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Middleton MR, Aroldi F, Sacco J, Milhem MM, Curti BD, Vanderwalde AM, Baum S, Samson A, Pavlick AC, Chesney JA, Niu J, Rhodes TD, Bowles TL, Olsson-Brown A, Laux DE, Bommareddy P, Deterding A, Elassal J, Coffin RS, Harrington K. An open-label, single-arm, phase II clinical trial of RP1, an enhanced potency oncolytic herpes virus, combined with nivolumab in four solid tumor types: Initial results from the skin cancer cohorts. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e22050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22050 Background: RP1 is an oncolytic HSV that encodes a fusogenic GALV-GP R- protein and GM-CSF. RP1 demonstrated tolerable safety and tumor regression alone and with nivolumab (nivo) in ph 1 in patients (pts) with a number of tumor types. To further define the efficacy of the combination, ph2 cohorts of 30 pts with 4 tumor types were then opened. Initial data from the melanoma (mel) and the non-mel skin cancer (NMSC) cohorts will be presented. Methods: Unresectable stage IIIb-IV mel pts for whom anti-PD-1 was indicated or who were refractory to 1 prior standard therapy including anti-PD-1 or ipi/nivo were enrolled. NMSC pts were anti-PD1 naïve. Pts received up to 8 doses of RP1 (<=10 mL/visit based on tumor diameter) Q2W (first dose 106 PFU/mL then 107 PFU/mL). From the second RP1 dose pts also received nivo (240 mg IV Q2W for 4 mos then 480 mg IV Q4W up to 2 yrs in the absence toxicity or confirmed progressive disease (PD)). Imaging was done every 8 wks and response assessed by RECISTv1.1 (with confirmation required for PD). Results: As of Jan 22nd 2020, 30 mel pts and 9 NMSC pts had been enrolled with follow up between <1 and 7mo. Of the mel pts 21 were cutaneous, 5 were mucosal and 4 were ocular. Of the NMSC pts, 6 had squamous cell, 1 had basal cell, 1 had Merkel cell carcinomas and 1 had angiosarcoma. Recruitment of the mel cohort is complete, with recruitment into the NMSC cohort ongoing. Based on initial data in melanoma, a further cohort of 125 pts with anti-PD1 refractory cutaneous mel has been opened. Adverse events (AEs) in the ph2 cohorts have been consistent with those in ph1, with RP1 side effects of in general Grade 1/2 constitutional and related symptoms, self-limiting within 72hrs of RP1 injections, with no exacerbation of the side effects expected for nivo. With currently short follow up, multiple objective responses have been observed in treatment naïve mel, anti-PD1 refractory mel (including ipi/nivo refractory and mucosal), and NMSC. Of note 3 of the first 4 anti-PD1 refractory mel pts treated are responding to treatment, as are 5 of the first 6 CSCC pts, including 3 CR. Tumor biopsies routinely showed immune activation, including robust recruitment of CD8+ T cells and increased PD-L1 expression. Treatment remains ongoing in the majority of patients, and current data will be presented. Conclusions: RP1 and nivo has continued to be well tolerated, with promising signs of efficacy in patients with skin cancers, including with anti-PD1 refractory disease. These data support the further development of RP1 combined with anti-PD1 blockade. Clinical trial information: NCT03767348 .
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Affiliation(s)
| | - Francesca Aroldi
- Department of Medical Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Joseph Sacco
- Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | | | - Brendan D. Curti
- Providence Cancer Center and Earle A. Chiles Research Institute, Portland, OR
| | - Ari M. Vanderwalde
- The University of Tennessee Health Science Center, West Cancer Center, Germantown, TN
| | | | | | - Anna C. Pavlick
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY
| | - Jason Alan Chesney
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY
| | - Jiaxin Niu
- Banner MD Anderson Cancer Center, Gilbert, AZ
| | | | | | | | | | | | | | | | | | - Kevin Harrington
- Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, United Kingdom
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Abstract
Supplemental Digital Content is available in the text. Background: To optimize preventive strategies for coronary heart disease (CHD), it is essential to understand and appropriately quantify the contribution of its key risk factors. Our objective was to compare the associations of key modifiable CHD risk factors—specifically lipids, systolic blood pressure (SBP), diabetes mellitus, and smoking—with incident CHD events based on their prognostic performance, attributable risk fractions, and treatment benefits, overall and by age. Methods: Pooled participant-level data from 4 observational cohort studies sponsored by the National Heart, Lung, and Blood Institute were used to create a cohort of 22 626 individuals aged 45 to 84 years who were initially free of cardiovascular disease. Individuals were followed for 10 years from baseline evaluation for incident CHD. Proportional hazards regression was used to estimate metrics of prognostic model performance (likelihood ratio, C index, net reclassification, discrimination slope), hazard ratios, and population attributable fractions for SBP, non–high-density lipoprotein cholesterol (non–HDL-C), diabetes mellitus, and smoking. Expected absolute risk reductions for antihypertensive and lipid-lowering treatment were assessed. Results: Age, sex, and race capture 63% to 80% of the prognostic performance of cardiovascular risk models. In contrast, adding either SBP, non–HDL-C, diabetes mellitus, or smoking to a model with other risk factors increases the C index by only 0.004 to 0.013. However, primordial prevention could have a substantial effect as demonstrated by population attributable fractions of 28% for SBP≥130 mm Hg and 17% for non–HDL-C≥130 mg/dL. Similarly, lowering the SBP of all individuals to <130 mm Hg or lowering low-density lipoprotein cholesterol by 30% would be expected to lower a baseline 10-year CHD risk of 10.7% to 7.0 and 8.0, respectively (absolute risk reductions: 3.7% and 2.7%, respectively). Prognostic performance decreases with age (C indices for age groups 45–54, 55–64, 65–74, 75–84 are 0.75, 0.72, 0.66, and 0.62, respectively), whereas absolute risk reductions increase (SBP: 1.1%, 2.3%, 5.4%, 10.3%, respectively; non–HDL-C: 1.1%, 2.0%, 3.7%, 5.9%, respectively). Conclusions: Although individual modifiable CHD risk factors contribute only modestly to prognostic performance, our models indicate that eliminating or controlling these individual factors would lead to substantial reductions in total population CHD events. Metrics used to judge importance of risk factors should be tailored to the research objectives.
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Affiliation(s)
- Michael J Pencina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.J.P., A.M.N., D.W., E.D.P.)
| | - Ann Marie Navar
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.J.P., A.M.N., D.W., E.D.P.)
| | - Daniel Wojdyla
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.J.P., A.M.N., D.W., E.D.P.)
| | | | - Irfan Khan
- Real-World Evidence and Clinical Outcomes, Sanofi, Bridgewater, NJ (I.K.)
| | - Joseph Elassal
- Regeneron Pharmaceuticals Inc, Tarrytown, NY (R.J.S., J.E.)
| | - Ralph B D'Agostino
- Department of Mathematics and Statistics, Boston University, MA (R.B.D.).,Baim Institute for Clinical Research, Boston, MA (R.B.D.)
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.J.P., A.M.N., D.W., E.D.P.)
| | - Allan D Sniderman
- Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada (A.D.S.)
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Nanna MG, Navar AM, Zakroysky P, Xiang Q, Goldberg AC, Robinson J, Roger VL, Virani SS, Wilson PWF, Elassal J, Lee LV, Wang TY, Peterson ED. Association of Patient Perceptions of Cardiovascular Risk and Beliefs on Statin Drugs With Racial Differences in Statin Use: Insights From the Patient and Provider Assessment of Lipid Management Registry. JAMA Cardiol 2019; 3:739-748. [PMID: 29898219 DOI: 10.1001/jamacardio.2018.1511] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance African American individuals face higher atherosclerotic cardiovascular disease risk than white individuals; reasons for these differences, including potential differences in patient beliefs regarding preventive care, remain unknown. Objective To evaluate differences in statin use between white and African American patients and identify the potential causes for any observed differences. Design, Setting, and Participants Using the 2015 Patient and Provider Assessment of Lipid Management (PALM) Registry data, we compared statin use and dosing between African American and white outpatient adults who were potentially eligible for primary or secondary prevention statins. A total of 138 US community health care practices contributed to the data. Data analysis was conducted from March 2017 to May 2018. Main Outcomes and Measures Primary outcomes were use and dosing of statin therapy according to the 2013 American College of Cardiology/American Heart Association guideline by African American or white race. Secondary outcomes included lipid levels and patient-reported beliefs. Poisson regression was used to evaluate the association between race and statin undertreatment, a category combining people who were not taking a statin or those taking a dose intensity lower than recommended. Results A total of 5689 patients (806 [14.2%] African American) in the PALM registry were eligible for statin therapy. African American individuals were less likely than white individuals to be treated with a statin (570/807 [70.6%] vs 3654/4883 [74.8%]; P = .02). Among those treated, African American patients were less likely than white patients to receive a statin at guideline-recommended intensity (269 [33.3%] vs 2145 [43.9%], respectively; P < .001; relative risk, 1.07 [95% CI, 1.00-1.15]; P = .05, after adjustment for demographic and clinical factors). The median (interquartile range) low-density lipoprotein cholesterol levels of patients receiving treatment were higher among African American than white individuals (97.0 [76.0-121.0] mg/dL vs 85.0 [68.0-105.0] mg/dL; P < .001). African American individuals were less likely than white individuals to believe statins were safe (292 [36.2%] vs 2800 [57.3%]; P < .001) or effective (564 [70.0%] vs 3635 [74.4%]; P = .008) and were less likely to trust their clinician (663 [82.3%] vs 4579 [93.8%]; P < .001). Group differences in statin undertreatment were not significant after adjusting for demographic, clinical, and clinician factors, socioeconomic status, and patient beliefs (final adjusted relative risk, 1.03 [95% CI 0.96-1.11]; P = .35). Conclusions and Relevance African American individuals were less likely to receive guideline-recommended statin therapy. Demographic, clinical, socioeconomic, belief-related, and clinician differences contributed to observed differences and represent potential targets for intervention.
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Affiliation(s)
| | - Ann Marie Navar
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Pearl Zakroysky
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Qun Xiang
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | | | | | | | - Peter W F Wilson
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia.,Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | | | | | - Tracy Y Wang
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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4
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Navar AM, Peterson ED, Li S, Robinson JG, Roger VL, Goldberg AC, Virani S, Wilson PWF, Nanna MG, Lee LV, Elassal J, Wang TY. Prevalence and Management of Symptoms Associated With Statin Therapy in Community Practice: Insights From the PALM (Patient and Provider Assessment of Lipid Management) Registry. Circ Cardiovasc Qual Outcomes 2019; 11:e004249. [PMID: 29545393 DOI: 10.1161/circoutcomes.117.004249] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/12/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Ann Marie Navar
- From the Department of Medicine (Cardiology), Duke Clinical Research Institute, Durham, NC (A.M.N., E.D.P., S.L., T.Y.W. M.G.N.); Department of Epidemiology, University of Iowa (J.G.R.); Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (V.L.R.); Washington University, St. Louis, MO (A.C.G.); VA Medical Center and Baylor College of Medicine, Houston, TX (S.V.); Department of Medicine, Emory University, Atlanta, GA (P.W.F.W.); Sanofi Pharmaceuticals, Bridgewater, NJ (L.V.L.); and Regeneron Pharmaceuticals, Tarrytown, NY (J.E.).
| | - Eric D Peterson
- From the Department of Medicine (Cardiology), Duke Clinical Research Institute, Durham, NC (A.M.N., E.D.P., S.L., T.Y.W. M.G.N.); Department of Epidemiology, University of Iowa (J.G.R.); Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (V.L.R.); Washington University, St. Louis, MO (A.C.G.); VA Medical Center and Baylor College of Medicine, Houston, TX (S.V.); Department of Medicine, Emory University, Atlanta, GA (P.W.F.W.); Sanofi Pharmaceuticals, Bridgewater, NJ (L.V.L.); and Regeneron Pharmaceuticals, Tarrytown, NY (J.E.)
| | - Shuang Li
- From the Department of Medicine (Cardiology), Duke Clinical Research Institute, Durham, NC (A.M.N., E.D.P., S.L., T.Y.W. M.G.N.); Department of Epidemiology, University of Iowa (J.G.R.); Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (V.L.R.); Washington University, St. Louis, MO (A.C.G.); VA Medical Center and Baylor College of Medicine, Houston, TX (S.V.); Department of Medicine, Emory University, Atlanta, GA (P.W.F.W.); Sanofi Pharmaceuticals, Bridgewater, NJ (L.V.L.); and Regeneron Pharmaceuticals, Tarrytown, NY (J.E.)
| | - Jennifer G Robinson
- From the Department of Medicine (Cardiology), Duke Clinical Research Institute, Durham, NC (A.M.N., E.D.P., S.L., T.Y.W. M.G.N.); Department of Epidemiology, University of Iowa (J.G.R.); Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (V.L.R.); Washington University, St. Louis, MO (A.C.G.); VA Medical Center and Baylor College of Medicine, Houston, TX (S.V.); Department of Medicine, Emory University, Atlanta, GA (P.W.F.W.); Sanofi Pharmaceuticals, Bridgewater, NJ (L.V.L.); and Regeneron Pharmaceuticals, Tarrytown, NY (J.E.)
| | - Veronique L Roger
- From the Department of Medicine (Cardiology), Duke Clinical Research Institute, Durham, NC (A.M.N., E.D.P., S.L., T.Y.W. M.G.N.); Department of Epidemiology, University of Iowa (J.G.R.); Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (V.L.R.); Washington University, St. Louis, MO (A.C.G.); VA Medical Center and Baylor College of Medicine, Houston, TX (S.V.); Department of Medicine, Emory University, Atlanta, GA (P.W.F.W.); Sanofi Pharmaceuticals, Bridgewater, NJ (L.V.L.); and Regeneron Pharmaceuticals, Tarrytown, NY (J.E.)
| | - Anne C Goldberg
- From the Department of Medicine (Cardiology), Duke Clinical Research Institute, Durham, NC (A.M.N., E.D.P., S.L., T.Y.W. M.G.N.); Department of Epidemiology, University of Iowa (J.G.R.); Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (V.L.R.); Washington University, St. Louis, MO (A.C.G.); VA Medical Center and Baylor College of Medicine, Houston, TX (S.V.); Department of Medicine, Emory University, Atlanta, GA (P.W.F.W.); Sanofi Pharmaceuticals, Bridgewater, NJ (L.V.L.); and Regeneron Pharmaceuticals, Tarrytown, NY (J.E.)
| | - Salim Virani
- From the Department of Medicine (Cardiology), Duke Clinical Research Institute, Durham, NC (A.M.N., E.D.P., S.L., T.Y.W. M.G.N.); Department of Epidemiology, University of Iowa (J.G.R.); Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (V.L.R.); Washington University, St. Louis, MO (A.C.G.); VA Medical Center and Baylor College of Medicine, Houston, TX (S.V.); Department of Medicine, Emory University, Atlanta, GA (P.W.F.W.); Sanofi Pharmaceuticals, Bridgewater, NJ (L.V.L.); and Regeneron Pharmaceuticals, Tarrytown, NY (J.E.)
| | - Peter W F Wilson
- From the Department of Medicine (Cardiology), Duke Clinical Research Institute, Durham, NC (A.M.N., E.D.P., S.L., T.Y.W. M.G.N.); Department of Epidemiology, University of Iowa (J.G.R.); Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (V.L.R.); Washington University, St. Louis, MO (A.C.G.); VA Medical Center and Baylor College of Medicine, Houston, TX (S.V.); Department of Medicine, Emory University, Atlanta, GA (P.W.F.W.); Sanofi Pharmaceuticals, Bridgewater, NJ (L.V.L.); and Regeneron Pharmaceuticals, Tarrytown, NY (J.E.)
| | - Michael G Nanna
- From the Department of Medicine (Cardiology), Duke Clinical Research Institute, Durham, NC (A.M.N., E.D.P., S.L., T.Y.W. M.G.N.); Department of Epidemiology, University of Iowa (J.G.R.); Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (V.L.R.); Washington University, St. Louis, MO (A.C.G.); VA Medical Center and Baylor College of Medicine, Houston, TX (S.V.); Department of Medicine, Emory University, Atlanta, GA (P.W.F.W.); Sanofi Pharmaceuticals, Bridgewater, NJ (L.V.L.); and Regeneron Pharmaceuticals, Tarrytown, NY (J.E.)
| | - L Veronica Lee
- From the Department of Medicine (Cardiology), Duke Clinical Research Institute, Durham, NC (A.M.N., E.D.P., S.L., T.Y.W. M.G.N.); Department of Epidemiology, University of Iowa (J.G.R.); Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (V.L.R.); Washington University, St. Louis, MO (A.C.G.); VA Medical Center and Baylor College of Medicine, Houston, TX (S.V.); Department of Medicine, Emory University, Atlanta, GA (P.W.F.W.); Sanofi Pharmaceuticals, Bridgewater, NJ (L.V.L.); and Regeneron Pharmaceuticals, Tarrytown, NY (J.E.)
| | - Joseph Elassal
- From the Department of Medicine (Cardiology), Duke Clinical Research Institute, Durham, NC (A.M.N., E.D.P., S.L., T.Y.W. M.G.N.); Department of Epidemiology, University of Iowa (J.G.R.); Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (V.L.R.); Washington University, St. Louis, MO (A.C.G.); VA Medical Center and Baylor College of Medicine, Houston, TX (S.V.); Department of Medicine, Emory University, Atlanta, GA (P.W.F.W.); Sanofi Pharmaceuticals, Bridgewater, NJ (L.V.L.); and Regeneron Pharmaceuticals, Tarrytown, NY (J.E.)
| | - Tracy Y Wang
- From the Department of Medicine (Cardiology), Duke Clinical Research Institute, Durham, NC (A.M.N., E.D.P., S.L., T.Y.W. M.G.N.); Department of Epidemiology, University of Iowa (J.G.R.); Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (V.L.R.); Washington University, St. Louis, MO (A.C.G.); VA Medical Center and Baylor College of Medicine, Houston, TX (S.V.); Department of Medicine, Emory University, Atlanta, GA (P.W.F.W.); Sanofi Pharmaceuticals, Bridgewater, NJ (L.V.L.); and Regeneron Pharmaceuticals, Tarrytown, NY (J.E.)
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Karalis DG, Mallya UG, Ghannam AF, Elassal J, Gupta R, Boklage SH. Prescribing Patterns of Proprotein Convertase Subtilisin-Kexin Type 9 Inhibitors in Eligible Patients With Clinical Atherosclerotic Cardiovascular Disease or Heterozygous Familial Hypercholesterolemia. Am J Cardiol 2018; 121:1155-1161. [PMID: 29548678 DOI: 10.1016/j.amjcard.2018.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/19/2018] [Accepted: 02/06/2018] [Indexed: 01/22/2023]
Abstract
Two proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors are approved for patients with atherosclerotic cardiovascular disease or heterozygous familial hypercholesterolemia who require additional low-density lipoprotein cholesterol (LDL-C) lowering. This retrospective study sought to determine differences between eligible patients who were prescribed and those who were not prescribed a PCSK9 inhibitor. Patients from an electronic medical record database were included in the analysis, and their demographic, clinical, and treatment characteristics were evaluated. Of 368,624 PCSK9 inhibitor-eligible patients, 1,752 (<0.5%) received a PCSK9 inhibitor prescription. Patients who received a PCSK9 inhibitor were more frequently associated with a higher cardiovascular disease risk category and a higher baseline LDL-C level (139.4 vs 103.5 mg/dl; p <0.0001) compared with those who did not. Patients with a PCSK9 inhibitor prescription were significantly more likely to be on ezetimibe, alone or in combination with a statin, at baseline compared with those without (29% vs 5%; p <0.0001). The use of a PCSK9 inhibitor was very low in the 2 groups of patients identified as PCSK9 inhibitor-eligible based on the American College of Cardiology Expert Consensus Decision Pathway. In conclusion, this study demonstrates that most PCSK9 inhibitor-eligible patients do not receive a PCSK9 inhibitor prescription, highlighting that many high-risk patients could benefit from additional LDL-C lowering with a PCSK9 inhibitor.
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Glueck CJ, Brown A, Goldberg AC, McKenney JM, Kantaros L, Stewart J, Elassal J, Koren A. Alirocumab in high-risk patients: Observations from the open-label expanded use program. J Clin Lipidol 2018. [DOI: 10.1016/j.jacl.2018.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Navar AM, Wang TY, Li S, Robinson JG, Goldberg AC, Virani S, Roger VL, Wilson PW, Elassal J, Lee LV, Peterson ED. Lipid management in contemporary community practice: Results from the Provider Assessment of Lipid Management (PALM) Registry. Am Heart J 2017; 193:84-92. [PMID: 29129260 DOI: 10.1016/j.ahj.2017.08.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/05/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The latest cholesterol guidelines have shifted focus from achieving low-density lipoprotein cholesterol (LDL-C) targets toward statin use and intensity guided by atherosclerotic cardiovascular disease (ASCVD) risk. METHODS Statin use and intensity were evaluated in 5,905 statin-eligible primary or secondary prevention patients from 138 PALM Registry practices. RESULTS Overall, 74.7% of eligible adults were on statins; only 42.4% were on guideline-recommended intensity. Relative to primary prevention patients, ASCVD patients were more likely to be on a statin (83.6% vs 63.4%, P<.0001) and guideline-recommended intensity (47.3% vs 36.0%, P<.0001). Men were more likely than women to be prescribed recommended intensity for primary (odds ratio [OR] 1.87, 95% CI 1.49-2.34) and secondary (OR 1.47, 95% CI 1.26-1.70) prevention. In primary prevention, increasing age, diabetes, obesity, hypertension, and lower 10-year ASCVD risk were associated with increased odds of receiving recommended intensity. Among ASCVD patients, those with coronary artery disease were more likely to be on recommended intensity than cerebrovascular or peripheral vascular disease patients (OR 1.71, 95% CI 1.41-2.09), as were those seen by cardiologists (OR 1.43, 95% CI 1.12-1.83). Median LDL-C levels were highest among patients not on statins (124.0 mg/dL) and slightly higher among those on lower-than-recommended intensity compared with recommended-therapy recipients (88.0 and 84.0 mg/dL, respectively; P≤.0001). CONCLUSIONS In routine contemporary practice, 1 in 4 guideline-eligible patients was not on a statin; less than half were on the recommended statin intensity. Untreated and undertreated patients had significantly higher LDL-C levels than those receiving guideline-directed statin treatment.
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Ming JE, Abrams RE, Bartlett DW, Tao M, Nguyen T, Surks H, Kudrycki K, Kadambi A, Friedrich CM, Djebli N, Goebel B, Koszycki A, Varshnaya M, Elassal J, Banerjee P, Sasiela WJ, Reed MJ, Barrett JS, Azer K. A Quantitative Systems Pharmacology Platform to Investigate the Impact of Alirocumab and Cholesterol-Lowering Therapies on Lipid Profiles and Plaque Characteristics. Gene Regul Syst Bio 2017; 11:1177625017710941. [PMID: 28804243 PMCID: PMC5484552 DOI: 10.1177/1177625017710941] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/17/2017] [Indexed: 12/20/2022]
Abstract
Reduction in low-density lipoprotein cholesterol (LDL-C) is associated with decreased risk for cardiovascular disease. Alirocumab, an antibody to proprotein convertase subtilisin/kexin type 9 (PCSK9), significantly reduces LDL-C. Here, we report development of a quantitative systems pharmacology (QSP) model integrating peripheral and liver cholesterol metabolism, as well as PCSK9 function, to examine the mechanisms of action of alirocumab and other lipid-lowering therapies, including statins. The model predicts changes in LDL-C and other lipids that are consistent with effects observed in clinical trials of single or combined treatments of alirocumab and other treatments. An exploratory model to examine the effects of lipid levels on plaque dynamics was also developed. The QSP platform, on further development and qualification, may support dose optimization and clinical trial design for PCSK9 inhibitors and lipid-modulating drugs. It may also improve our understanding of factors affecting therapeutic responses in different phenotypes of dyslipidemia and cardiovascular disease.
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Affiliation(s)
- Jeffrey E Ming
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
| | - Ruth E Abrams
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
| | | | - Mengdi Tao
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
| | - Tu Nguyen
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
| | - Howard Surks
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
| | | | | | | | - Nassim Djebli
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
| | - Britta Goebel
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
| | - Alex Koszycki
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
| | - Meera Varshnaya
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
| | | | | | | | | | - Jeffrey S Barrett
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
| | - Karim Azer
- Sanofi, Bridgewater, NJ, USA; Frankfurt Am Main, Germany, and Montpellier, France
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Boklage S, Malangone-Monaco E, Lopez-Gonzalez L, Ding Y, Elassal J. Statin Utilization Patterns Following An Acute Coronary Syndrome (ACS) Event. J Clin Lipidol 2017. [DOI: 10.1016/j.jacl.2017.04.056] [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: 10/19/2022]
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Burudpakdee C, Elassal J, Valcheva V, Gorcyca K, Iorga S, Roth E. CONTRASTING US PATIENTS WITH A FILL VERSUS A PRESCRIPTION FOR ALIROCUMAB: EARLY EVIDENCE FROM ADMINISTRATIVE CLAIMS, EMR AND LAB DATA. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35102-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Glueck CJ, Brown A, Goldberg A, McKenney J, Kantaros L, Stewart J, Elassal J, Koren A. ALIROCUMAB IN HIGH-RISK PATIENTS WITH BASELINE LDL-C ≥160 MG/DL: FINDINGS FROM THE COMPASSIONATE USE PROGRAM. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33544-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Karalis D, Mallya U, Elassal J, Ghannam AF, Gupta R, Boklage S. UNDERSTANDING THE PREDICTORS OF ACHIEVING LDL-C TARGETS WHEN ADDING EZETIMIBE IN HIGH RISK PATIENTS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35092-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wang T, Li S, Navar AM, Roger V, Robinson J, Goldberg A, Virani S, Elassal J, Lee LV, Wilson P, Peterson E. CONTEMPORARY PATTERNS OF LIPID TESTING IN PRIMARY AND SECONDARY PREVENTION PATIENTS: INSIGHTS FROM THE PALM REGISTRY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35084-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Boklage S, Malangone-Monaco E, Lopez-Gonzalez L, Ding Y, Henriques C, Elassal J, Wadhera R. STATIN UTILIZATION PATTERNS DURING INPATIENT ADMISSIONS FOR ACUTE CORONARY SYNDROME (ACS). J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33618-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Boggan AMN, Wang T, Li S, Pencina M, Stafford J, Goldberg A, Robinson J, Roger V, Virani S, Wilson P, Elassal J, Lee LV, Peterson E. PATIENTS’ PERCEIVED VERSUS PREDICTED CARDIOVASCULAR DISEASE RISK: CHALLENGES FOR SHARED DECISION-MAKING IN CHOLESTEROL MANAGEMENT. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31930-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Navar AM, Peterson ED, Li S, Virani SS, Wilson PW, Robinson JG, Goldberg AC, Roger VL, Elassal J, Lee LV, Wang TY. Abstract 118: Are Patients with Atherosclerotic Cardiovascular Disease Receiving Appropriate Lipid Management? Insights from the PALM Registry. Circ Cardiovasc Qual Outcomes 2016. [DOI: 10.1161/circoutcomes.9.suppl_2.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Prior ATPIII lipid guidelines recommended statin therapy for patients with clinical ASCVD to achieve low density lipoprotein cholesterol (LDL-C) targets, while the 2013 ACC/AHA lipid guidelines recommend high-intensity statin therapy for all ASCVD patients. How closely these recommendations are followed in routine clinical practice is unknown.
Methods:
We evaluated statin use, intensity, and LDL-C values in 1,483 patients with ASCVD (coronary heart disease, cerebrovascular disease, and peripheral arterial disease) enrolled and seen serially at 62 geographically dispersed US cardiology and primary care clinics in the Patient and Provider Assessment of Lipid Management (PALM) Registry between May - September 2015. Factors associated with high intensity statin use (atorvastatin ≥40 mg or rosuvastatin ≥20 mg daily) and LDL-C <70 mg/dL were evaluated in multivariable logistic regression.
Results:
Of 1,483 ASCVD patients, 86.2% were on a statin, but only 31.4% were on a high-intensity statin. Overall, 64.0% had an LDL-C <100 mg/dL, but only 29.0% had an LDL-C <70 mg/dL. Factors associated with high-intensity statin use in multivariable regression were younger age (OR 0.74 per 10 year increase, p<0.001, 95% CI 0.66-0.83), male sex (OR 1.69, p<0.001, 95% CI, 1.32-2.16), cerebrovascular disease (OR 1.55, p=0.008, 95% CI 1.12-2.13), coronary heart disease (OR 2.42, p<0.001, 95% CI 1.67-3.50), and being seen by a cardiologist (OR 1.35, p =0.04, 95% CI 1.01-1.81). Factors associated with an increased likelihood of LDL-C<70 were male sex (OR 1.55, p=0.001, 95% CI 1.20-2.01), white (OR 1.62, p=0.03, 95% CI 1.04-2.5-, diabetes (OR 1.64, p<0.001, 95% CI 1.29-2.09) and being seen by a cardiologist (OR 1.94, p<0.001, 95% CI 1.41-2.67).
Discussion:
Substantial gaps in care remain for secondary prevention of ASCVD despite simplified recommendations. While the majority of patients with ASCVD in community practice are on a statin, only one-third are on high intensity statins and over two-thirds have LDL ≥70 mg/dL.
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Affiliation(s)
| | | | - Shuang Li
- Duke Clinical Rsch Institute, Durham, NC
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Zhan S, Shapiro D, Zhan S, Zhang L, Hirschfeld S, Elassal J, Helman LJ. Concordant loss of imprinting of the human insulin-like growth factor II gene promoters in cancer. J Biol Chem 1995; 270:27983-6. [PMID: 7499276 DOI: 10.1074/jbc.270.47.27983] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The human insulin-like growth factor II (IGFII) gene has been shown to be imprinted for the promoters P2, P3, and P4 but not for the promoter P1 in liver and chondrocytes. Loss of imprinting of the IGFII gene has been found in a variety of human tumors including rhabdomyosarcoma and lung cancer. In this report, we determined whether loss of imprinting in tumors displays a promoter-specific pattern. We examined allelic expression of all four IGFII promoters in rhabdomyosarcoma, lung cancer, and normal skeletal muscle. We demonstrate that the imprinting of all IGFII promoters is relaxed in rhabdomyosarcoma and lung cancer. These data suggest that loss of imprinting of IGFII gene promoters may be regulated coordinately by a common mechanism in these tumors. Unexpectedly, we also found that P1, in addition to P2, P3, and P4 is monoallelically expressed in three informative adult skeletal muscle tissues. This indicates that imprinting of the IGFII promoter P1 occurs in a tissue-specific manner.
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Affiliation(s)
- S Zhan
- Pediatric Branch, National Cancer Institute, Bethesda, Maryland 20892, USA
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