1
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Mahler DA, Demirel S, Hollander R, Gopalan G, Shaikh A, Mahle CD, Elder J, Morrison C. High Prevalence of Suboptimal Peak Inspiratory Flow in Hospitalized Patients With COPD: A Real-world Study. Chronic Obstr Pulm Dis 2022; 9:427-438. [PMID: 35788259 PMCID: PMC9448011 DOI: 10.15326/jcopdf.2022.0291] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
For optimal drug delivery, dry powder inhalers (DPIs) depend on the patient's peak inspiratory flow (PIF) and the internal resistance of the device to create turbulent energy and disaggregate the powder. A suboptimal PIF may lead to ineffective drug inhalation into the lungs. Our objective was to report the prevalence of suboptimal PIF in patients with COPD hospitalized for any reason using 1 or more DPIs. In this real-world, observational, single‑site, retrospective study, PIF was measured for each DPI using the In-Check™ DIAL set to match the resistance of the DPI used by each patient. PIFs <60 and <30L/min were considered suboptimal for low to medium-high- and high-resistance DPIs, respectively. At initial hospitalization, the prevalence of suboptimal PIF was 44.6% in 829 patients (mean age, 71.7 years; 56.8% female); 21.2% were measured during admission for a COPD exacerbation. Suboptimal PIF percentages were 61.0% (38.1±9.5L/min [mean±standard deviation (SD)]) across low to medium-high-resistance DPIs and 17.2% (20.7±4.2L/min) for high-resistance DPIs. Overall, 190/829 patients had 1 or more 30-day all-cause readmission with 253 corresponding PIF measurements. For readmissions, suboptimal PIFs were observed in 49.5% (94/190) of patients. Suboptimal PIF percentages were 65.4% (38.4±9.2L/min) for low to medium-high-resistance DPIs and 19.8% (22.4±3.3L/min) for high-resistance DPIs. As the overall prevalence of suboptimal PIFs in hospitalized patients with COPD varied according to the specific internal resistance of the DPI, these findings may have clinical implications for inhaler selection.
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Affiliation(s)
- Donald A. Mahler
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
- Valley Regional Hospital, Claremont, New Hampshire, United States
| | - Shaban Demirel
- Legacy Research Institute, Portland, Oregon, United States
| | - Ramon Hollander
- Legacy Salmon Creek Medical Center, Vancouver, Washington, Unites States
| | - Gokul Gopalan
- Boehringer Ingelheim Pharmaceuticals, Incorporated, Ridgefield, Connecticut, United States
| | - Asif Shaikh
- Boehringer Ingelheim Pharmaceuticals, Incorporated, Ridgefield, Connecticut, United States
| | - Cathy D. Mahle
- Boehringer Ingelheim Pharmaceuticals, Incorporated, Ridgefield, Connecticut, United States
| | - Jessica Elder
- Boehringer Ingelheim Pharmaceuticals, Incorporated, Ridgefield, Connecticut, United States
| | - Curtis Morrison
- Legacy Salmon Creek Medical Center, Vancouver, Washington, Unites States
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2
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Edwards CL, Kaplan AG, Yawn BP, Kocks JWH, Bulathsinhala L, Carter VA, Chang KL, Fox C, Gopalan G, Han MK, Kruszyk M, Le Lievre CE, Mahle C, Make B, Pace WD, Price C, Shaikh A, Skolnik N, Price DB. Development of the Advancing the Patient Experience in COPD Registry: A Modified Delphi Study. Chronic Obstr Pulm Dis 2020; 8. [PMID: 33238085 DOI: 10.15326/jcopdf.2020.0154] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Chronic obstructive pulmonary disease (COPD) is commonly managed by family physicians, but little is known about specifics of management and how this may be improved. The Advancing the Patient Experience in COPD (APEX COPD) registry will be the first U.S. primary care, health system-based registry following patients diagnosed with COPD longitudinally, using a standardized set of variables to investigate how patients are managed in real life and assess outcomes of various management strategies. Objective Gaining expert consensus on a standardized list of variables to capture in the APEX COPD registry. Methods A modified, Delphi process was used to reach consensus on which data to collect in the registry from electronic health records (EHRs), patient-reported information (PRI) and patient-reported outcomes (PRO), and by physicians during subsequent office visits. The Delphi panel comprised 14 primary care and specialty COPD experts from the United States and internationally. The process consisted of 3 iterative rounds. Responses were collected electronically. Results Of the initial 195 variables considered, consensus was reached to include up to 115 EHR variables, 34 PRI/PRO variables and 5 office-visit variables in the APEX COPD registry. These should include information on symptom burden, diagnosis, COPD exacerbations, lung function, quality of life, comorbidities, smoking status/history, treatment specifics (including side effects), inhaler management, and patient education/self-management. Conclusion COPD experts agreed upon the core variables to collect from EHR data and from patients to populate the APEX COPD registry. Data will eventually be integrated, standardized and stored in the APEX COPD database and used for approved COPD-related research.
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Affiliation(s)
| | - Alan G Kaplan
- Observational and Pragmatic Research Institute, Singapore.,Family Physician Airways Group of Canada, Stouffville, Ontario.,University of Toronto, Toronto, Canada
| | - Barbara P Yawn
- University of Minnesota, Minneapolis, Minnesota, United States.,COPD Foundation, Washington, DC, United States
| | - Janwillem W H Kocks
- Optimum Patient Care, Cambridge, United Kingdom.,Observational Pragmatic Research Institute, Singapore.,General Practitioners Research Institute, Groningen, Netherlands
| | | | | | - Ku-Lang Chang
- College of Medicine, University of Florida, Gainesville, FL, United States
| | - Chester Fox
- DARTNet Institute, Aurora, Colorado, United States.,University at Buffalo, Buffalo, New York, United States
| | - Gokul Gopalan
- Boehringer Ingelheim, Ridgefield, Connecticut, United States
| | - MeiLan K Han
- University of Michigan, Ann Arbor, Michigan, United States
| | | | | | - Cathy Mahle
- Boehringer Ingelheim, Ridgefield, Connecticut, United States
| | - Barry Make
- Department of Medicine, National Jewish Health, Denver, Colorado, United States
| | - Wilson D Pace
- DARTNet Institute, Aurora, Colorado, United States.,University of Colorado, Denver, Colorado, United States
| | - Chris Price
- Optimum Patient Care, Cambridge, United Kingdom
| | - Asif Shaikh
- Boehringer Ingelheim, Ridgefield, Connecticut, United States
| | - Neil Skolnik
- Thomas Jefferson University, Pennsylvania, United States.,Abington Jefferson Health, Jenkintown, Pennsylvania, United States
| | - David B Price
- Optimum Patient Care, Cambridge, United Kingdom.,Observational Pragmatic Research Institute, Singapore.,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
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3
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Chipps B, Mosnaim G, Mathur SK, Shaikh A, Khoury S, Gopalan G, Palli SR, Lamerato L, Casciano J, Dotiwala Z, Settipane R. Add-on tiotropium versus step-up inhaled corticosteroid plus long-acting beta-2-agonist in real-world patients with asthma. Allergy Asthma Proc 2020; 41:248-255. [PMID: 32414426 DOI: 10.2500/aap.2020.41.200036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: A step-up approach (increasing inhaled corticosteroid [ICS] dose and/or add-on treatment) is recommended for asthma that is uncontrolled despite ICS plus long-acting beta-2-agonist (LABA) combination treatment. Understanding the impact of different treatment options on health outcomes can help guide treatment decision-making. Objective: To compare the effectiveness of add-on tiotropium 1.25 µg (two puffs once daily) versus an increased ICS plus LABA dose in a real-world cohort of patients with asthma initiated on ICS plus LABA. Methods: De-identified data from patients ages ≥12 years and with asthma who were initiated on ICS plus LABA, and then had tiotropium added (Tio group; index date) or an ICS plus LABA dose increased (inc-ICS group; index date) were collected from two medical and pharmacy claims data bases (2014-2018). To account for population/group differences, propensity score matching was performed. The primary end point was the exacerbation risk after the index date. Secondary end points included exacerbation rates 6 and 12 months postindex, health-care resource utilization, costs, and short-acting beta-2-agonist (SABA) refills 12 months postindex. Results: Overall, 7857 patients (Tio group, 2619; inc-ICS group, 5238) were included. The exacerbation risk was 35% lower in the Tio group than in the inc-ICS group (hazard ratio 0.65 [95% confidence interval, 0.43-0.99]; p = 0.044). Exacerbation rates in the Tio group also were significantly lower within 6 and 12 months postindex (64% and 73%, respectively). All-cause and asthma-related emergency department (ED) visits were 47% and 74% lower, respectively (p < 0.0001 for both), and all-cause and asthma-related hospitalizations were 48% (p < 0.01) and 76% (p < 0.001) lower, respectively, in the Tio group. Also, significantly fewer patients in the Tio group versus the inc-ICS group required SABA refills (56% versus 67%, p < 0.0001). Conclusion: Add-on tiotropium significantly decreased the risk and rate of exacerbations, decreased all-cause and asthma-related ED visits and hospitalizations, and reduced SABA refills compared with increasing the ICS plus LABA dose. The findings supported the use of add-on tiotropium for patients with uncontrolled asthma taking ICS plus LABA.
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Affiliation(s)
- Bradley Chipps
- From the Capital Allergy and Respiratory Disease Center, Sacramento, California
| | - Giselle Mosnaim
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, NorthShore University HealthSystem, Chicago, Illinois
| | - Sameer K. Mathur
- Division of Allergy, Pulmonary and Critical Care, Department of Medicine, University of Wisconsin, Madison, Wisconsin
| | - Asif Shaikh
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut
| | - Samir Khoury
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut
| | - Gokul Gopalan
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut
| | - Swetha R. Palli
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut
| | - Lois Lamerato
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | | | | | - Russell Settipane
- Allergy and Immunology, The Allergy and Asthma Center, East Providence, Rhode Island
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4
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Dotiwala Z, Casciano J, Davis JR, Fox K, Gopalan G, Rastogi S, Lamerato L, Mathur SK. Effect of clinically significant thresholds of eosinophil elevation on health care resource use in asthma. Ann Allergy Asthma Immunol 2020; 125:182-189. [PMID: 32371242 DOI: 10.1016/j.anai.2020.04.024] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/15/2020] [Accepted: 04/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Blood eosinophil counts correlate with exacerbations, but there is a lack of consensus on a clinically relevant definition of eosinophil count elevation. OBJECTIVE To analyze health care resource use among patients with elevated blood eosinophil counts defined at 150 cells/μL or greater and 300 cells/μL or greater. METHODS Data on patients who received a diagnosis of asthma between 2007 and 2016 were extracted from EMRClaims + database. Patients were defined as having elevated eosinophil counts if any test result during 3 months before follow-up found blood eosinophil count of 150 cells/μL or more or 300 cells/μL or more. Hospitalizations, emergency department visits, outpatient visits, and associated costs were compared. With logistic regression, likelihood of hospitalization was assessed in the presence of eosinophil elevation. RESULTS Among 3687 patients who met the study criteria, 1152 received a test within 3 months before the follow-up period, of whom 644 (56%) had elevated eosinophil counts of 150 cells/μL or greater and 322 (29%) had eosinophil counts of 300 cells/μL or greater. Overall, the mean (SD) number of hospitalizations for patients with elevated eosinophil counts vs the comparator was significantly greater (0.29 [0.92] vs 0.17 [0.57], P < .001 at ≥150 cells/μL and 0.30 [0.95] vs 0.18 [0.61] at ≥300 cells/μL, P = .001). The total mean cost was significantly greater for patients with elevated eosinophil counts (at ≥150 cells/μL: $10,262 vs $7149, P < .001 and at ≥300 cells/μL: $9966 vs $7468, P = .003). CONCLUSION Patients with asthma incurred greater health care resource use when their blood eosinophil counts were elevated at 150 cells/μL or greater and 300 cells/μL or greater as measured within 3 months of follow-up.
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Affiliation(s)
| | | | | | | | - Gokul Gopalan
- AstraZeneca, Gaithersburg, Maryland (at the time of manuscript development)
| | - Sarang Rastogi
- AstraZeneca, Gaithersburg, Maryland (at the time of manuscript development)
| | | | - Sameer K Mathur
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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5
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Bulathsinhala L, Eleangovan N, Heaney LG, Menzies-Gow A, Gibson PG, Peters M, Hew M, van Boven JFM, Lehtimäki L, van Ganse E, Belhassen M, Harvey ES, Perez de Llano L, Maitland-van der Zee AH, Papadopoulos NG, FitzGerald JM, Porsbjerg C, Canonica GW, Backer V, Rhee CK, Verhamme KMC, Buhl R, Cosio BG, Carter V, Price C, Le T, Stagno d'Alcontres M, Gopalan G, Tran TN, Price D. Development of the International Severe Asthma Registry (ISAR): A Modified Delphi Study. J Allergy Clin Immunol Pract 2018; 7:578-588.e2. [PMID: 30179741 DOI: 10.1016/j.jaip.2018.08.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/30/2018] [Accepted: 08/13/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND The lack of centralized data on severe asthma has resulted in a scarcity of information about the disease and its management. The development of a common data collection tool for the International Severe Asthma Registry (ISAR) will enable standardized data collection, subsequently enabling data interoperability. OBJECTIVES To create a standardized list of variables for the first international registry for severe asthma via expert consensus. METHODS A modified Delphi process was used to reach consensus on a minimum set of variables to capture in ISAR: the core variables. The Delphi panel brought together 27 international experts in the field of severe asthma research. The process consisted of 3 iterative rounds. In each round, all Delphi panel members were issued an electronic ISAR Delphi workbook to complete and return to the ISAR Delphi administrator. Workbooks and result summaries were anonymously distributed by the Delphi administrator to all panel members at subsequent rounds. Finalization of the core variable list was facilitated by 2 face-to-face meetings. RESULTS Of the initial 747 selected variables, the Delphi panel reached a consensus on 95. The chosen variables will allow severe asthma to be assessed against patient demographics and medical history, patient-reported outcomes, diagnostic information, and clinical characteristics. Physician-reported outcomes such as nonadherence and information about treatment and management strategies will also be recorded. CONCLUSIONS This is the first global attempt to generate an ISAR using a common set of core variables to ensure that data collected across all participating countries are standardized.
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Affiliation(s)
| | | | - Liam G Heaney
- UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Andrew Menzies-Gow
- UK Severe Asthma Network and National Registry, Royal Brompton & Harefield National Health Service (NHS) Foundation Trust, London, UK
| | - Peter G Gibson
- Australasian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia; Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Matthew Peters
- University of Sydney Medical School, Sydney, NSW, Australia
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Australia
| | - Job F M van Boven
- Department of General Practice, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, University of Tampere, Tampere, Finland
| | | | | | - Erin S Harvey
- Australasian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia; Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | | | - Anke H Maitland-van der Zee
- Amsterdam University Medical Center, University of Amsterdam, Department of Respiratory Medicine, Amsterdam, The Netherlands
| | | | | | | | - G Walter Canonica
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University & Research Hospital, Milan, Italy; SANI-Severe Asthma Network Italy, Italy
| | - Vibeke Backer
- Bispebjerg Hospital, Copenhagen University, Copenhagen, Denmark
| | | | | | | | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | | | | | - Thao Le
- Optimum Patient Care, Cambridge, UK
| | | | | | | | - David Price
- Optimum Patient Care, Cambridge, UK; Observational and Pragmatic Research Institute, Singapore; Academic Primary Care, University of Aberdeen, Aberdeen, UK.
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6
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Kerkhof M, Tran TN, van den Berge M, Brusselle GG, Gopalan G, Jones RCM, Kocks JWH, Menzies-Gow A, Nuevo J, Pavord ID, Rastogi S, Price DB. Association between blood eosinophil count and risk of readmission for patients with asthma: Historical cohort study. PLoS One 2018; 13:e0201143. [PMID: 30044863 PMCID: PMC6059485 DOI: 10.1371/journal.pone.0201143] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/08/2018] [Indexed: 11/18/2022] Open
Abstract
Background Recent studies have demonstrated an association between high blood eosinophil counts and greater risk of asthma exacerbations. We sought to determine whether patients hospitalized for an asthma exacerbation were at greater risk of readmission if they had a high blood eosinophil count documented before the first hospitalization. Methods This historical cohort study drew on 2 years of medical record data (Clinical Practice Research Datalink with Hospital Episode Statistics linkage) of patients (aged ≥5 years) admitted to hospital in England for asthma, with recorded blood eosinophil count within 1 baseline year before admission. We analyzed the association between high blood eosinophil count (≥0.35x109 cells/L) and readmission risk during 1 year of follow-up after hospital discharge, with adjustment for predefined, relevant confounders using forward selection. Results We identified 2,613 eligible patients with asthma-related admission, of median age 51 years (interquartile range, 36–69) and 76% women (1,997/2,613). Overall, 835/2,613 (32.0%) had a preadmission high blood eosinophil count. During the follow-up year, 130/2,613 patients (5.0%) were readmitted for asthma, including 55/835 (6.6%) with vs. 75/1,778 (4.2%) without high blood eosinophil count at baseline (adjusted hazard ratio [HR] 1.49; 95% CI 1.04–2.13, p = 0.029). The association was strongest in never-smokers (n = 1,296; HR 2.16, 95% CI 1.27–3.68, p = 0.005) and absent in current smokers (n = 547; HR 1.00, 95% CI 0.49–2.04, p = 0.997). Conclusions A high blood eosinophil count in the year before an asthma-related hospitalization is associated with increased risk of readmission within the following year. These findings suggest that patients with asthma and preadmission high blood eosinophil count require careful follow-up, with treatment optimization, after discharge.
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Affiliation(s)
- Marjan Kerkhof
- Observational & Pragmatic Research Institute Pte Ltd, Singapore, Singapore
| | - Trung N Tran
- AstraZeneca, Gaithersburg, MD, United States of America
| | - Maarten van den Berge
- University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | - Gokul Gopalan
- AstraZeneca, Gaithersburg, MD, United States of America
| | - Rupert C M Jones
- The Peninsula College of Medicine and Dentistry, Plymouth, United Kingdom
| | - Janwillem W H Kocks
- Observational & Pragmatic Research Institute Pte Ltd, Singapore, Singapore.,University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Andrew Menzies-Gow
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | | | - Ian D Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - David B Price
- Observational & Pragmatic Research Institute Pte Ltd, Singapore, Singapore.,Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom
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7
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Chacko A, Bedard ACV, Marks D, Gopalan G, Feirsen N, Uderman J, Chimiklis A, Heber E, Cornwell M, Anderson L, Zwilling A, Ramon M. Sequenced neurocognitive and behavioral parent training for the treatment of ADHD in school-age children. Child Neuropsychol 2018; 24:427-450. [PMID: 28277151 PMCID: PMC6224162 DOI: 10.1080/09297049.2017.1282450] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The present study examines the potential of sequencing a neurocognitive intervention with behavioral parent training (BPT) to improve executive functions (EFs), psychiatric symptoms, and multiple indices of functional impairment in school-age children aged 7 to 11 years who have been diagnosed with attention-deficit/hyperactivity disorder (ADHD). Specifically, in a randomized controlled trial design, 85 children were assigned to either Cogmed Working Memory Training (CWMT) followed by an empirically supported, manualized BPT intervention, or to a placebo version of CWMT followed by the same BPT intervention. Working memory maintenance (i.e., attention control/short-term memory), working memory processing and manipulation, ADHD and oppositional defiant disorder (ODD) symptoms, impairment in parent-child dynamics, familial impairment, and overall functional compromise were evaluated as outcomes. The results suggest specific effects of the combined CWMT and BPT program on verbal and nonverbal working memory storage and nonverbal working memory processing and manipulation but no incremental benefits in regard to ADHD symptoms, ODD symptoms, and functional outcomes. The present findings do not support the hypothesis regarding the complementary and augmentative benefits of sequenced neurocognitive and BPT interventions for the treatment of ADHD. These results, the study's limitations, and future directions for research are further discussed.
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Affiliation(s)
- A Chacko
- a Department of Applied Psychology , New York University , NY , USA
| | - A-C V Bedard
- b Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education , University of Toronto , Canada
| | - D Marks
- c Department of Child and Adolescent Psychiatry , New York University School of Medicine , NY , USA
| | - G Gopalan
- d Department of Social Work , University of Maryland at Baltimore , MD , USA
| | - N Feirsen
- e Department of Psychology , City University of New York , NY , USA
| | - J Uderman
- e Department of Psychology , City University of New York , NY , USA
| | - A Chimiklis
- e Department of Psychology , City University of New York , NY , USA
| | - E Heber
- e Department of Psychology , City University of New York , NY , USA
| | - M Cornwell
- e Department of Psychology , City University of New York , NY , USA
| | - L Anderson
- e Department of Psychology , City University of New York , NY , USA
| | - A Zwilling
- e Department of Psychology , City University of New York , NY , USA
| | - M Ramon
- e Department of Psychology , City University of New York , NY , USA
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8
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Xu X, O'Quinn S, Hirsch I, Gopalan G. Asthma Symptom Improvements with Benralizumab are Associated with Improvements in Activity Function and Quality of Life for Patients with Severe, Uncontrolled Asthma. Pneumologie 2018. [DOI: 10.1055/s-0037-1619157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- X Xu
- Astrazeneca, Gaithersburg, MD, USA
| | | | - I Hirsch
- Astrazeneca, Gaithersburg, MD, USA
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9
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O'Quinn S, Xu X, Hirsch I, Gopalan G. Patient-Reported Activity Impairment, Stress, and Tiredness Improvement in Patients with Severe, Uncontrolled Asthma with Eosinophilic Inflammation: Pooled Results from Two Phase III Trials of Benralizumab. Pneumologie 2018. [DOI: 10.1055/s-0037-1619397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - X Xu
- Astrazeneca, Gaithersburg, MD, USA
| | - I Hirsch
- Astrazeneca, Gaithersburg, MD, USA
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10
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Xu X, O'Quinn S, Hirsch I, Gopalan G. Impact of Asthma Control Status on Lung Function and Patient Well-Being Assessments in Patients with Severe, Uncontrolled Asthma. Pneumologie 2018. [DOI: 10.1055/s-0037-1619158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- X Xu
- Astrazeneca, Gaithersburg, MD, USA
| | | | - I Hirsch
- Astrazeneca, Gaithersburg, MD, USA
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11
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Park HS, Lee SH, Werkström V, Wu Y, Zangrilli J, Gopalan G. Benralizumab Reduces Exacerbations and Improves Lung Function in Patients From Republic of Korea With Severe, Uncontrolled Asthma: Subgroup Analysis of the SIROCCO Trial. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Price DB, Gefen E, Gopalan G, McDonald R, Thomas V, Ming SWY, Davis E. Real-life effectiveness and safety of salbutamol Steri-Neb™ vs. Ventolin Nebules® for exacerbations in patients with COPD: Historical cohort study. PLoS One 2018; 13:e0191404. [PMID: 29364929 PMCID: PMC5783390 DOI: 10.1371/journal.pone.0191404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 01/04/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction Ventolin Nebules® (reference product; GlaxoSmithKline) was the first licensed nebulizer solution containing the rapid-onset, short-acting β2-agonist salbutamol. Salbutamol Steri-Neb™ (comparator; Teva Pharmaceuticals, Inc.) has the same chemical composition as the reference product. This study evaluated whether the effectiveness of the comparator is non-inferior to the reference product alongside concomitant medications during real-life clinical management of COPD exacerbations. Safety in terms of adverse events (AEs) was also examined. Methods This matched (1:1) historical cohort study evaluated data from 2 UK primary care databases on patients prescribed the salbutamol comparator or reference. The study included a 1-year baseline period, starting 1 year before the index prescription date, and 1-year outcome period. Cohorts were matched for baseline COPD respiratory medications. The primary outcome was analysis of non-inferiority for the comparator versus reference product for the rate of moderate and severe COPD exacerbations. Non-inferiority was satisfied if the 95% confidence interval (CI) upper limit for mean differences in proportions between treatments was <15%. Secondary outcomes were examined through rate ratios (RR) of severe exacerbations and AEs. Results After matching, 1191 patients were included in each cohort. Adjusted upper 95% CI for the difference in proportion of patients experiencing moderate or severe exacerbations between comparator and reference groups was 0.032 (3.2%), demonstrating non-inferiority. No significant differences were observed in rates of moderate and severe exacerbations (RR: 1.00; 95% CI: 0.91, 1.10), severe exacerbations (RR: 0.76; 95% CI: 0.49, 1.17), or AEs (RR: 0.98; 95% CI: 0.78, 1.22) after adjusting for baseline confounders. No significant differences across cohorts were observed for rates of any AE or death. Conclusion This matched cohort study of real-life management of COPD patients supports the salbutamol comparator as non-inferior to the reference product, providing an effective treatment alternative for COPD exacerbations. Comparator and reference safety profiles were similar.
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Affiliation(s)
- David B. Price
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
- Observational & Pragmatic Research Institute, Singapore, Singapore
- * E-mail:
| | - Eran Gefen
- Teva Pharmaceuticals, Petach Tikva, Israel
| | - Gokul Gopalan
- Teva Pharmaceuticals, Frazer, Pennsylvania, United States of America
| | - Rosie McDonald
- Observational & Pragmatic Research Institute, Singapore, Singapore
| | - Vicky Thomas
- Observational & Pragmatic Research Institute, Singapore, Singapore
| | | | - Emily Davis
- Observational & Pragmatic Research Institute, Singapore, Singapore
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Price DB, Gefen E, Gopalan G, Miglio C, McDonald R, Thomas V, Wan Yau Ming S. Real-life effectiveness and safety of the inhalation suspension budesonide comparator vs the originator product for the treatment of patients with asthma: a historical cohort study using a US health claims database. Pragmat Obs Res 2017; 8:69-83. [PMID: 28572742 PMCID: PMC5441674 DOI: 10.2147/por.s132839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objective The objective of this study was to determine whether the effectiveness of budesonide comparator is non-inferior to budesonide reference in the prevention of asthma exacerbations. Asthma-related hospitalizations and safety were also examined. Methods This study used a matched, historic cohort design. Data were drawn from the Clinformatics™ Data Mart US claims database and included a 1-year baseline, starting 1 year before the index prescription date, and a 1-year outcome period. Patients received budesonide comparator or reference treatment. The primary outcome was the rate of asthma exacerbations. Non-inferiority for budesonide comparator vs budesonide reference was established if the 95% confidence interval (CI) upper limit of mean difference in proportions between treatments was <15%. Secondary outcomes examined rate of asthma-related hospitalizations and adverse events (AEs). Results The budesonide comparator and reference-matched cohorts each included 3109 patients. The adjusted upper 95% CI for the difference in proportions of patients experiencing asthma exacerbations was 0.035 (3.5%), demonstrating non-inferiority. Cohorts did not significantly differ in the rate of asthma exacerbations (adjusted rate ratio [RR]=1.04, 95% CI: 0.95–1.14) or rate of asthma-related hospitalizations (adjusted RR=1.10, 95% CI: 0.99–1.24) after adjusting for baseline confounders. No asthma exacerbations occurred during the outcome period in 72.9% of budesonide comparator patients and 71.8% of budesonide reference patients. No asthma-related hospitalizations occurred in 77.9% of patients in the budesonide comparator cohort and 79.0% of patients in the budesonide reference cohort. The most frequent AEs were throat irritation (≤0.4% of patients) and hoarseness/dysphonia (0.02% of patients). AEs did not significantly differ between treatment cohorts. Conclusion In this real-life study, non-inferiority of the budesonide comparator vs reference was met for the primary end point of asthma exacerbation rates. Asthma-related hospitalization and AE rates did not differ between the two treatment cohorts. The budesonide comparator is an effective and safe treatment alternative for asthma exacerbations.
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Affiliation(s)
- David B Price
- Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.,Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Eran Gefen
- Teva Pharmaceuticals, Petach Tikva, Israel
| | | | - Cristiana Miglio
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Rosie McDonald
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Vicky Thomas
- Observational and Pragmatic Research Institute, Singapore, Singapore
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Casciano J, Krishnan JA, Small MB, Buck PO, Gopalan G, Li C, Kemp R, Dotiwala Z. Value of peripheral blood eosinophil markers to predict severity of asthma. BMC Pulm Med 2016; 16:109. [PMID: 27473851 PMCID: PMC4966857 DOI: 10.1186/s12890-016-0271-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/22/2016] [Indexed: 11/23/2022] Open
Abstract
Background Asthma represents a significant clinical and economic burden to the US healthcare system. Along with other clinical manifestations of the disease, elevated sputum and blood eosinophil levels are observed in patients experiencing asthma exacerbations. The aim of this study was to evaluate the association between blood eosinophil levels and asthma severity defined using Expert Panel Report 3 guidelines. Methods Patients with asthma diagnosis between 2004 and 2011 were extracted from the EMRClaims+ database (eMAX Health, White Plains, NY) containing electronic medical records linked to insurance claims for over 675,000 patients. The date of first asthma diagnosis was defined as the ‘index date’. Patients were required to have at least 1 peripheral eosinophil test (elevated defined as ≥ 400 cells/μL) in the 12 month ‘assessment’ period following the index date. We classified patients as those with mild asthma and moderate-to-severe asthma based on the pattern of medication use, as recommended by the 2007 National Institutes of Health Expert Panel Report. Logistic regression models were used to determine if patients with moderate-to-severe asthma had increased likelihood of an elevated peripheral eosinophil count, after accounting for demographics and comorbidities. Results Among 1,144 patients with an asthma diagnosis, 60 % were classified as having moderate-to-severe asthma. Twenty four percent of patients with moderate-to-severe asthma and 19 % of patients with mild asthma had an elevated peripheral eosinophil count (p = 0.053). Logistic regression showed that moderate-to-severe asthma was associated with 38 % increased odds of elevated eosinophil level (OR 1.38, 95 % CI: 1.02 to 1.86, p = 0.04). Conclusion Patients with moderate-severe asthma are significantly more likely to have an elevated peripheral eosinophil count than patients with mild asthma.
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Affiliation(s)
- Julian Casciano
- eMAX Health Systems, LLC, 445 Hamilton Avenue, 11th floor, White Plains, NY, USA
| | - Jerry A Krishnan
- Medicine and Public Health, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | | | - Chenghui Li
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Robert Kemp
- eMAX Health Systems, LLC, 445 Hamilton Avenue, 11th floor, White Plains, NY, USA
| | - Zenobia Dotiwala
- eMAX Health Systems, LLC, 445 Hamilton Avenue, 11th floor, White Plains, NY, USA.
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Casciano J, Krishnan JA, Small MB, Buck PO, Gopalan G, Li C, Kemp R, Dotiwala Z. Burden of asthma with elevated blood eosinophil levels. BMC Pulm Med 2016; 16:100. [PMID: 27412347 PMCID: PMC4944449 DOI: 10.1186/s12890-016-0263-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 07/08/2016] [Indexed: 12/03/2022] Open
Abstract
Background Asthma is a common chronic condition with an economic burden of almost $56 billion annually in the US. Biologic markers like blood eosinophils, that help predict the risk of exacerbation could help guide more optimal treatment plans and reduce cost. The purpose of this study was to determine whether healthcare resource use and expenditures vary by eosinophil level among patients with asthma. Methods Patients with a diagnosis of asthma defined by ICD-9-CM code 493.xx between January 2004 and July 2011 were extracted from EMRClaims + database (eMAX Health, White Plains NY). Patients were classified as mild, moderate, or severe by medication use following diagnosis, based on recommendations of National Institutes of Health Expert Panel Report 3. Patients were classified as those with elevated eosinophils (≥400 cells/μL) and normal eosinophil level (<400 cells/μL). Patients were followed for resource use, defined as hospitalizations, ER visits and outpatient visit and associated costs were calculated to assess whether an economic difference exists between eosinophil groups. Non-parametric tests were used to compare resource use and associated cost between elevated and normal eosinophil groups. Multivariate modeling was performed to assess the contribution of eosinophil level on the likelihood of study outcomes among patients with severe asthma. Results Among the 2,164 patients meeting eligibility criteria, 1,144 had severity designations. Of these, 179(16 %) of patients had severe asthma of which 20 % (n = 35) had elevated eosinophils. Seventeen percent of patients with elevated eosinophils were admitted to the hospital during the follow-up period, significantly greater than patients with normal eosinophil levels (12 %; p = 0.011). Overall, compared to patients with normal eosinophil levels (n = 1734), patients with elevated eosinophil levels (n = 430) had significantly greater mean annual hospital admissions (0.51 vs. 0.21/year, p = 0.006) and hospital costs (2,536 vs. $1,091, p = 0.011). Logistic regressions showed that elevated eosinophil level was associated with 5.14 times increased odds of all cause admissions (95 % CI:1.76–14.99, p = 0.003) and 4.07 times increased odds of asthma related admissions (95 % CI: 1.26–13.12, p = 0.019). Conclusion Eosinophil elevation was associated with greater healthcare resource use in patients with asthma.
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Affiliation(s)
- Julian Casciano
- eMAX Health LLC, 445 Hamilton avenue, 11th floor, White Plains, NY, 10601, USA.
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | | | - Chenghui Li
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Robert Kemp
- eMAX Health LLC, 445 Hamilton avenue, 11th floor, White Plains, NY, 10601, USA
| | - Zenobia Dotiwala
- eMAX Health LLC, 445 Hamilton avenue, 11th floor, White Plains, NY, 10601, USA
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Virchow JC, Rodriguez-Roisin R, Papi A, Shah TP, Gopalan G. A randomized, double-blinded, double-dummy efficacy and safety study of budesonide-formoterol Spiromax® compared to budesonide-formoterol Turbuhaler® in adults and adolescents with persistent asthma. BMC Pulm Med 2016; 16:42. [PMID: 26987997 PMCID: PMC4794916 DOI: 10.1186/s12890-016-0200-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 02/24/2016] [Indexed: 12/17/2022] Open
Abstract
Background Budesonide and formoterol (BF) Spiromax® is a dry powder inhaler designed to deliver BF with maximum ease of use for patients with asthma or chronic obstructive pulmonary disease. Methods A phase 3b, 12-week, multicenter, double-blind, double-dummy, randomized, controlled trial in patients (≥12 years) with persistent asthma. Primary objective: to demonstrate non-inferiority of twice-daily BF Spiromax 160/4.5 mcg to BF Turbuhaler® 200/6 mcg in change from baseline in weekly average of daily trough morning peak expiratory flow (PEF). Secondary endpoints included: Patient Satisfaction and Preference Questionnaire scores, change from baseline in evening PEF, trough forced expiratory volume in one second, percentage of symptom-free and rescue-free 24-hour periods, and safety. Results The analysis was based on the per-protocol population (BF Spiromax, n = 290; BF Turbuhaler, n = 284). The least squares mean change from baseline to week 12 in morning PEF was: BF Spiromax, 18.8 L/min and BF Turbuhaler, 21.8 L/min. Non-inferiority of BF Spiromax vs BF Turbuhaler was demonstrated (the lower limit of the 95 % two-sided confidence interval was −9.02 L/min, which is greater than −15 L/min [the criteria specified for non-inferiority]). The mean difference in the total performance domains scores for BF Spiromax vs BF Turbuhaler were 0.248 at baseline and 0.353 at week 12 (both, p <0.001), indicating statistical superiority for BF Spiromax. No statistical or numerical differences were recorded in the total convenience domain score between the two devices. Scores for ‘device preference’ and ‘willingness to continue’ supported BF Spiromax at baseline and at week 12 (p = 0.0005 vs BF Turbuhaler). No significant between-group differences were observed in the other secondary efficacy endpoints. Both treatments were well tolerated, with no significant differences in adverse events or asthma exacerbations. Conclusions This study demonstrates the non-inferiority of BF Spiromax vs BF Turbuhaler in patients (≥12 years) with asthma. More patients preferred the Spiromax device over Turbuhaler for its performance, and were willing to continue therapy with BF Spiromax beyond the 12-week study period. Trial registration NCT01803555; February 28, 2013. Electronic supplementary material The online version of this article (doi:10.1186/s12890-016-0200-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Christian Virchow
- Department of Pneumology/Intensive Care Medicine, University of Rostock, Zentrum für Innere Medizin/Medizinische Klinik 1, Rostock, Germany.
| | - Roberto Rodriguez-Roisin
- Servei de Pneumologia (Institut del Tòrax), Hospital Clínic-IDIBAPS-CIBERES, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Gokul Gopalan
- Teva Pharmaceuticals, Malvern, PA, USA.,, Present address: 41 Spruce Hollow Road, Green Brook, NJ, 08812, USA
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Hewitt C, Heinzmann S, Safioti G, Gopalan G. Independent Identification of Handling Errors for Dry Powder Inhalers, Spiromax® and Turbuhaler®, Using a Delphi Process Involving Respiratory Device Experts. Pulm Ther 2015. [DOI: 10.1007/s41030-015-0008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Price DB, Rigazio A, Campbell JD, Bleecker ER, Corrigan CJ, Thomas M, Wenzel SE, Wilson AM, Small MB, Gopalan G, Ashton VL, Burden A, Hillyer EV, Kerkhof M, Pavord ID. Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study. Lancet Respir Med 2015; 3:849-58. [PMID: 26493938 DOI: 10.1016/s2213-2600(15)00367-7] [Citation(s) in RCA: 375] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/04/2015] [Accepted: 09/11/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Elevated sputum eosinophil counts predict asthma exacerbations and responsiveness to inhaled corticosteroids but are impractical to measure in primary care. We investigated the relation between blood eosinophil count and prospective annual asthma outcomes for a large UK cohort. METHODS This historical cohort study used anonymised medical record data to identify primary care patients with asthma aged 12-80 years with 2 years of continuous records, including 1 year before (baseline) and 1 year after (outcome) their most recent eosinophil count. Negative binomial regression was used to compare outcome exacerbation rates and logistic regression to compare odds of asthma control for patients with blood eosinophil counts of 400 cells per μL or less versus greater than 400 cells per μL, adjusting for age, sex, body-mass index, smoking status, and Charlson comorbidity index. The study is registered at ClinicalTrials.gov, number NCT02140541. FINDINGS Overall, 20 929 (16%) of 130 248 patients had blood eosinophil counts greater than 400 cells per μL. During the outcome year, these patients experienced significantly more severe exacerbations (adjusted rate ratio [RR] 1·42, 95% CI 1·36-1·47) and acute respiratory events (RR 1·28, 1·24-1·33) than those with counts of 400 cells per μL or less. They also had significantly lower odds of achieving overall asthma control (OR 0·74, 95% CI 0·72-0·77), defined as limited reliever use and no asthma-related hospital attendance or admission, acute course of oral corticosteroids, or prescription for antibiotics. Exacerbation rates increased progressively with nine ascending categories of blood eosinophil count as compared with a reference category of 200 cells per μL or less. INTERPRETATION Patients with asthma and blood eosinophil counts greater than 400 cells per μL experience more severe exacerbations and have poorer asthma control. Furthermore, a count-response relation exists between blood eosinophil counts and asthma-related outcomes. Blood eosinophil counts could add predictive value to Global Initiative for Asthma control-based risk assessment. FUNDING Teva Pharmaceuticals.
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Affiliation(s)
- David B Price
- Academic Primary Care, University of Aberdeen, Aberdeen, UK; Research in Real-Life, Cambridge, UK.
| | | | - Jonathan D Campbell
- Department of Clinical Pharmacy, Pharmaceutical Outcomes Research, University of Colorado School of Pharmacy, Aurora, CO, USA
| | - Eugene R Bleecker
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Mike Thomas
- Primary Care and Population Sciences, and NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton, Southampton, UK
| | - Sally E Wenzel
- University of Pittsburgh Asthma Institute at UPMC, Division of Pulmonary, Allergy and Critical Care Medicine, Pittsburgh, PA, USA
| | - Andrew M Wilson
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Mary Buatti Small
- Respiratory, Global Medical Affairs, TEVA Pharmaceuticals, Frazer, PA, USA
| | - Gokul Gopalan
- Respiratory, Global Medical Affairs, TEVA Pharmaceuticals, Frazer, PA, USA
| | | | | | | | | | - Ian D Pavord
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Chrystyn H, Safioti G, Keegstra JR, Gopalan G. Effect of inhalation profile and throat geometry on predicted lung deposition of budesonide and formoterol (BF) in COPD: An in-vitro comparison of Spiromax with Turbuhaler. Int J Pharm 2015; 491:268-76. [DOI: 10.1016/j.ijpharm.2015.05.076] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/27/2015] [Accepted: 05/30/2015] [Indexed: 11/26/2022]
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Virchow J, Gopalan G, Rodriguez-Roisin R, Shu Y. P227 Efficacy And Safety Of Budesonide-formoterol (bf) Spiromax(R) In Adults And Adolescents With Asthma: Randomised Comparison With Bf Turbuhaler(R). Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Postma DS, Roche N, Colice G, Israel E, Martin RJ, van Aalderen WM, Grigg J, Burden A, Hillyer EV, von Ziegenweidt J, Gopalan G, Price D. Comparing the effectiveness of small-particle versus large-particle inhaled corticosteroid in COPD. Int J Chron Obstruct Pulmon Dis 2014; 9:1163-86. [PMID: 25378918 PMCID: PMC4207569 DOI: 10.2147/copd.s68289] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Small airway changes and dysfunction contribute importantly to airway obstruction in chronic obstructive pulmonary disease (COPD), which is currently treated with inhaled corticosteroids (ICS) and long-acting bronchodilators at Global initiative for Obstructive Lung Disease (GOLD) grades 2–4. This retrospective matched cohort analysis compared effectiveness of a representative small-particle ICS (extrafine beclomethasone) and larger-particle ICS (fluticasone) in primary care patients with COPD. Patients and methods Smokers and ex-smokers with COPD ≥40 years old initiating or stepping-up their dose of extrafine beclomethasone or fluticasone were matched 1:1 for demographic characteristics, index prescription year, concomitant therapies, and disease severity during 1 baseline year. During 2 subsequent years, we evaluated treatment change and COPD exacerbations, defined as emergency care/hospitalization for COPD, acute oral corticosteroids, or antibiotics for lower respiratory tract infection. Results Mean patient age was 67 years, 57%–60% being male. For both initiation (n=334:334) and step-up (n=189:189) patients, exacerbation rates were comparable between extrafine beclomethasone and fluticasone cohorts during the 2 year outcome period. Odds of treatment stability (no exacerbation or treatment change) were significantly greater for patients initiating extrafine beclomethasone compared with fluticasone (adjusted odds ratio 2.50; 95% confidence interval, 1.32–4.73). Median ICS dose exposure during 2 outcome years was significantly lower (P<0.001) for extrafine beclomethasone than fluticasone cohorts (315 μg/day versus 436 μg/day for initiation, 438 μg/day versus 534 μg/day for step-up patients). Conclusion We observed that small-particle ICS at significantly lower doses had comparable effects on exacerbation rates as larger-particle ICS at higher doses, whereas initiation of small-particle ICS was associated with better odds of treatment stability during 2-years’ follow-up.
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Affiliation(s)
- Dirkje S Postma
- University of Groningen, Department of Pulmonary Medicine and Tuberculosis, University Medical Center Groningen, Groningen, the Netherlands
| | - Nicolas Roche
- Respiratory and Intensive Care Medicine, Cochin Hospital Group, APHP, Paris-Descartes University (EA2511), Paris, France
| | - Gene Colice
- Pulmonary, Critical Care and Respiratory Services, Washington Hospital Center and George Washington University School of Medicine, Washington DC, USA
| | - Elliot Israel
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Willem Mc van Aalderen
- Dept of Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital AMC, Amsterdam, the Netherlands
| | - Jonathan Grigg
- Blizard Institute, Queen Mary University London, London, UK
| | | | | | | | - Gokul Gopalan
- Respiratory, Global Scientific Affairs, Teva Pharmaceuticals, Frazer, PA, USA
| | - David Price
- Research in Real Life, Ltd, Cambridge, UK ; Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Bousquet J, Zuberbier T, Canonica GW, Fokkens WJ, Gopalan G, Shekar T. Randomized controlled trial of desloratadine for persistent allergic rhinitis: correlations between symptom improvement and quality of life. Allergy Asthma Proc 2013; 34:274-82. [PMID: 23676577 DOI: 10.2500/aap.2013.34.3668] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Allergic rhinitis (AR) symptoms can impart emotional, quality of life (QOL), and work productivity burdens, especially in persistent AR (PER). Desloratadine, an H1-receptor antagonist, has been shown to be effective against nasal and nonnasal AR symptoms and to improve QOL. Exploratory analyses were conducted to evaluate whether desloratadine-mediated symptom improvement correlated with improvements in QOL and productivity. The Aerius Control: Clinical and Evaluative Profile of Treatment 2 (NCT00405964) study was a 12-week, multinational, randomized, placebo-controlled prospective study of once-daily desloratadine at 5 mg in subjects with moderate-to-severe PER. Assessments included twice-daily symptom severity ratings (0 = none to 3 = severe; total and individual symptoms), sleep interference (morning [A.M.]), interference with activities of daily living (ADL; evening [P.M.]), the Rhinoconjunctivitis Quality of Life Questionnaire-Standardized version (baseline and days 29 and 85), and the Work Productivity and Activity Impairment-Allergy-Specific questionnaire (baseline and weekly). Pearson product-moment correlation statistics (r) were determined to assess correlations between symptom score improvements and QOL factors. All desloratadine-treated patients (n = 360) were included in this exploratory analysis. In the desloratadine-treated patients, all correlations tested were positive (all p < 0.0001). The highest coefficients were seen for the correlations between A.M./P.M. PRIOR total five-symptom score and interference with ADL (r = 0.72) and between A.M. NOW congestion and ADL interference (r = 0.69). Continuous daily treatment of moderate-to-severe PER with desloratadine at 5 mg/day significantly improved symptoms, which correlated positively, albeit moderately, with QOL benefits and reversal of functional impairments caused by PER.
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Bernstein DI, Teper A, Gopalan G, Gates D. Effects of intranasal mometasone furoate on itchy ear and palate in patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2012; 108:359-62. [PMID: 22541408 DOI: 10.1016/j.anai.2012.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 02/14/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Intranasal steroids relieve nasal symptoms and ocular itch in allergic rhinitis. Itchy ear and palate are also common and bothersome symptoms but have received little attention in clinical trials of allergic rhinitis. OBJECTIVE To ascertain the efficacy of mometasone furoate nasal spray in alleviating itchy ear and palate in seasonal allergic rhinitis. METHODS Data were pooled from 4 randomized, double-blind, placebo-controlled trials of mometasone furoate nasal spray, 200 μg/d. Participants rated ear and palate itching from baseline through treatment day 15 as follows: 0, none; 1, mild; 2, moderate; and 3, severe. RESULTS A total of 962 study participants received mometasone furoate nasal spray or placebo. Baseline least squares mean itchy ear and palate score was 1.81 for participants receiving mometasone furoate nasal spray (n = 480) and 1.85 for participants receiving placebo (n = 482). Mometasone furoate nasal spray was associated with a greater decrease in itchy and ear palate score vs placebo during the 15-day study period (least squares mean change, -0.73 vs -0.45; P < .001). The difference reached significance on day 2 and persisted through day 15 (P ≤ .01 for each day). Results were similar in a subgroup of patients (n = 305) with moderate-to-severe symptoms at baseline. Adverse events with mometasone furoate nasal spray were similar to those observed in other studies of intranasal steroid therapy. CONCLUSION These preliminary findings suggest that mometasone furoate nasal spray effectively treats itchy ear and palate in individuals with seasonal allergic rhinitis. Itchy ear and palate is a relevant end point for future clinical trials of allergic rhinitis.
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Affiliation(s)
- David I Bernstein
- Division of Immunology, Allergy, and Rheumatology, University of Cincinnati College of Medicine, 3255 Eden Ave, Cincinnati, OH 45267-0563, USA.
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Price D, Kemp L, Sims E, von Ziegenweidt J, Navaratnam P, Lee AJ, Chisholm A, Hillyer EV, Gopalan G. Observational study comparing intranasal mometasone furoate with oral antihistamines for rhinitis and asthma. Prim Care Respir J 2011; 19:266-73. [PMID: 20571732 DOI: 10.4104/pcrj.2010.00040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIMS Retrospective database study comparing upper and lower airway-related outcomes for patients with rhinitis and co-morbid asthma receiving mometasone furoate--an intranasal corticosteroid with low systemic bioavailability--or an oral antihistamine. METHODS 395 patients prescribed intranasal mometasone were matched on 10 demographic and respiratory-related criteria in a 1:2 ratio to 790 patients prescribed oral antihistamine. Asthma and rhinitis control were assessed over one year using predefined composite proxy measures. RESULTS Asthma control was achieved by 309/395 (78.2%) versus 580/790 (73.4%; p=0.071) patients in the mometasone and antihistamine cohorts, respectively. Rhinitis control was achieved by 293 (74.2%) versus 539 (68.2%; p=0.035), respectively. The adjusted odds ratios for antihistamines, relative to mometasone, were 0.71 (95% CI, 0.52-0.98) for achieving asthma control and 0.74 (95% CI, 0.56-0.97) for achieving rhinitis control. CONCLUSIONS Patients with rhinitis and co-morbid asthma initiating rhinitis therapy achieved significantly better upper as well as lower airway outcomes with intranasal mometasone than with oral antihistamine.
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Affiliation(s)
- David Price
- Academic Centre of Primary Care, University of Aberdeen, Aberdeen, UK.
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Salapatek AM, Patel P, Gopalan G, Varghese ST. Mometasone Furoate Nasal Spray Provides Early, Continuing Relief of Nasal Congestion and Improves Nasal Patency in Allergic Patients. Am J Rhinol Allergy 2010; 24:433-8. [DOI: 10.2500/ajra.2010.24.3548] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Patients report nasal congestion as the most bothersome seasonal allergic rhinitis (SAR) symptom. Measurement of this symptom in previous research has largely been based on subjective patient ratings. This study was designed to measure efficacy, onset, and duration of action of the corticosteroid mometasone furoate nasal spray (MFNS) on nasal congestion using an environmental exposure chamber (EEC) and the objective assessment acoustic rhinometry (AcR). Methods In a randomized, double-blind, placebo-controlled study, ragweed-sensitive subjects were exposed to ragweed pollen (3500 ± 500 pollen grains/m3) in an EEC (day 1). Subjects rated instantaneous total nasal symptom score (TNSS), including NSS for congestion (NSS-C). Qualifying subjects received MFNS, 200 micrograms, or placebo and rated postdosing symptoms; a subset received MFNS, 200 micrograms, or placebo q.d. for 6 subsequent days, returning to EEC on day 8. Days 1 and 8 assessments included AcR, TNSS, and the Rhinoconjunctivitis Quality of Life Questionnaire developed for use in the EEC (RQOLQ-EEC). Results At day 1, hour 6, patients receiving MFNS (n = 155) reported significantly reduced congestion versus placebo (n = 155) per AcR and NSS-C after one dose, showing numerically superior TNSS change from baseline (p = NS). Among the subset who received 6 additional days of treatment, MFNS (n = 78) yielded significantly lower TNSS versus placebo (n = 77) before day 8 EEC entry and throughout 4-hour exposure (p < 0.05), except at 3.5 hours. AcR showed lower congestion with MFNS versus placebo before day 8 EEC exposure and at 24 and 26 hours after final dose (p < 0.05 for all). AcR and NSS-C correlated at multiple time points. Day 8 RQOLQ-EEC between-group scores were significantly different (p = 0.02) for practical problems. Conclusion MFNS, 200 micrograms, showed onset of nasal congestion relief at 6 hours and duration of action beyond 24 hours postdosing. Objective and subjective assessments were correlated in subjects with maximal (placebo) or minimal (MFNS treatment) congestion symptoms; both assessments were correlated with improved QOL.
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Affiliation(s)
| | | | - Gokul Gopalan
- Schering-Plough Corporation, now Merck & Co., Inc., Kenilworth, New Jersey
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Meltzer EO, Munafo DA, Chung W, Gopalan G, Varghese ST. Intranasal mometasone furoate therapy for allergic rhinitis symptoms and rhinitis-disturbed sleep. Ann Allergy Asthma Immunol 2010; 105:65-74. [PMID: 20642206 DOI: 10.1016/j.anai.2010.04.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Allergic rhinitis (AR) and related nasal congestion cause rhinitis-disturbed sleep (RDS). Intranasal corticosteroids reduce nasal congestion and improve sleep quality in AR but have not been extensively studied in RDS. OBJECTIVE To evaluate the efficacy of mometasone furoate nasal spray (NS) on nasal symptoms, nasal patency, sleep variables, quality of life, and daytime functioning in perennial AR (PAR) and concomitant RDS. METHODS In this double-blind 4-week study, 30 adults with PAR and moderate RDS were randomized 2:1 to receive mometasone furoate NS, 200 microg, or placebo each morning. The primary end point was the apnea-hypopnea index. Secondary outcome measures included changes in total nasal symptom score (TNSS), nighttime symptom score, daytime peak nasal inspiratory flow, nighttime flow limitation index, Rhinoconjunctivitis Quality of Life Questionnaire-Standardized (RQLQ-S) score, Epworth Sleepiness Scale score, and Work Productivity and Activities Impairment-Allergy Specific (WPAI-AS) questionnaire score. Analysis of covariance was used for all efficacy end points. RESULTS The apnea-hypopnea index at study end was not statistically significantly different between groups. However, mometasone furoate NS therapy significantly improved morning (P = .04) and evening (P = .01) TNSSs, morning (P = .049) and evening (P = .03) nasal obstruction/blockage/congestion, daily peak nasal inspiratory flow (P = .03), flow limitation index (P = .02), Epworth Sleepiness Scale score (P = .048), RQLQ-S score (P = .03), and 2 of 5 WPAI-AS domains. Among patients receiving mometasone furoate NS, TNSS improvements were significantly correlated with improved work- and non-work-related productivity. CONCLUSIONS In patients with PAR and RDS, mometasone furoate NS use improved nasal symptoms, sleepiness, and impairment in daily activities. Correlated reduced nasal symptoms and improved performance suggest that improving AR symptoms with mometasone furoate NS administration can benefit sleep and daytime functioning.
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Affiliation(s)
- Eli O Meltzer
- Allergy and Asthma Medical Group and Research Center, San Diego, California 92123, USA.
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Bousquet J, Bachert C, Canonica GW, Mullol J, Van Cauwenberge P, Jensen CB, Fokkens WJ, Ring J, Keith P, Gopalan G, Lorber R, Zuberbier T. Efficacy of desloratadine in persistent allergic rhinitis - a GA²LEN study. Int Arch Allergy Immunol 2010; 153:395-402. [PMID: 20559006 DOI: 10.1159/000316351] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 02/01/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines proposed a classification for allergic rhinitis based on the duration of symptoms (intermittent or persistent) rather than on the time of allergen exposure (seasonal or perennial). There had been no placebo-controlled, randomized, clinical trial of desloratadine (DL) in patients with persistent allergic rhinitis to date. OBJECTIVES To assess the efficacy and safety of DL in patients with persistent allergic rhinitis based on the ARIA classification. METHODS Patients 12 years of age and older with persistent allergic rhinitis were assessed over 85 days of treatment with DL 5 mg once daily (n = 360) or placebo (n = 356). The primary endpoint was the AM/PM reflective total 5-symptom score (T5SS) averaged over days 1-29. Secondary endpoints included AM/PM instantaneous T5SS and individual symptoms, therapeutic response, symptom severity assessed by a visual analogue scale and quality of life. RESULTS The mean reduction in AM/PM reflective T5SS was significantly greater with DL than placebo over days 1-29 (-3.76 vs. -2.87, p < 0.001) and on each individual day (p < 0.05). The mean AM instantaneous T5SS was significantly reduced with DL compared with placebo as early as day 2 (-1.90 vs. -1.46; p < 0.001). The therapeutic response and improvement in quality of life were significantly greater with DL than placebo (p < 0.001 for each). The frequency of treatment-related adverse events was low and similar between DL (10.0%) and placebo (8.4%). CONCLUSIONS This study showed DL to be effective and safe in the treatment of persistent allergic rhinitis.
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Affiliation(s)
- Jean Bousquet
- University Hospital, Hôpital Arnaud de Villeneuve, Montpellier, France.
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Navaratnam P, Reardon G, Friedman H, Gopalan G, Krouse J. Patients With Mild Asthma and Concomitant Allergic Rhinitis (AR) Had Better AR and Asthma Treatment Success with Mometasone Furoate Nasal Spray when Compared with Leukotriene Receptor Antagonists, Non-Sedating Anti-Histamines (NSA) and Combinations of NSA and Decongestants. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Grossman J, Gopalan G. SP104 – Mometasone furoate for perennial AR in elderly subjects. Otolaryngol Head Neck Surg 2009. [DOI: 10.1016/j.otohns.2009.06.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Torkildsen GL, Gomes P, Welch D, Gopalan G, Srinivasan S. Evaluation of desloratadine on conjunctival allergen challenge-induced ocular symptoms. Clin Exp Allergy 2009; 39:1052-9. [DOI: 10.1111/j.1365-2222.2009.03224.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Grossman J, Gopalan G. Efficacy and Safety of Mometasone Furoate Nasal Spray in Elderly Subjects With Perennial Allergic Rhinitis. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.1047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rooklin A, Gopalan G, Gates D. Mometasone Furoate Nasal Spray Is Effective for Treatment of Mild-to-Moderate and Severe Seasonal Allergic Rhinitis. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Allergic rhinitis (AR) affects approximately 500 million people worldwide, and prevalence is increasing. Second-generation nonsedating antihistamines are first-line treatments for seasonal AR (SAR). This study was performed to evaluate early SAR symptom relief with second-generation antihistamines through a retrospective analysis of previously published data. In this study, 835 subjects aged 12-60 years with a > or = 2-year history of SAR were randomized to receive loratadine, 10 mg, once daily; fexofenadine, 60 mg, twice daily; or placebo for 7 days. Each subject recorded the severity of five symptoms of SAR on a scale of 0-3. This primary post hoc efficacy analysis was the mean change from baseline in daily average A.M./P.M. reflective and instantaneous total symptom score (TSS) on days 2 and 3. Significantly greater mean reductions from baseline were shown with loratadine compared with fexofenadine in average A.M./P.M. reflective TSS on days 2 (-3.51 versus -2.84, respectively; p < 0.002) and 3 (-3.80 versus -3.19, respectively; p = 0.007) and in average A.M./P.M. instantaneous TSS on day 3 (-3.68 versus -3.15, respectively; p = 0.022). Similar results were noted in average A.M./P.M. reflective and instantaneous total nasal symptom scores and for 10 of 20 individual symptom time points (p < 0.05). Loratadine was significantly more effective than placebo for all time points (p < 0.001). Early, sustained symptom relief was seen with loratadine, suggesting that it may be more effective for treating SAR symptoms.
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Abstract
Overexpression of Aurora-A oncogene has been shown to induce genomic instability and tumorigenesis. Cellular levels of Aurora-A are regulated by multiple mechanisms including the proteasome-dependent degradation of Aurora-A protein. Cell-cycle-dependent turnover of Aurora-A protein is mediated by cdh1 through ubiquitin (Ub)- and proteasome-dependent pathway. However, Aurora-A kinase interacting protein 1 (AURKAIP1), a negative regulator of Aurora-A, also promotes proteasome-dependent Aurora-A degradation through an Ub-independent mechanism. In an attempt to understand how AURKAIP1 promotes Aurora-A degradation through Ub-independent pathway, we demonstrate here that antizyme1 (Az1), a well-studied mediator of Ub-independent protein degradation pathway, regulates Aurora-A protein stability. We show that ectopic or polyamine-induced expression of Az1 can lower the steady-state levels of Aurora-A. The effect of Az1 on Aurora-A turnover was shown to be proteasome-dependent, but Ub-independent. Az1 interacts with Aurora-A in vivo and the interaction between Aurora-A and Az1 is essential for the Az1-mediated Aurora-A degradation. Furthermore, we observed that AURKAIP1 could not promote degradation of Aurora-A mutant, which is defective in Az1 interaction. Coexpression of the Az inhibitor (AzI), which downregulates Az1 functions, also abrogated AURKAIP1-mediated degradation of Aurora-A. We further demonstrated that AURKAIP1, Az1 and Aurora-A could exist as a ternary complex and AURKAIP1 enhances the interaction between Az1 and Aurora-A. We propose that AURKAIP1 might function upstream of the Az1 by enhancing the binding affinity of Az1 to Aurora-A to promote recognition, targeting to proteasome and subsequent degradation.
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Affiliation(s)
- S K Lim
- Laboratory of Gene Structure and Expression, Division of Molecular and Cellular Research, National Cancer Centre, Singapore, Singapore
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Gopalakrishnan S, Chadha SK, Gopalan G, Ravi D. Role of mastoid obliteration in patients with persistent cavity problems following modified radical mastoidectomy. J Laryngol Otol 2001; 115:967-72. [PMID: 11779325 DOI: 10.1258/0022215011909783] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A randomized clinical trial was conducted to determine the efficacy of mastoid obliteration in controlling persistent ear discharge, wax accumulation, fungal infection and granulation tissue formation in patients with cavity problems following modified radical mastoidectomy (MRM). Thirty patients underwent revision mastoidectomy with mastoid obliteration using a temporoparietal fascial flap. They were then followed up over a one-year period and the stated parameters observed. They were compared with 30 patients with similar complaints who were treated conservatively and kept under observation for 12 months. On follow-up, the number of patients in both the groups suffering from various cavity problems was compared. The chi-squared test was applied to the results and it was determined that there was a significantly lower incidence of discharging ear and formation of granulations in the operative group. However, audiological status, development of otomycosis and wax accumulation did not reveal any significant variation between the two groups.
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de Miguel M, Centanni JM, Gopalan G, Gilbert DJ, Copeland NG, Jenkins NA, Donovan PJ. Cellular apoptosis susceptibility gene capts maps to mouse chromosome 2. Mamm Genome 1998; 9:411-2. [PMID: 9545506 DOI: 10.1007/s003359900784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- M de Miguel
- Mammalian Genetics Laboratory, ABL-Basic Research Program, NCI-FCRDC, PO BOX B, Bldg 539, Frederick, Maryland 21702-1201, USA
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Centanni JM, de Miguel M, Gopalan G, Gilbert DJ, Copeland NG, Jenkins NA, Donovan PJ. Interleukin-1 receptor-associated kinase gene Il1rak maps to the mouse X chromosome. Mamm Genome 1998; 9:340-1. [PMID: 9530638 DOI: 10.1007/s003359900764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J M Centanni
- Mammalian Genetics Laboratory, National Cancer Institute, Frederick, Maryland 21702-1201, USA
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Gopalan G, Gilbert DJ, Copeland NG, Jenkins NA, Donovan PJ. Chromosome localization of two new mammalian kinases related to yeast and fly chromosome segregation-regulators. Mamm Genome 1998; 9:86-7. [PMID: 9434955 DOI: 10.1007/s003359900688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- G Gopalan
- Mammalian Genetics Laboratory, NCI-Frederick Research and Development Center, Maryland 21702, USA
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Gopalan G, Chan CS, Donovan PJ. A novel mammalian, mitotic spindle-associated kinase is related to yeast and fly chromosome segregation regulators. J Cell Biol 1997; 138:643-56. [PMID: 9245792 PMCID: PMC2141637 DOI: 10.1083/jcb.138.3.643] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/1997] [Revised: 05/16/1997] [Indexed: 02/04/2023] Open
Abstract
We describe a novel mammalian protein kinase related to two newly identified yeast and fly kinases-Ipl1 and aurora, respectively-mutations in which cause disruption of chromosome segregation. We have designated this kinase as Ipl1- and aurora-related kinase 1 (IAK1). IAK1 expression in mouse fibroblasts is tightly regulated temporally and spatially during the cell cycle. Transcripts first appear at G1/S boundary, are elevated at M-phase, and disappear rapidly after completion of mitosis. The protein levels and kinase activity of IAK1 are also cell cycle regulated with a peak at M-phase. IAK1 protein has a distinct subcellular and temporal pattern of localization. It is first identified on the centrosomes immediately after the duplicated centrosomes have separated. The protein remains on the centrosome and the centrosome-proximal part of the spindle throughout mitosis and is detected weakly on midbody microtubules at telophase and cytokinesis. In cells recovering from nocodazole treatment and in taxol-treated mitotic cells, IAK1 is associated with microtubule organizing centers. A wild-type and a mutant form of IAK1 cause mitotic spindle defects and lethality in ipl1 mutant yeast cells but not in wild-type cells, suggesting that IAK1 interferes with Ipl1p function in yeast. Taken together, these data strongly suggest that IAK1 may have an important role in centrosome and/ or spindle function during chromosome segregation in mammalian cells. We suggest that IAK1 is a new member of an emerging subfamily of the serine/threonine kinase superfamily. The members of this subfamily may be important regulators of chromosome segregation.
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Affiliation(s)
- G Gopalan
- Cell Biology of Development and Differentiation Group, ABL Basic Research Program, National Cancer Institute, Frederick Cancer Research and Development Center, Frederick, Maryland 21702-1201, USA
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Lock LF, Pines J, Hunter T, Gilbert DJ, Gopalan G, Jenkins NA, Copeland NG, Donovan PJ. A single cyclin A gene and multiple cyclin B1-related sequences are dispersed in the mouse genome. Genomics 1992; 13:415-24. [PMID: 1535334 DOI: 10.1016/0888-7543(92)90262-q] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cyclin activation of protein serine/threonine kinases plays a pivotal role in regulating the cell cycle. Multiple cyclins that fall into at least five classes, A, B, C, D, and E, have been identified. In some organisms, more than one member of a single cyclin class has been observed. To gain insight into the function of cyclin multiplicity, we determined the number of cyclin A- and B1-related sequences present in the mouse genome, the relationship between these cyclin-related sequences and previously described mutations in the mouse, and cyclin A and B1 mRNA expression in mouse embryos. By genetic mapping using human cyclin A and B1 probes, we identified 1 cyclin A gene located on chromosome 3 and 10 cyclin B1-related sequences located on chromosomes 4, 5, 7, 8, 13, 14, 15, and 17. Cyclin B1-related sequences map in the vicinity of the metaphase-arrest mutation oligosyndactyly (Os) and embryonic lethal mutations associated with the albino (c) locus and the t-complex. In Northern analysis, two cyclin A-related transcripts of 2.1 and 3.4 kb and three cyclin B1-related transcripts of 1.7, 2.1, and 2.7 kb were detected in embryonic stem cells and postimplantation embryos from Day 9.5 to 15.5 of development. Identification of multiple cyclin B1-related sequences in the mouse genome and multiple cyclin B1 mRNAs raises the possibility that seemingly redundant cyclin B genes might have developmental- and/or cell-type-specific functions.
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Affiliation(s)
- L F Lock
- Mammalian Genetics Laboratory, ABL-Basic Research Program, NCI-Frederick Cancer Research and Development Center, Maryland 21702
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Affiliation(s)
- G Gopalan
- Fachbereich Chemie, Philipps Universität, Marburg, FRG
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Gopalan G, Rajamanickam C. Role of exogenous hemin in the synthesis of hemoproteins and nonheme proteins during glucose repression in Saccharomyces cerevisiae. Arch Biochem Biophys 1986; 248:210-4. [PMID: 2873792 DOI: 10.1016/0003-9861(86)90418-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Exogenous addition of hemin to glucose-repressed cells of Saccharomyces cerevisiae stimulates the incorporation of amino acid into cytoplasmic proteins twofold. There was no significant change in the synthesis of total cytoplasmic RNA whereas a 40% increase in the synthesis of poly(A)-containing RNA was observed upon hemin treatment. Cell-free translation of cytoplasmic mRNAs and immunoprecipitation analysis of the translated products with antibodies against subunit V of cytochrome oxidase and the alpha and beta subunits of F1-ATPase reveals that there is an eightfold enrichment of the mRNA for subunit V of cytochrome oxidase upon hemin treatment. The effect of hemin on the alpha and beta subunits of F1-ATPase is only marginal, suggesting a differential role for heme in the synthesis of hemoproteins and nonheme proteins during glucose repression.
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Gopalan G, Rajamanickam C. Heme-mediated effect of cAMP on mitochondriogenesis during glucose repression-derepression in Saccharomyces cerevisiae. Indian J Biochem Biophys 1985; 22:214-7. [PMID: 3009306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Gopalan G, Jayaraman J, Rajamanickam C. Effect of exogenous addition of hemin on the biogenesis of mitochondrial membranes during glucose repression in Saccharomyces cerevisiae. Arch Biochem Biophys 1984; 235:159-66. [PMID: 6388505 DOI: 10.1016/0003-9861(84)90264-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Exogenous addition of hemin alleviated glucose repression by promoting mitochondrial membrane functions. It prevented the release of mitochondrial proteins into the cytosol by decreasing the activities of phospholipase C and phospholipase D. It restored oligomycin sensitivity of mitochondrial ATPase associated with repressed mitochondria. It enhanced cardiolipin content twofold, and decreased the sterol:phospholipid ratio. Studies on the amino acid incorporation into isolated mitochondria showed that hemin can also promote biogenesis of the organelle by stimulating amino acid incorporation into mitochondrial proteins, and this stimulation appeared to be mediated through some cytosolic factor(s).
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Seeni S, Mariappan T, Gopalan G, Gnanam A. Mechanical separation of palisade and spongy-parenchyma cells from the leaves of mesomorphic dicotyledons for photosynthetic studies. Planta 1983; 157:105-110. [PMID: 24264063 DOI: 10.1007/bf00393643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/1982] [Accepted: 10/29/1982] [Indexed: 06/02/2023]
Abstract
Palisade and spongy-parenchyma cells were isolated from the leaves of a number of mesomorphic dicotyledons by simply brushing the upper and lower sides, respectively, of the leaves with nylon brushes. Cross-contamination with the opposite cell type was minimal and both cell types were photosynthetically as active as leaf discs. The rates and early products of CO2 incorporation in the two cell types isolated from Zinnia elegans Jacq. plants grown in full natural light were the same, indicating that the photosynthetic physiology of the two cell types is quite similar.
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Affiliation(s)
- S Seeni
- Department of Plant Physiology, School of Biological Sciences, Madurai Kamaraj University, 625021, Madurai, India
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