Céline Coppo
- IQVIA, 17 bis Tsse. des Reflets, 92400 Courbevoie, France
| | - Laetitia Rey
- IQVIA, 17 bis Tsse. des Reflets, 92400 Courbevoie, France
| | - Amanda Carelli
- Roche, Rua Dr. Rubens Gomes Bueno, 691—Várzea de Baixo, São Paulo 04730-903, Brazil
| | - Veronica Díez
- F. Hoffmann-La Roche Ltd., C/Ribera del Loira 50, 28042 Madrid, Spain
| | | | - Liana Oliveira
- Roche, Rua Dr. Rubens Gomes Bueno, 691—Várzea de Baixo, São Paulo 04730-903, Brazil
| | - Ajay Patel
- Roche Products Ltd., Hexagon Place, Shire Park, Falcon Way, Welwyn Garden City AL7 1TW, UK
| | - Emilia Sicari
- Roche SpA, Viale Gian Battista Stucchi, 110, 20900 Monza, Italy
| | - Teresa Ramos
- F. Hoffmann-La Roche Ltd., C/Ribera del Loira 50, 28042 Madrid, Spain
| | - Susanne Schach
- Roche, Emil-Barell-Straße 1, 79639 Grenzach-Wyhlen, Germany
| | - Erika Schirghuber
- F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Alex Simpson
- F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Remy Choquet
- Roche, 4 Cr de l’Île Seguin, 92100 Boulogne-Billancourt, France
| | - Katell Le Lay
- Roche, 4 Cr de l’Île Seguin, 92100 Boulogne-Billancourt, France
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26
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Patell R, Hsu C, Shi M, Grosso MA, Duggal A, Buller HR, Raskob G, Zwicker JI. Impact of mild thrombocytopenia on bleeding and recurrent thrombosis in cancer. Haematologica 2024; 109:1849-1856. [PMID: 37855029 PMCID: PMC11141682 DOI: 10.3324/haematol.2023.284192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023] Open
Abstract
Thrombocytopenia occurs frequently in patients with cancer-associated thrombosis (CAT), however prospective evaluation of clinical outcomes following randomization to anticoagulants is limited. The HOKUSAI VTE Cancer study was a randomized, open-label, non-inferiority, phase III trial comparing dalteparin with edoxaban in CAT patients. This post hoc analysis of Hokusai VTE Cancer Study was performed to compare outcomes in patients with platelet count ≤100x109/L at one or more specified time points (baseline, 1-month, or 3-month) versus those without thrombocytopenia. Cumulative incidences at 180 days were calculated with death as a competing risk. The primary outcome was major bleeding; secondary outcomes were clinically relevant non-major bleeding (CRNMB), recurrent thrombosis, and survival. The analysis included 1,045 patients with primarily solid tumor malignancies (89%), median age 65 years, and 52% male. The thrombocytopenia group comprised 9.6% (N=101) of the cohort and relative to the non-thrombocytopenia cohort (N=944), experienced significantly higher major bleeding (9.0% vs. 4.0%, sub-distribution hazard ratio [SHR] =2.4; P=0.02) and CRNMB (17.9% vs. 9.6%, SHR=2.0; P=0.01). Thrombocytopenia did not impact recurrent venous thromboembolic event (VTE) (9.8% vs. 7.4%, SHR=1.3; P=0.37) nor overall mortality (21.8% vs. 26.0%, HR=0.9; P=0.48). Major bleeding was higher in patients with thrombocytopenia and gastrointestinal malignancies receiving edoxaban versus dalteparin (16.8% vs. 0; P<0.01) but similar for patients with other malignancies (P=0.30). In patients with hematologic malignances and thrombocytopenia major bleeding was higher for patients receiving dalteparin compared to edoxaban (19.0% vs. 0; P<0.01). Mild thrombocytopenia was associated with a doubling in risk of major hemorrhage in patients receiving anticoagulation for CAT. Bleeding risk for edoxaban and dalteparin varied in gastrointestinal and hematologic malignances in patients with thrombocytopenia (clinicaltrails gov. Identifier: NCT02073682).
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Affiliation(s)
- Rushad Patell
- Division of Hematology and Hematologic Malignancies, BIDMC, Boston, MA
| | - Charles Hsu
- Division of Hematology and Hematologic Malignancies, BIDMC, Boston, MA, USA; Department of Medicine, Hematology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Minggao Shi
- Daiichi Sankyo Pharma Development, Edison, NJ
| | | | - Anil Duggal
- Daiichi Sankyo Pharma Development, Edison, NJ
| | - Harry R Buller
- Department of Vascular Medicine, Amsterdam Academic Medical Center, Amsterdam, The Netherlands
| | - Gary Raskob
- Hudson College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jeffrey I Zwicker
- Department of Medicine, Hematology Service, Memorial Sloan Kettering Cancer Center, New York, NY.
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Littell JH. The Logic of Generalization From Systematic Reviews and Meta-Analyses of Impact Evaluations. EVALUATION REVIEW 2024; 48:427-460. [PMID: 38261473 DOI: 10.1177/0193841x241227481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Systematic reviews and meta-analyses are viewed as potent tools for generalized causal inference. These reviews are routinely used to inform decision makers about expected effects of interventions. However, the logic of generalization from research reviews to diverse policy and practice contexts is not well developed. Building on sampling theory, concerns about epistemic uncertainty, and principles of generalized causal inference, this article presents a pragmatic approach to generalizability assessment for use with systematic reviews and meta-analyses. This approach is applied to two systematic reviews and meta-analyses of effects of "evidence-based" psychosocial interventions for youth and families. Evaluations included in systematic reviews are not necessarily representative of populations and treatments of interest. Generalizability of results is limited by high risks of bias, uncertain estimates, and insufficient descriptive data from impact evaluations. Systematic reviews and meta-analyses can be used to test generalizability claims, explore heterogeneity, and identify potential moderators of effects. These reviews can also produce pooled estimates that are not representative of any larger sets of studies, programs, or people. Further work is needed to improve the conduct and reporting of impact evaluations and systematic reviews, and to develop practical approaches to generalizability assessment and guide applications of interventions in diverse policy and practice contexts.
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Affiliation(s)
- Julia H Littell
- Graduate School of Social Work and Social Research, Bryn Mawr College, Bryn Mawr, PA, USA
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Thangaraj PM, Oikonomou EK, Dhingra LS, Aminorroaya A, Jayaram R, Suchard MA, Khera R. Computational Phenomapping of Randomized Clinical Trials to Enable Assessment of their Real-world Representativeness and Personalized Inference. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.15.24306285. [PMID: 38798457 PMCID: PMC11118629 DOI: 10.1101/2024.05.15.24306285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Importance Randomized clinical trials (RCTs) are the standard for defining an evidence-based approach to managing disease, but their generalizability to real-world patients remains challenging to quantify. Objective To develop a multidimensional patient variable mapping algorithm to quantify the similarity and representation of electronic health record (EHR) patients corresponding to an RCT and estimate the putative treatment effects in real-world settings based on individual treatment effects observed in an RCT. Design A retrospective analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT; 2006-2012) and a multi-hospital patient cohort from the electronic health record (EHR) in the Yale New Haven Hospital System (YNHHS; 2015-2023). Setting A multicenter international RCT (TOPCAT) and multi-hospital patient cohort (YNHHS). Participants All TOPCAT participants and patients with heart failure with preserved ejection fraction (HFpEF) and ≥1 hospitalization within YNHHS. Exposures 63 pre-randomization characteristics measured across the TOPCAT and YNNHS cohorts. Main Outcomes and Measures Real-world generalizability of the RCT TOPCAT using a multidimensional phenotypic distance metric between TOPCAT and YNHHS cohorts. Estimation of the individualized treatment effect of spironolactone use on all-cause mortality within the YNHHS cohort based on phenotypic distance from the TOPCAT cohort. Results There were 3,445 patients in TOPCAT and 11,712 HFpEF patients across five hospital sites. Across the 63 TOPCAT variables mapped by clinicians to the EHR, there were larger differences between TOPCAT and each of the 5 EHR sites (median SMD 0.200, IQR 0.037-0.410) than between the 5 EHR sites (median SMD 0.062, IQR 0.010-0.130). The synthesis of these differences across covariates using our multidimensional similarity score also suggested substantial phenotypic dissimilarity between the TOPCAT and EHR cohorts. By phenotypic distance, a majority (55%) of TOPCAT participants were closer to each other than any individual EHR patient. Using a TOPCAT-derived model of individualized treatment benefit from spironolactone, those predicted to derive benefit and receiving spironolactone in the EHR cohorts had substantially better outcomes compared with predicted benefit and not receiving the medication (HR 0.74, 95% CI 0.62-0.89). Conclusions and Relevance We propose a novel approach to evaluating the real-world representativeness of RCT participants against corresponding patients in the EHR across the full multidimensional spectrum of the represented phenotypes. This enables the evaluation of the implications of RCTs for real-world patients. KEY POINTS Question: How can we examine the multi-dimensional generalizability of randomized clinical trials (RCT) to real-world patient populations?Findings: We demonstrate a novel phenotypic distance metric comparing an RCT to real-world populations in a large multicenter RCT of heart failure patients and the corresponding patients in multisite electronic health records (EHRs). Across 63 pre-randomization characteristics, pairwise assessments of members of the RCT and EHR cohorts were more discordant from each other than between members of the EHR cohort (median standardized mean difference 0.200 [0.037-0.410] vs 0.062 [0.010-0.130]), with a majority (55%) of RCT participants closer to each other than any individual EHR patient. The approach also enabled the quantification of expected real world outcomes based on effects observed in the RCT.Meaning: A multidimensional phenotypic distance metric quantifies the generalizability of RCTs to a given population while also offering an avenue to examine expected real-world patient outcomes based on treatment effects observed in the RCT.
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Heuts S, Gabrio A, Veenstra L, Maesen B, Kats S, Maessen JG, Walton AS, Nanayakkara S, Lansky AJ, van 't Hof AWJ, Vriesendorp PA. Stroke reduction by cerebral embolic protection devices in transcatheter aortic valve implantation: a systematic review and Bayesian meta-analysis. Heart 2024; 110:757-765. [PMID: 37996242 DOI: 10.1136/heartjnl-2023-323359] [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: 08/19/2023] [Accepted: 10/19/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVES The use of cerebral embolic protection (CEP) during transcatheter aortic valve implantation (TAVI) has been studied in several randomised trials. We aimed to perform a systematic review and Bayesian meta-analysis of randomised CEP trials, focusing on a clinically relevant reduction in disabling stroke. METHODS A systematic search was applied to three electronic databases, including trials that randomised TAVI patients to CEP versus standard treatment. The primary outcome was the risk of disabling stroke. Outcomes were presented as relative risk (RR), absolute risk differences (ARDs), numbers needed to treat (NNTs) and the 95% credible intervals (CrIs). The minimal clinically important difference was determined at 1.1% ARD, per expert consensus (NNT 91). The principal Bayesian meta-analysis was performed under a vague prior, and secondary analyses were performed under two informed literature-based priors. RESULTS Seven randomised studies were included for meta-analysis (n=3996: CEP n=2126, control n=1870). Under a vague prior, the estimated median RR of CEP use for disabling stroke was 0.56 (95% CrI 0.28 to 1.19, derived ARD 0.56% and NNT 179, I2=0%). Although the estimated posterior probability of any benefit was 94.4%, the probability of a clinically relevant effect was 0-0.1% under the vague and informed literature-based priors. Results were robust across multiple sensitivity analyses. CONCLUSION There is a high probability of a beneficial CEP treatment effect, but this is unlikely to be clinically relevant. These findings suggest that future trials should focus on identifying TAVI patients with an increased baseline risk of stroke, and on the development of new generation devices. PROSPERO REGISTRATION NUMBER CRD42023407006.
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Affiliation(s)
- Samuel Heuts
- Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Andrea Gabrio
- Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Leo Veenstra
- Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Bart Maesen
- Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Suzanne Kats
- Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jos G Maessen
- Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Antony S Walton
- Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- Heart Failure Research Group, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Shane Nanayakkara
- Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- Heart Failure Research Group, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Alexandra J Lansky
- Yale Cardiovascular Research Group, Yale Medical School, New Haven, Connecticut, USA
| | - Arnoud W J van 't Hof
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Pieter A Vriesendorp
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
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Stalsberg R, Darvik MD. Social Representativeness and Intervention Adherence-A Systematic Review of Clinical Physical Activity Trials in Breast Cancer Patients. Int J Public Health 2024; 69:1607002. [PMID: 38784387 PMCID: PMC11111874 DOI: 10.3389/ijph.2024.1607002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/10/2024] [Indexed: 05/25/2024] Open
Abstract
Objectives Representativeness in physical activity randomised controlled trials (RCT) in breast cancer patients is essential to analyses of feasibility and validity considering privileged- social groups. A step-by-step exclusion of less privileged groups through the trial process could reinforce health inequality. This study aimed at examining representativeness in breast cancer (BC) physical activity trials, investigate associations between socio-economic status (SES) and intervention adherence, and explore associations between representativeness and the relationship between SES and intervention adherence. Methods Systematic, computerised searches were performed in PubMed, CINAHL, AMED, EMBASE and PsycINFO. Additional citation-based searches retrieved 37 articles. Distributions of education level, ethnicity, and marital status in study samples were compared to national populations data to estimate representativeness in less privileged groups. Results A preponderance of studies favoured educated, married and white patients. Only six studies reported SES-adherence associations, hampering conclusions on this relationship and possible associations between representativeness and an SES-adherence relationship. Conclusion Less educated, unmarried and non-white individuals may be underrepresented in BC physical activity RCTs, while SES-adherence associations in such trials are inconclusive. Unintentional social misrepresentations may indicate that disguised inequity warrants revived attention.
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Affiliation(s)
- Ragna Stalsberg
- Department of Circulation and Medical Imaging, Norwegian University of Technology and Science (NTNU), Trondheim, Norway
| | - Monica Dahle Darvik
- Department of Neuromedicine and Movement Science, Norwegian University of Technology and Science (NTNU), Trondheim, Norway
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31
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Cheng W, Zhang D, Lei LL, Li K. Effects of Bright Light Therapy on Agitation Among Older Adults Living with Dementia in Macao: A Pilot Study. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024:1-19. [PMID: 38701196 DOI: 10.1080/01634372.2024.2349603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/26/2024] [Indexed: 05/05/2024]
Abstract
A randomized controlled trial was conducted to examine the effects of bright light therapy on agitation in older adults with dementia in Macao. This study involved 31 participants: 10 in the outdoor light treatment group, 11 in the indoor light-box treatment group, and 10 in the control group. Significant reductions in agitation were observed in the two treatment groups over four weeks compared to the control group. However, no statistical difference in cognitive function between experimental and control groups was found. This study supports the use of bright light therapy to reduce agitation in older people with dementia.
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Affiliation(s)
- Wanqing Cheng
- Department of Innovative Social Work, Faculty of Humanities and Social Sciences, City University of Macau, Macao, China
| | - Donghang Zhang
- Department of Innovative Social Work, Faculty of Humanities and Social Sciences, City University of Macau, Macao, China
| | | | - Keyang Li
- Institute of Analytical Psychology, Faculty of Humanities and Social Sciences, City University of Macau, Macao, China
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32
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Thomas SE, Barenbrug L, Hannink G, Seyger MMB, de Jong EMGJ, van den Reek JMPA. Drug Survival of IL-17 and IL-23 Inhibitors for Psoriasis: A Systematic Review and Meta-Analysis. Drugs 2024; 84:565-578. [PMID: 38630365 PMCID: PMC11190018 DOI: 10.1007/s40265-024-02028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND AND OBJECTIVE The most recently approved biologics for moderate-to-severe psoriasis are the interleukin (IL)-17 and IL-23 inhibitors. Drug survival is a frequently used outcome to assess drug performance in practice. An overview of the available drug survival studies regarding IL-17 and IL-23 inhibitors is lacking. Therefore, our objective was to assess the drug survival of IL-17 and IL-23 inhibitors for psoriasis. METHODS A search of PubMed, Embase, Cochrane Library and Web of Science was conducted (last search 27 December, 2023). Inclusion criteria were (1) cohort study; (2) patients aged ≥ 18 years with plaque psoriasis; and (3) evaluation of drug survival of at least one of the IL-17 and IL-23 inhibitors. Exclusion criteria were: primary focus on patients with psoriatic arthritis, fewer than ten study subjects and another language than English. The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed. Survival probabilities at monthly intervals were extracted from Kaplan-Meier curves using a semi-automated tool. Data were pooled using a non-parametric random-effects model to retrieve distribution-free summary survival curves. Summary drug survival curves were constructed per biologic for different discontinuation reasons: overall, ineffectiveness and adverse events, and split for the effect modifier biologic naivety. Results were analysed separately for registry/electronic health record data and for pharmacy/claims data. RESULTS A total of 69 studies aggregating drug survival outcomes of 48,704 patients on secukinumab, ixekizumab, brodalumab, guselkumab, risankizumab, and tildrakizumab were included. Summary drug survival estimates of registry/electronic health record studies for overall, ineffectiveness and adverse event related drug survival were high (all point estimates ≥ 0.8 at year 1) for included biologics, with highest estimates for guselkumab and risankizumab. All estimates for drug survival were higher in biologic naive than in experienced patients. Estimates of pharmacy/claims databases were substantially lower than estimates from the primary analyses based on registry/electronic health record data. CONCLUSIONS This meta-analysis showed that the investigated IL-17 and IL-23 inhibitors had high drug survival rates, with highest rates for guselkumab and risankizumab drug survival. We showed that effect modifiers such as biologic naivety, and the source of data used (registry/electronic health record data vs pharmacy/claims databases) is relevant when interpreting drug survival studies.
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Affiliation(s)
- Sarah E Thomas
- Department of Dermatology, Radboud University Medical Centre (Radboudumc), Mailbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Liana Barenbrug
- Department of Dermatology, Radboud University Medical Centre (Radboudumc), Mailbox 9101, 6500 HB, Nijmegen, The Netherlands
| | - Gerjon Hannink
- Department of Medical Imaging, Radboud University Medical Centre (Radboudumc), Nijmegen, The Netherlands
| | - Marieke M B Seyger
- Department of Dermatology, Radboud University Medical Centre (Radboudumc), Mailbox 9101, 6500 HB, Nijmegen, The Netherlands
| | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Centre (Radboudumc), Mailbox 9101, 6500 HB, Nijmegen, The Netherlands
- Radboud University, Nijmegen, The Netherlands
| | - Juul M P A van den Reek
- Department of Dermatology, Radboud University Medical Centre (Radboudumc), Mailbox 9101, 6500 HB, Nijmegen, The Netherlands
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McGinty EE, Alegria M, Beidas RS, Braithwaite J, Kola L, Leslie DL, Moise N, Mueller B, Pincus HA, Shidhaye R, Simon K, Singer SJ, Stuart EA, Eisenberg MD. The Lancet Psychiatry Commission: transforming mental health implementation research. Lancet Psychiatry 2024; 11:368-396. [PMID: 38552663 DOI: 10.1016/s2215-0366(24)00040-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 04/19/2024]
Affiliation(s)
| | - Margarita Alegria
- Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rinad S Beidas
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Lola Kola
- College of Medicine, University of Ibadan, Ibadan, Nigeria; Kings College London, London, UK
| | | | | | | | | | - Rahul Shidhaye
- Pravara Institute of Medical Sciences University, Loni, India; Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | | | - Sara J Singer
- Stanford University School of Medicine, Stanford, CA, USA
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Gandaglia G, Pellegrino F, Golozar A, De Meulder B, Abbott T, Achtman A, Imran Omar M, Alshammari T, Areia C, Asiimwe A, Beyer K, Bjartell A, Campi R, Cornford P, Falconer T, Feng Q, Gong M, Herrera R, Hughes N, Hulsen T, Kinnaird A, Lai LYH, Maresca G, Mottet N, Oja M, Prinsen P, Reich C, Remmers S, Roobol MJ, Sakalis V, Seager S, Smith EJ, Snijder R, Steinbeisser C, Thurin NH, Hijazy A, van Bochove K, Van den Bergh RCN, Van Hemelrijck M, Willemse PP, Williams AE, Zounemat Kermani N, Evans-Axelsson S, Briganti A, N'Dow J. Clinical Characterization of Patients Diagnosed with Prostate Cancer and Undergoing Conservative Management: A PIONEER Analysis Based on Big Data. Eur Urol 2024; 85:457-465. [PMID: 37414703 DOI: 10.1016/j.eururo.2023.06.012] [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: 12/26/2022] [Revised: 05/18/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Conservative management is an option for prostate cancer (PCa) patients either with the objective of delaying or even avoiding curative therapy, or to wait until palliative treatment is needed. PIONEER, funded by the European Commission Innovative Medicines Initiative, aims at improving PCa care across Europe through the application of big data analytics. OBJECTIVE To describe the clinical characteristics and long-term outcomes of PCa patients on conservative management by using an international large network of real-world data. DESIGN, SETTING, AND PARTICIPANTS From an initial cohort of >100 000 000 adult individuals included in eight databases evaluated during a virtual study-a-thon hosted by PIONEER, we identified newly diagnosed PCa cases (n = 527 311). Among those, we selected patients who did not receive curative or palliative treatment within 6 mo from diagnosis (n = 123 146). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patient and disease characteristics were reported. The number of patients who experienced the main study outcomes was quantified for each stratum and the overall cohort. Kaplan-Meier analyses were used to estimate the distribution of time to event data. RESULTS AND LIMITATIONS The most common comorbidities were hypertension (35-73%), obesity (9.2-54%), and type 2 diabetes (11-28%). The rate of PCa-related symptomatic progression ranged between 2.6% and 6.2%. Hospitalization (12-25%) and emergency department visits (10-14%) were common events during the 1st year of follow-up. The probability of being free from both palliative and curative treatments decreased during follow-up. Limitations include a lack of information on patients and disease characteristics and on treatment intent. CONCLUSIONS Our results allow us to better understand the current landscape of patients with PCa managed with conservative treatment. PIONEER offers a unique opportunity to characterize the baseline features and outcomes of PCa patients managed conservatively using real-world data. PATIENT SUMMARY Up to 25% of men with prostate cancer (PCa) managed conservatively experienced hospitalization and emergency department visits within the 1st year after diagnosis; 6% experienced PCa-related symptoms. The probability of receiving therapies for PCa decreased according to time elapsed after the diagnosis.
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Affiliation(s)
- Giorgio Gandaglia
- Guidelines Office, European Association of Urology, Arnhem, The Netherlands; Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Francesco Pellegrino
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Asieh Golozar
- Odysseus Data Services, New York, NY, USA; OHDSI Center, Northeastern University, Boston, MA, USA
| | | | | | | | - Muhammad Imran Omar
- Guidelines Office, European Association of Urology, Arnhem, The Netherlands; Academic Urology Unit, University of Aberdeen, Scotland, UK
| | | | | | | | - Katharina Beyer
- Translational Oncology and Urology Research, King's College London, London, UK
| | - Anders Bjartell
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Riccardo Campi
- Guidelines Office, European Association of Urology, Arnhem, The Netherlands; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Thomas Falconer
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Qi Feng
- Astellas Pharma, Inc., Northbrook, IL, USA
| | - Mengchun Gong
- Nanfang Hospital, Southern Medical University, Guangzhou, China; DHC Technologies, Beijing, China
| | | | | | - Tim Hulsen
- Philips Research, Department of Hospital Services & Informatics, Eindhoven, The Netherlands
| | | | | | | | - Nicolas Mottet
- Guidelines Office, European Association of Urology, Arnhem, The Netherlands
| | - Marek Oja
- Institute of Computer Science, University of Tartu, Tartu, Estonia; STACC, Tartu, Estonia
| | - Peter Prinsen
- Netherlands Comprehensive Cancer Organization, Eindhoven, The Netherlands
| | | | - Sebastiaan Remmers
- Erasmus University Medical Centre, Cancer Institute, Rotterdam, The Netherlands
| | - Monique J Roobol
- Erasmus University Medical Centre, Cancer Institute, Rotterdam, The Netherlands
| | - Vasileios Sakalis
- Department of Urology, General Hospital of Thessaloniki Agios Pavlos, Thessaloniki, Greece
| | | | - Emma J Smith
- Guidelines Office, European Association of Urology, Arnhem, The Netherlands
| | | | | | - Nicolas H Thurin
- INSERM CIC-P 1401, Bordeaux PharmacoEpi, Université de Bordeaux, Bordeaux, France
| | | | | | | | | | - Peter-Paul Willemse
- Guidelines Office, European Association of Urology, Arnhem, The Netherlands; Department of Urology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrew E Williams
- The Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, MA, USA
| | | | | | - Alberto Briganti
- Guidelines Office, European Association of Urology, Arnhem, The Netherlands; Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - James N'Dow
- Guidelines Office, European Association of Urology, Arnhem, The Netherlands; Academic Urology Unit, University of Aberdeen, Scotland, UK
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Cazzola M, Stolz D, Bafadhel M, Rogliani P. Understanding evidence from randomised controlled trials and meta-analyses: a comparative overview. Eur Respir J 2024; 63:2400694. [PMID: 38816037 DOI: 10.1183/13993003.00694-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/18/2024] [Indexed: 06/01/2024]
Affiliation(s)
- Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Daiana Stolz
- Department of Pneumology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Mona Bafadhel
- King's Centre of Lung Health, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy
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Cavallaro F, Clery A, Gilbert R, van der Meulen J, Kendall S, Kennedy E, Phillips C, Harron K. Evaluating the real-world implementation of the Family Nurse Partnership in England: a data linkage study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-223. [PMID: 38784984 DOI: 10.3310/bvdw6447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Background/objectives The Family Nurse Partnership is an intensive home visiting programme for adolescent mothers. We aimed to evaluate the effectiveness of the Family Nurse Partnership on outcomes up to age 7 using national administrative data. Design We created a linked cohort of all mothers aged 13-19 using data from health, educational and children's social care and defined mothers enrolled in the Family Nurse Partnership or not using Family Nurse Partnership system data. Propensity scores were used to create matched groups for analysis. Setting One hundred and thirty-six local authorities in England with active Family Nurse Partnership sites between 2010 and 2017. Participants Mothers aged 13-19 at last menstrual period with live births between April 2010 and March 2019, living in a Family Nurse Partnership catchment area and their firstborn child(ren). Interventions The Family Nurse Partnership includes up to 64 home visits by a family nurse from early pregnancy until the child's second birthday and is combined with usual health and social care. Controls received usual health and social care. Main outcome measures Indicators of child maltreatment (hospital admissions for injury/maltreatment, referral to social care services); child health and development (hospital utilisation and education) outcomes and maternal hospital utilisation and educational outcomes up to 7 years following birth. Data sources Family Nurse Partnership Information System, Hospital Episode Statistics, National Pupil Database. Results Of 110,520 eligible mothers, 25,680 (23.2%) were enrolled in the Family Nurse Partnership. Enrolment rates varied across 122 sites (range: 11-68%). Areas with more eligible mothers had lower enrolment rates. Enrolment was higher among mothers aged 13-15 (52%), than 18-19 year-olds (21%). Indicators of child maltreatment: we found no evidence of an association between the Family Nurse Partnership and indicators of child maltreatment, except for an increased rate of unplanned admissions for maltreatment/injury-related diagnoses up to age 2 for children born to Family Nurse Partnership mothers (6.6% vs. 5.7%, relative risk 1.15; 95% confidence interval 1.07 to 1.24). Child health and developmental outcomes: there was weak evidence that children born to Family Nurse Partnership mothers were more likely to achieve a Good Level of Development at age 5 (57.5% vs. 55.4%, relative risk 1.05; 95% confidence interval 1.00 to 1.09). Maternal outcomes: There was some evidence that Family Nurse Partnership mothers were less likely to have a subsequent delivery within 18 months of the index birth (8.4% vs. 9.3%, relative risk 0.92; 95% confidence interval 0.88 to 0.97). Younger and more vulnerable mothers received higher numbers of visits and were more likely to achieve fidelity targets. Meeting the fidelity targets was associated with some outcomes. Limitations Bias by indication and variation in the intervention and usual care over time and between areas may have limited our ability to detect effects. Multiple testing may have led to spurious, significant results. Conclusions This study supports findings from evaluations of the Family Nurse Partnership showing no evidence of benefit for maltreatment outcomes measured in administrative data. Amongst all the outcomes measured, we found weak evidence that the Family Nurse Partnership was associated with improvements in child development at school entry, a reduction in rapid repeat pregnancies and evidence of increased healthcare-seeking in the mother and child. Future work Future evaluations should capture better measures of Family Nurse Partnership interventions and usual care, more information on maternal risk factors and additional outcomes relating to maternal well-being. Study registration The study is registered as NIHR CRN Portfolio (42900). Funding This award was funded by the National Institute of Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/99/19) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 11. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
| | - Amanda Clery
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ruth Gilbert
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jan van der Meulen
- UCL Great Ormond Street Institute of Child Health, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Sally Kendall
- UCL Great Ormond Street Institute of Child Health, London, UK
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Eilis Kennedy
- UCL Great Ormond Street Institute of Child Health, London, UK
- Eilis Kennedy, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Catherine Phillips
- UCL Great Ormond Street Institute of Child Health, London, UK
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Katie Harron
- UCL Great Ormond Street Institute of Child Health, London, UK
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Lee D, Yang S, Berry M, Stinchcombe T, Cohen HJ, Wang X. genRCT: a statistical analysis framework for generalizing RCT findings to real-world population. J Biopharm Stat 2024:1-20. [PMID: 38590156 DOI: 10.1080/10543406.2024.2333136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
When evaluating the real-world treatment effect, the analysis based on randomized clinical trials (RCTs) often introduces generalizability bias due to the difference in risk factors between the trial participants and the real-world patient population. This problem of lack of generalizability associated with the RCT-only analysis can be addressed by leveraging observational studies with large sample sizes that are representative of the real-world population. A set of novel statistical methods, termed "genRCT", for improving the generalizability of the trial has been developed using calibration weighting, which enforces the covariates balance between the RCT and observational study. This paper aims to review statistical methods for generalizing the RCT findings by harnessing information from large observational studies that represent real-world patients. Specifically, we discuss the choices of data sources and variables to meet key theoretical assumptions and principles. We introduce and compare estimation methods for continuous, binary, and survival endpoints. We showcase the use of the R package genRCT through a case study that estimates the average treatment effect of adjuvant chemotherapy for the stage 1B non-small cell lung patients represented by a large cancer registry.
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Affiliation(s)
- Dasom Lee
- Department of Statistics, North Carolina State University, Elk Grove, USA
| | - Shu Yang
- Department of Statistics, North Carolina State University, Elk Grove, USA
| | - Mark Berry
- Department of Cardiothoracic Surgery, Stanford University, Stanford, USA
| | | | | | - Xiaofei Wang
- Department of Biostatistics & Bioinformatics, Duke University, Durham, USA
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Muñoz MA, Dal Pan GJ, Wei YJJ, Xiao H, Delcher C, Giffin A, Sadiq N, Winterstein AG. Sociodemographic Characteristics of Adverse Event Reporting in the USA: An Ecologic Study. Drug Saf 2024; 47:377-387. [PMID: 38353883 PMCID: PMC10955028 DOI: 10.1007/s40264-024-01397-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION The Food and Drug Administration Adverse Event Reporting System (FAERS) is a vital source of new drug safety information, but whether adverse event (AE) information collected from these systems adequately captures experiences of the overall United States (US) population is unknown. OBJECTIVE To examine determinants of consumer AE reporting in the USA. METHODS Five-year AE reporting rate per 100,000 residents per US county were calculated, mapped, and quartiled for AE reports received directly from consumers between 2011 and 2015. Associations between county-level sociodemographic factors obtained from County Health Rankings and AE reporting rates were evaluated using negative binomial regression. RESULTS Reporting rates were variable across US counties with > 17.6 reports versus ≤ 5.5 reports/100,000 residents in the highest and lowest reporting quartile, respectively. Controlling for drug utilization, counties with higher reporting rates had higher proportions of individuals age ≥ 65 years (e.g., 2.4% reporting increase per 1% increase in individuals age > 65, incidence rate ratio (IRR): 1.024, 95% confidence interval (CI): 1.017-1.030), higher proportions of females (IRR: 1.027, 95% CI 1.012-1.043), uninsured (IRR: 1.009, 95% CI 1.005-1.013), higher median log household incomes (IRR: 1.897, 95% CI 1.644-2.189) and more mental health providers per 100,000 residents (IRR: 1.003, 95% CI 1.001-1.004). Lower reporting was observed in counties with higher proportions of individuals age ≤ 18 years (IRR: 0.966, 95% CI 0.959-0.974), American Indian or Alaska Native individuals (IRR: 0.991, 95% CI 0.986-0.996), individuals not proficient in English (IRR: 0.978, 95% CI 0.965-0.991), and individuals residing in rural areas within a county (IRR: 0.998, 95% CI 0.997-0.998). CONCLUSIONS Observed variations in consumer AE reporting may be related to sociodemographic factors and healthcare access. Because these factors may also correspond to AE susceptibility, voluntary AE reporting systems may be suboptimal for capturing emerging drug safety concerns among more vulnerable populations.
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Affiliation(s)
- Monica A Muñoz
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
| | - Gerald J Dal Pan
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Yu-Jung Jenny Wei
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA
- Division of Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Hong Xiao
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Chris Delcher
- Department of Pharmacy Practice and Science, College of Pharmacy, Institute for Pharmaceutical Outcomes and Policy, University of Kentucky, Lexington, KY, USA
| | - Andrew Giffin
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Nabila Sadiq
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA
- Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
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Ryan CG, Karran EL, Wallwork SB, Pate JW, O'Keeffe M, Fullen BM, Livadas N, Jones N, Toumbourou JW, Gilchrist P, Cameron PA, Fatoye F, Ravindran D, Lorimer Moseley G. We Are All in This Together-Whole of Community Pain Science Education Campaigns to Promote Better Management of Persistent Pain. THE JOURNAL OF PAIN 2024; 25:902-917. [PMID: 37918470 DOI: 10.1016/j.jpain.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/02/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
Persistent pain is a major public health issue-estimated to affect a quarter of the world's population. Public understanding of persistent pain is based on outdated biomedical models, laden with misconceptions that are contrary to best evidence. This understanding is a barrier to effective pain management. Thus, there have been calls for public health-based interventions to address these misconceptions. Previous pain-focussed public education campaigns have targeted pain beliefs and behaviours that are thought to promote recovery, such as staying active. However, prevailing pain-related misconceptions render many of these approaches counter-intuitive, at best. Pain Science Education improves understanding of 'how pain works' and has been demonstrated to improve pain and disability outcomes. Extending Pain Science Education beyond the clinic to the wider community seems warranted. Learning from previous back pain-focussed and other public health educational campaigns could optimise the potential benefit of such a Pain Science Education campaign. Pain Science Education-grounded campaigns have been delivered in Australia and the UK and show promise, but robust evaluations are needed before any firm conclusions on their population impact can be made. Several challenges exist going forward. Not least is the need to ensure all stakeholders are involved in the development and implementation of Pain Science Education public messaging campaigns. Furthermore, it is crucial that campaigns are undertaken through a health equity lens, incorporating underrepresented communities to ensure that any intervention does not widen existing health inequalities associated with persistent pain. PERSPECTIVE: Public misconceptions about pain are a significant public health challenge and a viable intervention target to reduce the personal, social, and economic burden of persistent pain. Adaptation of Pain Science Education, which improves misconceptions in a clinical setting, into the public health setting seems a promising approach to explore.
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Affiliation(s)
- Cormac G Ryan
- Pain Education Team to Advance Learning (PETAL) Collaboration; Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, UK
| | - Emma L Karran
- Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Sarah B Wallwork
- Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Joshua W Pate
- Pain Education Team to Advance Learning (PETAL) Collaboration; Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Mary O'Keeffe
- Pain Education Team to Advance Learning (PETAL) Collaboration; Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, University of Sydney, Australia
| | - Brona M Fullen
- Pain Education Team to Advance Learning (PETAL) Collaboration; UCD School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
| | - Nick Livadas
- Pain Education Team to Advance Learning (PETAL) Collaboration; Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, UK
| | - Niki Jones
- Pain Education Team to Advance Learning (PETAL) Collaboration
| | - John W Toumbourou
- Pain Education Team to Advance Learning (PETAL) Collaboration; Deakin University, School of Psychology and Centre for Social and Early Emotional Development, Geelong, Australia
| | - Peter Gilchrist
- Pain Education Team to Advance Learning (PETAL) Collaboration; The University of Adelaide Rural Clinical School, Rural Generalist Program, South Australia
| | - Paul A Cameron
- Pain Education Team to Advance Learning (PETAL) Collaboration; Fife Health & Social Care Partnership, Scotland, UK; School of Medicine, Cardiff University, UK
| | - Francis Fatoye
- Pain Education Team to Advance Learning (PETAL) Collaboration; Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, UK; Lifestyle Disease Entity, North-West University, South Africa
| | - Deepak Ravindran
- Pain Education Team to Advance Learning (PETAL) Collaboration; Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, UK; Department of Pain Medicine, Royal Berkshire NHS Foundation Trust, UK
| | - G Lorimer Moseley
- Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
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Ellen JG, Matos J, Viola M, Gallifant J, Quion J, Anthony Celi L, Abu Hussein NS. Participant flow diagrams for health equity in AI. J Biomed Inform 2024; 152:104631. [PMID: 38548006 DOI: 10.1016/j.jbi.2024.104631] [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: 09/30/2023] [Revised: 12/29/2023] [Accepted: 03/26/2024] [Indexed: 04/01/2024]
Abstract
Selection bias can arise through many aspects of a study, including recruitment, inclusion/exclusion criteria, input-level exclusion and outcome-level exclusion, and often reflects the underrepresentation of populations historically disadvantaged in medical research. The effects of selection bias can be further amplified when non-representative samples are used in artificial intelligence (AI) and machine learning (ML) applications to construct clinical algorithms. Building on the "Data Cards" initiative for transparency in AI research, we advocate for the addition of a participant flow diagram for AI studies detailing relevant sociodemographic and/or clinical characteristics of excluded participants across study phases, with the goal of identifying potential algorithmic biases before their clinical implementation. We include both a model for this flow diagram as well as a brief case study explaining how it could be implemented in practice. Through standardized reporting of participant flow diagrams, we aim to better identify potential inequities embedded in AI applications, facilitating more reliable and equitable clinical algorithms.
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Affiliation(s)
| | - João Matos
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA; Faculty of Engineering, University of Porto, Porto, Portugal; Institute for Systems and Computer Engineering, Technology and Science (INESCTEC), Porto, Portugal
| | | | - Jack Gallifant
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Critical Care, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Justin Quion
- University of the East Ramon Magsaysay Memorial Medical School, Quezon City, Philippines
| | - Leo Anthony Celi
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Rivelli A, Lefaiver C, Shields M, Ozoani-Lohrer O, Marek A, Hirschtick J, Fitzpatrick V. A novel approach to assessing disparity in representativeness of clinical trial participants within a large midwestern healthcare system. Contemp Clin Trials Commun 2024; 38:101274. [PMID: 38390273 PMCID: PMC10881410 DOI: 10.1016/j.conctc.2024.101274] [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: 10/02/2023] [Revised: 01/09/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
Background Representativeness in clinical trials (CT) serves as a metric of access to healthcare and reflects differences that may determine differential efficacy of medical interventions; thus, quantifying representativeness in CT participation is critical. Methods This retrospective, descriptive study utilized patient demographic data extracted from the largest Midwestern non-profit healthcare system. Using data between January 1, 2019 and December 31, 2021, a CT Participant Sample of 4,537 system patients who were active CT participants was compared to a CT Patient Population of 195,726 system patients receiving care by the PI of active CTs, which represented the target population. Chi-square goodness-of-fit tests were used to test differences in distributions of demographic variables between groups, indicating disparity in CT participation. Two metrics adapted from literature - participation incidence disparity (PID) and participation incidence ratio (PIR) - were calculated to quantify absolute and relative disparity in representativeness proportions, respectively. Descriptive approaches to assessing representativeness are also provided. Results Results showed significant differences by race/ethnicity (χ2 = 50.64; p < 0.0001), age categories (χ2 = 56.64; p < 0.0001), and insurance (χ2 = 41.29; p < 0.0001). PID and PIR metrics revealed reduced CT participation among non-White racial/ethnic groups and increased CT participation among White Non-Hispanic patients. Further, CT participants ≥80 or Worker's Compensation were underrepresented while those with Self-Pay insurance were overrepresented as CT participants. Conclusions Despite progress, continued efforts to not only enroll participants into CTs that are representative of the healthcare system and region, but also to better assess representativeness quantitatively are still needed.
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Affiliation(s)
- Anne Rivelli
- Advocate Aurora Research Institute, Milwaukee, WI, USA
- Advocate Health, Milwaukee, WI, USA
| | - Cheryl Lefaiver
- Advocate Aurora Research Institute, Milwaukee, WI, USA
- Center for Child and Family Research, Milwaukee, WI, USA
- Advocate Health, Milwaukee, WI, USA
| | - Maureen Shields
- Advocate Aurora Research Institute, Milwaukee, WI, USA
- Advocate Health, Milwaukee, WI, USA
| | - Osondi Ozoani-Lohrer
- Advocate Aurora Research Institute, Milwaukee, WI, USA
- Center for Child and Family Research, Milwaukee, WI, USA
| | - Andy Marek
- Advocate Aurora Research Institute, Milwaukee, WI, USA
- Advocate Health, Milwaukee, WI, USA
| | - Jana Hirschtick
- Advocate Aurora Research Institute, Milwaukee, WI, USA
- Advocate Health, Milwaukee, WI, USA
| | - Veronica Fitzpatrick
- Advocate Aurora Research Institute, Milwaukee, WI, USA
- Advocate Health, Milwaukee, WI, USA
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van der Hulst HC, van der Bol JM, Bastiaannet E, Portielje JEA, Dekker JWT. The effect of prehabilitation on long-term survival and hospital admissions in older patients undergoing elective colorectal cancer surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108244. [PMID: 38452716 DOI: 10.1016/j.ejso.2024.108244] [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: 10/24/2023] [Revised: 01/17/2024] [Accepted: 03/01/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION There is a growing body of evidence for a beneficial effect of prehabilitation on short-term outcomes after colorectal cancer (CRC) surgery in older patients. However, long-term effects on survival or hospital admissions have not been investigated. This study reports these long-term outcomes from a previously published observational cohort study. METHODS We compared patients ≥75 years who received elective CRC surgery in Reinier de Graaf Hospital before (2010-2013: standard care) and after implementation of a multimodal prehabilitation program (2014-2015; prehabilitation). With a six-year follow-up period, we analyzed survival using the Kaplan-Meier method and the occurrence of one or more hospital admissions using logistic regression analyses. RESULTS Overall, 137 patients were included in the standard care group and 86 patients in the prehabilitation group. There were no differences in patients, tumor and treatment characteristics. After six years, 51.1% in the standard care group and 59.3% in the prehabilitation group (p = 0.167) were still alive. When corrected for confounders in the prehabilitation group less patients had one or more hospital admissions during follow-up (odds ratio (OR) 0.43 (95% CI 0.24-0.77). CONCLUSIONS Unfortunately these limited historical cohorts did not allow for strong conclusions concerning long-time survival. However, after prehabilitation less patients had hospital admissions during follow up. Hopefully, this first study into the long-term effects of multimodal prehabilitation will trigger more future research.
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Affiliation(s)
- Heleen C van der Hulst
- Department of Surgery, Reinier De Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, the Netherlands.
| | - Jessica M van der Bol
- Department of Geriatric Medicine, Reinier De Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, the Netherlands
| | - Esther Bastiaannet
- Institute of Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
| | - Johanna E A Portielje
- Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Jan Willem T Dekker
- Department of Surgery, Reinier De Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, the Netherlands
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Rosenfield MN, Beaudoin FL, Gaither R, Hallowell BD, Daly MM, Marshall BDL, Chambers LC. Association between comorbid chronic pain or prior hospitalization for mental illness and substance use treatment among a cohort at high risk of opioid overdose. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209273. [PMID: 38113996 DOI: 10.1016/j.josat.2023.209273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/25/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Chronic pain and serious mental illness increase risk of opioid use, and opioid use can exacerbate both conditions. Substance use disorder (SUD) treatment can be lifesaving, but chronic pain and serious mental illness may make recovery challenging. We evaluated the association between current chronic pain and prior hospitalization for mental illness and 90-day SUD treatment engagement, among emergency department (ED) patients at high risk of opioid overdose. METHODS We conducted a cohort analysis of 648 ED patients enrolled in a randomized controlled trial in Rhode Island. We linked baseline study data on chronic pain and prior hospitalization for mental illness to statewide administrative data on state-licensed treatment programs (including methadone) and buprenorphine treatment via prescription. We defined treatment engagement as initiation of a state-licensed treatment program, transfer between state-licensed programs/providers, or a buprenorphine prescription (re-)fill. We used modified Poisson models to estimate the association between each baseline comorbidity and treatment engagement within 90 days following the ED visit, adjusted for a priori potential confounders. In an exploratory analysis, models were stratified by baseline treatment status. RESULTS The mean age of participants was 37 years; 439 (68 %) were male, and 446 (69 %) had been recently unhoused. Overall, 278 participants (43 %) engaged in treatment within 90 days of the ED visit. Participants with prior hospitalization for mental illness were more likely to engage in treatment than those without (adjusted risk ratio [ARR] = 1.24, 95 % confidence interval [CI] = 1.01-1.53), although this association was only among those already accessing treatment at baseline (ARR = 1.58, 95 % CI = 1.10-2.27). Chronic pain was not associated with 90-day treatment engagement overall (ARR = 1.12, 95 % CI = 0.91-1.38) or within baseline treatment subgroups. CONCLUSIONS Among ED patients at high risk of opioid overdose and accessing treatment at baseline, those with prior hospitalization for mental illness (but not chronic pain) were more likely to engage in treatment following the ED visit, which may reflect disproportionate initiation of additional treatment programs, transfer between programs/providers, or ongoing buprenorphine treatment. Touchpoints within the medical system should be leveraged to ensure that everyone, including those with serious mental illness, can access high-quality SUD treatment at the desired intensity level.
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Affiliation(s)
- Maayan N Rosenfield
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Rachel Gaither
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | | | - Mackenzie M Daly
- Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, Providence, RI, United States
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Laura C Chambers
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States.
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Curth A, Peck RW, McKinney E, Weatherall J, van der Schaar M. Using Machine Learning to Individualize Treatment Effect Estimation: Challenges and Opportunities. Clin Pharmacol Ther 2024; 115:710-719. [PMID: 38124482 DOI: 10.1002/cpt.3159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
The use of data from randomized clinical trials to justify treatment decisions for real-world patients is the current state of the art. It relies on the assumption that average treatment effects from the trial can be extrapolated to patients with personal and/or disease characteristics different from those treated in the trial. Yet, because of heterogeneity of treatment effects between patients and between the trial population and real-world patients, this assumption may not be correct for many patients. Using machine learning to estimate the expected conditional average treatment effect (CATE) in individual patients from observational data offers the potential for more accurate estimation of the expected treatment effects in each patient based on their observed characteristics. In this review, we discuss some of the challenges and opportunities for machine learning to estimate CATE, including ensuring identification assumptions are met, managing covariate shift, and learning without access to the true label of interest. We also discuss the potential applications as well as future work and collaborations needed to further improve identification and utilization of CATE estimates to increase patient benefit.
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Affiliation(s)
- Alicia Curth
- Department of Applied Mathematics & Theoretical Physics, University of Cambridge, Cambridge, UK
| | - Richard W Peck
- Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, UK
- Roche Pharma Research & Early Development (pRED), Roche Innovation Center, Basel, Switzerland
| | - Eoin McKinney
- Cambridge Institute for Immunotherapy & Infectious Disease, Jeffrey Cheah Biomedical Center, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
- Cambridge Centre for AI in Medicine, Cambridge, UK
| | - James Weatherall
- AstraZeneca R&D Data Science and Artificial Intelligence, Cambridge, UK
| | - Mihaela van der Schaar
- Department of Applied Mathematics & Theoretical Physics, University of Cambridge, Cambridge, UK
- Cambridge Centre for AI in Medicine, Cambridge, UK
- The Alan Turing Institute, London, UK
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Igland J, Forster R, Jenum AK, Strandberg RB, Berg TJ, Røssberg JI, Iversen MM, Buhl ES. How valid is a prescription-based multimorbidity index (Rx-risk) in predicting mortality in the Outcomes and Multimorbidity In Type 2 diabetes (OMIT) study? A nation-wide registry-based cohort study from Norway. BMJ Open 2024; 14:e077027. [PMID: 38548358 PMCID: PMC10982738 DOI: 10.1136/bmjopen-2023-077027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 03/08/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE The prescription-based Rx-risk index has previously been developed to measure multimorbidity. We aimed to adapt and evaluate the validity of the Rx-risk index in prediction of mortality among persons with type 2 diabetes. DESIGN Registry-based study. SETTING Adults with type 2 diabetes in Norway identified within the 'Outcomes and Multimorbidity In Type 2 diabetes' cohort, with linkage to prescriptions from the Norwegian Prescription Database and mortality from the Population Registry. PARTICIPANTS We defined a calibration sample of 42 290 adults diagnosed with type 2 diabetes 1950-2013, and a temporal validation sample of 7085 adults diagnosed 2014-2016 to evaluate the index validity over time PRIMARY OUTCOME MEASURE: All-cause mortality METHODS: For the calibration sample, dispensed drug prescriptions in 2013 were used to define 44 morbidity categories. Weights were estimated using regression coefficients from a Cox regression model with 5 year mortality as the outcome and all morbidity categories, age and sex included as covariates. The Rx-risk index was computed as a weighted sum of morbidities. The validity of the index was evaluated using C-statistic and calibration plots. RESULTS In the calibration sample, mean (SD) age at start of follow-up and duration of diabetes was 63.8 (12.4) and 10.1 (7.0) years, respectively. The overall C-statistic was 0.82 and varied from 0.74 to 0.85 when stratifying on age groups, sex, level of education and country of origin. In the validation sample, mean (SD) age and duration of diabetes was 59.7 (13.0) and 2.0 (0.8) years, respectively. Despite younger age, shorter duration of diabetes and later time period, the C-index was high both in the total sample (0.84) and separately for men (0.83) and women (0.84). CONCLUSIONS The Rx-risk index showed good discrimination and calibration in predicting mortality and thus presents a valid tool to assess multimorbidity among persons with type 2 diabetes.
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Affiliation(s)
- Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Hordaland, Norway
| | - Rachel Forster
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Hordaland, Norway
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Karen Jenum
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Ragnhild B Strandberg
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Hordaland, Norway
| | - Tore Julsrud Berg
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Marjolein Memelink Iversen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Hordaland, Norway
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Thangaraj PM, Shankar SV, Huang S, Nadkarni G, Mortazavi B, Oikonomou EK, Khera R. A Novel Digital Twin Strategy to Examine the Implications of Randomized Control Trials for Real-World Populations. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.25.24304868. [PMID: 38585929 PMCID: PMC10996766 DOI: 10.1101/2024.03.25.24304868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Randomized clinical trials (RCTs) are essential to guide medical practice; however, their generalizability to a given population is often uncertain. We developed a statistically informed Generative Adversarial Network (GAN) model, RCT-Twin-GAN, that leverages relationships between covariates and outcomes and generates a digital twin of an RCT (RCT-Twin) conditioned on covariate distributions from a second patient population. We used RCT-Twin-GAN to reproduce treatment effect outcomes of the Systolic Blood Pressure Intervention Trial (SPRINT) and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure Trial, which tested the same intervention but had different treatment effect results. To demonstrate treatment effect estimates of each RCT conditioned on the other RCT patient population, we evaluated the cardiovascular event-free survival of SPRINT digital twins conditioned on the ACCORD cohort and vice versa (SPRINT-conditioned ACCORD twins). The conditioned digital twins were balanced by the intervention arm (mean absolute standardized mean difference (MASMD) of covariates between treatment arms 0.019 (SD 0.018), and the conditioned covariates of the SPRINT-Twin on ACCORD were more similar to ACCORD than a sprint (MASMD 0.0082 SD 0.016 vs. 0.46 SD 0.20). Most importantly, across iterations, SPRINT conditioned ACCORD-Twin datasets reproduced the overall non-significant effect size seen in ACCORD (5-year cardiovascular outcome hazard ratio (95% confidence interval) of 0.88 (0.73-1.06) in ACCORD vs median 0.87 (0.68-1.13) in the SPRINT conditioned ACCORD-Twin), while the ACCORD conditioned SPRINT-Twins reproduced the significant effect size seen in SPRINT (0.75 (0.64-0.89) vs median 0.79 (0.72-0.86)) in ACCORD conditioned SPRINT-Twin). Finally, we describe the translation of this approach to real-world populations by conditioning the trials on an electronic health record population. Therefore, RCT-Twin-GAN simulates the direct translation of RCT-derived treatment effects across various patient populations with varying covariate distributions.
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Affiliation(s)
- Phyllis M. Thangaraj
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sumukh Vasisht Shankar
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sicong Huang
- Department of Computer Science and Engineering, Texas A&M University, College Station, TX
| | - Girish Nadkarni
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Division of Data Driven and Digital Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bobak Mortazavi
- Department of Computer Science and Engineering, Texas A&M University, College Station, TX
| | - Evangelos K. Oikonomou
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, CT
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
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Chow SC, Wang P. On the use of RWD in support of regulatory submission in drug development. J Biopharm Stat 2024:1-28. [PMID: 38501166 DOI: 10.1080/10543406.2024.2330213] [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: 03/20/2024]
Abstract
For the approval of a drug product, the United States Food and Drug Administration requires substantial evidence (SE) regarding effectiveness and safety of the test drug to be provided. In recent years, the use of real-world data in support of regulatory submission of pharmaceutical development has received much attention, and real-world evidence (RWE) is treated as complementary to SE by evaluating the real-world performance of the test treatment. In this article, we start by summarizing current regulatory perspectives on drug evaluation and some potential challenges in using RWE. To test for superiority in co-primary endpoints, a two-stage hybrid RCT/RWS adaptive design that combines randomized control trial for providing SE and real-world study for generating RWE is proposed. We use superiority in effectiveness and non-inferiority in safety as an example to illustrate how to implement this design. Numerical studies have shown that the proposed design has merits in reducing the required sample size compared with traditional co-primary endpoint tests while maintaining statistical power and controlling type I error inflation. The proposed design can be implemented in drug development considering co-primary endpoints, especially for oncology and rare disease drug development.
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Affiliation(s)
- Shein-Chung Chow
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Peijin Wang
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
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Schaafsma HN, Jantzi HA, Seabrook JA, McEachern LW, Burke SM, Irwin JD, Gilliland JA. The impact of smartphone app-based interventions on adolescents' dietary intake: a systematic review and evaluation of equity factor reporting in intervention studies. Nutr Rev 2024; 82:467-486. [PMID: 37330675 PMCID: PMC10925905 DOI: 10.1093/nutrit/nuad058] [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] [Indexed: 06/19/2023] Open
Abstract
CONTEXT Adolescence is a critical stage for improving nutrition. The popularity of smartphones makes them an ideal platform for administering interventions to adolescents. A systematic review has yet to assess the impact of smartphone app-based interventions exclusively on adolescents' dietary intake. Furthermore, despite the impact of equity factors on dietary intake and the claim for mobile health of increased accessibility, there is minimal research on the reporting of equity factors in the evaluation of smartphone app-based nutrition-intervention research. OBJECTIVES This systematic review examines the effectiveness of smartphone app-based interventions on adolescents' dietary intake and the frequency with which equity factors and statistical analyses specific to equity factors are reported in these intervention studies. DATA SOURCES Databases (ie, Scopus, CINAHL, EMBASE, MEDLINE, PsycINFO, ERIC, and Cochrane Central Register for Randomized Control Trials) were searched for studies published from January 2008 to October 2022. Smartphone app-based intervention studies that were nutrition focused, evaluated at least 1 dietary intake variable, and included participants with a mean age between 10 and 19 years were included. All geographic locations were included. DATA EXTRACTION AND ANALYSIS Study characteristics, intervention results, and reported equity factors were extracted. Because of the heterogeneity of dietary outcomes, findings were reported as a narrative synthesis. CONCLUSION In total, 3087 studies were retrieved, 14 of which met the inclusion criteria. Eleven studies reported a statistically significant improvement in at least 1 dietary outcome because of the intervention. Reporting of at least 1 equity factor across articles' Introduction, Methods, Results, and Discussion sections was minimal (n = 5), and statistical analyses specific to equity factors were rare, occurring in only 4 of the 14 included studies. Future interventions should include a measurement of intervention adherence and report the impact of equity factors on the effectiveness and applicability of interventions for equity-deserving groups.
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Affiliation(s)
- Holly N Schaafsma
- Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Children’s Health Research Institute, London, Ontario, Canada
| | - Heather A Jantzi
- Children’s Health Research Institute, London, Ontario, Canada
- Department of Geography, Western University, London, Ontario, Canada
| | - Jamie A Seabrook
- Children’s Health Research Institute, London, Ontario, Canada
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Louise W McEachern
- Children’s Health Research Institute, London, Ontario, Canada
- Department of Geography, Western University, London, Ontario, Canada
| | - Shauna M Burke
- Children’s Health Research Institute, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- School of Health Studies, Western University, London, Ontario, Canada
| | - Jennifer D Irwin
- School of Health Studies, Western University, London, Ontario, Canada
| | - Jason A Gilliland
- Children’s Health Research Institute, London, Ontario, Canada
- Department of Geography, Western University, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- School of Health Studies, Western University, London, Ontario, Canada
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Faithfull S, Greenfield D. Cancer survivor late-effects, chronic health problems after cancer treatment: what's the evidence from population and registry data and where are the gaps? Curr Opin Support Palliat Care 2024; 18:55-64. [PMID: 38170192 DOI: 10.1097/spc.0000000000000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Improvements in cancer treatment have led to more people living with and beyond a cancer diagnosis but survivors may have increased health problems as they age. The purpose of this review is to critically evaluate population data exploring incidence of late effects for cancer survivors. RECENT FINDINGS 18 studies were identified between 2013 and 2023 that explored the impact on survivors' physical and emotional health. Patients who had been treated at least 2 years previously for cancer had significant cardiovascular risk factors compared with age-matched controls. Women with breast cancer were more likely to have cardiovascular disease, including hypertension, arrythmias and congestive heart failure. This was associated with anthracyclines and/or trastuzumab as part of systemic anti-cancer therapy. Survivors of colorectal cancer were three times more likely to have acute kidney injury than age-matched controls. Stress and mood disorders were higher in survivors of testicular cancer and prostate cancer. SUMMARY Population studies are important to identify the 'real world' consequences of cancer and its treatment beyond clinical trials. Knowledge is critical for managing an ageing cancer population. Data to personalise cancer survivorship care, not only helps determine potential health risks, but can improve secondary prevention, emotional health, recovery, and long-term outcomes.
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Affiliation(s)
- Sara Faithfull
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, the University of Dublin, Trinity Centre for Health Sciences St. James's Hospital Campus Dublin 8, Ireland
| | - Diana Greenfield
- Specialised Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust
- Medicine and Population Health, University of Sheffield, Sheffield, UK
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Habib MH, Alibhai SMH, Puts M. How representative are participants in geriatric oncology clinical trials? The case of the 5C RCT in geriatric oncology: A cross-sectional comparison to a geriatric oncology clinic. J Geriatr Oncol 2024; 15:101703. [PMID: 38228054 DOI: 10.1016/j.jgo.2024.101703] [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: 07/14/2023] [Revised: 11/25/2023] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Frail older adults make up a substantial portion of the older adult population. However, frail patients are often excluded from randomized controlled trials. This underrepresentation restricts the extent to which trial findings can be generalized to this population. We compared a sample from the Canadian 5C Randomized Controlled Trial investigating comprehensive geriatric assessment (CGA) in the geriatric oncology setting in terms of frailty to patients referred to the Older Adults with Cancer Clinic (OACC) to determine if the trial sample was representative of the normal geriatric oncology practice. MATERIALS AND METHODS Baseline CGA data of 5C Trial participants seen at the Princess Margaret Cancer Centre (PM), were compared to data from OACC patients that were seen during the duration of the 5C trial (between April 2018 and April 2020) and that satisfied the 5C inclusion criteria. To assess the frailty of samples, sex, age, disease site, comorbidity level, medical optimization, social supports, functional status, falls risk, nutrition, cognition, and mood were compared between 5C participants and OACC patients using Fisher's exact and independent samples t-test. RESULTS A sample of 115 5C participants and 205 OACC patients were included. The mean age of 5C participants and OACC patients was 75.4 and 81.6 years, respectively (p < 0.001). The distribution of disease sites was significantly different between the samples (p < 0.001) and OACC patients were also significantly more impaired compared to 5C participants in comorbidity (23.4% versus 10.4% high comorbidity) (p = 0.001), IADL dependence (55.1% versus 42.6%) (p = 0.036), impaired physical function (70.6% versus 31.3%) (p < 0.001), falls risk (67.8% versus 27%) (p < 0.001), impaired nutrition (55.6% versus 40.9%) (p = 0.014), and cognition (47.2% versus 10%) (p < 0.001). There were no differences in sex, medication optimization, poor social supports, and impaired mood between the samples. DISCUSSION The 5C sample was less frail and younger than patients seen in the geriatric oncology clinic. Finding strategies to address barriers to the inclusion of frailer older adults is important to increase their representation in future trials to allow findings to be generalized to this vulnerable population. TRIAL REGISTRATION Clinicaltrials.gov # NCT03154671.
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Affiliation(s)
- Mohammed H Habib
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
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