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Wachter R, Klebs S, Balas B, Kap E, Engelhard J, Schlienger R, Bruce Wirta S, Fonseca AF. Heart failure signs and symptoms, hospital referrals, and prescription patterns in patients receiving sacubitril/valsartan in primary care and cardiologist settings in Germany. ESC Heart Fail 2020; 7:2318-2330. [PMID: 33121216 PMCID: PMC7524125 DOI: 10.1002/ehf2.12768] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 04/08/2020] [Accepted: 05/02/2020] [Indexed: 12/11/2022] Open
Abstract
Aims The aim of this paper was to analyse heart failure (HF) signs and symptoms, hospital referrals, and prescription patterns in patients receiving sacubitril/valsartan (sac/val) in primary care and cardiology settings in Germany. Methods and results A retrospective cohort study of electronic medical records identified 1263 adults (aged ≥18 years) in the German IMS® Disease Analyzer database who were prescribed sac/val during 2016 and had at least 6 months of data following sac/val initiation. Clinical characteristics were collected during the 12 months before the first recorded sac/val prescription (index date) and 6 months post‐index. Details of sac/val dose and prescription patterns were also recorded in the 6 months post‐index. HF signs, symptoms, and all‐cause hospital referrals were evaluated for 90 days pre‐index and 30–120 days post‐index. Most patients (62%) were prescribed the lowest sac/val dose of 24/26 mg twice daily (b.i.d.) at index; only 14% of patients initiated on 24/26 mg or 49/51 mg b.i.d. were up‐titrated to the 97/103 mg b.i.d. target dose during the 6 months post‐index, while 6% of patients initiated on either 49/51 mg or 97/103 mg b.i.d. were stably down‐titrated. Evaluation of prescription patterns in relation to clinical characteristics did not clearly explain the reluctance to up‐titrate in the majority of patients. More patients experienced HF signs or symptoms or all‐cause referrals to hospital during the 90 days pre‐index than during the 30–120 days post‐index. Conclusions The majority of patients receiving sac/val are not up‐titrated, contrary to recommendations of the EU summary of product characteristics; this is not fully explained by patients' clinical characteristics. Further research is required to understand the reasons for clinician inertia.
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Affiliation(s)
- Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Sven Klebs
- Novartis Pharma GmbH, Nuremberg, Germany
| | | | - Elisabeth Kap
- IQVIA Germany (IQVIA Commercial GmbH & Co. OHG), Frankfurt, Germany
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Gadgeel S, Peters S, Mok T, Shaw AT, Kim DW, Ou SI, Pérol M, Wrona A, Novello S, Rosell R, Zeaiter A, Liu T, Nüesch E, Balas B, Camidge DR. Alectinib versus crizotinib in treatment-naive anaplastic lymphoma kinase-positive (ALK+) non-small-cell lung cancer: CNS efficacy results from the ALEX study. Ann Oncol 2019; 29:2214-2222. [PMID: 30215676 PMCID: PMC6290889 DOI: 10.1093/annonc/mdy405] [Citation(s) in RCA: 197] [Impact Index Per Article: 39.4] [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] [Indexed: 12/21/2022] Open
Abstract
Background The phase III ALEX study in patients with treatment-naive advanced anaplastic lymphoma kinase mutation-positive (ALK+) non-small-cell lung cancer (NSCLC) met its primary end point of improved progression-free survival (PFS) with alectinib versus crizotinib. Here, we present detailed central nervous system (CNS) efficacy data from ALEX. Patients and methods Overall, 303 patients aged ≥18 years underwent 1:1 randomization to receive twice-daily doses of alectinib 600 mg or crizotinib 250 mg. Brain imaging was conducted in all patients at baseline and every subsequent 8 weeks. End points (analyzed by subgroup: patients with/without baseline CNS metastases; patients with/without prior radiotherapy) included PFS, CNS objective response rate (ORR), and time to CNS progression. Results In total, 122 patients had Independent Review Committee-assessed baseline CNS metastases (alectinib, n = 64; crizotinib, n = 58), 43 had measurable lesions (alectinib, n = 21; crizotinib, n = 22), and 46 had received prior radiotherapy (alectinib, n = 25; crizotinib, n = 21). Investigator-assessed PFS with alectinib was consistent between patients with baseline CNS metastases [hazard ratio (HR) 0.40, 95% confidence interval (CI): 0.25–0.64] and those without (HR 0.51, 95% CI: 0.33–0.80, P interaction = 0.36). Similar results were seen in patients regardless of prior radiotherapy. Time to CNS progression was significantly longer with alectinib versus crizotinib and comparable between patients with and without baseline CNS metastases (P < 0.0001). CNS ORR was 85.7% with alectinib versus 71.4% with crizotinib in patients who received prior radiotherapy and 78.6% versus 40.0%, respectively, in those who had not. Conclusion Alectinib demonstrated superior CNS activity and significantly delayed CNS progression versus crizotinib in patients with previously untreated, advanced ALK+ NSCLC, irrespective of prior CNS disease or radiotherapy. Clinical trial registration ClinicalTrials.gov NCT02075840
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Affiliation(s)
- S Gadgeel
- Division of Hematology & Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, USA.
| | - S Peters
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - T Mok
- Department of Clinical Oncology, State Key Laboratory of South China, Chinese University of Hong Kong, Shatin, Hong Kong
| | - A T Shaw
- Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - D W Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - S I Ou
- Irvine School of Medicine, Chao Family Comprehensive Cancer Center, University of California, Orange, USA
| | - M Pérol
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | - A Wrona
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - S Novello
- Department of Oncology, University of Turin, Turin, Italy
| | - R Rosell
- Catalan Institute of Oncology, Barcelona, Spain
| | - A Zeaiter
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - T Liu
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - E Nüesch
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - B Balas
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - D R Camidge
- Division of Medical Oncology, University of Colorado, Aurora, USA
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Novello S, Mazières J, Oh IJ, de Castro J, Migliorino MR, Helland Å, Dziadziuszko R, Griesinger F, Kotb A, Zeaiter A, Cardona A, Balas B, Johannsdottir HK, Das-Gupta A, Wolf J. Alectinib versus chemotherapy in crizotinib-pretreated anaplastic lymphoma kinase (ALK)-positive non-small-cell lung cancer: results from the phase III ALUR study. Ann Oncol 2019; 29:1409-1416. [PMID: 29668860 PMCID: PMC6005013 DOI: 10.1093/annonc/mdy121] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [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] [Indexed: 11/16/2022] Open
Abstract
Background This is the first trial to directly compare efficacy and safety of alectinib versus standard chemotherapy in advanced/metastatic anaplastic lymphoma kinase (ALK)-positive non-small-cell lung cancer (NSCLC) patients who have progressed on, or were intolerant to, crizotinib. Patients and methods ALUR (MO29750; NCT02604342) was a randomized, multicenter, open-label, phase III trial of alectinib versus chemotherapy in advanced/metastatic ALK-positive NSCLC patients previously treated with platinum-based doublet chemotherapy and crizotinib. Patients were randomized 2 : 1 to receive alectinib 600 mg twice daily or chemotherapy (pemetrexed 500 mg/m2 or docetaxel 75 mg/m2, both every 3 weeks) until disease progression, death, or withdrawal. Primary end point was investigator-assessed progression-free survival (PFS). Results Altogether, 107 patients were randomized (alectinib, n = 72; chemotherapy, n = 35) in 13 countries across Europe and Asia. Median investigator-assessed PFS was 9.6 months [95% confidence interval (CI): 6.9–12.2] with alectinib and 1.4 months (95% CI: 1.3–1.6) with chemotherapy [hazard ratio (HR) 0.15 (95% CI: 0.08–0.29); P < 0.001]. Independent Review Committee-assessed PFS was also significantly longer with alectinib [HR 0.32 (95% CI: 0.17–0.59); median PFS was 7.1 months (95% CI: 6.3–10.8) with alectinib and 1.6 months (95% CI: 1.3–4.1) with chemotherapy]. In patients with measurable baseline central nervous system (CNS) disease (alectinib, n = 24; chemotherapy, n = 16), CNS objective response rate was significantly higher with alectinib (54.2%) versus chemotherapy (0%; P < 0.001). Grade ≥3 adverse events were more common with chemotherapy (41.2%) than alectinib (27.1%). Incidence of AEs leading to study-drug discontinuation was lower with alectinib (5.7%) than chemotherapy (8.8%), despite alectinib treatment duration being longer (20.1 weeks versus 6.0 weeks). Conclusion Alectinib significantly improved systemic and CNS efficacy versus chemotherapy for crizotinib-pretreated ALK-positive NSCLC patients, with a favorable safety profile. Trial registration ClinicalTrials.gov NCT02604342; Roche study MO29750
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Affiliation(s)
- S Novello
- Department of Oncology, University of Turin, Turin, Italy
| | - J Mazières
- Department of Pneumology, Toulouse University Hospital, Paul Sabatier University, Toulouse, France
| | - I-J Oh
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun-gun Jeollanam-do, Republic of Korea
| | - J de Castro
- Department of Translational Oncology, La Paz University Hospital, Madrid, Spain
| | - M R Migliorino
- Azienda Ospedaliera San Camillo Forlanini Hospital, Rome, Italy
| | - Å Helland
- Department of Cancer Genetics and Department of Oncology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - R Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - F Griesinger
- Department of Hematology and Oncology, Pius Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - A Kotb
- F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - A Zeaiter
- F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - A Cardona
- F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - B Balas
- F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | | | - A Das-Gupta
- F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - J Wolf
- Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne, Cologne, Germany.
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Wachter R, Fonseca AF, Balas B, Kap E, Engelhard J, Schlienger R, Klebs S, Wirta SB, Kostev K. Real-world treatment patterns of sacubitril/valsartan: a longitudinal cohort study in Germany. Eur J Heart Fail 2019; 21:588-597. [PMID: 30972918 PMCID: PMC6607491 DOI: 10.1002/ejhf.1465] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/30/2019] [Accepted: 03/05/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS To analyse real-world treatment patterns of sacubitril/valsartan (sac/val) using data from a pharmacy database in Germany. METHODS AND RESULTS A retrospective cohort study of 26 191 adult patients (aged ≥ 18 years) in the IMS® longitudinal prescriptions database in Germany who were dispensed sac/val from January 2016 to June 2017 was conducted. The analysis included sac/val dose titration assessed in the 6 months from first sac/val prescription; prescriptions of concomitant cardiovascular medications in the 6 months pre- and post-index and compliance and persistence during 12 months post-index. Two-thirds of patients were prescribed the lowest sac/val dose of 50 mg twice daily (b.i.d.) at index and up-titration during the first 6 months was attempted in 41% of these patients. Ten percent of patients prescribed 200 mg b.i.d. at index had to be stably down-titrated; among patients prescribed 50 or 100 mg b.i.d. at index that were up-titrated, > 80% remained on the higher dose. Overall, the mean daily diuretic dose decreased by 25% after initiation of sac/val. High compliance and persistence rates were observed across sac/val doses, increasing with higher sac/val dose at index. Prior dose of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker had only minor impact on first sac/val dose, compliance and persistence. CONCLUSIONS Most patients prescribed sac/val are not initiated on the recommended dose nor up-titrated as recommended by the EU Summary of Product Characteristics. Initiation of sac/val was associated with high persistence and compliance and a dose reduction of diuretics. Barriers to up-titration must be explored.
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Affiliation(s)
- Rolf Wachter
- Clinic and Polyclinic for Cardiology, University Hospital Leipzig, Leipzig, Germany.,German Cardiovascular Research Center, Partner Site Göttingen, Göttingen, Germany
| | | | - Bogdan Balas
- Novartis Pharma AG, Basel, Switzerland.,F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Elisabeth Kap
- IQVIA Germany (IQVIA Commercial GmbH & Co. OHG), Frankfurt, Germany
| | | | | | - Sven Klebs
- Novartis Pharma GmbH, Nuremberg, Germany
| | | | - Karel Kostev
- IQVIA Germany (IQVIA Commercial GmbH & Co. OHG), Frankfurt, Germany
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Wirta SB, Balas B, Proenca CC, Bailey H, Phillips Z, Jackson J, Cotton S. Perceptions of heart failure symptoms, disease severity, treatment decision-making, and side effects by patients and cardiologists: a multinational survey in a cardiology setting. Ther Clin Risk Manag 2018; 14:2265-2272. [PMID: 30532549 PMCID: PMC6247946 DOI: 10.2147/tcrm.s183200] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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] [Indexed: 01/14/2023] Open
Abstract
Purpose Explore the extent to which heart failure (HF) symptoms and side effects of HF treatment experienced by patients are recognized by cardiologists, and concordance between patient-cardiologist perceptions of HF severity and patients' contributions to treatment decision-making. Methods A multinational, cross-sectional survey of cardiologists and patients with HF was conducted. Patient-record forms (PRFs) were completed by cardiologists for consecutive consulting patients with HF, who completed a patient self-completion questionnaire (PSC). Responses from PRFs with an associated PSC were analyzed to compare patient- and cardiologist-reported occurrences of HF symptoms and treatment side effects, patient-perceived severity of HF and cardiologists' perceived risk of death within 12 months, and patient input into treatment decisions. Concordance was calculated as the number of response agreements between PSCs and PRFs for total number of matched pairs. Over- or underreporting of symptoms and side effects by cardiologists relative to patient-reported occurrences were calculated. Results Overall, 2,454 patient-cardiologist pairs were identified. High levels of concordance between matched pairs were observed for the occurrence of reported HF symptoms (93%), side effects (77%-98%) and degree of patient input into treatment decisions (74%); for perceived HF severity, concordance was 54%. Most symptoms (except dyspnea when active and fatigue/weakness, experienced by >50% of patients) were underreported by cardiologists. Of patients reporting to have been informed by their cardiologist that their HF was mild, 28% were perceived by their cardiologist to have a moderate-high/very high risk of death within 12 months. Treatment choice was not discussed with almost a third of patients. When discussed, 94% of patients (n=1,540) reported the cardiologist made the final decision. Cardiologists more often under- than overreported the occurrence of side effects reported by patients. Conclusion Improved patient-cardiologist dialogue and shared decision-making is required for optimizing patient care and outcomes in HF.
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Affiliation(s)
- Sara Bruce Wirta
- Real World Evidence, Cardio-Metabolic Franchise, Novartis Sweden, Stockholm, Sweden
| | - Bogdan Balas
- Real World Evidence, Cardio-Metabolic Franchise, Novartis Pharma, Basel, Switzerland
| | | | - Hollie Bailey
- Real World Research, Adelphi Real World, Bollington, UK,
| | - Zoe Phillips
- Real World Research, Adelphi Real World, Bollington, UK,
| | - James Jackson
- Real World Research, Adelphi Real World, Bollington, UK,
| | - Sarah Cotton
- Real World Research, Adelphi Real World, Bollington, UK,
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Gagne JJ, Tsacogianis T, Bruce Wirta S, Rogers JR, Calado F, Chang CL, Turner SJ, Schlienger RG, Balas B, Abdurrob A, Najafzadeh M, Wang SV. Characteristics of early sacubitril/valsartan patients and considerations for studies in electronic health record data. J Comp Eff Res 2018; 7:1073-1082. [DOI: 10.2217/cer-2017-0088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We examined characteristics of early sacubitril/valsartan users in a large US electronic health records database. Patients & methods: We identified three cohorts of patients with heart failure (HF): sacubitril/valsartan patients with a prior HF diagnosis; patients with HF with reduced ejection fraction; and patients with HF treated with an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker and a β-blocker. Results: Sacubitril/valsartan patients were younger than patients in the other cohorts; the mean age of sacubitril/valsartan patients increased by 2 years in the first 15 months of marketing. Most sacubitril/valsartan patients had prior use of HF treatment. Conclusion: Overall, sacubitril/valsartan patients resembled those in the HF with reduced ejection fraction cohort, and commonly used other drugs for HF.
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Affiliation(s)
- Joshua J Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA
| | - Theodore Tsacogianis
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA
| | | | - James R Rogers
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA
| | | | - Chun-Lan Chang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA
| | - Stuart J Turner
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA
| | | | | | - Abdurrahman Abdurrob
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA
| | - Mehdi Najafzadeh
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA
| | - Shirley V Wang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA
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Clark AL, Bruce Wirta S, Zhou M, Kazmi S, Goode KM, Pellicori P, Corda S, Balas B, Calado F, Cleland JGF. P6530What proportion of patients with heart failure are candidates for sacubitril/valsartan? Differences between guideline recommendations and regulatory labels. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6530] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A L Clark
- Hull York Medical School (at University of Hull), Castle Hill Hospital, Department of Cardiology, Kingston upon Hull, United Kingdom
| | - S Bruce Wirta
- Novartis Sweden AB, Real World Evidence Center of Excellence, Stockholm, Sweden
| | - M Zhou
- IQVIA, Real-World Insights, Basel, Switzerland
| | - S Kazmi
- Hull York Medical School (at University of Hull), Castle Hill Hospital, Department of Cardiology, Kingston upon Hull, United Kingdom
| | - K M Goode
- Hull York Medical School (at University of Hull), Castle Hill Hospital, Department of Cardiology, Kingston upon Hull, United Kingdom
| | - P Pellicori
- Hull York Medical School (at University of Hull), Castle Hill Hospital, Department of Cardiology, Kingston upon Hull, United Kingdom
| | - S Corda
- Novartis, Basel, Switzerland
| | - B Balas
- Novartis, Basel, Switzerland
| | | | - J G F Cleland
- University of Hull, Kingston upon Hull, United Kingdom
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Wachter R, Balas B, Klebs S, Kap E, Engelhard J, Fonseca AF, Schlienger R, Dworak M, Bruce Wirta S. P907Titration patterns and clinical characteristics of patients prescribed sacubitril/valsartan in the primary care and cardiology settings in Germany. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p907] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Wachter
- Universitätsklinikum Leipzig, Leipzig, Germany
| | - B Balas
- Novartis Pharma AG, Basel, Switzerland
| | - S Klebs
- Novartis Pharma GmbH, Nuremberg, Germany
| | - E Kap
- IQVIA Germany (IQVIA Commercial GmbH & Co. OHG), Frankfurt, Germany
| | - J Engelhard
- IQVIA Germany (IQVIA Commercial GmbH & Co. OHG), Frankfurt, Germany
| | | | | | - M Dworak
- Novartis Pharma GmbH, Nuremberg, Germany
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Jackson JD, Cotton SE, Bruce Wirta S, Proenca CC, Zhang M, Lahoz R, Balas B, Calado FJ. Care pathways and treatment patterns for patients with heart failure in China: results from a cross-sectional survey. Drug Des Devel Ther 2018; 12:2311-2321. [PMID: 30100706 PMCID: PMC6067623 DOI: 10.2147/dddt.s166277] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Purpose The objective of this study was to describe the clinical care pathways, management and treatment patterns, and hospitalizations for patients with heart failure (HF) in China. Subjects and methods A cross-sectional survey of cardiologists and their patients with HF was conducted. Patient record forms were completed by 150 cardiologists for 10 consecutive patients. Patients for whom a patient record form was completed were invited to complete a patient self-completion questionnaire. Results Most of the 1,500 patients (mean [SD] age 66 [10] years; 55% male) included in the study received care in tier-2 and -3 hospitals in large cities. Cardiologists were responsible for initial consultation, diagnosis, and treatment of patients with HF. The use of guideline-recommended diagnostics was high. However, guideline-recommended double- and triple-combination therapy was received by only 51% and 18% of patients, respectively. In total, 20% of patients with HF reported that they were not consulted on the choice of therapy. Concordance was high (≥80%) between matched cardiologist and patient pairs for the occurrence of side effects, while cardiologists more often under- than overreported the occurrence of side effects of treatment reported by patients. Conclusion The management of HF was predominantly overseen by cardiologists. The use of diagnostic tests was high, but the use of guideline-recommended treatment was low in this population. Improved communication between patients and cardiologists is essential to optimize treatment decision making and to increase awareness of treatment side effects.
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Affiliation(s)
| | - Sarah E Cotton
- Real World Research, Adelphi Real World, Bollington, UK,
| | - Sara Bruce Wirta
- Real World Evidence, Cardio-Metabolic Franchise, Novartis Sweden AB, Stockholm, Sweden
| | | | - Milun Zhang
- Health Economics and Outcomes Research, Novartis Pharma China, Beijing, China
| | - Raquel Lahoz
- Medical Affairs, Cardio-Metabolic Franchise, Novartis Pharma AG, Basel, Switzerland
| | - Bogdan Balas
- Medical Affairs, Cardio-Metabolic Franchise, Novartis Pharma AG, Basel, Switzerland
| | - Frederico J Calado
- Medical Affairs, Cardio-Metabolic Franchise, Novartis Pharma AG, Basel, Switzerland
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Wachter R, Viriato D, Klebs S, Grunow SS, Schindler M, Engelhard J, Proenca CC, Calado F, Schlienger R, Dworak M, Balas B, Bruce Wirta S. Early insights into the characteristics and evolution of clinical parameters in a cohort of patients prescribed sacubitril/valsartan in Germany. Postgrad Med 2018; 130:308-316. [DOI: 10.1080/00325481.2018.1442090] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Daniel Viriato
- Global Health Economics and Outcomes Research, Novartis Pharma AG, Basel, Switzerland
| | - Sven Klebs
- Health Economics and Outcomes Research, Cardio Metabolic, Novartis Pharma GmbH, Nuremberg, Germany
| | - Stefanie S Grunow
- Real World Insights, QuintilesIMS Germany (IMS HEALTH GmbH & Co. OHG), Frankfurt, Germany
| | | | - Johanna Engelhard
- Real World Insights, QuintilesIMS Germany (IMS HEALTH GmbH & Co. OHG), Frankfurt, Germany
| | | | - Frederico Calado
- Real World Evidence, Cardio Metabolic, Novartis Sweden AB, Stockholm, Sweden
| | - Raymond Schlienger
- Quality and Safety Epidemiology, Cardio Metabolic, Novartis Pharma AG, Basel, Switzerland
| | - Markus Dworak
- Clinical Research, Cardio Metabolic, Novartis Pharma GmbH, Nuremberg, Germany
| | - Bogdan Balas
- Global Medical Affairs Cardio Metabolic, Novartis Pharma AG, Basel, Switzerland
| | - Sara Bruce Wirta
- Real World Evidence, Cardio Metabolic, Novartis Sweden AB, Stockholm, Sweden
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Mok T, Peters S, Camidge D, Ou SHI, Ahn J, Tan E, Li Z, Lee JS, Cho B, Geater S, Sriuranpong V, Ho J, Chan OSH, Zeaiter A, Balas B, Nueesch E, Mitry E, Morcos P, Kim DW. Alectinib (ALC) vs crizotinib (CRZ) in treatment-naïve ALK+ non-small-cell lung cancer (NSCLC): Asian vs non-Asian subgroup analysis of the ALEX study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx729.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Patel J, Gadgeel S, Ou S, Le Maitre A, Schulz M, Liu S, Zeaiter A, Balas B, Gupta R, Shaw A. PS02.22 Alectinib Following Prior ALK Tyrosine Kinase Inhibitor (TKI) Therapy: Results from the US Expanded Access Program (EAP). J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mazieres J, Novello S, De Castro J, Migliorino M, Helland Å, Dziadziuszko R, Griesinger F, Wolf J, Zeaiter A, Cardona A, Balas B, Karagiannis T, Chlistalla M, Smoljanovic V, Oh I. P1.01-013 Patient-Reported Outcomes and Safety from the Phase III ALUR Study of Alectinib vs Chemotherapy in Pre-Treated ALK+ NSCLC. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Novello S, Mazieres J, Oh IJ, de Castro J, Migliorino M, Helland A, Dziadziuszko R, Griesinger F, Kotb A, Zeiter A, Cardona A, Balas B, Johannsdottir H, Das-Gupta A, Wolf J. Primary results from the phase III ALUR study of alectinib versus chemotherapy in previously treated ALK+ non-small-cell lung cancer (NSCLC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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de Castro J, Novello S, Mazieres J, Oh IJ, Migliorino M, Helland A, Dziadziuszko R, Griesinger F, de Marinis F, Zeaiter A, Cardona A, Balas B, Johannsdottir H, Chlistalla M, Smoljanovic V, Wolf J. CNS efficacy results from the phase III ALUR study of alectinib vs chemotherapy in previously treated ALK+ NSCLC. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx380.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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16
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Gadgeel S, Peters S, Mok T, Shaw A, Kim DW, Ou SH, Perol M, Dziadziuszko R, Ahn J, Rosell R, Zeaiter A, Mitry E, Nueesch E, Balas B, Camidge R. Alectinib vs crizotinib in treatment-naïve ALK+ NSCLC: CNS efficacy results from the ALEX study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gagne J, Tsacogianis T, Wirta S, Rogers J, Calado F, Chang C, Turner S, Schlienger R, Balas B, Abdurrob A, Najafzadeh M, Wang S. P1467Characteristics of early sacubitril/valsartan users in US electronic health record data. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1467] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Klebs S, Balas B, Grunow S, Schindler M, Engelhard J, Proenca C, Calado F, Schlienger R, Dworak M, Bruce Wirta S. P4395Characteristics of patients with heart failure prescribed sacubitril/valsartan in the primary care setting in Germany. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4395] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bruce Wirta S, Klebs S, Grunow S, Schindler M, Engelhard J, Proenca C, Calado F, Schlienger R, Dworak M, Balas B. P608Characteristics of patients with heart failure prescribed sacubitril/valsartan in the primary care and cardiology settings in Germany. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p608] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Barlesi F, Dingemans AM, Yang JH, Ou SH, Ahn J, De Petris L, Hughes B, Lena H, Bordogna W, Golding S, Morcos P, Balas B, Zeaiter A, Kim DW. Updated efficacy and safety from the global phase II NP28673 study of alectinib in patients (pts) with previously treated ALK+ non-small-cell lung cancer (NSCLC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw383.63] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lasser R, Ostrowitzki S, Scheltens P, Boada M, Dubois B, Dorflinger E, Balas B, Nikolcheva T, Volz D, Ashford E, Edgar C, Garibaldi G, Fontoura P, Santarelli L. DT‐01‐03: Efficacy and safety of gantenerumab in prodromal Alzheimer's disease: Results from scarlet road—a global, multicenter trial. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.08.153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Chris Edgar
- Roche Products LtdWelwyn Garden CityUnited Kingdom
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Tonsager C, Balas B. The effect of contrast negation on real/artificial face discrimination. J Vis 2014. [DOI: 10.1167/14.10.1402] [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: 11/24/2022] Open
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23
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Huynh C, Tonsager C, Balas B. The inversion effect as a function of orientation information in emotional face and body recognition. J Vis 2014. [DOI: 10.1167/14.10.567] [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: 11/24/2022] Open
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24
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Saville A, Huynh C, Balas B. Face animacy does not impact the N170 inversion effect. J Vis 2014. [DOI: 10.1167/14.10.127] [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: 11/24/2022] Open
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25
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Kuylen C, Balas B, Thomas L. Both own and other object shadows compress perceived distance. J Vis 2014. [DOI: 10.1167/14.10.142] [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: 11/24/2022] Open
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Conlin C, Balas B. Invariant texture recognition depends on high-order statistics. J Vis 2014. [DOI: 10.1167/14.10.1424] [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: 11/24/2022] Open
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Gastaldelli A, Balas B, Ratner R, Rosenstock J, Charbonnel B, Bolli GB, Boldrin M, Balena R. A direct comparison of long- and short-acting GLP-1 receptor agonists (taspoglutide once weekly and exenatide twice daily) on postprandial metabolism after 24 weeks of treatment. Diabetes Obes Metab 2014; 16:170-8. [PMID: 23911196 DOI: 10.1111/dom.12192] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 05/21/2013] [Accepted: 07/29/2013] [Indexed: 01/06/2023]
Abstract
AIMS T-emerge 2 was a randomized, open-label, 24-week trial comparing subcutaneous taspoglutide 10 mg weekly (Taspo10), taspoglutide 20 mg weekly (Taspo20; titrated after 4 weeks of Taspo10), with exenatide 10 mcg BID (Exe; after 4 weeks of Exe 5 mcg) in patients inadequately controlled on metformin, a thiazolidinedione, or both. T-emerge 2 showed that once-weekly Taspo provided better glycaemic control than Exe. This report focuses on a subset of T-emerge 2 participants undergoing a standardized liquid meal comparing Taspo to Exe, which has been previously shown to lower postprandial glucose. METHODS Meal tolerance tests (MTT) were performed at baseline and at week 24 in a subset of Taspo10, Taspo20 and Exe patients (n = 42, 39 and 67, respectively). Blood samples for glucose, insulin, glucagon and C-peptide were obtained before and after (30, 60, 90, 120 and 180 min) ingestion of a standardized liquid meal. RESULTS The 2-h postprandial, mean 0-3 h and iAUC0-3 h glucose during the MTT was reduced to a similar extent in all groups and the time profile of the postprandial glucose showed a similar pattern. Taspo10 and Taspo20, but not Exe, significantly increased insulin from baseline (both mean and iAUC0-3 h). Although changes from baseline in C-peptide were not significant within any treatment group, the mean change from baseline (both mean 0-3 h and iAUC0-3 h) was significantly increased in Taspo10 vs. Exe. Mean glucagon showed significant decreases in all groups. CONCLUSION Taspoglutide and Exe improved postprandial glucose tolerance to a similar extent but possibly with different intimate mechanisms.
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Muscogiuri G, Salmon AB, Aguayo-Mazzucato C, Li M, Balas B, Guardado-Mendoza R, Giaccari A, Reddick RL, Reyna SM, Weir G, DeFronzo RA, Van Remmen H, Musi N. Genetic disruption of SOD1 gene causes glucose intolerance and impairs β-cell function. Diabetes 2013; 62:4201-7. [PMID: 24009256 PMCID: PMC3837066 DOI: 10.2337/db13-0314] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Oxidative stress has been associated with insulin resistance and type 2 diabetes. However, it is not clear whether oxidative damage is a cause or a consequence of the metabolic abnormalities present in diabetic subjects. The goal of this study was to determine whether inducing oxidative damage through genetic ablation of superoxide dismutase 1 (SOD1) leads to abnormalities in glucose homeostasis. We studied SOD1-null mice and wild-type (WT) littermates. Glucose tolerance was evaluated with intraperitoneal glucose tolerance tests. Peripheral and hepatic insulin sensitivity was quantitated with the euglycemic-hyperinsulinemic clamp. β-Cell function was determined with the hyperglycemic clamp and morphometric analysis of pancreatic islets. Genetic ablation of SOD1 caused glucose intolerance, which was associated with reduced in vivo β-cell insulin secretion and decreased β-cell volume. Peripheral and hepatic insulin sensitivity were not significantly altered in SOD1-null mice. High-fat diet caused glucose intolerance in WT mice but did not further worsen the glucose intolerance observed in standard chow-fed SOD1-null mice. Our findings suggest that oxidative stress per se does not play a major role in the pathogenesis of insulin resistance and demonstrate that oxidative stress caused by SOD1 ablation leads to glucose intolerance secondary to β-cell dysfunction.
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Affiliation(s)
- Giovanna Muscogiuri
- Diabetes Division, University of Texas Health Science Center, San Antonio, Texas
| | - Adam B. Salmon
- Barshop Institute for Longevity and Aging Studies, San Antonio, Texas
- Geriatric Research, Education, and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
| | | | - Mengyao Li
- Diabetes Division, University of Texas Health Science Center, San Antonio, Texas
| | - Bogdan Balas
- Diabetes Division, University of Texas Health Science Center, San Antonio, Texas
| | | | - Andrea Giaccari
- Division of Endocrinology and Metabolic Diseases, Università Cattolica del Sacro Cuore, Policlinico “A. Gemelli,” Rome, and Fondazione Don Gnocchi, Milan, Italy
| | - Robert L. Reddick
- Department of Pathology, University of Texas Health Science Center, San Antonio, Texas
| | - Sara M. Reyna
- Diabetes Division, University of Texas Health Science Center, San Antonio, Texas
| | - Gordon Weir
- Section on Islet Cell and Regenerative Biology, Joslin Diabetes Center, Boston, Massachusetts
| | - Ralph A. DeFronzo
- Diabetes Division, University of Texas Health Science Center, San Antonio, Texas
| | - Holly Van Remmen
- Barshop Institute for Longevity and Aging Studies, San Antonio, Texas
- Geriatric Research, Education, and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
| | - Nicolas Musi
- Diabetes Division, University of Texas Health Science Center, San Antonio, Texas
- Barshop Institute for Longevity and Aging Studies, San Antonio, Texas
- Geriatric Research, Education, and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
- Corresponding author: Nicolas Musi,
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Saville A, Balas B. Invariant properties of detecting personal familiarity in "thin slices" of behavior. J Vis 2013. [DOI: 10.1167/13.9.868] [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: 11/24/2022] Open
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Huynh C, Balas B. Emotion recognition (sometimes) depends on horizontal orientations. J Vis 2013. [DOI: 10.1167/13.9.589] [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: 11/24/2022] Open
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Balas B, Koldewyn K. Face animacy perception is species-specific. J Vis 2013. [DOI: 10.1167/13.9.991] [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: 11/24/2022] Open
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Kuylen C, Thomas L, Balas B. Cast-body shadows compress perceived distances. J Vis 2013. [DOI: 10.1167/13.9.214] [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: 11/24/2022] Open
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Rosenstock J, Balas B, Charbonnel B, Bolli GB, Boldrin M, Ratner R, Balena R. The fate of taspoglutide, a weekly GLP-1 receptor agonist, versus twice-daily exenatide for type 2 diabetes: the T-emerge 2 trial. Diabetes Care 2013; 36:498-504. [PMID: 23139373 PMCID: PMC3579343 DOI: 10.2337/dc12-0709] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Taspoglutide is a long-acting glucagon-like peptide 1 receptor agonist developed for treatment of type 2 diabetes. The efficacy and safety of once-weekly taspoglutide was compared with twice-daily exenatide. RESEARCH DESIGN AND METHODS Overweight adults with inadequately controlled type 2 diabetes on metformin ± a thiazolidinedione were randomized to subcutaneous taspoglutide 10 mg weekly (n = 399), taspoglutide 20 mg weekly (n = 398), or exenatide 10 µg twice daily (n = 392) in an open-label, multicenter trial. The primary end point was change in HbA(1c) after 24 weeks. RESULTS Mean baseline HbA(1c) was 8.1%. Both doses of taspoglutide reduced HbA(1c) significantly more than exenatide (taspoglutide 10 mg: -1.24% [SE 0.09], difference -0.26, 95% CI -0.37 to -0.15, P < 0.0001; taspoglutide 20 mg: -1.31% [0.08], difference -0.33, -0.44 to -0.22, P < 0.0001; exenatide: -0.98% [0.08]). Both taspoglutide doses reduced fasting plasma glucose significantly more than exenatide. Taspoglutide reduced body weight (taspoglutide 10 mg, -1.6 kg; taspoglutide 20 mg, -2.3 kg) as did exenatide (-2.3 kg), which was greater than with taspoglutide 10 mg (P < 0.05). HbA(1c) and weight effects were maintained after 52 weeks. More adverse events with taspoglutide 10 and 20 mg than exenatide developed over time (nausea in 53, 59, and 35% and vomiting in 33, 37, and 16%, respectively). Allergic and injection-site reactions were more common with taspoglutide. Discontinuations were greater with taspoglutide. Antitaspoglutide antibodies were detected in 49% of patients. CONCLUSIONS Once-weekly taspoglutide demonstrated greater glycemic control than twice-daily exenatide with comparable weight loss, but with unacceptable levels of nausea/vomiting, injection-site reactions, and systemic allergic reactions.
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Affiliation(s)
- Julio Rosenstock
- Dallas Diabetes and Endocrine Center at Medical City, Dallas, TX, USA.
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Stevenson K, Mangini M, Balas B. Luminance and Chromatic Negation equally affect Human and Monkey Face Recognition in Adulthood and Early Childhood. J Vis 2012. [DOI: 10.1167/12.9.24] [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: 11/24/2022] Open
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Balas B. Contrast-negation and texture synthesis differentially disrupt natural texture appearance. J Vis 2012. [DOI: 10.1167/12.9.100] [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: 11/24/2022] Open
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Sun HM, Balas B. Chinese-reading expertise leads to holistic crowding between faces and Chinese characters. J Vis 2012. [DOI: 10.1167/12.9.342] [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: 11/24/2022] Open
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Kuylen C, Balas B, Thomas L. Hand dominance influences outcome predictions when observing self-generated actions. J Vis 2012. [DOI: 10.1167/12.9.832] [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: 11/24/2022] Open
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Raj A, Rosenholtz R, Balas B. Collinearity and Containment Grouping have Different Effects on Object Substitution Masking. J Vis 2011. [DOI: 10.1167/11.11.1083] [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: 11/24/2022] Open
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Balas B, Raj A, Rosenholtz R. A summary-statistic model of the visual periphery predicts the difficulty of visual curve tracing. J Vis 2011. [DOI: 10.1167/11.11.1207] [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: 11/24/2022] Open
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Abstract
INTRODUCTION. We previously demonstrated increases in β-adrenergic receptor (β-AR) density in rat liver, in association with increased β-AR-mediated stimulation of glucose output in rat hepatocytes, during senescent aging. We therefore hypothesized that pharmacologic β-adrenergic stimulation might induce insulin resistance and glucose output in liver of aging rats in vivo. METHODS. In this study, pancreatic clamps were performed on young adult (4-month-old) and senescent (24-month-old) Fischer 344 male rats by infusing somatostatin (3 μg/kg/min) at time 0 to inhibit insulin secretion, and then infusing insulin (1 mU/kg/min) to replace basal insulin concentrations. At time 0 rats also received either the β-AR agonist isoproterenol (100 ng/kg/min) or saline (control). After 120 min the insulin infusion rate was increased to 4 mU/kg/min for an additional 120 min. Tritiated glucose was infused throughout the study to measure glucose turnover rates. RESULTS AND CONCLUSION. The results of the pancreatic clamp studies demonstrated that under saline control conditions hepatic glucose production (HGP) was suppressed during hyperinsulinemia in both young and old rats, with a trend toward reduced insulin sensitivity in the older animals. Isoproterenol infusion impaired insulin-induced suppression of HGP in both age groups. The results suggest that β-AR stimulation by isoproterenol increases HGP and acutely induces hepatic insulin resistance in both young and old rats. A similar role for β-adrenergic-mediated hepatic insulin resistance in aging humans would suggest a novel therapeutic target for the treatment or prevention of glucose dysregulation and diabetes developing with advancing age.
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Affiliation(s)
- Giovanna Muscogiuri
- Department of Medicine, University of Texas Health Science Center at San Antonio, Texas 78229, USA
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Raj A, Rosenholtz R, Balas B. Texture processing model visualizes perception of Pinna-Gregory illusion. J Vis 2010. [DOI: 10.1167/9.8.990] [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: 11/24/2022] Open
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Abstract
BACKGROUND Plasma adiponectin is decreased in NASH patients and the mechanism(s) for histological improvement during thiazolidinedione treatment remain(s) poorly understood. AIM To evaluate the relationship between changes in plasma adiponectin following pioglitazone treatment and metabolic/histological improvement. METHODS We measured in 47 NASH patients and 20 controls: (i) fasting glucose, insulin, FFA and adiponectin concentrations; (ii) hepatic fat content by magnetic resonance spectroscopy; and (iii) peripheral/hepatic insulin sensitivity (by double-tracer oral glucose tolerance test). Patients were then treated with pioglitazone (45 mg/day) or placebo and all measurements were repeated after 6 months. RESULTS Patients with NASH had decreased plasma adiponectin levels independent of the presence of obesity. Pioglitazone increased 2.3-fold plasma adiponectin and improved insulin resistance, glucose tolerance and glucose clearance, steatosis and necroinflammation (all P < 0.01-0.001 vs. placebo). In the pioglitazone group, plasma adiponectin was significantly associated (r = 0.52, P = 0.0001) with hepatic insulin sensitivity and with the change in both variables (r = 0.44, P = 0.03). Increase in adiponectin concentration was related also to histological improvement, in particular, to hepatic steatosis (r = -0.46, P = 0006) and necroinflammation (r = -0.56, P < 0.0001) but importantly also to fibrosis (r = -0.29, P = 0.03). CONCLUSIONS Adiponectin exerts an important metabolic role at the level of the liver, and its increase during pioglitazone treatment is critical to reverse insulin resistance and improve liver histology in NASH patients.
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Affiliation(s)
- A Gastaldelli
- The University of Texas Health Science Center at San Antonio, 78284-3900, USA
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Balas B, Sinha P. A speed-dependent inversion effect in dynamic object matching. J Vis 2010. [DOI: 10.1167/8.6.837] [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: 11/24/2022] Open
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Nakano L, Rosenholtz R, Balas B. A texture-perception model of crowding for general stimuli, Version 1.0. J Vis 2010. [DOI: 10.1167/8.6.433] [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: 11/24/2022] Open
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Balas B. Using innate visual biases to guide face learning in natural scenes: A computational investigation. J Vis 2010. [DOI: 10.1167/9.8.477] [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: 11/24/2022] Open
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