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Butzkueven H, Hillert J, Soilu-Hänninen M, Ziemssen T, Kuhle J, Wergeland S, Magyari M, Berger JR, Moore N, Aydemir A, Bezemer I, Sabidó M. The CLARION study: first report on safety findings in patients newly initiating treatment with cladribine tablets or fingolimod for multiple sclerosis. Curr Med Res Opin 2023; 39:1367-1374. [PMID: 37675878 DOI: 10.1080/03007995.2023.2256220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES As part of the CLARION study: (1) characterize the incidence of severe infections, herpes zoster, and malignancies in patients newly initiating cladribine or fingolimod for relapsing multiple sclerosis (MS); (2) estimate the incidence of severe lymphopenia among cladribine users; and (3) describe prior/subsequent disease-modifying therapy (DMT) in both cohorts. METHODS Patients were identified from seven participating MS registries/data sources. The incidence rate (IR) of each outcome per 1000 patient-years and its 95% confidence interval (95%CI) were estimated for cohorts using Poisson regression. RESULTS By cut-off date (01-April-2020), 742 cladribine and 867 fingolimod users were included. Mean follow-up was ∼1 year. The IR for severe infections from all contributing sources (except Denmark) was: cladribine, 7.37 (2.76,19.6); fingolimod, 6.55 (2.46,17.4). The corresponding IR for herpes zoster was 5.51 (1.78,17.1) and 3.27 (0.82,13.1), respectively, while values for opportunistic infections were 0 (0,6.76) and 1.63 (0.23,11.6), respectively. There were no events of progressive multifocal leukoencephalopathy in either cohort. The IR of severe lymphopenia was 63.9 (40.7,100.1) in 349 cladribine users from contributing sources. The IR of malignancies (cut-off date 01-April-2022) was 3.55 (1.59,7.90) for the cladribine cohort (n = 1035) and 3.55 (1.48,8.52) for the fingolimod cohort (n = 843) from three MS registries/data sources. In the combined data sources, 36.8% of cladribine and 27.4% of fingolimod users were DMT-naïve; after initiation of study treatment, 2.5% and 20.2% switched to another DMT, respectively. CONCLUSION No new safety signal was observed in patients treated with cladribine tablets, although results are limited by a relatively short duration of follow-up.
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Affiliation(s)
- Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- The Alfred Hospital, Melbourne, VIC, Australia
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Merja Soilu-Hänninen
- Turku University Hospital Neurocenter and Division of Clinical Neurosciences, University of Turku, Turku, Finland
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, Dresden University of Technology, Dresden, Germany
| | - Jens Kuhle
- Multiple Sclerosis Center and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Stig Wergeland
- Norwegian MS Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Melinda Magyari
- Danish Multiple Sclerosis Center and the Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Joseph R Berger
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nicholas Moore
- Bordeaux PharmacoEpi (BPE), Université de Bordeaux, Bordeaux, France
| | - Aida Aydemir
- EMD Serono Research & Development Institute, Inc, Billerica, MA, USA, an affiliate of Merck KGaA
| | - Irene Bezemer
- Global Epidemiology, IQVIA, Amsterdam, The Netherlands
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Studham M, Vazquez‐Mateo C, Samy E, Haselmayer P, Aydemir A, Rolfe PA, Merrill JT, Morand EF, DeMartino J, Kao A, Townsend R. Identifying lupus Patient Subsets Through Immune Cell Deconvolution of Gene Expression Data in Two Atacicept Phase II Studies. ACR Open Rheumatol 2023; 5:536-546. [PMID: 37710418 PMCID: PMC10570667 DOI: 10.1002/acr2.11594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/06/2023] [Accepted: 07/03/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVE To use cell-based gene signatures to identify patients with systemic lupus erythematous (SLE) in the phase II/III APRIL-SLE and phase IIb ADDRESS II trials most likely to respond to atacicept. METHODS A published immune cell deconvolution algorithm based on Affymetrix gene array data was applied to whole blood gene expression from patients entering APRIL-SLE. Five distinct patient clusters were identified. Patient characteristics, biomarkers, and clinical response to atacicept were assessed per cluster. A modified immune cell deconvolution algorithm was developed based on RNA sequencing data and applied to ADDRESS II data to identify similar patient clusters and their responses. RESULTS Patients in APRIL-SLE (N = 105) were segregated into the following five clusters (P1-5) characterized by dominant cell subset signatures: high neutrophils, T helper cells and natural killer (NK) cells (P1), high plasma cells and activated NK cells (P2), high B cells and neutrophils (P3), high B cells and low neutrophils (P4), or high activated dendritic cells, activated NK cells, and neutrophils (P5). Placebo- and atacicept-treated patients in clusters P2,4,5 had markedly higher British Isles Lupus Assessment Group (BILAG) A/B flare rates than those in clusters P1,3, with a greater treatment effect of atacicept on lowering flares in clusters P2,4,5. In ADDRESS II, placebo-treated patients from P2,4,5 were less likely to be SLE Responder Index (SRI)-4, SRI-6, and BILAG-Based Combined Lupus Assessment responders than those in P1,3; the response proportions again suggested lower placebo effect and a greater treatment differential for atacicept in P2,4,5. CONCLUSION This exploratory analysis indicates larger differences between placebo- and atacicept-treated patients with SLE in a molecularly defined patient subset.
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Affiliation(s)
| | | | | | | | | | | | - Joan T. Merrill
- University of Oklahoma Health Sciences CenterOklahoma CityOKUnited States
| | - Eric F. Morand
- Monash University School of Clinical SciencesClaytonAustralia
| | | | - Amy Kao
- EMD SeronoBillericaMAUnited States
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Giovannoni G, Boyko A, Correale J, Edan G, Freedman MS, Montalban X, Rammohan K, Stefoski D, Yamout B, Leist T, Aydemir A, Borsi L, di Cantogno EV. A plain language summary on assessing the long-term effectiveness of cladribine tablets in people living with relapsing multiple sclerosis: The CLASSIC-MS study. Neurodegener Dis Manag 2023; 13:261-268. [PMID: 37535336 DOI: 10.2217/nmt-2023-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
WHAT IS THIS SUMMARY ABOUT? Previous studies have shown that people living with multiple sclerosis (MS) treated with cladribine tablets have fewer relapses (where new symptoms occur or existing symptoms get worse for 24 hours or more) and delayed disability progression (slowing down of the disease getting worse). The CLASSIC-MS study looked at the long-term effectiveness of treatment with cladribine tablets in people living with MS who had taken part in the original CLARITY and CLARITY Extension clinical studies. WHAT WERE THE RESULTS? Results showed that people treated with cladribine tablets maintained their mobility (the ability to move freely) for longer and experienced other positive effects long after their treatment ended, including being less likely to need further treatment for their MS. WHAT DO THE RESULTS MEAN? The results obtained from CLASSIC-MS show that the benefits of taking cladribine tablets carry on even when patients stop taking the treatment.
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Affiliation(s)
- Gavin Giovannoni
- Blizard Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Alexey Boyko
- Pirogov Russian National Research Medical University, Department of Neurology, Neurosurgery & Medical Genetics, Federal Center of Brain Research & Neurotechnologies, Moscow, Russia
| | - Jorge Correale
- Department of Neurology, FLENI Institute, Buenos Aires, Argentina
| | - Gilles Edan
- Department of Neurology, University Hospital of Rennes, Rennes, France
| | - Mark S Freedman
- University of Ottawa, Department of Medicine & the Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Kottil Rammohan
- University of Miami School of Medicine, MS Research Center, Miami, FL, USA
| | - Dusan Stefoski
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
| | - Bassem Yamout
- Neurology Institute, Harley Street Medical Center, Abu Dhabi, UAE
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Thomas Leist
- Division of Clinical Neuroimmunology, Jefferson University, Comprehensive MS Center, Philadelphia, PA, USA
| | - Aida Aydemir
- EMD Serono Research & Development Institute, Inc., Billerica, MA, USA (an affiliate of Merck KGaA)
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Er B, Mızrak B, Aydemir A, Binay S, Doğu C, Kazancı D, Turan S. Is diaphragm ultrasound better than rapid shallow breathing index for predicting weaning in critically ill elderly patients? Tuberk Toraks 2023; 71:197-202. [PMID: 37740623 PMCID: PMC10795238 DOI: 10.5578/tt.20239701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/03/2023] [Indexed: 09/24/2023] Open
Abstract
Introduction Prolonged weaning is associated with worse clinical outcomes in elderly patients. Beside traditional rapid shallow breathing index (RSBI), diaphragm ultrasound is a promising technique to evaluate the weaning process. We aimed to perform diaphragm ultrasonography for predicting the weaning process and its relation with frailty in the critically ill elderly population. Materials and Methods We enrolled thirthy-two patients over 65 years of age who were mechanically ventilated for at least 48 hours. Thickness of diaphragm and excursion were evaluated within 48 h of intubation and during spontaneous breathing trial (SBT). Clinical parameters, frailty, diaphragm ultrasound results were compared according to the weaning status. Results Mean age (standard deviation) was 79.3 ± 7.9 years, and 18 (56.3%) patients were classified as weaning failure. Diaphragmatic excursion during SBT was the only statistically significant parameter associated with weaning failure [2.37 cm (0.67) vs 1.43 cm (0.15), p= 0.0359]. There was no statistically significant difference regarding RSBI between the groups [70.5 (46) vs 127.5 (80), p= 0.09]. Baseline thickness of diaphragm and excursion at SBT were moderately correlated with frailty. Conclusion Ultrasound can be used to show diaphragm dysfunction in the elderly frail population, and a multifactorial approach to the extubation process may include ultrasound instead of using traditional RSBI alone.
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Affiliation(s)
- B. Er
- Intensive Care Unit, University of Health Sciences Ankara Bilkent City
Hospital, Ankara, Türkiye
- Department of Anesthesiology and Reanimation, University of Health
Sciences Ankara Bilkent City Hospital, Ankara, Türkiye
| | - B. Mızrak
- Department of Anesthesiology and Reanimation, University of Health
Sciences Ankara Bilkent City Hospital, Ankara, Türkiye
| | - A. Aydemir
- Department of Anesthesiology and Reanimation, University of Health
Sciences Ankara Bilkent City Hospital, Ankara, Türkiye
| | - S. Binay
- Intensive Care Unit, University of Health Sciences Ankara Bilkent City
Hospital, Ankara, Türkiye
| | - C. Doğu
- Intensive Care Unit, University of Health Sciences Ankara Bilkent City
Hospital, Ankara, Türkiye
| | - D. Kazancı
- Intensive Care Unit, University of Health Sciences Ankara Bilkent City
Hospital, Ankara, Türkiye
| | - S. Turan
- Intensive Care Unit, University of Health Sciences Ankara Bilkent City
Hospital, Ankara, Türkiye
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Giovannoni G, Boyko A, Correale J, Edan G, Freedman MS, Montalban X, Rammohan K, Stefoski D, Yamout B, Leist T, Aydemir A, Borsi L, Verdun di Cantogno E. Long-term follow-up of patients with relapsing multiple sclerosis from the CLARITY/CLARITY Extension cohort of CLASSIC-MS: An ambispective study. Mult Scler 2023; 29:719-730. [PMID: 37012898 PMCID: PMC10176755 DOI: 10.1177/13524585231161494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND CLASSIC-MS evaluated the long-term efficacy of cladribine tablets in patients with relapsing multiple sclerosis. OBJECTIVE Report long-term mobility and disability beyond treatment courses received in CLARITY/CLARITY Extension. METHODS This analysis represents CLASSIC-MS patients who participated in CLARITY with/without participation in CLARITY Extension, and received ⩾1 course of cladribine tablets or placebo (N = 435). Primary objective includes evaluation of long-term mobility (no wheelchair use in the 3 months prior to first visit in CLASSIC-MS and not bedridden at any time since last parent study dose (LPSD), i.e. Expanded Disability Status Scale (EDSS) score <7). Secondary objective includes long-term disability status (no use of an ambulatory device (EDSS < 6) at any time since LPSD). RESULTS At CLASSIC-MS baseline, mean ± standard deviation EDSS score was 3.9 ± 2.1 and the median time since LPSD was 10.9 (range = 9.3-14.9) years. Cladribine tablets-exposed population: 90.6% (N = 394), including 160 patients who received a cumulative dose of 3.5 mg/kg over 2 years. Patients not using a wheelchair and not bedridden: exposed, 90.0%; unexposed, 77.8%. Patients with no use of an ambulatory device: exposed, 81.2%; unexposed, 75.6%. CONCLUSION With a median 10.9 years' follow-up after CLARITY/CLARITY Extension, findings suggest the sustained long-term mobility and disability benefits of cladribine tablets.
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Affiliation(s)
- Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Alexey Boyko
- Department of Neurology, Neurosurgery and Medical Genetics, Federal Center of Brain Research and Neurotechnologies, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Jorge Correale
- Department of Neurology, FLENI Institute, Buenos Aires, Argentina
| | - Gilles Edan
- Department of Neurology, University Hospital of Rennes, Rennes, France
| | - Mark S Freedman
- Department of Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Kottil Rammohan
- MS Research Center, School of Medicine, University of Miami, Miami, FL, USA
| | - Dusan Stefoski
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
| | - Bassem Yamout
- Neurology Institute, Harley Street Medical Center, Abu Dhabi, UAE/American University of Beirut Medical Center, Beirut, Lebanon
| | - Thomas Leist
- Division of Clinical Neuroimmunology, Comprehensive MS Center, Jefferson University, Philadelphia, PA, USA
| | - Aida Aydemir
- EMD Serono Research & Development Institute, Inc., Billerica, MA, USA, an affiliate of Merck KGaA
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Goteti K, French J, Garcia R, Li Y, Casset‐Semanaz F, Aydemir A, Townsend R, Mateo CV, Studham M, Guenther O, Kao A, Gastonguay M, Girard P, Benincosa L, Venkatakrishnan K. Disease trajectory of SLE clinical endpoints and covariates affecting disease severity and probability of response: Analysis of pooled patient-level placebo (Standard-of-Care) data to enable model-informed drug development. CPT Pharmacometrics Syst Pharmacol 2022; 12:180-195. [PMID: 36350330 PMCID: PMC9931431 DOI: 10.1002/psp4.12888] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/12/2022] [Accepted: 10/27/2022] [Indexed: 11/10/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease affecting multiple organ systems. Many investigational agents have failed or shown only modest effects when added to standard of care (SoC) therapy in placebo-controlled trials, and only two therapies have been approved for SLE in the last 60 years. Clinical trial outcomes have shown discordance in drug effects between clinical endpoints. Herein, we characterized longitudinal disease activity in the SLE population and the sources of variability by developing a latent disease trajectory model for SLE component endpoints (Systemic Lupus Erythematosus Disease Activity Index [SLEDAI], Physician's Global Assessment [PGA], British Isles Lupus Assessment Group Index [BILAG]) and composite endpoints (Systemic Lupus Erythematosus Responder Index [SRI], BILAG-based Composite Lupus Assessment [BICLA], and Lupus Low Disease Activity State [LLDAS]) using patient-level historical SoC data from nine phase II and III studies. Across all endpoints, in predictions up to 52 weeks from the final disease trajectory model, the following baseline covariates were associated with a greater decrease in SLE disease activity and higher response to placebo + SoC: Hispanic ethnicity from Central/South America, absence of hypocomplementemia, recent SLE diagnosis, and high baseline disease activity score using SLEDAI and BILAG separately. No discernible differences were observed in the trajectory of response to placebo + SoC across different SoC medications (antimalarial and immunosuppressant such as mycophenolate, methotrexate, and azathioprine). Across all endpoints, disease trajectory showed no difference in Asian versus non-Asian patients, supporting Asia-inclusive global SLE drug development. These results describe the first population approach to support a model-informed drug development framework in SLE.
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Affiliation(s)
- Kosalaram Goteti
- EMD Serono Research and Development Institute, Inc (an affiliate of Merck KGaA, Darmstadt Germany)BillericaMassachusettsUSA
| | | | | | - Ying Li
- EMD Serono Research and Development Institute, Inc (an affiliate of Merck KGaA, Darmstadt Germany)BillericaMassachusettsUSA
| | - Florence Casset‐Semanaz
- EMD Serono Research and Development Institute, Inc (an affiliate of Merck KGaA, Darmstadt Germany)BillericaMassachusettsUSA
| | - Aida Aydemir
- EMD Serono Research and Development Institute, Inc (an affiliate of Merck KGaA, Darmstadt Germany)BillericaMassachusettsUSA
| | - Robert Townsend
- EMD Serono Research and Development Institute, Inc (an affiliate of Merck KGaA, Darmstadt Germany)BillericaMassachusettsUSA
| | - Cristina Vazquez Mateo
- EMD Serono Research and Development Institute, Inc (an affiliate of Merck KGaA, Darmstadt Germany)BillericaMassachusettsUSA
| | - Matthew Studham
- EMD Serono Research and Development Institute, Inc (an affiliate of Merck KGaA, Darmstadt Germany)BillericaMassachusettsUSA
| | | | - Amy Kao
- EMD Serono Research and Development Institute, Inc (an affiliate of Merck KGaA, Darmstadt Germany)BillericaMassachusettsUSA
| | | | - Pascal Girard
- Merck Institute of PharmacometricsLausanneSwitzerland
| | - Lisa Benincosa
- EMD Serono Research and Development Institute, Inc (an affiliate of Merck KGaA, Darmstadt Germany)BillericaMassachusettsUSA
| | - Karthik Venkatakrishnan
- EMD Serono Research and Development Institute, Inc (an affiliate of Merck KGaA, Darmstadt Germany)BillericaMassachusettsUSA
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Butzkueven H, Moore N, Aydemir A, Sõnajalg J, Bezemer I, Korhonen P, Sabidó M. The CLARION study design and status update: a long-term, registry-based study evaluating adverse events of special interest in patients with relapsing multiple sclerosis newly started on cladribine tablets. Curr Med Res Opin 2022; 38:1167-1176. [PMID: 35357268 DOI: 10.1080/03007995.2022.2059977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the design of the CLARION post-approval safety study (EU PAS Register number, EUPAS24484) and provide a status update, including characteristics of patients included up to 1 May 2021. METHODS CLARION aims to further evaluate adverse events of special interest in patients who are newly initiating treatment with cladribine tablets for relapsing multiple sclerosis (MS). The study population consists of two cohorts: patients newly initiating cladribine tablets (cladribine cohort) and patients newly initiating oral fingolimod tablets (comparator fingolimod cohort), with an aim to include 8000 patients (4000 patients per cohort). The study relies on secondary use of data from pre-existing MS registries/data sources (except in Germany, where primary data collection is performed). The study is projected to last 15 years, with an anticipated 5-year inclusion period. Study outcomes are: malignancies; severe infections; tuberculosis; progressive multifocal leukoencephalopathy; other opportunistic infections; herpes zoster; severe lymphopenia (Grade ≥ 3); and treatment discontinuation. RESULTS As of 1 May 2021, 2393 patients were included in CLARION from seven participating MS registries/data sources (cladribine cohort, n = 1266; fingolimod cohort, n = 1127). The majority of patients are female (cladribine cohort, 72.5%; fingolimod cohort, 68.0%), with mean age at onset of MS of 31.5 years for the cladribine cohort and 30.9 years for the fingolimod cohort. The majority of patients in both cohorts had relapsing MS (cladribine cohort, 92.1%; fingolimod cohort, 93.5%). CONCLUSION By providing further information on adverse events of special interest during long-term follow-up, CLARION will assist neurologists and patients regarding treatment decision-making for management of relapsing MS.
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Affiliation(s)
- Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- The Alfred Hospital, Melbourne, Australia
| | - Nicholas Moore
- Bordeaux PharmacoEpi (BPE), Université de Bordeaux, Bordeaux, France
| | - Aida Aydemir
- Global Biostatistics, EMD Serono Research & Development Institute, Inc, Billerica, MA, USA (an affiliate of Merck KGaA)
| | | | - Irene Bezemer
- Global Epidemiology and Outcomes Research, IQVIA, Amsterdam, The Netherlands
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Isenberg D, Lin C, Kao A, Aydemir A, Gordon C. FC055: Effect of Atacicept on Renal Function in SLE Patients. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac108.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Atacicept is a dual BLyS/APRIL inhibitor. APRIL-SLE was a double-blind, placebo-controlled phase 2 study, which randomized moderate-to-severe systemic lupus erythematosus (SLE) patients to atacicept 75 mg, atacicept 150 mg or placebo. The primary endpoint was the proportion of subjects who experienced a new flare during the 52-week treatment period. In total, 111 patients in the placebo group, 112 patients in the atacicept 75 mg group and 62 patients in the atacicept 150 mg group completed 52 weeks of treatment. Patients with severe renal disease were excluded, while patients with proteinuria and mild–moderate chronic kidney disease, as assessed by KDIGO criteria, were eligible. The effect of atacicept on measures of renal function in these patients has not previously been reported.
METHOD
The study excluded moderate to severe glomerulonephritis, as defined by either of the following: urinary protein/creatinine ratio > 1 mg/mg and/or hematuria or a significant renal impairment as defined by glomerular filtration rate (GFR) < 50 mL/min/1.73 m2. Urine protein/creatinine ratio (UPCR) and GFR were measured at baseline, week 2, and then every 4 weeks until week 52.
RESULTS
In the APRIL-SLE study, the analysis for GFR and UPCR are of all patients (62–111 per group) with up to 15% of patients having a history of SLE-related renal disease. GFR time course showed stability for the atacicept groups compared to a 4.3% decline in the placebo group at week 52 from baseline (figure and table). Furthermore, reductions in UPCR from baseline at week 52 were observed in the atacicept groups compared to an increase in the placebo group.
CONCLUSION
In this phase 2 APRIL-SLE study, analysis of renal data suggests potential for improved renal function with atacicept treatment in SLE renal disease.
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Affiliation(s)
- David Isenberg
- University College London, Division of Medicine, Centre for Rheumatology, London, UK
| | - Celia Lin
- Vera Therapeutics, Inc, Brisbane, CA, USA
| | - Amy Kao
- EMD Serono Research & Development Institute, Inc., Translational Innovation Platform (TIP) Immunology, Billerica, MA, USA
| | - Aida Aydemir
- EMD Serono Research & Development Institute, Inc, Global Biostatistics, Billerica, MA, USA
| | - Caroline Gordon
- University of Birmingham, Rheumatology Research Group, Institute of Inflammation and Ageing (IIA), Birmingham, UK
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Barratt J, Tumlin J, Suzuki Y, Kao A, Aydemir A, Pudota K, Jin H, Gühring H, Appel G. Randomized Phase II JANUS Study of Atacicept in Patients With Immunoglobulin A Nephropathy and Persistent Proteinuria. Kidney Int Rep 2022; 7:1831-1841. [PMID: 35967104 PMCID: PMC9366370 DOI: 10.1016/j.ekir.2022.05.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/04/2022] [Accepted: 05/16/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction Patients with IgA nephropathy (IgAN) and persistent proteinuria are at risk of progression to kidney failure. Atacicept is a novel B-cell–targeted immunomodulator, shown to reduce immunoglobulin levels in patients with autoimmune diseases. Methods JANUS (NCT02808429) was a phase II study that assessed the safety, pharmacodynamic effects, and efficacy of atacicept in patients with IgAN and proteinuria ≥1 g/d or 0.75 mg/mg on 24-hour UPCR despite maximal standard of care therapy. Results A total of 16 patients were randomized 1:1:1 to placebo (n = 5), atacicept 25 mg (n = 6), or atacicept 75 mg (n = 5) once weekly using subcutaneous injection. Twelve (75%) completed ≥48 weeks of treatment; 8 (50%) completed 72 weeks of treatment and the 24-week safety follow-up period. Fourteen patients reported treatment-emergent adverse events (TEAEs). Most TEAEs were mild or moderate in severity. Three patients (placebo n = 1; atacicept 25 mg n = 2) reported serious TEAEs, none of which were treatment related. Dose-dependent reductions in IgA, IgG, IgM, and galactose-deficient (Gd)-IgA1 with atacicept at week 24 were maintained to week 72. Early reduction in proteinuria was observed at week 24 with atacicept. Renal function progressively declined with placebo but remained stable under exposure to atacicept. Conclusion Atacicept has an acceptable safety profile in patients with IgAN and is effective at reducing the levels of pathogenic factor Gd-IgA1, with potential improvements in proteinuria and renal function.
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Giovannoni G, Leist T, Aydemir A, Cantogno EVD. Long-Term Efficacy for Patients Receiving Cladribine Tablets in CLARITY/CLARITY Extension: Primary Results from 9–15 Years of Follow-Up in the CLASSIC-MS Study. Mult Scler Relat Disord 2022. [DOI: 10.1016/j.msard.2022.103633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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Wallace DJ, Isenberg DA, Morand EF, Vazquez-Mateo C, Kao AH, Aydemir A, Pudota K, Ona V, Aranow C, Merrill JT. Safety and clinical activity of atacicept in the long-term extension of the phase 2b ADDRESS II study in systemic lupus erythematosus. Rheumatology (Oxford) 2021; 60:5379-5389. [PMID: 33547784 DOI: 10.1093/rheumatology/keab115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/28/2021] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES Atacicept reduced SLE disease activity in the phase 2b ADDRESS II study, particularly in patients with high disease activity (HDA; SLEDAI-2K ≥10) at screening. We assessed long-term safety and efficacy of atacicept in the long-term extension (LTE) of ADDRESS II. METHODS In the 24-week, randomized, double-blind, placebo-controlled ADDRESS II study, patients received weekly atacicept (75 or 150 mg) or placebo. Atacicept was continued at the same dose in atacicept-treated patients in the LTE; placebo-treated patients switched to atacicept 150 mg. Long-term safety was the primary endpoint. Secondary endpoints included SLE responder index (SRI)-4 and SRI-6 response rates and flares. RESULTS In total, 253 patients entered the ADDRESS II LTE; 88 received atacicept 150 mg, 82 atacicept 75 mg and 83 placebo/atacicept 150 mg. Median active treatment duration in the LTE was 83.8 weeks. Frequencies of treatment-emergent adverse events (TEAEs) were similar across groups (90.4-93.2%), and 12.5%, 14.6% and 21.7% of patients in the atacicept 150 mg, atacicept 75 mg and placebo/atacicept 150 mg groups reported serious TEAEs during the treatment period. The proportions of patients with TEAEs leading to discontinuation were 5.7%, 4.9% and 10.8%, respectively. SRI-4 and SRI-6 response rates were maintained with atacicept in the modified intent-to-treat and HDA populations and those on continuous 150 mg had a reduced risk of first severe flare and longer time to first severe flare vs those who initially received placebo. CONCLUSION Long-term treatment with atacicept 150 mg in SLE patients had an acceptable safety profile, with durable efficacy. TRIAL REGISTRATION ClinicalTrials.gov, http://clinicaltrials.gov, NCT02070978.
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Affiliation(s)
- Daniel J Wallace
- Division of Rheumatology, Cedars-Sinai Medical Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - David A Isenberg
- Centre for Rheumatology/Division of Medicine, University College London, London, UK
| | - Eric F Morand
- Centre for Inflammatory Disease, Monash University, Melbourne, Australia
| | | | | | | | | | - Victor Ona
- Global Safety, EMD Serono Research and Development Institute, Inc. (a business of Merck KGaA, Darmstadt, Germany), Billerica, MA
| | - Cynthia Aranow
- Center for Autoimmunity, Musculoskeletal and Hematologic Diseases, Feinstein Institute for Medical Research, Manhasset, NY
| | - Joan T Merrill
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
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Isenberg DA, Kao AH, Aydemir A, Merrill JT. Commentary: Systematic Review of Safety and Efficacy of Atacicept in Treating Immune-Mediated Disorders. Front Immunol 2020; 11:592639. [PMID: 33262771 PMCID: PMC7687657 DOI: 10.3389/fimmu.2020.592639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- David A. Isenberg
- Centre for Rheumatology/Division of Medicine, University College London, London, United Kingdom
| | - Amy H. Kao
- Global Clinical Development, EMD Serono Research and Development Institute, Inc., Billerica, MA, United States (an affiliate of Merck KGaA, Darmstadt, Germany
| | - Aida Aydemir
- Global Biostatistics, EMD Serono Research and Development Institute, Inc., Billerica, MA, United States (an affiliate of Merck KGaA, Darmstadt, Germany
| | - Joan T. Merrill
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
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13
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Roemer FW, Kraines J, Aydemir A, Wax S, Hochberg MC, Crema MD, Guermazi A. Evaluating the structural effects of intra-articular sprifermin on cartilage and non-cartilaginous tissue alterations, based on sqMRI assessment over 2 years. Osteoarthritis Cartilage 2020; 28:1229-1234. [PMID: 32619609 DOI: 10.1016/j.joca.2020.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Sprifermin (recombinant human fibroblast growth factor-18), a potential disease-modifying osteoarthritis (OA) drug, demonstrated dose-dependent effects on femorotibial cartilage thickness (by quantitative magnetic resonance imaging [MRI]) in the phase II FORWARD study. This post-hoc analysis evaluated the potential effects of sprifermin on several articular structures in the whole joint over 24 months using semi-quantitative MRI assessment. DESIGN Patients aged 40-85 years with symptomatic radiographic knee OA, Kellgren-Lawrence grade 2 or 3, and medial minimum joint space width ≥2.5 mm in the target knee were randomized (1:1:1:1:1) to receive three double-blinded, once-weekly, intra-articular injections of sprifermin 30 μg or 100 μg or placebo every 6 (q6mo) or 12 months. 1.5- or 3 T MRIs were read using the Whole-Organ Magnetic Resonance Imaging Score (WORMS) system at baseline and 24 months. Change from baseline at 24 months on compartment and/or whole knee level was assessed for cartilage morphology, bone marrow lesions (BMLs), and osteophytes by delta-subregional and delta-sum (DSM) approaches. Menisci, Hoffa-synovitis, and effusion-synovitis were also evaluated for worsening. RESULTS 549 patients were included. Dose-dependent treatment effects from baseline to 24 months were observed on cartilage morphology (sprifermin 100 μg q6mo vs placebo; mean DSM (95% confidence interval [CI]) -0.6 (-1.5, 0.2); less cartilage worsening) in the entire knee and BMLs sprifermin 100 μg q6mo vs placebo; mean DSM (95% CI) -0.2 (-0.5, 0.1) in the patellofemoral compartment. No effects over 24 months were observed on osteophytes, menisci, Hoffa-synovitis or effusion-synovitis. CONCLUSIONS Positive effects associated with sprifermin were observed for cartilage morphology changes, and BML improvement. There were no meaningful negative or positive effects associated with sprifermin in the other joint tissues examined.
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Affiliation(s)
- F W Roemer
- Boston University School of Medicine, Boston, MA, USA; University of Erlangen-Nuremberg, Erlangen, Germany.
| | - J Kraines
- EMD Serono, Inc., Billerica, MA, USA, a business of Merck KGaA, Darmstadt, Germany
| | - A Aydemir
- EMD Serono, Inc., Billerica, MA, USA, a business of Merck KGaA, Darmstadt, Germany
| | - S Wax
- EMD Serono, Inc., Billerica, MA, USA, a business of Merck KGaA, Darmstadt, Germany
| | - M C Hochberg
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - M D Crema
- Boston University School of Medicine, Boston, MA, USA; Institute of Sports Imaging, French National Institute of Sports, Paris, France
| | - A Guermazi
- Boston University School of Medicine, Boston, MA, USA; Department of Radiology, VA Boston Healthcare System, West Roxbury, MA, 02132, USA
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Barratt J, Tumlin JA, Suzuki Y, Kao A, Aydemir A, Zima Y, Appel G. MO039THE 24-WEEK INTERIM ANALYSIS RESULTS OF A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED PHASE II STUDY OF ATACICEPT IN PATIENTS WITH IGA NEPHROPATHY AND PERSISTENT PROTEINURIA. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa140.mo039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
IgA nephropathy (IgAN) is the most common primary glomerulonephritis in the world. Despite being described over 50 years ago, there remains no approved therapy for this common global cause of kidney failure. The central pathogenic feature in IgAN is the formation of circulating IgA containing immune complexes which have the propensity to deposit in the kidneys and trigger glomerular inflammation and tubulointerstitial scarring. The primary substrate for immune complex formation is an excess of poorly O-galactosylated polymeric IgA1 (Gd-IgA1) in the circulation. These IgA1 O-glycoforms are thought to trigger the formation of IgA and IgG autoantibodies. Atacicept is a human TACI-Ig fusion protein that inhibits B cell-stimulating factors, BLyS and APRIL, and has been associated with reductions in levels of serum IgA and IgG, as well as reductions in mature B cells and plasma cells. A number of studies have shown elevated levels of BLyS, APRIL and Gd-IgA1 in IgAN patients which have been linked to worse clinical outcomes. IgAN patients with persistent proteinuria >1 g/day are at increased risk of progression to end-stage renal disease. This Phase II study examines the safety and efficacy of atacicept in reducing pathogenic Gd-IgA1 levels and measures of renal activity in IgAN.
Method
This Phase II study (NCT02808429) enrolled patients with IgAN and proteinuria ≥1 g/day or 0.75 mg/mg on 24-hour urine protein-creatinine ratio (UPCR) despite maximal standard of care therapy (angiotensin converting enzyme inhibitor and/or angiotensin receptor blocker). Enrolled patients were randomized 1:1:1 to receive placebo or atacicept 25mg or 75mg once weekly by subcutaneous injection. The primary endpoint was a change in proteinuria by 24-hour UPCR at Week 48; key secondary endpoints included change in eGFR, serum immunoglobulin and Gd-IgA1 levels.
Results
Data from the 24-week interim analysis are reported here for enrolled patients (placebo=5; atacicept 25mg=6; atacicept 75mg=5). A consistent, dose-dependent reduction in serum immunoglobulins (IgA, IgG and IgM) and, in particular, Gd-IgA1 (Figure) were observed through Week 24. In parallel, proteinuria (24-hour UPCR) showed a higher median % reduction from baseline with atacicept at Week 24: -18.67% and -25.34% with atacicept 25 mg and 75 mg, respectively, vs +0.098% with placebo (Figure). eGFR remained stable over time. TEAEs were reported by 81% of the subjects. TEAEs were mild or moderate in severity, with no severe TEAEs reported. No serious related events, events with severe hypogammaglobulinemia or fatal outcome were reported.
Conclusion
These 24-week interim analysis results provide early proof of concept for the potential treatment of atacicept in patients with IgAN and persistent proteinuria.
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Affiliation(s)
- Jonathan Barratt
- Leicester General Hospital, John Walls Renal Unit, Leicester, United Kingdom
| | - James A Tumlin
- Emory University School of Medicine, GA Nephrology, Atlanta, United States of America
| | - Yusuke Suzuki
- Juntendo University Faculty of Medicine, Department of Nephrology, Tokyo, Japan
| | - Amy Kao
- EMD Serono Research and Development Institute, Inc., Immunology, Billerica, United States of America
| | - Aida Aydemir
- EMD Serono Research and Development Institute, Inc., Billerica, United States of America
| | - Yulia Zima
- EMD Serono Research and Development Institute, Inc., Billerica, United States of America
| | - Gerald Appel
- Columbia University Medical Center, Division of Nephrology and Hypertension, New York, United States of America
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Kwoh CK, Guehring H, Aydemir A, Hannon MJ, Eckstein F, Hochberg MC. Predicting knee replacement in participants eligible for disease-modifying osteoarthritis drug treatment with structural endpoints. Osteoarthritis Cartilage 2020; 28:782-791. [PMID: 32247871 DOI: 10.1016/j.joca.2020.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 03/17/2020] [Accepted: 03/26/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Evaluate associations between 2-year change in radiographic or quantitative magnetic resonance imaging (qMRI) structural measures, and knee replacement (KR), within a subsequent 7-year follow-up period. METHOD Participants from the Osteoarthritis Initiative were selected based on potential eligibility criteria for a disease-modifying osteoarthritis (OA) drug trial: Kellgren-Lawrence grade 2 or 3; medial minimum joint space width (mJSW) ≥2.5 mm; knee pain at worst 4-9 in the past 30 days on an 11-point scale, or 0-3 if medication was taken for joint pain; and availability of structural measures over 2 years. Mean 2-year change in structural measures was estimated and compared with two-sample independent t-tests for KR and no KR. Area under the receiver operating characteristic curve (AUC) was estimated using 2-year change in structural measures for prediction of future KR outcomes. RESULTS Among 627 participants, 107 knees underwent KR during a median follow-up of 6.7 years after the 2-year imaging period. Knees that received KR during follow-up had a greater mean loss of cartilage thickness in the total femorotibial joint and medial femorotibial compartment on qMRI, as well as decline in medial fixed joint space width on radiographs, compared with knees that did not receive KR. These imaging measures had similar, although modest discrimination for future KR (AUC 0.62, 0.60, and 0.61, respectively). CONCLUSIONS 2-year changes in qMRI femorotibial cartilage thickness and radiographic JSW measures had similar ability to discriminate future KR in participants with knee OA, suggesting that these measures are comparable biomarkers/surrogate endpoints of structural progression.
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Affiliation(s)
- C K Kwoh
- University of Arizona Arthritis Center, University of Arizona College of Medicine, Tucson, AZ, USA.
| | | | - A Aydemir
- EMD Serono Global Clinical Development Center, Billerica, MA, USA.
| | - M J Hannon
- University of Pittsburgh, Pittsburgh, PA, USA.
| | - F Eckstein
- Institute of Anatomy & Cell Biology, Paracelsus Medical University, Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany.
| | - M C Hochberg
- University of Maryland School of Medicine, Baltimore, MD, USA.
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16
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Eckstein F, Kraines JL, Aydemir A, Wirth W, Maschek S, Hochberg MC. Intra-articular sprifermin reduces cartilage loss in addition to increasing cartilage gain independent of location in the femorotibial joint: post-hoc analysis of a randomised, placebo-controlled phase II clinical trial. Ann Rheum Dis 2020; 79:525-528. [PMID: 32098758 PMCID: PMC7147175 DOI: 10.1136/annrheumdis-2019-216453] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/08/2020] [Accepted: 01/25/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES In the phase II FGF-18 Osteoarthritis Randomized Trial with Administration of Repeated Doses (FORWARD) study, sprifermin demonstrated cartilage modification in the total femorotibial joint and in both femorotibial compartments by MRI in patients with knee osteoarthritis. Here, we evaluate whether sprifermin reduces cartilage loss and increases cartilage thickness, independent of location. METHODS Patients were randomised 1:1:1:1:1 to three once-weekly intra-articular injections of 30 µg sprifermin every 6 months (q6mo); 30 µg sprifermin every 12 months (q12mo); 100 µg sprifermin q6mo; 100 µg sprifermin q12mo; or placebo. Post-hoc analysis using thinning/thickening scores and ordered values evaluated femorotibial cartilage thickness change from baseline to 24 months independent of location. Changes were indirectly compared with those of Osteoarthritis Initiative healthy subjects. RESULTS Thinning scores were significantly lower for sprifermin 100 µg q6mo versus placebo (mean (95% CI) difference: 334 µm (114 to 554)), with a cartilage thinning score similar to healthy subjects. Thickening scores were significantly greater for sprifermin 100 µg q6mo, 100 µg q12mo and 30 µg q6mo versus placebo (mean (95% CI) difference: 425 µm (267 to 584); 450 µm (305 to 594) and 139 µm (19 to 259), respectively) and more than doubled versus healthy subjects. CONCLUSIONS Sprifermin increases cartilage thickness, and substantially reduces cartilage loss, expanding FORWARD primary results. TRIAL REGISTRATION NUMBER NCT01919164.
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Affiliation(s)
- Felix Eckstein
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University, Salzburg, Austria .,Chondrometrics GmbH, Ainring, Germany.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Jeffrey L Kraines
- Global Clinical Development - Immunology, EMD Serono Research and Development Institute, Inc, Billerica, Massachusetts, USA
| | - Aida Aydemir
- Global Biostatistics and Epidemiology, EMD Serono Reserach and Development Institute, Inc, Billerica, Massachusetts, USA
| | - Wolfgang Wirth
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University, Salzburg, Austria.,Chondrometrics GmbH, Ainring, Germany.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Susanne Maschek
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University, Salzburg, Austria.,Chondrometrics GmbH, Ainring, Germany
| | - Marc C Hochberg
- University of Maryland School of Medicine, Baltimore, Maryland, USA
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Butzkueven H, Korhonen P, Hillert J, Trojano M, Aydemir A, Magyari M, Khanfir H, Pinuaga C, Sabidó M. Long Term, Registry-Based, Prospective, Post-Authorization Safety Study Evaluating Adverse Events of Special Interest in Patients with Highly Active Relapsing Multiple Sclerosis Newly Started on Cladribine Tablets − CLARION. Mult Scler Relat Disord 2020. [DOI: 10.1016/j.msard.2019.11.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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18
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Hochberg MC, Guermazi A, Guehring H, Aydemir A, Wax S, Fleuranceau-Morel P, Reinstrup Bihlet A, Byrjalsen I, Ragnar Andersen J, Eckstein F. Effect of Intra-Articular Sprifermin vs Placebo on Femorotibial Joint Cartilage Thickness in Patients With Osteoarthritis: The FORWARD Randomized Clinical Trial. JAMA 2019; 322:1360-1370. [PMID: 31593273 PMCID: PMC6784851 DOI: 10.1001/jama.2019.14735] [Citation(s) in RCA: 195] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Sprifermin is under investigation as a disease-modifying osteoarthritis drug. OBJECTIVE To evaluate the effects of sprifermin on changes in total femorotibial joint cartilage thickness in the more symptomatic knee of patients with osteoarthritis. DESIGN, SETTING, AND PARTICIPANTS FORWARD (FGF-18 Osteoarthritis Randomized Trial with Administration of Repeated Doses) was a 5-year, dose-finding, multicenter randomized clinical trial conducted at 10 sites. Eligible participants were aged 40 to 85 years with symptomatic, radiographic knee osteoarthritis and Kellgren-Lawrence grade 2 or 3. Enrollment began in July 2013 and ended in May 2014; the last participant visit occurred on May 8, 2017. The primary outcome at 2 years and a follow-up analysis at 3 years are reported. INTERVENTIONS Participants were randomized to 1 of 5 groups: intra-articular injections of 100 μg of sprifermin administered every 6 months (n = 110) or every 12 months (n = 110), 30 μg of sprifermin every 6 months (n = 111) or every 12 months (n = 110), or placebo every 6 months (n = 108). Each treatment consisted of weekly injections over 3 weeks. MAIN OUTCOMES AND MEASURES The primary end point was change in total femorotibial joint cartilage thickness measured by quantitative magnetic resonance imaging at 2 years. The secondary end points (of 15 total) included 2-year change from baseline in total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. The minimal clinically important difference (MCID) is unknown for the primary outcome; for total WOMAC score in patients with hip and knee osteoarthritis, the absolute MCID is 7 U (95% CI, 4 to 10 U) and the percentage MCID is 14% (95% CI, 9% to 18%). RESULTS Among 549 participants (median age, 65.0 years; 379 female [69.0%]), 474 (86.3%) completed 2-year follow-up. Compared with placebo, the changes from baseline to 2 years in total femorotibial joint cartilage thickness were 0.05 mm (95% CI, 0.03 to 0.07 mm) for 100 μg of sprifermin administered every 6 months; 0.04 mm (95% CI, 0.02 to 0.06 mm) for 100 μg of sprifermin every 12 months; 0.02 mm (95% CI, -0.01 to 0.04 mm) for 30 μg of sprifermin every 6 months; and 0.01 mm (95% CI, -0.01 to 0.03 mm) for 30 μg of sprifermin every 12 months. Compared with placebo, there were no statistically significant differences in mean absolute change from baseline in total WOMAC scores for 100 μg of sprifermin administered every 6 months or every 12 months, or for 30 μg of sprifermin every 6 months or every 12 months. The most frequently reported treatment-emergent adverse event was arthralgia (placebo: n = 46 [43.0%]; 100 μg of sprifermin administered every 6 months: n = 45 [41.3%]; 100 μg of sprifermin every 12 months: n = 50 [45.0%]; 30 μg of sprifermin every 6 months: n = 40 [36.0%]; and 30 μg of sprifermin every 12 months: n = 48 [44.0%]). CONCLUSIONS AND RELEVANCE Among participants with symptomatic radiographic knee osteoarthritis, the intra-articular administration of 100 μg of sprifermin every 6 or 12 months vs placebo resulted in an improvement in total femorotibial joint cartilage thickness after 2 years that was statistically significant, but of uncertain clinical importance; there was no significant difference for 30 μg of sprifermin every 6 or 12 months vs placebo. Durability of response also was uncertain. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01919164.
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Affiliation(s)
| | - Ali Guermazi
- School of Medicine, Boston University, Boston, Massachusetts
- Boston Imaging Core Lab LLC, Boston, Massachusetts
| | | | - Aida Aydemir
- EMD Serono Research and Development Institute Inc, Billerica, Massachusetts
| | - Stephen Wax
- EMD Serono Research and Development Institute Inc, Billerica, Massachusetts
| | | | | | | | | | - Felix Eckstein
- Institute of Anatomy, Department of Imaging and Functional Musculoskeletal Research, Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria
- Chondrometrics GmbH, Ainring, Germany
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Roemer FW, Aydemir A, Lohmander S, Crema MD, Marra MD, Muurahainen N, Felson DT, Eckstein F, Guermazi A. Structural effects of sprifermin in knee osteoarthritis: a post-hoc analysis on cartilage and non-cartilaginous tissue alterations in a randomized controlled trial. BMC Musculoskelet Disord 2016; 17:267. [PMID: 27393009 PMCID: PMC4938999 DOI: 10.1186/s12891-016-1128-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 06/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A recent publication on efficacy of Sprifermin for knee osteoarthritis (OA) using quantitatively MRI-defined central medial tibio-femoral compartment cartilage thickness as the structural primary endpoint reported no statistically significant dose response. However, Sprifermin was associated with statistically significant, dose-dependent reductions in loss of total and lateral tibio-femoral cartilage thickness. Based on these preliminary promising data a post-hoc analysis of secondary assessment and endpoints was performed to evaluate potential effects of Sprifermin on semi-quantitatively evaluated structural MRI parameters. Aim of the present analysis was to determine effects of sprifermin on several knee joint tissues over a 12 month period. METHODS 1.5 T or 3 T MRIs were acquired at baseline and 12 months follow-up using a standard protocol. MRIs were read according to the Whole-Organ Magnetic Resonance Imaging Score (WORMS) scoring system (in 14 articular subregions) by four muskuloskeletal radiologists independently. Analyses focused on semiquantitative changes in the 100 μg subgroup and matching placebo of multiple MRI-defined structural alterations. Analyses included a delta-subregional and delta-sum approach for the whole knee and the medial and lateral tibio-femoral (MTFJ, LTFJ), and patello-femoral (PFJ) compartments, taking into account number of subregions showing no change, improvement or worsening and changes in the sum of subregional scores. Mann-Whitney - Wilcoxon tests assessed differences between groups. RESULTS Fifty-seven and 18 patients were included in the treatment and matched placebo subgroups. Less worsening of cartilage damage was observed from baseline to 12 months in the PFJ (0.02, 95 % confidence interval (CI) (-0.04, 0.08) vs. placebo 0.22, 95 % CI (-0.05, 0.49), p = 0.046). For bone marrow lesions (BMLs), more improvement was observed from 6 to 12 months for whole knee analyses (-0.14, 95 % CI (-0.48, 0.19) vs. placebo 0.44, 95 % CI (-0.15, 1.04), p = 0.042) although no significant effects were seen from the baseline visit, or in Hoffa-synovitis, effusion-synovitis, menisci and osteophytes. CONCLUSIONS In this post-hoc analysis cartilage showed less worsening from baseline to 12 months in the PFJ, and BMLs showed more improvement from 6 to 12 months for the whole knee. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01033994 .
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Affiliation(s)
- Frank W Roemer
- Quantitative Imaging Center (QIC), Boston University School of Medicine, Boston, MA, USA. .,Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany.
| | | | | | - Michel D Crema
- Quantitative Imaging Center (QIC), Boston University School of Medicine, Boston, MA, USA
| | - Monica Dias Marra
- Quantitative Imaging Center (QIC), Boston University School of Medicine, Boston, MA, USA
| | | | - David T Felson
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
| | - Felix Eckstein
- Department of Anatomy, Paracelsus Medical University, Salzburg, Austria.,Chondometrics GmbH, Ainring, Germany
| | - Ali Guermazi
- Quantitative Imaging Center (QIC), Boston University School of Medicine, Boston, MA, USA
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Dahlberg LE, Aydemir A, Muurahainen N, Gühring H, Fredberg Edebo H, Krarup-Jensen N, Ladel CH, Jurvelin JS. A first-in-human, double-blind, randomised, placebo-controlled, dose ascending study of intra-articular rhFGF18 (sprifermin) in patients with advanced knee osteoarthritis. Clin Exp Rheumatol 2016; 34:445-450. [PMID: 27050139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 11/23/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To evaluate the safety of intra-articular sprifermin (primary), and to evaluate systemic exposure, biomarkers, histology, and other cartilage parameters in patients with advanced osteoarthritis (OA). METHODS This was a first-in-human, double-blind, randomised, placebo-controlled trial of single and multiple ascending doses of sprifermin from 3-300 μg in knee OA patients scheduled for total knee replacement. Patients were randomised 3:1 to sprifermin or placebo, injected into the target knee once or once weekly for 3 weeks, and followed-up for 24 weeks. RESULTS Fifty-five patients were treated with sprifermin, 25 with single and 30 with multiple doses, 18 received placebo. There was no clear difference between the active and placebo groups in incidence, severity, and nature of reported treatment emergent adverse events. Acute inflammatory reactions were slightly more common with sprifermin 300 μg, but none led to discontinuation. No clear difference was seen between placebo and sprifermin in physician-assessed local tolerability, pain, or swelling in the knee. No meaningful changes over time, or differences between treatment groups, were observed for safety laboratory parameters or ECG. Although individual abnormalities were observed, no patterns were evident suggesting a relation to treatment or potential safety concern. No systemic sprifermin exposure, anti-FGF18 antibodies, or clear-cut effects on systemic biomarkers were detected. CONCLUSIONS This first clinical trial of sprifermin revealed no serious safety concerns, although larger studies are needed. The possibility of positive effects of intra-articular sprifermin on histological and other cartilage parameters in knee OA also warrant further investigation.
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Affiliation(s)
- Leif E Dahlberg
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.
| | - Aida Aydemir
- EMD Serono Research and Development Institute, Billerica, MA, USA
| | | | - Hans Gühring
- Global Research and Development, Merck KGaA, Darmstadt, Germany
| | | | - Niels Krarup-Jensen
- Department of Orthopaedic Surgery, Regionshospitalet Viborg, Viborg, Denmark
| | | | - Jukka S Jurvelin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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Eckstein F, Wirth W, Guermazi A, Maschek S, Aydemir A. Brief report: intraarticular sprifermin not only increases cartilage thickness, but also reduces cartilage loss: location-independent post hoc analysis using magnetic resonance imaging. Arthritis Rheumatol 2016; 67:2916-22. [PMID: 26138203 PMCID: PMC5061102 DOI: 10.1002/art.39265] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/25/2015] [Indexed: 01/01/2023]
Abstract
Objective To determine whether an anabolic drug (sprifermin) is capable of reducing cartilage loss wherever it occurs in a given knee, using a subject‐specific, location‐independent analysis of cartilage change in patients with knee osteoarthritis (OA). Methods Study participants (n = 168; ages ≥40 years, 69% women) had symptomatic femorotibial OA not confined to the medial compartment. Sprifermin (10, 30, or 100 μg) or placebo was injected intraarticularly 3 times over 3 weeks, both after randomization (baseline) and 3 months later. Coronal magnetic resonance images were acquired at baseline and 3, 6, and 12 months after treatment. The femorotibial cartilage of each subject was segmented, and changes in cartilage thickness were computed across 16 subregions. Location‐independent post hoc analysis was used to compute summary scores of negative and positive changes in the subregions, summarized as the total cartilage thinning sum score (ThCTnS) and the total cartilage thickening sum score (ThCTkS), capturing change in either direction in each knee. Ordered values of the magnitude of subject‐specific subregional changes in thickness were determined. The ThCTnS and ThCTkS in each sprifermin dose group at 12 months of followup were compared with the values in the matched placebo groups, using the Wilcoxon‐Mann‐Whitney test. Results The mean ± SD ThCTnS was −591 ± 617 μm (median −360 μm, Q1/Q3 = −820/−200 μm) in patients treated with 100 μg sprifermin (n = 57), and −921 ± 777 μm (median −745 μm, Q1/Q3 = −1,190/−380 μm) in patients given placebo (n = 18). The mean difference in the ThCTnS between the 100‐μg sprifermin group and the placebo group was 331 μm (95% confidence interval [95% CI] 24, 685), a difference that was statistically significant (P = 0.03). The mean difference in the ThCTkS in the 100‐μg sprifermin group compared with the placebo group was 237 μm (95% CI 34, 440), also a statistically significant difference (P = 0.028). Conclusion Sprifermin not only increases cartilage thickness, but also reduces cartilage loss. Subject‐specific, location‐independent analysis of both cartilage thinning and thickening represents a sensitive and informative approach for studying the effects of disease‐modifying OA drugs.
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Affiliation(s)
- Felix Eckstein
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria and Chondrometrics GmbH, Ainring, Germany
| | - Wolfgang Wirth
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria and Chondrometrics GmbH, Ainring, Germany
| | - Ali Guermazi
- Boston University School of Medicine and Boston Imaging Core Lab, LLC, Boston, Massachusetts
| | - Susanne Maschek
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria and Chondrometrics GmbH, Ainring, Germany
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Roemer F, Aydemir A, Lohmander S, Crema M, Marra M, Muurahainen N, Felson D, Guermazi A. AB0852 Sprifermin Alters Cartilage Morphology and Subchondral Bone Marrow Lesions in Knee Osteoarthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Castaño PM, Aydemir A, Sampson-Landers C, Lynen R. The folate status of reproductive-aged women in a randomised trial of a folate-fortified oral contraceptive: dietary and blood assessments. Public Health Nutr 2014; 17:1375-83. [PMID: 23534865 PMCID: PMC10282410 DOI: 10.1017/s1368980013000864] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 02/04/2013] [Accepted: 02/20/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To assess the folate status of US women in a study of a folate-fortified oral contraceptive (OC) using the Short Folate Food Frequency Questionnaire and plasma and red blood cell (RBC) folate samples. DESIGN Sub-analysis from a multi-centre, randomised, double-blind, controlled contraceptive trial with assessments at baseline and 6 months. We calculated dietary folate equivalents (DFE) consumed and the proportion of participants meeting folate adequacy benchmarks. SETTING Eight centres in the USA. SUBJECTS Healthy women aged 18-40 years requesting contraception with no contraindications for OC use. RESULTS Overall, 385 participants were randomised to either a novel folate-fortified OC or a marketed OC. The 262 (68 %) participants compliant with the protocol were included in the analysis set. Baseline daily DFE consumption was 529·8 (sd 342·1) μg and similar in both groups. At follow-up, the fortified OC group had higher intake than the conventional OC group (1225·9 (sd 346·2) μg compared with 500·6 (sd 361·2) μg). Mean plasma folate level increased from 44·5 (sd 17·2) to 55·8 (sd 21·1) nmol/l. Mean RBC folate level increased from 996·7 (sd 369·8) to 1311·9 (sd 436·0) nmol/l. The proportion meeting selected folate adequacy benchmarks increased in the fortified OC group (P < 0·001). CONCLUSIONS Lack of adequate folate intake in reproductive-aged women from dietary sources or supplements alone suggests the need for novel approaches. Use of folate-fortified OC ensures adequate folate levels and meeting of folate benchmarks.
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Affiliation(s)
- Paula M Castaño
- Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 West 168th Street, PH 16-69, New York, NY 10032, USA
| | - Aida Aydemir
- Bayer HealthCare Pharmaceuticals Inc., Wayne, NJ, USA
| | | | - Richard Lynen
- Bayer HealthCare Pharmaceuticals Inc., Wayne, NJ, USA
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Castaño P, Aydemir A, Lynen R, Sampson-Landers C. The folate status of reproductive-aged women desiring contraception: dietary and blood assessments from a randomized trial. Contraception 2012. [DOI: 10.1016/j.contraception.2012.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Parker MM, Gordon D, Reilly A, Horowitz HW, Waters M, Bennett R, Hallack R, Smith J, Lamson D, Aydemir A, Dvali N, Agins BD, Drusano GL, Taylor J. Prevalence of drug-resistant and nonsubtype B HIV strains in antiretroviral-naïve, HIV-infected individuals in New York State. AIDS Patient Care STDS 2007; 21:644-52. [PMID: 17919091 DOI: 10.1089/apc.2006.0172] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The duration of HIV infection is usually unknown for most patients entering into HIV care. Data on the frequency at which resistance mutations are detected in these patients are needed to support practical guidance on the use of resistance testing in this clinical situation. Furthermore, little is known about HIV subtype diversity in much of the United States. Therefore, we analyzed the prevalence of drug resistance mutations and nonsubtype B strains of HIV among antiretroviral-naïve individuals presenting for HIV care in New York State between September 2000 and January 2004. Sequences were obtained using a commercial HIV genotyping assay. Seventeen of 151 subjects (11.3%; 95% confidence interval 7.2%-17.3%) had at least one drug-resistance mutation, including 5 subjects with fewer than 200 CD4(+) T cells, indicative of advanced infection. Nucleoside reverse transcriptase inhibitor, non-nucleoside reverse transcriptase inhibitor, and protease inhibitor resistance mutations were detected in 6.6%, 5.3%, and 0.7% of subjects, respectively. Subjects from New York City-based clinics were less likely to have resistant virus than subjects from clinics elsewhere in New York State. Nonsubtype B strains of HIV were detected in 9 (6.0%) individuals and were associated with heterosexual contact. Two nonsubtype B strains from this cohort also carried drug-resistance mutations. These data indicate that drug-resistant virus is frequently detected in antiretroviral-naïve individuals entering HIV care in New York State. Furthermore, a diverse set of nonsubtype B strains were identified and evidence suggests that nonsubtype B strains, including those carrying drug-resistance mutations, are being transmitted in New York State.
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Affiliation(s)
- Monica M. Parker
- Wadsworth Center, New York State Department of Health, Albany, New York
| | - Daniel Gordon
- Center for Community Health, New York State Department of Health, Albany, New York
| | - Andrew Reilly
- Wadsworth Center, New York State Department of Health, Albany, New York
- University at Albany School of Public Health, Albany, New York
| | | | - Mark Waters
- AIDS Institute, New York State Department of Health, New York, New York
| | - Ryan Bennett
- Wadsworth Center, New York State Department of Health, Albany, New York
| | - Renee Hallack
- Wadsworth Center, New York State Department of Health, Albany, New York
| | - Joseph Smith
- Wadsworth Center, New York State Department of Health, Albany, New York
| | - Daryl Lamson
- Wadsworth Center, New York State Department of Health, Albany, New York
| | - Aida Aydemir
- Wadsworth Center, New York State Department of Health, Albany, New York
- University at Albany School of Public Health, Albany, New York
| | - Natia Dvali
- Wadsworth Center, New York State Department of Health, Albany, New York
| | - Bruce D. Agins
- AIDS Institute, New York State Department of Health, New York, New York
| | - George L. Drusano
- Wadsworth Center, New York State Department of Health, Albany, New York
- Ordway Research Institute, Albany, New York
| | - Jill Taylor
- Wadsworth Center, New York State Department of Health, Albany, New York
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Aydemir A, Abbasoglu O, Topaloglu S, Ertoy D, Ayhan A, Kilinç K, Karabulut E, Sayek I. Protective effect of roscovitine on renal ischemia–reperfusion injury. Transplant Proc 2002; 34:2027-8. [PMID: 12270300 DOI: 10.1016/s0041-1345(02)02838-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A Aydemir
- Hacettepe University School of Medicine, Ankara, Turkey
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