1
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Yi TW, Smyth B, Di Tanna GL, Arnott C, Cardoza K, Kang A, Pollock C, Agarwal R, Bakris G, Charytan DM, de Zeeuw D, Heerspink HJL, Neal B, Wheeler DC, Cannon CP, Zhang H, Zinman B, Perkovic V, Levin A, Mahaffey KW, Jardine M. Kidney and Cardiovascular Effects of Canagliflozin According to Age and Sex: A Post Hoc Analysis of the CREDENCE Randomized Clinical Trial. Am J Kidney Dis 2023; 82:84-96.e1. [PMID: 36889425 DOI: 10.1053/j.ajkd.2022.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/30/2022] [Accepted: 12/21/2022] [Indexed: 03/08/2023]
Abstract
RATIONALE & OBJECTIVE It is unclear whether the effect of canagliflozin on adverse kidney and cardiovascular events in those with diabetic kidney disease varies by age and sex. We assessed the effects of canagliflozin among age group categories and between sexes in the Canagliflozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) study. STUDY DESIGN Secondary analysis of a randomized controlled trial. SETTING & PARTICIPANTS Participants in the CREDENCE trial. INTERVENTION Participants were randomly assigned to receive canagliflozin 100mg/d or placebo. OUTCOMES Primary composite outcome of kidney failure, doubling of serum creatinine concentration, or death due to kidney or cardiovascular disease. Prespecified secondary and safety outcomes were also analyzed. Outcomes were evaluated by age at baseline (<60, 60-69, and≥70 years) and sex in the intention-to-treat population using Cox regression models. RESULTS The mean age of the cohort was 63.0±9.2 years, and 34% were female. Older age and female sex were independently associated with a lower risk of the composite of adverse kidney outcomes. There was no evidence that the effect of canagliflozin on the primary outcome (a composite of kidney failure, a doubling of serum creatinine concentration, or death from kidney or cardiovascular causes) differed between age groups (HRs, 0.67 [95% CI, 0.52-0.87], 0.63 [0.48-0.82], and 0.89 [0.61-1.29] for ages<60, 60-69, and≥70 years, respectively; P=0.3for interaction) or sexes (HRs, 0.71 [95% CI, 0.54-0.95] and 0.69 [0.56-0.84] in women and men, respectively; P=0.8for interaction). No differences in safety outcomes by age group or sex were observed. LIMITATIONS This was a post hoc analysis with multiple comparisons. CONCLUSIONS Canagliflozin consistently reduced the relative risk of kidney events in people with diabetic kidney disease in both sexes and across age subgroups. As a result of greater background risk, the absolute reduction in adverse kidney outcomes was greater in younger participants. FUNDING This post hoc analysis of the CREDENCE trial was not funded. The CREDENCE study was sponsored by Janssen Research and Development and was conducted collaboratively by the sponsor, an academic-led steering committee, and an academic research organization, George Clinical. TRIAL REGISTRATION The original CREDENCE trial was registered at ClinicalTrials.gov with study number NCT02065791.
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Affiliation(s)
- Tae Won Yi
- The George Institute for Global Health, University of New South Wales, New South Wales, Australia; Department of Medicine, Clinician Investigator Program, University of British Columbia, Vancouver, British Columbia
| | - Brendan Smyth
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney Medical School, New South Wales, Australia; Department of Renal Medicine, St George Hospital, Kogarah, New South Wales, Australia; National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia.
| | - Gian Luca Di Tanna
- The George Institute for Global Health, University of New South Wales, New South Wales, Australia
| | - Clare Arnott
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney Medical School, New South Wales, Australia
| | - Kathryn Cardoza
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Amy Kang
- Department of Renal Medicine, Prince of Wales Hospital, New South Wales, Australia
| | - Carol Pollock
- Kolling Institute of Medical Research, Sydney Medical School, New South Wales, Australia; Department of Renal Medicine, Royal North Shore Hospital, New South Wales, Australia
| | - Rajiv Agarwal
- Indiana University School of Medicine and VA Medical Center, Indianapolis, IN
| | - George Bakris
- Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - David M Charytan
- Nephrology Division, New York University Langone Medical Center, New York University School Grossman of Medicine, New York, NY
| | - Dick de Zeeuw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, New South Wales, Australia; Charles Perkins Centre, University of Sydney, New South Wales, Australia; School of Public, Imperial College London, London, United Kingdom
| | - David C Wheeler
- Department of Renal Medicine, University College London Medical School, London, United Kingdom
| | - Christopher P Cannon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Hong Zhang
- Renal Division, Peking University First Hospital, Beijing, China
| | - Bernard Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vlado Perkovic
- The George Institute for Global Health, University of New South Wales, New South Wales, Australia; Department of Renal Medicine, Royal North Shore Hospital, New South Wales, Australia
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Meg Jardine
- The George Institute for Global Health, University of New South Wales, New South Wales, Australia; Department of Nephrology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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2
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Cheng WH, Cheung H, Kang A, Fan J, Cooper J, Anwer M, Barron C, Wilkinson A, Hu G, Yue J, Cripton PA, Vocadlo DJ, Wellington CL. Altered Tau Kinase Activity in rTg4510 Mice after a Single Interfaced CHIMERA Traumatic Brain Injury. Int J Mol Sci 2023; 24:ijms24119439. [PMID: 37298388 DOI: 10.3390/ijms24119439] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Traumatic brain injury (TBI) is an established risk factor for neurodegenerative diseases. In this study, we used the Closed Head Injury Model of Engineered Rotational Acceleration (CHIMERA) to investigate the effects of a single high-energy TBI in rTg4510 mice, a mouse model of tauopathy. Fifteen male rTg4510 mice (4 mo) were impacted at 4.0 J using interfaced CHIMERA and were compared to sham controls. Immediately after injury, the TBI mice showed significant mortality (7/15; 47%) and a prolonged duration of loss of the righting reflex. At 2 mo post-injury, surviving mice displayed significant microgliosis (Iba1) and axonal injury (Neurosilver). Western blotting indicated a reduced p-GSK-3β (S9):GSK-3β ratio in TBI mice, suggesting chronic activation of tau kinase. Although longitudinal analysis of plasma total tau suggested that TBI accelerates the appearance of tau in the circulation, there were no significant differences in brain total or p-tau levels, nor did we observe evidence of enhanced neurodegeneration in TBI mice compared to sham mice. In summary, we showed that a single high-energy head impact induces chronic white matter injury and altered GSK-3β activity without an apparent change in post-injury tauopathy in rTg4510 mice.
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Affiliation(s)
- Wai Hang Cheng
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Honor Cheung
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Amy Kang
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Jianjia Fan
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Jennifer Cooper
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Mehwish Anwer
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Carlos Barron
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Anna Wilkinson
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Grace Hu
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Jefferey Yue
- Department of Chemistry, Simon Fraser University, Vancouver, BC V5A 1S6, Canada
| | - Peter A Cripton
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- International Collaboration on Repair Discoveries, Vancouver, BC V5Z 1M9, Canada
| | - David J Vocadlo
- Department of Chemistry, Simon Fraser University, Vancouver, BC V5A 1S6, Canada
| | - Cheryl L Wellington
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- International Collaboration on Repair Discoveries, Vancouver, BC V5Z 1M9, Canada
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3
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Kang A, Smyth B, Neuen BL, Heerspink HJL, Di Tanna GL, Zhang H, Arnott C, Hockham C, Agarwal R, Bakris G, Charytan DM, de Zeeuw D, Greene T, Levin A, Pollock C, Wheeler DC, Mahaffey KW, Perkovic V, Jardine MJ. The sodium-glucose cotransporter-2 inhibitor canagliflozin does not increase risk of non-genital skin and soft tissue infections in people with type 2 diabetes mellitus: A pooled post hoc analysis from the CANVAS Program and CREDENCE randomized double-blind trials. Diabetes Obes Metab 2023. [PMID: 37161691 DOI: 10.1111/dom.15091] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/01/2023] [Accepted: 04/09/2023] [Indexed: 05/11/2023]
Abstract
AIMS To assess whether the sodium-glucose cotransporter-2 (SGLT2) inhibitor canagliflozin affects risk of non-genital skin and soft tissue infections (SSTIs). MATERIALS AND METHODS We performed a post hoc pooled individual participant analysis of the CANVAS Program and CREDENCE trials that randomized people with type 2 diabetes at high cardiovascular risk and/or with chronic kidney disease to either canagliflozin or placebo. Investigator-reported adverse events were assessed by two blinded authors following predetermined criteria for non-genital SSTIs. Risks of non-genital SSTIs, overall and within prespecified subgroups, and risk of non-genital fungal SSTIs, were analysed using Cox regression models. Factors associated with non-genital SSTIs were assessed using multivariable Cox regression models. RESULTS Overall, 903 of 14 531 participants (6%) experienced non-genital SSTIs over a median follow-up of 26 months. No difference was observed in non-genital SSTI rates between canagliflozin and placebo (24.0 events/1000 person-years vs. 23.9 events/1000 person-years, respectively; hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.85-1.11; P = 0.70), with consistent results across subgroups (all P interaction > 0.05). The risk of recurrent events and non-genital fungal infection also did not differ significantly between canagliflozin and placebo (HR 1.06, 95% CI 0.94-1.19 [P = 0.32] and HR 1.18, 95% CI 0.88-1.60 [P = 0.27], respectively). Baseline factors independently associated with non-genital SSTIs were younger age, male sex, higher body mass index, higher glycated haemoglobin, lower estimated glomerular filtration rate (eGFR), established peripheral vascular disease, and history of neuropathy. CONCLUSIONS Canagliflozin did not affect risk of non-genital SSTIs or non-genital fungal SSTIs compared with placebo. These findings suggest that any SGLT2 inhibitor-mediated change in skin microenvironment is unlikely to have meaningful clinical consequences.
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Affiliation(s)
- Amy Kang
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
- Department of Nephrology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Brendan Smyth
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Renal Medicine, St George Hospital, Sydney, New South Wales, Australia
| | - Brendon L Neuen
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Hiddo J L Heerspink
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gian Luca Di Tanna
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Hong Zhang
- Renal Division of Peking University First Hospital, Beijing, China
| | - Clare Arnott
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney Medical School, Sydney, New South Wales, Australia
| | - Carinna Hockham
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Rajiv Agarwal
- Indiana University School of Medicine and VA Medical Center, Indianapolis, Indiana, USA
| | - George Bakris
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - David M Charytan
- Nephrology Division, New York University Langone Medical Center, New York University School of Medicine, New York, New York, USA
| | - Dick de Zeeuw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Tom Greene
- University of Utah, Salt Lake City, Utah, USA
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carol Pollock
- Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - David C Wheeler
- Department of Renal Medicine, University College London Medical School, London, UK
| | - Kenneth W Mahaffey
- Stanford Centre for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Vlado Perkovic
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Meg J Jardine
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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4
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Kang A, Ariue B. FACIAL SWELLING, RESPIRATORY FAILURE, FLUCTUATING COMPLEMENT 4 LEVELS, AND RELIGIOUS CONSIDERATION IN A PEDIATRIC PATIENT. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.812] [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: 11/11/2022]
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5
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Wicky BIM, Milles LF, Courbet A, Ragotte RJ, Dauparas J, Kinfu E, Tipps S, Kibler RD, Baek M, DiMaio F, Li X, Carter L, Kang A, Nguyen H, Bera AK, Baker D. Hallucinating symmetric protein assemblies. Science 2022; 378:56-61. [PMID: 36108048 PMCID: PMC9724707 DOI: 10.1126/science.add1964] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Deep learning generative approaches provide an opportunity to broadly explore protein structure space beyond the sequences and structures of natural proteins. Here, we use deep network hallucination to generate a wide range of symmetric protein homo-oligomers given only a specification of the number of protomers and the protomer length. Crystal structures of seven designs are very similar to the computational models (median root mean square deviation: 0.6 angstroms), as are three cryo-electron microscopy structures of giant 10-nanometer rings with up to 1550 residues and C33 symmetry; all differ considerably from previously solved structures. Our results highlight the rich diversity of new protein structures that can be generated using deep learning and pave the way for the design of increasingly complex components for nanomachines and biomaterials.
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Affiliation(s)
- B. I. M. Wicky
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - L. F. Milles
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - A. Courbet
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
- Howard Hughes Medical Institute, University of Washington, Seattle, WA, USA
| | - R. J. Ragotte
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - J. Dauparas
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - E. Kinfu
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - S. Tipps
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - R. D. Kibler
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - M. Baek
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - F. DiMaio
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - X. Li
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - L. Carter
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - A. Kang
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - H. Nguyen
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - A. K. Bera
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - D. Baker
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
- Howard Hughes Medical Institute, University of Washington, Seattle, WA, USA
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6
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Dauparas J, Anishchenko I, Bennett N, Bai H, Ragotte RJ, Milles LF, Wicky BIM, Courbet A, de Haas RJ, Bethel N, Leung PJY, Huddy TF, Pellock S, Tischer D, Chan F, Koepnick B, Nguyen H, Kang A, Sankaran B, Bera AK, King NP, Baker D. Robust deep learning-based protein sequence design using ProteinMPNN. Science 2022; 378:49-56. [PMID: 36108050 PMCID: PMC9997061 DOI: 10.1126/science.add2187] [Citation(s) in RCA: 214] [Impact Index Per Article: 107.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Although deep learning has revolutionized protein structure prediction, almost all experimentally characterized de novo protein designs have been generated using physically based approaches such as Rosetta. Here, we describe a deep learning-based protein sequence design method, ProteinMPNN, that has outstanding performance in both in silico and experimental tests. On native protein backbones, ProteinMPNN has a sequence recovery of 52.4% compared with 32.9% for Rosetta. The amino acid sequence at different positions can be coupled between single or multiple chains, enabling application to a wide range of current protein design challenges. We demonstrate the broad utility and high accuracy of ProteinMPNN using x-ray crystallography, cryo-electron microscopy, and functional studies by rescuing previously failed designs, which were made using Rosetta or AlphaFold, of protein monomers, cyclic homo-oligomers, tetrahedral nanoparticles, and target-binding proteins.
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Affiliation(s)
- J. Dauparas
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - I. Anishchenko
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - N. Bennett
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
- Molecular Engineering Graduate Program, University of Washington, Seattle, WA, USA
| | - H. Bai
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - R. J. Ragotte
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - L. F. Milles
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - B. I. M. Wicky
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - A. Courbet
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
- Howard Hughes Medical Institute, University of Washington, Seattle, WA, USA
| | - R. J. de Haas
- Department of Physical Chemistry and Soft Matter, Wageningen University and Research, Wageningen, The Netherlands
| | - N. Bethel
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
- Howard Hughes Medical Institute, University of Washington, Seattle, WA, USA
| | - P. J. Y. Leung
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
- Molecular Engineering Graduate Program, University of Washington, Seattle, WA, USA
| | - T. F. Huddy
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - S. Pellock
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - D. Tischer
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - F. Chan
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - B. Koepnick
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - H. Nguyen
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - A. Kang
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - B. Sankaran
- Berkeley Center for Structural Biology, Molecular Biophysics and Integrated Bioimaging, Lawrence Berkeley Laboratory, 1 Cyclotron Road, Berkeley, CA 94720, USA
| | - A. K. Bera
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - N. P. King
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
| | - D. Baker
- Department of Biochemistry, University of Washington, Seattle, WA, USA
- Institute for Protein Design, University of Washington, Seattle, WA, USA
- Howard Hughes Medical Institute, University of Washington, Seattle, WA, USA
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7
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Kang A, Jiang J, Li X, Li D, Schuler P, Saha S, Terasaka N. Real-world assessment of anti-platelet therapies for recurrent stroke prevention in non-atrial fibrillation Japanese patients after recent ischemic stroke or transient ischemic attack. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2661] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Stroke is one of the leading causes of cardiovascular-related deaths and disability for adults in Japan and is more commonly seen among the elderly. The risks of developing a secondary stroke resulting in permanent damage after the incident ischemic stroke (IS)/transient ischemic stroke (TIA) are very high. It is critical to understand the treatment landscape for the secondary stroke prevention (SSP) and unmet needs of patients with prior IS/ TIA events.
Purpose
To evaluate the antiplatelet therapy (APT) treatment patterns for SSP after first hospitalization for IS/TIA events among the Japanese population.
Methods
Japan's Medical Data Vision (MDV) from Q12011 to Q22021 was used for this study. MDV is a hospital-based claims database covering approximately 35.5 million individuals in the inpatient and outpatient settings among 438 hospitals. Adult patients with an inpatient primary diagnosis of IS/TIA during the index period were identified. Patients require at least one medical claim each quarter within the 1 year before and after index date to ensure longitudinal analysis. Atrial fibrillation patients or patients on oral anticoagulant use were excluded. Patients' characteristics, treatment pattern and duration were evaluated.
Results
Of 18,948 patients in this study, the mean age was 75 years and 36.7% were female; 91.5% were treated with APT and 8.5% were untreated within 90 days of hospital discharge. Among 17,332 APT treated patients, 76.9% were initiated on single APT (SAPT), 22.7% were initiated on dual APT (DAPT), and <1% were initiated on multiple APT (MAPT). The most used SAPT were aspirin (ASA; 33.2%), clopidogrel (28.7%) or cilostazol (14.8%) and the most used DAPT were ASA+clopidogrel (15.1%), ASA+cilostazol (4.2%) or cilostazol+clopidogrel (2.7%). The median duration of APT was 320, 414 and 411 days for patients who initiated ASA, clopidogrel and cilostazol, respectively. The median duration of APT for patients who initiated ASA+clopidogrel, ASA+cilostazol and cilostazol+clopidogrel was 298, 359 and 473 days respectively. Of patients initiated on ASA+clopidogrel, 52.4% were de-escalated to SAPT (71% clopidogrel, 29% ASA; median duration of 20 days); 36.2% of patients initiated on ASA+cilostazol were de-escalated to SAPT within a median of 19 days (84% cilostazol, 16% ASA); lastly, 54.4% of patients initiated on cilostazol+clopidogrel de-escalated to SAPT within a median of 35 days (76% cilostazol, 24% clopidogrel). Two years after initial hospitalization of IS/TIA, 52%-56% discontinued APT treatments among those previously receiving SAPT while 46%-57% of patients receiving DAPT discontinued treatment.
Conclusion
Majority of patients at risk of secondary stroke received APT. Further analyses are needed to explore reasons for early APT discontinuation, for no APT use, and to evaluate outcomes of patients in this study.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This study was sponsored by Bristol Myers Squibb and Janssen Research & Development, LLC. – Anonymised and used for statistical purposes only
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Affiliation(s)
- A Kang
- Bristol Myers Squibb , Lawrenceville , United States of America
| | - J Jiang
- Bristol Myers Squibb , Lawrenceville , United States of America
| | - X Li
- Bristol Myers Squibb , Lawrenceville , United States of America
| | - D Li
- Bristol Myers Squibb , Lawrenceville , United States of America
| | - P Schuler
- Bristol Myers Squibb , Lawrenceville , United States of America
| | - S Saha
- Mu Sigma Inc , Bangalore , India
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8
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Greene S, Spertus JA, Tang W, Kang A, Zhong Y, Myers M, Shen S, Jiang J, Liu X, Steffen DR, Viola M, Felker GM. Heart failure across the range of preserved ejection fraction in United States clinical practice. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.863] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Recent clinical trials of heart failure with preserved ejection fraction (HFpEF) have observed varying patient profiles by ejection fraction (EF), with attenuation of treatment benefits as EF increases. In routine clinical practice, the degree to which patients hospitalized for HF with EF≥60% may differ from those with lower EF is unknown.
Purpose
To compare patient characteristics, treatment patterns, and clinical outcomes across the range of EF among patients hospitalized for HFpEF.
Methods
Using the Humedica electronic medical records database between Jan 2010 and Dec 2020, patients hospitalized for a primary diagnosis of HF with EF>40% and who were haemodynamically stable at admission, without concurrent acute coronary syndrome or end-stage renal disease, and treated with intravenous (IV) diuretic agents within 48 h of admission were identified. Patient characteristics, treatment patterns, and clinical outcomes were compared by EF ranges of 41–49%, 50–59%, and ≥60%.
Results
Of 47,026 patients hospitalized with HFpEF, 6,335 (13%) had EF 41–49%, 18,603 (40%) had EF 50–59%, and 22,088 (47%) had EF≥60%. Across all 3 groups, patients were similar with respect to age (median 77 years for each group), race (83–84% White, 12–13% Black), systolic blood pressure (137–138 mmHg at admission), and eGFR (63–64 mL/min/1.73 m2 at admission). With progressively higher EF group, the proportion of women increased (45% vs 54% vs 65%) and median NT-proBNP decreased (4,221 vs 2,945 vs 2,234 pg/mL). Patients with EF ≥60% had the lowest rates of coronary artery disease and atrial fibrillation, and the highest rates of chronic pulmonary disease (Figure 1, Panel A). Discharge medications were generally similar, with exception of less beta-blocker use and more calcium channel blocker use among those with EF ≥60% (Figure 1, Panel B). Discharge use of angiotensin receptor-neprilysin inhibitor and sodium glucose cotransporter-2 inhibitor therapies were each <1% in all groups. Hospital length of stay (median 4 days for each group) and in-hospital mortality (1.1–1.3%) were similar across groups, but rates of in-hospital acute respiratory failure were higher among patients with EF ≥60% (27% vs 230-25% for lower EF groups). Rates of 30-day and 12-month post-discharge clinical events were high irrespective of EF, without meaningful differences between groups (Figure 2).
Conclusion
In a contemporary real-world population of US patients hospitalized for HF with EF >40%, nearly half had an EF≥60%. While clinical profiles and discharge medications varied, post-discharge outcomes were similarly poor irrespective of EF. There remain important opportunities to improve the care and outcomes for patients with HF across the range of preserved ejection fraction.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): MyoKardia, Inc., a wholly owned subsidiary of Bristol Myers Squibb
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Affiliation(s)
- S Greene
- Duke Clinical Research Institute , Durham , United States of America
| | - J A Spertus
- St. Luke's Mid America Heart Institute , Kansas City , United States of America
| | - W Tang
- Duke Clinical Research Institute , Durham , United States of America
| | - A Kang
- Bristol-Myers Squibb Company , Lawrenceville , United States of America
| | - Y Zhong
- Bristol-Myers Squibb Company , Lawrenceville , United States of America
| | - M Myers
- Bristol-Myers Squibb Company , Lawrenceville , United States of America
| | - S Shen
- Bristol-Myers Squibb Company , Lawrenceville , United States of America
| | - J Jiang
- Bristol-Myers Squibb Company , Lawrenceville , United States of America
| | - X Liu
- Bristol-Myers Squibb Company , Lawrenceville , United States of America
| | - D R Steffen
- Analysis Group Inc. , New York , United States of America
| | - M Viola
- Analysis Group Inc. , New York , United States of America
| | - G M Felker
- Duke Clinical Research Institute , Durham , United States of America
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9
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Kang A, Beuttler R, Minejima E. Evaluation of step-down oral antibiotic therapy for uncomplicated streptococcal bloodstream infections on clinical outcomes. Ther Adv Infect Dis 2022; 9:20499361211073248. [PMID: 35127081 PMCID: PMC8808041 DOI: 10.1177/20499361211073248] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Despite the severity and frequency of streptococcal bloodstream infections (BSIs), the effectiveness of oral definitive therapy remains unknown. The objective of this study was to evaluate the clinical outcomes of step-down oral antibiotics for the treatment of uncomplicated streptococcal BSIs. Methods: In this retrospective cohort study, adult patients admitted with uncomplicated streptococcal BSI between June 2015 and June 2017 were included. Patients were excluded if they received <48 h of antibiotic therapy; therapy was started >48 h after first positive culture; had complicated infections of endocarditis, bone and joint infections, or central nervous system infections; Pitt bacteremia score (PBS) ⩾ 4; or failed to respond to effective therapy necessitating continued intravenous (IV) therapy. Patients were grouped by receipt of step-down oral antibiotic therapy (PO group) versus continued IV therapy (IV group). Outcomes included hospital length of stay (LOS), 30-day recurrence of BSI, 30-day readmission, 30-day all-cause mortality, and catheter-related or drug-related adverse events (AEs). Results: Of 244 patients included, 40% received step-down oral therapy (n = 98). Overall, the most common source of BSI was pneumonia (22%), followed by skin and soft tissue infections (SSTI) (18%). Severity of illness measured by intensive care unit (ICU) admission and PBS was similar. The IV group had significantly longer LOS [median 10 (interquartile range [IQR] = 5–21) versus 5 (4–6) days, p < 0.01] compared with the PO group. BSI recurrence, readmission, all-cause mortality within 30 days, and AEs were similar between the groups (p = ns). Conclusion: In uncomplicated streptococcal BSI, patients treated with step-down oral antibiotic therapy had significantly shorter LOS compared with continued IV therapy without compromise of clinical outcomes.
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Affiliation(s)
- Amy Kang
- Department of Pharmacy Practice, School of Pharmacy, Chapman University, Irvine, CA, USA
- Department of Pharmacy, Harbor-UCLA Medical Center, Torrance, CA, USA
- The Lundquist Institute, Torrance, CA, USA
| | - Richard Beuttler
- Department of Pharmacy Practice, School of Pharmacy, Chapman University, Irvine, CA, USA
| | - Emi Minejima
- Department of Clinical Pharmacy, School of Pharmacy, University of Southern California, Los Angeles, CA, USA
- Department of Pharmacy, LAC + USC Medical Center, PSC B15-B, Health Sciences Campus, 90089-9121, Los Angeles, CA, USA
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10
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Young TK, Toussaint ND, Di Tanna GL, Arnott C, Hockham C, Kang A, Schutte AE, Perkovic V, Mahaffey KW, Agarwal R, Bakris GL, Charytan DM, Heerspink HJL, Levin A, Pollock C, Wheeler DC, Zhang H, Jardine MJ. Risk Factors for Fracture in Patients with Coexisting Chronic Kidney Disease and Type 2 Diabetes: An Observational Analysis from the CREDENCE Trial. J Diabetes Res 2022; 2022:9998891. [PMID: 35677742 PMCID: PMC9168808 DOI: 10.1155/2022/9998891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/08/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The fracture pathophysiology associated with type 2 diabetes and chronic kidney disease (CKD) is incompletely understood. We examined individual fracture predictors and prediction sets based on different pathophysiological hypotheses, testing whether any of the sets improved prediction beyond that based on traditional osteoporotic risk factors. METHODS Within the CREDENCE cohort with adjudicated fracture outcomes, we assessed the association of individual factors with fracture using Cox regression models. We used the Akaike information criteria (AIC) and Schwartz Bayes Criterion (SBC) to assess six separate variable sets based on hypothesized associations with fracture, namely, traditional osteoporosis, exploratory general population findings, cardiovascular risk, CKD-mineral and bone disorder, diabetic osteodystrophy, and an all-inclusive set containing all variables. RESULTS Fracture occurred in 135 (3.1%) participants over a median 2.35 [1.88-2.93] years. Independent fracture predictors were older age (hazard ratio [HR] 1.04, confidence interval [CI] 1.01-1.06), female sex (HR 2.49, CI 1.70-3.65), previous fracture (HR 2.30, CI 1.58-3.34), Asian race (HR 1.74, CI 1.09-2.78), vitamin D therapy requirement (HR 2.05, CI 1.31-3.21), HbA1c (HR 1.14, CI 1.00-1.32), prior cardiovascular event (HR 1.60, CI 1.10-2.33), and serum albumin (HR 0.41, CI 0.23-0.74) (lower albumin associated with greater risk). The goodness of fit of the various hypothesis sets was similar (AIC range 1870.92-1849.51, SBC range 1875.60-1948.04). CONCLUSION Independent predictors of fracture were identified in the CREDENCE participants with type 2 diabetes and CKD. Fracture prediction was not improved by models built on alternative pathophysiology hypotheses compared with traditional osteoporosis predictors.
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Affiliation(s)
- Tamara K. Young
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Nigel D. Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine (RMH), University of Melbourne, Parkville, Victoria, Australia
| | | | - Clare Arnott
- The George Institute for Global Health, UNSW, Sydney, Australia
- Department of Cardiology Royal Prince Alfred Hospital, Sydney, Australia
| | - Carinna Hockham
- The George Institute for Global Health, Imperial College London, UK
| | - Amy Kang
- The George Institute for Global Health, UNSW, Sydney, Australia
- Prince of Wales Hospital, Randwick, Australia
| | - Aletta E. Schutte
- The George Institute for Global Health, UNSW, Sydney, Australia
- Faculty of Medicine, UNSW, Australia
| | - Vlado Perkovic
- The George Institute for Global Health, UNSW, Sydney, Australia
- Faculty of Medicine, UNSW, Australia
| | - Kenneth W. Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Rajiv Agarwal
- Indiana University School of Medicine and Veterans Affairs Medical Center, Indianapolis, Indiana, USA
| | - George L. Bakris
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - David M. Charytan
- Nephrology Division, NYU School of Medicine and NYU Langone Medical Center, New York, New York, USA
| | - Hiddo J. L. Heerspink
- The George Institute for Global Health, UNSW, Sydney, Australia
- University of Groningen, Groningen, Netherlands
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carol Pollock
- Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Australia
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | | | - Hong Zhang
- Renal Division of Peking University First Hospital, Beijing, China
| | - Meg J. Jardine
- The George Institute for Global Health, UNSW, Sydney, Australia
- NHMRC Clinical Trial Centre, University of Sydney NSW, Australia
- Concord Repatriation General Hospital, Sydney, Australia
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11
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Young TK, Li JW, Kang A, Heerspink HJL, Hockham C, Arnott C, Neuen BL, Zoungas S, Mahaffey KW, Perkovic V, de Zeeuw D, Fulcher G, Neal B, Jardine M. Effects of canagliflozin compared with placebo on major adverse cardiovascular and kidney events in patient groups with different baseline levels of HbA 1c, disease duration and treatment intensity: results from the CANVAS Program. Diabetologia 2021; 64:2402-2414. [PMID: 34448033 PMCID: PMC8494676 DOI: 10.1007/s00125-021-05524-1] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/19/2021] [Indexed: 01/14/2023]
Abstract
AIMS/HYPOTHESIS Type 2 diabetes mellitus can manifest over a broad clinical range, although there is no clear consensus on the categorisation of disease complexity. We assessed the effects of canagliflozin, compared with placebo, on cardiovascular and kidney outcomes in the CANagliflozin cardioVascular Assessment Study (CANVAS) Program over a range of type 2 diabetes mellitus complexity, defined separately by baseline intensity of treatment, duration of diabetes and glycaemic control. METHODS We performed a post hoc analysis of the effects of canagliflozin on major adverse cardiovascular events (MACE) according to baseline glucose-lowering treatments (0 or 1, 2 or 3+ non-insulin glucose-lowering treatments, or insulin-based treatment), duration of diabetes (<10, 10 to 16, >16 years) and HbA1c (≤53.0 mmol/mol [<7.0%], >53.0 to 58.5 mmol/mol [>7.0% to 7.5%], >58.5 to 63.9 mmol/mol [>7.5 to 8.0%], >63.9 to 69.4 mmol/mol [8.0% to 8.5%], >69.4 to 74.9 mmol/mol [>8.5 to 9.0%] or >74.9 mmol/mol [>9.0%]). We analysed additional secondary endpoints for cardiovascular and kidney outcomes, including a combined kidney outcome of sustained 40% decline in eGFR, end-stage kidney disease or death due to kidney disease. We used Cox regression analyses and compared the constancy of HRs across subgroups by fitting an interaction term (p value for significance <0.05). RESULTS At study initiation, 5095 (50%) CANVAS Program participants were treated with insulin, 2100 (21%) had an HbA1c > 74.9 mmol/mol (9.0%) and the median duration of diabetes was 12.6 years (interquartile interval 8.0-18 years). Canagliflozin reduced MACE (HR 0.86 [95% CI 0.75, 0.97]) with no evidence that the benefit differed between subgroups defined by the number of glucose-lowering treatments, the duration of diabetes or baseline HbA1c (all p-heterogeneity >0.17). Canagliflozin reduced MACE in participants receiving insulin with no evidence that the benefit differed from other participants in the trial (HR 0.85 [95% CI 0.72, 1.00]). Similar results were observed for other cardiovascular outcomes and for the combined kidney outcome (HR for combined kidney outcome 0.60 [95% CI 0.47, 0.77]), with all p-heterogeneity >0.37. CONCLUSIONS/INTERPRETATION In people with type 2 diabetes mellitus at high cardiovascular risk, there was no evidence that cardiovascular and renal protection with canagliflozin differed across subgroups defined by baseline treatment intensity, duration of diabetes or HbA1c.
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Affiliation(s)
- Tamara K Young
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Jing-Wei Li
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Amy Kang
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | | | - Carinna Hockham
- The George Institute for Global Health, Imperial College London, London, UK.
| | - Clare Arnott
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia.
- University of Sydney, Sydney, NSW, Australia.
| | - Brendon L Neuen
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Sophia Zoungas
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Monash University, Melbourne, VIC, Australia
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Vlado Perkovic
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Dick de Zeeuw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Bruce Neal
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Meg Jardine
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
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12
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Lip G, Keshishian A, Kang A, Luo X, Atreja N, Zhang Y, Schuler P, Jiang J, Lovett K, Yuce H, Deitelzweig S. Effectiveness and safety of non-vitamin K antagonist oral anticoagulants versus warfarin among nonvalvular atrial fibrillation patients with prior bleeding events. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0571] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with non-valvular atrial fibrillation (NVAF) use oral anticoagulants such as warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) for the prevention of stroke. However, the effectiveness and safety of warfarin and NOACs can be influenced by pre-existing patient comorbidities, such as a history of bleeding, and limited evidence are available to inform the choice of the most appropriate anticoagulant treatment for NVAF patients with bleeding history.
Purpose
This study used five United States insurance claims databases to evaluate the risk of stroke/systemic embolism (S/SE) and major bleeding (MB) among NVAF patients with prior bleeding events who were prescribed NOACs versus warfarin.
Methods
This retrospective observational study used data from 5 databases (CMS Medicare and four commercial databases, covering >180 million beneficiaries) to select adult NVAF patients who were treated with apixaban, dabigatran, rivaroxaban, or warfarin (01JAN2013–30JUN2019). Patients were required to have a prior bleeding event, defined as a hospitalization with a diagnosis for intracranial hemorrhage (ICH), gastrointestinal (GI) bleeding or bleeding at other key sites prior to or during the index treatment episode. In each database, three 1:1 NOAC-warfarin propensity-score-matched (PSM) cohorts were created before pooling the results. Outcome measures were time to first stroke/SE, (ischemic stroke, hemorrhagic stroke, and SE), and time to first MB (gastrointestinal bleeding, intracranial hemorrhage, and MB at other key sites), and were measured from the index treatment episode to treatment discontinuation or switch, death, health plan disenrollment, or end of study period. Hazard ratios of S/SE and MB were calculated using Cox proportional hazards models.
Results
Among the eligible NVAF population, 8.2% of patients had a prior bleeding event (ICH: 12.3%; GI: 60.7%; Other: 27.0%). After PSM, a total of 43,092 apixaban-warfarin, 11,295 dabigatran-warfarin, and 32,723 rivaroxaban-warfarin patient pairs with prior bleeding were selected with a mean follow-up of 8–9 months. Apixaban and rivaroxaban were associated with a lower risk of S/SE, and dabigatran was associated with a similar risk of S/SE when compared to warfarin. Apixaban and dabigatran were associated with a lower risk of MB, and rivaroxaban was associated with a similar risk of MB, compared to warfarin (Figure).
Conclusion
Among NVAF patients with prior bleeding events, NOACs were associated with varying risks of S/SE and MB compared to warfarin. These results can help inform healthcare providers concerning the impact of OAC treatment in NVAF patients with history of bleeding.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Bristol-Myers Squibb Company and Pfizer, Inc.
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Affiliation(s)
- G.Y.H Lip
- University of Liverpool, Liverpool, United Kingdom
| | - A Keshishian
- STATinMED Research, Ann Arbor, United States of America
| | - A Kang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - X Luo
- Pfizer, Inc., New York, United States of America
| | - N Atreja
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - Y Zhang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - P Schuler
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - J Jiang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - K Lovett
- STATinMED Research, Ann Arbor, United States of America
| | - H Yuce
- City University of New York, New York, United States of America
| | - S Deitelzweig
- Ochsner Clinic Foundation, New Orleans, United States of America
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13
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Deitelzweig S, Keshishian A, Kang A, Jenkins A, Atreja N, Schuler P, Jiang J, Lovett K, Yuce H, Lip G. Time at home among nonvalvular atrial fibrillation patients treated with non-vitamin K antagonist oral anticoagulants: an ARISTOPHANES analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0574] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patient-centered outcomes, such as home time, are becoming increasingly important quality-of-life measures. There are limited data on the impact of oral anticoagulants (OACs) on home time among patients with non-valvular atrial fibrillation.
Purpose
This analysis, based on the previously published ARISTOPHANES study, used five US insurance claims databases (CMS Medicare and four commercial databases) to compare home time among NVAF patients who were prescribed non-vitamin K antagonist OACs (NOACs).
Methods
Adult NVAF patients who were newly prescribed apixaban, dabigatran, or rivaroxaban (01JAN2013–30SEP2015) were selected. Time at home was calculated as the number of days from the index date (NOAC prescription) without any of the following: an inpatient, skilled nursing facility (SNF) or nursing facility, hospice, or inpatient rehabilitation facility admission. Time at home and without external AF-related care was defined as days from index date without any events from the home time endpoint or any days with a claim for bleeding, stroke/systemic embolism (S/SE), AF, or an INR test. Time at home and without external AF-related care were measured during the 180 days of follow-up; patients were required to have been alive and have 180 days of follow-up post index. In each database, three 1:1 NOAC-NOAC propensity-score-matched (PSM) cohorts were created before combining the databases. For each NOAC-NOAC matched cohort, Poisson regression was conducted to compare time at home and time at home without external AF-related care.
Results
After PSM, 37,314 apixaban-dabigatran, 107,236 apixaban-rivaroxaban, and 37,693 rivaroxaban-dabigatran patient pairs were created of which 37–44% had 180 days of follow-up available. Across the NOAC cohorts, approximately 21–25% of patients had an admission to a hospital, SNF, nursing facility, rehabilitation center, or hospice during the 180-day follow-up. The time at home was generally consistent between the NOAC cohorts (177 days); however, apixaban patients had 0.5 more days at home compared to rivaroxaban patients. Across all NOAC cohorts, 7–8% had a claim for a S/SE, 11–15% had a claim for bleeding, and 15–22% had an INR test, while 87–89% of all patients had an AF-claim during the 180-day follow-up. Patients prescribed apixaban had 1 more day at home without external AF-related care compared to dabigatran, and 1.5 more days at home without external AF-related care compared to rivaroxaban. Dabigatran had <1 more day at home without external AF-related care compared to rivaroxaban.
Conclusion
Among NVAF patients treated with NOACs, there were small differences in the time at home and time at home without external AF-related care during the first 6 months of NOAC treatment. As NVAF is a chronic condition, it is important to understand the impact of NOAC treatment on these patient-centered outcomes.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Bristol-Myers Squibb Company and Pfizer Inc.
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Affiliation(s)
- S Deitelzweig
- Ochsner Clinic Foundation, New Orleans, United States of America
| | - A Keshishian
- STATinMED Research, Ann Arbor, United States of America
| | - A Kang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - A Jenkins
- Pfizer Ltd, Tadworth, United Kingdom
| | - N Atreja
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - P Schuler
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - J Jiang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - K Lovett
- STATinMED Research, Ann Arbor, United States of America
| | - H Yuce
- City University of New York, New York, United States of America
| | - G.Y.H Lip
- University of Liverpool, Liverpool, United Kingdom
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14
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Deitelzweig S, Keshishian A, Kang A, Jenkins A, Atreja N, Schuler P, Jiang J, Lovett K, Yuce H, Lip G. Time at home among nonvalvular atrial fibrillation patients treated with non-vitamin K antagonist oral anticoagulants versus warfarin. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0573] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Clinical trials and real-world database studies have shown the benefits of non-vitamin K antagonist oral anticoagulants (NOACs) compared to warfarin; however, measures of functional outcomes are critical in evaluating a patient's quality of life. Previous measures of time spent out of hospital in a home setting and time spent receiving disease-related care among non-valvular atrial fibrillation (NVAF) patients are lacking in the current literature.
Purpose
This analysis was based on the previously published ARISTOPHANES study, and used multiple data sources to evaluate the amount of time spent at a patient's home among NVAF patients who were prescribed NOACs versus warfarin.
Methods
This retrospective observational study used US data from CMS Medicare and four commercial databases to select adult NVAF patients who initiated apixaban, dabigatran, rivaroxaban, or warfarin (01JAN2013–30SEP2015). Time at home and time at home without external AF-related care were measured during the 180 days after the index date (OAC prescription). Time at home was defined as days from index date without any of the following: an inpatient, skilled nursing facility or nursing facility, hospice, or inpatient rehabilitation facility admission. Time at home and without external AF-related care was defined as days away from home and days with a claim for bleeding, stroke/systemic embolism, AF, or an INR test. Each day a claim was observed was counted as one day. In each database, three 1:1 NOAC-warfarin propensity-score-matched (PSM) cohorts were created before pooling the results. After PSM, a subgroup of patients who were alive and had ≥180 days of follow-up was created. Poisson regression was conducted in each NOAC-warfarin matched cohort to compare time at home and time at home without external AF-related care.
Results
After matching, a total of 100,977 apixaban-warfarin, 36,990 dabigatran-warfarin, and 125,068 rivaroxaban-warfarin patient pairs were selected. Of those patients, 38–46% had 180 days of follow-up available. Across treatment cohorts, approximately 75% of patients were at home for the 180-day follow-up. Apixaban, dabigatran, and rivaroxaban patients had 1.3, 0.9, and 0.8 more days at home, respectively, compared to warfarin patients. Patients treated with apixaban had 13.4 more days at home without AF-related care compared to warfarin, while dabigatran and rivaroxaban had 11.6 and 11.7 more days at home without AF-related care compared to warfarin. A greater proportion of warfarin patients than NOAC patients had an INR test (81–82% vs 14–21%), and days with INR testing were the main driver for external AF-related care for warfarin patients.
Conclusion
Among NVAF patients treated with OACs, NOACs were associated with a longer time at home and time at home without external AF-related care compared to warfarin. These results can help inform healthcare providers and patients regarding the impact of NOAC treatment in NVAF patients.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Bristol-Myers Squibb Company and Pfizer Inc.
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Affiliation(s)
- S Deitelzweig
- Ochsner Clinic Foundation, New Orleans, United States of America
| | - A Keshishian
- STATinMED Research, Ann Arbor, United States of America
| | - A Kang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - A Jenkins
- Pfizer Ltd, Tadworth, United Kingdom
| | - N Atreja
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - P Schuler
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - J Jiang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - K Lovett
- STATinMED Research, Ann Arbor, United States of America
| | - H Yuce
- City University of New York, New York, United States of America
| | - G.Y.H Lip
- University of Liverpool, Liverpool, United Kingdom
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15
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Lip G, Keshishian A, Kang A, Luo X, Atreja N, Zhang Y, Schuler P, Jiang J, Lovett K, Yuce H, Deitelzweig S. Effectiveness and safety of non-vitamin K antagonist oral anticoagulants among nonvalvular atrial fibrillation patients with prior bleeding events. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0572] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Among non-valvular atrial fibrillation (NVAF) patients with a history of bleeding, there is a reluctance to use oral anticoagulants (OACs) due to concerns about the risk of bleeding associated with OACs. However, lack of OAC treatments for NVAF patients is associated with a higher risk of stroke and mortality. Non-vitamin K antagonist OAC (NOACs) have been approved for the prevention of stroke in NVAF patients. There are limited data comparing the risk of stroke/systemic embolism (S/SE) and major bleeding (MB) between patients prescribed NOACs and with a history of bleeding.
Purpose
This study used multiple United States data sources to evaluate the risk of S/SE and MB among NVAF patients with prior bleeding events who were prescribed NOACs.
Methods
This retrospective observational study used data from CMS Medicare and four commercial databases–covering >180 million beneficiaries. The study selected adult NVAF patients who were prescribed apixaban, dabigatran, or rivaroxaban (01JAN2013–30JUN2019) and had a prior bleeding event which was defined as a hospitalization with a bleeding diagnosis (intracranial hemorrhage [ICH], gastrointestinal [GI] bleeding, or other bleeding sites) prior to or during the index treatment episode. After 1:1 propensity-score-matched (PSM) in each database between NOACs (apixaban-dabigatran, apixaban-rivaroxaban, and dabigatran-rivaroxaban), the resulting patient records were pooled. S/SE and MB (identified by inpatient claims) were captured during the follow-up period, which was defined as the time between the day after the index treatment date and treatment discontinuation or switch, death, end of study period, or end of medical and pharmacy enrollment. Hazard ratios of S/SE and MB were calculated using Cox proportional hazards models.
Results
Of the overall NVAF population treated with NOACs, 6.2% had a prior bleeding event (ICH: 13.5%; GI: 61.8%; Other: 24.6%). After PSM, a total of 11,106 apixaban-dabigatran, 30,665 apixaban-rivaroxaban, and 11,148 dabigatran-rivaroxaban pairs were matched. Apixaban was associated with a lower risk of S/SE compared to dabigatran and rivaroxaban, and dabigatran was associated with a similar risk of S/SE compared to rivaroxaban. Apixaban was associated with a lower risk of MB compared to dabigatran and rivaroxaban, and dabigatran was associated with a lower risk of MB compared to rivaroxaban (Figure).
Conclusions
In this subgroup of NVAF patients with a history of bleeding, apixaban was associated with a lower risk of S/SE and MB compared to dabigatran and rivaroxaban. Dabigatran was associated with a lower risk of MB compared to rivaroxaban. These results are informative for understanding the impact of NOAC treatment in NVAF patients with prior bleeding events.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Bristol-Myers Squibb Company and Pfizer, Inc.
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Affiliation(s)
- G.Y.H Lip
- University of Liverpool, Liverpool, United Kingdom
| | - A Keshishian
- STATinMED Research, Ann Arbor, United States of America
| | - A Kang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - X Luo
- Pfizer, Inc., Groton, United States of America
| | - N Atreja
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - Y Zhang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - P Schuler
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - J Jiang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - K Lovett
- STATinMED Research, Ann Arbor, United States of America
| | - H Yuce
- City University of New York, New York, United States of America
| | - S Deitelzweig
- Ochsner Clinic Foundation, New Orleans, United States of America
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16
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Kang A, Arnold R, Gallagher M, Snelling P, Green J, Fernando M, Kiernan MC, Hand S, Grimley K, Burman J, Heath A, Rogers K, Bhattacharya A, Smyth B, Bradbury T, Hawley C, Perkovic V, Krishnan AV, Jardine MJ. Effect of Hemodiafiltration on the Progression of Neuropathy with Kidney Failure: A Randomized Controlled Trial. Clin J Am Soc Nephrol 2021; 16:1365-1375. [PMID: 34233923 PMCID: PMC8729572 DOI: 10.2215/cjn.17151120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/02/2020] [Accepted: 06/23/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Neuropathy is a common complication of kidney disease that lacks proven disease-modifying treatments. Hemodiafiltration improves clearance of uremic toxins and is associated with better nerve function than hemodialysis. We aimed to determine whether hemodiafiltration reduces the progression of neuropathy in people receiving hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Filtration in the Neuropathy of End-Stage Kidney Disease Symptom Evolution (FINESSE) study was an open-label, blinded end point assessment, controlled trial that randomized maintenance hemodialysis recipients to hemodiafiltration or high-flux hemodialysis for 48 months or until death or cessation of dialysis at four study centers. The primary outcome was the mean change in the yearly modified total neuropathy score from baseline, with time points weighted equally. RESULTS A total of 124 participants were randomized and followed for a mean of 41 months. At baseline, neuropathy was present in 91 (73%) participants (modified total neuropathy score greater than or equal to two), and 38 (31%) had moderate to severe neuropathy (modified total neuropathy score 9-28). Convection volume in the hemodiafiltration arm was a median of 24.7 (interquartile range, 22.4-26.5) L. The mean modified total neuropathy score (SEM) worsened by 1.7 (0.4)/28 and 1.2 (0.4)/28 in the hemodiafiltration and hemodialysis groups, respectively, with a mean difference of 0.5 (95% confidence interval, -0.7 to 1.7; P=0.37). There was no difference in survival (hazard ratio, 1.24; 95% confidence interval, 0.61 to 2.51; log rank P=0.55) or any of the prespecified adverse events. There was no difference between groups in the number of participants who suffered an adverse event adjusted by follow-up time (relative risk, 1.05; 95% confidence interval, 0.83 to 1.32; P=0.68). CONCLUSIONS Neuropathy is still a common complication of kidney disease without disease-altering therapy. Hemodiafiltration did not affect neuropathy progression compared with hemodialysis. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Filtration in the Neuropathy of End-Stage Kidney Disease Symptom Evolution (FINESSE), ACTRN12609000615280.
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Affiliation(s)
- Amy Kang
- Renal and Metabolic Division, The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Renal Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Department of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Ria Arnold
- Department of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Martin Gallagher
- Renal and Metabolic Division, The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Renal Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - Paul Snelling
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Julianne Green
- Department of Renal Medicine, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Mangalee Fernando
- Department of Renal Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Department of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Matthew C Kiernan
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Samantha Hand
- Department of Renal Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - Kim Grimley
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jenny Burman
- Department of Renal Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - Anne Heath
- Department of Renal Medicine, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Kris Rogers
- Statistics Division, The George Institute The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Statistics, University of Technology, Sydney, New South Wales, Australia
| | - Amritendu Bhattacharya
- Statistics Division, The George Institute The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Brendan Smyth
- Renal and Metabolic Division, The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Kidney Health Division, National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.,Department of Renal Medicine, St. George Hospital, Sydney, New South Wales, Australia
| | - Thomas Bradbury
- Renal and Metabolic Division, The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Carmel Hawley
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia
| | - Vlado Perkovic
- Renal and Metabolic Division, The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Arun V Krishnan
- Department of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Prince of Wales Hospital, Sydney, New South Wales, Australia
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17
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Li H, Kang A, An B, Chou LY, Shieh FK, Tsung CK, Zhong C. Encapsulation of bacterial cells in cytoprotective ZIF-90 crystals as living composites. Mater Today Bio 2021; 10:100097. [PMID: 33733083 PMCID: PMC7937694 DOI: 10.1016/j.mtbio.2021.100097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/22/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 12/19/2022] Open
Abstract
Exploiting metal-organic frameworks (MOFs) as selectively permeable shelters for encapsulating engineered cells to form hybrid living materials has attracted increasing attention in recent years. Optimizing the synthesis process to improve encapsulation efficiency (EE) is critical for further technological development and applications. Here, using ZIF-90 and genetically engineered Escherichia coli (E. coli) as a demo, we fabricated E. coli@ZIF-90 living composites in which E. coli cells were encapsulated in ZIF-90 crystals. We illustrated that ZIF-90 could serve as a protective porous cage for cells to shield against toxic bactericides including benzaldehyde, cinnamaldehyde, and kanamycin. Notably, the E. coli cells remained alive and could self-reproduce after removing the ZIF-90 crystal cages in ethylenediaminetetraacetic acid, suggesting a feasible route for protecting and prolonging the lifespan of bacterial cells. Moreover, an aqueous multiple-step deposition approach was developed to improve EE of the E. coli@ZIF-90 composites: the EE increased to 61.9 ± 5.2%, in contrast with the efficiency of the traditional method (21.3 ± 4.4%) prepared with PBS buffer. In short, we develop a simple yet viable strategy to manufacture MOF-based living hybrid materials that promise new applications across diverse fields.
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Affiliation(s)
- H. Li
- Materials and Physical Biology Division, School of Physical Science and Technology, ShanghaiTech University, Shanghai 201210, China
| | - A. Kang
- Materials and Physical Biology Division, School of Physical Science and Technology, ShanghaiTech University, Shanghai 201210, China
| | - B. An
- Materials and Physical Biology Division, School of Physical Science and Technology, ShanghaiTech University, Shanghai 201210, China
| | - L.-Y. Chou
- Materials and Physical Biology Division, School of Physical Science and Technology, ShanghaiTech University, Shanghai 201210, China
| | - F.-K. Shieh
- Department of Chemistry, National Central University, Taoyuan 32001, Taiwan
| | - C.-K. Tsung
- Boston College Chemistry Department, Merkert Chemistry Center, 2609 Beacon St, Chestnut Hill, MA 02467, USA
| | - C. Zhong
- Materials and Physical Biology Division, School of Physical Science and Technology, ShanghaiTech University, Shanghai 201210, China
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18
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Affiliation(s)
- Amy Kang
- Renal and Metabolic Division, The George Institute for Global Health, UNSW Sydney, Sydney, Australia.,Prince of Wales Hospital, Sydney, Australia
| | - Meg J Jardine
- Renal and Metabolic Division, The George Institute for Global Health, UNSW Sydney, Sydney, Australia. .,NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia. .,Concord Repatriation General Hospital, Sydney, Australia.
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19
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Lee BV, Fong G, Bolaris M, Neely M, Minejima E, Kang A, Lee G, Gong CL. 'Cost-benefit analysis comparing trough, two-level AUC, and Bayesian AUC dosing for vancomycin': authors' reply. Clin Microbiol Infect 2021; 27:929-930. [PMID: 33524587 DOI: 10.1016/j.cmi.2021.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/12/2021] [Accepted: 01/16/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Brian V Lee
- School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Gary Fong
- School of Pharmacy, Chapman University, Irvine, CA, USA; Department of Pediatrics, The Lundquist Institute, Torrance, CA, USA; Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Michael Bolaris
- Division of Pediatric Infectious Diseases, Harbor-UCLA Medical Center, Torrance, CA, USA; Department of Pediatrics, The Lundquist Institute, Torrance, CA, USA
| | - Michael Neely
- Division of Infectious Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Laboratory of Applied Pharmacokinetics and Bioinformatics, The Saban Research Institute, Los Angeles, CA, USA
| | - Emi Minejima
- School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Amy Kang
- School of Pharmacy, Chapman University, Irvine, CA, USA; Department of Pediatrics, The Lundquist Institute, Torrance, CA, USA; Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Grace Lee
- Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Cynthia L Gong
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Fetal & Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Los Angeles, CA, USA; Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA.
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20
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Zhang H, Rogers K, Sukkar L, Jun M, Kang A, Young T, Campain A, Cass A, Chow CK, Comino E, Foote C, Gallagher M, Knight J, Liu B, Lung T, McNamara M, Peiris D, Pollock C, Sullivan D, Wong G, Zoungas S, Jardine M, Hockham C. Prevalence, incidence and risk factors of diabetes in Australian adults aged ≥45 years: A cohort study using linked routinely-collected data. J Clin Transl Endocrinol 2020; 22:100240. [PMID: 33294382 PMCID: PMC7691170 DOI: 10.1016/j.jcte.2020.100240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 09/12/2020] [Accepted: 11/04/2020] [Indexed: 01/03/2023]
Abstract
Aims To use linked routinely-collected health data to estimate diabetes prevalence and incidence in an Australian cohort of adults aged ≥45 years, and examine risk factors associated with incident disease. Research design and methods The EXamining ouTcomEs in chroNic Disease in the 45 and Up Study (EXTEND45) Study is a linked data study that combines baseline questionnaire responses from the population-based 45 and Up Study (2006–2009, n = 267,153) with multiple routinely-collected health databases up to December 2014. Among participants with ≥1 linked result for any laboratory test, diabetes status was determined from multiple data sources according to standard biochemical criteria, use of glucose-lowering medication or self-report, and the prevalence and incidence rate calculated. Independent risk factors of incident diabetes were examined using multivariable Cox regression. Results Among 152,169 45 and Up Study participants with ≥1 linked laboratory result in the EXTEND45 database (mean age 63.0 years; 54.9% female), diabetes prevalence was 10.8% (95% confidence interval [CI] 10.6%–10.9%). Incident disease in those without diabetes at baseline (n = 135,810; mean age 62.5 years; 56.1% female) was 10.0 per 1,000 person-years (95% CI 9.8–10.2). In all age groups, diabetes incidence was lower in women compared to men, an association that persisted in the fully adjusted analyses. Other independent risk factors of diabetes were older age, being born outside of Australia (with the highest rate of 19.2 per 1,000 person-years observed in people born in South and Central Asia), lower education status, lower annual household income, residence in a major city, family history of diabetes, personal history of cardiovascular disease or hypertension, higher body mass index, smoking and long sleeping hours. Conclusions Our study represents an efficient approach to assessing diabetes frequency and its risk factors in the community. The infrastructure provided by the EXTEND45 Study will be useful for diabetes surveillance and examining other important clinical and epidemiological questions.
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Affiliation(s)
- Hongmei Zhang
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kris Rogers
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Louisa Sukkar
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- School of Public Health, University of Sydney, Sydney, Australia
| | - Min Jun
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Amy Kang
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Tamara Young
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Anna Campain
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Clara K Chow
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Elizabeth Comino
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Celine Foote
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Martin Gallagher
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Concord Repatriation General Hospital, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - John Knight
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Bette Liu
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Thomas Lung
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | - David Peiris
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Carol Pollock
- Renal Division, Kolling Institute for Medical Research, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - David Sullivan
- Sydney Medical School, University of Sydney, Sydney, Australia
- Department of Chemical Pathology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
| | - Sophia Zoungas
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Meg Jardine
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Carinna Hockham
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Corresponding author at: The George Institute for Global Health, 1 King Street, Newtown, NSW 2042, Australia.
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21
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Xie Y, Baker J, Young T, Jun M, Sukkar L, Campain A, Kang A, Cass A, Hu J, Peiris D, Pollock C, Wong G, Zoungas S, Rogers K, Jardine M, Hockham C. Therapy Escalation Following an Elevated HbA 1c in Adults Aged 45 Years and Older Living With Diabetes in Australia: A Real-World Observational Analysis. Diabetes Care 2020; 43:e185-e187. [PMID: 32928956 DOI: 10.2337/dc20-0269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 08/07/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Ying Xie
- The Second Affiliated Hospital of Soochow University, Suzhou, China.,The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Jannah Baker
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Tamara Young
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Min Jun
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Louisa Sukkar
- The George Institute for Global Health, Sydney, New South Wales, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anna Campain
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Amy Kang
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Ji Hu
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - David Peiris
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Carol Pollock
- Renal Division, Kolling Institute for Medical Research, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales, Australia
| | - Sophia Zoungas
- The George Institute for Global Health, Sydney, New South Wales, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kris Rogers
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Meg Jardine
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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22
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Kang A, Sukkar L, Hockham C, Jun M, Young T, Scaria A, Foote C, Neuen BL, Cass A, Pollock C, Comino E, Lung T, Pecoits-Filho R, Rogers K, Jardine MJ. Risk Factors for Incident Kidney Disease in Older Adults: an Australian Prospective Population-Based Study. Intern Med J 2020; 52:808-817. [PMID: 33012112 DOI: 10.1111/imj.15074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/23/2020] [Accepted: 09/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to determine risk factors for incident CKD in a large population-based cohort. METHODS This prospective opt-in population-based cohort study is based on the 45 and Up Study, where New South Wales residents aged ≥45 years were randomly sampled from the Services Australia enrolment database and agreed to complete the 45 and Up Study baseline questionnaire and have their responses linked to their health data in routinely-collected databases. The primary outcome was the development of incident CKD, defined as eGFR<60ml/min/1.73m2 . CKD incidence was calculated using Poisson regression. Risk factors for incident CKD were assessed using Cox regression in multivariable models. RESULTS In 39,574 participants who did not have CKD at enrolment, independent factors associated with developing CKD included: older age, regional residence (HR 1.38 [1.27-1.50] for outer regional versus major city), smoking (1.13 [1.00-1.27] for current smoker versus non-smoker), obesity (1.25 [1.16-1.35] for obese versus normal body mass index), diabetes mellitus (1.41 [1.33-1.50]), hypertension (1.53 [1.44-1.62]), coronary heart disease (1.13 [1.07-1.20]), depression/anxiety (1.16 [1.09-1.24]), and cancer (1.29 [1.20-1.39]). Migrants were less likely to develop CKD compared with people born in Australia (0.88 [0.83-0.94]). Gender, partner status and socioeconomic factors were not independently associated with developing CKD. CONCLUSIONS This large population-based study found multiple modifiable and non-modifiable factors were independently associated with developing CKD. In the Australian setting, the risk of CKD was higher with regional residence. Differences according to socioeconomic status were predominantly explained by age, comorbidities and harmful health-related behaviours This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Amy Kang
- The George Institute for Global Health, UNSW Sydney, Australia
| | - Louisa Sukkar
- The George Institute for Global Health, UNSW Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Carinna Hockham
- The George Institute for Global Health, UNSW Sydney, Australia
| | - Min Jun
- The George Institute for Global Health, UNSW Sydney, Australia
| | - Tamara Young
- The George Institute for Global Health, UNSW Sydney, Australia
| | - Anish Scaria
- The George Institute for Global Health, UNSW Sydney, Australia
| | - Celine Foote
- The George Institute for Global Health, UNSW Sydney, Australia.,Concord Hospital, Concord, New South Wales, Australia
| | - Brendon L Neuen
- The George Institute for Global Health, UNSW Sydney, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Carol Pollock
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | | | - Thomas Lung
- The George Institute for Global Health, UNSW Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Roberto Pecoits-Filho
- School of Medicine, Pontificia Universidade Catolica do Parana, Brazil.,Arbor Research Collaborative for Health, USA
| | - Kris Rogers
- The George Institute for Global Health, UNSW Sydney, Australia.,Graduate School of Health, University of Technology, Sydney, Australia
| | - Meg J Jardine
- The George Institute for Global Health, UNSW Sydney, Australia.,Concord Hospital, Concord, New South Wales, Australia.,NHMRC Clinical Trials Centre, University of Sydney
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Kang A, Neuen B, Lambers Heerspink H, Di Tanna GL, Neal B, Zhang H, Hockham C, Agarwal R, Bakris G, Charytan DM, De Zeeuw D, Greene T, Levin A, Pollock C, Wheeler D, Zinman B, Mahaffey KW, Perkovic V, Jardine M. P1013CANAGLIFLOZIN AND RISK OF GENITAL INFECTIONS AND URINARY TRACT INFECTIONS IN PEOPLE WITH DIABETES MELLITUS AND KIDNEY DISEASE- A POST-HOC ANALYSIS OF THE CREDENCE TRIAL. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1013] [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: 11/13/2022] Open
Abstract
Abstract
Background and Aims
To describe genital mycotic infections (GMI) and urinary tract infections (UTI) in the CREDENCE trial, determine whether canagliflozin increased the risk of these infections overall and in subgroups, and describe predictors of risk for genital mycotic infections.
Method
The CREDENCE trial randomised people with type 2 diabetes and albuminuric stage 2 and 3 chronic kidney disease to canagliflozin 100mg daily or placebo. We analysed the risk of GMI and UTI with canagliflozin compared to placebo overall and in patient subgroups. The primary analysis was conducted in the on-treatment population, as the more conservative approach with sensitivity analyses conducted using an intention-to-treat population. When canagliflozin increased risk, we determined patient risk factors for GMIs using multivariable Cox regression models adjusting for age, gender, race, markers of disease severity (body mass index (BMI), haemoglobin A1c, diabetes duration, other glucose lowering medications at baseline and kidney function).
Results
Overall 31/2905 (1.1%) men and 32/1492 (2.1%) women experienced 91 GMIs and 166/2905 (5.7%) men and 300/1492 (20.1%) women experienced 669 UTIs. Canagliflozin increased the risk of GMI (HR 3.83 [95% CI 2.08-7.06] p<0.0001). The hazard ratio for canagliflozin compared to placebo was consistent across most subgroups, though the risk with canagliflozin was greater in those with a higher BMI (HR 5.91 [95% CI 2.65-13.15] for BMI ≥30 kg/m2 vs HR 1.36 [95% CI 0.47-3.92] for BMI<30 kg/m2, p interaction=0.03) and was higher in men (HR 9.30 [95% CI 2.83-30.60] vs HR 2.10 [95% CI 1.00-4.45] for men and women respectively, p interaction=0.04). In those who were randomised to canagliflozin, independent risk factors for GMI were higher BMI (HR 1.53 [95% CI 1.29-1.83] per 5 units p<0.0001) and longer diabetes duration (HR 1.18 [95% CI 1.01-1.40] per 5 years p=0.04). Canagliflozin did not affect the risk of UTI over placebo (HR 1.08 [95% CI 0.90-1.29] p=0.42) overall or in any subgroup, however risk was higher in women (HR 1.23 [95% CI 0.98-1.54] vs HR 0.82 [0.60-1.11] for women and men respectively, p interaction=0.04).58/669 (8.7%) UTIs but no GMIs were reported as serious. Drug was continued in 56/63 (89%) of first GMIs, with similar frequency of subsequent GMI in those continuing on canagliflozin (13/43, 30.2%) or placebo (4/13, 30.8%). Drug was continued in 385/466 (82.6%) first UTIs, with similar frequency of subsequent UTIs in those continuing on cangliflozin (50/199 (25.1%) or placebo 49/186 (26.3%). All findings were similar when conducted using an intention-to-treat approach.
Conclusion
Canagliflozin increased the risk of genital mycotic infections but not urinary tract infections. The risk of genital mycotic infections from canagliflozin over placebo was higher in men and those with higher BMI. In those treated with canagliflozin, higher BMI and longer diabetes duration independently predicted infection. Most participants continued treatment following their first infection with similar recurrence rates in the canagliflozin and placebo groups.These findings will be useful in clinical care, and help identify those at greatest risk for genital infections with canagliflozin treatment.
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Affiliation(s)
- Amy Kang
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
| | - Brendon Neuen
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
| | - Hiddo Lambers Heerspink
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
- University Medical Center Groningen, Groningen, Netherlands
| | | | - Bruce Neal
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
| | - Hong Zhang
- Peking University First Hospital, P.R. China
| | - Carinna Hockham
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
| | - Rajiv Agarwal
- Indiana University - Purdue University Indianapolis, Indianapolis, United States of America
| | - George Bakris
- The University of Chicago, Chicago, United States of America
| | | | - Dick De Zeeuw
- University Medical Center Groningen, Groningen, Netherlands
| | - Tom Greene
- The University of Utah, Salt Lake City, United States of America
| | - Adeera Levin
- The University of British Columbia, Vancouver, Canada
| | | | | | - Bernard Zinman
- University of Toronto - St. George Campus, Toronto, Canada
| | | | | | - Meg Jardine
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
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Young T, Li JW, Kang A, Heerspink H, Hockham C, Arnott C, Neuen B, Zoungas S, Mahaffey KW, Perkovic V, De Zeeuw D, Fulcher G, Neal B, Jardine M. P1028EFFECTS OF CANAGLIFLOZIN ON MAJOR ADVERSE CARDIOVASCULAR OUTCOMES IN PATIENTS WITH DIFFERENT BASELINE LEVELS OF TYPE 2 DIABETES MELLITUS DISEASE SEVERITY: RESULTS FROM THE CANVAS PROGRAM. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1028] [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: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Patient with type 2 diabetes mellitus (T2DM) included in trials of sodium-glucose cotransporter 2 inhibitors are heterogeneous in terms of disease severity. We assessed the effects of canagliflozin compared to placebo on cardiovascular and renal outcomes in the CANVAS program according to severity of T2DM as indicated by intensity of treatment, duration of diabetes and glycaemic control.
Method
We compared effects on major adverse cardiovascular events ([MACE], defined as cardiovascular death, non-fatal myocardial infarction or non-fatal stroke) according to three indicators of T2DM severity at study baseline: number of oral glucose lowering treatments or insulin therapy (0-1, 2, 3+, insulin), duration of diabetes (<10, 10-16, >16 years) and HbA1c (<7.0, 7.0-7.5, 7.5-8.0, 8.0-8.5, 8.5-9, >9.0%). We also assessed effects on other pre-specified cardiovascular outcomes, and an adjudicated composite of end-stage kidney disease, renal death or sustained 40% decline in estimated glomerular filtration rate. We assessed for constancy of hazard ratios across subgroups by fitting an interaction term that tested for linear trend.
Results
Of 10,142 participants in the CANVAS Program, 1011 experienced a MACE during a mean follow-up of 3.6 years. Event rates for MACE were higher in those with longer duration of diabetes and higher HbA1c at baseline. The effect of canagliflozin on MACE in the overall population (HR 0.86, 95 % CI 0.75-0.97) was consistent irrespective of the number of glucose lowering treatments (p=0.509), duration of diabetes (p=0.174) and baseline HbA1c (p =0.314). Effects were also consistent across different levels of T2DM disease severity for all other outcomes studied.
Conclusion
Higher event rates were observed in those with longer disease duration and higher HbA1c. The proportional risk reductions achieved with canagliflozin were comparable regardless of diabetes duration, number of therapies or HbA1C at baseline.
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Affiliation(s)
- Tamara Young
- The George Institute for Global Health, Newtown, Australia
| | - Jing-wei Li
- The George Institute for Global Health, Newtown, Australia
| | - Amy Kang
- The George Institute for Global Health, Newtown, Australia
| | | | | | - Clare Arnott
- The George Institute for Global Health, Newtown, Australia
| | - Brendon Neuen
- The George Institute for Global Health, Newtown, Australia
| | - Sophia Zoungas
- The George Institute for Global Health, Newtown, Australia
- Monash University, Melbourne, Australia
| | | | - Vlado Perkovic
- The George Institute for Global Health, Newtown, Australia
| | - Dick De Zeeuw
- University Medical Center Groningen, Groningen, Netherlands
| | | | - Bruce Neal
- The George Institute for Global Health, Newtown, Australia
| | - Meg Jardine
- The George Institute for Global Health, Newtown, Australia
- Concord Repatriation General Hospital, Concord, Australia
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25
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Kang A, Smyth B, Neuen B, Lambers Heerspink H, Di Tanna GL, Neal B, Zhang H, Hockham C, Agarwal R, Bakris G, Charytan DM, De Zeeuw D, Greene T, Levin A, Pollock C, Wheeler D, Zinman B, Mahaffey KW, Perkovic V, Jardine M. P1019CANAGLIFLOZIN AND RISK OF SKIN AND SOFT TISSUE INFECTIONS IN PEOPLE WITH DIABETES MELLITUS AND KIDNEY DISEASE - A POST-HOC ANALYSIS OF THE CREDENCE TRIAL. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1019] [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: 11/15/2022] Open
Abstract
Abstract
Background and Aims
The skin’s hypertonic microenvironment has a hypothesized protective antimicrobial function that may be disrupted by SGLT2i. The association between sodium glucose cotransporter inhibitors (SGLT2i) and genital mycotic infections is well established, but it is not known if these agents increase the risk of other skin and soft tissue infections (SSTI). We aimed to describe SSTI in the CREDENCE trial, and determine whether canagliflozin affects the risk of skin and soft tissue infections (SSTIs) overall and in subgroups.
Method
We performed a post-hoc analysis of the CREDENCE trial that randomised people with type 2 diabetes and albuminuric stage 2 and 3 chronic kidney disease to either canagliflozin 100mg daily or placebo. Infections reported as adverse events were assessed by two blinded authors following predetermined criteria for SSTI with discrepancies resolved by consensus. We analysed the risks of SSTIs in the on-treatment population as the more conservative approach, with a sensitivity analysis conducted in the intention-to-treat population. Univariable time-to first-event regression models were assessed.
Results
Overall 373/4397 (8.5%) participants experienced 478 events comprising 252 bacterial skin infections (including 2 episodes of necrotising fasciitis), 94 fungal skin infections, 109 other skin infections and 23 soft tissue infections. Of these, 136/478 (28%) were serious. Drug was continued in 290/373 (78%) of first events, with similar frequency of subsequent events between groups (31/133 (23%) and 33/157 (21%) for those continuing canagliflozin and placebo respectively). In both cases of necrotising fasciitis, drug was withdrawn and the participants recovered.Canagliflozin did not increase the risk of SSTI (HR 0.85 [95% Confidence Interval (CI) 0.69-1.04] p=0.11) (Figure 1). Results were similar in the intention-to-treat population (HR 0.88 [95% CI 0.73-1.07] p=0.20), in analyses confined to serious SSTI (HR 0.83 [95% CI 0.58-1.21] p=0.33), and in the predefined subgroups.
Conclusion
Although other studies suggest that SGLT2i may reduce the sodium content of the skin, we found that canagliflozin does not increase the risk of skin and soft tissue infections, overall or in any subgroup, in people with type 2 diabetes mellitus and albuminuric chronic kidney disease.
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Affiliation(s)
- Amy Kang
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
| | - Brendan Smyth
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
| | - Brendon Neuen
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
| | - Hiddo Lambers Heerspink
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
- University Medical Center Groningen, Groningen, Netherlands
| | | | - Bruce Neal
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
| | - Hong Zhang
- Peking University First Hospital, P.R. China
| | - Carinna Hockham
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
| | - Rajiv Agarwal
- Indiana University - Purdue University Indianapolis, Indianapolis, United States of America
| | - George Bakris
- The University of Chicago, Chicago, United States of America
| | | | - Dick De Zeeuw
- University Medical Center Groningen, Groningen, Netherlands
| | - Tom Greene
- The University of Utah, Salt Lake City, United States of America
| | - Adeera Levin
- The University of British Columbia, Vancouver, Canada
| | | | | | - Bernard Zinman
- University of Toronto - St. George Campus, Toronto, Canada
| | | | | | - Meg Jardine
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
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26
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Sukkar L, Kang A, Hockham C, Young T, Jun M, Foote C, Pecoits-Filho R, Neuen B, Rogers K, Pollock C, Cass A, Sullivan D, Wong G, Knight J, Peiris D, Gallagher M, Jardine M. Incidence and Associations of Chronic Kidney Disease in Community Participants With Diabetes: A 5-Year Prospective Analysis of the EXTEND45 Study. Diabetes Care 2020; 43:982-990. [PMID: 32161053 PMCID: PMC7809711 DOI: 10.2337/dc19-1803] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/31/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the incidence of and factors associated with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 in people with diabetes. RESEARCH DESIGN AND METHODS We identified people with diabetes in the EXamining ouTcomEs in chroNic Disease in the 45 and Up Study (EXTEND45), a population-based cohort study (2006-2014) that linked the Sax Institute's 45 and Up Study cohort to community laboratory and administrative data in New South Wales, Australia. The study outcome was the first eGFR measurement <60 mL/min/1.73 m2 recorded during the follow-up period. Participants with eGFR < 60 mL/min/1.73 m2 at baseline were excluded. We used Poisson regression to estimate the incidence of eGFR <60 mL/min/1.73 m2 and multivariable Cox regression to examine factors associated with the study outcome. RESULTS Of 9,313 participants with diabetes, 2,106 (22.6%) developed incident eGFR <60 mL/min/1.73 m2 over a median follow-up time of 5.7 years (interquartile range, 3.0-5.9 years). The eGFR <60 mL/min/1.73 m2 incidence rate per 100 person-years was 6.0 (95% CI 5.7-6.3) overall, 1.5 (1.3-1.9) in participants aged 45-54 years, 3.7 (3.4-4.0) for 55-64 year olds, 7.6 (7.1-8.1) for 65-74 year olds, 15.0 (13.0-16.0) for 75-84 year olds, and 26.0 (22.0-32.0) for those aged 85 years and over. In a fully adjusted multivariable model incidence was independently associated with age (hazard ratio 1.23 per 5-year increase; 95% CI 1.19-1.26), geography (outer regional and remote versus major city: 1.36; 1.17-1.58), obesity (obese class III versus normal: 1.44; 1.16-1.80), and the presence of hypertension (1.52; 1.33-1.73), coronary heart disease (1.13; 1.02-1.24), cancer (1.30; 1.14-1.50), and depression/anxiety (1.14; 1.01-1.27). CONCLUSIONS In participants with diabetes, the incidence of an eGFR <60 mL/min/1.73 m2 was high. Older age, remoteness of residence, and the presence of various comorbid conditions were associated with higher incidence.
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Affiliation(s)
- Louisa Sukkar
- The George Institute for Global Health, University of New South Wales, Sydney, Australia .,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Amy Kang
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Carinna Hockham
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Tamara Young
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Min Jun
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Celine Foote
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Concord Repatriation General Hospital, Concord West, New South Wales, Australia
| | | | - Brendon Neuen
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Kris Rogers
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Carol Pollock
- Kolling Institute for Medical Research, St. Leonards, New South Wales, Australia
| | - Alan Cass
- Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - David Sullivan
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Germaine Wong
- Centre for Kidney Research, University of Sydney, Sydney, New South Wales, Australia
| | - John Knight
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - David Peiris
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Martin Gallagher
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Concord Repatriation General Hospital, Concord West, New South Wales, Australia
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27
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Foote C, Hockham C, Sukkar L, Campain A, Kang A, Young T, Cass A, Chow CK, Comino E, Gallagher M, Jan S, Knight J, Liu B, McNamara M, Peiris D, Pollock C, Sullivan D, Wong G, Zoungas S, Rogers K, Jun M, Jardine M. EXamining ouTcomEs in chroNic Disease in the 45 and Up Study (the EXTEND45 Study): Protocol for an Australian Linked Cohort Study. JMIR Res Protoc 2020; 9:e15646. [PMID: 32285803 PMCID: PMC7189250 DOI: 10.2196/15646] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 12/06/2019] [Accepted: 01/07/2020] [Indexed: 01/04/2023] Open
Abstract
Background Chronic kidney disease (CKD) and diabetes are the major causes of death and disability worldwide. They are associated with high health service utilization persisting over many years. Their slow progression and wide clinical variation make them eminently suitable for study in population-based cohorts. However, current understanding of their prevalence, incidence, and progression is largely based on studies conducted in clinical populations. Objective This study aims to establish a novel link between an existing population-based cohort (the 45 and Up Study) and routinely collected laboratory and administrative data to facilitate research across the full disease spectrum of CKD and diabetes. Methods In the EXTEND45 Study (EXamining OuTcomEs in chroNic Disease in the 45 and Up Study), baseline questionnaire responses of over 260,000 participants of the 45 and Up Study aged ≥45 years living in New South Wales (NSW), collected between January 2006 and December 2009, are linked to data from laboratory service providers as well as national- and state-based administrative datasets via probabilistic linkage. Routinely collected data were obtained for participants who could be linked between January 2005 and July 2013. Laboratory data will enable the identification of early cases of chronic disease and the assessment of clinically relevant biochemical targets during the disease course. Health administrative datasets will allow for the examination of health service use, pharmacological management, and clinical outcomes. Results The study received ethics approval from the NSW Population and Health Services Research Ethics Committee in February 2014. Data linkage for 267,153 of the 45 and Up Study participants was completed in June 2016, with congruent linkage achieved for 265,086 (99.23%) individuals. To date, the CKD and diabetes cohorts have been identified (published elsewhere), and a diverse portfolio of research projects relating to disease burden, risk factors, health outcomes, and health service utilization is in development. Conclusions The EXTEND45 Study represents an unparalleled opportunity to perform extensive research into diseases of considerable public health and clinical importance. Strengths include the population-based nature of the cohort and the availability of longitudinal information on the complete disease pathway for affected individuals. International Registered Report Identifier (IRRID) RR1-10.2196/15646
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Affiliation(s)
- Celine Foote
- The George Institute for Global Health, Sydney, Australia.,Concord Repatriation General Hospital, Sydney, Australia
| | - Carinna Hockham
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Louisa Sukkar
- The George Institute for Global Health, Sydney, Australia.,School of Public Health, University of Sydney, Sydney, Australia
| | - Anna Campain
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Amy Kang
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Tamara Young
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Clara K Chow
- The George Institute for Global Health, Sydney, Australia.,Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Elizabeth Comino
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Martin Gallagher
- The George Institute for Global Health, Sydney, Australia.,Concord Repatriation General Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Stephen Jan
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - John Knight
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Bette Liu
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | | | - David Peiris
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Carol Pollock
- Renal Division, Kolling Institute for Medical Research, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - David Sullivan
- Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Chemical Pathology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
| | - Sophia Zoungas
- The George Institute for Global Health, Sydney, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kris Rogers
- The George Institute for Global Health, Sydney, Australia.,Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Min Jun
- The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Meg Jardine
- The George Institute for Global Health, Sydney, Australia.,Concord Repatriation General Hospital, Sydney, Australia
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Dyke J, Kang A, Singh T, Lind C. 55. Association between IgG4-related disease and dural arteriovenous fistula formation. Pathology 2020. [DOI: 10.1016/j.pathol.2020.01.055] [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: 10/25/2022]
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29
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Kang A, Kang L, Stewart C, Koay MHE. An unusual case of metastatic gastric adenocarcinoma to the ovary with yolk sac differentiation and AFP production. Pathology 2020. [DOI: 10.1016/j.pathol.2020.01.255] [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: 11/26/2022]
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Arnott C, Li Q, Kang A, Neuen BL, Bompoint S, Lam CSP, Rodgers A, Mahaffey KW, Cannon CP, Perkovic V, Jardine MJ, Neal B. Sodium-Glucose Cotransporter 2 Inhibition for the Prevention of Cardiovascular Events in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2020; 9:e014908. [PMID: 31992158 PMCID: PMC7033896 DOI: 10.1161/jaha.119.014908] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [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] [Indexed: 02/06/2023]
Abstract
Background Several trials have demonstrated protective effects from inhibition of sodium‐glucose cotransporter 2 among patients with type 2 diabetes mellitus. There is uncertainty about the consistency of the cardiovascular benefits achieved across patient subsets. Methods and Results We included 4 large‐scale trials of sodium‐glucose cotransporter 2 inhibition compared with placebo in patients with diabetes mellitus that reported effects on cardiovascular outcomes overall and for participant subgroups defined at baseline by cardiovascular disease, reduced kidney function, and heart failure. Fixed effects models with inverse variance weighting were used to estimate summary hazard ratios and 95% CIs. There were 38 723 patients from 4 trials, with a mean 2.9 years of follow‐up. Of the patients, 22 870 (59%) had cardiovascular disease, 7754 (20%) had reduced kidney function, and 4543 (12%) had heart failure. There were 3828 major adverse cardiac events. There was overall benefit for major adverse cardiac events (0.88; 95% CI, 0.82–0.94; P<0.001) and no evidence that the effects of sodium‐glucose cotransporter 2 inhibition varied across patient subgroups, defined by the presence of cardiovascular disease or heart failure at baseline (all P interaction >0.252; I2<25%). All patient subgroups benefited with respect to hospitalization for heart failure (all P interaction>0.302; I2<10%), cardiovascular death (all P interaction>0.167; I2<50%), and death from any cause (all P interaction>0.354; I2=0%). The only difference in effects across subgroups was for stroke, with protection observed among those with reduced kidney function but not those with preserved kidney function (P interaction=0.020; I2=81%). Conclusions Sodium‐glucose cotransporter 2 inhibitors protect against cardiovascular disease and death in diverse subsets of patients with type 2 diabetes mellitus regardless of cardiovascular disease history.
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Affiliation(s)
- Clare Arnott
- The George Institute for Global Health University of New South Wales Sydney Australia.,Department of Cardiology Royal Prince Alfred Hospital Sydney Australia.,Sydney Medical School University of Sydney Sydney Australia
| | - Qiang Li
- The George Institute for Global Health University of New South Wales Sydney Australia
| | - Amy Kang
- The George Institute for Global Health University of New South Wales Sydney Australia
| | - Brendon L Neuen
- The George Institute for Global Health University of New South Wales Sydney Australia.,Department of Epidemiology and Biostatistics Imperial College London London United Kingdom
| | - Severine Bompoint
- The George Institute for Global Health University of New South Wales Sydney Australia
| | - Carolyn S P Lam
- The George Institute for Global Health University of New South Wales Sydney Australia.,National Heart Centre Singapore and Duke-National University of Singapore Singapore
| | - Anthony Rodgers
- The George Institute for Global Health University of New South Wales Sydney Australia.,Department of Epidemiology and Biostatistics Imperial College London London United Kingdom
| | - Kenneth W Mahaffey
- Department of Medicine Stanford Center for Clinical Research Stanford University School of Medicine Stanford CA
| | - Christopher P Cannon
- Cardiovascular Division Brigham and Women's Hospital and Baim Institute for Clinical Research Boston MA
| | - Vlado Perkovic
- The George Institute for Global Health University of New South Wales Sydney Australia
| | - Meg J Jardine
- The George Institute for Global Health University of New South Wales Sydney Australia
| | - Bruce Neal
- The George Institute for Global Health University of New South Wales Sydney Australia.,Department of Epidemiology and Biostatistics Imperial College London London United Kingdom
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Selvanayagam S, Kang A, Ha D. Baloxavir Marboxil: A New Antiviral for Acute Influenza. J Contemp Pharm Pract 2020. [DOI: 10.37901/jcphp19-00004] [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: 11/11/2022] Open
Abstract
Baloxavir is a newly approved, single-dose, oral influenza antiviral indicated for acute uncomplicated influenza in patients 12 years and older if symptomatic for less than 48 hours. The purpose of this article is to review currently available literature on the mechanism of action, pharmacokinetics, safety, and clinical and virologic efficacy of baloxavir. Its novel mechanism of action prevents influenza replication by targeting the viral cap-dependent endonuclease enzyme. In clinical trials baloxavir was shown to be superior to placebo and comparable to oseltamivir with regard to time to alleviation of symptoms and viral titer reduction and was well tolerated with minimal adverse effects. Baloxavir is a viable treatment option for acute uncomplicated influenza in certain age groups.
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Deitelzweig S, Keshishian A, Kang A, Dhamane A, Luo X, Li X, Balachander N, Rosenblatt L, Mardekian J, Jiang J, Di Fusco M, B Garcia Reeves A, Yuce H, Lip GYH. P4794Comparative effectiveness and safety of non-VKA oral anticoagulants versus warfarin in non-valvular atrial fibrillation patients with differential treatment duration: an ARISTOPHANES study analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1170] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The ARISTOPHANES (Anticoagulants for Reduction In STroke: Observational Pooled analysis on Health outcomes ANd Experience of patientS) study showed that non-vitamin K antagonist oral anticoagulants (NOACs) were associated with lower risks of stroke/systemic embolism (S/SE) and variable comparative risks of major bleeding (MB) versus warfarin.
Purpose
To assess long-term use of non-VKA oral anticoagulants (NOACs) vs. warfarin in
ARISTOPHANES by evaluating the risk of S/SE and MB among non-valvular atrial fibrillation (NVAF) patients by duration of treatment (<1 and ≥1 year).
Methods
In the ARISTOPHANES study, NVAF patients initiating apixaban, dabigatran, rivaroxaban, or warfarin from 01/01/2013–09/30/2015 were identified from the CMS Medicare data and four US commercial claims databases, covering >180 million beneficiaries annually (∼56% of US population). After 1:1 propensity score matching (PSM) in each database between NOACs and warfarin (apixaban-warfarin, dabigatran-warfarin, and rivaroxaban-warfarin), the resulting patient records were pooled. Treatment duration was defined as time between the day after the treatment index date and discontinuation (30 days after a 30-day gap in the prescription), treatment switch, death, end of study period, or end of continuous medical and pharmacy enrollment, whichever occurred first. Matched patients with observed treatment duration <1 or ≥1 year were separately examined. Cox models were used to estimate hazard ratios of S/SE and MB (identified by inpatient claims) during observed treatment duration.
Results
The mean treatment duration for patients with shorter (<1 year) vs longer (≥1 year) duration was 4–5 months vs 18–21 months across the three matched cohorts. All the matched baseline variables remained balanced. The incidence rates of S/SE and MB and the proportion of patients with treatment discontinuation were higher in patients with shorter treatment duration. Regardless of treatment duration, apixaban patients had a lower risk of S/SE and MB versus warfarin; dabigatran patients had a lower risk of MB versus warfarin; and rivaroxaban patients had a lower risk of S/SE versus warfarin. Compared to warfarin patients, dabigatran patients with treatment duration <1 year had a similar risk of S/SE, while those with treatment duration ≥1 year had lower S/SE risk; rivaroxaban patients with treatment duration <1 year had a higher risk of MB, while those with treatment duration ≥1 year had similar MB risk.
Conclusions
Among NVAF patients with duration of treatment <1 and ≥1 year in the ARISTOPHANES study, apixaban and rivaroxaban were associated with lower risk of S/SE, while apixaban and dabigatran were associated with lower risk of MB, compared to warfarin. These findings indicate varying long-term effectiveness and safety outcomes between NOACs and warfarin.
Acknowledgement/Funding
This study was funded by Bristol-Myers Squibb and Pfizer Inc.
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Affiliation(s)
- S Deitelzweig
- Ochsner Clinic Foundation, Department of Hospital Medicine, New Orleans, LA, United States of America
| | - A Keshishian
- STATinMED, Ann Arbor, MI, United States of America
| | - A Kang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - A Dhamane
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - X Luo
- Pfizer, Inc., Groton, CT, United States of America
| | - X Li
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - N Balachander
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - L Rosenblatt
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - J Mardekian
- Pfizer, Inc., New York, NY, United States of America
| | - J Jiang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - M Di Fusco
- Pfizer, Inc., New York, NY, United States of America
| | - A B Garcia Reeves
- University of North Carolina, Chapel Hill, NC, United States of America
| | - H Yuce
- New York City College of Technology, City University of New York,, New York, NY, United States of America
| | - G Y H Lip
- University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
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Deitelzweig S, Keshishian A, Kang A, Dhamane A, Luo X, Li X, Balachander N, Rosenblatt L, Mardekian J, Jiang J, Di Fusco M, B Garcia Reeves A, Yuce H, Lip GYH. P4768Comparative effectiveness and safety between non-VKA oral anticoagulants in non-valvular atrial fibrillation patients with differential duration of treatment: an analysis of the ARISTOPHANES study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1144] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The ARISTOPHANES (Anticoagulants for Reduction In STroke: Observational Pooled analysis on Health outcomes ANd Experience of patientS) study showed that apixaban was associated with lower risks of stroke/systemic embolism (S/SE) and major bleeding (MB) versus dabigatran and rivaroxaban; dabigatran was associated with similar risk of S/SE and lower risk of MB compared to rivaroxaban.
Purpose
To assess long-term use of non-VKA oral anticoagulants (NOACs) in ARISTOPHANES by evaluating the risk of S/SE and MB among non-valvular atrial fibrillation (NVAF) patients receiving different NOACs by duration of treatment (<1 and ≥1 year).
Methods
In the ARISTOPHANES study, NVAF patients initiating apixaban, dabigatran, and rivaroxaban from 01/01/2013–09/30/2015 were identified from the CMS Medicare data and four US commercial claims databases, covering >180 million beneficiaries annually (∼56% of US population). After 1:1 propensity score matching (PSM) in each database between NOACs (apixaban-dabigatran, apixaban-dabigatran, and dabigatran-rivaroxaban), the resulting patient records were pooled. Treatment duration was defined as time between the day after the index treatment date and discontinuation (defined using a 30-day gap in the prescription), treatment switch, death, end of study period, or end of continuous medical and pharmacy enrollment, whichever occurred first. Matched patients with observed treatment duration <1 or ≥1 year were separately examined. Cox models were used to estimate hazard ratios of S/SE and MB (identified by inpatient claims) during observed treatment duration. S/SE included ischemic stroke, hemorrhagic stroke, and SE; MB included gastrointestinal (GI) bleeding, intracranial hemorrhage (ICH), and other MB.
Results
The mean treatment duration for patients with shorter (<1 year) vs longer (≥1 year) duration was ∼4 months vs 18–21 months across the three matched cohorts. All the matched baseline variables remained balanced. The incidence rates of S/SE and MB and the proportion of patients with treatment discontinuation were higher in patients with shorter treatment duration. Regardless of treatment duration, apixaban and dabigatran had a lower risk of MB versus rivaroxaban; and dabigatran had a similar risk of S/SE versus rivaroxaban. Compared to dabigatran patients, apixaban patients with treatment duration <1 year had a lower risk of S/SE and MB, while those with treatment duration ≥1 year had similar S/SE and MB risk. Compared to rivaroxaban patients, apixaban patients with treatment duration <1 year had a lower risk of S/SE, while those with treatment duration ≥1 year had similar S/SE risk.
Conclusions
Across NVAF patients with duration of treatment <1 and ≥1 year in the ARISTOPHANES study, both apixaban and dabigatran were associated with a lower risk of MB compared to rivaroxaban. These findings indicate varying long-term safety outcomes among different NOACs.
Acknowledgement/Funding
This study was funded by Bristol-Myers Squibb and Pfizer Inc.
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Affiliation(s)
- S Deitelzweig
- Ochsner Clinic Foundation, Department of Hospital Medicine, New Orleans, LA, United States of America
| | - A Keshishian
- STATinMED, Ann Arbor, MI, United States of America
| | - A Kang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - A Dhamane
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - X Luo
- Pfizer, Inc., Groton, CT, United States of America
| | - X Li
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - N Balachander
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - L Rosenblatt
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - J Mardekian
- Pfizer, Inc., New York, NY, United States of America
| | - J Jiang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - M Di Fusco
- Pfizer, Inc., New York, NY, United States of America
| | - A B Garcia Reeves
- University of North Carolina, Chapel Hill, NC, United States of America
| | - H Yuce
- New York City College of Technology, City University of New York, New York, NY, United States of America
| | - G Y H Lip
- University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool Centre for Cardiovascular Science, Liverpool, UK, United States of America
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Misitzis A, Kang A, Weinstock MA, Risica PM. The 'Check-It-Out' intervention increases confidence and practices of thorough skin self-examination. J Eur Acad Dermatol Venereol 2019; 34:e77-e78. [PMID: 31568597 DOI: 10.1111/jdv.15969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Misitzis
- Department of Dermatology, Brown University, Providence, RI, USA.,Center for Dermatoepidemiology, Providence VA Medical Center, Providence, RI, USA
| | - A Kang
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA.,Center for Health Equity Research, Brown School of Public Health, Providence, RI, USA
| | - M A Weinstock
- Department of Dermatology, Brown University, Providence, RI, USA.,Center for Dermatoepidemiology, Providence VA Medical Center, Providence, RI, USA
| | - P M Risica
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA.,Center for Health Equity Research, Brown School of Public Health, Providence, RI, USA
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Jain R, Watzker A, Luo X, Kang A, Baker C, Rosenblatt L, Mardekian J, Menzin J. P3346Validation of obesity coding among newly-treated nonvalvular atrial fibrillation patients using an integrated electronic medical record and claims database. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0222] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Obesity is prevalent among patients with non-valvular atrial fibrillation (NVAF). Administrative claims databases offer the opportunity to evaluate obesity and morbid obesity in this patient population. However, there is limited information about the use and accuracy of diagnosis codes in claims data to identify obesity and morbid obesity among patients with NVAF.
Purpose
To evaluate the use and accuracy of diagnosis codes in claims data for identifying obesity and morbid obesity among newly-treated NVAF patients using a large geographically-diverse US database.
Methods
This retrospective study used Optum's de-identified integrated electronic medical record (EMR) and claims database (1/1/2013–3/31/2018). Adult (≥18 years) patients with ≥1 claim for an oral anticoagulant (OAC) from 1/1/2014–9/30/2017 were identified (treatment date as index date). Patients were required to have ≥1 atrial fibrillation diagnosis prior to the index date and were excluded if they had evidence of OAC use or valvular disease during the 12 months prior to the index date. Patients were required to have ≥12 months of continuous enrollment prior to and ≥6 months after the index date as well as ≥1 BMI measurement in the EMR data during the 6 months before or after the index date. Based on the World Health Organization's definition, patients were classified as obese if their BMI was ≥30 kg/m2 and morbidly obese if their BMI was ≥40 kg/m2. Sensitivity, specificity, and positive predictive value (PPV) were calculated to assess the accuracy of diagnosis codes for obesity (ICD-9 diagnosis codes: 278.00, 278.01, 278.03, V85.30-V85.39, V85.41-V85.45; ICD-10 diagnosis codes: E66.01, E66.09, E66.2, E66.8, E66.9, Z68.30-Z68.39, Z68.41-Z68.45) and morbid obesity (ICD-9 diagnosis codes: 278.01, V85.41-V85.45; ICD-10 diagnosis codes: E66.01, E66.2, Z68.41-Z68.45) commonly used in claims database research.
Results
There were 7,501 patients included in the newly-treated NVAF cohort (mean [±SD] age=72.4 [±10.7] years, 55% male, 90% white, and mean [±SD] Quan-Charlson Comorbidity Index =2.10 [±2.08]). Forty-six percent of these patients had BMI≥30 kg/m2, of whom about one-quarter (11% of the overall sample) had a BMI≥40 kg/m2. In contrast, 25% and 10% of patients had a diagnosis code for obesity or morbid obesity, respectively. For obesity diagnosis codes, sensitivity, specificity, and PPV were 49% (95% CI: 47%-50%), 95% (95%-96%), and 90% (88%-91%), respectively. For morbid obesity diagnosis codes, sensitivity, specificity, and PPV were 63% (59%-63%), 96% (96%-97%) and 68% (64%-71%), respectively.
Conclusion
Among newly-treated NVAF patients, obesity diagnosis codes in the claims database had high PPV, high specificity, and modest sensitivity. Morbid obesity diagnosis codes also had high specificity but modest PPV and sensitivity. These findings have implications for both case selection and control for obesity as a confounder in observational studies using a claims database.
Acknowledgement/Funding
The funding for the research project was provided by Pfizer Inc.
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Affiliation(s)
- R Jain
- Boston Health Economics Inc., Boston, Massachusetts, United States of America
| | - A Watzker
- Boston Health Economics Inc., Boston, Massachusetts, United States of America
| | - X Luo
- Pfizer Inc., Groton, Connecticut, United States of America
| | - A Kang
- Bristol-Myers Squibb Company, Lawrenceville, New Jersey, United States of America
| | - C Baker
- Pfizer Inc., New York, New York, United States of America
| | - L Rosenblatt
- Bristol-Myers Squibb Company, Lawrenceville, New Jersey, United States of America
| | - J Mardekian
- Pfizer Inc., New York, New York, United States of America
| | - J Menzin
- Boston Health Economics Inc., Boston, Massachusetts, United States of America
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Kang A, Antonelou M, Wong NL, Tanna A, Arulkumaran N, Tam FWK, Pusey CD. Dr. Kang, et al, reply. J Rheumatol 2019; 46:1244. [PMID: 31263073 DOI: 10.3899/jrheum.181446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Amy Kang
- Imperial College Renal and Transplant Centre, Imperial College Healthcare National Health Service (NHS) Trust
| | - Marilina Antonelou
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust
| | - Nikki L Wong
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust
| | - Anisha Tanna
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | | | - Frederick W K Tam
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Charles D Pusey
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.
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Weiner M, Goh SM, Mohammad AJ, Hrušková Z, Tanna A, Sharp P, Kang A, Bruchfeld A, Selga D, Chocová Z, Westman K, Eriksson P, Harper L, Pusey CD, Tesař V, Salama AD, Segelmark M. Effect of Treatment on Damage and Hospitalization in Elderly Patients with Microscopic Polyangiitis and Granulomatosis with Polyangiitis. J Rheumatol 2019; 47:580-588. [DOI: 10.3899/jrheum.190019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 11/22/2022]
Abstract
Objective.Age is a risk factor for organ damage, adverse events, and mortality in microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA). However, the relationship between treatment and damage, hospitalizations, and causes of death in elderly patients is largely unknown.Methods.Consecutive patients from Sweden, the United Kingdom, and the Czech Republic diagnosed between 1997 and 2013 were included. Inclusion criteria were a diagnosis of MPA or GPA and age 75 years or more at diagnosis. Treatment with cyclophosphamide (CYC), rituximab (RTX), and corticosteroids the first 3 months was registered. Outcomes up to 2 years from diagnosis included Vasculitis Damage Index (VDI), hospitalization, and cause of death.Results.Treatment data were available for 167 of 202 patients. At 2 years, 4% had no items of damage. There was a positive association between VDI score at 2 years and Birmingham Vasculitis Activity Score at onset, and a negative association with treatment using CYC or RTX. Intravenous methylprednisolone dose was associated with treatment-related damage. During the first year, 69% of patients were readmitted to hospital. Myeloperoxidase–antineutrophil cytoplasmic antibody positivity and lower creatinine levels decreased the odds of readmission. The most common cause of death was infection, and this was associated with cumulative oral prednisolone dose.Conclusion.Immunosuppressive treatment with CYC or RTX in elderly patients with MPA and GPA was associated with development of less permanent organ damage and was not associated with hospitalization. However, higher doses of corticosteroids during the first 3 months was associated with treatment-related damage and fatal infections.
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YOUNG T, Hockham C, Sukkar L, Kang A, Jun M, Baker J, Rogers K, Cass A, Jardine M. SAT-288 Trends in pharmacotherapy for diabetes in a large Australian cohort: results from the EXTEND45 study. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.326] [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: 11/30/2022] Open
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HOCKHAM C, Kang A, Young T, Sukkar L, Jun M, Rogers K, Baker J, Cass A, Jardine M. SAT-241 SMALL AREA-LEVEL VARIATION IN CHRONIC KIDNEY DISEASE PREVALENCE AND INCIDENCE IN NEW SOUTH WALES. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.277] [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: 11/15/2022] Open
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Kang A, Antonelou M, Wong NL, Tanna A, Arulkumaran N, Tam FWK, Pusey CD. Dr. Kang, et al reply. J Rheumatol 2019; 46:866-867. [PMID: 31154407 DOI: 10.3899/jrheum.190500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Amy Kang
- Imperial College Renal and Transplant Centre, Imperial College Healthcare National Health Service (NHS) Trust
| | - Marilina Antonelou
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust
| | - Nikki L Wong
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust
| | - Anisha Tanna
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | | | - Frederick W K Tam
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Charles D Pusey
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.
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Kang A, Thompson A, Rau J, Pollock A. Effects of clinical decision support and pharmacist prescribing authority on a therapeutic interchange program. Am J Health Syst Pharm 2019; 75:S77-S81. [PMID: 30139727 DOI: 10.2146/ajhp170465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Results of an evaluation of therapeutic interchange (TI) program outcomes with use of prescriber alerts alone or in combination with pharmacist prescribing are reported. METHODS A retrospective single-center study was conducted to compare TI outcomes before incorporation of prescriber alerts encouraging formulary agent use into the electronic medical record (period 1), after alert implementation (period 2), and after implementation and expansion of TI protocols including pharmacist prescribing authority (period 3). The evaluation focused on TI orders for 3 drug classes: angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (HMG-CoA RIs). The primary outcome was formulary medication utilization. RESULTS In total, 2,881, 2,700, and 3,088 prescriptions for medications in the ACEI, ARB, or HMG-CoA RI class were ordered during periods 1, 2, and 3, respectively. Overall formulary adherence improved from 78.3% in period 1 to 97.6% in period 2 and 99.2% in period 3 (p < 0.001 for both comparisons with period 1). The percentages of inappropriate dosing conversions were 51.6%, 37.2%, and 2.4% in periods 1, 2, and 3, respectively; the corresponding percentages of inappropriate discharge medications were 64.5%, 16.3%, and 2.4%. CONCLUSION Percentages of formulary medications in 3 medication classes, considered separately and together, increased with the implementation of TI alerts for prescribers and the addition of TI-related pharmacist prescribing authority. Over the same study periods, percentages of inappropriate dosing conversions and inappropriate discharge medications decreased.
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Affiliation(s)
- Amy Kang
- Department of Pharmacy Practice, Chapman University, Irvine, CA
| | - Ashley Thompson
- Department of Pharmacy Practice, Chapman University, Irvine, CA
| | - Johnny Rau
- Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, CA, and Department of Pharmaceutical Services, UCSF Medical Center San Francisco, CA
| | - Allison Pollock
- Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, CA, and Department of Pharmaceutical Services, UCSF Medical Center, San Francisco, CA
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Mcadoo S, Tanna A, Kang A, Azam S, Gulati K, Tam F, Griffith M, Cairns T, Levy J, Pusey C. 260. LONG TERM OUTCOMES OF PATIENTS WITH ANCA-ASSOCIATED VASCULITIS PRESENTING WITH SEVERE RENAL DYSFUNCTION. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez062.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Anisha Tanna
- Imperial College NHS Trust Hammersmith Hospital Campus London, United Kingdom
| | - Amy Kang
- Imperial College NHS Trust London, United Kingdom
| | - Sultana Azam
- Imperial College NHS Trust London, United Kingdom
| | | | | | | | | | - Jeremy Levy
- Imperial College NHS Trust Hammersmith Hospital Campus London, United Kingdom
| | - Charles Pusey
- Imperial College NHS Trust Hammersmith Hospital Campus London, United Kingdom
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Wong N, Kang A, Mcadoo S, Cook T, Pusey C. 121. MEST-C SCORE IN ADULT HENOCH-SCHÖNLEIN PURPURA NEPHRITIS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez058.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nikki Wong
- Imperial College Renal and Transplant Centre, Imperial College London London, United Kingdom
| | - Amy Kang
- Imperial College NHS Trust London, United Kingdom
| | - Stephen Mcadoo
- Imperial College NHS Trust Hammersmith Hospital Campus London, United Kingdom
| | - Terry Cook
- Imperial College Renal and Transplant Centre, Imperial College London London, United Kingdom
| | - Charles Pusey
- Imperial College Renal and Transplant Centre, Imperial College London London, United Kingdom
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Kang A, Ireland A, Combrinck M, Thomas C, Robinson C, Harvey J, Sterrett G, Dessauvagie B. 14. Pathological complete response of breast cancer post neoadjuvant chemotherapy is associated with elevated pre-treatment Ki-67 proliferative index. Pathology 2019. [DOI: 10.1016/j.pathol.2018.09.014] [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: 10/27/2022]
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Vadlamudi NK, Parhar K, Altre Malana KL, Kang A, Marra F. Immunogenicity and safety of the 13-valent pneumococcal conjugate vaccine compared to 23-valent pneumococcal polysaccharide in immunocompetent adults: A systematic review and meta-analysis. Vaccine 2019; 37:1021-1029. [DOI: 10.1016/j.vaccine.2019.01.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/15/2018] [Accepted: 01/02/2019] [Indexed: 11/29/2022]
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Kang A, Armstrong M, Parry J. 48. CD30 expression in a small bowel follicular lymphoma transforming to diffuse large B cell lymphoma; should CD30 be part of the standard workup of all follicular lymphomas? Pathology 2019. [DOI: 10.1016/j.pathol.2018.09.047] [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: 10/27/2022]
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Smyth B, Krishnan AV, Gallagher M, Kiernan M, Snelling P, Hawley C, Fernando M, Hand S, Grimley K, Burman J, Heath A, Kang A, Perkovic V, Jardine MJ. Randomised controlled trial of the impact of haemodiafiltration on uraemic neuropathy: FINESSE study protocol. BMJ Open 2019; 9:e023736. [PMID: 30782714 PMCID: PMC6340424 DOI: 10.1136/bmjopen-2018-023736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The majority of patients undergoing haemodialysis (HD) show evidence of uraemic neuropathy, a condition with no known disease-modifying treatments. The pathogenesis of uraemic neuropathy is poorly understood, but may be related to cumulative exposure to middle molecules or other solutes such as potassium. It is not known whether haemodiafiltration (HDF) reduces the progression of uraemic neuropathy. METHODS AND ANALYSIS Filtration In the Neuropathy of End-Stage kidney disease Symptom Evolution (FINESSE) is a multicentre, randomised, open-label, blinded endpoint assessment, controlled trial designed to assess the impact of HDF versus HD on uraemic neuropathy. Maintenance HD patients will be randomised in a 1:1 ratio to receive HDF or HD with high-flux membranes for 4 years. The primary endpoint is the difference in the mean change in Total Neuropathy Score (TNS)-a measure of peripheral neuropathy combining symptoms, signs and nerve conduction velocity-over the study period. Secondary outcomes include change at annual timepoints in the TNS and the Neuropathy Symptom Score; and in morbidity, mortality and safety events. ETHICS AND DISSEMINATION The FINESSE trial has been approved by the Ethics Review Committee of the Sydney South West Area Health Service (HREC/09/RPAH/268) and of Adventist HealthCare Limited (2012-027). When published in a peer-reviewed journal, it will be the largest and longest reported randomised trial aimed at reducing the incidence and severity of uraemic neuropathy. It will advance the understanding of the natural history of uraemic neuropathy and the influence of convective therapies on both neurophysiological and clinical outcomes. It will also allow refinement of current hypotheses surrounding the pathogenesis of uraemic neuropathy and, most importantly, may lead to improvements in the lives of the many patients affected by this debilitating condition. TRIAL REGISTRATION NUMBER ACTRN12609000615280.
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Affiliation(s)
- Brendan Smyth
- Renal and Metabolic, The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia
| | - Arun V Krishnan
- Neurology, Prince of Wales Clinical School, UNSW, Sydney, New South Wales, Australia
| | - Martin Gallagher
- Renal and Metabolic, The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia
- Renal Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Matthew Kiernan
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Snelling
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Carmel Hawley
- Renal Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Mangalee Fernando
- Renal Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Samantha Hand
- Renal Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Kim Grimley
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jenny Burman
- Renal Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Anne Heath
- Renal Medicine, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Amy Kang
- Renal and Metabolic, The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia
| | - Vlado Perkovic
- Renal and Metabolic, The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia
| | - Meg J Jardine
- Renal and Metabolic, The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia
- Renal Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- Renal Medicine, Sydney Adventist Hospital, Sydney, New South Wales, Australia
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Kang A. The Art of Time Management - A Must Know for Effective Student Pharmacists. J Contemp Pharm Pract 2018. [DOI: 10.37901/jcphp18-000e4] [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: 11/11/2022] Open
Abstract
To gain a competitive edge in successfully obtaining post-graduate programs or to land their dream jobs at desirable locations, pharmacy students must juggle multiple responsibilities with their pharmacy organizations/leadership positions, internships, research, and community outreach programs. Cultivating effective time management skills is critical to fulfill the aforementioned responsibilities while concurrently managing a rigorous pharmacy school curriculum. This editorial article presents effective time management strategies to assist students in navigating through their busy schedules.
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Kang A, Bor C, Chen J, Gandawidjaja M, Minejima E. 1001. Evaluation of the Clinical Efficacy and Safety of Oral Antibiotic Therapy for Streptococcus spp. Bloodstream Infections. Open Forum Infect Dis 2018. [PMCID: PMC6254367 DOI: 10.1093/ofid/ofy210.838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Despite the severity and frequency of bloodstream infections (BSI), the effectiveness of oral definitive therapy remains unknown. The objective of this study was to evaluate the efficacy and safety of step down oral antibiotics for the treatment of Streptococcus spp. BSI. Methods This was a retrospective cohort study of adult, hospitalized patients with Streptococcus spp. BSI between June 2015 and June 2017. Patients were excluded if received <48 hours of antibiotic therapy or therapy was started >48 hours from first positive culture. Patients were grouped by receipt of step down oral antibiotic therapy (PO group) vs. full course IV therapy (IV group) and compared for demographics, clinical course, and outcomes. The primary outcome was 30-day mortality and hospital length of stay (LOS). The secondary outcomes included 30-day recurrence of BSI and adverse events (AEs). Results One hundred ninety-five patients met inclusion criteria; median age was 51 year old, 68% were male, 57% were Hispanic, and 71% had community-onset BSI. Sixty-four (33%) were treated with step down oral therapy. The most common source of bacteremia was pneumonia (21%); 8% had endocarditis. Comorbidities were similar between the groups, with diabetes being most common (IV 22% vs. PO 19%, P = 0.29). Severity of illness measured by need for ICU admission, initial lactate level, and SOFA score was similar between the two groups. S. viridans was the most frequent pathogen isolated (IV 28% vs. PO 27%, P = 0.87). Ceftriaxone (39%) for the IV group and levofloxacin (30%) for the PO group were the most common definitive therapy prescribed. PO group received 4 days of IV therapy prior to transition to orals. The IV group had significantly higher mortality rate (11% vs. 2%, P = 0.02) and longer LOS (median 9 days [IQR 5–18] vs. 5 days [4–7.75], P ≤ 0.01) compared with the PO group. 30-day recurrence (IV 2% vs. PO 5%, P = 0.40) and AEs (IV 2% vs. PO 3%, P = 0.60) were similar between the two groups. Conclusion In Streptococcus spp. BSI, step down oral antibiotic therapy was associated with a significantly shorter LOS compared with IV only therapy without compromise of clinical outcomes. Larger prospective trials evaluating step down oral therapy are warranted to confirm our results. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Amy Kang
- USC School of Pharmacy, Los Angeles, California
| | - Cynthia Bor
- USC School of Pharmacy, Los Angeles, California
| | - Jamie Chen
- USC School of Pharmacy, Los Angeles, California
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Kang A, Antonelou M, Wong NL, Tanna A, Arulkumaran N, Tam FWK, Pusey CD. High Incidence of Arterial and Venous Thrombosis in Antineutrophil Cytoplasmic Antibody-associated Vasculitis. J Rheumatol 2018; 46:285-293. [PMID: 30385704 DOI: 10.3899/jrheum.170896] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the incidence of arterial thrombotic events (ATE) and venous thromboembolism (VTE) in antineutrophil cytoplasmic antibody-associated vasculitis (AAV). METHODS This is a retrospective cohort study presenting the incidence of ATE (coronary events or ischemic stroke) and VTE [pulmonary embolism (PE) or deep venous thrombosis (DVT)] in patients diagnosed with AAV between 2005 and 2014. RESULTS There were 204 patients with AAV who were identified. Median followup for surviving patients was 5.8 (range 1-10) years, accounting for 1088 person-years (PY). The incidence of ATE was 2.67/100 PY (1.56 for coronary events and 1.10 for ischemic stroke) and for VTE was 1.47/100 PY (0.83 for DVT only and 0.64 for PE with/without DVT). On multivariate analysis, prior ischemic heart disease (IHD) and advancing age were the only independent predictors of ATE. Among patients without prior IHD or stroke, the incidence of ATE remained elevated at 2.32/100 PY (1.26 for coronary events and 1.06 for ischemic stroke). ATE, but not VTE, was an independent predictor of all-cause mortality. Event rates for both ATE and VTE were highest in the first year after diagnosis of AAV but remained above the population incidence during the 10-year followup period. In comparison to reported rates for the UK population, the event rates in our AAV patients were 15-times higher for coronary events, 11-times higher for incident stroke, and 20-times higher for VTE. CONCLUSION Patients with AAV have a high incidence of arterial and venous thrombosis, particularly in the first year after diagnosis.
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Affiliation(s)
- Amy Kang
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Marilina Antonelou
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Nikki L Wong
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Anisha Tanna
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Nishkantha Arulkumaran
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Frederick W K Tam
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK.,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London
| | - Charles D Pusey
- From the Imperial College Renal and Transplant Centre, Imperial College Healthcare UK National Health Service (NHS) Trust, London; Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, London, UK. .,A. Kang, FRACP, MBBS (Hons), Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; M. Antonelou, MRCP, BSc, Academic Clinical Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; N.L. Wong, FRACP, MBBS, Clinical Research Fellow, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; A. Tanna, MBBS, BSc, Clinical Research Training Fellow, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; N. Arulkumaran, PhD, MBBS, Renal Specialty Registrar, Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust; F.W. Tam, PhD, MB BChir, Ken and Mary Minton Chair of Renal Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London; C.D. Pusey, DSc, MB BChir, Professor of Medicine, Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London.
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