1
|
Somersan-Karakaya S, Mylonakis E, Mou J, Oviedo-Orta E, O’Brien MP, Mas Casullo V, Mahmood A, Hooper AT, Hussein M, Ali S, Marty FM, Forleo-Neto E, Bhore R, Hamilton JD, Herman GA, Hirshberg B, Weinreich DM. Effectiveness of Casirivimab and Imdevimab Antibody Combination in Immunocompromised Hospitalized Patients With Coronavirus Disease 2019: A Post Hoc Analysis in a Phase 1/2/3 Double-Blind Trial. Open Forum Infect Dis 2023; 10:ofad211. [PMID: 37229174 PMCID: PMC10205469 DOI: 10.1093/ofid/ofad211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/14/2023] [Indexed: 05/27/2023] Open
Abstract
Background Individuals who are immunocompromised (IC) are at high risk for severe coronavirus disease 2019 (COVID-19). Methods Post hoc analyses of a double-blind trial conducted prior to Omicron (June 2020-April 2021), in hospitalized patients with COVID-19 assessed viral load, clinical outcomes, and safety of casirivimab plus imdevimab (CAS + IMD) versus placebo in IC versus overall study patients. Results Ninety-nine of 1940 (5.1%) patients were IC. IC versus overall patients were more frequently seronegative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies (68.7% vs 41.2%) and had higher median baseline viral loads (7.21 vs 6.32 log10 copies/mL). On placebo, IC versus overall patients had slower viral load declines. CAS + IMD reduced viral load in IC and overall patients; least-squares mean difference versus placebo in time-weighted average change from baseline viral load at day 7 was -0.69 (95% confidence interval [CI], -1.25 to -.14) log10 copies/mL for IC patients and -0.31 (95% CI, -.42 to -.20) log10 copies/mL for overall patients. For IC patients, the cumulative incidence of death or mechanical ventilation at day 29 was lower with CAS + IMD (11.0%) versus placebo (17.2%), consistent with overall patients (15.7% CAS + IMD vs 18.3% placebo). IC and overall patients receiving CAS + IMD exhibited similar rates of treatment-emergent adverse events (30.4% and 26.6%, respectively), grade ≥2 hypersensitivity or infusion-related reactions (1.4% and 2.5%), and deaths (8.7% and 12.2%). Conclusions IC patients were more likely to exhibit high viral loads and be seronegative at baseline. For susceptible SARS-CoV-2 variants, CAS + IMD reduced viral load and resulted in fewer death or mechanical ventilation events in IC and overall study patients. There were no new safety findings among IC patients. Clinical Trials Registration. NCT04426695.
Collapse
Affiliation(s)
- Selin Somersan-Karakaya
- Correspondence: Selin Somersan-Karakaya, MD, Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Road, Tarrytown, NY 10591-6707 (); Meagan P. O’Brien, MD, Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Road, Tarrytown, NY 10591-6707 ()
| | | | - Jenni Mou
- Global Development, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | - Meagan P O’Brien
- Correspondence: Selin Somersan-Karakaya, MD, Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Road, Tarrytown, NY 10591-6707 (); Meagan P. O’Brien, MD, Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Road, Tarrytown, NY 10591-6707 ()
| | | | - Adnan Mahmood
- Global Development, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Andrea T Hooper
- Global Development, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Mohamed Hussein
- Medical Affairs, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Shazia Ali
- Global Development, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | - Eduardo Forleo-Neto
- Global Development, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Rafia Bhore
- Global Development, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Jennifer D Hamilton
- Global Development, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Gary A Herman
- Global Development, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Boaz Hirshberg
- Global Development, Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | |
Collapse
|
2
|
Gatesy SW, Bertucci H, Vessely M, Vessely M, Valdes A, Alisoltanidehkordi A, Ozer EA, Marty FM, Mekalanos J, Hauser AR, Bachta KER. 147. Identification of Novel Colistin Resistance Genes in an Extremely Colistin Resistant Pseudomonas aeruginosa Clinical Isolate. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.225] [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: 12/23/2022] Open
Abstract
Abstract
Background
Pseudomonas aeruginosa (PA) readily acquires genomic mutations and exogenous genetic elements that confer antimicrobial resistance (AMR). With the rise in AMR, there are limited antibiotics available to treat multidrug-resistant (MDR) PA. As such, clinicians have returned to previously used antibiotics. Colistin, sidelined for neurotoxicity and nephrotoxicity, has returned to clinical practice as a viable but suboptimal option for MDR-PA treatment. The most common mechanism of resistance to colistin involves modifications of the lipid A moiety within the bacterial lipopolysaccharide (LPS). Following the identification of a MDR PA isolate, BWH047, we experimentally determined its colistin MIC to be > 1,280 µg/mL and used genomic approaches to identify novel genetic mechanisms of extreme colistin resistance.
Methods
We created a random, saturated transposon (Tn) insertion library in PA BWH047 using the Himar1 mariner system. After exposure of the library to 640 µg/mL colistin for 10 hours, genomic DNA was harvested, and the Tn insertion sites were sequenced. Insertion sequencing (INSeq) analysis was performed. We identified 27 genes conditionally important for BWH047 growth in the presence of colistin. We selected five initial targets arnC, dedA, wapH, speE2, and bchE and tested their impact on colistin resistance using standard microbroth dilution methods.
Results
Of our deletion mutants, three showed loss of resistance to colistin. ArnC was chosen as a positive control as its role in colistin resistance in PA is well described. Colistin MICs of BWH047 ΔarnC, ΔdedA, ΔwapH, ΔspeE2, and ΔbchE were determined to be 0.5, 0.5, 1, > 1,280 and > 1280 μg/mL, respectively.
Conclusion
Here, we used INSeq to identify novel genes involved in extreme colistin resistance. Thus far, we have identified two new candidate genes dedA and wapH, critical for colistin resistance in PA BWH047. Neither gene has been associated with colistin resistance in PA; However, dedA orthologs in Burkholderia thailandenesis and Klebsiella pneumoniae have been shown to be important for colistin resistance. The gene wapH is part of the LPS core oligosaccharide biosynthetic pathway and its discovery hints that additional alterations in the bacterial outer membrane may impact colistin resistance.
Disclosures
All Authors: No reported disclosures.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Egon A Ozer
- Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | | | | | | | | |
Collapse
|
3
|
Gonzalez-Bocco IH, Cheng M, Aleissa MM, Arbona EI, Chen K, Zhou E, Beluch K, Cho A, Burchett S, Hammond SP, Issa NC, Sherman AC, Marty FM. 733. Letermovir treatment for refractory or resistant cytomegalovirus infection or disease with concurrent organ dysfunction: an interim analysis of a Phase 2 open label study. Open Forum Infect Dis 2022. [PMCID: PMC9752064 DOI: 10.1093/ofid/ofac492.024] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Cytomegalovirus (CMV) disease is associated with increased morbidity and mortality following solid organ and hematopoietic cell transplantation. Currently, standard of care CMV treatments often have significant myelosuppressive or renal toxicities. Given letermovir’s favorable safety profile when used prophylactically, it may be a safe and efficacious alternative agent for CMV treatment. Methods A proof-of-concept, open-label trial was conducted in patients who lacked effective therapeutic options or presented with baseline organ dysfunction. Participants were eligible for enrollment if they were ≥12 years old and had documented CMV infection refractory to treatment defined as failure to achieve >1 log reduction in CMV viral load (VL) (when VL > 500 IU/mL) or lack of clinical improvement for CMV end-organ disease after ≥14 days of standard CMV treatment. Alternatively, patients with severe myelosuppression and renal dysfunction at baseline or genotypic antiviral resistance were also eligible. Participants were excluded if their current CMV infection developed while receiving letermovir for CMV prophylaxis. Letermovir was administered daily (480 mg PO/IV) for up to 12 weeks, with optional additional 12 weeks of treatment for secondary prophylaxis if clinically indicated. Results Ten patients met eligibility criteria and were enrolled. Reasons for enrollment included ganciclovir resistance (1/10), refractory CMV infection (6/10), renal dysfunction (7/10), and myelosuppression (7/10). The median baseline CMV VL was 1272 IU/ml [interquartile range (IQR); 925, 2546]. Six patients completed the study, three died due to complications of primary disease, and one discontinued due to diarrhea. Five patients (50%) had documented CMV viremia clearance, with a median time to first unquantifiable/undetectable CMV VL of 13 days [IQR; 9,18] and a median treatment duration of 53 days [IQR; 15,84]. Infections and GI disorders were the most common adverse events (AE), none considered related to study drug. No unexpected AE were observed during letermovir treatment. Conclusion Letermovir may be a safe and tolerable alternative for patients with treatment refractory CMV infection or for patients with severe baseline myelosuppression and renal dysfunction. Disclosures Matthew Cheng, MD, AstraZeneca: Honoraria|Cidara Therapeutics: Grant/Research Support|Scynexis Inc.: Grant/Research Support Sandra Burchett, MD, MSc, merck: Grant/Research Support Sarah P. Hammond, MD, F2G: Advisor/Consultant|F2G: Grant/Research Support|GSK: Grant/Research Support|Merck: Grant/Research Support|pfizer: Advisor/Consultant|Scynexis: Grant/Research Support Nicolas C. Issa, MD, AiCuris: Grant/Research Support|Merck: Grant/Research Support Francisco M. Marty, MD, SM, AlloVir: Advisor/Consultant|Amplyx: Advisor/Consultant|Amplyx: Grant/Research Support|Ansun: Grant/Research Support|Avir: Advisor/Consultant|Chimerix: Grant/Research Support|Cidara: Grant/Research Support|F2G: Advisor/Consultant|F2G: Grant/Research Support|Gilead: Grant/Research Support|Janssen: Advisor/Consultant|Kyorin: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Regeneron: Advisor/Consultant|Regeneron: Grant/Research Support|ReViral: Advisor/Consultant|Scynexis: Grant/Research Support|Symbio: Advisor/Consultant|Takeda: Grant/Research Support|United Medical: Advisor/Consultant|WHISCO: Grant/Research Support.
Collapse
Affiliation(s)
| | - Matthew Cheng
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Kaiwen Chen
- Robert Wood Johnson Medical School, Piscataway, New Jersey
| | | | | | - Alyssa Cho
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Sandra Burchett
- Boston Childrens Hospital/Harvard Medical School, Boston, Massachusetts
| | | | | | | | | |
Collapse
|
4
|
Aleissa MM, Gonzalez-Bocco IH, Zekery-Saad S, Kubiak DW, Zhang EM, Signorelli J, Hammond SP, Mohareb AM, Luskin MR, Manne-Goehler J, Marty FM. The relationship between antibiotic agent and mortality in patients with febrile neutropenia due to Staphylococcal bloodstream infection: a multicenter cohort study. Open Forum Infect Dis 2022; 9:ofac306. [PMID: 35949404 PMCID: PMC9356691 DOI: 10.1093/ofid/ofac306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Methicillin-susceptible Staphylococcus aureus (MSSA) is a common cause of bloodstream infection (BSI) in patients with febrile neutropenia, but treatment practices vary, and guidelines are not clear on the optimal regimen. Methods We conducted a multicenter retrospective cohort study of MSSA BSI in febrile neutropenia. We divided patients into 3 treatment groups: (1) broad-spectrum beta-lactams (ie, piperacillin-tazobactam, cefepime, meropenem); (2) narrow-spectrum beta-lactams (ie, cefazolin, oxacillin, nafcillin); and (3) combination beta-lactams (ie, both narrow- and broad-spectrum). We used multivariable logistic regression to compare 60-day mortality and bacteremia recurrence while adjusting for potential confounders. Results We identified 889 patients with MSSA BSI, 128 of whom had neutropenia at the time of the index culture: median age 56 (interquartile range, 43–65) years and 76 (59%) male. Of those, 56 (44%) received broad-spectrum beta-lactams, 30 (23%) received narrow-spectrum beta-lactams, and 42 (33%) received combination therapy. After adjusting for covariates, including disease severity, combination therapy was associated with a significantly higher odds for 60-day all-cause mortality compared with broad spectrum beta-lactams (adjusted odds ratio [aOR], 3.39; 95% confidence interval [CI], 1.29–8.89; P = .013) and compared with narrow spectrum beta-lactams, although the latter was not statistically significant (aOR, 3.30; 95% CI, .80–13.61; P = .071). Conclusions Use of combination beta-lactam therapy in patients with MSSA BSI and febrile neutropenia is associated with a higher mortality compared with treatment with broad-spectrum beta-lactam after adjusting for potential confounders. Patients in this study who transitioned to narrow-spectrum beta-lactam antibiotics did not have worse clinical outcomes compared with those who continued broad-spectrum beta-lactam therapy.
Collapse
Affiliation(s)
- Muneerah M Aleissa
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
- Harvard T.H. Chan School of Public Health , Boston, MA , USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School , Boston, MA , USA
| | - Isabel H Gonzalez-Bocco
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School , Boston, MA , USA
| | - Sara Zekery-Saad
- Department of Pharmacy, Brigham and Women's Hospital , Boston, MA , USA
| | - David W Kubiak
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
- Department of Pharmacy, Brigham and Women's Hospital , Boston, MA , USA
| | - Eric M Zhang
- Department of Pharmacy, Brigham and Women's Hospital , Boston, MA , USA
| | - Jessie Signorelli
- Department of Pharmacy, Massachusetts General Hospital , Boston, MA , USA
| | - Sarah P Hammond
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School , Boston, MA , USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Harvard Medical School , Boston, MA , USA
| | - Amir M Mohareb
- Department of Pharmacy, Massachusetts General Hospital , Boston, MA , USA
| | - Marlise R Luskin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School , Boston, MA , USA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Harvard Medical School , Boston, MA , USA
| | - Francisco M Marty
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School , Boston, MA , USA
| |
Collapse
|
5
|
Ison MG, Marty FM, Chao N, Moon SH, Zhang Z, Chandak A. Economic and clinical burden associated with respiratory viral infections after allogeneic hematopoietic cell transplant in the United States. Transpl Infect Dis 2022; 24:e13866. [PMID: 35598293 PMCID: PMC9542538 DOI: 10.1111/tid.13866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
Abstract
Background Methods Results Conclusion
Collapse
Affiliation(s)
- Michael G. Ison
- Northwestern University Feinberg School of Medicine Chicago IL
| | | | | | | | | | | |
Collapse
|
6
|
Hammond SP, Ho VT, Marty FM. Hepatitis B virus vaccination after allogeneic hematopoietic cell transplantation prevents post-transplant HBV reactivation. Transplant Cell Ther 2022; 28:402.e1-402.e5. [PMID: 35413458 DOI: 10.1016/j.jtct.2022.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/04/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hepatitis B virus (HBV) reactivation in allogeneic hematopoietic-cell transplant (HCT) recipients with evidence of pre-transplantation resolved HBV infection is an important cause of morbidity, usually occurring a year or later after HCT. OBJECTIVES We retrospectively studied a cohort of allogeneic HCT recipients with resolved HBV infection, some of whom were vaccinated for HBV following transplantation, to understand if post-HCT HBV vaccination influenced the risk of HBV reactivation. STUDY DESIGN The study included all patients with resolved HBV who underwent allogeneic HCT at our institution between 1/1/2000 and 12/31/2015, where HBV vaccination starting at 1 year after HCT became standard in 2012 and antiviral prophylaxis is not utilized. Resolved HBV infection was defined as positive HBV-core IgG (HBcAb), negative HBV-surface antigen (HBsAg) and undetectable HBV DNA before HCT. HBV reactivation was defined as development of detectable HBsAg and HBV DNA after HCT. Follow up for outcomes concluded 1/1/2018. RESULTS Among 136 patients with resolved HBV before HCT, 19 developed reactivation during follow up (cumulative incidence 14%). Median time to HBV reactivation was 21 months (range, 2-47 months). The cumulative probability of HBV reactivation among HCT recipients who survived for a year or more after transplant without early HBV reactivation and were HBV-vaccinated versus those who were unvaccinated was 2.9% vs. 10.0 % at two years and 6.6% vs. 26.5% at 4 years post-HCT (P = 0.03, Gray's test). In a time-dependent Cox model, the adjusted hazard ratio (aHR) of HBV reactivation in patients with pre-transplant HBsAb levels greater than 10 IU/L was 0.34 (95% confidence interval [CI], 0.13-0.90). The aHR of HBV reactivation in patients who were vaccinated with 2 or more doses of recombinant HBV vaccine after HCT was 0.18 (95% CI, 0.04-0.80) compared to those who received 1 or no post-HCT vaccine doses. CONCLUSIONS HBV reactivation is a late complication of allogeneic HCT in at-risk recipients, particularly in those with low pre-HCT HBsAb. HBV vaccination starting 1 year after HCT may be protective.
Collapse
Affiliation(s)
- Sarah P Hammond
- Division of Infectious Diseases, Boston, MA 02115; Dana-Farber Cancer Institute, Boston, MA 02115; Harvard Medical School, Boston, MA 02115; Divisions of Infectious Diseases and Hematology/Oncology, Massachusetts General Hospital, Boston, MA 02114.
| | - Vincent T Ho
- Division of Medical Oncology, Boston, MA 02115; Dana-Farber Cancer Institute, Boston, MA 02115; Harvard Medical School, Boston, MA 02115
| | - Francisco M Marty
- Division of Infectious Diseases, Boston, MA 02115; Dana-Farber Cancer Institute, Boston, MA 02115; Harvard Medical School, Boston, MA 02115
| |
Collapse
|
7
|
Al Dhaheri F, Lee RA, Sharma TS, Nakamura MM, Marty FM. Epidemiology and outcomes of invasive aspergillosis among pediatric immunocompromised patients: a 12-year single-center experience. Med Mycol 2022; 60:6524907. [PMID: 35138378 DOI: 10.1093/mmy/myac014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/11/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Invasive aspergillosis (IA) remains a common cause of mortality in pediatric immunocompromised populations. Much of our knowledge of IA stems from adult literature. We conducted a retrospective evaluation of cases of proven or probable IA, defined according to the 2019 EORTC/MSG criteria, in patients with underlying immunocompromising conditions at Boston Children's Hospital from January 1, 2007 to January 1, 2019. We estimated survival curves over 12 weeks using the Kaplan-Meier method for all-cause mortality, and we used univariate Cox proportional hazards modeling to evaluate for mortality risk factors. We identified 59 cases, 29% with proven and 71% with probable IA. Pulmonary IA was the most common presentation (78%). The median age at diagnosis was 11 years (range, 0.5-28). Hematopoietic cell transplantation (HCT) was the most frequent predisposing underlying condition (41%). Among affected patients, 44.8% were neutropenic and 59.3% were lymphopenic at diagnosis. The 12-week all-cause mortality rate was 25.4%; HCT recipients comprised the majority of deaths (9/15) with a hazard ratio of 2.47 [95% CI, 0.87-6.95]. No patients with congenital immunodeficiencies (n = 8) died within 12 weeks of IA diagnosis. Other risk factors that were significantly associated with mortality included mechanical ventilation at diagnosis, intensive care unit stay, and lymphopenia; treatment with an Aspergillus-active azole was associated with decreased mortality. In conclusion, our study found that in pediatric immunocompromised hosts, IA is associated with a high 12-week all-cause mortality rate, with a particular impact on the HCT population.
Collapse
Affiliation(s)
- Fatima Al Dhaheri
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Rose A Lee
- Division of Infectious Disease, Department of Pediatrics, Boston Children's Hospital, Boston, United States.,Harvard Medical School, Boston, United States
| | - Tanvi S Sharma
- Division of Infectious Disease, Department of Pediatrics, Boston Children's Hospital, Boston, United States.,Harvard Medical School, Boston, United States
| | - Mari M Nakamura
- Division of Infectious Disease, Department of Pediatrics, Boston Children's Hospital, Boston, United States.,Harvard Medical School, Boston, United States.,Antimicrobial Stewardship Program, Boston Children's Hospital, Boston, United States
| | - Francisco M Marty
- Harvard Medical School, Boston, United States.,Division of Infectious Diseases, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, United States
| |
Collapse
|
8
|
Gottlieb RL, Vaca CE, Paredes R, Mera J, Webb BJ, Perez G, Oguchi G, Ryan P, Nielsen BU, Brown M, Hidalgo A, Sachdeva Y, Mittal S, Osiyemi O, Skarbinski J, Juneja K, Hyland RH, Osinusi A, Chen S, Camus G, Abdelghany M, Davies S, Behenna-Renton N, Duff F, Marty FM, Katz MJ, Ginde AA, Brown SM, Schiffer JT, Hill JA. Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients. N Engl J Med 2022; 386:305-315. [PMID: 34937145 PMCID: PMC8757570 DOI: 10.1056/nejmoa2116846] [Citation(s) in RCA: 676] [Impact Index Per Article: 338.0] [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: 12/15/2022]
Abstract
BACKGROUND Remdesivir improves clinical outcomes in patients hospitalized with moderate-to-severe coronavirus disease 2019 (Covid-19). Whether the use of remdesivir in symptomatic, nonhospitalized patients with Covid-19 who are at high risk for disease progression prevents hospitalization is uncertain. METHODS We conducted a randomized, double-blind, placebo-controlled trial involving nonhospitalized patients with Covid-19 who had symptom onset within the previous 7 days and who had at least one risk factor for disease progression (age ≥60 years, obesity, or certain coexisting medical conditions). Patients were randomly assigned to receive intravenous remdesivir (200 mg on day 1 and 100 mg on days 2 and 3) or placebo. The primary efficacy end point was a composite of Covid-19-related hospitalization or death from any cause by day 28. The primary safety end point was any adverse event. A secondary end point was a composite of a Covid-19-related medically attended visit or death from any cause by day 28. RESULTS A total of 562 patients who underwent randomization and received at least one dose of remdesivir or placebo were included in the analyses: 279 patients in the remdesivir group and 283 in the placebo group. The mean age was 50 years, 47.9% of the patients were women, and 41.8% were Hispanic or Latinx. The most common coexisting conditions were diabetes mellitus (61.6%), obesity (55.2%), and hypertension (47.7%). Covid-19-related hospitalization or death from any cause occurred in 2 patients (0.7%) in the remdesivir group and in 15 (5.3%) in the placebo group (hazard ratio, 0.13; 95% confidence interval [CI], 0.03 to 0.59; P = 0.008). A total of 4 of 246 patients (1.6%) in the remdesivir group and 21 of 252 (8.3%) in the placebo group had a Covid-19-related medically attended visit by day 28 (hazard ratio, 0.19; 95% CI, 0.07 to 0.56). No patients had died by day 28. Adverse events occurred in 42.3% of the patients in the remdesivir group and in 46.3% of those in the placebo group. CONCLUSIONS Among nonhospitalized patients who were at high risk for Covid-19 progression, a 3-day course of remdesivir had an acceptable safety profile and resulted in an 87% lower risk of hospitalization or death than placebo. (Funded by Gilead Sciences; PINETREE ClinicalTrials.gov number, NCT04501952; EudraCT number, 2020-003510-12.).
Collapse
Affiliation(s)
- Robert L Gottlieb
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Carlos E Vaca
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Roger Paredes
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Jorge Mera
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Brandon J Webb
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Gilberto Perez
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Godson Oguchi
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Pablo Ryan
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Bibi U Nielsen
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Michael Brown
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Ausberto Hidalgo
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Yessica Sachdeva
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Shilpi Mittal
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Olayemi Osiyemi
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Jacek Skarbinski
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Kavita Juneja
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Robert H Hyland
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Anu Osinusi
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Shuguang Chen
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Gregory Camus
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Mazin Abdelghany
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Santosh Davies
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Nicole Behenna-Renton
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Frank Duff
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Francisco M Marty
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Morgan J Katz
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Adit A Ginde
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Samuel M Brown
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Joshua T Schiffer
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| | - Joshua A Hill
- From Baylor University Medical Center and Baylor Scott and White Research Institute, Dallas (R.L.G.), and Care United Research, Forney (S.M.) - all in Texas; the Nuren Medical and Research Center, Miami (C.E.V.), Evolution Clinical Trials, Hialeah Gardens (G.P.), the Midland Florida Clinical Research Center, DeLand (G.O.), Luminous Clinical Research-South Florida Urgent Care, Pembroke Pines (A.H.), and Triple O Research Institute Professional Association, West Palm Beach (O.O.) - all in Florida; Hospital Universitari Germans Trias i Pujol and IrsiCaixa AIDS Research Institute, Barcelona (R.P.), and Hospital Universitario Infanta Leonor and Gregorio Marañón Health Research Institute, Madrid (P.R.) - all in Spain; the Cherokee Nation Outpatient Health Center, Tahlequah, OK (J.M.); Intermountain Healthcare (B.J.W., S.M.B.) and the University of Utah School of Medicine (S.M.B.) - both in Murray; Copenhagen University Hospital-Rigshospitalet, Copenhagen (B.U.N.); University College London Hospitals NHS Foundation Trust and the London School of Hygiene and Tropical Medicine - both in London (M.B.); the Institute of Liver Health, Mesa, AZ (Y.S.); Kaiser Permanente, Oakland (J.S.), and Gilead Sciences, Foster City (K.J., R.H.H., A.O., S.C., G.C., M.A., S.D., N.B.-R., F.D.) - both in California; Brigham and Women's Hospital and Harvard Medical School - both in Boston (F.M.M.); Johns Hopkins University School of Medicine, Baltimore (M.J.K.); the University of Colorado School of Medicine, Aurora (A.A.G.); and the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine - both in Seattle (J.T.S., J.A.H.)
| |
Collapse
|
9
|
Cheng AP, Cheng MP, Loy CJ, Lenz JS, Chen K, Smalling S, Burnham P, Timblin KM, Orejas JL, Silverman E, Polak P, Marty FM, Ritz J, De Vlaminck I. Cell-free DNA profiling informs all major complications of hematopoietic cell transplantation. Proc Natl Acad Sci U S A 2022; 119:e2113476118. [PMID: 35058359 PMCID: PMC8795552 DOI: 10.1073/pnas.2113476118] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/16/2021] [Indexed: 12/13/2022] Open
Abstract
Allogeneic hematopoietic cell transplantation (HCT) provides effective treatment for hematologic malignancies and immune disorders. Monitoring of posttransplant complications is critical, yet current diagnostic options are limited. Here, we show that cell-free DNA (cfDNA) in blood is a versatile analyte for monitoring of the most important complications that occur after HCT: graft-versus-host disease (GVHD), a frequent immune complication of HCT, infection, relapse of underlying disease, and graft failure. We demonstrate that these therapeutic complications are informed from a single assay, low-coverage bisulfite sequencing of cfDNA, followed by disease-specific bioinformatic analyses. To inform GVHD, we profile cfDNA methylation marks to trace the cfDNA tissues-of-origin and to quantify tissue-specific injury. To inform infection, we implement metagenomic cfDNA profiling. To inform cancer relapse, we implement analyses of tumor-specific genomic aberrations. Finally, to detect graft failure, we quantify the proportion of donor- and recipient-specific cfDNA. We applied this assay to 170 plasma samples collected from 27 HCT recipients at predetermined timepoints before and after allogeneic HCT. We found that the abundance of solid-organ-derived cfDNA in the blood at 1 mo after HCT is predictive of acute GVHD (area under the curve, 0.88). Metagenomic profiling of cfDNA revealed the frequent occurrence of viral reactivation in this patient population. The fraction of donor-specific cfDNA was indicative of relapse and remission, and the fraction of tumor-specific cfDNA was informative of cancer relapse. This proof-of-principle study shows that cfDNA has the potential to improve the care of allogeneic HCT recipients by enabling earlier detection and better prediction of the complex array of complications that occur after HCT.
Collapse
Affiliation(s)
| | - Matthew Pellan Cheng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA 02215
| | - Conor James Loy
- Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY 14853
| | - Joan Sesing Lenz
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853
| | - Kaiwen Chen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA 02215
| | - Sami Smalling
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853
| | - Philip Burnham
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104
| | - Kaitlyn Marie Timblin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA 02215
| | - José Luis Orejas
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA 02215
| | - Emily Silverman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA 02215
| | - Paz Polak
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Francisco M Marty
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA 02215
- Department of Medicine, Harvard Medical School, Boston, MA 02115
| | - Jerome Ritz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215
- Department of Medicine, Harvard Medical School, Boston, MA 02115
| | - Iwijn De Vlaminck
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853;
| |
Collapse
|
10
|
Gonzalez-Bocco IH, Aleissa MM, Zhou E, Manne-Goehler J, Koo S, Cheng MP, Marty FM. Clarithromycin-Rifampin-Based Treatment for Nontuberculous Mycobacteria Infections in Immunocompromised Patients who Require Concomitant CYP-Metabolized Medications. Open Forum Infect Dis 2022; 9:ofab582. [PMID: 34988253 PMCID: PMC8709895 DOI: 10.1093/ofid/ofab582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/19/2021] [Indexed: 11/23/2022] Open
Abstract
Clarithromycin (CYP inhibitor) can be used instead of azithromycin for nontuberculous mycobacteria therapy in patients requiring CYP substrates to mitigate rifampin's CYP induction. We found no differences in adverse events (10/13 vs 14/17; P = .73), drug intolerability (1/5 vs 4/11; P = 1), or 90-day mortality (0/13 vs 1/17; P = 1) in patients receiving clarithromycin vs azithromycin.
Collapse
Affiliation(s)
- Isabel H Gonzalez-Bocco
- Division of Infectious Disease, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Infectious Disease, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Muneerah M Aleissa
- Division of Infectious Disease, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Infectious Disease, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Eric Zhou
- Division of Infectious Disease, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Infectious Disease, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jennifer Manne-Goehler
- Division of Infectious Disease, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sophia Koo
- Division of Infectious Disease, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Infectious Disease, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew P Cheng
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Medical Microbiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- McGill Interdisciplinary Initiative in Infection and Immunity, Montreal, Quebec, Canada
| | - Francisco M Marty
- Division of Infectious Disease, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Infectious Disease, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
11
|
Aleissa MM, Gonzalez-Bocco IH, Kubiak DW, Zekery-Saad S, Signorelli J, Hammond SP, Manne-Goehler J, Marty FM. 186. Evaluating Clinical Outcomes for Treatment of Staphylococcal Bloodstream Infection in Patients with Febrile Neutropenia. Open Forum Infect Dis 2021. [PMCID: PMC8644996 DOI: 10.1093/ofid/ofab466.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Staphylococcus aureus bloodstream infections (BSIs) in patients with febrile neutropenia (FN) is associated with a mortality rate of up to 49%. For documented infections in patients with FN, guidelines recommend narrowing therapy once susceptibilities result and fever has resolved. Although anti-staphylococcal beta-lactams are the mainstay of treatment for Methicillin-Susceptible and Penicillin-Susceptible Staphylococcus aureus (MSSA and PSSA) BSIs, some clinicians opt to continue broad antibiotics against Pseudomonas during FN. Studies evaluating treatment modalities and outcomes of MSSA and PSSA BSI in patients with FN are lacking.
Methods
We conducted a retrospective cohort study of adult patients with MSSA or PSSA BSI who received antibiotics for the treatment of FN (absolute neutrophil count < 500 cells/L and temperature > 100.4F) at Brigham and Women’s Hospital and Dana-Farber Cancer Institute from 1/2010 to 4/2021. Patients who received < 72-h of antibiotics were excluded. The primary outcome was composite clinical failure (60-day all-cause mortality and/or 60-day BSI recurrence). Other outcomes included inpatient mortality, 60-day readmission, 60-day infection outcomes, incidence of acute kidney injury and hepatotoxicity. Data was analyzed using Chi-Square test or Fisher’s Exact test.
Results
Among 108 patients who met our criteria, 58% were male, median age was 57 years (IQR 44, 66), 94% had a hematologic malignancy, 4% had a solid tumor, and 2% had both. A total of 41 (38%) received combination therapy with broad spectrum and anti-staphylococcal beta-lactam, 48 (44%) received broad spectrum beta-lactam followed by anti-staphylococcal beta-lactam after neutrophil recovery, and 19 (18%) were narrowed to an anti-staphylococcal beta-lactam prior to resolution of neutropenia. Clinical failure was similar across all treatment arms (34% for combination therapy, 25% for broad spectrum beta-lactam, and 37% for anti-staphylococcal beta-lactam) (Table).
Table. Outcomes
Conclusion
De-escalation to an anti-staphylococcal beta-lactam prior to neutrophil recovery in FN patients with MSSA or PSSA BSIs did not result in significantly higher clinical failures. Further prospective studies are needed to support antimicrobial stewardship initiatives in oncology patients.
Disclosures
All Authors: No reported disclosures
Collapse
Affiliation(s)
| | | | | | | | | | - Sarah P Hammond
- Massachusetts General Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | - Francisco M Marty
- Massachusetts General Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
12
|
Pappas PG, Cornely O, Koehler P, McCarty TP, Alexander BD, Miller R, Vazquez JA, Sanders JW, Morse C, Ostrosky-Zeichner L, Krause R, Prattes J, Spec A, Rautemaa-Richardson R, Bazaz R, Walsh TJ, Marty FM, Gonzalez-Bocco IH, Miceli M, Hoenigl M, Hoenigl M, Patterson TF, Azie N, Angulo DA. 123. Oral Ibrexafungerp Outcomes by Fungal Disease in Patients from an Interim Analysis of a Phase 3 Open-label Study (FURI). Open Forum Infect Dis 2021. [PMCID: PMC8644751 DOI: 10.1093/ofid/ofab466.123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Candida species are a major cause of invasive and mucocutaneouls infections. There are limited oral treatment options available for patients with Candida infections who are unresponsive to or who are intolerant of currently available antifungals. Oral ibrexafungerp is an investigational broad-spectrum glucan synthase inhibitor antifungal with activity against Candida and Aspergillus species, including azole- and echinocandin-resistant strains. A Phase 3 open-label, single-arm study of ibrexafungerp (FURI; NCT03059992) is ongoing for the treatment of patients intolerant of or with fungal disease refractory to standard antifungal therapy. We present an analysis of patient outcomes from the FURI study by fungal disease type. Table 1: FURI Outcomes by Fungal Disease ![]()
Methods FURI patients were eligible for enrollment if they have proven or probable, severe mucocutaneous candidiasis, invasive candidiasis or invasive aspergillosis,other fungal diseases and evidence of failure to, intolerance to, or toxicity related to a currently approved standard-of-care antifungal treatment or can not receive approved oral antifungal options (e.g., susceptibility of the organism) and a continued IV antifungal therapy is clinically undesirable or unfeasible. Results An independent Data Review Committee (DRC) provided an assessment of treatment response for 74 patients enrolled in the FURI study from 22 centers in US, UK and EU treated with ibrexafungerp for mucocutaneous or invasive fungal infections from 2016- 2020. A total of 39 (52.7%) patients had invasive candidiasis, 32 (43.2%) had mucocutaneous candidiasis and 3 (4.5%) patients had invasive aspergillosis. The percent of patients who were determined to have a complete response (CR), partial response (PR), clinical improvement (CI) was 63.5%, stable disease (SD) was 23.0%, patients with progression of disease 6.8% and 4 patients were indeterminate. Additionally, there was 1 death in the FURI study that was not related to fungal disease. Table 1 shows outcomes by fungal disease type as determined by the DRC. Conclusion Analysis of 74 patients from the FURI study indicates that oral ibrexafungerp provides a favorable therapeutic response in patients with challenging fungal disease and limited treatment options. Disclosures Peter G. Pappas, MD, Astellas (Research Grant or Support)Cidara (Research Grant or Support)F2G (Consultant)Matinas (Consultant, Scientific Research Study Investigator)Mayne Pharma (Research Grant or Support)Scynexis (Research Grant or Support) Oliver Cornely, Prof., Actelion (Consultant, Grant/Research Support)Al-Jazeera Pharmaceuticals (Consultant)Allecra Therapeutics (Consultant)Amplyx (Consultant, Grant/Research Support)Astellas (Consultant, Grant/Research Support)Basilea (Consultant, Grant/Research Support)Biocon (Consultant)Biosys (Consultant)Cidara (Consultant, Grant/Research Support)CoRe Consulting (Consultant)Da Volterra (Consultant, Grant/Research Support)DFG (German Research Foundation) (Grant/Research Support)Entasis (Consultant)F2G (Consultant, Grant/Research Support)German Federal Ministry of Research and Education (Grant/Research Support)Gilead (Consultant, Grant/Research Support)Grupo Biotoscana (Consultant)Immunic (Grant/Research Support)IQVIA (Consultant)Janssen (Grant/Research Support)Matinas (Consultant)Medicines Company (Grant/Research Support)MedPace (Consultant, Grant/Research Support)Melinta Therapeutics (Grant/Research Support)Menarini (Consultant)Merck/MSD (Consultant, Grant/Research Support)Molecular Partners (Consultant)MSG-ERC (Consultant)Mylan (Consultant)Nabriva (Consultant)Noxxon (Consultant)Octapharma (Consultant)Paratek (Consultant)Pfizer (Consultant, Grant/Research Support)PSI (Consultant)Roche Diagnostics (Consultant)Scynexis (Consultant, Grant/Research Support)Seres (Consultant)Shionogi (Consultant)Wiley (Blackwell) (Other Financial or Material Support) Philipp Koehler, MD, Ambu GmbH (Consultant, Speaker's Bureau)Astellas Pharma (Speaker's Bureau)Euopean Confederation of Medical Mycology (Speaker's Bureau)German Federal Ministry of Research and Education (Grant/Research Support)Gilead (Consultant, Speaker's Bureau)MSD (Speaker's Bureau)Noxxon N.V. (Consultant)Pfizer (Speaker's Bureau)State of North Rhine-Westphalia, Germany (Grant/Research Support) Todd P. McCarty, MD, Cidara (Grant/Research Support)GenMark (Grant/Research Support, Other Financial or Material Support, Honoraria for Research Presentation)T2 Biosystems (Consultant) Barbara D. Alexander, MD, MHS, SCYNEXIS, Inc. (Consultant) Rachel Miller, MD, SCYNEXIS, Inc. (Scientific Research Study Investigator) Caryn Morse, MD, Chimerix (Scientific Research Study Investigator)Covis Pharma (Scientific Research Study Investigator)Gilead Sciences Inc. (Scientific Research Study Investigator)Ridgeback Biotherapeutics (Scientific Research Study Investigator)Roche (Scientific Research Study Investigator)SCYNEXIS, Inc. (Scientific Research Study Investigator)Theratechnologies (Advisor or Review Panel member)Viiv (Advisor or Review Panel member) Luis Ostrosky-Zeichner, MD, Amplyx (Consultant)Cidara (Consultant)F2G (Consultant)Gilead (Grant/Research Support, Speaker's Bureau)Pfizer (Scientific Research Study Investigator, Speaker's Bureau)Scynexis (Grant/Research Support, Scientific Research Study Investigator)Viracor (Consultant) Jürgen Prattes, Dr, AbbVie Inc. (Shareholder)Gilead (Speaker's Bureau)MSD (Grant/Research Support)Novo Nordisk (Shareholder)Pfizer (Advisor or Review Panel member)Stryker (Shareholder) Andrej Spec, MD, MSCI, Mayne Pharma (Grant/Research Support) Riina Rautemaa-Richardson, DDS, PhD, FRCPath, SCYNEXIS, Inc. (Scientific Research Study Investigator) Thomas J. Walsh, MD, PhD (hon), Scynexis (Consultant, Grant/Research Support)Shionogi (Consultant, Grant/Research Support) Francisco M. Marty, MD, SCYNEXIS, Inc. (Scientific Research Study Investigator) Marisa Miceli, MD, SCYNEXIS, Inc. (Advisor or Review Panel member) Martin Hoenigl, MD, Astellas (Grant/Research Support)Gilead (Grant/Research Support)Pfizer (Grant/Research Support) Martin Hoenigl, MD, Astellas (Individual(s) Involved: Self): Grant/Research Support; F2G (Individual(s) Involved: Self): Grant/Research Support; Gilead (Individual(s) Involved: Self): Grant/Research Support; Pfiyer (Individual(s) Involved: Self): Grant/Research Support; Scýnexis (Individual(s) Involved: Self): Grant/Research Support Thomas F. Patterson, MD, SCYNEXIS, Inc. (Advisor or Review Panel member) Nkechi Azie, MD, SCYNEXIS, Inc. (Employee, Shareholder) David A. Angulo, MD, SCYNEXIS, Inc. (Employee, Shareholder)
Collapse
Affiliation(s)
- Peter G Pappas
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Oliver Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Philipp Koehler
- University Hospital of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Todd P McCarty
- University of Alabama at Birmingham; Birmingham VA Medical Center, Birmingham, Alabama
| | | | | | - Jose A Vazquez
- Medical College of Georgia at Augusta University, Augusta, Georgia
| | - John W Sanders
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Caryn Morse
- Wake Forest Baptist Hospital, Winston-Salem, North Carolina
| | | | - Robert Krause
- Medical University of Graz, Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Graz, Steiermark, Austria
| | | | - Andrej Spec
- Division of Infectious Diseases Washington University in St. Louis, ST LOUIS, MO
| | | | - Rohit Bazaz
- Manchester University NHS Foundation Trust, Manchester, England, United Kingdom
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Vazquez JA, Cornely O, Koehler P, Rautemaa-Richardson R, Bazaz R, Marshall Lyon G, Marty FM, Gonzalez-Bocco IH, Miller R, Walsh TJ, Pappas P, McCarty TP, Sanders JW, Morse C, Ostrosky-Zeichner L, Krause R, Prattes J, Spec A, Andes D, Witzke O, Azie N, Angulo DA. 992. Oral Ibrexafungerp Outcomes in Patients with Oropharyngeal and Esophageal Candidiasis from an Interim Analysis of a Phase 3 Open-label Study (FURI). Open Forum Infect Dis 2021. [DOI: 10.1093/ofid/ofab466.1186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Candida albicans is the predominant organism causing esophageal candidiasis (EC) and oropharyngel candidiasis (OPC). These infections may arise from subjects colonized with Candida who are predisposed due to illness, debility or a local reduction in host resistance to an overgrowth of their own indigenous flora. Patients with mucocutaneous Candida infections can be treated in the outpatient setting, yet there are limited oral treatment options available for patients who are unresponsive to or who are intolerant to currently available antifungals. Oral ibrexafungerp is an investigational broad-spectrum glucan synthase inhibitor antifungal with activity against Candida species, including azole- and echinocandin-resistant strains. A Phase 3 open-label, single-arm study of ibrexafungerp (FURI; NCT03059992) is ongoing for the treatment of patients intolerant of or with fungal disease refractory to standard antifungal therapy.
Table 1. FURI Outcomes in OPC and EC
Methods
FURI subjects were eligible for enrollment if they had proven or probable severe mucocutaneous candidiasis, invasive candidiasis, invasive aspergillosis, or other fungal diseases with evidence of treatment failure, intolerance, or toxicity related to a currently approved standard-of-care antifungal treatment or if they were unable to receive an approved oral antifungal option (e.g., susceptibility of the organism) and a continued IV antifungal therapy was clinically undesirable or unfeasible.
Results
An independent Data Review Committee (DRC) provided an assessment of treatment response for 74 subjects enrolled in the FURI study from 22 centers in US, UK and EU treated with ibrexafungerp for mucocutaneous or invasive fungal infections from 2016- 2020. A total 32 subjects (43.2%) had mucocutaneous candidiasis and 24 subjects were diagnosed with OPC or EC. The percent of patients who were determined to have a complete response (CR) or partial response (PR) was 62.5%, stable disease (SD), 20.8%, and progression of disease, 16.7%. Table 1 shows outcomes by EC and OPC as determined by the DRC.
Conclusion
Analysis of 24 EC and OPC patients from the FURI study indicates that oral ibrexafungerp provides a favorable therapeutic response in patients with challenging mucocutaneous fungal disease and limited treatment options.
Disclosures
Oliver Cornely, Prof., Actelion (Consultant, Grant/Research Support)Al-Jazeera Pharmaceuticals (Consultant)Allecra Therapeutics (Consultant)Amplyx (Consultant, Grant/Research Support)Astellas (Consultant, Grant/Research Support)Basilea (Consultant, Grant/Research Support)Biocon (Consultant)Biosys (Consultant)Cidara (Consultant, Grant/Research Support)CoRe Consulting (Consultant)Da Volterra (Consultant, Grant/Research Support)DFG (German Research Foundation) (Grant/Research Support)Entasis (Consultant)F2G (Consultant, Grant/Research Support)German Federal Ministry of Research and Education (Grant/Research Support)Gilead (Consultant, Grant/Research Support)Grupo Biotoscana (Consultant)Immunic (Grant/Research Support)IQVIA (Consultant)Janssen (Grant/Research Support)Matinas (Consultant)Medicines Company (Grant/Research Support)MedPace (Consultant, Grant/Research Support)Melinta Therapeutics (Grant/Research Support)Menarini (Consultant)Merck/MSD (Consultant, Grant/Research Support)Molecular Partners (Consultant)MSG-ERC (Consultant)Mylan (Consultant)Nabriva (Consultant)Noxxon (Consultant)Octapharma (Consultant)Paratek (Consultant)Pfizer (Consultant, Grant/Research Support)PSI (Consultant)Roche Diagnostics (Consultant)Scynexis (Consultant, Grant/Research Support)Seres (Consultant)Shionogi (Consultant)Wiley (Blackwell) (Other Financial or Material Support) Philipp Koehler, MD, Ambu GmbH (Consultant, Speaker’s Bureau)Astellas Pharma (Speaker’s Bureau)Euopean Confederation of Medical Mycology (Speaker’s Bureau)German Federal Ministry of Research and Education (Grant/Research Support)Gilead (Consultant, Speaker’s Bureau)MSD (Speaker’s Bureau)Noxxon N.V. (Consultant)Pfizer (Speaker’s Bureau)State of North Rhine-Westphalia, Germany (Grant/Research Support) Riina Rautemaa-Richardson, DDS, PhD, FRCPath, SCYNEXIS, Inc. (Scientific Research Study Investigator) G. Marshall Lyon, MD, SCYNEXIS, Inc. (Scientific Research Study Investigator) Francisco M. Marty, MD, SCYNEXIS, Inc. (Scientific Research Study Investigator) Rachel Miller, MD, SCYNEXIS, Inc. (Scientific Research Study Investigator) Thomas J. Walsh, MD, PhD (hon), Scynexis (Consultant, Grant/Research Support)Shionogi (Consultant, Grant/Research Support) Peter Pappas, MD, Astellas (Grant/Research Support)Cidara (Grant/Research Support, Advisor or Review Panel member)Mayne (Grant/Research Support, Advisor or Review Panel member)Merck (Grant/Research Support)SCYNEXIS, Inc. (Consultant, Grant/Research Support) Todd P. McCarty, MD, Cidara (Grant/Research Support)GenMark (Grant/Research Support, Other Financial or Material Support, Honoraria for Research Presentation)T2 Biosystems (Consultant) Caryn Morse, MD, Chimerix (Scientific Research Study Investigator)Covis Pharma (Scientific Research Study Investigator)Gilead Sciences Inc. (Scientific Research Study Investigator)Ridgeback Biotherapeutics (Scientific Research Study Investigator)Roche (Scientific Research Study Investigator)SCYNEXIS, Inc. (Scientific Research Study Investigator)Theratechnologies (Advisor or Review Panel member)Viiv (Advisor or Review Panel member) Luis Ostrosky-Zeichner, MD, Amplyx (Consultant)Cidara (Consultant)F2G (Consultant)Gilead (Grant/Research Support, Speaker’s Bureau)Pfizer (Scientific Research Study Investigator, Speaker’s Bureau)Scynexis (Grant/Research Support, Scientific Research Study Investigator)Viracor (Consultant) Jürgen Prattes, Dr, AbbVie Inc. (Shareholder)Gilead (Speaker’s Bureau)MSD (Grant/Research Support)Novo Nordisk (Shareholder)Pfizer (Advisor or Review Panel member)Stryker (Shareholder) Andrej Spec, MD, MSCI, SCYNEXIS, Inc. (Consultant, Scientific Research Study Investigator) David Andes, MD, SCYNEXIS, Inc. (Scientific Research Study Investigator) Oliver Witzke, MD, SCYNEXIS, Inc. (Scientific Research Study Investigator) Nkechi Azie, MD, SCYNEXIS, Inc. (Employee, Shareholder) David A. Angulo, MD, SCYNEXIS, Inc. (Employee, Shareholder)
Collapse
Affiliation(s)
- Jose A Vazquez
- Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Oliver Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Philipp Koehler
- University Hospital of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | | | - Rohit Bazaz
- Manchester University NHS Foundation Trust, Manchester, England, United Kingdom
| | | | | | | | | | | | - Peter Pappas
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Todd P McCarty
- University of Alabama at Birmingham; Birmingham VA Medical Center, Birmingham, Alabama
| | - John W Sanders
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Caryn Morse
- Wake Forest Baptist Hospital, Winston-Salem, North Carolina
| | | | - Robert Krause
- Medical University of Graz, Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Graz, Steiermark, Austria
| | | | - Andrej Spec
- Washingotn University In St Louis, School of Medicine, St. Louis, Missouri
| | | | - Oliver Witzke
- University Hospital, Essen, Essen, Nordrhein-Westfalen, Germany
| | | | | |
Collapse
|
14
|
Leon AR, Koshy S, Perez P, Garcia S, Sandoval N, Marty FM, Samayoa J, Koo S. 711. A Unique Breath Secondary Metabolite Volatile Signature for the Diagnosis of Histoplasmosis. Open Forum Infect Dis 2021. [PMCID: PMC8644043 DOI: 10.1093/ofid/ofab466.908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Histoplasmosis is a common endemic fungal infection in the Americas, causing significant morbidity and mortality, particularly in immunocompromised patients. Existing diagnostic methods are limited in their sensitivity (especially in pulmonary histoplasmosis) and turnaround time. Methods We examined prospectively collected breath samples from 84 patients with suspected histoplasmosis 3/2019 - 2/2020 at Hospital Roosevelt (HR; Guatemala City, Guatemala, n = 56) and suspected invasive fungal disease 1/2018 - 10/2019 at Brigham and Women’s Hospital (BWH; Boston, MA, USA, n = 28) using thermal desorption gas chromatography-tandem mass spectrometry (TDU-GC-MS/MS). Patients were evaluated for histoplasmosis and other infections according to the local standard of care – of note, 18/56 patients at HR did not have Histoplasma urine antigen testing. Results Median age was 44 years, 60 (71%) were male, 23 (27%) had HIV, 15 (18%) had hematologic malignancy. 7 patients were diagnosed with histoplasmosis over the study period (4 at HR, 5 at BWH), with a clinical syndrome + positive Histoplasma urine or serum antigen test, with some patients also having yeast forms on tissue biopsy. 3 patients had disseminated and 4 pulmonary histoplasmosis. 4 patients with histoplasmosis had co-infections – 2 tuberculosis (TB), 1 influenza, and 1 Pneumocystis jirovecii (PJP) pneumonia. 4 patients were receiving antifungal therapy active against Histoplasma at the time of their first breath sample. We found 3 sesquiterpenes: (A) cyperene, (B) 1R,4aR,8aR)-2,5,5,8a-Tetramethyl-4,5,6,7,8,8a-hexahydro-1H-1,4a-methanonaphthalene, and (C) viridiflorol in patients with histoplasmosis, that distinguished these patients from those with other pneumonia (TB, coccidioidomycosis, invasive aspergillosis, mucormycosis, PJP, bacterial pneumonia) with 100% sensitivity and 70% (95% CI 59, 80) specificity. Figure 1. TDU GC-MS/MS spectral comparison in histoplasmosis vs. the other invasive mycoses aspergillosis or mucormycosis. A: Cyperene; B: (1R,4aR,8aR)-2,5,5,8a Tetramethyl-4,5,6,7,8,8a-hexahydro-1H-1,4a-methanonaphthalene; C: viridiflorol; D: 1H-Indene, 2,3,3a,4-tetrahydro-3,3a,6-trimethyl-1-(1-methylethyl)-; E: β-funebrene; F: trans-α-bergamotene; G: eremophilene; H: spathulenol; I: cedrene; J: cedranoxide, 8,14- ![]()
Conclusion Conclusion: Patients with histoplasmosis have a unique secondary metabolite breath signature that can be used for the noninvasive diagnosis of pulmonary and disseminated histoplasmosis. Many patients in this cohort did not undergo urine antigen testing or other diagnostic workup for histoplasmosis, which may have affected our specificity estimates. Disclosures Francisco M. Marty, MD, SCYNEXIS, Inc. (Scientific Research Study Investigator)
Collapse
Affiliation(s)
- Armando R Leon
- Brigham and Women's Hospital, Harvard Medical School, Philadelphia, PA
| | | | - Pablo Perez
- Hospital Roosevelt, Guatemala City, Alta Verapaz, Guatemala
| | - Sucely Garcia
- Hospital Roosevelt, Guatemala City, Alta Verapaz, Guatemala
| | - Nancy Sandoval
- Hospital Roosevelt, Guatemala City, Alta Verapaz, Guatemala
| | | | | | - Sophia Koo
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA
| |
Collapse
|
15
|
Gonzalez-Bocco IH, Aleissa MM, Cheng M, Manne-Goehler J, Marty FM. 1399. Clarithromycin–Rifampin-based Treatment for Non-tuberculous Mycobacterial Infections in Immunocompromised Patients Who Require Concomitant CYP-Metabolized Medications. Open Forum Infect Dis 2021. [PMCID: PMC8643767 DOI: 10.1093/ofid/ofab466.1591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Non-tuberculous mycobacteria (NTM) are causes of pulmonary and extrapulmonary disease that frequently affect immunocompromised hosts (ICH). Current treatment guidelines recommend a macrolide-based, multi-drug regimen that includes rifampin. Rifampin is a potent cytochrome P450 (CYP) 3A inducer, which often results in drug-drug interactions in ICH receiving multiple CYP substrates. One way to mitigate rifampin’s CYP induction is to utilize clarithromycin, a CYP inhibitor, as the accompanying macrolide. We evaluated the incidence of NTM treatment-related adverse events (AEs) in patients who received a clarithromycin-based regimen compared to patients who received an azithromycin-based regimen. Methods We conducted a retrospective review of NTM infection in 30 immunocompromised adults. All participants had a positive culture for a NTM and had received a rifamycin (rifampin or rifabutin) with a macrolide (azithromycin or clarithromycin) for treatment at Brigham and Women’s Hospital between 01/01/2011-10/18/2020 or Dana-Farber Cancer Institute between 06/03/2015-07/01/2020. The primary outcome was the incidence of NTM treatment-related AEs in patients who received a clarithromycin-based regimen compared to those who received an azithromycin-based regimen. Results There were no significant differences in the reasons for discontinuation of NTM treatment or 90-day mortality between groups. The number of AEs possibly related to NTM treatment were similar in patients who received a clarithromycin-based regimen and those who received an azithromycin-based one (10/13 vs. 14/17; p=0.73). The most common AE was liver function test abnormalities (Table 1). Additionally, the proportion of patients requiring dose adjustments for interacting medications and patients with out-of-range tacrolimus levels were similar between the two groups (23.1% vs. 29.4%; p=0.76 and 8.0% vs. 6.0%; p=1.00, respectively). Table 1: Adverse events ![]()
Conclusion A clarithromycin-based regimen for NTM treatment was safe and well tolerated in our patient population. This combination provides a good alternative for patients requiring medications that are CYP substrates, or those who cannot tolerate azithromycin. Disclosures Matthew Cheng, MD, GEn1E Lifesciences (Advisor or Review Panel member)Kanvas Biosciences (Board Member, Shareholder)nplex biosciences (Advisor or Review Panel member)
Collapse
Affiliation(s)
| | | | - Matthew Cheng
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Francisco M Marty
- Massachusetts General Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
16
|
Avery RK, Alain S, Alexander BD, Blumberg EA, Chemaly RF, Cordonnier C, Duarte RF, Florescu DF, Kamar N, Kumar D, Maertens J, Marty FM, Papanicolaou GA, Silveira FP, Witzke O, Wu J, Sundberg AK, Fournier M. Maribavir for Refractory Cytomegalovirus Infections With or Without Resistance Post-Transplant: Results From a Phase 3 Randomized Clinical Trial. Clin Infect Dis 2021; 75:690-701. [PMID: 34864943 PMCID: PMC9464078 DOI: 10.1093/cid/ciab988] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Therapies for refractory cytomegalovirus infections (with or without resistance [R/R]) in transplant recipients are limited by toxicities. Maribavir has multimodal anti-cytomegalovirus activity through the inhibition of UL97 protein kinase. METHODS In this phase 3, open-label study, hematopoietic-cell and solid-organ transplant recipients with R/R cytomegalovirus were randomized 2:1 to maribavir 400 mg twice daily or investigator-assigned therapy (IAT; valganciclovir/ganciclovir, foscarnet, or cidofovir) for 8 weeks, with 12 weeks of follow-up. The primary endpoint was confirmed cytomegalovirus clearance at end of week 8. The key secondary endpoint was achievement of cytomegalovirus clearance and symptom control at end of week 8, maintained through week 16. RESULTS 352 patients were randomized (235 maribavir; 117 IAT). Significantly more patients in the maribavir versus IAT group achieved the primary endpoint (55.7% vs 23.9%; adjusted difference [95% confidence interval (CI)]: 32.8% [22.80-42.74]; P < .001) and key secondary endpoint (18.7% vs 10.3%; adjusted difference [95% CI]: 9.5% [2.02-16.88]; P = .01). Rates of treatment-emergent adverse events (TEAEs) were similar between groups (maribavir, 97.4%; IAT, 91.4%). Maribavir was associated with less acute kidney injury versus foscarnet (8.5% vs 21.3%) and neutropenia versus valganciclovir/ganciclovir (9.4% vs 33.9%). Fewer patients discontinued treatment due to TEAEs with maribavir (13.2%) than IAT (31.9%). One patient per group had fatal treatment-related TEAEs. CONCLUSIONS Maribavir was superior to IAT for cytomegalovirus viremia clearance and viremia clearance plus symptom control maintained post-therapy in transplant recipients with R/R cytomegalovirus. Maribavir had fewer treatment discontinuations due to TEAEs than IAT. Clinical Trials Registration. NCT02931539 (SOLSTICE).
Collapse
Affiliation(s)
- Robin K Avery
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sophie Alain
- Department of Virology and National Reference Center for Herpesviruses, Limoges University Hospital, UMR Inserm 1092, University of Limoges, Limoges, France
| | - Barbara D Alexander
- Division of Infectious Diseases and International Health, Duke University, Durham, North Carolina, USA
| | - Emily A Blumberg
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Catherine Cordonnier
- Haematology Department, Henri Mondor Hospital and University Paris-Est-Créteil, Créteil, France
| | - Rafael F Duarte
- Department of Haematology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Diana F Florescu
- Infectious Diseases Division, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, INFINITY-Inserm U1291-CNRS U5051, University Paul Sabatier, Toulouse, France
| | - Deepali Kumar
- Transplant Centre, University Health Network, Toronto, Ontario, Canada
| | - Johan Maertens
- Haematology Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | | | - Genovefa A Papanicolaou
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Fernanda P Silveira
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Medicine Essen, University Duisburg-Essen, Essen, Germany
| | - Jingyang Wu
- Biostatistics, Takeda Development Center Americas, Inc, Lexington, Massachusetts, USA
| | - Aimee K Sundberg
- Clinical Sciences, Takeda Development Center Americas, Inc, Lexington, Massachusetts, USA
| | - Martha Fournier
- Correspondence: M. Fournier, Takeda Development Center Americas, Inc, 300 Shire Way, Lexington, MA 02421 ()
| | | |
Collapse
|
17
|
Wingard JR, Alexander BD, Baden LR, Chen M, Sugrue MW, Leather HL, Caliendo AM, Clancy CJ, Denning DW, Marty FM, Nguyen MH, Wheat LJ, Logan BR, Horowitz MM, Marr KA. Impact of Changes of the 2020 Consensus Definitions of Invasive Aspergillosis on Clinical Trial Design: Unintended Consequences for Prevention Trials? Open Forum Infect Dis 2021; 8:ofab441. [PMID: 34631917 PMCID: PMC8496761 DOI: 10.1093/ofid/ofab441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/23/2021] [Indexed: 12/20/2022] Open
Abstract
Background Consensus definitions for the diagnosis of invasive fungal diseases (IFDs) were updated in 2020 to increase the certainty of IFD for inclusion in clinical trials, for instance by increasing biomarker cutoff limits to define positivity. To date, there is a paucity of data as to the impact of the revised definitions on clinical trials. Methods In this study, we sought to determine the impact of the new definitions on classifying invasive aspergillosis (IA), the most common invasive mold disease in immunocompromised patients. We reclassified 226 proven and probable IA cases plus 139 possible IFD cases in the Aspergillus Technology Consortium (AsTeC) and in an antifungal prophylaxis trial (BMT CTN 0101) using the new criteria. Results Fewer cases met the more stringent diagnostic 2020 criteria after applying the reclassification criteria to define probable IA. Of 188 evaluable probable cases, 41 (22%) were reclassified to 40 possible IA and 1 probable IFD. Reclassification to possible IFD occurred in 22% of hematologic malignancy (HM) patients, 29% of hematopoietic cell transplant (HCT) patients, and in no lung transplant (LT) patients. Date of diagnosis was established a median (range) of 3 (1–105) days later in 15% of probable IA cases using the new criteria. Applying the new definitions to the BMT CTN 0101 trial, the power to detect the same odds ratio decreased substantially. Conclusions The updated IA consensus definitions may impact future trial designs, especially for antifungal prophylaxis studies.
Collapse
Affiliation(s)
- John R Wingard
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Barbara D Alexander
- Departments of Medicine and Pathology, Duke University, Durham, North Carolina, USA
| | - Lindsey R Baden
- Department of Medicine, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Min Chen
- CIBMTR Milwaukee, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michele W Sugrue
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Helen L Leather
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Angela M Caliendo
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Cornelius J Clancy
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - David W Denning
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Francisco M Marty
- Department of Medicine, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - M Hong Nguyen
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Brent R Logan
- CIBMTR Milwaukee, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mary M Horowitz
- CIBMTR Milwaukee, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kieren A Marr
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
18
|
Kauke M, Panayi AC, Safi AF, Haug V, Perry B, Kollar B, Nizzi MC, Broyles J, Annino DJ, Marty FM, Sinha I, Lian CG, Murphy GF, Chandraker A, Pomahac B. Full facial retransplantation in a female patient-Technical, immunologic, and clinical considerations. Am J Transplant 2021; 21:3472-3480. [PMID: 34033210 DOI: 10.1111/ajt.16696] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 01/25/2023]
Abstract
There is limited experience with facial retransplantation (fRT). We report on the management of facial retransplantation in a facial vascularized composite allotransplant recipient following irreversible allograft loss 88 months after the first transplant. Chronic antibody-mediated rejection and recurrent cellular rejection resulted in a deteriorated first allograft and the patient underwent retransplantation. We summarize the events between the two transplantations, focusing on the final rejection episode. We describe the surgical technique of facial retransplantation, the immunological and psychosocial management, and the 6-month postoperative outcomes. Removal of the old allograft and inset of the new transplant were done in one operation. The donor and recipient were a good immunological match. The procedure was technically complex, requiring more proximal arterial anastomoses and an interposition vein graft. During the first and second transplantation, the facial nerve was coapted at the level of the branches. There was no hyperacute rejection in the immediate postoperative phase. Outcomes 6 months postoperatively are promising. We provide proof-of-concept that facial retransplantation is a viable option for patients who suffer irreversible facial vascularized composite allograft loss.
Collapse
Affiliation(s)
- Martin Kauke
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adriana C Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ali-Farid Safi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Valentin Haug
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bridget Perry
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Charlestown, Massachusetts, USA
| | - Branislav Kollar
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marie-Christine Nizzi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Justin Broyles
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Donald J Annino
- Division of Otolaryngology, Department of Surgery, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Francisco M Marty
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Indranil Sinha
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christine G Lian
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - George F Murphy
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anil Chandraker
- Schuster Transplantation Research Center, Renal Division, Boston, Massachusetts, USA
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
19
|
Slavin MA, Chen YC, Cordonnier C, Cornely OA, Cuenca-Estrella M, Donnelly JP, Groll AH, Lortholary O, Marty FM, Nucci M, Rex JH, Rijnders BJA, Thompson GR, Verweij PE, White PL, Hargreaves R, Harvey E, Maertens JA. When to change treatment of acute invasive aspergillosis: an expert viewpoint. J Antimicrob Chemother 2021; 77:16-23. [PMID: 34508633 PMCID: PMC8730679 DOI: 10.1093/jac/dkab317] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Invasive aspergillosis (IA) is an acute infection affecting patients who are immunocompromised, as a result of receiving chemotherapy for malignancy, or immunosuppressant agents for transplantation or autoimmune disease. Whilst criteria exist to define the probability of infection for clinical trials, there is little evidence in the literature or clinical guidelines on when to change antifungal treatment in patients who are receiving prophylaxis or treatment for IA. To try and address this significant gap, an advisory board of experts was convened to develop criteria for the management of IA for use in designing clinical trials, which could also be used in clinical practice. For primary treatment failure, a change in antifungal therapy should be made: (i) when mycological susceptibility testing identifies an organism from a confirmed site of infection, which is resistant to the antifungal given for primary therapy, or a resistance mutation is identified by molecular testing; (ii) at, or after, 8 days of primary antifungal treatment if there is increasing serum galactomannan, or galactomannan positivity in serum, or bronchoalveolar lavage fluid when the antigen was previously undetectable, or there is sudden clinical deterioration, or a new clearly distinct site of infection is detected; and (iii) at, or after, 15 days of primary antifungal treatment if the patient is clinically stable but with ≥2 serum galactomannan measurements persistently elevated compared with baseline or increasing, or if the original lesions on CT or other imaging, show progression by >25% in size in the context of no apparent change in immune status.
Collapse
Affiliation(s)
- Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Yee-Chun Chen
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Catherine Cordonnier
- Service d'Hématologie clinique et de Thérapie cellulaire, DMU Cancer, CHU Henri Mondor, 94000 Créteil, France
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD); Clinical Trials Centre Cologne (ZKS Köln), Kerpener Str. 62, 50937 Cologne, Germany
| | - Manuel Cuenca-Estrella
- Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo Km2, Majadahonda, Madrid 28220, Spain
| | | | - Andreas H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Münster, Germany
| | - Olivier Lortholary
- Paris University, Necker Pasteur Center for Infectious Diseases and Tropical Medicine, IHU Imagine, Necker Enfants Malades University Hospital, and Institute Pasteur, CNRS, Molecular Mycology Unit, APHP 149, rue de Sèvres, 75015 Paris, France
| | | | - Marcio Nucci
- University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - John H Rex
- F2G Ltd, Lankro Way, Eccles, Manchester, M30 0LX, UK.,McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Bart J A Rijnders
- Department of Internal Medicine, Section of Infectious Diseases and Department of Medical Microbiology and Infectious Diseases Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases, 4150 V Street, Suite G500, Sacramento, CA 95817, USA
| | - Paul E Verweij
- Radboudumc-CWZ Center of Expertise for Mycology, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.,Center for Infectious Disease Research, Diagnostics and Laboratory Surveillance National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - P Lewis White
- Public Health Wales Mycology Reference Laboratory, University Hospital of Wales, Heath Park, Cardiff, UK
| | | | - Emma Harvey
- F2G Ltd, Lankro Way, Eccles, Manchester, M30 0LX, UK
| | - Johan A Maertens
- Department of Microbiology, Immunology, and Transplantation, K.U. Leuven, Leuven, Belgium.,Department of Hematology, U.Z. Leuven, Leuven, Belgium
| |
Collapse
|
20
|
Hakki M, Aitken SL, Danziger-Isakov L, Michaels MG, Carpenter PA, Chemaly RF, Papanicolaou GA, Boeckh M, Marty FM. American Society for Transplantation and Cellular Therapy Series: #3-Prevention of Cytomegalovirus Infection and Disease After Hematopoietic Cell Transplantation. Transplant Cell Ther 2021; 27:707-719. [PMID: 34452721 DOI: 10.1016/j.jtct.2021.05.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [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: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 11/20/2022]
Abstract
The Practice Guidelines Committee of the American Society for Transplantation and Cellular Therapy partnered with its Transplant Infectious Disease Special Interest Group to update its 2009 compendium-style infectious diseases guidelines for the care of hematopoietic cell transplant (HCT) recipients. A new approach was taken with the goal of better serving clinical providers by publishing each standalone topic in the infectious disease series as a concise format of frequently asked questions (FAQ), tables, and figures. Adult and pediatric infectious disease and HCT content experts developed and answered FAQs. Topics were finalized with harmonized recommendations that were made by assigning an A through E strength of recommendation paired with a level of supporting evidence graded I through III. The third topic in the series focuses on the prevention of cytomegalovirus infection and disease in HCT recipients by reviewing prophylaxis and preemptive therapy approaches; key definitions, relevant risk factors, and diagnostic monitoring considerations are also reviewed.
Collapse
Affiliation(s)
- Morgan Hakki
- Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, Portland, Oregon.
| | - Samuel L Aitken
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lara Danziger-Isakov
- Division of Infectious Disease, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Marian G Michaels
- Division of Pediatric Infectious Diseases, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh and the University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control, & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Michael Boeckh
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Vaccine and Infectious Disease Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Francisco M Marty
- Division of Infectious Diseases, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
21
|
Chemaly RF, Marty FM, Wolfe CR, Lawrence SJ, Dadwal S, Soave R, Farthing J, Hawley S, Montanez P, Hwang J, Ho JHC, Lewis S, Wang G, Boeckh M. DAS181 Treatment of Severe Lower Respiratory Tract Parainfluenza Virus Infection in Immunocompromised Patients: A Phase 2 Randomized, Placebo-Controlled Study. Clin Infect Dis 2021; 73:e773-e781. [PMID: 33569576 PMCID: PMC8326557 DOI: 10.1093/cid/ciab113] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/29/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There are no antiviral therapies for parainfluenza virus (PIV) infections. DAS181, a sialidase fusion protein, has demonstrated activity in in vitro and in animal models of PIV. METHODS Adult immunocompromised patients diagnosed with PIV lower respiratory tract infection (LRTI) who required oxygen supplementation were randomized 2:1 to nebulized DAS181 (4.5 mg/day) or matching placebo for up to 10 days. Randomization was stratified by need for mechanical ventilation (MV) or supplemental oxygen (SO). The primary endpoint was the proportion of patients reaching clinical stability survival (CSS) defined as returning to room air (RTRA), normalization of vital signs for at least 24 hours, and survival up to day 45 from enrollment. RESULTS A total of 111 patients were randomized to DAS181 (n = 74) or placebo (n = 37). CSS was achieved by 45.0% DAS181-treated patients in the SO stratum compared with 31.0% for placebo (P = .15), whereas patients on MV had no benefit from DAS181. The proportion of patients achieving RTRA was numerically higher for SO stratum DAS181 patients (51.7%) compared with placebo (34.5%) at day 28 (P = .17). In a post hoc analysis of solid organ transplant, hematopoietic cell transplantation within 1 year, or chemotherapy within 1 year, more SO stratum patients achieved RTRA on DAS181 (51.8%) compared with placebo (15.8%) by day 28 (P = .012). CONCLUSIONS The primary endpoint was not met, but post hoc analysis of the RTRA component suggests DAS181 may have clinical activity in improving oxygenation in select severely immunocompromised patients with PIV LRTI who are not on mechanical ventilation. Clinical Trials Registration. NCT01644877.
Collapse
Affiliation(s)
- Roy F Chemaly
- Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Francisco M Marty
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Cameron R Wolfe
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Steven J Lawrence
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sanjeet Dadwal
- Department of Infectious Disease, City of Hope, Duarte, California, USA
| | - Rosemary Soave
- New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, USA
| | | | | | | | | | | | | | | | - Michael Boeckh
- Vaccine and Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| |
Collapse
|
22
|
Wongboonsin J, Shah SI, Marty FM, Mount DB, Rennke HG, Murakami N. Osmotic Tubulopathy in a Patient With COVID-19 Treated With Remdesivir. Kidney Int Rep 2021; 6:1987-1991. [PMID: 33997535 PMCID: PMC8112887 DOI: 10.1016/j.ekir.2021.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/05/2021] [Accepted: 04/26/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Sujal I Shah
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Francisco M Marty
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - David B Mount
- Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Helmut G Rennke
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Naoka Murakami
- Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
23
|
Durand ML, Kitt TM, Song Y, Marty FM. Isavuconazole treatment of invasive fungal sinusitis: a post hoc analysis of the SECURE and VITAL trials. Clin Infect Dis 2021; 73:e1380-e1383. [PMID: 33914864 DOI: 10.1093/cid/ciab386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Indexed: 12/26/2022] Open
Abstract
This post-hoc analysis of international phase III isavuconazole trials identified 50 patients (90% immunocompromised or diabetic) with invasive fungal sinusitis (88% mucormycetes, Aspergillus) who received isavuconazole as primary (33) or salvage (17) therapy for median 82 days (range 2-882). Overall survival was 82% at day 42, 70% at day 84.
Collapse
Affiliation(s)
- Marlene L Durand
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
| | | | - Yi Song
- Astellas Pharma Global Development, Inc, Northbrook, IL
| | - Francisco M Marty
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| |
Collapse
|
24
|
Chemaly RF, Dadwal SS, Bergeron A, Ljungman P, Kim YJ, Cheng GS, Pipavath SN, Limaye AP, Blanchard E, Winston DJ, Stiff PJ, Zuckerman T, Lachance S, Rahav G, Small CB, Mullane KM, Patron RL, Lee DG, Hirsch HH, Waghmare A, McKevitt M, Jordan R, Guo Y, German P, Porter DP, Gossage DL, Watkins TR, Marty FM, Chien JW, Boeckh M. A Phase 2, Randomized, Double-blind, Placebo-Controlled Trial of Presatovir for the Treatment of Respiratory Syncytial Virus Upper Respiratory Tract Infection in Hematopoietic-Cell Transplant Recipients. Clin Infect Dis 2021; 71:2777-2786. [PMID: 31793991 PMCID: PMC7108134 DOI: 10.1093/cid/ciz1166] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [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: 08/23/2019] [Accepted: 12/02/2019] [Indexed: 11/13/2022] Open
Abstract
Background Hematopoietic-cell transplant (HCT) recipients are at risk for severe respiratory syncytial virus (RSV) infection. We evaluated the RSV fusion inhibitor presatovir in a randomized, double-blind, Phase II trial in HCT recipients with RSV upper respiratory tract infections. Methods Patients were stratified by lymphopenia (<200/µL) and ribavirin use; were randomized, stratified by lymphopenia (<200/μL) and ribavirin use, to receive oral presatovir at 200 mg or a placebo on Days 1, 5, 9, 13, and 17, and were followed through Day 28. The coprimary efficacy endpoints were the time-weighted average change in the nasal RSV viral load between Days 1 and 9 and the proportion of patients developing lower respiratory tract complications (LRTCs) through Day 28. Results From 23 January 2015 to 16 June 2017, 189 patients were randomly assigned to treatment (96 to presatovir and 93 to the placebo). Presatovir treatment, compared with the placebo treatment, did not significantly affect (prespecified α = 0.01) a time-weighted average decline in the RSV viral load from Day 1 to 9 (treatment difference, −0.33 log10 copies/mL; 95% confidence interval [CI] −.64 to −.02 log10 copies/mL; P = .040) or the progression to LRTC (11.2% vs 19.5%, respectively; odds ratio, 0.50; 95% CI, .22–1.18; P = .11). In a post hoc analysis among patients with lymphopenia, presatovir decreased LRTC development by Day 28 (2/15 [13.3%] vs 9/14 [64.3%], respectively; P = .008), compared with the placebo. Adverse events were similar for patients receiving presatovir and the placebo. Conclusions Presatovir had a favorable safety profile in adult HCT recipients with RSV but did not achieve the coprimary endpoints. Exploratory analyses suggest an antiviral effect among patients with lymphopenia. Clinical Trials Registration NCT02254408; EUDRA-CT#2014-002474-36.
Collapse
Affiliation(s)
- Roy F Chemaly
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanjeet S Dadwal
- Division of Infectious Disease, City of Hope National Medical Center, Duarte, California, USA
| | - Anne Bergeron
- Service de Pneumologie, Université Paris Diderot, Hôpital Saint Louis, Paris, France
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Yae-Jean Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Guang-Shing Cheng
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | - Sudhakar N Pipavath
- Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ajit P Limaye
- Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | - Elodie Blanchard
- Department of Respiratory Diseases, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Drew J Winston
- Department of Medicine, University of California Los Angeles Ronald Reagan Medical Center, Los Angeles, California, USA
| | - Patrick J Stiff
- Department of Hematology/Oncology, Loyola University Medical Center, Chicago, Illinois, USA
| | - Tsila Zuckerman
- Hematology Institute, Rambam Medical Health Care Campus, Haifa, Israel
| | - Silvy Lachance
- Hematology-Oncology Department, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Galia Rahav
- Infectious Diseases Unit, Chaim Sheba Medical Center, Tel Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Catherine B Small
- Department of Medicine/Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| | - Kathleen M Mullane
- Section of Infectious Diseases, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Roberto L Patron
- Department of Infectious Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Dong-Gun Lee
- Department of Infectious Disease, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hans H Hirsch
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Alpana Waghmare
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | | | | | - Ying Guo
- Gilead Sciences Inc., Foster City, California, USA
| | | | | | | | | | - Francisco M Marty
- Department of Infectious Disease, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Michael Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| |
Collapse
|
25
|
Chen K, Arbona-Haddad E, Cheng MP, McDonnell AM, Gooptu M, Orejas JL, Timblin K, Silverman E, Al-Hamed R, Soiffer RJ, Hammond SP, Marty FM. Cytomegalovirus events in high-risk allogeneic hematopoietic-cell transplantation patients who received letermovir prophylaxis. Transpl Infect Dis 2021; 23:e13619. [PMID: 33866648 DOI: 10.1111/tid.13619] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 11/30/2022]
Abstract
Letermovir is approved for the prevention of cytomegalovirus (CMV) reactivation and clinical disease in patients undergoing allogeneic hematopoietic-cell transplantation (HCT). However, there is uncertainty about letermovir's ability to prevent clinical events during the period of prophylaxis as well as after the discontinuation of prophylaxis in the post-transplant setting. We performed a retrospective cohort study in CMV-seropositive allogeneic HCT recipients at high risk of CMV events, who received letermovir for primary prophylaxis from November 2017 through December 2019. We analyzed CMV outcomes for these patients during and after prophylaxis was discontinued. Patient outcomes were followed through June 2020. Sixty patients received letermovir for a median of 13 weeks (range, 1-72 weeks). Thirteen (22%) patients had quantifiable CMV DNAemia (reactivation) during letermovir prophylaxis a median of 9 days (range, 1-59 days) after starting letermovir. Five (8%) of these patients discontinued prophylaxis and received preemptive therapy (PET) with valganciclovir; eight (13%) continued letermovir as prophylaxis and CMV DNAemia resolved without PET. Thirteen patients (22%) had post-prophylaxis CMV reactivation a median of 33 days (range, 14-109 days) after letermovir discontinuation. In four (7%) of these patients, CMV DNAemia resolved without PET, and nine (15%) received PET. No patient developed CMV disease. Patients who developed CMV reactivation during prophylaxis did so shortly after initiation of letermovir, and most patients who developed CMV reactivation post-prophylaxis did so within 60 days after discontinuation of letermovir. Letermovir prophylaxis has changed the presentation of CMV infection in high-risk HCT patients.
Collapse
Affiliation(s)
- Kaiwen Chen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Esther Arbona-Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew P Cheng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anne M McDonnell
- Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA
| | - Mahasweta Gooptu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jose L Orejas
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kaitlyn Timblin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Emily Silverman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rama Al-Hamed
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert J Soiffer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sarah P Hammond
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Francisco M Marty
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
26
|
Schneeweiss S, Carver PL, Datta K, Galar A, Johnson MD, Letourneau AR, Marty FM, Nagel J, Najdzinowicz M, Saul M, Schuster M, Shoham S, Silveira FP, Varughese C, Wilck M, Weatherby L, Oene JV, Walker AM. Long-term risk of hepatocellular carcinoma mortality in 23220 hospitalized patients treated with micafungin or other parenteral antifungals. J Antimicrob Chemother 2021; 75:221-228. [PMID: 31580432 DOI: 10.1093/jac/dkz396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/06/2019] [Accepted: 08/13/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Liver tumours observed in rats exposed to micafungin led to a black box warning upon approval in Europe in 2008. Micafungin's risk for liver carcinogenicity in humans has not been investigated. We sought to describe the risk of fatal hepatocellular carcinoma (HCC) among persons who received micafungin and other parenteral antifungals (PAFs) with up to 12 years of follow-up. METHODS We assembled a US multicentre cohort of hospitalized patients who received micafungin or other PAFs between 2005 and 2012. We used propensity score (PS) matching on patient characteristics from electronic medical records to compare rates of HCC mortality identified through the National Death Index though to the end of December 2016. We computed HRs and 95% CIs. RESULTS A total of 40110 patients who received a PAF were identified; 6903 micafungin recipients (87% of those identified) were successfully matched to 16317 comparator PAF users. Ten incident HCC deaths, one in the micafungin-exposed group and nine among comparator PAF users, occurred in 71285 person-years of follow-up. The HCC mortality rate was 0.05 per 1000 person-years in micafungin patients and 0.17 per 1000 person-years in comparator PAF patients. The PS-matched HR for micafungin versus comparator PAF was 0.29 (95% CI 0.04-2.24). CONCLUSIONS Both micafungin and comparator PAFs were associated with HCC mortality rates of <0.2 per 1000 person-years. Given the very low event rates, any potential risk for HCC should not play a role in clinical decisions regarding treatment with micafungin or other PAFs investigated in this study.
Collapse
Affiliation(s)
- Sebastian Schneeweiss
- WHISCON, Dedham, MA, USA.,Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham & Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Peggy L Carver
- University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Kausik Datta
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alicia Galar
- Division of Infectious Diseases, Department of Medicine, Brigham & Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Melissa D Johnson
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Alyssa R Letourneau
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - Francisco M Marty
- Division of Infectious Diseases, Department of Medicine, Brigham & Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Jerod Nagel
- University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Maryann Najdzinowicz
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Melissa Saul
- Division of Infectious Diseases, University of Pittsburgh, and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mindy Schuster
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shmuel Shoham
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fernanda P Silveira
- Division of Infectious Diseases, University of Pittsburgh, and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christy Varughese
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - Marissa Wilck
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | |
Collapse
|
27
|
Cheng AP, Cheng MP, Gu W, Sesing Lenz J, Hsu E, Schurr E, Bourque G, Bourgey M, Ritz J, Marty FM, Chiu CY, Vinh DC, De Vlaminck I. Cell-free DNA tissues of origin by methylation profiling reveals significant cell, tissue, and organ-specific injury related to COVID-19 severity. Med 2021; 2:411-422.e5. [PMID: 33521749 PMCID: PMC7836424 DOI: 10.1016/j.medj.2021.01.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/16/2020] [Accepted: 01/06/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) primarily affects the lungs, but evidence of systemic disease with multi-organ involvement is emerging. Here, we developed a blood test to broadly quantify cell-, tissue-, and organ-specific injury due to COVID-19. METHODS Our test leverages genome-wide methylation profiling of circulating cell-free DNA in plasma. We assessed the utility of this test to identify subjects with severe disease in two independent, longitudinal cohorts of hospitalized patients. Cell-free DNA profiling was performed on 104 plasma samples from 33 COVID-19 patients and compared to samples from patients with other viral infections and healthy controls. FINDINGS We found evidence of injury to the lung and liver and involvement of red blood cell progenitors associated with severe COVID-19. The concentration of cell-free DNA correlated with the World Health Organization (WHO) ordinal scale for disease progression and was significantly increased in patients requiring intubation. CONCLUSIONS This study points to the utility of cell-free DNA as an analyte to monitor and study COVID-19. FUNDING This work was supported by NIH grants 1DP2AI138242 (to I.D.V.), R01AI146165 (to I.D.V., M.P.C., F.M.M., and J.R.), 1R01AI151059 (to I.D.V.), K08-CA230156 (to W.G.), and R33-AI129455 to C.Y.C., a Synergy award from the Rainin Foundation (to I.D.V.), a SARS-CoV-2 seed grant at Cornell (to I.D.V.), a National Sciences and Engineering Research Council of Canada fellowship PGS-D3 (to A.P.C.), and a Burroughs-Wellcome CAMS Award (to W.G.). D.C.V. is supported by a Fonds de la Recherche en Sante du Quebec Clinical Research Scholar Junior 2 award. C.Y.C. is supported by the California Initiative to Advance Precision Medicine, and the Charles and Helen Schwab Foundation.
Collapse
Affiliation(s)
| | | | - Wei Gu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
- UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, USA
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Joan Sesing Lenz
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Elaine Hsu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Erwin Schurr
- Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Guillaume Bourque
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Canadian Centre for Computational Genomics, Montreal, QC, Canada
| | - Mathieu Bourgey
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Canadian Centre for Computational Genomics, Montreal, QC, Canada
| | - Jerome Ritz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Francisco M Marty
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, USA
| | - Charles Y Chiu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
- UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, USA
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA
| | - Donald C Vinh
- McGill University Health Center, Montreal, QC, Canada
| | - Iwijn De Vlaminck
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| |
Collapse
|
28
|
Schwartz S, Cornely OA, Hamed K, Marty FM, Maertens J, Rahav G, Herbrecht R, Heinz WJ. Isavuconazole for the treatment of patients with invasive fungal diseases involving the central nervous system. Med Mycol 2021; 58:417-424. [PMID: 31613363 PMCID: PMC7261609 DOI: 10.1093/mmy/myz103] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [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: 06/10/2019] [Revised: 09/16/2019] [Accepted: 10/02/2019] [Indexed: 12/17/2022] Open
Abstract
The incidence of invasive fungal diseases (IFDs) with central nervous system (CNS) involvement is increasing due to the rising numbers of immunocompromised individuals, such as patients receiving chemotherapy, transplantation procedures, or immune-modulating therapies. CNS IFDs cause significant morbidity and mortality, and treatments are complicated by difficulties in identifying fungal pathogens and delivering antifungal agents to the CNS. Isavuconazole is a novel triazole with broad-spectrum activity that has shown good blood–brain barrier penetration in animal models. We present a retrospective analysis of isavuconazole in the treatment of patients with CNS IFDs and who either participated in the phase III VITAL or SECURE clinical trials, or were included in a named-patient program. A total of 36 patients were identified, including 27 patients from the clinical trials. Of these patients, 47.2% had hematologic malignancies, while 13.9% had no identifiable underlying conditions. Mucorales, Aspergillus species, and Cryptococcus species accounted for 30.6%, 22.2%, and 13.9% of infections, respectively. The overall survival rate was 80.6% at day 42 and 69.4% at day 84, and at the end of treatment, a complete or partial clinical response was achieved in 58.3% of patients. Isavuconazole exhibited clinical activity in a variety of CNS IFDs.
Collapse
Affiliation(s)
- Stefan Schwartz
- Department of Hematology and Oncology, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Oliver A Cornely
- Department I of Internal Medicine, European Diamond Excellence Center of Medical Mycology, University Hospital Cologne; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD); and Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
| | - Kamal Hamed
- Basilea Pharmaceutica International Ltd., Basel, Switzerland
| | - Francisco M Marty
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Johan Maertens
- Department of Hematology, University Hospital Gasthuisberg, Gasthuisberg; and Department of Infection, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Galia Rahav
- Infectious Disease Unit, Sheba Medical Center, Tel Hashomer; and Sackler Medical School, Tel Aviv University, Israel
| | - Raoul Herbrecht
- Department of Oncology and Hematology, Hautepierre University Hospital; and University of Strasbourg, INSERM UMR1113/IRFAC, Strasbourg, France
| | - Werner J Heinz
- Weiden Clinic, Weiden; and University Medical Center, Würzburg, Germany
| |
Collapse
|
29
|
Feldman CH, Speyer C, Ashby R, L Bermas B, Bhattacharyya S, Chakravarty E, Everett B, Ferucci E, Hersh AO, Marty FM, Merola JF, Ramsey-Goldman R, Rovin BH, Son MB, Tarter L, Waikar S, Yazdany J, Weissman JS, Costenbader KH. Development of a Set of Lupus-Specific, Ambulatory Care-Sensitive, Potentially Preventable Adverse Conditions: A Delphi Consensus Study. Arthritis Care Res (Hoboken) 2021; 73:146-157. [PMID: 31628721 DOI: 10.1002/acr.24095] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/15/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Individuals with systemic lupus erythematosus (SLE) are at high risk for infections and SLE- and medication-related complications. The present study was undertaken to define a set of SLE-specific adverse outcomes that could be prevented, or their complications minimized, if timely, effective ambulatory care had been received. METHODS We used a modified Delphi process beginning with a literature review and key informant interviews to select initial SLE-specific potentially preventable conditions. We assembled a panel of 16 nationally recognized US-based experts from 8 subspecialties. Guided by the RAND-UCLA Appropriateness Method, we held 2 survey rounds with controlled feedback and an interactive webinar to reach consensus regarding preventability and importance on a population level for a set of SLE-specific adverse conditions. In a final round, the panelists endorsed the potentially preventable conditions. RESULTS Thirty-five potential conditions were initially proposed; 62 conditions were ultimately considered during the Delphi process. The response rate was 100% for both survey rounds, 88% for the webinar, and 94% for final approval. The 25 SLE-specific conditions meeting consensus as potentially preventable and important on a population level fell into 4 categories: vaccine-preventable illnesses (6 conditions), medication-related complications (8 conditions), reproductive health-related complications (6 conditions), and SLE-related complications (5 conditions). CONCLUSION We reached consensus on a diverse set of adverse outcomes relevant to SLE patients that may be preventable if patients receive high-quality ambulatory care. This set of outcomes may be studied at the health system level to determine how to best allocate resources and improve quality to reduce avoidable outcomes and disparities among those at highest risk.
Collapse
Affiliation(s)
- Candace H Feldman
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Cameron Speyer
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rachel Ashby
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Brendan Everett
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Francisco M Marty
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joseph F Merola
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Brad H Rovin
- Ohio State University Wexner Medical Center, Columbus
| | - Mary Beth Son
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Laura Tarter
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sushrut Waikar
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Karen H Costenbader
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
30
|
Ljungman P, Schmitt M, Marty FM, Maertens J, Chemaly RF, Kartsonis NA, Butterton JR, Wan H, Teal VL, Sarratt K, Murata Y, Leavitt RY, Badshah C. A Mortality Analysis of Letermovir Prophylaxis for Cytomegalovirus (CMV) in CMV-seropositive Recipients of Allogeneic Hematopoietic Cell Transplantation. Clin Infect Dis 2021; 70:1525-1533. [PMID: 31179485 PMCID: PMC7146004 DOI: 10.1093/cid/ciz490] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [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: 02/05/2019] [Accepted: 06/07/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND In a phase 3 trial, letermovir reduced clinically significant cytomegalovirus infections (CS-CMVi) and all-cause mortality at week 24 versus placebo in CMV-seropositive allogeneic hematopoietic cell transplantation (HCT) recipients. This post hoc analysis of phase 3 data further investigated the effects of letermovir on all-cause mortality. METHODS Kaplan-Meier survival curves were generated by treatment group for all-cause mortality. Observations were censored at trial discontinuation for reasons other than death or at trial completion. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox modeling, adjusting for risk factors associated with mortality. RESULTS Of 495 patients with no detectable CMV DNA at randomization, 437 had vital-status data available through week 48 post-HCT at trial completion (101 deaths, 20.4%). Following letermovir prophylaxis, the HR for all-cause mortality was 0.58 (95% CI, 0.35-0.98; P = .04) at week 24 and 0.74 (95% CI, 0.49-1.11; P = .14) at week 48 post-HCT versus placebo. Incidence of all-cause mortality through week 48 post-HCT in the letermovir group was similar in patients with or without CS-CMVi (15.8 vs 19.4%; P = .71). However, in the placebo group, all-cause mortality at week 48 post-HCT was higher in patients with versus those without CS-CMVi (31.0% vs 18.2%; P = .02). The HR for all-cause mortality in patients with CS-CMVi was 0.45 (95% CI, 0.21-1.00; P = .05) at week 48 for letermovir versus placebo. CONCLUSIONS Letermovir may reduce mortality by preventing or delaying CS-CMVi in HCT recipients. CLINICAL TRIALS REGISTRATION clinicaltrials.gov, NCT02137772.
Collapse
Affiliation(s)
- Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | - Francisco M Marty
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Roy F Chemaly
- University of Texas, MD Anderson Cancer Center, Houston
| | | | | | - Hong Wan
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | | | | | | | | |
Collapse
|
31
|
Alexander BD, Cornely O, Pappas P, Miller R, Vazquez JA, Ostrosky-Zeichner L, Spec A, Rautemaa-Richardson R, Krause R, Thompson III GR, Morse C, Sanders JW, Andes D, Andes D, Lyon G, Marty FM, Silverman E, Miceli MH, Patterson TF, Hoenigl M, Azie N, Angulo DA. 1248. Efficacy and Safety of Oral Ibrexafungerp in 41 Patients with Refractory Fungal Diseases, Interim Analysis of a Phase 3 Open-label Study (FURI). Open Forum Infect Dis 2020. [PMCID: PMC7777495 DOI: 10.1093/ofid/ofaa439.1432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Candida infections resistant to currently available antifungals are an emerging global threat. Ibrexafungerp is an investigational broad-spectrum glucan synthase inhibitor antifungal with activity against Candida and Aspergillus species, including azole- and echinocandin-resistant strains. A Phase 3 open-label, single-arm study of oral ibrexafungerp (FURI) (Clinicaltrials.gov NCT03059992) is ongoing for the treatment of patients (≥18 years) with fungal diseases who are intolerant of or refractory to standard antifungal therapies.
Methods
An independent Data Review Committee (DRC) provided an assessment of treatment response for 41 patients. Patients were enrolled in 22 centers from 6 countries. Patients were eligible for enrollment if they had proven or probable, invasive or severe mucocutaneous candidiasis and documented evidence of failure of, intolerance to, or toxicity related to a currently approved standard-of-care antifungal treatment or could not receive approved oral antifungal options (e.g., susceptibility of the organism) and a continued IV antifungal therapy was undesirable or unfeasible.
Results
The 41 patients assessed had the following infection types: intra-abdominal abscesses, oropharyngeal candidiasis, esophageal candidiasis, candidemia, and others. The DRC adjudicated 23 patients (56%) as achieving complete or partial response, 11 patients (27%) maintaining stable disease, 6 patients (15%) with progression of disease and one case was considered as indeterminate. The efficacy of oral ibrexafungerp by pathogen is shown in Table 1. Ibrexafungerp was well-tolerated with the most common treatment-related adverse events being of gastrointestinal origin. No deaths due to progression of fungal disease were reported.
Table 1: Ibrexafungerp Outcomes by Pathogen
Conclusion
Preliminary analysis of these 41 cases indicate that oral ibrexafungerp provides a favorable therapeutic response in the majority of patients with difficult to treat Candida spp. infections, including those caused by non-albicans Candida species.
Disclosures
Barbara D. Alexander, MD, MHS, SCYNEXIS, Inc. (Employee, Scientific Research Study Investigator, Research Grant or Support) Oliver Cornely, Prof., Actelion (Grant/Research Support)Actelion (Other Financial or Material Support, Personal fees)Al Jazeera Pharmaceuticals (Consultant)Allecra Therapeutics (Other Financial or Material Support, Personal fees)Amplyx (Other Financial or Material Support, Personal fees)Amplyx (Grant/Research Support)Astellas (Grant/Research Support)Astellas (Other Financial or Material Support, Personal fees)Basilea (Other Financial or Material Support, Personal fees)Basilea (Grant/Research Support)Biosys UK Limited (Other Financial or Material Support, Personal fees)Cidara (Other Financial or Material Support, Personal fees)Cidara (Grant/Research Support)Da Volterra (Grant/Research Support)Da Volterra (Other Financial or Material Support, Personal fees)Entasis (Other Financial or Material Support, Personal fees)F2G (Other Financial or Material Support)F2G (Grant/Research Support)Gilead (Grant/Research Support)Gilead (Other Financial or Material Support, Personal fees)Grupo Biotoscana (Other Financial or Material Support, Personal fees)Janssen Pharmaceuticals (Grant/Research Support)Matinas (Other Financial or Material Support, Personal fees)Medicines Company (Grant/Research Support)MedPace (Grant/Research Support)MedPace (Other Financial or Material Support, Personal fees)Melinta Therapeutics (Grant/Research Support)Menarini Ricerche (Other Financial or Material Support, Personal fees)Merck/MSD (Other Financial or Material Support, Personal fees)Merck/MSD (Grant/Research Support)Mylan Pharmaceuticals (Consultant)Nabriva Therapeutics (Other Financial or Material Support, Personal fees)Octapharma (Other Financial or Material Support, Personal fees)Paratek Pharmaceuticals (Other Financial or Material Support, Personal fees)Pfizer (Other Financial or Material Support, Personal fees)Pfizer (Grant/Research Support)PSI (Other Financial or Material Support, Personal fees)Rempex (Other Financial or Material Support, Personal fees)Roche Diagnostics (Other Financial or Material Support, Personal fees)Scynexis (Other Financial or Material Support, Personal fees)Scynexis (Grant/Research Support)Seres Therapeutics (Other Financial or Material Support, Personal fees)Tetraphase (Other Financial or Material Support, Personal fees) Peter Pappas, MD, SCYNEXIS, Inc. (Consultant, Advisor or Review Panel member, Research Grant or Support) Rachel Miller, MD, SCYNEXIS, Inc. (Scientific Research Study Investigator) Luis Ostrosky-Zeichner, MD, Amplyx (Scientific Research Study Investigator)Astellas (Consultant, Scientific Research Study Investigator, Other Financial or Material Support, Non-branded educational speaking)Biotoscana (Consultant, Other Financial or Material Support, Non-branded educational speaking)Cidara (Consultant, Scientific Research Study Investigator)F2G (Consultant)Gilead (Consultant)Mayne (Consultant)Octapharma (Consultant)Pfizer (Other Financial or Material Support, Non-branded educational speaking)Scynexis (Consultant, Grant/Research Support, Scientific Research Study Investigator)Stendhal (Consultant)Viracor (Consultant) Andrej Spec, MD, SCYNEXIS, Inc. (Scientific Research Study Investigator, Advisor or Review Panel member) Riina Rautemaa-Richardson, DDS, PhD, FRCPath, SCYNEXIS, Inc. (Scientific Research Study Investigator) Robert Krause, MD, SCYNEXIS, Inc. (Scientific Research Study Investigator) Caryn Morse, MD, SCYNEXIS, Inc. (Scientific Research Study Investigator) John W. Sanders, III, MD, SCYNEXIS, Inc. (Scientific Research Study Investigator) David Andes, MD, SCYNEXIS, Inc. (Scientific Research Study Investigator, Advisor or Review Panel member) George Lyon, MD, SCYNEXIS, Inc. (Scientific Research Study Investigator) Francisco M. Marty, MD, Allovir (Consultant)Amplyx (Consultant)Ansun (Scientific Research Study Investigator)Avir (Consultant)Cidara (Scientific Research Study Investigator)F2G (Consultant, Scientific Research Study Investigator)Kyorin (Consultant)Merck (Consultant, Grant/Research Support, Scientific Research Study Investigator)New England Journal of Medicine (Other Financial or Material Support, Honorarium for Video)Regeneron (Consultant, Scientific Research Study Investigator)ReViral (Consultant)Scynexis (Scientific Research Study Investigator)Symbio (Consultant)Takeda (Scientific Research Study Investigator)United Medical (Consultant)WHISCON (Scientific Research Study Investigator) Marisa H. Miceli, MD, FIDSA, SCYNEXIS, Inc. (Advisor or Review Panel member) Thomas F. Patterson, MD, SCYNEXIS, Inc. (Advisor or Review Panel member) Martin Hoenigl, MD, SCYNEXIS, Inc. (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member) Nkechi Azie, MD, SCYNEXIS, Inc. (Employee, Shareholder) David A. Angulo, MD, SCYNEXIS, Inc. (Employee, Shareholder)
Collapse
Affiliation(s)
| | - Oliver Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Peter Pappas
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Jose A Vazquez
- Medical College of Georgia at Augusta University, Augusta, Georgia
| | | | - Andrej Spec
- Washington University, St. Louis, St. Louis, Missouri
| | | | | | | | - Caryn Morse
- Wake Forest Baptist Hospital, Winston-Salem, North Carolina
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Marty FM, Malhotra P, Gottlieb RL, Tashima KT, Galli M, Chai LYA, SenGupta D, Hyland RH, Wang H, Zhong L, Cao H, Chokkalingam A, Osinusi A, Brainard DM, Brown M, Goikoetxea AJ, Jain M, Hui DSC, Bernasconi E, Spinner C. 72. Remdesivir vs Standard Care in Patients with Moderate covid-19. Open Forum Infect Dis 2020. [PMCID: PMC7777983 DOI: 10.1093/ofid/ofaa439.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Remdesivir (RDV) shortens time to recovery time in patients with severe COVID-19. Its effect in patients with moderate COVID-19 remains unclear. Methods We conducted an open-label, phase 3 trial (NCT04252664) involving hospitalized patients with confirmed SARS-CoV-2 infection, evidence of pulmonary infiltrates, and oxygen saturation >94% on room air. Patients were randomly assigned 1:1:1 to receive up to 5d or 10d of RDV with standard of care (SoC), or SoC alone; patients could be discharged prior to completing per-protocol assigned treatment duration. RDV was dosed intravenously at 200 mg on d1, 100 mg daily thereafter. Patients were evaluated daily while hospitalized, and via telephone if discharged. The primary endpoint was clinical status on d11 assessed on a 7-point ordinal scale. Results regarding the primary endpoint are expected to be published before IDWeek 2020; we plan to present d28 results at the meeting. Results In total, 584 patients underwent randomization and started their assigned treatment (191, 5d RDV; 193, 10d RDV; 200, SoC). By d11, ³ 2 point improvement on the ordinal scale occurred in 70% of patients in the 5d arm, 65% in the 10d arm, and 61% in the SoC arm. Patients in the 5d RDV arm were significantly more likely to have an improvement in clinical status than those receiving SoC (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.09–2.48; P=0.017); OR of improvement for the 10d RDV arm compared to SoC was 1.31 (95% CI, 0.88–1.95]; p=0.183). This improvement in the 5-day arm over the SOC arm was noted from d6 through d11. We observed a peak of discharges corresponding with the assigned treatment duration of RDV, with increased discharges at d6 in the 5-day arm and at d11 in the 10-day arm. A worsening of clinical status of ≥ 1 point in the ordinal scale was observed more commonly in the SoC am (n=19, 10%) versus the 5d RDV (n=7, 4%) and 10d RDV (n=9, 5%). Conclusion RDV for up to 5 days was superior to SoC in improving the clinical status of patients with moderate COVID-19 by d11. We will report d28 outcomes at the meeting. Disclosures Francisco M. Marty, MD, Allovir (Consultant)Amplyx (Consultant)Ansun (Scientific Research Study Investigator)Avir (Consultant)Cidara (Scientific Research Study Investigator)F2G (Consultant, Scientific Research Study Investigator)Kyorin (Consultant)Merck (Consultant, Grant/Research Support, Scientific Research Study Investigator)New England Journal of Medicine (Other Financial or Material Support, Honorarium for Video)Regeneron (Consultant, Scientific Research Study Investigator)ReViral (Consultant)Scynexis (Scientific Research Study Investigator)Symbio (Consultant)Takeda (Scientific Research Study Investigator)United Medical (Consultant)WHISCON (Scientific Research Study Investigator) Prashant Malhotra, MD, Gilead Sciences Inc. (Scientific Research Study Investigator) Robert L. Gottlieb, MD, Gilead Sciences Inc. (Scientific Research Study Investigator) Karen T. Tashima, MD, Bristol-Myers Squibb (Research Grant or Support)Gilead Sciences Inc. (Grant/Research Support, Scientific Research Study Investigator)GlaxoSmithKline (Research Grant or Support)Merck (Research Grant or Support)Tibotec (Research Grant or Support)Viiv Healthcare (Research Grant or Support) Massimo Galli, MD, Gilead Sciences Inc. (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Other Financial or Material Support, Personal fees) Louis Yi Ann Chai, MD, Gilead Sciences Inc. (Scientific Research Study Investigator) Devi SenGupta, MD, Gilead Sciences Inc. (Employee, Shareholder) Robert H. Hyland, MD, Gilead Sciences Inc. (Employee, Shareholder) Hongyuan Wang, PhD, Gilead Sciences Inc. (Employee, Shareholder) Lijie Zhong, PhD, Gilead Sciences Inc. (Employee, Shareholder) Huyen Cao, MD, Gilead Sciences Inc. (Employee, Shareholder) Anand Chokkalingam, PhD, Gilead Sciences (Employee) Anu Osinusi, MD, Gilead Sciences (Employee) Diana M. Brainard, MD, Gilead Sciences (Employee) Michael Brown, MD, Gilead Sciences Inc. (Scientific Research Study Investigator) Ane Josune Goikoetxea, MD, Gilead Sciences Inc. (Scientific Research Study Investigator) Mamta Jain, MD, Gilead Sciences Inc. (Scientific Research Study Investigator, Research Grant or Support)GlaxoSmithKline (Advisor or Review Panel member)Janssen (Research Grant or Support)Merck (Research Grant or Support) David Shu Cheong Hui, MD, Gilead Sciences Inc. (Scientific Research Study Investigator) Enos Bernasconi, MD, Gilead Sciences Inc. (Scientific Research Study Investigator) Christoph Spinner, MD, AbbVie (Advisor or Review Panel member, Other Financial or Material Support, Travel)Bristol-Myers Squibb (Grant/Research Support, Advisor or Review Panel member, Other Financial or Material Support, Travel)Gilead Sciences Inc. (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Other Financial or Material Support, Travel)Janssen (Grant/Research Support, Advisor or Review Panel member, Other Financial or Material Support, Travel)MSD (Grant/Research Support, Advisor or Review Panel member, Other Financial or Material Support, Travel)Viiv Healthcare (Grant/Research Support, Advisor or Review Panel member, Other Financial or Material Support, Travel)
Collapse
Affiliation(s)
| | | | | | | | - Massimo Galli
- Dipartimento di Malattie Infettive, Malattie Infettive I- Malattie Infettive III, ASST Fatebenfratelli Sacco Ospedale Luigi Sacco, Milano, Lombardia, Italy
| | - Louis Yi Ann Chai
- National University Hospital, National University Health System, Singapore, Not Applicable, Singapore
| | | | | | | | | | - Huyen Cao
- Gilead Sciences Inc., Foster City, California
| | | | | | | | - Michael Brown
- University College Hospital, London, England, United Kingdom
| | | | | | | | - Enos Bernasconi
- Servizio Malattie infettive, Ente Ospedaliero Cantonale, Ospedale, Ticino, Luzern, Switzerland
| | - Christoph Spinner
- Department of Medicine II, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany, Munich, Bayern, Germany
| |
Collapse
|
33
|
Ison MG, Chao N, Marty FM, Moon SH, Zhang Z, Chandak A. 195. Economic and Clinical Burden of Respiratory Virus Infections in Allogeneic Hematopoietic Cell Transplantation Recipients. Open Forum Infect Dis 2020. [PMCID: PMC7776792 DOI: 10.1093/ofid/ofaa439.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Respiratory viruses (RV), including respiratory syncytial virus (RSV), influenza, parainfluenza virus (PIV), and human metapneumovirus (HMPV), frequently lead to serious complications such as lower respiratory tract infections and death in allogeneic hematopoietic cell transplantation (HCT) recipients. We used a large US claims database to compare the total reimbursement (TR), health resource utilization (HRU) and clinical outcomes between HCT patients with and without RV infections (RVI).
Methods
We used the Decision Resources Group Real World Evidence Data Repository to identify HCT recipients with date of service for the procedure from 1/1/2012-12/31/2017. We estimated the reimbursements from submitted charges using a reimbursement to charge ratio of 0.425. We examined the study outcomes in the year following HCT in patients with and without RVI. We also used a generalized linear model to determine adjusted TR stratified by the presence or absence of any acute or chronic graft-versus-host diseases (GVHD) after adjusting for age, health plan, underlying disease, stem cell source, number of comorbidities, baseline costs, and follow-up time.
Results
The study included 13,363 patients, representing 22% of HCTs reported to CIBMTR for the study period, of which 1,368 (10%) were coded with an RVI in the year following HCT: 578 (4%) RSV, 687 (5%) influenza, 166 (1%) PIV, and 181 (1%) HMPV. Unadjusted median TR were $132,395 higher for any RVI ($139,439 RSV, $101,963 influenza, $185,041 PIV and $248,029 HMPV) compared to those without RVI (Table 1). Adjusted TR were significantly higher for patients with any RVI compared to patients without that infection (p< .01) with or without GVHD (Figure 1). Patients with any RVI had significantly longer length of stay (LOS) for the HCT hospitalization, readmission rate and LOS after HCT hospitalization compared to patients without RVI (p< 0.05) (Table 2). A significantly higher proportion of patients with any RVI had pneumonia as compared to patients without that infection, irrespective of presence of GVHD (p< .0001).
Table 1: Total healthcare reimbursement within one year of undergoing allogeneic HCT for patients with and without respiratory viral infections
Figure 1: Adjusted total reimbursements within one year of undergoing allogeneic HCT for patients with and without respiratory viral infections
Table 2: Health resource utilization within one year of undergoing allogeneic HCT for patients with and without respiratory viral infections
Conclusion
Allogeneic HCT patients with RVI have a significantly higher burden of TR, health resource utilization and worse clinical outcomes such as pneumonia during one year of undergoing HCT, regardless of the presence of GVHD.
Disclosures
Michael G. Ison, MD MS, AlloVir (Consultant) Francisco M. Marty, MD, Allovir (Consultant)Amplyx (Consultant)Ansun (Scientific Research Study Investigator)Avir (Consultant)Cidara (Scientific Research Study Investigator)F2G (Consultant, Scientific Research Study Investigator)Kyorin (Consultant)Merck (Consultant, Grant/Research Support, Scientific Research Study Investigator)New England Journal of Medicine (Other Financial or Material Support, Honorarium for Video)Regeneron (Consultant, Scientific Research Study Investigator)ReViral (Consultant)Scynexis (Scientific Research Study Investigator)Symbio (Consultant)Takeda (Scientific Research Study Investigator)United Medical (Consultant)WHISCON (Scientific Research Study Investigator) Seung Hyun Moon, MD, MPA, AlloVir (Employee, Shareholder) Zhiji Zhang, MS, AlloVir (Independent Contractor) Aastha Chandak, PhD, AlloVir (Independent Contractor)
Collapse
|
34
|
Marty FM, Chemaly RF, Mullane KM, Lee DG, Hirsch HH, Small CB, Bergeron A, Shoham S, Ljungman P, Waghmare A, Blanchard E, Kim YJ, McKevitt M, Porter DP, Jordan R, Guo Y, German P, Boeckh M, Watkins TR, Chien JW, Dadwal SS. A Phase 2b, Randomized, Double-blind, Placebo-Controlled Multicenter Study Evaluating Antiviral Effects, Pharmacokinetics, Safety, and Tolerability of Presatovir in Hematopoietic Cell Transplant Recipients with Respiratory Syncytial Virus Infection of the Lower Respiratory Tract. Clin Infect Dis 2020; 71:2787-2795. [PMID: 31915807 PMCID: PMC7108198 DOI: 10.1093/cid/ciz1167] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/28/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Presatovir significantly reduced nasal viral load, signs, and symptoms of respiratory syncytial virus (RSV) infection in a human challenge study. We evaluated presatovir in hematopoietic-cell transplant (HCT) recipients with RSV lower respiratory tract infection (LRTI). METHODS Patients with confirmed RSV in upper and lower respiratory tract and new chest X-ray abnormalities were randomized (1:1), stratified by supplemental oxygen and ribavirin use, to receive oral presatovir 200 mg or placebo every 4 days for 5 doses. The primary endpoint was time-weighted average change in nasal RSV viral load through day 9. Secondary endpoints included supplemental oxygen-free days, incident respiratory failure requiring mechanical ventilation, and all-cause mortality. RESULTS From January 31, 2015, to March 20, 2017, 60 patients from 17 centers were randomized (31 presatovir, 29 placebo); 59 received study treatment (50 allogeneic, 9 autologous HCT). In the efficacy population (29 presatovir, 28 placebo), presatovir treatment did not significantly reduce time-weighted average change in viral load (-1.12 vs -1.09 log10 copies/mL; treatment difference -0.02 log10 copies/mL, 95% confidence interval: -.62, .57; P = .94), median supplemental oxygen-free days (26 vs 28 days, P = .84), incident respiratory failure (10.3 vs 10.7%, P = .98), or all-cause mortality (0 vs 7.1%, P = .19) versus placebo. Adverse events were similar between arms (presatovir 80%, placebo 79%). Resistance-associated substitutions in RSV fusion protein emerged in 6/29 presatovir-treated patients. CONCLUSIONS Presatovir treatment was well tolerated in HCT patients with RSV LRTI but did not improve virologic or clinical outcomes versus placebo. CLINICAL TRIALS REGISTRATION www.clinicaltrials.gov, NCT02254421; EudraCT, #2014-002475-29.
Collapse
Affiliation(s)
- Francisco M Marty
- Division of Infectious Disease, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kathleen M Mullane
- Section of Infectious Diseases, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Dong-Gun Lee
- Department of Infectious Disease, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hans H Hirsch
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Catherine B Small
- Department of Medicine/Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| | - Anne Bergeron
- Service de pneumologie, Univ Paris Diderot, Hôpital Saint Louis, Paris, France
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Alpana Waghmare
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | - Elodie Blanchard
- Department of Respiratory Diseases, CHU de Bordeaux, Bordeaux, France
| | - Yae-Jean Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | - Ying Guo
- Gilead Sciences, Inc., Foster City, California, USA
| | | | - Michael Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | | | | | - Sanjeet S Dadwal
- Division of Infectious Disease, City of Hope National Medical Center, Duarte, California, USA
| |
Collapse
|
35
|
|
36
|
Kauke-Navarro M, Tchiloemba B, Haug V, Kollar B, Diehm Y, Safi AF, Treister NS, Annino DJ, Marty FM, Lian CG, Murphy GF, Pomahac B. Pathologies of oral and sinonasal mucosa following facial vascularized composite allotransplantation. J Plast Reconstr Aesthet Surg 2020; 74:1562-1571. [PMID: 33376080 DOI: 10.1016/j.bjps.2020.11.028] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/28/2020] [Accepted: 11/22/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cutaneous changes of facial vascularized composite allotransplants (fVCAs) are extensively described in the literature. Parts of the nose, nasal, and oral cavities are included in most fVCAs. Distinctively, the nose and mouth are lined by mucosa. Little is known about the histopathology and complications of the mucosa involved in fVCA patients. METHODS The study constitutes a retrospective cohort study of nine fVCA patients. Medical records were reviewed for information about changes of oral and nasal mucous membranes. Types of mucosal lesions were recorded and analyzed. Uni- and multivariate generalized estimating equation (GEE) models were used to assess the odds of developing mucosal inflammation in the presence of clinico-pathologic variables. RESULTS A total of 186 clinical encounters with examination of oral and nasal mucous membranes were included. Membranes were devoid of clinical pathology in 101 instances (53% of all clinical assessments). Ulcerations/erosions (27%), edema (18%), and erythema (14%) were the most common lesions. Oral lesions affected the lips (58%), buccal mucosa (38%), and palate (5%). Sinonasal processes predominantly affected nasal vestibules and septae. In univariate analysis, sirolimus, skin rejection, and skin Banff grade were associated with the presence of an acute inflammatory mucosal lesion (p<0.05). In multivariate analysis, skin Banff grade and sirolimus were independent predictors of mucosal inflammation. CONCLUSION Pathologies of fVCA mucous membranes are more common than previously reported. Mucosal assessment plays an important role in the pleomorphic allograft rejection process evaluation rather than diagnosis and treatment based on cutaneous pathology. A closer look at the pathophysiology of fVCA mucosal rejection and inflammation is warranted.
Collapse
Affiliation(s)
- Martin Kauke-Navarro
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
| | - Bianief Tchiloemba
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Valentin Haug
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Branislav Kollar
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Yannick Diehm
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Ali-Farid Safi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Nathaniel S Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, United States
| | - Donald J Annino
- Division of Otolaryngology, Department of Surgery, Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, United States
| | - Francisco M Marty
- Division of Infectious Diseases, Brigham and Women's Hospital, United States
| | - Christine G Lian
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - George F Murphy
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
| |
Collapse
|
37
|
Goldman JD, Lye DCB, Hui DS, Marks KM, Bruno R, Montejano R, Spinner CD, Galli M, Ahn MY, Nahass RG, Chen YS, SenGupta D, Hyland RH, Osinusi AO, Cao H, Blair C, Wei X, Gaggar A, Brainard DM, Towner WJ, Muñoz J, Mullane KM, Marty FM, Tashima KT, Diaz G, Subramanian A. Remdesivir for 5 or 10 Days in Patients with Severe Covid-19. N Engl J Med 2020; 383:1827-1837. [PMID: 32459919 PMCID: PMC7377062 DOI: 10.1056/nejmoa2015301] [Citation(s) in RCA: 915] [Impact Index Per Article: 228.8] [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: 01/08/2023]
Abstract
BACKGROUND Remdesivir is an RNA polymerase inhibitor with potent antiviral activity in vitro and efficacy in animal models of coronavirus disease 2019 (Covid-19). METHODS We conducted a randomized, open-label, phase 3 trial involving hospitalized patients with confirmed SARS-CoV-2 infection, oxygen saturation of 94% or less while they were breathing ambient air, and radiologic evidence of pneumonia. Patients were randomly assigned in a 1:1 ratio to receive intravenous remdesivir for either 5 days or 10 days. All patients received 200 mg of remdesivir on day 1 and 100 mg once daily on subsequent days. The primary end point was clinical status on day 14, assessed on a 7-point ordinal scale. RESULTS In total, 397 patients underwent randomization and began treatment (200 patients for 5 days and 197 for 10 days). The median duration of treatment was 5 days (interquartile range, 5 to 5) in the 5-day group and 9 days (interquartile range, 5 to 10) in the 10-day group. At baseline, patients randomly assigned to the 10-day group had significantly worse clinical status than those assigned to the 5-day group (P = 0.02). By day 14, a clinical improvement of 2 points or more on the ordinal scale occurred in 64% of patients in the 5-day group and in 54% in the 10-day group. After adjustment for baseline clinical status, patients in the 10-day group had a distribution in clinical status at day 14 that was similar to that among patients in the 5-day group (P = 0.14). The most common adverse events were nausea (9% of patients), worsening respiratory failure (8%), elevated alanine aminotransferase level (7%), and constipation (7%). CONCLUSIONS In patients with severe Covid-19 not requiring mechanical ventilation, our trial did not show a significant difference between a 5-day course and a 10-day course of remdesivir. With no placebo control, however, the magnitude of benefit cannot be determined. (Funded by Gilead Sciences; GS-US-540-5773 ClinicalTrials.gov number, NCT04292899.).
Collapse
Affiliation(s)
- Jason D Goldman
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - David C B Lye
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - David S Hui
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Kristen M Marks
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Raffaele Bruno
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Rocio Montejano
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Christoph D Spinner
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Massimo Galli
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Mi-Young Ahn
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Ronald G Nahass
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Yao-Shen Chen
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Devi SenGupta
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Robert H Hyland
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Anu O Osinusi
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Huyen Cao
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Christiana Blair
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Xuelian Wei
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Anuj Gaggar
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Diana M Brainard
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - William J Towner
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Jose Muñoz
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Kathleen M Mullane
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Francisco M Marty
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Karen T Tashima
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - George Diaz
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| | - Aruna Subramanian
- From the Swedish Center for Research and Innovation, Swedish Medical Center, and the University of Washington, Seattle (J.D.G.), and Providence Regional Medical Center, Everett (G.D.) - both in Washington; the National Center for Infectious Diseases, Lee Kong Chian School of Medicine, Tan Tock Seng Hospital, Singapore (D.C.B.L.); the Chinese University of Hong Kong-Prince of Wales Hospital, Hong Kong (D.S.H.); New York-Presbyterian Hospital and Weill Cornell Medicine, New York (K.M. Marks); Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia-Università di Pavia, Pavia (R.B.), and Università di Milano, Department of Biomedical and Clinical Sciences, L. Sacco Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milan (M.G.) - both in Italy; Hospital Universitario La Paz, IdiPAZ, Madrid (R.M.), and Barcelona Institute for Global Health (ISGlobal) Hospital Clínic-Universitat de Barcelona, Barcelona (J.M.); Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany (C.D.S.); Seoul Medical Center, Seoul, South Korea (M.-Y.A.); ID Care, Hillsborough, and Robert Wood Johnson University Hospital Somerset, Somerville - both in New Jersey (R.G.N.); Kaohsiung Veterans General Hospital, Taiwan (Y.-S.C.); Gilead Sciences, Foster City (D.S., R.H.H., A.O.O., H.C., C.B., X.W., A.G., D.M.B.), Kaiser Permanente, Los Angeles (W.J.T.), and Stanford University, Palo Alto (A.S.) - all in California; University of Chicago, Chicago (K.M. Mullane); Brigham and Women's Hospital and Harvard Medical School, Boston (F.M.M.); and Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI (K.T.T.)
| |
Collapse
|
38
|
Affiliation(s)
- Matthew P Cheng
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Caroline Quach
- Department of Clinical Laboratory Medicine, Centre hospitalier universitaire Sainte-Justine, University of Montreal, Quebec, Canada
| | - Francisco M Marty
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
39
|
Cheng MP, Kusztos AE, Bold TD, Ho VT, Glotzbecker BE, Hsieh C, Baker MA, Baden LR, Hammond SP, Marty FM. Risk of Latent Tuberculosis Reactivation After Hematopoietic cell Transplantation. Clin Infect Dis 2020; 69:869-872. [PMID: 30689792 DOI: 10.1093/cid/ciz048] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 01/14/2019] [Indexed: 12/29/2022] Open
Abstract
There were no cases of tuberculosis in a cohort of 2531 patients who underwent hematopoietic cell transplantation from 2010 to 2015 after 7323 person-years of follow up (95% confidence interval [CI], 0.0-0.05 cases/100 person-years), including 29 (1.15%) patients with untreated latent tuberculosis after 89 person-years of follow-up (95% CI, 0.0-4.06 cases/100 person-years).
Collapse
Affiliation(s)
- Matthew P Cheng
- Division of Infectious Diseases, Brigham and Women's Hospital.,Department of Medical Oncology, Dana-Farber Cancer Institute.,Harvard Medical School, Boston, Massachusetts
| | - Amanda E Kusztos
- Division of Infectious Diseases, Brigham and Women's Hospital.,Department of Medical Oncology, Dana-Farber Cancer Institute
| | - Tyler D Bold
- Division of Infectious Diseases, Brigham and Women's Hospital.,Harvard Medical School, Boston, Massachusetts.,Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Vincent T Ho
- Department of Medical Oncology, Dana-Farber Cancer Institute.,Harvard Medical School, Boston, Massachusetts
| | - Brett E Glotzbecker
- Department of Medical Oncology, Dana-Farber Cancer Institute.,Harvard Medical School, Boston, Massachusetts
| | - Candace Hsieh
- Department of Medical Oncology, Dana-Farber Cancer Institute
| | - Meghan A Baker
- Division of Infectious Diseases, Brigham and Women's Hospital.,Department of Medical Oncology, Dana-Farber Cancer Institute.,Harvard Medical School, Boston, Massachusetts
| | - Lindsey R Baden
- Division of Infectious Diseases, Brigham and Women's Hospital.,Department of Medical Oncology, Dana-Farber Cancer Institute.,Harvard Medical School, Boston, Massachusetts
| | - Sarah P Hammond
- Division of Infectious Diseases, Brigham and Women's Hospital.,Department of Medical Oncology, Dana-Farber Cancer Institute.,Harvard Medical School, Boston, Massachusetts
| | - Francisco M Marty
- Division of Infectious Diseases, Brigham and Women's Hospital.,Department of Medical Oncology, Dana-Farber Cancer Institute.,Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
40
|
Spinner CD, Gottlieb RL, Criner GJ, Arribas López JR, Cattelan AM, Soriano Viladomiu A, Ogbuagu O, Malhotra P, Mullane KM, Castagna A, Chai LYA, Roestenberg M, Tsang OTY, Bernasconi E, Le Turnier P, Chang SC, SenGupta D, Hyland RH, Osinusi AO, Cao H, Blair C, Wang H, Gaggar A, Brainard DM, McPhail MJ, Bhagani S, Ahn MY, Sanyal AJ, Huhn G, Marty FM. Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients With Moderate COVID-19: A Randomized Clinical Trial. JAMA 2020; 324:1048-1057. [PMID: 32821939 PMCID: PMC7442954 DOI: 10.1001/jama.2020.16349] [Citation(s) in RCA: 846] [Impact Index Per Article: 211.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Remdesivir demonstrated clinical benefit in a placebo-controlled trial in patients with severe coronavirus disease 2019 (COVID-19), but its effect in patients with moderate disease is unknown. OBJECTIVE To determine the efficacy of 5 or 10 days of remdesivir treatment compared with standard care on clinical status on day 11 after initiation of treatment. DESIGN, SETTING, AND PARTICIPANTS Randomized, open-label trial of hospitalized patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and moderate COVID-19 pneumonia (pulmonary infiltrates and room-air oxygen saturation >94%) enrolled from March 15 through April 18, 2020, at 105 hospitals in the United States, Europe, and Asia. The date of final follow-up was May 20, 2020. INTERVENTIONS Patients were randomized in a 1:1:1 ratio to receive a 10-day course of remdesivir (n = 197), a 5-day course of remdesivir (n = 199), or standard care (n = 200). Remdesivir was dosed intravenously at 200 mg on day 1 followed by 100 mg/d. MAIN OUTCOMES AND MEASURES The primary end point was clinical status on day 11 on a 7-point ordinal scale ranging from death (category 1) to discharged (category 7). Differences between remdesivir treatment groups and standard care were calculated using proportional odds models and expressed as odds ratios. An odds ratio greater than 1 indicates difference in clinical status distribution toward category 7 for the remdesivir group vs the standard care group. RESULTS Among 596 patients who were randomized, 584 began the study and received remdesivir or continued standard care (median age, 57 [interquartile range, 46-66] years; 227 [39%] women; 56% had cardiovascular disease, 42% hypertension, and 40% diabetes), and 533 (91%) completed the trial. Median length of treatment was 5 days for patients in the 5-day remdesivir group and 6 days for patients in the 10-day remdesivir group. On day 11, patients in the 5-day remdesivir group had statistically significantly higher odds of a better clinical status distribution than those receiving standard care (odds ratio, 1.65; 95% CI, 1.09-2.48; P = .02). The clinical status distribution on day 11 between the 10-day remdesivir and standard care groups was not significantly different (P = .18 by Wilcoxon rank sum test). By day 28, 9 patients had died: 2 (1%) in the 5-day remdesivir group, 3 (2%) in the 10-day remdesivir group, and 4 (2%) in the standard care group. Nausea (10% vs 3%), hypokalemia (6% vs 2%), and headache (5% vs 3%) were more frequent among remdesivir-treated patients compared with standard care. CONCLUSIONS AND RELEVANCE Among patients with moderate COVID-19, those randomized to a 10-day course of remdesivir did not have a statistically significant difference in clinical status compared with standard care at 11 days after initiation of treatment. Patients randomized to a 5-day course of remdesivir had a statistically significant difference in clinical status compared with standard care, but the difference was of uncertain clinical importance. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04292730.
Collapse
Affiliation(s)
- Christoph D. Spinner
- Technical University of Munich, School of Medicine, University Hospital Rechts der Isar, Munich, Germany
| | | | - Gerard J. Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | - Antonella Castagna
- IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | | | | | | | | | | | | | | | | | | | - Huyen Cao
- Gilead Sciences, Foster City, California
| | | | | | | | | | | | | | | | | | | | - Francisco M. Marty
- Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
41
|
Pearson JC, Dionne B, Richterman A, Vidal SJ, Weiss Z, Velásquez GE, Marty FM, Sax PE, Yawetz S. Omadacycline for the Treatment of Mycobacterium abscessus Disease: A Case Series. Open Forum Infect Dis 2020; 7:ofaa415. [PMID: 33094118 PMCID: PMC7566545 DOI: 10.1093/ofid/ofaa415] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/03/2020] [Indexed: 01/22/2023] Open
Abstract
Background Omadacycline is an aminomethylcycline antimicrobial approved by the US Food and Drug Administration in 2018 for community-acquired bacterial pneumonia and acute bacterial skin and skin structure infections. It has in vitro activity against nontuberculous mycobacteria, including Mycobacterium abscessus complex, but clinical data for this indication are lacking. Methods Omadacycline use was reviewed at an 804-bed academic medical center. Patients were included if they received omadacycline for culture-proven M abscessus disease in 2019. Results Four patients received omadacycline for the treatment of culture-positive M abscessus disease in 2019. Two patients had cutaneous disease, 1 had pulmonary disease, and 1 had osteomyelitis and bacteremia. The patients received omadacycline for a median duration of 166 days (range, 104-227) along with a combination of other antimicrobial agents. Omadacycline-containing regimens were associated with a clinical cure in 3 of 4 patients, with 1 patient improving on ongoing treatment. Omadacycline's tolerability was acceptable for patients with M abscessus disease, with 1 patient discontinuing therapy in month 6 due to nausea. Conclusions Omadacycline is a novel oral option for the treatment of M abscessus disease, for which safe and effective options are needed. Although this case series is promising, further data are required to determine omadacycline's definitive role in the treatment of M abscessus disease.
Collapse
Affiliation(s)
- Jeffrey C Pearson
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Correspondence: Jeffrey C. Pearson, PharmD, 181 Longwood Avenue, Boston, MA 02115 ()
| | - Brandon Dionne
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- School of Pharmacy, Northeastern University, Boston, Massachusetts, USA
| | - Aaron Richterman
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Samuel J Vidal
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Zoe Weiss
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Gustavo E Velásquez
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Francisco M Marty
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Paul E Sax
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Sigal Yawetz
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
42
|
Affiliation(s)
| | | | - Kelly A Verrill
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
| |
Collapse
|
43
|
Bold TD, Cheng MP, Marty FM. Reply to Singh. Clin Infect Dis 2020; 71:471-472. [PMID: 31584622 DOI: 10.1093/cid/ciz981] [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] [Received: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tyler D Bold
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Matthew P Cheng
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Francisco M Marty
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
44
|
Papanicolaou GA, Silveira FP, Langston AA, Pereira MR, Avery RK, Uknis M, Wijatyk A, Wu J, Boeckh M, Marty FM, Villano S. Maribavir for Refractory or Resistant Cytomegalovirus Infections in Hematopoietic-cell or Solid-organ Transplant Recipients: A Randomized, Dose-ranging, Double-blind, Phase 2 Study. Clin Infect Dis 2020; 68:1255-1264. [PMID: 30329038 PMCID: PMC6451997 DOI: 10.1093/cid/ciy706] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [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: 04/24/2018] [Accepted: 10/03/2018] [Indexed: 12/27/2022] Open
Abstract
Background Cytomegalovirus (CMV) infections that are refractory or resistant (RR) to available antivirals ([val]ganciclovir, foscarnet, cidofovir) are associated with higher mortality in transplant patients. Maribavir is active against RR CMV strains. Methods Hematopoietic-cell or solid-organ transplant recipients ≥12 years old with RR CMV infections and plasma CMV deoxyribonucleic acid (DNA) ≥1000 copies/mL were randomized (1:1:1) to twice-daily dose-blinded maribavir 400, 800, or 1200 mg for up to 24 weeks. The primary efficacy endpoint was the proportion of patients with confirmed undetectable plasma CMV DNA within 6 weeks of treatment. Safety analyses included the frequency and severity of treatment-emergent adverse events (TEAEs). Results From July 2012 to December 2014, 120 patients were randomized and treated (40 per dose group): 80/120 (67%) patients achieved undetectable CMV DNA within 6 weeks of treatment (95% confidence interval, 57–75%), with rates of 70%, 63%, and 68%, respectively, for maribavir 400, 800, and 1200 mg twice daily. Recurrent on-treatment CMV infections occurred in 25 patients; 13 developed mutations conferring maribavir resistance. Maribavir was discontinued due to adverse events in 41/120 (34%) patients, and 17/41 discontinued due to CMV infections. During the study, 32 (27%) patients died, 4 due to CMV disease. Dysgeusia was the most common TEAE (78/120; 65%) and led to maribavir discontinuation in 1 patient. Absolute neutrophil counts <1000/µL were noted in 12/106 (11%) evaluable patients, with rates similar across doses. Conclusions Maribavir ≥400 mg twice daily was active against RR CMV infections in transplant recipients; no new safety signals were identified. Clinical Trials Registration NCT01611974.
Collapse
Affiliation(s)
| | - Fernanda P Silveira
- The Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Marcus R Pereira
- Department of Medicine, Columbia University Medical Center, New York, New York
| | | | - Marc Uknis
- Shire Pharmaceuticals, Wayne, Pennsylvania
| | | | - Jingyang Wu
- Shire Pharmaceuticals, Lexington, Massachusetts
| | - Michael Boeckh
- The Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | |
Collapse
|
45
|
Marty FM, Ljungman PT, Chemaly RF, Wan H, Teal VL, Butterton JR, Yeh WW, Leavitt RY, Badshah CS. Outcomes of patients with detectable CMV DNA at randomization in the phase III trial of letermovir for the prevention of CMV infection in allogeneic hematopoietic cell transplantation. Am J Transplant 2020; 20:1703-1711. [PMID: 31883426 DOI: 10.1111/ajt.15764] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/13/2019] [Accepted: 12/23/2019] [Indexed: 01/25/2023]
Abstract
Letermovir, a cytomegalovirus (CMV) terminase-complex inhibitor, is indicated for prophylaxis of CMV infection and disease in adult CMV-seropositive recipients of allogeneic hematopoietic cell transplantation (HCT). In a phase III, double-blind, randomized trial, letermovir significantly reduced the risk of clinically significant CMV infection (CS-CMVi) vs placebo through Week 24 post-HCT. This analysis investigated outcomes in participants with detectable CMV DNA at randomization, who were excluded from the primary efficacy analysis. In total, 70 of 565 randomized participants had detectable CMV DNA at randomization (letermovir 48; placebo 22). Study treatment completion rates were greater in letermovir-treated participants compared with placebo (52.1% vs 9.1%). The incidence of CS-CMVi or imputed primary endpoint events through Week 24 were 64.6% and 90.9% in the letermovir and placebo groups, respectively (treatment difference -26.1%; P = .010). Kaplan-Meier event rates for CS-CMVi onset through Week 14 (end-of-treatment period) were 33.1% for letermovir and 86.6% for placebo (P < .001). Median viral loads at the CS-CMVi events was similar in both treatment arms. All-cause mortality through Week 24 posttransplant was 15.0% for letermovir and 18.2% for placebo; through Week 48, mortality rates were 26.5% and 40.9%, respectively (P = .268). Overall, clinical outcomes were similar to those reported for participants with undetectable CMV DNA at randomization.
Collapse
Affiliation(s)
- Francisco M Marty
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Per T Ljungman
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Roy F Chemaly
- MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Hong Wan
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | | | | | | | | |
Collapse
|
46
|
Affiliation(s)
- Francisco M Marty
- From the Division of Infectious Diseases, Brigham and Women's Hospital (F.M.M., K.C.), and the Division of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center (K.A.V.) - both in Boston
| | - Kaiwen Chen
- From the Division of Infectious Diseases, Brigham and Women's Hospital (F.M.M., K.C.), and the Division of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center (K.A.V.) - both in Boston
| | - Kelly A Verrill
- From the Division of Infectious Diseases, Brigham and Women's Hospital (F.M.M., K.C.), and the Division of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center (K.A.V.) - both in Boston
| |
Collapse
|
47
|
Kaminski MM, Alcantar MA, Lape IT, Greensmith R, Huske AC, Valeri JA, Marty FM, Klämbt V, Azzi J, Akalin E, Riella LV, Collins JJ. A CRISPR-based assay for the detection of opportunistic infections post-transplantation and for the monitoring of transplant rejection. Nat Biomed Eng 2020; 4:601-609. [PMID: 32284553 DOI: 10.1038/s41551-020-0546-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/06/2020] [Indexed: 12/26/2022]
Abstract
In organ transplantation, infection and rejection are major causes of graft loss. They are linked by the net state of immunosuppression. To diagnose and treat these conditions earlier, and to improve long-term patient outcomes, refined strategies for the monitoring of patients after graft transplantation are needed. Here, we show that a fast and inexpensive assay based on CRISPR-Cas13 accurately detects BK polyomavirus DNA and cytomegalovirus DNA from patient-derived blood and urine samples, as well as CXCL9 messenger RNA (a marker of graft rejection) at elevated levels in urine samples from patients experiencing acute kidney transplant rejection. The assay, which we adapted for lateral-flow readout, enables-via simple visualization-the post-transplantation monitoring of common opportunistic viral infections and of graft rejection, and should facilitate point-of-care post-transplantation monitoring.
Collapse
Affiliation(s)
- Michael M Kaminski
- Institute for Medical Engineering and Science and Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Miguel A Alcantar
- Institute for Medical Engineering and Science and Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Isadora T Lape
- Schuster Transplantation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Greensmith
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Allison C Huske
- Institute for Medical Engineering and Science and Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jacqueline A Valeri
- Institute for Medical Engineering and Science and Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Francisco M Marty
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | - Verena Klämbt
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jamil Azzi
- Schuster Transplantation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Enver Akalin
- Montefiore Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Leonardo V Riella
- Schuster Transplantation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - James J Collins
- Institute for Medical Engineering and Science and Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA. .,Infectious Disease and Microbiome Program, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
| |
Collapse
|
48
|
Iriarte C, Vaitkevicius H, Marty FM, Miller AL, Loscalzo J. Missing the Target. N Engl J Med 2020; 382:1353-1359. [PMID: 32242362 DOI: 10.1056/nejmcps1901669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Christopher Iriarte
- From the Departments of Medicine (C.I., F.M.M., A.L.M., J.L.) and Neurology (H.V.), Brigham and Women's Hospital, and the Departments of Medicine (C.I., F.M.M., A.L.M., J.L.) and Neurology (H.V.), Harvard Medical School - both in Boston
| | - Henrikas Vaitkevicius
- From the Departments of Medicine (C.I., F.M.M., A.L.M., J.L.) and Neurology (H.V.), Brigham and Women's Hospital, and the Departments of Medicine (C.I., F.M.M., A.L.M., J.L.) and Neurology (H.V.), Harvard Medical School - both in Boston
| | - Francisco M Marty
- From the Departments of Medicine (C.I., F.M.M., A.L.M., J.L.) and Neurology (H.V.), Brigham and Women's Hospital, and the Departments of Medicine (C.I., F.M.M., A.L.M., J.L.) and Neurology (H.V.), Harvard Medical School - both in Boston
| | - Amy L Miller
- From the Departments of Medicine (C.I., F.M.M., A.L.M., J.L.) and Neurology (H.V.), Brigham and Women's Hospital, and the Departments of Medicine (C.I., F.M.M., A.L.M., J.L.) and Neurology (H.V.), Harvard Medical School - both in Boston
| | - Joseph Loscalzo
- From the Departments of Medicine (C.I., F.M.M., A.L.M., J.L.) and Neurology (H.V.), Brigham and Women's Hospital, and the Departments of Medicine (C.I., F.M.M., A.L.M., J.L.) and Neurology (H.V.), Harvard Medical School - both in Boston
| |
Collapse
|
49
|
Iriarte C, Zambrotta M, Vaitkevicius H, Vaidya A, Marty FM. Missing the Target. N Engl J Med 2020; 382:e23. [PMID: 32212523 DOI: 10.1056/nejmimc1909410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
50
|
Cheng MP, Marty FM. Reply to Aronson et al. Clin Infect Dis 2020; 70:1262. [PMID: 31297517 DOI: 10.1093/cid/ciz595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Matthew P Cheng
- Division of Infectious Diseases, Brigham and Women's Hospital.,Department of Medical Oncology, Dana-Farber Cancer Institute.,Harvard Medical School, Boston, Massachusetts
| | - Francisco M Marty
- Division of Infectious Diseases, Brigham and Women's Hospital.,Department of Medical Oncology, Dana-Farber Cancer Institute.,Harvard Medical School, Boston, Massachusetts
| |
Collapse
|