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Kwatra SG, Lio P, Weidinger S, Calimlim B, Ladizinski B, Vigna N, Botha W, Mansfield C. Patient preferences for atopic dermatitis treatments: a discrete choice experiment. J DERMATOL TREAT 2023; 34:2222201. [PMID: 37349865 DOI: 10.1080/09546634.2023.2222201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Patients with moderate-to-severe atopic dermatitis (AD) experience skin lesions and intense itch that substantially affect quality of life. Patients have choices among systemic AD treatments that offer varied benefit-risk profiles. OBJECTIVE Measure patients' willingness to trade off the risks and benefits of systemic treatments among individuals with a physician-confirmed diagnosis of moderate-to-severe AD. METHODS Patients participated in a discrete choice experiment online survey with a series of choices between hypothetical AD treatments defined by six attributes reflecting benefits and risks of treatments (itch reduction, time until noticeable itch reduction, chance of clear or almost clear skin, risk of serious infection, risk of developing acne, and need for prescription topical steroids). Data were analyzed with a random parameters logit model to quantify preferences and the relative importance of attributes for treatment alternatives. RESULTS Respondents (n = 200) placed the highest relative importance on itch reduction, speed of itch reduction, and skin clearance, and were generally willing to accept clinically relevant levels of risk of serious infection and acne in exchange for treatment benefits. CONCLUSIONS Patients with moderate-to-severe AD were willing to trade clinically relevant treatment risks for greater or more rapid itch reduction and skin clearance offered by systemic therapies.
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Affiliation(s)
- Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter Lio
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Cesnakova L, Meadows K, Avey S, Barrett J, Calimlim B, Chatterjee M, Goss S, Keyloun KR, Lambert J, Northcott CA, Patalano F, Sirbu D, Begolka WS, Thyssen N, Zorman S, Goldsack JC. A patient-centred conceptual model of nocturnal scratch and its impact in atopic dermatitis: A mixed-methods study supporting the development of novel digital measurements. Skin Health Dis 2023; 3:e262. [PMID: 37799371 PMCID: PMC10549806 DOI: 10.1002/ski2.262] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/09/2023] [Accepted: 06/01/2023] [Indexed: 10/07/2023]
Abstract
Background Emerging digital measures and clinical outcome assessments (COAs) leveraging digital health technologies (DHTs) could address the need for objective, quantitative measures of symptoms of atopic dermatitis (AD), such as nocturnal scratching. Development of such measures needs to be supported by evidence reflecting meaningfulness to patients. Objectives To assess nocturnal scratching as a concept of interest associated with meaningful aspects of health of patients with AD (adults and children); and to explore patient-centred considerations for novel COAs measuring nocturnal scratch using DHTs. Methods Phase 1 evaluated disease impacts on everyday life and the lived experience with nocturnal scratching through qualitative interviews of AD patients and caregivers. Phase 2 deployed a quantitative survey to a sample of AD patients as well as caregivers. Results Four cohorts with various AD severity levels participated in Phase 1: (1) adults with AD (n = 15), (2) their caregivers/spouses/partners (n = 6), (3) children with AD (n = 14), and (4) their adult caregivers (n = 14). Findings were used to develop a conceptual model for nocturnal scratching as a potential concept of interest. The Phase 2 survey was completed by 1349 of 27640 invited adults with AD and caregivers of children with AD. The most burdensome aspects of AD reported were itchy skin and scratching. Overall, ∼65% of participants reported nocturnal scratching ≥1 day/week, resulting in ∼1-1.4 h of sleep lost per night. In all, 85%-91% of respondents considered it at least somewhat valuable that a treatment reduces night-time scratching. About 50% reported willingness to use technology to this end and ∼25% were unsure. Conclusion Our results represented by the conceptual model confirm that nocturnal scratch is a concept of interest related to meaningful aspects of health for patients with AD and therefore is worth being captured as a distinct outcome for clinical and research purposes. DHTs are suitable tools presenting an important measurement opportunity to assess and evaluate occurrence, frequency, and other parameters of nocturnal scratching as a disease biomarker or COA of treatment efficacy.
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Affiliation(s)
| | | | - Stefan Avey
- Janssen Research & Development LLCRaritanNew JerseyUSA
| | - Judy Barrett
- Health Outcomes Insights Ltd.FaringdonOxfordshireUK
| | | | | | | | | | | | | | | | | | | | | | - Sylvain Zorman
- Novartis Pharma AGBaselSwitzerland
- ActiGraph LLCPensacolaFlordiaUSA
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Silverberg JI, Simpson B, Abuabara K, Guttman-Yassky E, Calimlim B, Wegzyn C, Krueger W, Gamelli A, Munoz B, Faller RW, Crawford JM, Grada A, Eichenfield LF. Prevalence and burden of atopic dermatitis involving the head, neck, face, and hand: A cross sectional study from the TARGET-DERM AD cohort. J Am Acad Dermatol 2023; 89:519-528. [PMID: 37150299 DOI: 10.1016/j.jaad.2023.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/02/2023] [Accepted: 04/07/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is severely burdensome, and there has been poor characterization of any differences in impact based on the area affected. OBJECTIVE To estimate the prevalence and HRQoL impact of head/face/neck/hand (HFNH) involvement among patients with moderate-to-severe atopic dermatitis. METHODS All TARGET-DERM AD registry patients with moderate/severe Investigator Global Assessment (vIGA-AD) were assessed using the Patient Oriented SCORing Atopic Dermatitis, Patient Oriented Eczema Measure (POEM) and the (Children's) Dermatology Life Quality Index ((C)DLQI). RESULTS 541 participants met the criteria (75.0% adults) and 84% (N = 453) reported HFNH involvement. HFNH and non-HFNH involved participants had similar characteristics; 55.2% female and 46.9% White. Compared to the non-HFNH involved, the involved had severe vIGA-AD (28.5% vs 16.3%, P = .02) and higher median body surface area affected (15% vs 10%, P ≤ .01) and were twice as likely to have higher (C)DLQI and POEM scores. LIMITATIONS This was an analysis of real-world and patient reported outcome data. CONCLUSION Real-world HFNH involved AD patients were associated with significantly worse quality of life, POEM/(C)DLQI, and more severe disease. Detailed assessments of specific areas affected by AD are needed to personalize treatment.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, George Washington University, Washington, District of Columbia.
| | | | - Katrina Abuabara
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | | | - Breda Munoz
- Target RWE Health Evidence Solutions, Durham, North Carolina
| | - Rachel W Faller
- Target RWE Health Evidence Solutions, Durham, North Carolina
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Guttman-Yassky E, Bar J, Rothenberg-Lausell C, Eichenfield L, Grada A, Abuabara K, Chapman M, Calimlim B, Wegzyn C, Gamelli A, Krueger W, Munoz B, Knapp K, Faller R, Crawford J, Silverberg J. Do Atopic Dermatitis Patient-Reported Outcomes Correlate With Validated Investigator Global Assessment? Insights From TARGET-AD Registry. J Drugs Dermatol 2023; 22:344-354. [PMID: 37026893 DOI: 10.36849/jdd.7473] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Research examining associations between the clinician-reported validated Investigator Global Assessment for AD (vIGA-AD) and patient-reported disease burden is sparse. This study aims to evaluate the relationship between vIGA-AD with patient-reported disease severity and quality of life (QoL). METHODS A cross-sectional analysis was conducted using a September 2021 data cut from the TARGET-DERM AD study, a real-world, longitudinal cohort of children, adolescents, and adults with AD enrolled at 44 academic and community dermatology and allergy sites in the US. Clinical AD severity was measured using vIGA-AD while disease severity and QoL were assessed by the Patient Oriented Eczema Measure (POEM) and (Children’s) Dermatology Life Quality Index (C/DLQI), respectively. Patient characteristics, clinical- and patient reported-outcomes were assessed by stratified POEM and C/DLQI categories using descriptive statistics. Associations with vIGA-AD were evaluated using unadjusted and adjusted ordinal logistic regression and linear regression models. RESULTS The analysis cohort (n=1,888) primarily consisted of adults (57%), females (56%), and patients with private insurance (63%). Unadjusted analyses suggest that clinical AD severity was associated with age, with more adolescents and adults having moderate/severe vIGA-AD than pediatric patients. Clinical AD severity was also associated with disease severity, with greater POEM scores observed at greater vIGA-AD severity levels (r = 0.496 and 0.45 for adults and pediatrics, respectively). Clinical AD severity and QoL were positively correlated, with greater CDLQI/DLQI scores at greater vIGA-AD severity levels (r = 0.458 and 0.334 for DLQI and CDLQI, respectively). After adjusting for demographics and other risk factors, vIGA-AD continued to show significant associations with POEM and DLQI/CDLQI. Compared to patients with clear/almost clear disease, adults and pediatrics with moderate-to-severe AD were 8.19 and 5.78 times as likely to be in a more severe POEM category, respectively. Similarly, compared to patients with clear/almost clear disease, adults and pediatrics with moderate/severe AD were 6.69 and 3.74 times as likely to be in a more severe DLQI/CDLQI category. Adjusted linear regression analyses of DLQI in adults showed significant differences by vIGA-AD level, with mild AD and moderate/severe AD associated with a 2.26-point and 5.42-point greater DLQI relative to clear/almost clear AD. CONCLUSIONS In this real-world study of patients with AD, greater clinician-reported disease severity is positively correlated with higher patient-reported disease severity and lower QoL. J Drugs Dermatol. 2023;22(4): doi:10.36849/JDD.7473 Access Supplementary Material here Citation: Guttman-Yassky E, Bar J, Rothenberg Lausell C, et al. Do atopic dermatitis patient-reported outcomes correlate with validated investigator global assessment? Insights from TARGET-AD registry. J Drugs Dermatol. 2023;22(4):344-355. doi:10.36849/JDD.7473.
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Cather J, Magnolo N, Cameron M, Calimlim B, Lane M, Hays S, Gamelli A, Woo YR. 357 The effect of upadacitinib on the genital region in moderate-to-severe atopic dermatitis: an analysis from the Measure Up 1 and Measure Up 2 studies. Br J Dermatol 2023. [DOI: 10.1093/bjd/ljac140.048] [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: 01/27/2023]
Abstract
Abstract
Atopic dermatitis (AD) is a chronic, inflammatory skin disease that can be debilitating, impacting all body areas, including the genital region. Genital AD results in impairments in daily activity levels, sexual function and sleep, contributing to impaired quality of life in patients with moderate-to-severe AD. Upadacitinib (UPA) is a selective oral Janus kinase (JAK) inhibitor with greater inhibitory potency for JAK1 vs. JAK2, JAK3 and tyrosine kinase 2, indicated for the treatment of moderate to severe AD. The SCORing Atopic Dermatitis (SCORAD) measure assesses the extent and severity to which a body area is affected, as well as itch and sleeplessness due to AD. In this post-hoc analysis of the Measure Up 1 and Measure Up 2 studies, we evaluated the proportion of patients whose genital AD resolved with UPA 15 mg or UPA 30 mg compared with placebo. Measure Up 1 and 2 are phase 3 multicenter, randomized, double-blind studies comparing the safety and efficacy of UPA 15 mg and UPA 30 mg to placebo in adolescent and adult patients with moderate-to-severe AD. Patients were randomized to oral once daily UPA 15 mg, UPA 30 mg or placebo. The current study assessed the proportion of patients with genital involvement at baseline who achieved genital AD resolution at week 2 and week 16 based on data collected from the SCORAD. Non-responder imputation was used. Of the 1679 participants, 239 (14.2%) had genital AD at baseline and were randomized to UPA 15 mg (n = 77), UPA 30 mg (n = 86) or placebo (n = 76). More participants with genital involvement vs. those without were male (61.1% vs. 54.1%), ≥18 years old (92.1% vs. 85.5%), and severe according to the Validated Investigator Global Assessment Scale for Atopic Dermatitis (66.9% vs. 47.2%) at baseline. On average, participants with genital involvement at baseline also reported greater disease duration (25.0 vs. 22.8 years) and higher Dermatology Life Quality Index (DLQI) scores (19.2 vs. 16.3). At week 2, the proportion of patients whose genital AD was resolved was 70.1% of the UPA 15 mg group, and 82.6% of the UPA 30 mg group, both of which were greater than the placebo group (31.6%; P < 0.001). At week 16, the proportion of patients whose genital AD was resolved increased in the UPA 15 mg (80.5%) and UPA 30 mg (83.7%) groups, but not in the placebo group (28.9%) which remained lower than both groups (P < 0.001). More patients with moderate-to-severe AD achieved resolution of their genital AD with UPA 15 mg or 30 mg monotherapy daily compared to placebo, with >70% rapidly achieving genital AD resolution after 2 weeks and >80% after 16 weeks of UPA treatment. In addition to overall improvements in moderate-to-severe AD with UPA, resolution of genital AD may correspond to improvements in sexual functioning, reductions in sleeplessness and greater quality of life. These findings underscore the importance of considering genital involvement when assessing the burden of AD to comprehensively inform integrated shared decision-making treatment discussions between patients and physicians.
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Affiliation(s)
- Jennifer Cather
- Mindful Dermatology and Modern Research Associates , Dallas, TX , USA
| | - Nina Magnolo
- Department of Dermatology, University Hospital Münster , Münster , Germany
| | - Michael Cameron
- Department of Dermatology, Mount Sinai Hospital , New York, NY , USA
| | | | | | | | | | - Yu Ri Woo
- Department of Dermatology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea
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Kwatra SG, De Bruin-Weller M, Lio P, Deleuran M, Ofori S, Teixeira HD, Calimlim B, Liu Y, Weidinger S. 33152 Targeted combined endpoint improvement in patient and disease domains in atopic dermatitis (AD) among adults with moderate-to-severe AD treated with upadacitinib. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.864] [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: 11/27/2022]
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Prajapati V, Glick B, Spelman L, Figueras Nart I, Calimlim B, Ladizinski B, Wu T, Liu Y, Davis J, Aydin H, Ehst B. 308 Incremental improvements after switching from dupilumab (DUPI) to upadacitinib (UPA) in the Heads Up open-label extension (OLE) study. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.316] [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]
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Guttman-Yassky E, Teixeira HD, Simpson EL, Papp KA, Pangan AL, Blauvelt A, Thaçi D, Chu CY, Hong HCH, Katoh N, Paller AS, Calimlim B, Gu Y, Hu X, Liu M, Yang Y, Liu J, Tenorio AR, Chu AD, Irvine AD. Once-daily upadacitinib versus placebo in adolescents and adults with moderate-to-severe atopic dermatitis (Measure Up 1 and Measure Up 2): results from two replicate double-blind, randomised controlled phase 3 trials. Lancet 2021; 397:2151-2168. [PMID: 34023008 DOI: 10.1016/s0140-6736(21)00588-2] [Citation(s) in RCA: 214] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/12/2021] [Accepted: 03/02/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Upadacitinib is an oral Janus kinase (JAK) inhibitor with greater inhibitory potency for JAK1 than JAK2, JAK3, and tyrosine kinase 2. We aimed to assess the efficacy and safety of upadacitinib compared with placebo for the treatment of moderate-to-severe atopic dermatitis. METHODS Measure Up 1 and Measure Up 2 were replicate multicentre, randomised, double-blind, placebo-controlled, phase 3 trials; Measure Up 1 was done at 151 clinical centres in 24 countries across Europe, North and South America, Oceania, and the Asia-Pacific region; and Measure Up 2 was done at 154 clinical centres in 23 countries across Europe, North America, Oceania, and the Asia-Pacific region. Eligible patients were adolescents (aged 12-17 years) and adults (aged 18-75 years) with moderate-to-severe atopic dermatitis (≥10% of body surface area affected by atopic dermatitis, Eczema Area and Severity Index [EASI] score of ≥16, validated Investigator's Global Assessment for Atopic Dermatitis [vIGA-AD] score of ≥3, and Worst Pruritus Numerical Rating Scale score of ≥4). Patients were randomly assigned (1:1:1) using an interactive response technology system to receive upadacitinib 15 mg, upadacitinib 30 mg, or placebo once daily for 16 weeks, stratified by baseline disease severity, geographical region, and age. Coprimary endpoints were the proportion of patients who had achieved at least a 75% improvement in EASI score from baseline (EASI-75) and the proportion of patients who had achieved a vIGA-AD response (defined as a vIGA-AD score of 0 [clear] or 1 [almost clear] with ≥2 grades of reduction from baseline) at week 16. Efficacy was analysed in the intention-to-treat population and safety was analysed in all randomly assigned patients who received at least one dose of study drug. These trials are registered with ClinicalTrials.gov, NCT03569293 (Measure Up 1) and NCT03607422 (Measure Up 2), and are both active but not recruiting. FINDINGS Between Aug 13, 2018, and Dec 23, 2019, 847 patients were randomly assigned to upadacitinib 15 mg (n=281), upadacitinib 30 mg (n=285), or placebo (n=281) in the Measure Up 1 study. Between July 27, 2018, and Jan 17, 2020, 836 patients were randomly assigned to upadacitinib 15 mg (n=276), upadacitinib 30 mg (n=282), or placebo (n=278) in the Measure Up 2 study. At week 16, the coprimary endpoints were met in both studies (all p<0·0001). The proportion of patients who had achieved EASI-75 at week 16 was significantly higher in the upadacitinib 15 mg (196 [70%] of 281 patients) and upadacitinib 30 mg (227 [80%] of 285 patients) groups than the placebo group (46 [16%] of 281 patients) in Measure Up 1 (adjusted difference in EASI-75 response rate vs placebo, 53·3% [95% CI 46·4-60·2] for the upadacitinib 15 mg group; 63·4% [57·1-69·8] for the upadacitinib 30 mg group) and Measure Up 2 (166 [60%] of 276 patients in the upadacitinib 15 mg group and 206 [73%] of 282 patients in the upadacitinib 30 mg group vs 37 [13%] of 278 patients in the placebo group; adjusted difference in EASI-75 response rate vs placebo, 46·9% [39·9-53·9] for the upadacitinib 15 mg group; 59·6% [53·1-66·2] for the upadacitinib 30 mg group). The proportion of patients who achieved a vIGA-AD response at week 16 was significantly higher in the upadacitinib 15 mg (135 [48%] patients) and upadacitinib 30 mg (177 [62%] patients) groups than the placebo group (24 [8%] patients) in Measure Up 1 (adjusted difference in vIGA-AD response rate vs placebo, 39·8% [33·2-46·4] for the upadacitinib 15 mg group; 53·6% [47·2-60·0] for the upadacitinib 30 mg group) and Measure Up 2 (107 [39%] patients in the upadacitinib 15 mg group and 147 [52%] patients in the upadacitinib 30 mg group vs 13 [5%] patients in the placebo group; adjusted difference in vIGA-AD response rate vs placebo, 34·0% [27·8-40·2] for the upadacitinib 15 mg group; 47·4% [41·0-53·7] for the upadacitinib 30 mg group). Both upadacitinib doses were well tolerated. The incidence of serious adverse events and adverse events leading to study drug discontinuation were similar among groups. The most frequently reported treatment-emergent adverse events were acne (19 [7%] of 281 patients in the upadacitinib 15 mg group, 49 [17%] of 285 patients in the upadacitinib 30 mg group, and six [2%] of 281 patients in the placebo group in Measure Up 1; 35 [13%] of 276 patients in the upadacitinib 15 mg group, 41 [15%] of 282 patients in the upadacitinib 30 mg group, and six [2%] of 278 patients in the placebo group in Measure Up 2), upper respiratory tract infection (25 [9%] patients, 38 [13%] patients, and 20 [7%] patients; 19 [7%] patients, 17 [16%] patients, and 12 [4%] patients), nasopharyngitis (22 [8%] patients, 33 [12%] patients, and 16 [6%] patients; 16 [6%] patients, 18 [6%] patients, and 13 [5%] patients), headache (14 [5%] patients, 19 [7%] patients, and 12 [4%] patients; 18 [7%] patients, 20 [7%] patients, and 11 [4%] patients), elevation in creatine phosphokinase levels (16 [6%] patients, 16 [6%] patients, and seven [3%] patients; nine [3%] patients, 12 [4%] patients, and five [2%] patients), and atopic dermatitis (nine [3%] patients, four [1%] patients, and 26 [9%] patients; eight [3%] patients, four [1%] patients, and 26 [9%] patients). INTERPRETATION Monotherapy with upadacitinib might be an effective treatment option and had a positive benefit-risk profile in adolescents and adults with moderate-to-severe atopic dermatitis. FUNDING AbbVie.
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Affiliation(s)
- Emma Guttman-Yassky
- Department of Dermatology and Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - Kim A Papp
- Probity Medical Research, Waterloo, ON, Canada; K Papp Clinical Research, Waterloo, ON, Canada
| | | | | | - Diamant Thaçi
- Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University College of Medicine, Taipei, Taiwan
| | - H Chih-Ho Hong
- Probity Medical Research, Waterloo, ON, Canada; Dr Chih-ho Hong Medical, Surrey, BC, Canada; Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Norito Katoh
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Amy S Paller
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | | | | | | | | | | | | | | | - Alan D Irvine
- Clinical Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland; Wellcome-HRB Clinical Research Facility, St James' Hospital, Dublin, Ireland.
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Kimball AB, Crowley JJ, Papp K, Calimlim B, Duan Y, Fleischer AB, Sobell J. Baseline patient-reported outcomes from UNITE: an observational, international, multicentre registry to evaluate hidradenitis suppurativa in clinical practice. J Eur Acad Dermatol Venereol 2020; 34:1302-1308. [PMID: 31800124 PMCID: PMC7317945 DOI: 10.1111/jdv.16132] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/12/2019] [Indexed: 12/14/2022]
Abstract
Background Hidradenitis suppurativa (HS) is a chronic, inflammatory, skin condition associated with many comorbidities and often has a substantial impact on patients’ lives. Objectives To evaluate symptom burden and health‐related quality of life (HRQoL) at baseline in patients with HS in an observational, real‐world, clinical setting using several tools including a validated HS‐specific instrument. Methods This study evaluated HRQoL data from the international UNITE HS disease registry. Administration of patient‐reported outcome (PRO) instruments and collection of data were executed per local regulations. All data were assessed using descriptive statistical methods. Results PRO data from 529 adults and 65 adolescents were evaluated. Most adults (64.5%) and adolescents (73.8%) were classified as Hurley Stage II with substantial disease burden at baseline. HS had a large effect (mean DLQI = 12.6) and moderate effect (mean CDLQI = 6.9) on the lives of adults and adolescents, respectively. Approximately 58% of adults and 41% of adolescents had anxiety scores beyond the normal range; 30% of adults and 16% of adolescents exhibited symptoms of depression. Based on HSSA and HSIA scores, approximately 30% of adults reported a substantial burden of multiple HS clinical symptoms and more than 45% reported a significant emotional impact of HS that adversely affected their intimate relationships. Only 60% of adults were employed and of those, 64% reported at least some degree of impairment while working because of HS. Conclusions Based on PROs collected from patients enrolled in the UNITE registry, a real‐world, clinical setting, HS has a significant negative impact on the everyday lives of patients affected by this disease.
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Affiliation(s)
- A B Kimball
- Harvard Medical School and Beth Israel Deaconess Hospital, Boston, MA, USA
| | - J J Crowley
- Bakersfield Dermatology, Bakersfield, CA, USA
| | - K Papp
- Clinical Research and Probity Medical Research, Waterloo, ON, Canada
| | | | - Y Duan
- AbbVie Inc, North Chicago, IL, USA
| | - A B Fleischer
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - J Sobell
- Department of Dermatology, Tufts University School of Medicine, Boston, MA, USA
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Elewski B, Baker C, Crowley J, Poulin Y, Okun M, Calimlim B, Geng Z, Reyes Servin O, Rich P. Adalimumab for nail psoriasis: efficacy and safety over 52 weeks from a phase-3, randomized, placebo-controlled trial. J Eur Acad Dermatol Venereol 2019; 33:2168-2178. [PMID: 31304993 PMCID: PMC6899987 DOI: 10.1111/jdv.15793] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/13/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Few clinical trials have evaluated long-term treatment of nail psoriasis with biologics. OBJECTIVE Safety and efficacy of adalimumab [ADA; Humira AbbVie Inc, North Chicago, IL, USA)] long-term treatment (52 weeks) was evaluated in a phase-3, randomized trial in patients with moderate-to-severe plaque psoriasis and concomitant moderate-to-severe fingernail psoriasis. Results from the first 26 weeks (Period A) have been reported. METHODS Patients receiving 40 mg ADA every other week or placebo in Period A, continued with or switched to 40 mg ADA every-other-week treatment in the subsequent 26-week open-label extension (OLE) period. Main efficacy evaluations were ≥75% improvement in total-fingernail modified Nail Psoriasis Severity Index (mNAPSI 75) and achievement of Physician's Global Assessment for Fingernail Psoriasis of clear or minimal disease (PGA-F 0/1) with a ≥2-grade improvement from baseline, across the trial for patients who continued ADA from Period A through the OLE (Continuous-ADA Population). Safety was evaluated during the OLE and for patients receiving ADA at any time during the study (All-ADA Population). RESULTS Of the 217 patients initially randomized in Period A, 188 (86.6%; 94 in each treatment group) entered the OLE after completion of or early escape from Period A. For the Continuous-ADA Population (N = 109), endpoint achievement rates improved from OLE entry (Week 26) to Week 52, including total-fingernail mNAPSI 75 (47.4-54.5%); PGA-F 0/1 (51.1-55.6%) and total-fingernail mNAPSI = 0 (6.6-17.9%). Serious adverse event and serious infection rates for the All-ADA Population (N = 203) were 6.9% and 3.4%, respectively. CONCLUSIONS In this population of psoriasis patients with concomitant, moderate-to-severe nail psoriasis, long-term efficacy and improvement in signs and symptoms of nail disease were demonstrated after every-other-week ADA treatment, including incremental improvements in rate of total clearance of nail disease. No new safety risks were identified for patients receiving at least one ADA dose across 52 weeks.
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Affiliation(s)
- B.E. Elewski
- School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - C.S. Baker
- Skin & Cancer Foundation Inc and Probity Medical ResearchCarltonVic.Australia
| | | | - Y. Poulin
- Centre de Recherche Dermatologique du Québec MétropolitainQuébec CityQCCanada
| | | | | | - Z. Geng
- AbbVie IncNorth ChicagoILUSA
| | | | - P.A. Rich
- Oregon Health and Science University HospitalPortlandORUSA
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Tzellos T, Yang H, Mu F, Calimlim B, Signorovitch J. 化脓性汗腺炎对工作损失、间接成本和收入的影响. Br J Dermatol 2019. [DOI: 10.1111/bjd.18069] [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: 11/27/2022]
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Tzellos T, Yang H, Mu F, Calimlim B, Signorovitch J. Impact of HS on work loss, indirect costs and income. Br J Dermatol 2019. [DOI: 10.1111/bjd.18053] [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: 11/27/2022]
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13
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Beck L, Hong C, Hu X, Chen S, Calimlim B, Teixeira H, Guttman-Yassky E. UPADACITINIB EFFECT ON PRURITUS IN MODERATE-TO-SEVERE ATOPIC DERMATITIS; FROM A PHASE 2B RANDOMIZED, PLACEBO-CONTROLLED TRIAL. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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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Walshaw PD, Gyulai L, Bauer M, Bauer MS, Calimlim B, Sugar CA, Whybrow PC. Adjunctive thyroid hormone treatment in rapid cycling bipolar disorder: A double-blind placebo-controlled trial of levothyroxine (L-T 4 ) and triiodothyronine (T 3 ). Bipolar Disord 2018; 20:594-603. [PMID: 29869405 PMCID: PMC6323302 DOI: 10.1111/bdi.12657] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES This report describes the first comparative double-blind, placebo-controlled trial of levothyroxine (L-T4 ) and triiodothyronine (T3 ) as adjunctive treatments in rapid cycling bipolar disorder. METHODS Thirty-two treatment-resistant, rapid cycling patients who had failed a trial of lithium were randomized into three treatment arms: L-T4 , T3 , or placebo. They were followed for ≥4 months with weekly clinical and endocrine assessments. RESULTS There were no statistically significant differences between the groups in age, gender, duration of illness, or thyroid status. Markov chain analyses were employed to assess treatment effects on cycling patterns among mood states (euthymia, depression, mania, and mixed). Within groups, post-treatment the L-T4 group spent significantly less time depressed or in a mixed state and greater time euthymic. The T3 and placebo groups did not differ significantly pre- and post-treatment in any mood state, although the pattern of effects was the same for the T3 group as for the L-T4 group. Between groups, the L-T4 group had a significantly greater increase in time euthymic and decrease in time in the mixed state than the placebo group. Other group differences were not significant, although they were in the expected direction. CONCLUSIONS The findings in this first double-blind study directly comparing the effects of L-T4 and T3 therapy against placebo provide evidence for the benefit of adjunctive L-T4 in alleviating resistant depression, reducing time in mixed states and increasing time euthymic. Adjunctive T3 did not show statistically significant evidence of benefit over placebo in reducing the time spent in disturbed mood states.
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Affiliation(s)
- Patricia D. Walshaw
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Laszlo Gyulai
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA and Corporate Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mark S. Bauer
- Department of Psychiatry, Harvard Medical School & the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Brian Calimlim
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA,Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Catherine A. Sugar
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA,Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Peter C. Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
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Tzellos T, Yang H, Mu F, Calimlim B, Signorovitch J. Impact of hidradenitis suppurativa on work loss, indirect costs and income. Br J Dermatol 2018; 181:147-154. [PMID: 30120887 PMCID: PMC7379487 DOI: 10.1111/bjd.17101] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [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] [Accepted: 08/13/2018] [Indexed: 12/02/2022]
Abstract
Background Hidradenitis suppurativa (HS), a chronic cutaneous disease, can negatively affect work life. Objectives This retrospective cohort study evaluates the indirect burden among employed patients with HS in the U.S.A. Methods Newly diagnosed and general patients with HS, who were employees (age 18–64 years) from a large claims database (Q1 1999 to Q1 2015), were matched 1 : 5 to controls. Income growth and risk of leaving the workforce were assessed among the newly diagnosed HS and control cohorts in the 5‐year study period. Income, work loss days and indirect costs (absenteeism and disability) were assessed among the general HS and control cohorts in the 1‐year study period. Results Newly diagnosed (n = 1003, mean age 39·5 years, 66·3% female) and general patients with HS (n = 1204, mean age 39·9 years, 69·1% female) were matched to 5015 and 6020 controls, respectively. Newly diagnosed patients with HS had significantly slower income growth ($324 per year) and higher risk of leaving the workforce (adjusted hazard ratio 1·65, 95% confidence interval 1·45–1·88) compared with controls (all P < 0·05). General patients with HS had more total days of work loss (18·4 vs. 7·7), higher annual total indirect costs ($2925 vs. $1483) and lower annual income ($54 925 vs. $62 357) than controls (all P < 0·001). Conclusions Patients with newly diagnosed HS and general patients with HS experienced a greater indirect burden than matched controls. What's already known about this topic? Hidradenitis suppurativa (HS), a chronic inflammatory disease, can negatively affect work life.
What does this study add? This retrospective claims analysis found that HS is associated with high indirect burden, in terms of slower income growth, higher risk of leaving the workforce and higher indirect costs. These results indicate that patients with HS have unmet disease management needs.
Linked Editorial: Zouboulis. Br J Dermatol 2019; 181:7–8. Plain language summary available online Respond to this article
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Affiliation(s)
- T Tzellos
- Department of Dermatology, Faculty of Health Sciences, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, Arctic University, Tromsø, Norway
| | - H Yang
- Analysis Group, Inc., 111 Huntington Ave, Floor 14, Boston, MA, 02199, U.S.A
| | - F Mu
- Analysis Group, Inc., 111 Huntington Ave, Floor 14, Boston, MA, 02199, U.S.A
| | - B Calimlim
- AbbVie, Inc., 1 N. Waukegan Road, North Chicago, IL, 60064, U.S.A
| | - J Signorovitch
- Analysis Group, Inc., 111 Huntington Ave, Floor 14, Boston, MA, 02199, U.S.A
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Eliasson L, de Freitas HM, Dearden L, Calimlim B, Lloyd AJ. Patients' Preferences for the Treatment of Metastatic Castrate-resistant Prostate Cancer: A Discrete Choice Experiment. Clin Ther 2017; 39:723-737. [PMID: 28366592 DOI: 10.1016/j.clinthera.2017.02.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 10/17/2016] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 01/28/2023]
Abstract
PURPOSE Patient treatment preferences are increasingly being used to inform health care decision making. This discrete choice experiment assessed how men perceive the risks and benefits of hypothetical treatment options for metastatic castrate-resistant prostate cancer (mCRPC). METHODS Treatment attributes for inclusion were identified through a review of the literature and product labels. Expert interviews confirmed clinical appropriateness and patient relevance of the attributes, which included effectiveness (delay in months before chemotherapy), steroid use, possible drug interactions (additional hospital visits for monitoring), fogginess (effects on cognition and memory), fatigue (extreme tiredness), food restrictions, and bone pain. Following a pilot, the final discrete choice experiment included 18 choice sets presenting treatments for mCRPC and was completed by men with mCRPC in France, Germany, and the United Kingdom. Data were analyzed using a conditional logit model, with odds ratios (ORs) used to indicate preference for attributes, and tradeoff measures (TOM) were estimated using the ratio of coefficients. FINDINGS Within each attribute category and with all other factors being equal, participants (N = 285) indicated a strong preference for treatments that fully control bone pain (OR = 12.069 [95% CI, 10.555-13.800]) and for treatments that delay chemotherapy (OR, 1.727 [95% CI, 1.548-1.927]). They also preferred treatments that were associated with the lowest risk of fogginess (OR, 2.115 [95% CI, 1.849-2.420]), a lower risk of fatigue (OR, 1.365 [95% CI 1.219-1.528]), and fewer additional hospital visits (OR, 1.245 [95% CI 1.111-1.397]) than the respective reference categories. Participants preferred to use steroids under advice from a physician (OR, 1.275 [95% CI 1.132-1.437]). Food restrictions related to taking medication were not a significant concern for participants. TOM results indicated that large tradeoffs in effectiveness, fogginess, and fatigue are required for patients to prefer a treatment with uncontrolled bone pain that is very difficult to live with. IMPLICATIONS Men with mCRPC consider a wide range of factors when making decisions regarding their treatment. They showed a strong preference for treatment associated with better control of bone pain. They also placed value on treatments that could delay the need for chemotherapy, and they preferred to avoid side effects such as cognition and memory loss, and extreme tiredness. TOMs highlighted the importance of symptom control, even compared with potential side effects. An understanding of the degree to which patients value the attributes associated with various treatment options will assist clinicians and health care professionals when making decisions regarding the management of men with mCRPC.
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Affiliation(s)
- Lina Eliasson
- Clinical Outcomes Assessment, ICON Clinical Research Plc, UK.
| | | | | | - Brian Calimlim
- Medical Affairs Statistical Analysis, ICON plc, San Francisco, California
| | - Andrew J Lloyd
- Clinical Outcomes Assessment, ICON Clinical Research Plc, UK
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Altshuler LL, Sugar CA, McElroy SL, Calimlim B, Gitlin M, Keck PE, Aquino-Elias A, Martens BE, Fischer EG, English TL, Roach J, Suppes T. Switch Rates During Acute Treatment for Bipolar II Depression With Lithium, Sertraline, or the Two Combined: A Randomized Double-Blind Comparison. Am J Psychiatry 2017; 174:266-276. [PMID: 28135846 DOI: 10.1176/appi.ajp.2016.15040558] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors compared medication-induced mood switch risk (primary outcome), as well as treatment response and side effects (secondary outcomes) with three acute-phase treatments for bipolar II depression. METHOD In a 16-week, double-blind, multisite comparison study, 142 participants with bipolar II depression were randomly assigned to receive lithium monotherapy (N=49), sertraline monotherapy (N=45), or combination treatment with lithium and sertraline (N=48). At each visit, mood was assessed using standardized rating scales. Rates of switch were compared, as were rates of treatment response and the presence and severity of treatment-emergent side effects. RESULTS Twenty participants (14%) experienced a switch during the study period (hypomania, N=17; severe hypomania, N=3). Switch rates did not differ among the three treatment groups, even after accounting for dropout. No patient had a manic switch or was hospitalized for a switch. Most switches occurred within the first 5 weeks of treatment. The treatment response rate for the overall sample was 62.7% (N=89), without significant differences between groups after accounting for dropout. The lithium/sertraline combination group had a significantly higher overall dropout rate than the monotherapy groups but did not have an accelerated time to response. CONCLUSIONS Lithium monotherapy, sertraline monotherapy, and lithium/sertraline combination therapy were associated with similar switch and treatment response rates in participants with bipolar II depression. The dropout rate was higher in the lithium/sertraline combination treatment group, without any treatment acceleration advantage.
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Affiliation(s)
- Lori L Altshuler
- From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles; the Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles; the Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles; the Department of Biostatistics, School of Public Health, University of California, Los Angeles; the Lindner Center of HOPE, Mason, Ohio; the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati; the Department of Psychiatry and Biobehavioral Sciences, Stanford University School of Medicine, Stanford, Calif.; the VA Palo Alto Health Care System, Palo Alto, Calif.; and the Department of Psychiatry, Olive View-UCLA Medical Center, Sylmar, Calif
| | - Catherine A Sugar
- From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles; the Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles; the Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles; the Department of Biostatistics, School of Public Health, University of California, Los Angeles; the Lindner Center of HOPE, Mason, Ohio; the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati; the Department of Psychiatry and Biobehavioral Sciences, Stanford University School of Medicine, Stanford, Calif.; the VA Palo Alto Health Care System, Palo Alto, Calif.; and the Department of Psychiatry, Olive View-UCLA Medical Center, Sylmar, Calif
| | - Susan L McElroy
- From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles; the Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles; the Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles; the Department of Biostatistics, School of Public Health, University of California, Los Angeles; the Lindner Center of HOPE, Mason, Ohio; the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati; the Department of Psychiatry and Biobehavioral Sciences, Stanford University School of Medicine, Stanford, Calif.; the VA Palo Alto Health Care System, Palo Alto, Calif.; and the Department of Psychiatry, Olive View-UCLA Medical Center, Sylmar, Calif
| | - Brian Calimlim
- From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles; the Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles; the Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles; the Department of Biostatistics, School of Public Health, University of California, Los Angeles; the Lindner Center of HOPE, Mason, Ohio; the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati; the Department of Psychiatry and Biobehavioral Sciences, Stanford University School of Medicine, Stanford, Calif.; the VA Palo Alto Health Care System, Palo Alto, Calif.; and the Department of Psychiatry, Olive View-UCLA Medical Center, Sylmar, Calif
| | - Michael Gitlin
- From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles; the Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles; the Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles; the Department of Biostatistics, School of Public Health, University of California, Los Angeles; the Lindner Center of HOPE, Mason, Ohio; the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati; the Department of Psychiatry and Biobehavioral Sciences, Stanford University School of Medicine, Stanford, Calif.; the VA Palo Alto Health Care System, Palo Alto, Calif.; and the Department of Psychiatry, Olive View-UCLA Medical Center, Sylmar, Calif
| | - Paul E Keck
- From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles; the Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles; the Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles; the Department of Biostatistics, School of Public Health, University of California, Los Angeles; the Lindner Center of HOPE, Mason, Ohio; the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati; the Department of Psychiatry and Biobehavioral Sciences, Stanford University School of Medicine, Stanford, Calif.; the VA Palo Alto Health Care System, Palo Alto, Calif.; and the Department of Psychiatry, Olive View-UCLA Medical Center, Sylmar, Calif
| | - Ana Aquino-Elias
- From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles; the Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles; the Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles; the Department of Biostatistics, School of Public Health, University of California, Los Angeles; the Lindner Center of HOPE, Mason, Ohio; the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati; the Department of Psychiatry and Biobehavioral Sciences, Stanford University School of Medicine, Stanford, Calif.; the VA Palo Alto Health Care System, Palo Alto, Calif.; and the Department of Psychiatry, Olive View-UCLA Medical Center, Sylmar, Calif
| | - Brian E Martens
- From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles; the Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles; the Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles; the Department of Biostatistics, School of Public Health, University of California, Los Angeles; the Lindner Center of HOPE, Mason, Ohio; the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati; the Department of Psychiatry and Biobehavioral Sciences, Stanford University School of Medicine, Stanford, Calif.; the VA Palo Alto Health Care System, Palo Alto, Calif.; and the Department of Psychiatry, Olive View-UCLA Medical Center, Sylmar, Calif
| | - E Grace Fischer
- From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles; the Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles; the Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles; the Department of Biostatistics, School of Public Health, University of California, Los Angeles; the Lindner Center of HOPE, Mason, Ohio; the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati; the Department of Psychiatry and Biobehavioral Sciences, Stanford University School of Medicine, Stanford, Calif.; the VA Palo Alto Health Care System, Palo Alto, Calif.; and the Department of Psychiatry, Olive View-UCLA Medical Center, Sylmar, Calif
| | - Teri L English
- From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles; the Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles; the Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles; the Department of Biostatistics, School of Public Health, University of California, Los Angeles; the Lindner Center of HOPE, Mason, Ohio; the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati; the Department of Psychiatry and Biobehavioral Sciences, Stanford University School of Medicine, Stanford, Calif.; the VA Palo Alto Health Care System, Palo Alto, Calif.; and the Department of Psychiatry, Olive View-UCLA Medical Center, Sylmar, Calif
| | - Janine Roach
- From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles; the Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles; the Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles; the Department of Biostatistics, School of Public Health, University of California, Los Angeles; the Lindner Center of HOPE, Mason, Ohio; the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati; the Department of Psychiatry and Biobehavioral Sciences, Stanford University School of Medicine, Stanford, Calif.; the VA Palo Alto Health Care System, Palo Alto, Calif.; and the Department of Psychiatry, Olive View-UCLA Medical Center, Sylmar, Calif
| | - Trisha Suppes
- From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles; the Jane and Terry Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles; the Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles; the Department of Biostatistics, School of Public Health, University of California, Los Angeles; the Lindner Center of HOPE, Mason, Ohio; the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati; the Department of Psychiatry and Biobehavioral Sciences, Stanford University School of Medicine, Stanford, Calif.; the VA Palo Alto Health Care System, Palo Alto, Calif.; and the Department of Psychiatry, Olive View-UCLA Medical Center, Sylmar, Calif
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Wang A, Richhariya A, Gandra SR, Calimlim B, Kim L, Quek RGW, Nordyke RJ, Toth PP. Systematic Review of Low-Density Lipoprotein Cholesterol Apheresis for the Treatment of Familial Hypercholesterolemia. J Am Heart Assoc 2016; 5:JAHA.116.003294. [PMID: 27385428 PMCID: PMC5015370 DOI: 10.1161/jaha.116.003294] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [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: 01/04/2023]
Abstract
BACKGROUND Apheresis is an important treatment for reducing low-density lipoprotein cholesterol (LDL-C) in patients with familial hypercholesterolemia (FH). We systematically reviewed the current literature surrounding LDL-C apheresis for FH. METHODS AND RESULTS Electronic databases were searched for publications of LDL-C apheresis in patients with FH. Inclusion criteria include articles in English published in 2000-2013 that provide descriptions of practice patterns, efficacy/effectiveness, and costs related to LDL-C apheresis in patients with FH. Data were stratified by country and FH genotype where possible. Thirty-eight studies met the inclusion criteria: 8 open-label clinical trials, 11 observational studies, 17 reviews/guidelines, and 2 health technology assessments. The prevalence of FH was not well characterized by country, and underdiagnosis was a barrier to FH treatment. Treatment guidelines varied by country, with some guidelines recommending LDL-C apheresis as first-line treatment in patients with homozygous FH and after drug therapy failure in patients with heterozygous FH. Additionally, guidelines typically recommended weekly or biweekly LDL-C apheresis treatments conducted at apheresis centers that may last 2 to >3 hours per session. Studies reported a range for mean LDL-C reduction after apheresis: 57-75% for patients with homozygous FH and 58-63% for patients with heterozygous FH. Calculated annual costs (in US$2015) may reach US$66 374 to US$228 956 per patient for weekly treatment. CONCLUSIONS LDL-C apheresis treatment may be necessary for patients with FH when drug therapy is inadequate in reducing LDL-C to target levels. While apheresis reduces LDL-C, high per-session costs and the frequency of guideline-recommended treatment result in substantial annual costs, which are barriers to the optimal treatment of FH.
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Affiliation(s)
| | | | | | | | | | | | | | - Peter P Toth
- University of Illinois College of Medicine, Peoria, IL Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
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Wang A, Richhariya A, Gandra SR, Calimlim B, Kim L, Nordyke R. An Assessment Of The Current Literature On Apheresis Use In The Treatment Of Familial Hypercholesterolemia. Value Health 2014; 17:A474. [PMID: 27201366 DOI: 10.1016/j.jval.2014.08.1353] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- A Wang
- ICON, El Segundo, CA, USA
| | | | | | | | - L Kim
- ICON, El Segundo, CA, USA
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Massey P, Prelip M, Calimlim B, Afifi A, Quiter E, Nessim S, Wongvipat-Kalev N, Glik D. Findings toward a multidimensional measure of adolescent health literacy. Am J Health Behav 2013; 37:342-50. [PMID: 23985181 DOI: 10.5993/ajhb.37.3.7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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: 11/12/2022]
Abstract
OBJECTIVE To explore a multidimensional measure of health literacy that incorporates skills necessary to manage one's health environment. METHODS We designed a questionnaire to assess variation in an expanded understanding of health literacy among publicly insured adolescents in California (N = 1208) regarding their health care experiences and insurance. RESULTS Factor loading and item clustering patterns reflected in the exploratory principal components factor analysis suggest that the data are parsimoniously described by 6 domains. CONCLUSION This multidimensional measure becomes relevant in an era of health care reform in which many will for the first time have health insurance requiring them to navigate a system that uses a managed care model.
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Affiliation(s)
- Philip Massey
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
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Pouliot F, Pantuck A, Imbeault A, Shuch B, Calimlim B, Audet JF, Finley DS, Dujardin T. Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time. Can Urol Assoc J 2013. [DOI: 10.5489/cuaj.588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Partial nephrectomy (PN) is now the gold standardfor the surgical treatment of small renal masses. We evaluated theeffect of WIT and other factors on RDF assessed by preoperativeand postoperative renal scintigraphy.Methods: Between 2003 and 2008, 182 consecutive laparoscopicPN (LPN) were performed in an academic centre. Among those,56 had mercaptoacetyl triglycine (MAG3) lasix renal scintigraphypreoperatively and postoperatively.Results: Medians for age, preoperative estimated glomerular filtrationrate and computed tomography scan tumour size were 62years, 82 mL/min/1.73m2 and 26 mm, respectively. Median WITand preoperative RDF were 30 minutes and 50%, respectively.Median loss of RDF after surgery was 14%. Linear regression curvesshowed that loss in RDF rate was 0.2% per minute when WIT was<30 minutes and 0.7% per minute when WIT was ≥30 minutes.In multivariate analysis, length of WIT and endophytic tumourlocation were associated with a statistically significant loss of RDF(p < 0.05), but only in the group who experienced >30 minutesof WIT.Interpretation: Our results suggest that the factors associated withloss of RDF are not the same before and after 30 minutes of WITand that the rate of loss in RDF increases after 30 minutes. Since,the effect of WIT is small up to 30 minutes, we believe that surgeryshould focus on limiting the resection of normal parenchymaand to ensure negative margins and hemostasis, rather than onpremature unclamping.
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Pouliot F, Pantuck A, Imbeault A, Shuch B, Calimlim B, Audet JF, Finley DS, Dujardin T. Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time. Can Urol Assoc J 2011; 5:89-95. [PMID: 21470531 DOI: 10.5489/cuaj.10044] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Partial nephrectomy (PN) is now the gold standard for the surgical treatment of small renal masses. We evaluated the effect of WIT and other factors on RDF assessed by preoperative and postoperative renal scintigraphy. METHODS Between 2003 and 2008, 182 consecutive laparoscopic PN (LPN) were performed in an academic centre. Among those, 56 had mercaptoacetyl triglycine (MAG3) lasix renal scintigraphy preoperatively and postoperatively. RESULTS Medians for age, preoperative estimated glomerular filtration rate and computed tomography scan tumour size were 62 years, 82 mL/min/1.73m(2) and 26 mm, respectively. Median WIT and preoperative RDF were 30 minutes and 50%, respectively. Median loss of RDF after surgery was 14%. Linear regression curves showed that loss in RDF rate was 0.2% per minute when WIT was <30 minutes and 0.7% per minute when WIT was ≥30 minutes. In multivariate analysis, length of WIT and endophytic tumour location were associated with a statistically significant loss of RDF (p < 0.05), but only in the group who experienced >30 minutes of WIT. INTERPRETATION Our results suggest that the factors associated with loss of RDF are not the same before and after 30 minutes of WIT and that the rate of loss in RDF increases after 30 minutes. Since, the effect of WIT is small up to 30 minutes, we believe that surgery should focus on limiting the resection of normal parenchyma and to ensure negative margins and hemostasis, rather than on premature unclamping.
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Affiliation(s)
- Frédéric Pouliot
- Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC; Institute of Urologic Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA Dr. Pouliot was supported in part by a scholarship from Les Bourses McLaughlin du Doyen, a scholarship from the Association des Urologues du Québec and a scholarship from the CMDP (Committee of physicians, dentists and pharmacists) of the Laval University Hospital Centre
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Pouliot F, Anterasian C, Li Z, Shuch B, Calimlim B, Pantuck A, Belldegrun A. 1792 VALIDATION OF CA-IX POLYMORPHISM RS12553173 AS AN INDEPENDENT PROGNOSTIC FACTOR OF OVERALL SURVIVAL IN METASTATIC CLEAR CELL RENAL CELL CARCINOMA. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1716] [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: 11/16/2022]
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Dean BB, Aguilar D, Johnson LF, Fass R, Orr WC, McGuigan JE, Calimlim B, Yan N, Morgenstern D, Dubois RW. The relationship between the prevalence of nighttime gastroesophageal reflux disease and disease severity. Dig Dis Sci 2010; 55:952-9. [PMID: 19693672 DOI: 10.1007/s10620-009-0885-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [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] [Received: 02/10/2009] [Accepted: 06/19/2009] [Indexed: 12/09/2022]
Abstract
BACKGROUND Nighttime gastrointestinal reflux disease (GERD) prevalence and severity estimates vary substantially across studies. METHODS We assessed nighttime GERD (NTG) prevalence and symptom frequency and severity through a web survey of US adults, using the GERD Symptom and Medication Questionnaire (GERD-SMQ), a validated symptom questionnaire. NTG was based on episodes of nighttime heartburn per week and time of occurrence. Symptom severity and impact were assessed and compared for GERD cases with and without NTG. RESULTS GERD prevalence among respondents (n = 2,603) was 27%. Forty-five percent of symptomatic GERD respondents had NTG. Among respondents with both daytime and nighttime symptoms, 51% reported that nighttime symptoms were more bothersome. NTG respondents reported greater disease severity compared with those without (P < 0.0001). CONCLUSIONS NTG symptoms are very common among those identified with GERD. People with nighttime symptoms have greater disease severity than those with exclusively or primarily daytime symptoms.
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Affiliation(s)
- Bonnie B Dean
- Cerner LifeSciences, 9100 Wilshire Blvd., Suite 655 East Tower, Beverly Hills, CA, 90212, USA.
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Pouliot F, Pantuck AJ, Calimlim B, Dujardin T. Identification of factors predicting loss of renal differential function on the operated kidney after laparoscopic partial nephrectomy. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e16015] [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: 11/20/2022] Open
Abstract
e16015 Background: Partial nephrectomy (PN) is now the gold standard for small renal mass of less than 4 cm since it prevents renal insufficiency that may occur with radical nephrectomy. The impact of warm ischemis time (WIT) on the operated kidney's renal differential function (RDF) have been poorly studied in the litterature, especially when WIT is less than 30 minutes. We evaluated the effect of WIT and other perioperative factors on RDF function assessed by pre- and post-operative renal scintigraphy. Methods: Between 2003 and 2008, 182 laparoscopic PN were performed by a single surgeon on patients with two kidneys. Among those, 56 had a MAG3-lasix renal scintigraphy pre- and post-operatively between 7 and 14 days. Data were collected prospectively. Loss in RDF is calculated as follow: Loss in RDF=(RDF preoperatively-RDF postoperatively/RDF preoperatively) × 100. Results: Medians for age, pre- op creatinine, pre-op GFR (Cockroft formula) and tumor CT-size were 61 years, 83 μM, 83,2 ml/min and 26 mm, respectively. Median WIT and pre-operative RDF were 30 minutes and 50%. Median loss of RDF after surgery was 24%. In multivariate analysis, low pre-operative RDF, WIT and intrarenal location of the tumor were associated with a statistically significant loss of RDF (p<0.05). Age, pre-op GFR, tumor CT-size, diabetes and HTN did not predict loss in RDF. Fitting the relative RDF loss versus WIT to a polynomial curve suggests that the rate of loss in RDF increase with WIT. The point of inflection of the polynomial curve (reflecting the maximal change in rates of loss in RDF) was estimated to be at 32 minutes. Linear regression curves show that loss in RDF rate is 0.8% per minute when WIT is less than 32 minutes and 1.3 % per minute when WIT is more or equal to 32 minutes. Conclusions: We show that a WIT of less than 32 minutes optimizes the chances of preserving RDF of the operated kidney and that the rate of loss in RDF is higher above 32 minutes. Finally, higher loss in RDF must be expected if the patient has a low pre-operative RDF and intrarenal location of the tumor. No significant financial relationships to disclose.
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Affiliation(s)
- F. Pouliot
- Laval University, Québec, QC, Canada; University of California, Los Angeles, Los Angeles, CA
| | - A. J. Pantuck
- Laval University, Québec, QC, Canada; University of California, Los Angeles, Los Angeles, CA
| | - B. Calimlim
- Laval University, Québec, QC, Canada; University of California, Los Angeles, Los Angeles, CA
| | - T. Dujardin
- Laval University, Québec, QC, Canada; University of California, Los Angeles, Los Angeles, CA
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Tinkelman D, Khandker R, Calimlim B, Dean B, Yan S, Ciuryla V, McDermott L. ABSENTEEISM FROM SCHOOL OR WORK AMONG UNCONTROLLED ASTHMA PATIENTS. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.484a] [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: 11/01/2022] Open
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Tinkelman D, Yan S, Calimlim B, Dean B, Khandker R, Ciuryla V, McDermott L. HEALTH-RELATED QUALITY OF LIFE AMONG UNCONTROLLED ASTHMA PATIENTS. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.450a] [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: 11/01/2022] Open
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