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Hofstad T, Nyttingnes O, Markussen S, Johnsen E, Killackey E, McDaid D, Rinaldi M, Dean K, Brinchmann B, Douglas K, Gröning L, Bjørkly S, Palmstierna T, Strømme MF, Blindheim A, Rugkåsa J, Hofmann BM, Pedersen R, Widding‐Havneraas T, Rypdal K, Mykletun A. Long term outcomes and causal modelling of compulsory inpatient and outpatient mental health care using Norwegian registry data: Protocol for a controversies in psychiatry research project. Int J Methods Psychiatr Res 2023; 33:e1980. [PMID: 37421245 PMCID: PMC10807697 DOI: 10.1002/mpr.1980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/19/2023] [Indexed: 07/10/2023] Open
Abstract
OBJECTIVES Compulsory mental health care includes compulsory hospitalisation and outpatient commitment with medication treatment without consent. Uncertain evidence of the effects of compulsory care contributes to large geographical variations and a controversy on its use. Some argue that compulsion can rarely be justified and should be reduced to an absolute minimum, while others claim compulsion can more frequently be justified. The limited evidence base has contributed to variations in care that raise issues about the quality/appropriateness of care as well as ethical concerns. To address the question whether compulsory mental health care results in superior, worse or equivalent outcomes for patients, this project will utilise registry-based longitudinal data to examine the effect of compulsory inpatient and outpatient care on multiple outcomes, including suicide and overall mortality; emergency care/injuries; crime and victimisation; and participation in the labour force and welfare dependency. METHODS By using the natural variation in health providers' preference for compulsory care as a source of quasi-randomisation we will estimate causal effects of compulsory care on short- and long-term trajectories. CONCLUSIONS This project will provide valuable insights for service providers and policy makers in facilitating high quality clinical care pathways for a high risk population group.
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Affiliation(s)
- Tore Hofstad
- Centre for Research and Education in Forensic PsychiatryHaukeland University HospitalBergenNorway
- Centre for Medical EthicsUniversity of OsloOsloNorway
| | - Olav Nyttingnes
- Centre for Research and Education in Forensic PsychiatryHaukeland University HospitalBergenNorway
- Health Services Research UnitAkershus University HospitalLørenskogNorway
| | | | - Erik Johnsen
- Division of PsychiatryHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
- NORMENTCentre of ExcellenceHaukeland University HospitalBergenNorway
| | - Eoin Killackey
- OrygenMelbourneAustralia
- Centre for Youth Mental HealthThe University of MelbourneMelbourneAustralia
| | - David McDaid
- Care Policy and Evaluation CentreDepartment of Health PolicyLondon School of Economics and Political ScienceLondonUK
| | - Miles Rinaldi
- Centre for Research and Education in Forensic PsychiatryHaukeland University HospitalBergenNorway
- Centre for Work and Mental HealthNordland Hospital TrustBodøNorway
- South West London and St George's Mental Health NHS TrustLondonUK
| | - Kimberlie Dean
- Discipline of Psychiatry and Mental HealthSchool of Clinical MedicineUniversity of New South WalesSydneyAustralia
- Justice Health and Forensic Mental Health NetworkSydneyNSWAustralia
| | - Beate Brinchmann
- Centre for Work and Mental HealthNordland Hospital TrustBodøNorway
| | - Kevin Douglas
- Centre for Research and Education in Forensic PsychiatryHaukeland University HospitalBergenNorway
- Department of PsychologySimon Fraser UniversityVancouverBritish ColumbiaCanada
- Regional Centre for Research and Education in Forensic PsychiatryOslo University HospitalOsloNorway
| | - Linda Gröning
- Centre for Research and Education in Forensic PsychiatryHaukeland University HospitalBergenNorway
- Faculty of LawUniversity of BergenBergenNorway
| | - Stål Bjørkly
- Regional Centre for Research and Education in Forensic PsychiatryOslo University HospitalOsloNorway
- Faculty of Health and Social SciencesMolde University CollegeMoldeNorway
| | - Tom Palmstierna
- Department of Clinical NeuroscienceCentre for Psychiatric ResearchKarolinska InstitutetStockholmSweden
- Faculty of Medicine and Health SciencesDepartment of Mental HealthNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Maria Fagerbakke Strømme
- Division of PsychiatryHaukeland University HospitalBergenNorway
- NORMENTCentre of ExcellenceHaukeland University HospitalBergenNorway
| | - Anne Blindheim
- Division of PsychiatryHaukeland University HospitalBergenNorway
| | - Jorun Rugkåsa
- Health Services Research UnitAkershus University HospitalLørenskogNorway
- Centre for Care ResearchUniversity of South‐Eastern NorwayPorsgrunnNorway
- Department of Mental HealthOslo Metropolitan UniversityOsloNorway
| | - Bjørn Morten Hofmann
- Centre for Medical EthicsUniversity of OsloOsloNorway
- Faculty of Medicine and Health SciencesDepartment of Health SciencesNorwegian University of Science and TechnologyGjøvikNorway
| | | | - Tarjei Widding‐Havneraas
- Centre for Research and Education in Forensic PsychiatryHaukeland University HospitalBergenNorway
| | - Knut Rypdal
- Centre for Research and Education in Forensic PsychiatryHaukeland University HospitalBergenNorway
| | - Arnstein Mykletun
- Centre for Research and Education in Forensic PsychiatryHaukeland University HospitalBergenNorway
- Centre for Work and Mental HealthNordland Hospital TrustBodøNorway
- UiT—The Arctic University of NorwayTromsøNorway
- Division for Health ServicesNorwegian Institute of Public HealthOsloNorway
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Baraliakos X, Ranza R, Östör A, Ciccia F, Coates LC, Rednic S, Walsh JA, Douglas K, Gao T, Kato K, Song IH, Ganz F, Deodhar A. Efficacy and safety of upadacitinib in patients with active psoriatic arthritis and axial involvement: results from two phase 3 studies. Arthritis Res Ther 2023; 25:56. [PMID: 37038159 PMCID: PMC10084601 DOI: 10.1186/s13075-023-03027-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/08/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND The objective of this post-hoc analysis was to assess the efficacy and safety of upadacitinib in psoriatic arthritis (PsA) patients with axial involvement. METHODS Post-hoc analysis of SELECT-PsA 1 and SELECT-PsA 2 in patients randomized to upadacitinib 15 mg (UPA15), placebo (switched to UPA15 at week 24), or adalimumab 40 mg (ADA; SELECT-PsA 1 only). Axial involvement was determined by investigator judgement (yes or no; based on the totality of available clinical information, such as duration and characteristics of back pain, age of onset, and previous lab investigations and imaging, if available) alone, or investigator judgement and patient-reported outcome (PRO)-based criteria (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] ≥ 4 and BASDAI Q2 ≥ 4). Efficacy outcomes that describe axial disease activity, including BASDAI endpoints, such as change from baseline in the overall BASDAI score or proportion of patients achieving BASDAI50 (≥ 50% improvement from baseline), as well as Ankylosing Spondylitis Disease Activity Score (ASDAS) endpoints, such as mean change from baseline in overall ASDAS or proportion of patients achieving ASDAS inactive disease or low disease activity, were evaluated at weeks 12, 24, and 56, with nominal P-values shown. Treatment-emergent adverse events (TEAEs) are summarized through week 56. RESULTS 30.9% of patients in SELECT-PsA 1 and 35.7% in SELECT-PsA 2 had axial involvement by investigator judgement alone; 22.6% (SELECT-PsA 1) and 28.6% (SELECT-PsA 2) had axial involvement by investigator judgement and PRO-based criteria. Greater proportions of patients achieved BASDAI50 with UPA15 versus placebo using either criterion, and versus ADA using investigator judgement alone, at week 24 in SELECT-PsA 1 (investigator alone: UPA15, 59.0%, placebo, 26.9%, P < 0.0001, ADA, 44.1%, P = 0.015; investigator and PRO-based: UPA15, 60.4%, placebo, 29.3%, P < 0.0001, ADA, 47.1%, P = 0.074), with comparable findings in SELECT-PsA 2. Similar results were observed with UPA15 for additional BASDAI and ASDAS endpoints at weeks 12 and 24, with improvements maintained at week 56. Rates of TEAEs were generally similar across sub-groups irrespective of axial involvement status. CONCLUSIONS PsA patients with axial involvement determined by predefined criteria showed greater BASDAI and ASDAS responses with UPA15 versus placebo, and numerically similar/greater responses versus ADA. Safety results were generally comparable between patients with or without axial involvement. TRIAL REGISTRATION ClinicalTrials.gov: SELECT-PsA 1, NCT03104400; SELECT-PsA 2, NCT0310437.
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Affiliation(s)
- Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Claudiusstr. 45, 44649, Herne, Germany.
| | - Roberto Ranza
- Serviço de Reumatología, Hospital de Clinicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Andrew Östör
- Monash University, Cabrini Hospital & Emeritus Research, Melbourne & ANU, Canberra, Australia
| | | | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Simona Rednic
- Rheumatology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Jessica A Walsh
- Salt Lake City Veterans Affairs Health, Salt Lake City, UT, USA
- University of Utah Health, Salt Lake City, UT, USA
| | | | | | | | | | | | - Atul Deodhar
- Oregon Health & Science University, Portland, OR, USA
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Douglas K, Odia R, Campbell-Forde M, Cardenas D, Seshadri S, Serhal P, Saab W. P-292 Laboratory performance in PGT-SR cases in carriers of chromosomal rearrangements. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Could laboratory outcomes, such as fertilisation and blastocyst formation rates be altered based on which partner carries a chromosomal rearrangement in PGT-SR cases?
Summary answer
Blastocyst formation is significantly reduced when both partners carry a mutation, compared to patients carrying paternally derived translocations
What is known already
Some research suggests that the presence of paternal translocations may significantly increase miscarriage rates in patients who conceive naturally, versus patients who conceive after PGT-SR. Additionally, there may be a trend towards a shorter time to livebirth when considering PGT-SR patients, versus those who conceive by natural conception. This could aid treatment choices for patients in this cohort. Research has evaluated laboratory and clinical outcomes for PGT-M patients and found that this cohort of patients have slightly higher success rates, when compared to PGT-SR patients. The commonality of these studies being multicentre warrants further investigation from a single centre ART.
Study design, size, duration
An observational single centre study performing retrospective analysis of data for patients having PGT-M or PGT-SR between 2015 and 2020. After exclusion criteria were considered, this study evaluated laboratory findings for 484 patients. This included PGT-SR patients affected by reciprocal and Robertsonian translocations as well as PGT-M patients, who were the control group. Patients with more complicated chromosomal rearrangements were excluded from analysis.
Participants/materials, setting, methods
IDEAS® (V6.0) software was used to capture all laboratory details relating to the patient cohort. This included number of cycles, number of oocytes collected, oocyte maturity, fertilisation rate and blastocyst formation rate. The official PGT-M or PGT-SR reports were consulted for information related to the embryos tested for each patient. Genetic testing was performed by Igenomix, CooperGenomics or Reprogenetics. All variables were evaluated using Chi-Square to establish whether there were any statistically significant differences noted.
Main results and the role of chance
A total of 5,149 oocytes were inseminated and 3,825 embryos were created from the 484 cycles included in this analysis. There were no significant differences in fertilisation rates for maternal or paternal mutations by direct comparison (p > 0.05). Of these, 2,354 embryos formed blastocysts suitable for PGT-M or PGT-SR. Blastocyst formation rates were marginally statistically lower when both partners carried a mutation when compared to maternal or paternal translocations or exclusively paternal translocations, respectively (p = 0.047; p = 0.033). We observed a slight trend towards decreased fertilisation and blastocyst formation rates when maternal and paternal mutations were present, but this was not statistically significant.
Limitations, reasons for caution
This study was limited by modest sample size; further research would include a larger cohort of patients. This study evaluated laboratory outcomes, but future research could assess clinical outcomes to establish any impact of the origin of chromosomal rearrangement on implantation, pregnancy, and live birth rates.
Wider implications of the findings
This study suggests reduced blastocyst formation rates when both partners carry a mutation; this information may be used to counsel patients. It may impact the treatment options and number of embryo batching cycles prior to blastocyst culture for PGT. This could help to improve and better inform the patient experience.
Trial registration number
IRB-001C02-01-22
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Affiliation(s)
- K Douglas
- Centre for Reproductive and Genetic Health , Embryology, London, United Kingdom
| | - R Odia
- Centre for Reproductive and Genetic Health , Embryology, London, United Kingdom
| | - M Campbell-Forde
- Centre for Reproductive and Genetic Health , Embryology, London, United Kingdom
| | - D Cardenas
- Centre for Reproductive and Genetic Health , Clinical, London, United Kingdom
| | - S.S Seshadri
- Centre for Reproductive and Genetic Health , Clinical, London, United Kingdom
| | - P Serhal
- Centre for Reproductive and Genetic Health , Clinical, London, United Kingdom
| | - W Saab
- Centre for Reproductive and Genetic Health , Clinical, London, United Kingdom
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Overgaard Donskov A, Mackie S, Hauge EM, Toro Gutiérrez C, Hansen I, Hemmig A, Van der Maas A, Gheita TA, Dalsgaard Nielsen B, Douglas K, Conway R, Rezus E, Dasgupta B, Monti S, Matteson E, Sattui SE, Matza M, Ocampo V, Bran A, Appenzeller S, Goecke A, Colman MC Leod N, Keen H, Kuwana M, Gupta L, Salim B, Harifi G, Erraoui M, Ziade N, Al-Ani NA, Ajibade A, Knitza J, Frølund L, Yates M, Pimentel-Quiroz V, Lyrio A, Sandovici M, Van der Geest K, Helliwell T, Brouwer E, Dejaco C, Keller K. AB0584 MANAGEMENT OF REFERRALS, TREATMENT STRATEGY, AND RESEARCH CHALLENGES IN POLYMYALGIA RHEUMATICA AMONGST RHEUMATOLOGISTS WORLDWIDE: A QUESTIONNAIRE BASED STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPolymyalgia rheumatica (PMR) is diagnosed and treated by both general practitioners (GP) and rheumatologists. How rheumatologists around the world manage the referral process of patients with PMR from GP’s has not been described. EULAR/ACR guidelines recommend initial prednisolone doses between 12.5 and 25 mg, but it is unknown if guidelines are followed in daily clinical practice1. In addition, the understanding of challenges for recruitment to clinical trials in PMR is currently limited.ObjectivesThis study aims to describe the management of referrals, treatment strategy, and recruitment to clinical trials in PMR among rheumatologists worldwide.MethodsAn English language questionnaire was drafted by a working group of rheumatologists and GP’s from 6 different countries. Questions concerned: 1: respondent, 2: referrals, 3: prednisolone, and 4: barriers to research. Questionnaires were distributed to rheumatologists via members of the International PMR/GCA study group. Answers were collected via an online survey tool (Redcap), from 2nd of November 2021 to 27th of January 2022. Countries were grouped by income and geographical region based on the World bank classifications. Data were weighted by number of inhabitants in a country, based on the United Nations age specific population count, divided by number of respondents in a country. Countries with more than 20 respondents were included.ResultsResults from 27 countries were analysed including 1000 responders in total (Figure 1). There was large variation in time from referral to first assessment, initial dose of prednisolone was high, duration of treatment was relatively short, and a large proportion of patients with newly diagnosed PMR received prednisolone prior to rheumatological evaluation (Table 1). Concerning the 15% of respondents who performed research in PMR, 52% had participated in clinical trials and 56% of the responders experienced difficulties with recruitment.Table 1.Characteristics of reponders, referrals, and treatment.Geographical regionIncomeThe worldEurope and Central AsiaNorth AmericaLatin AmericaEast Asia and PacificSouth AsiaMiddle East and AfricaHigh- income countriesLow- and middle- income countriesRespondersResponders (n), Completed questionnaire (total)875 (1000)294 (304)78 (81)136 (152)53 (53)53 (72)261 (338)446 (458)429 (542)Experience as rheumatologist (years)11 (6-20)12 (6-20)7 (4-20)11 (6-23)21 (10-30)7 (4-10)9 (5-18)11 (5-22)8 (5-12)ReferralsGP’s can discuss patients prior to referral, %647979575860677461Referred patients seen (%)100 (90-100)100 (90-100)100 (100-100)100 (100-100)100 (95-100)100 (100-100)100 (60-100)100 (100-100)100 (90-100)Evaluation > 2 weeks after referral, %26498060216185815PrednisoloneStarted prior to rheumatological evaluation (%)50 (20-50)60 (30-80)70 (50-80)50 (10-50)30 (20-50)50 (20-80)20 (0-50)50 (30-80)50 (10-70)Initial dose (mg)20 (15-40)20 (15-20)20 (15-20)20 (20-40)15 (15-15)20 (15-40)20 (15-40)15 (15-20)20 (15-40)Initial dose > 25 mg, %32964104143642Duration of treatment (months)12 (6-12)12 (12-18)12 (10-18)6 (3-12)18 (12-18)12 (6-12)6 (3-12)12 (12-18)9 (6-12)Data presented as weighted median (interquartile range) unless otherwise stated.GP: general practitionerConclusionThis is the first description of current practice in managing referrals and treatment of PMR by rheumatologists worldwide. In general, median treatment duration was according to EULAR/ACR guidelines, but initial dose of prednisolone was often higher than recommended in many parts of the world. PMR patients were often seen more than two weeks after referral, and treatment had started prior to first rheumatological evaluation.References[1]Dejaco C, Singh YP, Perel P, et al. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Annals of the rheumatic diseases 2015; 74(10): 1799-807.AcknowledgementsThis study was endorsed by the international PMR/GCA study group.Disclosure of InterestsAgnete Overgaard Donskov: None declared, Sarah Mackie: None declared, Ellen-Margrethe Hauge Speakers bureau: AbbVie, Sanofi, Sobi, MSD, UCB, Consultant of: AbbVie, Sanofi, Sobi, MSD, UCB, Grant/research support from: Novo Nordic Foundation, Danish Rheumatism Association, Danish Regions Medicine Grants, Roche, Novartis, Celgene, MSD, Pfizer, Roche, Sobi, CARLOS TORO GUTIÉRREZ: None declared, Ib Hansen: None declared, Andrea Hemmig: None declared, Aatke van der Maas: None declared, Tamer A Gheita: None declared, Berit Dalsgaard NIelsen Paid instructor for: Roche, Karen Douglas: None declared, Richard Conway Speakers bureau: Janssen, Roche, Sanofi, Abbvie,, Elena Rezus: None declared, Bhaskar Dasgupta: None declared, Sara Monti: None declared, Eric Matteson Consultant of: Boehringer-Ingelheim,, Grant/research support from: Boehringer Ingelheim,, Sebastian E. Sattui Grant/research support from: AstraZeneca, Mark Matza: None declared, Vanessa Ocampo Speakers bureau: Abbvie, Andrea Bran: None declared, Simone Appenzeller Grant/research support from: GSK, Annelise Goecke Speakers bureau: Abbvie, Boehringer Ingelheim, Recalcine. Consultant Abbvie, Boehringer Ingelheim, NELLY COLMAN MC LEOD Speakers bureau: Laboratorios FAPASA (Farmacéutica Paraguay), Helen Keen Speakers bureau: Roche, Abbvie, Masataka Kuwana: None declared, Latika Gupta: None declared, Babur Salim: None declared, Ghita Harifi Speakers bureau: Abvie, Johnson and johnson, Lilly, Novartis, Mariama Erraoui: None declared, Nelly Ziade Speakers bureau: Abbvie, Eli Lilly, Janssen, Pfizer, Pierre Fabre, Roche, Novartis, Sanofi-Aventis, Paid instructor for: Abbvie, Eli Lilly, Sanofi-Aventis, Pfizer, Janssen, Novartis., Consultant of: Abbvie, Eli Lilly, Janssen, Pfizer, Roche, Novartis, Sandoz, Grant/research support from: Abbvie, Celgene - Algorithm, Bristol-Myers Squibb - NewBridge, Pfizer, Nizar Abdulateef Al-Ani: None declared, Adeola Ajibade: None declared, Johannes Knitza: None declared, Line Frølund: None declared, Max Yates: None declared, Victor Pimentel-Quiroz: None declared, Andre Lyrio: None declared, Maria Sandovici: None declared, Kornelis van der Geest Speakers bureau: Roche, Toby Helliwell Grant/research support from: Valneva, Elisabeth Brouwer Speakers bureau: Roche, Christian Dejaco Speakers bureau: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Galapagos and Sanofi, Consultant of: Abbvie, Eli Lilly, Janssen, Roche, Galapagos and Sanofi, Kresten Keller: None declared
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Merola JF, Mcinnes I, Kavanaugh A, Nash P, Xue Z, Stakias V, Eldred A, Ciecinski S, Douglas K, Coates L. POS1029 EFFECTS OF TREATMENT WITH RISANKIZUMAB ON MINIMAL DISEASE ACTIVITY (MDA) AND DISEASE ACTIVITY IN PSORIATIC ARTHRITIS (DAPSA): AN ANALYSIS OF THE KEEPsAKE-1 AND -2 TRIALS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundRisankizumab (RZB) is a monoclonal antibody that specifically inhibits interleukin 23.ObjectivesTo evaluate the achievement of Minimal Disease Activity (MDA), its components, and achievement of Disease Activity in PsA Low Disease Activity and Remission (DAPSA LDA+REM, [DAPSA score ≤14]) in patients receiving RZB or placebo (PBO) in the KEEPsAKE 1 and 2 clinical trials.MethodsKEEPsAKE-1 and -2, double-blind, phase 3 trials, evaluated the efficacy of RZB versus PBO for the treatment of adult patients with active psoriatic arthritis (PsA). Patients were randomized (1:1) to receive subcutaneous RZB 150 mg or PBO at weeks 0, 4, and 16. The open label extension began at Week 24 with all patients receiving RZB 150 mg every 12 weeks thereafter. Achievement of MDA, its components, and achievement of DAPSA LDA+REM are reported using non-responder imputation.ResultsMDA achievement at Week 52 in KEEPsAKE-1 was 37.9% for patients originally randomized to RZB and 27.4% for patients originally randomized to PBO. In KEEPsAKE-2, MDA achievement was 27.2% and 33.8% for patients originally randomized to RZB and PBO, respectively. Achievement of MDA and its components are presented in Figure 1. In KEEPsAKE-1, at Week 52 59.2% of patients originally randomized to RZB and 51.4% of patients originally randomized to PBO achieved DAPSA LDA+REM. At Week 52 in KEEPsAKE-2, DAPSA LDA+REM was achieved by 44.6% of patients originally randomized to RZB and 46.6% of patients originally randomized to PBO (Figure 1).ConclusionPatients treated with RZB demonstrate achievement of MDA, its components, and DAPSA LDA+REM at Weeks 24 and 52.AcknowledgementsAbbVie Inc, participated in the study design; study research; collection, analysis and interpretation of data; and writing, reviewing, and approving of this abstract for submission. AbbVie funded the research for this study and provided writing support for this abstract. Medical writing assistance was provided by Trisha Rettig, Ph.D. of AbbVieDisclosure of InterestsJoseph F. Merola Consultant of: Amgen, Bristol-Myers Squibb, Abbvie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Sanofi, Regeneron, Sun Pharma, Biogen, Pfizer and Leo Pharma, Iain McInnes Consultant of: AbbVie, Amgen, Astra Zeneca, Compugen, Cabaletta, Evelo, Janssen, Lilly, Novartis, Pfizer, Sanofi, and UCB, Grant/research support from: AbbVie, Amgen, Astra Zeneca, Janssen, Lilly, Novartis, Pfizer, UCB, Arthur Kavanaugh Consultant of: AbbVie Inc., Amgen, Astra-Zeneca, BMS, Celgene, Centocor-Janssen, Pfizer, Roche, and UCB, Grant/research support from: AbbVie Inc., Amgen, Astra-Zeneca, BMS, Celgene, Centocor-Janssen, Pfizer, Roche, and UCB, Peter Nash Speakers bureau: Abbvie, Amgen, Janssen, Lilly, Novartis, Pfizer, UCB, BMS, Rocje, Sanofi, Gilead/Galapagos, MSD, Samsung, Celgene, Amgen, Boehringer, Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, Pfizer, UCB, BMS, Rocje, Sanofi, Gilead/Galapagos, MSD, Samsung, Celgene, Amgen, Boehringer, Grant/research support from: Abbvie, Amgen, Janssen, Lilly, Novartis, Pfizer, UCB, BMS, Rocje, Sanofi, Gilead/Galapagos, MSD, Samsung, Celgene, Amgen, Boehringer, Zhenyi Xue Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Vassilis Stakias Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Ann Eldred Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Sandra Ciecinski Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Kevin Douglas Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Laura Coates Speakers bureau: AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, Medac, Novartis, Pfizer and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Gilead, Galapagos, Janssen, Novartis, Pfizer and UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis and Pfizer
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Overgaard Donskov A, Mackie S, Hauge EM, Toro Gutiérrez C, Hemmig A, Van der Maas A, Dalsgaard Nielsen B, Hansen I, Yates M, Frølund L, Douglas K, Van der Geest K, Rezus E, Monti S, Gromova M, Ocampo V, Appenzeller S, Erraoui M, Ajibade A, Marun Lyrio A, Grainger R, Sandovici M, Helliwell T, Brouwer E, Dejaco C, Keller K. AB0583 REFERRAL PATTERN AND TREATMENT OF POLYMYALGIA RHEUMATICA IN GENERAL PRACTICE: AN INTERNATIONAL QUESTIONNAIRE BASED STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundIn most countries polymyalgia rheumatica (PMR) is diagnosed and managed by both general practitioners (GP) and rheumatologists. However, the referral pattern from GP’s to specialist around the world has not been described. The initial prednisolone dose recommended by EULAR/ACR is between 12.5 and 25 mg1, but little is known about whether these guidelines are followed everywhere by GP’s in clinical practice2.ObjectivesThis study aims to describe the refererral pattern and treatment strategy for PMR in general practice in several countries worldwide.MethodsAn English language questionnaire was drafted by a working group of rheumatologists and GP’s from 6 different countries. The questionnaire contained questions on: 1: Respondent, 2: Referral pattern and 3: Prednisolone. Questionnaires were distributed to GP’s via members of the International PMR/GCA study group. Answers were collected via an online survey tool (Redcap), from 3rd of November 2021 to 27th of January 2022. Countries with more than 15 responders to the questionnaire were included in the analysis.ResultsData from 11 countries were analysed. Referral patterns differed widely among countries (Table 1). Almost all patients initially seen by rheumatologists were returned to GP’s for treatment. In all countries a proportion of the GP’s prescribed higher initial prednisolone doses than recommended, with a large variation between countries (Table 1).Table 1.Characteristics of responders, referral pattern, and treatment strategyAustriaCanadaColombiaDenmarkItalyNether-landsNew ZealandRomaniaRussiaSwitzer-landUnited KingdomRespondersResponders (n), Completed questionnaire (total)26 (29)15 (15)17 (23)53 (53)36 (41)22 (22)17 (17)37 (43)42 (49)26 (26)34 (35)Experience (years)20 (12-34)8 (4-10)6 (4-9)12 (10-17)15 (5-27)23 (17-30)14 (9-27)21 (16-30)6 (5-9)26 (15-32)16 (11-24)Available PMR/GCA guideline, n (%)26 (100)15(100)17 (100)53 (100)36 (100)22 (100)17 (100)37 (100)42 (100)26 (100)34 (100)Adherence to guideline, n (%)21 (82)15 (100)17 (100)51 (97)34 (94)21 (95)17 (100)37 (100)42 (100)26 (100)34 (100)ReferralsNew PMR patients referred for diagnose (%)58 (10-100)50 (2-100)100 (13-100)50-(20-100)60 (28-100)20 (10-50)10 (10-20)60 (10-88)1 (1-2)28 (10-50)10 (1-25)Patients returned to GP for treatment (%)100 (50-100)50 (2-100)8 (0-50)85 (40-100)50 (0-100)50 (10-90)100 (90-100)80 (50-98)1 (1-1)80 (10-100)100 (100-100)Patients referred during treatment (%)50 (25-90)50 (10-100)100 (50-100)20 (10-33)50 (15-80)15 (10-30)20 (10-25)30 (10-80)1(1-1)20 (10-30)10 (10-20)PrednisoloneInitial dose (mg)38 (25-50)20 (20-50)20 (10-30)25 (15-40)25 (25-25)15 (15-15)20 (15-40)15 (12-20)15 (15-15)50 (25-50)15 (15-20)Initial dose > 25 mg, n (%)12 (47)4 (25)7 (40)14 (26)9 (25)1 (5)6 (38)7 (20)3 (8)22 (83)3 (9)Duration of treatment (months)9 (6-12)6 (2-9)6 (4-24)12 (8-18)5 (3-12)11 (6-12)12 (10-18)2 (2-5)6 (6-6)12 (12-14)15 (12-24)Data are presented as weighted median (interquartile range) unless otherwise stated. GP: general practitioner, PMR: polymyalgia rheumatica, GCA: great cell arteritis.ConclusionAlthough many patients were referred to the hospital for initial PMR diagnosis or during the disease course, a large proportion of patients received treatment in general practice worldwide. GPs frequently use a higher starting dose of prednisolone and shorter treatment duration than recommended by EULAR/ACR.References[1]Dejaco C, Singh YP, Perel P, et al. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Annals of the rheumatic diseases 2015; 74(10): 1799-807.[2]Helliwell T, Hider SL, Mallen CD. Polymyalgia rheumatica: diagnosis, prescribing, and monitoring in general practice. The British journal of general practice: the journal of the Royal College of General Practitioners 2013; 63(610): e361-6.AcknowledgementsThis study was endorsed by the international PMR/GCA study group.Disclosure of InterestsAgnete Overgaard Donskov: None declared, Sarah Mackie: None declared, Ellen-Margrethe Hauge Speakers bureau: AbbVie, Sanofi, Sobi, MSD, UCB, Consultant of: AbbVie, Sanofi, Sobi, MSD, UCB, Grant/research support from: Novo Nordic Foundation, Danish Rheumatism Association, Danish Regions Medicine Grants, Roche, Novartis,Celgene, MSD, Pfizer, Roche, Sobi, CARLOS TORO GUTIÉRREZ: None declared, Andrea Hemmig: None declared, Aatke van der Maas: None declared, Berit Dalsgaard NIelsen Paid instructor for: Roche, Ib Hansen: None declared, Max Yates: None declared, Line Frølund: None declared, Karen Douglas: None declared, Kornelis van der Geest Speakers bureau: Roche, Elena Rezus: None declared, Sara Monti: None declared, Margarita Gromova: None declared, Vanessa Ocampo Speakers bureau: Abvie, Simone Appenzeller Speakers bureau: Janssen, UCB, Lilly and Pfizer, Mariama Erraoui: None declared, Adeola Ajibade: None declared, Andre Marun Lyrio: None declared, Rebecca Grainger: None declared, Maria Sandovici: None declared, Toby Helliwell: None declared, Elisabeth Brouwer Speakers bureau: Roche, Consultant of: Roche, Christian Dejaco Speakers bureau: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Galapagos and Sanofi, Consultant of: Abbvie, Eli Lilly, Janssen, Roche, Galapagos and Sanofi, Kresten Keller: None declared
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Baraliakos X, Ranza R, Ostor A, Ciccia F, Coates L, Rednic S, Walsh JA, Gao T, Lertratanakul A, Song IH, Ganz F, Douglas K, Deodhar A. POS0934 EFFICACY OF UPADACITINIB ON PSORIATIC ARTHRITIS WITH AXIAL INVOLVEMENT DEFINED BY INVESTIGATOR ASSESSMENT AND PRO-BASED CRITERIA: RESULTS FROM TWO PHASE 3 STUDIES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatients with PsA and axial involvement have higher disease activity and greater reductions in quality of life;1 however, there are no accepted criteria for identifying axial involvement in PsA.ObjectivesThe objective of this post-hoc analysis is to assess the efficacy of upadacitinib (UPA), a Janus kinase inhibitor, on axial symptoms in patients with active PsA and axial involvement defined by investigator assessment and PRO-based criteria from two phase 3 SELECT trials.2,3MethodsPatients with active PsA (≥3 swollen joints and ≥3 tender joints) and prior inadequate response or intolerance to ≥1 non-biologic (SELECT-PsA 1) or ≥1 biologic (SELECT-PsA 2) DMARD were randomly assigned to once daily oral UPA 15 mg or 30 mg, placebo (PBO), or every other week subcutaneous adalimumab (ADA) 40 mg (SELECT-PsA 1 only).2,3 At baseline, axial involvement in PsA was determined by investigator assessment based on the totality of clinical information, such as duration and character of back pain, age of onset, and previous imaging. In addition to investigator assessment, PRO-based criteria for axial involvement (BASDAI ≥4 and BASDAI Question 2 ≥4 at baseline) were applied for this analysis to identify patients with active disease. Efficacy in the sub-group of patients defined using both investigator assessment and PRO-based criteria was evaluated at week 24 for UPA 15 mg vs PBO and ADA (SELECT-PsA 1 only). Data were analyzed using mixed-effect model repeated measures (MMRM) or non-responder imputation (NRI), with nominal P-values shown.ResultsBased on investigator assessment alone, 31.3% (n=534/1704) of patients in SELECT-PsA 1 and 34.2% (n=219/641) in SELECT-PsA 2 were defined as having axial involvement. When both investigator assessment and PRO-based criteria were applied, 23.1% (n=393/1704) of patients in SELECT-PsA 1, or 73.6% (n=393/534) of those defined using investigator assessment alone, and 27.5% (n=176/641) in SELECT-PsA 2, or 80.4% (n=176/219) using investigator assessment alone, met the combined criteria for axial involvement. In both studies, UPA 15 mg showed significantly greater clinical responses vs PBO at week 24 across all endpoints assessed (Figure 1). In SELECT-PsA 1, UPA showed numerically greater responses than ADA at week 24 across all BASDAI and Ankylosing Spondylitis Disease Activity Score (ASDAS) endpoints. The proportion of patients achieving ASDAS clinically important improvement (CII) at week 24 was significantly greater with UPA vs ADA based on nominal P-value.ConclusionPatients with active PsA and axial involvement defined by both investigator assessment and PRO-based criteria demonstrated statistically greater clinical responses related to their axial involvement with UPA 15 mg compared to PBO, and consistently numerically higher responses compared to ADA, at week 24 in the SELECT-PsA trials. Findings from this post-hoc analysis are consistent with previous data based on investigator assessment alone.4References[1]Mease PJ et al. J Rheumatol. 2018; 45(10):1389-96[2]McInnes IB et al. N Engl J Med. 2021; 384(13):1227-39[3]Mease PJ et al. Ann Rheum Dis. 2020; 80(3):312-20[4]Deodhar A et al. Arthritis Rheumatol. 2020; 72(Suppl 10)AcknowledgementsAbbVie funded these studies and participated in the study design, research, analysis, data collection, interpretation of data, reviewing, and approval of the publication. No honoraria or payments were made for authorship. Medical writing support was provided by Monica R.P. Elmore, PhD of AbbVie.Disclosure of InterestsXenofon Baraliakos Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB, R Ranza Speakers bureau: AbbVie, Janssen, Novartis, and Pfizer, Consultant of: AbbVie, Janssen, Novartis, and Pfizer, Andrew Ostor Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, Gilead, MSD, Novartis, Pfizer, and Roche, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, Gilead, MSD, Novartis, Pfizer, and Roche, francesco ciccia Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, MSD, Novartis, Pfizer, Janssen, Sanofi, Sandoz, Galapagos, Sobi, and UCB, Grant/research support from: AbbVie, Celgene, Pfizer, Roche, and UCB, Laura Coates Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, MSD, Novartis, Pfizer, Janssen, Sanofi, Sandoz, Galapagos, Sobi, and UCB, Grant/research support from: AbbVie, Celgene, Pfizer, Roche, and UCB, Simona Rednic Consultant of: AbbVie, Boehringer Ingelheim, Eli Lilly, MSD, Novartis, and Pfizer, Grant/research support from: AbbVie, Boehringer Ingelheim, Eli Lilly, MSD, Novartis, Pfizer, and UCB, Jessica A. Walsh Consultant of: AbbVie, Amgen, Eli Lilly, Merck, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Eli Lilly, Merck, Novartis, Pfizer, and UCB, Tianming Gao Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Apinya Lertratanakul Shareholder of: Formerly of AbbVie, Employee of: Former employee of AbbVie, In-Ho Song Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Fabiana Ganz Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Kevin Douglas Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Atul Deodhar Consultant of: AbbVie, Amgen, Aurinia, BMS, Boehringer Ingelheim, GSK, Janssen, Lilly, MoonLake, Novartis, Pfizer and UCB, Grant/research support from: AbbVie, GSK, Lilly, Novartis, Pfizer and UCB
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Aletaha D, Mease PJ, Lippe R, Behrens F, Haaland D, Palominos P, Lertratanakul A, Lane M, Douglas K, Nash P, Kavanaugh A. POS1026 PREDICTORS FOR ACHIEVEMENT OF LOW DISEASE ACTIVITY AT WEEK 56 IN PATIENTS WITH PSORIATIC ARTHRITIS WHO RECEIVED UPADACITINIB 15 MG ONCE DAILY: POOLED ANALYSIS OF TWO PHASE 3 STUDIES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundUpadacitinib (UPA) 15 mg once daily (QD) has demonstrated efficacy and safety in patients with psoriatic arthritis (PsA) for up to 56 weeks in the Phase 3 SELECT-PsA 1 and 2 trials.1,2ObjectivesThis post hoc analysis of these studies explored the association of baseline characteristics and short-term responses with achievement of minimal disease activity (MDA) and Disease Activity Index for Psoriatic Arthritis (DAPSA) low disease activity (LDA).MethodsData were pooled from patients with prior inadequate response or intolerance to ≥1 non-biologic (b) DMARDs (SELECT-PsA 1) or ≥1 bDMARDs (SELECT-PsA 2) originally randomized to UPA 15 mg QD. Logistic regression models were used to assess the association between baseline characteristics and short-term (Week 12) responses with achieving MDA or DAPSA LDA at 56 weeks, sustained MDA (MDA at Weeks 36 and 56), or sustained DAPSA LDA (DAPSA LDA at Weeks 36, 44, and 56). Each predictor was evaluated separately in an initial model that included effects for study and concurrent non-bDMARD use. Odds ratios and concordance (c-)statistics were used to determine the predictive accuracy. Statistically significant predictors were then evaluated simultaneously using stepwise logistic regression with the Akaike Information Criterion for model-building.ResultsOf 640 patients included in the analysis, 40% and 47% achieved MDA and DAPSA LDA, respectively, at 56 weeks. Evaluated separately, younger age, sex (male), geographic region, lower weight, lower body mass index, the presence of dactylitis or enthesitis, and lower scores of Patient’s Assessment of Pain (Pt-Pain), Patient’s Global Assessment (PtGA), tender joint count in 68 joints, and Health Assessment Questionnaire-Disability Index (HAQ-DI) were significant baseline predictors for achieving MDA and DAPSA LDA at Week 56. Lower Pt-Pain (Weeks 12–24) and PtGA (Weeks 16–24) scores were strongly predictive (c-statistics >0.8) of achieving MDA at Week 56, and both measures (from Week 8) were moderately predictive (c-statistics >0.7) of achieving DAPSA LDA. Evaluated simultaneously with several baseline characteristics, lower Pt-Pain and HAQ-DI scores at Week 12 were included in models strongly predictive of achieving MDA (c-statistic=0.850; Figure 1) and DAPSA LDA (c-statistic=0.840; Figure 2) at Week 56. For each 1-point increase in Pt-Pain or HAQ-DI scores at Week 12 (after adjusting for other effects in the model), patients were less likely to achieve MDA (by 32% or 56%, respectively) or DAPSA LDA (by 23% or 31%, respectively) at Week 56. Predictors for achieving sustained MDA and sustained DAPSA LDA were generally similar to those identified for achieving MDA and DAPSA LDA, respectively.ConclusionIn patients with PsA receiving UPA 15 mg, baseline characteristics and early responses strongly predicted achievement of MDA or DAPSA LDA at Week 56. This may guide considerations of treatment targets in clinical trials and encourage physicians to further optimize treatment of their patients in clinical practice.References[1]McInnes IB, et al. Ann Rheum Dis 2020;79:16–7.[2]Mease PJ, et al. Rheumatol Ther 2021 [Epub ahead of print].AcknowledgementsAbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, review, and approval of the abstract. No honoraria or payments were made for authorship. Medical writing support was provided by Hilary Wong, PhD, of 2 the Nth (Cheshire, UK), which was funded by AbbVie.Disclosure of InterestsDaniel Aletaha Consultant of: AbbVie, Grünenthal, Janssen, Medac, Merck, Mitsubishi/Tanabe, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, Grünenthal, Janssen, Medac, Merck, Mitsubishi/Tanabe, Pfizer, Roche, and UCB, Philip J Mease Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Genentech, Gilead, and Janssen, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Genentech, Gilead, and Janssen, Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, and Janssen, Ralph Lippe Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Frank Behrens Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, and UCB, Grant/research support from: Chugai, GlaxoSmithKline, Janssen, Pfizer, and Roche, Derek Haaland Speakers bureau: AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, Takeda, and UCB, Consultant of: AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, Takeda, and UCB, Grant/research support from: AbbVie, Adiga Life Sciences, Amgen, Bristol-Myers Squibb, Can-Fite BioPharma, Celgene, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, Regeneron, Sanofi, and UCB, Penelope Palominos Speakers bureau: AbbVie, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Janssen, Novartis, Pfizer, and UCB, Apinya Lertratanakul Shareholder of: formerly of AbbVie, Employee of: former employee of AbbVie, Michael Lane Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Kevin Douglas Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Peter Nash Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, and UCB, Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, and UCB, Arthur Kavanaugh Speakers bureau: AbbVie, Amgen, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Janssen, Novartis, Pfizer, and UCB
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De Lorenzis E, Kakkar V, Ross R, DI Donato S, Barnes T, Saleem B, Herrick A, Nisar M, Morley C, Douglas K, Denton CP, Derrett-Smith E, Helliwell P, Del Galdo F. POS0876 SERUM INTERFERON SCORE PREDICTS SEVERITY OF PATIENT REPORTED HAND DISABILITY IN SYSTEMIC SCLEROSIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundHand involvement is a major cause of disability in systemic sclerosis (SSc) patients. Loss of hand function is the result of a complex and overlapping series of manifestations including Raynaud’s, cutaneous ulcerations as well as skin fibrosis, joint inflammation, and contractures. The natural history of hand involvement in SSc and potential biomarkers to predict its outcome are still poorly defined. Type 1 Interferon (IFN) activation has been extensively correlated with skin fibrosis, joint disease activity, vascular manifestations, and poor prognosis in SSc patients.ObjectivesTo characterize hand disability burden in SSc and explore its relationship with IFN activation in a national, multicenter, longitudinal, observational cohort of patients with SSc.MethodsThe Cochin Hand Function Scale (CHFS) was assessed in consecutively enrolled SSc patients at baseline and after 12 months. CHFS values above the patient acceptable symptom state (PASS)(CHFS>25)1 were considered as clinically meaningful hand impairment (CMHI). Minimal clinically important difference (MCID) in CHFS for improvement (reduction of 13.1%) and worsening (increase >24.6%) were assessed in longitudinal analysis. Serum IFN score was evaluated as previously described2.ResultsA total of 397 SSc patients from 10 centers (female 85.3%, aged 54.9±11.5 years, white Caucasian 88.2%) were available for longitudinal (12m) analysis. The median disease duration was 9 (IQR 3-16) years, 37.1% of patients had a diffuse cutaneous variant, while anticentromere (ACA) and anti-Scl70 antibody positivity was reported in 41.2% and 33.5% of cases, respectively. Hand digital ulcers, forearm-hand-finger skin score ≥6, and tenosynovitis/arthritis were clinically reported in 24.0%, 15.3%, and 17.9% of patients, respectively. 37.3% of patients reported a CHFS > PASS at baseline. CMHI was associated with male gender (p<.001), diffuse cutaneous variant (p<.001), anti Scl70 positivity (p<.001), ACA negativity (p=.002), and digital ulcers (p=.001). Patients with CMHI had greater serum IFN score than patients with CHFS < PASS (p=.002). In multivariate logistic regression analysis, high serum IFN score remained associated with CHFS>PASS when adjusted for male gender, ACA positivity, anti-Scl70 positive, diffuse subset, and current digital ulcers (OR 2.67, p=.005). Over the 12-month follow-up, vasoactive and immunosuppressive treatment were escalated or introduced in 7.2 and 7.8% of patients, respectively. Median CHFS worsened over time (from 18 (IQR 5-37) to 21 (IQR 6-37), p=.002)) with 32.5% of patients having a clinically meaningful worsening and 32.0% improving their hand function. Functional hand worsening was associated with lower baseline CHFS (p=.001) and ACA negativity (p=.002), while improving with female gender (p=.047), limited cutaneous subset (p=.029), higher baseline CHFS (p=.001), and active baseline tenosynovitis (p=.014).ConclusionOne third of the patients within our cohort complain of a significant hand impairment. This is associated with higher IFN activation and worsens at group level in patients despite standard of care treatment.References[1]Daste C et al. Semin Arthritis Rheum. 2019;48(4):694-700. [2] Hinchcliff M et al. Arthritis Rheumatol. 2021; 73 (suppl 10).Disclosure of InterestsEnrico De Lorenzis: None declared, Vishal Kakkar: None declared, rebecca ross: None declared, Stefano Di Donato: None declared, Theresa Barnes: None declared, Benazir Saleem: None declared, Ariane Herrick: None declared, Muhammad Nisar: None declared, Catherine Morley: None declared, Karen Douglas: None declared, Christopher P Denton: None declared, Emma Derrett-Smith: None declared, Philip Helliwell Consultant of: PH received consulting fees (Eli Lilly) and fees for educational services (Abbvie, Amgen, Novartis, Janssen), Grant/research support from: PH received consulting fees (Eli Lilly) and fees for educational services (Abbvie, Amgen, Novartis, Janssen), Francesco Del Galdo Consultant of: FDG has received research support and personal fees, not directly related to the content of this study, fromAbbvie, AstraZeneca, Boehringer-Ingelheim, Capella Biosciences, Chemomab LTD, Janssen, Kymab LTD, Mitsubishi-Tanabe, Grant/research support from: FDG has received research support and personal fees, not directly related to the content of this study, fromAbbvie, AstraZeneca, Boehringer-Ingelheim, Capella Biosciences, Chemomab LTD, Janssen, Kymab LTD, Mitsubishi-Tanabe
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Mease P, Kavanaugh A, Gladman D, FitzGerald O, Soriano ER, Nash P, Feng D, Lertratanakul A, Douglas K, Lippe R, Gossec L. Disease Control with Upadacitinib in Patients with Psoriatic Arthritis: A Post Hoc Analysis of the Randomized, Placebo-Controlled SELECT-PsA 1 and 2 Phase 3 Trials. Rheumatol Ther 2022; 9:1181-1191. [PMID: 35606663 PMCID: PMC9314475 DOI: 10.1007/s40744-022-00449-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/07/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Low disease activity (LDA)/remission is the target of treatment in patients with psoriatic arthritis (PsA). We assessed the proportions of patients with PsA receiving upadacitinib who achieved LDA/remission over 1 year. Methods This was a post hoc analysis of the double-blind, placebo-controlled SELECT-PsA 1 (also adalimumab-controlled) and SELECT-PsA 2 trials. Treatment targets assessed included LDA/remission defined by Disease Activity in Psoriatic Arthritis (≤ 14/ ≤ 4) and Psoriatic Arthritis Disease Activity Scores (≤ 3.2/ ≤ 1.9), as well as minimal disease activity (MDA)/very low disease activity (VLDA) states (5/7 and 7/7 components, respectively, of MDA criteria). Targets were assessed at 24 and 56 weeks. For binary outcomes, non-responder imputation was used for missing data. Data from patients receiving upadacitinib 30 mg was not included in the analysis. Results Overall, 1386 patients were analyzed. Disease control (i.e., LDA/MDA) was achieved at 24 weeks in upadacitinib 15 mg-treated patients across both studies: LDA/MDA was achieved by 25–48% of patients receiving upadacitinib 15 mg versus 2–16% of patients receiving placebo, and remission/VLDA rates were 7–14% with upadacitinib 15 mg versus 0–4% with placebo. The proportions of patients achieving treatment targets were numerically similar to upadacitinib 15 mg and adalimumab. All responses were sustained at 56 weeks. Conclusions Remission and LDA are feasible targets with upadacitinib treatment in patients with PsA. Trial Registration ClinicalTrial.gov identifiers NCT03104400 (SELECT-PsA 1) and NCT03104374 (SELECT-PsA 2). Supplementary Information The online version contains supplementary material available at 10.1007/s40744-022-00449-6. Psoriatic arthritis is a disease that causes inflammation of the skin and joints. Doctors measure how bad a patient’s disease is by measuring signs and symptoms of the disease, and using these to make a “score.” The aim of treatment is to reduce the score to low levels (known as “low disease activity”) or very low levels (“remission”). This study looked at results from two clinical trials that compared upadacitinib, a medicine used to treat psoriatic arthritis, with no medicine (placebo) to see how many patients had low disease activity or were in remission after 1 year of treatment. The results showed that more patients who were taking upadacitinib had low disease activity or were in remission after the first 6 months of treatment compared with those who took placebo. This difference between upadacitinib and placebo could still be seen after 1 year of treatment. These results show that treatment with upadacitinib is effective enough for some patients with psoriatic arthritis to achieve low disease activity or remission and to stay at this level, even after more than 1 year of treatment.
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Affiliation(s)
- Philip Mease
- Department of Rheumatology, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA, USA.
| | | | - Dafna Gladman
- Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Division of Rheumatology, Department of Medicine, and Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Oliver FitzGerald
- Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland
| | - Enrique R Soriano
- Rheumatology Unit, Internal Medicine Services, Hospital Italiano de Buenos Aires and Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Peter Nash
- School of Medicine, Griffith University, Brisbane, Australia
| | - Dai Feng
- AbbVie Inc, North Chicago, IL, USA
| | | | | | - Ralph Lippe
- AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.,Rheumatology Department, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, Paris, France
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Bodi A, Burke MP, Butler AA, Douglas K, Eskola AJ, Green WH, Guo H, Heard DE, Heathcote D, Hochlaf M, Klippenstein SJ, Kuwata KT, Lawrence JE, Lester MI, Lourderaj U, Mebel A, Milesevic D, Mullin AS, Nguyen TL, Olzmann M, Orr-Ewing AJ, Osborn DL, Pazdera TM, Pfeifle M, Plane JMC, Pun R, Robertson PA, Robinson MS, Seakins PW, Shannon RJ, Taatjes CA, Troe J, Vallance C, Welz O, Zádor J, Zhang F. Impact of Lindemann and related theories: general discussion. Faraday Discuss 2022; 238:700-740. [DOI: 10.1039/d2fd90051c] [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: 11/21/2022]
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Kavanaugh A, Mease PJ, Douglas K, Behrens F, Haaland D, Palominos P, Lertratanakul A, Lane M, Lippe R, Aletaha D, Nash P. AB0547 ASSOCIATION BETWEEN ACHIEVEMENT OF LOW DISEASE ACTIVITY OR REMISSION WITH IMPROVEMENT IN QUALITY OF LIFE IN UPADACITINIB-TREATED PATIENTS IN THE PHASE 3 SELECT-PsA 1 AND 2 STUDIES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The efficacy and safety of upadacitinib (UPA) in patients (pts) with active psoriatic arthritis (PsA) was demonstrated in the phase 3 SELECT-PsA 1 and SELECT-PsA 2 clinical trials.1,2Objectives:To explore the relationship between achievement of low disease activity (LDA) or remission (REM) and pt-reported outcomes (PROs) in SELECT-PsA 1 and 2.Methods:The SELECT-PsA program enrolled pts with prior inadequate response or intolerance to ≥1 non-biologic disease-modifying antirheumatic drug (DMARD; SELECT-PsA 1) or ≥1 biologic DMARD (SELECT-PsA 2). Pts were randomized to 56 weeks (wks) of blinded treatment with UPA 15 or 30 mg once daily (QD), placebo switched to UPA 15 or 30 mg QD at Wk 24, or adalimumab (SELECT-PsA 1 only) 40 mg every other wk. LDA and REM were evaluated using the minimal disease activity (MDA; fulfillment of 5 out of 7) criteria and the Disease Activity index for Psoriatic Arthritis (DAPSA; cutoff ≤4), respectively. PROs assessed included Health Assessment Questionnaire-Disability Index (HAQ-DI), 36-Item Short-Form Survey physical component summary (SF-36 PCS), 5-Level EuroQol 5-Dimension (EQ-5D-5L) Index, and EQ-5D-5L Visual Analog Scale (VAS). Integrated data through Wk 56 from SELECT-PsA 1 and 2 from the full analysis set with both continuous UPA 15 mg and 30 mg groups were analyzed by responder status at Wks 24 and 56. Changes from baseline (BL) in PROs were analyzed using mixed effects repeated measures models (fixed effects for study, current use of non-biologic DMARDs, treatment group, visit, responder status, and continuous BL PROs). As-observed data were used in the models.Results:A total of 1281 pts were included in the analysis (UPA 15 mg, n=640; UPA 30 mg, n=641). MDA was achieved by 33% (UPA 15 mg) and 40% (UPA 30 mg) of patients atWk 24, and 40% (UPA 15 mg) and 43% (UPA 30 mg) at Wk 56; and DAPSA-REM by 10% (UPA 15 mg) and 17% (UPA 30 mg) at Wk 24, and 16% (UPA 15 mg) and 18% (UPA 30 mg) at Wk 56. Pts who achieved MDA or DAPSA-REM (responders) at Wk 56 achieved larger reductions in HAQ-DI and larger increases in SF-36 PCS, EQ-5D-5L Index and EQ-5D-5L VAS compared with non-responders (Table 1) (all p<0.0001; statistical significance was exploratory in nature). MDA or DAPSA-REM response at Wk 24 was also associated with greater PRO improvements at Wk 56 (Figure 1). Consistent with the results presented for MDA and DAPSA-REM, patients who achieved Very Low Disease Activity or DAPSA-LDA also experienced greater improvements in PROs than those who did not.Table 1.Change from BL in PROs at Wk 56 by MDA and DAPSA-REM responder status at Wk 56UPA 15 mg QD(n=640)UPA 30 mg QD(n=641)Least squares mean change from BL(95% CI), unless stated otherwiseNon-responderResponderNon-responderResponderMDA, na386254368273HAQ-DI−0.26 (−0.30, −0.22)−0.61* (−0.66, −0.56)−0.27 (−0.31, −0.23)−0.69* (−0.74, −0.64)SF-36 PCS5.25 (4.60, 5.90)12.63* (11.84, 13.41)5.09 (4.42, 5.75)13.84* (13.08,14.59)EQ-5D-5L Index0.11 (0.09, 0.12)0.25* (0.23, 0.26)0.10 (0.09, 0.12)0.27* (0.25, 0.28)EQ-5D-5L VAS9.3 (7.8, 10.9)23.3* (21.4, 25.1)9.0 (7.4, 10.5)26.1* (24.4, 27.9)DAPSA-REM, na539101526115HAQ-DI−0.36 (−0.39, −0.32)−0.63* (−0.71, −0.55)−0.39 (−0.43, −0.35)−0.71* (−0.78, −0.63)SF-36 PCS6.99 (6.39, 7.59)14.54* (13.22, 15.86)7.43 (6.82, 8.03)15.16* (13.91, 16.40)EQ-5D-5L Index0.14 (0.13, 0.15)0.27* (0.24, 0.30)0.15 (0.14, 0.16)0.29* (0.26, 0.31)EQ-5D-5L VAS12.7 (11.3, 14.0)26.7* (23.7, 29.8)13.3 (11.9, 14.7)30.0* (27.1, 32.8)*p<0.0001 vs non-responder (statistical significance was exploratory in nature)an may vary by PRO assessedConclusion:Among UPA-treated pts with PsA, improvements in quality of life and physical function were greater in pts who achieved MDA or DAPSA-REM than in those who did not. Despite DAPSA-REM being a more stringent measure (achieved by a smaller proportion of patients), these improvements were similar between MDA and DAPSA-REM responders.References:[1]McInnes I, et al. Ann Rheum Dis 2020;79(Suppl 1):16–7; 2. Mease PJ, et al. Ann Rheum Dis 2020Figure 1.Acknowledgements:AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and participated in the writing, review, and approval of the abstract. No honoraria or payments were made for authorship. Medical writing support was provided by Laura Chalmers, PhD, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.Disclosure of Interests:Arthur Kavanaugh Grant/research support from: Research grants and/or personal fees from AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, and Pfizer, Philip J Mease Grant/research support from: Research grants and personal fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, and Janssen; and personal fees from Boehringer Ingelheim, Galapagos, Genentech, and Gilead, Kevin Douglas Employee of: Employee of AbbVie and may own stock or options, Frank Behrens Grant/research support from: Research grants from Celgene, Chugai, Janssen, Pfizer, and Roche; personal fees from AbbVie, Boehringer Ingelheim, Celgene, Chugai, Eli Lilly, Genzyme, Janssen, MSD, Novartis, Pfizer, Roche, and Sanofi; and investigator fees from Eli Lilly, Derek Haaland Speakers bureau: Advisory board/speaker bureau membership for AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, GSK, Janssen, Novartis, Pfizer, Roche, Sanofi, and Takeda, Consultant of: Honoraria or other fees from AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GSK, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, Takeda, and UCB, Grant/research support from: Research grants from AbbVie, Adiga Life Sciences, Amgen, Bristol-Myers Squibb, Can-Fite Biopharma, Celgene, Eli Lilly, Gilead, GSK, Janssen, Novartis, Pfizer, Regeneron, Sanofi Genzyme, and UCB, Penelope Palominos Speakers bureau: Advisory board/speaker bureau membership for Janssen and Novartis, Consultant of: Personal fees from AbbVie, Grant/research support from: Research support from Novartis, Pfizer, and Roche, Apinya Lertratanakul Employee of: Employee of AbbVie and may own stock or options, Michael Lane Employee of: Employee of AbbVie and may own stock or options, Ralph Lippe Employee of: Employee of AbbVie and may own stock or options, Daniel Aletaha Consultant of: AbbVie, Grünenthal, Janssen, Medac, Mitsubishi Tanabe, MSD, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, Grünenthal, Janssen, Medac, Mitsubishi Tanabe, MSD, Pfizer, Roche, and UCB, Peter Nash Grant/research support from: Received honoraria and research support from AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Eli Lilly, Gilead/Galapagos, Janssen, MSD, Novartis, Pfizer, Roche, Samsung, Sanofi, and UCB.
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Penmetsa G, Pei S, Sauer B, Walsh JA, Feng B, Walker J, Douglas K, Clewell J. POS0262 IDENTIFYING EROSIVE DISEASE FROM RADIOLOGY REPORTS OF VETERANS WITH INFLAMMATORY ARTHRITIS USING NATURAL LANGUAGE PROCESSING. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The presence of erosive disease influences diagnosis, management, and prognosis in inflammatory arthritis (IA).Research of IA in large datasets is limited by a lack of methods for identifying erosions.Objectives:To develop methods for identifying articular erosions in radiology reports from veterans with IA.Methods:Included veterans had ≥2 ICD codes for ankylosing spondylitis (AS), psoriatic arthritis (PsA), or rheumatoid arthritis (RA) between 2005- 2019, in Veterans Affairs Corporate Data Warehouse. Chart review & annotation of radiology notes produced the reference standard, & identified erosion terms that informed classification rule development. A rule-based natural language processing (NLP) model was created & revised in training snippets. The NLP method was validated in an independent reference sample of IA patients at the snippet & patient levelsStepDescriptionNumber & example1 Radiology notesa.Select note titles potentially relevant to IAa. 35,141 notes titlesb.Extract notes with titles potentially related to IAb. 2,926,113 radiology notes2 Possible meaningful termsa.Compile list of root terms that may indicate erosiona. 11 root terms (i.e. ero*, pencil*cup, irreg*)b.Query radiology notes for root term variationsb. 1178 variations (i.e. erosion, erotic, erode)c.Select possible meaningful termsc. 179 possible terms (i.e. erosion, erode)3 Annotationa.Extract snippets^ containing possible meaningful termsa.5000 snippets from radiology notesb.Classify snippets according to: 1) Meaningful term, 2) Relevance to joint, 3) Attribution to IA, 4) Affirmationb.4068 classifications with 1017 snippets (in rounds of 50-417 snippets for NLP training & testing)4 Rule developmenta.Identify meaningful terms representing erosiona. 6 terms (pencil * cup, erosion, erosive, etc.)b.Exclude erosive processes irrelevant to joint(s)b. 28 irrelevant processes (i.e. gastric erosion)c. Exclude articular erosive processes not attributed to IAc. 5 non-IA processes IA (i.e. infection)d. Classify as affirmed/negated (erosion present/absent)d. 83 affirmation/negation rules5 NLP trainingDesign & revise NLP model until accuracy ≥90%6 rounds, 817 snippets (AS 417, RA 200, PsA 200)6 NLP testingTest NLP model200 snippets (AS 100, RA 50, PsA 50)7 Pt classificationa. Develop rules for classifying pts with discordant snippetsa. 5 rules developed in 368 ptsb. Build reference sample (pts classified as erosive or non-erosive via chart review)b. 30 IA pts (10 AS, 10 RA, 10 PsA)8 NLP validationValidate NLP model in reference sample at snippet level149 snippets (29 AS, 76 RA, 44 PsA)9 Method validationValidate methods (NLP+pt classification) at pt level30 IA pts (reference sample)pt= patient. ^Snippets include text containing 30 words before & after meaningful termsResults:In 168,667 veterans with IA, the mean age was 63.1 & 90.3% were male. Method development involved radiology note & erosion term selection, rule development, NLP model building, & method validation. The NLP model accuracy was 94.6% at the snippet level & 90.0% at the patient level, for all IA patients.Accuracy of methods.Conclusion:The methods accurately identify erosions from radiology reports of veterans with IA. They may facilitate a broad range of research involving cohort identification & disease severity stratificationReferences:[1]Walsh JA, et al. J Rheumatol. 2020;47(1):42-49Disclosure of Interests:Gopi Penmetsa: None declared, Shaobo Pei: None declared, Brian Sauer Grant/research support from: I have been an investigator on research contracts supported by Abbvie., Jessica A. Walsh Consultant of: AbbVie, Amgen, Janssen, Lilly, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Merck, Pfizer, Bingjian Feng Grant/research support from: Bing-Jian Feng reports funding and sponsorship to his institution on his behalf from Pfizer Inc., Regeneron Genetics Center LLC, and Astra Zeneca (UK). The PERCH software, for which Bing-Jian Feng is the inventor, has been non-exclusively licensed to Ambry Genetics for clinical genetic testing services and research., Jodi Walker Shareholder of: Abbvie and mutual funds containing various pharmaceutical companies, Employee of: Abbvie, Kevin Douglas Shareholder of: employed by Abbvie, Employee of: employed by Abbvie, Jerry Clewell Shareholder of: Own Abbvie Shares and mutual funds that hold pharmaceutical and other health care stocks, Employee of: I am current Abbvie Inc employee and past employee of Eli Lilly co
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Mease PJ, Kavanaugh A, Gladman DD, Fitzgerald O, Soriano E, Nash P, Feng D, Lertratanakul A, Douglas K, Lippe R, Gossec L. AB0529 CHARACTERIZATION OF REMISSION IN PATIENTS WITH PSORIATIC ARTHRITIS TREATED WITH UPADACITINIB: POST-HOC ANALYSIS FROM TWO PHASE 3 TRIALS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:For patients (pts) with PsA, several disease activity measures are available including very low/minimal disease activity (VLDA/MDA), cutoffs based on the Disease Activity in PsA (DAPSA) score, and on the Psoriatic Arthritis Disease Activity Score (PASDAS) score.Objectives:To assess the rates of pts achieving these remission or low disease activity (LDA) criteria at Wk 24 using data from the SELECT-PsA 1 and SELECT-PsA 2 phase 3 studies;1,2 Additionally, we assessed the distribution of individual MDA components among pts who did or did not achieve MDA criteria at Wk 24.Methods:In SELECT-PsA 1 and SELECT-PsA 2, pts with PsA and prior inadequate response (IR) or intolerance to ≥1 non-biologic DMARD (N=1705) or ≥1 biologic DMARD (N=642), respectively, were randomized to once daily upadacitinib (UPA) 15mg, UPA 30mg, adalimumab (ADA) 40mg every other week (SELECT-PsA 1 only), or placebo (PBO). Remission and LDA were assessed using VLDA/MDA, DAPSA scores of ≤4/≤14, and PASDAS scores of ≤1.9/≤3.2, at Wk 24 (Table 1). Non-responder imputation (NRI) was used for handling missing data; pts rescued at Wk 16 were considered non-responders. Pairwise comparisons between UPA doses and PBO or ADA were conducted using the Cochran-Mantel-Haenszel test.Results:Overall, 2345 pts were analyzed; mean age 51 years, 53% female. In both studies, higher rates of remission and LDA were observed with both UPA doses vs PBO at Wk 24 (nominal P-values <0.05 for both time points; Table 1). Generally, higher rates of remission and LDA were also observed with UPA30 vs ADA in non-biologic DMARD-IR pts (nominal P-values <0.05). Greater rates of MDA/VLDA were observed at Wk 24 with UPA15 and UPA30 vs PBO in both studies and with UPA30 vs ADA in non-biologic DMARD-IR pts (nominal P-values <0.05 for all comparisons). The proportion of responder or non-responder pts receiving UPA15 or UPA30 was similar for each of the MDA components in both studies. At Wk 24, more responder and non-responder pts in both studies achieved Swollen Joint Count (SJC) 66 ≤1, Psoriasis Area and Severity Index (PASI) ≤1 or Body Surface Area-Psoriasis (BSA-Ps) ≤3%, and Leeds Enthesitis Index (LEI) ≤1 (Figure 1). Conversely, the proportion of pts Achieving Tender Joint Count (TJC) 68 ≤1 and Pt’s Global Assessment of Pain ≤1.5 tended to be lower.Conclusion:Regardless of previous biologic DMARD failure, pts treated with UPA15 or UPA30 achieved a higher rate of remission or LDA measured by various disease activity measures vs PBO at Wk 24; higher rates of response were observed in most of the remission and LDA measures with UPA30 vs ADA in non-biologic DMARD-IR pts. Among pts who did or did not achieve MDA criteria at Wk 24, a greater proportion of UPA-treated pts achieved physician derived measures such as SJC ≤1, PASI ≤1 or BSA-Ps ≤3%, and LEI ≤1.References:[1]McInnes IB, et al. Ann Rheum Dis, 2020; 79:12.[2]Genovese MC, et al. Ann Rheum Dis, 2020; 79:139.Table 1.Proportion of Patients Achieving Remission and LDA Measures at Week 24Endpoint, n (%)SELECT-PsA 1SELECT-PsA 2PBON=423ADA 40mg EOWN=429UPA 15mg QDN=429UPA 30mg QDN=423PBON=212UPA 15mg QDN=211UPA 30mg QDN=218MDA52 (12.3)143 (33.3)157 (36.6) *, #192(45.4) *, †, #6 (2.8)53 (25.1) *, #63 (28.9) *, #≥6 VLDA components25 (5.9)90 (21.0)105 (24.5) *134 (31.7) *, †3 (1.4)26 (12.3) *44 (20.2) *VLDA11 (2.6)62 (14.5)55 (12.8) *72 (17.0) *3 (1.4)16 (7.6) *21(9.6) *DAPSA REM9 (2.1)43 (10.0)47 (11.0) *79 (18.7) *, †1 (0.5)15 (7.1) *28 (12.8) *DAPSA LDA70 (16.5)198 (46.2)204 (47.6) *235(55.6) *, †14 (6.6)73 (34.6) *91 (41.7) *PASDAS REM12 (2.8)51 (11.9)60 (14.0) *91 (21.5) *, †4 (1.9)20 (9.5) *31 (14.2) *PASDAS LDA63 (14.9)168 (39.2)195 (45.5) *211 (49.9) *, †9 (4.2)69 (32.7) *82 (37.6) **P ≤ 0.05 for UPA15 and UPA30 vs PBO; †P ≤ 0.05 for UPA30 vs ADA; #Statistically significant in the multiplicity-controlled analysis.MDA (5/7) and VLDA (7/7): TJC ≤ 1; SJC ≤ 1; PASI ≤ 1 or BSA-Psoriasis ≤ 3%; Patient’s Assessment of Pain NRS ≤ 1.5; PtGA-Disease Activity NRS ≤ 2.0; HAQ-DI score ≤ 0.5; and tender entheseal points ≤ 1.DAPSA REM ≤ 4; DAPSA LDA ≤ 14.PASDAS REM ≤ 1.9; PASDAS LDA ≤ 3.2.Figure 1Acknowledgements:AbbVie and the authors thank the patients, study sites, and investigators who participated in this clinical trial. AbbVie, Inc was the study sponsor, contributed to study design, data collection, analysis & interpretation, and to writing, reviewing, and approval of final version. No honoraria or payments were made for authorship. Medical writing support was provided by Ramona Vladea, PhD of AbbVie Inc.Disclosure of Interests:Philip J Mease Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers, Celgene, Galapagos, Gilead, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Sun Pharma, and UCB., Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers, Celgene, Galapagos, Gilead, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Sun Pharma, and UCB., Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers, Celgene, Galapagos, Gilead, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Sun Pharma, and UCB., Arthur Kavanaugh Consultant of: AbbVie Inc., Amgen, Astra-Zeneca, BMS, Celgene, Centocor-Janssen, Pfizer, Roche, and UCB, Grant/research support from: AbbVie Inc., Amgen, Astra-Zeneca, BMS, Celgene, Centocor-Janssen, Pfizer, Roche, and UCB, Dafna D Gladman Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene Corporation, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer Inc, and UCB, Oliver FitzGerald Speakers bureau: AbbVie, Amgen, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Consultant of: AbbVie, Amgen, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: AbbVie, Amgen, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Enrique Soriano Speakers bureau: AbbVie, Amgen, Bristol Myers, Celgene, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, and UCB, Consultant of: AbbVie, Amgen, Bristol Myers, Celgene, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, and UCB, Grant/research support from: AbbVie, Amgen, Bristol Myers, Celgene, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, and UCB, Peter Nash Speakers bureau: AbbVie, BMS, Roche, Pfizer, Janssen, Amgen, Sanofi-Aventis, UCB, Eli Lilly, Novartis, and Celgene, Consultant of: AbbVie, BMS, Roche, Pfizer, Janssen, Amgen, Sanofi-Aventis, UCB, Eli Lilly, Novartis, and Celgene, Grant/research support from: AbbVie, BMS, Roche, Pfizer, Janssen, Amgen, Sanofi-Aventis, UCB, Eli Lilly, Novartis, and Celgene, Dai Feng Shareholder of: AbbVie, Employee of: AbbVie, Apinya Lertratanakul Shareholder of: AbbVie, Employee of: AbbVie, Kevin Douglas Shareholder of: AbbVie, Employee of: AbbVie, Ralph Lippe Shareholder of: AbbVie, Employee of: AbbVie, Laure Gossec Consultant of: AbbVie,Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Samsung, Sanofi, UCB, Grant/research support from: Lilly, Pfizer, and Sandoz.
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Cheila M, Douglas K, Koutsianas C. FRI0280 COMPARATIVE DRUG SURVIVAL OF TNF INHIBITORS AND SECUKINUMAB IN BIOLOGIC NAÏVE PATIENTS WITH ANKYLOSING SPONDYLITIS AND PSORIATIC ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Secukinumab (SEC) was approved for treating ankylosing spondylitis (AS) and psoriatic arthritis (PsA) in the UK in 2016/17 respectively, providing an alternative mechanism of action to TNF inhibitors (TNFi), which were, until that time, the most frequently prescribed biologic therapies for these rheumatic conditions. SEC’s efficacy and safety has been shown in clinical trials1, 2, but real world data on its survival remains scarce.Objectives:This study aimed to compare SEC and TNFi drug survival in AS and PsA biologic naïve patients.Methods:Observational retrospective study of consecutive biologic naïve patients attending the Dudley Group NHS Foundation Trust (DGFT) with a clinical diagnosis of AS (fulfilling ASAS criteria) or PsA (fulfilling CASPAR criteria) who received at least one dose of biologic therapy between 01/07/2017 and 30/09/2019, with a follow-up period until December 31st, 2019. The biologics database, patient medical records and investigations were reviewed and data on demographics, disease characteristics, previous cDMARD therapy and reasons for discontinuation of biologic were collected. Analysis was performed using descriptive statistics, Kaplan-Meier plots and Cox regression on SPSS version 23.Results:We identified 153 AS or PsA patients starting biologic therapy in this time interval. 103 (68.7%) were biologic naïve, commencing either TNFi (38, 36.9%), SEC (63, 61.1%) or Ixekizumab (2, 1.9% -excluded from analysis) for AS (45.5%) and PsA (54.5%). The patients were evenly distributed in terms of sex (female 50.5%), had a mean (±SD) age of 45 (±13.8) years and a median (IQR) disease duration of 5 (7.7) years. The median (IQR) follow up time was 13 (13) months.The overall 1 and 2-year drug survival was 86.8% and 79.3% respectively for TNFi and 81.5% and 77.4% for SEC treated patients. There was no statistically significant difference between the estimated means for drug survival time for the two treatment modalities (TNFi: 24.4 vs SEC:22.9 months,log rank:0.991) (Figure 1). The analysis of SEC’s drug survival in AS in comparison to PsA did not show statistically significant difference (21.8 vs 22.0 months respectively,log rank: 0.419). We observed a trend for worse TNFi survival in AS compared to PsA, but this did not reach statistical significance (18.9 vs 26.1 months respectively,log rank: 0.09).Figure 1.Comparative cumulative drug survival (months) in biologic naïve AS and PsA patientsNo significant difference in reasons for discontinuation between treatments was observed. Age, sex, disease duration, previous DMARD use and extra-articular manifestations were variables that were not associated with drug survival on Cox regression analysis.Conclusion:The estimated 1 year drug survival for TNFi and SEC was 86.8% and 81.5% respectively. Data from our cohort of real-life previously biologic naïve patients with AS and PsA showed no difference in drug survival and reasons for discontinuation between TNFi and SEC. Age, sex, previous DMARD use and extra-articular manifestations were not predictors for drug survival.References:[1]Kavanaugh et al. Secukinumab for Long-Term Treatment of Psoriatic Arthritis: A Two-Year Followup From a Phase III, Randomized, Double-Blind Placebo-Controlled Study. Arthritis Care Res (Hoboken). 2017 Mar;69(3):347-355.[2]Braun et al. Effect of secukinumab on clinical and radiographic outcomes in ankylosing spondylitis: 2-year results from the randomised phase III MEASURE 1 study. Ann Rheum Dis. 2017 Jun;76(6):1070-1077Disclosure of Interests:None declared
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Baniotopoulos P, Pagkopoulou E, Soulaidopoulos S, Sandoo A, Katsiki N, Karagiannis A, Douglas K, Garyfallos A, Kitas G, Dimitroulas T. SAT0312 SUBCLINICAL ATHEROSCLEROSIS IN SYSTEMIC SCLEROSIS AND RHEUMATOID ARTHRITIS: A COMPARATIVE MATCHED-COHORT STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Systemic autoimmune inflammatory disorders confer a higher risk of cardiovascular (CV) disease leading to increased morbidity and mortality compared to the general population. CV risk in Systemic Sclerosis (SSc) has not been studied so extensively as in other diseases, such as Rheumatoid Arthritis (RA), and the real impact of CV disease on SSc prognosis remains unknown. Surrogate markers of atherosclerosis namely carotid intima media thickness (cIMT) and pulse wave velocity (PWV) are impaired in some but not all studies in SSc patients.Objectives:The aim of the study was to investigate the prevalence of subclinical atherosclerosis assessed by cIMT and PWV between two well-characterized SSc and RA cohorts.Methods:Consecutive SSc patients attending the Scleroderma Clinic were compared with RA patients recruited in the Dudley Rheumatoid Arthritis Co-morbidity Cohort (DRACCO), a prospective study examining CV burden in RA. Cardiovascular risk was assessed using the QRisk3 and cIMT, Augmentation Index (AIx75) and central systolic and diastolic blood pressure were measured in all participants. Propensity score matching, was utilized to select patients from the two cohorts with similar demographic characteristics, CV risk factors (smoking, hypertension, obesity, dyslipidemia, diabetes) and inflammatory load. Unpaired t-test and Chi-square test of independence were applied.Results:Fifty five age- and sex-matched SSc and RA patients with similar distribution of CV risk factors were included. No difference was demonstrated between SSc and RA regarding cIMT and AIx75% (0.65 vs 0,61mm p=0,17 and 33.4 vs 31,7 p=0,397 respectively). However average QRisk3 score was significantly higher in the RA compared to the SSc group (P<0.05).Conclusion:The results of this comparative study show that subclinical atherosclerosis is comparable between individuals with SSc and RA, a systemic disease with well-defined high atherosclerotic burden. RA patients have higher CV risk (QRisk3 algorithm) suggesting that disease-specific factors such chronic high-grade inflammation may influence the CV risk in this population.References:[1]Ozen G, et al. Subclinical Atherosclerosis in Systemic Sclerosis: Not Less Frequent Than Rheumatoid Arthritis and Not Detected With Cardiovascular Risk Indices. Arthritis Care Res (Hoboken) 2016; 68:1538-46[2]Pagkopoulou E, et al., Cardiovascular risk in systemic sclerosis: Micro- and Macro-vascular involvement. Indian J Rheumatol 2017;12: 211-7Table 1.Demographic and cardiovascular risk factors of the matched patientsRASScPN=55N=55Age63.6 (14.8)61.3 (10.9)0.140Female49 (89.1%)53 (96.4%)0.438Smoking10 (18.2%)13 (23.6%)0.5Diabetes0 (0.00%)1 (1.82%)0.364Hyperlipidemia:7 (12.7%)6 (10.9%)1.000Hypertension:23 (41.8%)19 (34.5%)0.441ESRD20.4 (18.4)22.0 (19.1)0.666CRP8.38 (11.6)6.65 (30.2)0.692Table 2.Comparison of IMT, AIx75, Framingham and QRISK3 between matched patientsRASScPN=55N=55IMT right average0.65 (0.17)0.61 (0.12)0.175IMT left average0.67 (0.15)0.64 (0.13)0.214IMT average0.66 (0.14)0.63 (0.10)0.137AIX 75% (%)33.4 (9.23)31.7 (10.8)0.397Framingham risk< 0.001< 10%9 (31.0%)37 (74.0%)10 – 20%12 (41.4%)9 (18.0%)20 – 30%3 (10.3%)4 (8.00%)>30%5 (17.2%)0 (0.00%)QRISK318.2 (15.3)11.1 (10.6)0.006Disclosure of Interests:Pantelis Baniotopoulos: None declared, Eleni Pagkopoulou: None declared, Stergios Soulaidopoulos: None declared, Aamer Sandoo: None declared, Niki Katsiki: None declared, Asterios Karagiannis: None declared, Karen Douglas: None declared, Alexandros Garyfallos Grant/research support from: MSD, Aenorasis SA, Speakers bureau: MSD, Novartis, gsk, Georeg Kitas: None declared, Theodoros Dimitroulas: None declared
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Rosenbaum JT, Bodaghi B, Couto C, Zierhut M, Acharya N, Pavesio C, Tay-Kearney ML, Neri P, Douglas K, Pathai S, Song AP, Kron M, Foster CS. New observations and emerging ideas in diagnosis and management of non-infectious uveitis: A review. Semin Arthritis Rheum 2019; 49:438-445. [DOI: 10.1016/j.semarthrit.2019.06.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 04/18/2019] [Accepted: 06/05/2019] [Indexed: 02/07/2023]
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Mease PJ, Liu C, Siegel E, Richmond H, Wu M, Chen L, Douglas K, Lockshin B. Impact of Clinical Specialty Setting and Geographic Regions on Disease Management in Patients with Psoriatic Arthritis in the United States: A Multicenter Observational Study. Am J Clin Dermatol 2019; 20:873-880. [PMID: 31612380 PMCID: PMC6872709 DOI: 10.1007/s40257-019-00470-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 01/18/2023]
Abstract
Background Information on the factors that influence treatment management decisions for psoriatic arthritis (PsA) is limited. Objective Our objective was to evaluate the impact of clinical specialty setting and geographic region on the management of patients with PsA in the USA. Methods LOOP was a multicenter, cross-sectional, observational study conducted across 44 sites in the USA. Patients were aged ≥ 18 years with a suspected or established diagnosis of PsA and were routinely visiting a rheumatologist or dermatologist. All patients enrolled in the study were assessed by both a rheumatologist and a dermatologist. Primary outcomes were the times from symptom onset to PsA diagnosis; PsA diagnosis to first conventional synthetic disease-modifying antirheumatic drug (csDMARD); PsA diagnosis to first biologic DMARD (bDMARD); and first csDMARD to first bDMARD. Results Of 681 patients enrolled in the study, 513 had a confirmed diagnosis of PsA and were included in this analysis. More patients were recruited by rheumatologists (71.3%) than by dermatologists (28.7%). The median time from symptom onset to diagnosis of PsA was significantly shorter for patients enrolled by rheumatologists than for those enrolled by dermatologists (1.0 vs. 2.6 years; p < 0.001). Disease activity and burden were generally similar across enrolling specialties. However, patients in western areas of the USA had less severe disease than those in central or eastern areas, including measures of joint involvement, enthesitis, and dactylitis. Conclusions There was a substantial delay in the time from symptom onset to diagnosis in this study population, and this was significantly longer for patients enrolled in the dermatology versus the rheumatology setting. This supports the need for collaboration across specialties to ensure faster recognition and treatment of PsA. Electronic supplementary material The online version of this article (10.1007/s40257-019-00470-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Phillip J Mease
- Swedish Medical Center, Providence St. Joseph Health, and University of Washington, Seattle, WA, USA.
| | - Clive Liu
- Bellevue Dermatology Clinic, Bellevue, WA, USA
| | - Evan Siegel
- Arthritis and Rheumatism Associates and Georgetown University, Rockville, MD, USA
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Weston E, Noel M, Douglas K, Terrones K, Grumbine F, Stone R, Levinson K. The impact of an enhanced recovery after surgery (ERAS) program on opioid use reduction in patients undergoing minimally invasive hysterectomy (MIH) in gynecology oncology. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mills I, Sheard C, Hays M, Douglas K, Winchester CC, Gattrell WT. Professional medical writing support and the reporting quality of randomized controlled trial abstracts among high-impact general medical journals. F1000Res 2017; 6:1489. [PMID: 29034080 PMCID: PMC5615774 DOI: 10.12688/f1000research.12268.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2017] [Indexed: 11/30/2022] Open
Abstract
Background: In articles reporting randomized controlled trials, professional medical writing support is associated with increased adherence to Consolidated Standards of Reporting Trials (CONSORT). We set out to determine whether professional medical writing support was also associated with improved adherence to CONSORT for Abstracts. Methods: Using data from a previously published cross-sectional study of 463 articles reporting randomized controlled trials published between 2011 and 2014 in five top medical journals, we determined the association between professional medical writing support and CONSORT for Abstracts items using a Wilcoxon rank-sum test. Results: The mean proportion of adherence to CONSORT for Abstracts items reported was similar with and without professional medical writing support (64.3% vs 66.5%, respectively; p=0.30). Professional medical writing support was associated with lower adherence to reporting study setting (relative risk [RR]; 0.40; 95% confidence interval [CI], 0.23–0.70), and higher adherence to disclosing harms/side effects (RR 2.04; 95% CI, 1.37–3.03) and funding source (RR 1.75; 95% CI, 1.18–2.60). Conclusions: Although professional medical writing support was not associated with increased overall adherence to CONSORT for Abstracts, important aspects were improved with professional medical writing support, including reporting of adverse events and funding source. This study identifies areas to consider for improvement.
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Affiliation(s)
- Ira Mills
- PAREXEL International, Hackensack, NJ, 07601, USA
| | - Catherine Sheard
- Department of Archaeology and Anthropology, University of Bristol, Bristol, BS8 1TH, UK
| | - Meredith Hays
- Department of Medicine, Uniformed Services University, Bethesda, MD, 20814, USA
| | - Kevin Douglas
- Department of Medicine, Uniformed Services University, Bethesda, MD, 20814, USA
| | - Christopher C Winchester
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, TS17 6BH, UK.,Research Evaluation Unit, Oxford PharmaGenesis Ltd, Oxford, OX13 5QJ, UK
| | - William T Gattrell
- Oxford Brookes University, Oxford, OX3 0BP, UK.,Ipsen Pharma, Abingdon, OX14 4RL, UK
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Wells AF, Curtis JR, Betts KA, Douglas K, Du EX, Ganguli A. Systematic Literature Review and Meta-analysis of Tumor Necrosis Factor–Alpha Experienced Rheumatoid Arthritis. Clin Ther 2017; 39:1680-1694.e2. [DOI: 10.1016/j.clinthera.2017.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/05/2017] [Accepted: 06/28/2017] [Indexed: 12/29/2022]
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Sturgiss EA, Sargent GM, Haesler E, Rieger E, Douglas K. Therapeutic alliance and obesity management in primary care - a cross-sectional pilot using the Working Alliance Inventory. Clin Obes 2016; 6:376-379. [PMID: 27863074 DOI: 10.1111/cob.12167] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/31/2016] [Accepted: 09/28/2016] [Indexed: 11/28/2022]
Abstract
Therapeutic alliance is a well-recognized predictor of patient outcomes within psychological therapy. It has not been applied to obesity interventions, and Bordin's theoretical framework shows particular relevance to the management of obesity in primary health care. This cross-sectional study of a weight management programme in general practice aimed to determine if therapeutic alliance was associated with patient outcomes. The Working Alliance Inventory short revised version (WAI-SR) was administered to 23 patients and 11 general practitioners (GPs) at the end of a 6-month weight management programme. Use of the WAI-SR indicated that the strength of therapeutic alliance varied between different patient-GP relationships in this pilot intervention. A robust therapeutic alliance was strongly associated with patient engagement in the weight management programme indicated by number of appointments. It was also associated with some general health and quality of life outcomes. These are promising results that require confirmation with larger studies in primary health care. The measurement of therapeutic alliance using the WAI-SR may predict patient attendance and outcomes in obesity interventions in primary healthcare settings.
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Affiliation(s)
- E A Sturgiss
- Academic Unit of General Practice, Australian National University Medical School, Canberra, Australia
| | - G M Sargent
- Research School of Population Health, College of Medicine, Biology and Environment, Australian National University, Canberra, Australia
| | - E Haesler
- Academic Unit of General Practice, Australian National University Medical School, Canberra, Australia
| | - E Rieger
- Research School of Psychology, Australian National University, Canberra, Australia
| | - K Douglas
- Academic Unit of General Practice, Australian National University Medical School, Canberra, Australia
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Hays M, Andrews M, Wilson R, Callender D, O'Malley PG, Douglas K. Reporting quality of randomised controlled trial abstracts among high-impact general medical journals: a review and analysis. BMJ Open 2016; 6:e011082. [PMID: 27470506 PMCID: PMC4985789 DOI: 10.1136/bmjopen-2016-011082] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess adherence to the Consolidated Standards of Reporting Trials (CONSORT) for Abstracts by five high-impact general medical journals and to assess whether the quality of reporting was homogeneous across these journals. DESIGN This is a descriptive, cross-sectional study. SETTING Randomised controlled trial (RCT) abstracts in five high-impact general medical journals. PARTICIPANTS We used up to 100 RCT abstracts published between 2011 and 2014 from each of the following journals: The New England Journal of Medicine (NEJM), the Annals of Internal Medicine (Annals IM), The Lancet, the British Medical Journal (The BMJ) and the Journal of the American Medical Association (JAMA). MAIN OUTCOME The primary outcome was per cent overall adherence to the 19-item CONSORT for Abstracts checklist. Secondary outcomes included per cent adherence in checklist subcategories and assessing homogeneity of reporting quality across the individual journals. RESULTS Search results yielded 466 abstracts, 3 of which were later excluded as they were not RCTs. Analysis was performed on 463 abstracts (97 from NEJM, 66 from Annals IM, 100 from The Lancet, 100 from The BMJ, 100 from JAMA). Analysis of all scored items showed an overall adherence of 67% (95% CI 66% to 68%) to the CONSORT for Abstracts checklist. The Lancet had the highest overall adherence rate (78%; 95% CI 76% to 80%), whereas NEJM had the lowest (55%; 95% CI 53% to 57%). Adherence rates to 8 of the checklist items differed by >25% between journals. CONCLUSIONS Among the five highest impact general medical journals, there is variable and incomplete adherence to the CONSORT for Abstracts reporting checklist of randomised trials, with substantial differences between individual journals. Lack of adherence to the CONSORT for Abstracts reporting checklist by high-impact medical journals impedes critical appraisal of important studies. We recommend diligent assessment of adherence to reporting guidelines by authors, reviewers and editors to promote transparency and unbiased reporting of abstracts.
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Affiliation(s)
- Meredith Hays
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Mary Andrews
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Ramey Wilson
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - David Callender
- Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Patrick G O'Malley
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Kevin Douglas
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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Betts KA, Griffith J, Ganguli A, Li N, Douglas K, Wu EQ. Economic Burden and Treatment Patterns of Cycling between Conventional Synthetic Disease-modifying Antirheumatic Drugs Among Biologic-treated Patients with Rheumatoid Arthritis. Clin Ther 2016; 38:1205-16. [PMID: 27045991 DOI: 10.1016/j.clinthera.2016.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/29/2016] [Accepted: 03/04/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the economic outcomes and treatment patterns among patients with rheumatoid arthritis (RA) who used 1, 2, or 3 or more conventional synthetic disease-modifying antirheumatic drugs (DMARDs) before receiving a biologic therapy. METHODS Adult patients with ≥2 RA diagnoses (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 714.xx) on different dates, ≥1 claim for a conventional synthetic DMARD, and ≥1 claim for a biologic DMARD were identified from a large commercial claims database. The initiation date of the first biologic DMARD was defined as the index date. Based on the number of distinct conventional synthetic DMARDs initiated between the first RA diagnosis and the index date, patients were classified into 3 cohorts: those who used 1, 2, or 3 or more conventional synthetic DMARDs. Baseline characteristics were measured 6 months preindex date and compared between the 3 cohorts. All-cause health care costs (in 2014 US$) were compared during the follow-up period (12 months postbiologic initiation) using multivariable gamma models adjusting for baseline characteristics. Time to discontinuation of the index biologic DMARD and time to switching to a new DMARD were compared using multivariable Cox proportional hazards models. FINDINGS The 1, 2, and 3 or more conventional synthetic DMARD cohorts included 6215; 3227; and 976 patients, respectively. At baseline, patients in the 3 or more conventional synthetic DMARD cohort had the least severe RA, as indicated by the lowest claims-based index for RA severity score (1 vs 2 vs 3 or more = 6.1 vs 5.9 vs 5.8). During the study period, there was a significant association between number of conventional synthetic DMARDs and higher all-cause total health care costs (adjusted mean difference, 1 vs 2: $772; P < 0.001; 2 vs 3 or more: $2390; P < 0.001). The all-cause medical and pharmacy costs were also significantly higher with the increasing number of conventional synthetic DMARDs. Patients who cycled more conventional synthetic DMARDs were also more likely to switch treatment after biologic initiation (1 vs 2: adjusted hazard ratio = 0.89; P = 0.005; 2 vs 3 or more: adjusted hazard ratio = 0.89; P = 0.087). There were no differences in index biologic discontinuation between the 3 cohorts. IMPLICATIONS Patients with RA who cycled more conventional synthetic DMARDs had increased economic burden in the 12 months following biologic initiation and were more likely to switch therapy. These results highlight the importance of timely switching to biologic DMARDs for the treatment of RA.
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Affiliation(s)
| | | | | | - Nanxin Li
- Analysis Group, Inc, Boston, Massachusetts
| | | | - Eric Q Wu
- Analysis Group, Inc, Boston, Massachusetts
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Dimitroulas T, Hodson J, Sandoo A, Smith J, Douglas K, Kitas G. FRI0100 The Role of Insulin Resistance and Inflammation on Symmetric Dimethylarginine in Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1885] [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: 11/04/2022]
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Howell C, Douglas K, Cho G, El-Ghariani K, Taylor P, Potok D, Rintala T, Watkins S. Guideline on the clinical use of apheresis procedures for the treatment of patients and collection of cellular therapy products. Transfus Med 2015; 25:57-78. [PMID: 26013470 DOI: 10.1111/tme.12205] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 01/19/2023]
Affiliation(s)
- C. Howell
- Diagnostic & Therapeutic Services; NHS Blood and Transplant; Bristol UK
| | - K. Douglas
- Beatson West of Scotland Cancer Centre; Glasgow UK
- Scottish National Blood Transfusion Service; Glasgow UK
| | - G. Cho
- London North West Healthcare NHS Trust; Harrow UK
| | - K. El-Ghariani
- Therapeutics & Tissue Services; NHS Blood and Transplant; Sheffield UK
| | - P. Taylor
- The Rotherham NHS Foundation Trust; Rotherham UK
| | - D. Potok
- Diagnostic & Therapeutic Services; NHS Blood and Transplant; Leeds UK
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Cho G, Douglas K. BCSH guideline on the clinical use of apheresis procedures: new changes and future directions. Transfus Med 2015; 25:55-6. [PMID: 25959959 DOI: 10.1111/tme.12203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 04/20/2015] [Indexed: 11/29/2022]
Affiliation(s)
- G Cho
- London North West Healthcare NHS Trust, Department of Haematology, London, UK
| | - K Douglas
- Scottish National Blood Transfusion Service, Beatson West of Scotland Cancer Centre, Glasgow, Scotland
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Douglas K, Hillis G, Croal B, Gibson P, Cuthbertson B. B-type natriuretic peptide and echocardiographic indices of left ventricular filling in critically ill patients with severe sepsis: a cohort study. Br J Anaesth 2014; 113:884-5. [DOI: 10.1093/bja/aeu354] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dimitroulas T, Sandoo A, Hodson J, Smith J, Douglas K, Kitas G. THU0490 Mthfr C677T Polymorphism but not DDAH Gene Variants Are Associated with Asymmetric Dimethylarginine in Patients with Rheumatoid Arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4594] [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: 11/03/2022]
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Dimitroulas T, Sandoo A, Hodson J, Smith J, Douglas K, Kitas G. AB0363 Assymetric Dimethylarginine is Associated with Cumulative Inflammatory Burden in Rheumatoid Arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1772] [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: 11/04/2022]
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Reyes-Bahamonde J, Raimann JG, Canaud B, Etter M, Kooman JP, Levin NW, Marcelli D, Marelli C, Power A, Van Der Sande FM, Thijssen S, Usvyat LA, Wang Y, Kotanko P, Blank PR, Szucs TD, Gibertoni D, Torroni S, Mandreoli M, Rucci P, Fantini MP, Santoro A, Van Der Veer SN, Nistor I, Bernaert P, Bolignano D, Brown EA, Covic A, Farrington K, Kooman J, Macias J, Mooney A, Van Munster BC, Van Den Noortgate N, Topinkova E, Wirnsberger G, Jager KJ, Van Biesen W, Stubnova V, Os I, Grundtvig M, Waldum B, Wu HY, Peng YS, Wu MS, Chu TS, Chien KL, Hung KY, Wu KD, Carrero JJ, Huang X, Sui X, Ruiz JR, Hirth V, Ortega FB, Blair SN, Coppolino G, Bolignano D, Rivoli L, Presta P, Mazza G, Fuiano G, Marx S, Petrilla A, Hengst N, Lee WC, Ruggajo P, Skrunes R, Svarstad E, Skjaerven R, Reisaether AV, Vikse BE, Fujii N, Hamano T, Akagi S, Watanabe T, Imai E, Nitta K, Akizawa T, Matsuo S, Makino H, Scalzotto E, Corradi V, Nalesso F, Zaglia T, Neri M, Martino F, Zanella M, Brendolan A, Mongillo M, Ronco C, Occelli F, Genin M, Deram A, Glowacki F, Cuny D, Mansurova I, Alchinbayev M, Malikh MA, Song S, Shin MJ, Rhee H, Yang BY, Kim I, Seong EY, Lee DW, Lee SB, Kwak IS, Isnard Bagnis C, Speyer E, Beauger D, Caille Y, Baudelot C, Mercier S, Jacquelinet C, Gentile SM, Briancon S, Yu TM, Li CY, Krivoshiev S, Borissova AM, Shinkov A, Svinarov D, Vlachov J, Koteva A, Dakovska L, Mihaylov G, Popov A, Polner K, Mucsi I, Braunitzer H, Kiss A, Nadasdi Z, Haris A, Zdrojewski L, Zdrojewski T, Rutkowski B, Minami S, Hesaka A, Yamaguchi S, Iwahashi E, Sakai S, Fujimoto T, Sasaki K, Fujita Y, Yokoyama K, Dey V, Farrah T, Traynor J, Spalding E, Robertson S, Geddes CC, Mann MC, Hobbs A, Hemmelgarn BR, Roberts D, Ahmed SB, Rabi D, Elewa U, Fernandez B, Alegre ER, Mahillo I, Egido J, Ortiz A, Marx S, Pomerantz D, Vietri J, Zewinger S, Speer T, Kleber ME, Scharnagl H, Woitas R, Pfahler K, Seiler S, Heine GH, Lepper PM, Marz W, Silbernagel G, Fliser D, Caldararu CD, Gliga ML, Tarta ID, Szanto A, Carlan O, Dogaru GA, Battaglia Y, Del Prete MA, De Gregorio MG, Errichiello C, Gisonni P, Russo L, Scognamiglio B, Storari A, Russo D, Kuma A, Serino R, Miyamoto T, Tamura M, Otsuji Y, Kung LF, Naito S, Iimori S, Okado T, Rai T, Uchida S, Sasaki S, Kang YU, Kim HY, Choi JS, Kim CS, Bae EH, Ma SK, Kim SW, Muthuppalaniappan VM, Byrne C, Sheaff M, Rajakariar R, Blunden M, Delmas Y, Loirat C, Muus P, Legendre C, Douglas K, Hourmant M, Herthelius M, Trivelli A, Goodship T, Bedrosian CL, Licht C, Marks A, Black C, Clark L, Prescott G, Robertson L, Simpson W, Simpson W, Fluck N, Wang SL, Hsu YH, Pai HC, Chang YM, Liu WH, Hsu CC, Shvetsov M, Nagaytseva S, Gerasimov A, Shalyagin Y, Ivanova E, Shilov E, Zhang Y, Zuo W, Marx S, Manthena S, Newmark J, Zdrojewski L, Rutkowski M, Zdrojewski T, Bandosz P, Gaciong Z, Solnica B, Rutkowski B, Wyrzykowski B, Ensergueix G, Karras A, Levi C, Chauvet S, Trivin C, Ficheux M, Augusto JF, Boudet R, Chambaraud T, Boudou-Rouquette P, Tubiana-Mathieu N, Aldigier JC, Jacquot C, Essig M, Thervet E, Oh YJ, Lee CS, Malho Guedes A, Silva AP, Goncalves C, Sampaio S, Morgado E, Santos V, Bernardo I, Leao Neves P, Onuigbo M, Agbasi N. CKD GENERAL AND CLINICAL EPIDEMIOLOGY 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu146] [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] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Mohty M, Hübel K, Kröger N, Aljurf M, Apperley J, Basak GW, Bazarbachi A, Douglas K, Gabriel I, Garderet L, Geraldes C, Jaksic O, Kattan MW, Koristek Z, Lanza F, Lemoli RM, Mendeleeva L, Mikala G, Mikhailova N, Nagler A, Schouten HC, Selleslag D, Suciu S, Sureda A, Worel N, Wuchter P, Chabannon C, Duarte RF. Autologous haematopoietic stem cell mobilisation in multiple myeloma and lymphoma patients: a position statement from the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 2014; 49:865-72. [PMID: 24686988 DOI: 10.1038/bmt.2014.39] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 01/19/2014] [Accepted: 01/28/2014] [Indexed: 12/16/2022]
Abstract
Autologous haematopoietic SCT with PBSCs is regularly used to restore BM function in patients with multiple myeloma or lymphoma after myeloablative chemotherapy. Twenty-eight experts from the European Group for Blood and Marrow Transplantation developed a position statement on the best approaches to mobilising PBSCs and on possibilities of optimising graft yields in patients who mobilise poorly. Choosing the appropriate mobilisation regimen, based on patients' disease stage and condition, and optimising the apheresis protocol can improve mobilisation outcomes. Several factors may influence mobilisation outcomes, including older age, a more advanced disease stage, the type of prior chemotherapy (e.g., fludarabine or melphalan), prior irradiation or a higher number of prior treatment lines. The most robust predictive factor for poor PBSC collection is the CD34(+) cell count in PB before apheresis. Determination of the CD34(+) cell count in PB before apheresis helps to identify patients at risk of poor PBSC collection and allows pre-emptive intervention to rescue mobilisation in these patients. Such a proactive approach might help to overcome deficiencies in stem cell mobilisation and offers a rationale for the use of novel mobilisation agents.
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Affiliation(s)
- M Mohty
- Department of Haematology, Saint Antoine Hospital, Paris, France
| | - K Hübel
- University Hospital Cologne, Cologne, Germany
| | - N Kröger
- University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M Aljurf
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabi
| | | | - G W Basak
- The Medical University of Warsaw, Warsaw, Poland
| | | | - K Douglas
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - L Garderet
- Department of Haematology, Saint Antoine Hospital, Paris, France
| | - C Geraldes
- University Hospital Coimbra, Coimbra, Portugal
| | - O Jaksic
- University Hospital Dubrava, Zagreb, Croatia
| | - M W Kattan
- Quantitative Health Sciences Cleveland Clinic, Cleveland, OH, USA
| | - Z Koristek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - F Lanza
- Cremona Hospital, Cremona, Italy
| | | | - L Mendeleeva
- National Research Centre for Haematology, Moscow, Russia
| | - G Mikala
- St Istvan and St Laszlo Hospital, Budapest, Hungary
| | - N Mikhailova
- Institute of Children Haematology and Transplantation n.a. R Gorbacheva, St Petersburg State Pavlov Medical University, St Petersburg, Russia
| | - A Nagler
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - H C Schouten
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - D Selleslag
- Department of Haematology, AZ Sint-Jan, Brugge-Oostende, Belgium
| | - S Suciu
- EORTC Headquarters, Brussels, Belgium
| | - A Sureda
- Addenbrooke's Hospital, Cambridge, UK
| | - N Worel
- Medical University Vienna, Vienna, Austria
| | - P Wuchter
- Department of Medicine V, Heidelberg University, Heidelberg, Germany
| | - C Chabannon
- Institut Paoli-Calmettes and Inserm CBT-510, Marseille, France
| | - R F Duarte
- Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
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Legendre CM, Licht C, Muus P, Greenbaum LA, Babu S, Bedrosian C, Bingham C, Cohen DJ, Delmas Y, Douglas K, Eitner F, Feldkamp T, Fouque D, Furman RR, Gaber O, Herthelius M, Hourmant M, Karpman D, Lebranchu Y, Mariat C, Menne J, Moulin B, Nürnberger J, Ogawa M, Remuzzi G, Richard T, Sberro-Soussan R, Severino B, Sheerin NS, Trivelli A, Zimmerhackl LB, Goodship T, Loirat C. Terminal complement inhibitor eculizumab in atypical hemolytic-uremic syndrome. N Engl J Med 2013; 368:2169-81. [PMID: 23738544 DOI: 10.1056/nejmoa1208981] [Citation(s) in RCA: 1017] [Impact Index Per Article: 92.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Atypical hemolytic-uremic syndrome is a genetic, life-threatening, chronic disease of complement-mediated thrombotic microangiopathy. Plasma exchange or infusion may transiently maintain normal levels of hematologic measures but does not treat the underlying systemic disease. METHODS We conducted two prospective phase 2 trials in which patients with atypical hemolytic-uremic syndrome who were 12 years of age or older received eculizumab for 26 weeks and during long-term extension phases. Patients with low platelet counts and renal damage (in trial 1) and those with renal damage but no decrease in the platelet count of more than 25% for at least 8 weeks during plasma exchange or infusion (in trial 2) were recruited. The primary end points included a change in the platelet count (in trial 1) and thrombotic microangiopathy event-free status (no decrease in the platelet count of >25%, no plasma exchange or infusion, and no initiation of dialysis) (in trial 2). RESULTS A total of 37 patients (17 in trial 1 and 20 in trial 2) received eculizumab for a median of 64 and 62 weeks, respectively. Eculizumab resulted in increases in the platelet count; in trial 1, the mean increase in the count from baseline to week 26 was 73×10(9) per liter (P<0.001). In trial 2, 80% of the patients had thrombotic microangiopathy event-free status. Eculizumab was associated with significant improvement in all secondary end points, with continuous, time-dependent increases in the estimated glomerular filtration rate (GFR). In trial 1, dialysis was discontinued in 4 of 5 patients. Earlier intervention with eculizumab was associated with significantly greater improvement in the estimated GFR. Eculizumab was also associated with improvement in health-related quality of life. No cumulative toxicity of therapy or serious infection-related adverse events, including meningococcal infections, were observed through the extension period. CONCLUSIONS Eculizumab inhibited complement-mediated thrombotic microangiopathy and was associated with significant time-dependent improvement in renal function in patients with atypical hemolytic-uremic syndrome. (Funded by Alexion Pharmaceuticals; C08-002 ClinicalTrials.gov numbers, NCT00844545 [adults] and NCT00844844 [adolescents]; C08-003 ClinicalTrials.gov numbers, NCT00838513 [adults] and NCT00844428 [adolescents]).
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Affiliation(s)
- C M Legendre
- Université Paris Descartes and Assistance Publique–Hôpitaux de Paris, Hôpital Necker, INSERM Unité 845, Paris, France.
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Legendre C, Cohen D, Delmas Y, Feldkamp T, Fouque D, Furman R, Gaber O, Greenbaum L, Goodship T, Haller H, Herthelius M, Hourmant M, Licht C, Moulin B, Sheerin N, Trivelli A, Bedrosian CL, Loirat C, Legendre C, Babu S, Cohen D, Delmas Y, Furman R, Gaber O, Greenbaum L, Hourmant M, Jungraithmayr T, Lebranchu Y, Riedl M, Sheerin N, Bedrosian CL, Loirat C, Sheerin N, Legendre C, Greenbaum L, Furman R, Cohen D, Gaber AO, Bedrosian C, Loirat C, Haller H, Licht C, Muus P, Legendre C, Douglas K, Hourmant M, Herthelius M, Trivelli A, Goodship T, Remuzzi G, Bedrosian C, Loirat C, Kourouklaris A, Ioannou K, Athanasiou I, Demetriou K, Panagidou A, Zavros M, Rodriguez C NY, Blasco M, Arcal C, Quintana LF, Rodriguez de Cordoba S, Campistol JM, Bachmann N, Eisenberger T, Decker C, Bolz HJ, Bergmann C, Pesce F, Cox SN, Serino G, De Palma G, Sallustio FP, Schena F, Falchi M, Pieri M, Stefanou C, Zaravinos A, Erguler K, Lapathitis G, Dweep H, Sticht C, Anastasiadou N, Zouvani I, Voskarides K, Gretz N, Deltas CC, Ruiz A, Bonny O, Sallustio F, Serino G, Curci C, Cox S, De Palma G, Schena F, Kemter E, Sklenak S, Aigner B, Wanke R, Kitzler TM, Moskowitz JL, Piret SE, Lhotta K, Tashman A, Velez E, Thakker RV, Kotanko P, Leierer J, Rudnicki M, Perco P, Koppelstaetter C, Mayer G, Sa MJN, Alves S, Storey H, Flinter F, Willems PJ, Carvalho F, Oliveira J, Arsali M, Papazachariou L, Demosthenous P, Lazarou A, Hadjigavriel M, Stavrou C, Yioukkas L, Voskarides K, Deltas C, Zavros M, Pierides A, Arsali M, Demosthenous P, Papazachariou L, Voskarides K, Kkolou M, Hadjigavriel M, Zavros M, Deltas C, Pierides A, Toka HR, Dibartolo S, Lanske B, Brown EM, Pollak MR, Familiari A, Zavan B, Sanna Cherchi S, Fabris A, Cristofaro R, Gambaro G, D'Angelo A, Anglani F, Toka H, Mount D, Pollak M, Curhan G, Sengoge G, Bajari T, Kupczok A, von Haeseler A, Schuster M, Pfaller W, Jennings P, Weltermann A, Blake S, Sunder-Plassmann G, Kerti A, Csohany R, Wagner L, Javorszky E, Maka E, Tulassay T, Tory K, Kingswood J, Nikolskaya N, Mbundi J, Kingswood J, Jozwiak S, Belousova E, Frost M, Kuperman R, Bebin M, Korf B, Flamini R, Kohrman M, Sparagana S, Wu J, Brechenmacher T, Stein K, Bissler J, Franz D, Kingswood J, Zonnenberg B, Frost M, Cheung W, Wang J, Brechenmacher T, Lam D, Bissler J, Budde K, Ivanitskiy L, Sowershaewa E, Krasnova T, Samokhodskaya L, Safarikova M, Jana R, Jitka S, Obeidova L, Kohoutova M, Tesar V, Evrengul H, Ertan P, Serdaroglu E, Yuksel S, Mir S, Yang n Ergon E, Berdeli A, Zawada A, Rogacev K, Rotter B, Winter P, Fliser D, Heine G, Bataille S, Moal V, Berland Y, Daniel L, Rosado C, Bueno E, Fraile P, Lucas C, Garcoa-Cosmes P, Tabernero JM, Gonzalez R, Rosado C, Bueno E, Fraile P, Lucas C, Garcia-Cosmes P, Tabernero JM, Gonzalez R, Silska-Dittmar M, Zaorska K, Malke A, Musielak A, Ostalska-Nowicka D, Zachwieja J, K d r V, Uz E, Yigit A, Altuntas A, Yigit B, Inal S, Uz E, Sezer M, Yilmaz R, Visciano B, Porto C, Acampora E, Russo R, Riccio E, Capuano I, Parenti G, Pisani A, Feriozzi S, Perrin A, West M, Nicholls K, Sunder-Plassmann G, Torras J, Cybulla M, Conti M, Angioi A, Floris M, Melis P, Asunis AM, Piras D, Pani A, Warnock D, Guasch A, Thomas C, Wanner C, Campbell R, Vujkovac B, Okur I, Biberoglu G, Ezgu F, Tumer L, Hasanoglu A, Bicik Z, Akin Y, Mumcuoglu M, Ecder T, Paliouras C, Mattas G, Papagiannis N, Ntetskas G, Lamprianou F, Karvouniaris N, Alivanis P. Genetic diseases and molecular genetics. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft126] [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: 11/12/2022] Open
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Douglas G, Douglas K, Henry F. George Keith Douglas. West J Med 2011. [DOI: 10.1136/bmj.d4405] [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: 11/03/2022]
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El Sharkawy M, Elsaeed K, Kamel M, Aziz A, Del Pozo C, Balk A, Castello-Banyuls J, Navarro D, Pere B, Faura CC, Ballesta JJ, Rodig N, Vilalta R, Hernandez J, Camacho Diaz J, Lapeyraque AL, Sherwinter J, Gruppo R, Fremont O, Baudouin V, Langman C, Simonetti GD, Loirat C, Muus P, Legendre C, Douglas K, Hourmant M, Delmas Y, Herthelius M, Trivelli A, Goodship T, Bedrosian C, Licht C, Schlesinger N, Lin HY, De Meulemeester M, Rovensky J, Krammer G, Balfour A, So A, Carrero JJ, Sonmez A, Saglam M, Stenvinkel P, Yaman H, Quresi AR, Yenicesu M, Yilmaz MI, McQuarrie E, Freel M, Mark P, Patel R, Steedman T, Fraser R, Dargie H, Connell J, Jardine A, McQuarrie E, Freel M, Mark P, Fraser R, Connell J, Jardine A, Oh SW, Chin HJ, Na KY, Chae DW, Alfieri C, Vettoretti S, Cafforio C, Floreani R, Bonanomi C, Danzi G, Messa P, Whelton A, MacDonald P, Hunt B, Gunawardhana L, Rusu E, Voiculescu M, Zilisteanu D, Ecobici M, Arsenescu I, Ismail G, Macarie C, Chan D, Irish A, Watts G, Dogra G, Krueger T, Schlieper G, Cozzolino M, Eckardt KU, Jadoul M, Ketteler M, Leunissen K, Rump LC, Stenvinkel P, Wiecek A, Westenfeld R, Hilgers RD, Mahnken AH, Schurgers LJ, Floege J, Onuigbo M, Onuigbo N, Onuigbo M, Trevisani F, Sciarrone Alibrandi MT, Bertini R, Montorsi F, Delli Carpini S, Camerota TC, Antoniolli S, Citterio L, Querques M, Merlino L, Manunta P, Ebah L, Morgan J, Brenchley P, Mitra S, Krumme B, Boehler J, Mettang T, Strutz F, Georginova O, Rykova S, Gafarova M, Smyr K, Sokolova I, Krasnova T, Kozlovskaya L. Pathophysiology and clinical studies in CKD 1-5. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.50] [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: 11/12/2022] Open
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Escabi Y, San Miguel L, Judd T, Hertza J, Nicholson J, Schiff W, Bell C, Estes B, Millikin C, Shelton P, Marotta P, Wingler I, Barth J, Parmenter B, Andrews G, Riordan P, Lipinski D, Sawyer J, Brewer V, Kirk J, Green C, Kirkwood M, Brooks B, Fay T, Barlow K, Chelune G, Duff K, Wang A, Franchow E, Card S, Zamrini E, Foster N, Duff K, Chelune G, Wang A, Card S, Franchow E, Zamrini E, Foster N, Green D, Polikar R, Clark C, Kounios J, Malek-Ahmadi M, Kataria R, Belden C, Connor D, Pearson C, Jacobson S, Yaari R, Singh U, Sabbagh M, Manning K, Arnold S, Moelter S, Davatzikos C, Clark C, Moberg P, Singer R, Seelye A, Smith A, Schmitter-Edgecombe M, Viamonte S, Murman D, West S, Fonseca F, McCue R, Golden C, Cox D, Crowell T, Fazeli P, Vance D, Ross L, Ackerman M, Hill B, Tremont G, Davis J, Westervelt H, Alosco M, O'Connor K, Ahearn D, Pella R, Jain G, Noggle C, Sohi J, Jeetwani A, Thompson J, Barisa M, Sohi J, Noggle C, Jeetwani A, Jain S, Thompson J, Barisa M, Vanderslice-Barr J, Gillen R, Zimmerman E, Holdnack J, Creamer S, Rice J, Fitzgerald K, Elbin R, Patwardhan S, Covassin T, Kiewel N, Kontos A, Meyers C, Hakun J, Ravizza S, Berger K, Paltin I, Hertza J, Phillips F, Estes B, Schiff W, Bell C, Anderson J, Horton A, Reynolds C, Huckans M, Vandenbark A, Dougherty M, Loftis J, Langill M, Roberts R, Iverson G, Appel-Cresswell S, Stoessl A, Lazarus J, Olcese R, Juncos J, McCaskell D, Walsh K, Allen E, Shubeck L, Hamilton D, Novack G, Sherman S, Livingson R, Schmitt A, Stewart R, Doyle K, Smernoff E, West S, Galusha J, Hua S, Mattingly M, Rinehardt E, Benbadis S, Borzog A, Rogers-Neame N, Vale F, Frontera A, Schoenberg M, Rosenbaum K, Norman M, Woods S, Houshyarnejad A, Filoteo W, Corey-Bloom J, Pachet A, Larco C, Raymond M, Rinehardt E, Mattingly M, Golden C, Benbadis S, Borzog A, Rogers-Neame N, Vale F, Frontera A, Schoenberg M, Schmitt A, Stewart R, Livingston R, Doyle K, Copenheaver D, Smernoff E, Werry A, Claunch J, Galusha J, Uysal S, Mazzeffi M, Lin H, Reich D, August-Fedio A, Sexton J, Zand D, Keller J, Thomas T, Fedio P, Austin A, Millikin C, Baade L, Shelton P, Yamout K, Marotta J, Boatwright B, Kardel P, Heinrichs R, Blake T, Silverberg N, Anton H, Bradley E, Lockwood C, Hull A, Poole J, Demadura T, Storzbach D, Acosta M, Tun S, Hull A, Greenberg L, Lockwood C, Hutson L, Belsher B, Sullivan C, Poole J, La Point S, Harrison A, Packer R, Suhr J, Heilbronner R, Lange R, Iverson G, Brubacher J, Lange R, Waljas M, Iverson G, Hakulinen U, Dastidar P, Trammell B, Hartikainen K, Soimakallio S, Ohman J, Lee-Wilk T, Ryan P, Kurtz S, Dux M, Dischinger P, Auman K, Murdock K, Mazur-Mosiewicz A, Kane R, Lockwood C, Hull A, Poole J, MacGregor A, Watt D, Puente A, Marceaux J, Dilks L, Carroll A, Dean R, Ashworth B, Dilks S, Thrasher A, Carbonaro S, Blancett S, Ringdahl E, Finton M, Thaler N, Drane D, Umuhoza D, Barber B, Schoenberg M, Umuhoza D, Allen D, Roebuck-Spencer T, Vincent A, Schlegel R, Gilliland K, Lazarus T, Brown F, Katz L, Mucci G, Franchow E, Suchy Y, Kraybill M, Eastvold A, Funes C, Stern S, Morris M, Graham L, Parikh M, Hynan L, Buchbinder D, Grosch M, Weiner M, Cullum M, Hart J, Lavach J, Holcomb M, Allen R, Holcomb M, Renee A, Holland A, Chang R, Erdodi L, Hellings J, Catoe A, Lajiness-O'Neill R, Whiteside D, Smith A, Brown J, Hardin J, Rutledge J, Carmona J, Wang R, Harrison D, Horton A, Reynolds C, Horton A, Reynolds C, Jurado M, Monroy M, Eddinger K, Serrano M, Rosselli M, Chakravarti P, Riccio C, Banville F, Schretlen D, Wahlberg A, Vannorsdall T, Yoon H, Sung K, Simek A, Gordon B, Vaughn C, Kibby M, Barwick F, Arnett P, Rabinowitz A, Vargas G, Barwick F, Arnett P, Rabinowitz A, Vargas G, Davis J, Ramos C, Hynd G, Sherer C, Stone M, Wall J, Davis J, Bagley A, McHugh T, Axelrod B, Hanks R, Denning J, Gervais R, Dougherty M, Sellbom M, Wygant D, Klonoff P, Lange R, Iverson G, Carone D, O'Connor Pennuto T, Kluck A, Ball J, Pella R, Rice J, Hietpas-Wilson T, McCoy K, VanBuren K, Hilsabeck R, Shahani L, Noggle C, Jain G, Sohi J, Thomspon J, Barisa M, Golden C, Vincent A, Roebuck-Spencer T, Cooper D, Bowles A, Gilliland K, Womble M, Rohling M, Gervais R, Greiffenstein M, Harrison A, Jones K, Suhr J, Armstrong C, Mazur-Mosiewicz A, Holcomb M, Trammell B, Dean R, Puente A, Whigham K, Rodriguez M, West S, Golden C, Kelley E, Poole J, Larco C, May N, Nemeth D, Olivier T, Whittington L, Hamilton J, Steger A, McDonald K, Jeffay E, Gammada E, Zakzanis K, Ramanathan D, Wardecker B, Slocomb J, Hillary F, Rohling M, Demakis G, Larrabee G, Binder L, Ploetz D, Schatz P, Smith A, Stolberg P, Thayer N, Mayfield J, Jones W, Allen D, Storzbach D, Demadura T, Tun S, Sutton G, Ringdahl E, Thaler N, Barney S, Mayfield J, Pinegar J, Allen D, Terranova J, Kazakov D, McMurray J, Mayfield J, Allen D, Villemure R, Nolin P, Le Sage N, Yeung E, Zakzanis K, Gammada E, Jeffay E, Yi A, Small S, Macciocchi S, Barlow K, Seel R, Rabinowitz A, Arnett P, Rabinowitz A, Barwick F, Arnett P, Bailey T, Brown M, Whiteside D, Waters D, Golden C, Grzybkowska A, Wyczesany M, Katz L, Brown F, Roth R, McNeil K, Vroman L, Semrud-Clikeman T, Terrie, Seydel K, Holster J, Corsun-Ascher C, Golden C, Holster J, Corsun-Ascher C, Golden C, Bolanos J, Bergman B, Rodriguez M, Patel F, Frisch D, Golden C, Brooks B, Holdnack J, Iverson G, Brown M, Lowry N, Whiteside D, Bailey T, Dougherty M, West S, Golden C, Estes B, Bell C, Hertza J, Dennison A, Jones K, Holster J, Caorsun-Ascher C, Armstrong C, Golden C, Mackelprang J, Karle J, Najmabadi S, Valley-Gray S, Cash R, Gonzalez E, Metoyer K, Holster J, Golden C, Natta L, Gomez R, Trettin L, Tennakoon L, Schatzberg A, Keller J, Davis J, Sherer C, Wall J, Ramos C, Patterson C, Shaneyfelt K, DenBoer J, Hall S, Gunner J, Miele A, Lynch J, McCaffrey R, Lo T, Cottingham M, Aretsen T, Boone K, Goldberg H, Miele A, Gunner J, Lynch J, McCaffrey R, Miele A, Benigno A, Gunner J, Leigh K, Lynch J, Drexler M, McCaffrey R, Weiss E, Ploetz D, Rohling M, Lankey M, Womble M, Yeung S, Silverberg N, Zakzanis K, Amirthavasagam S, Jeffay E, Gammada E, Yeung E, McDonald K, Constantinou M, DenBoer J, Hall S, Lee S, Klaver J, Kibby M, Stern S, Morris M, Morris R, Whittington L, Nemeth D, Olivier T, May N, Hamilton J, Steger A, Chan R, West S, Golden C, Landstrom M, Dodzik P, Boneff T, Williams T, Robbins J, Martin P, Prinzi L, Golden C, Barber B, Mucci G, Brzinski B, Frish D, Rosen S, Golden C, Hamilton J, Nemeth D, Martinez A, Kirk J, Exalona A, Wicker N, Green C, Broshek D, Kao G, Kirkwood M, Quigg M, Cohen M, Riccio C, Olson K, Rice J, Dougherty M, Golden C, Sharma V, Rodriguez M, Golden C, Paltin I, Walsh K, Rosenbaum K, Copenheaver D, Zand D, Kardel P, Acosta M, Packer R, Vasserman M, Fonseca F, Tourgeman I, Stack M, Demsky Y, Golden C, Horwitz J, McCaffey R, Ojeda C, Kadushin F, Wingler I, Lazarus G, Green J, Barth J, Puente A, Parikh M, Graham L, Hynan L, Grosch M, Weiner M, Cullum C, Tourgeman I, Bure-Reyes A, Stewart J, Stack M, Demsky Y, Golden C, Zhang J, Tourgeman I, Demsky Y, Stack M, Golden C, Bures-Reye A, Stewart J, Tourgeman I, Demsky Y, Stack M, Golden C, Finlay L, Goldberg H, Arentsen T, Lo T, Moriarti T, Mackelprang J, Karle J, Aragon P, Gonzalez E, Valley-Gray S, Cash R, Mackelprang J, Karle J, Hardie R, Cash R, Gonzalez E, Valley-Gray S, Mason J, Keller J, Gomez R, Trettin L, Schatzberg A, Moore R, Mausbach B, Viglione D, Patterson T, Morrow J, Barber B, Restrepo L, Mucci G, Golden C, Buchbinder D, Chang R, Wang R, Pearlson J, Scarisbrick D, Rodriguez M, Golden C, Restrepo L, Morrow J, Golden C, Switalska J, Torres I, DeFreitas C, DeFreitas V, Bond D, Yatham L, Zakzanis K, Gammada E, Jeffay E, Yeung E, Amirathavasagam S, McDonald K, Hertza J, Bell C, Estes B, Schiff W, Bayless J, McCormick L, Long J, Brumm M, Lewis J, Benigno A, Leigh K, Drexler M, Weiss E, Bharadia V, Walker L, Freedman M, Atkins H, Jackson A, Perna R, Cooper D, Lau D, Lyons H, Culotta V, Griffith K, Coiro M, Papadakis A, Weden S, Sestito N, Brennan L, Benjamin T, Ciaudelli B, Fanning M, Giovannetti T, Chute D, Vathhauer K, Steh B, Osuji J, Steh B, Katz D, Ackerman M, Vance D, Fazeli P, Ross L, Strang J, Strauss A, Bienia K, Hollingsworth D, Ensley M, Atkins J, Grigorovich A, Bell C, Fish J, Hertza J, Leach L, Schiff W, Gomez M, Estes B, Dennison A, Davis A, Roberds E, Lutz J, Byerley A, Mazur-Mosiewicz A, Davis M, Sutton S, Moses J, Doan B, Hanna M, Adam G, Wile A, Butler M, Self B, Heaton K, Brininger T, Edwards M, Johnson K, O'Bryan S, Williams J, Joes K, Frazier D, Moses J, Giesbrecht C, Nielson H, Barone C, Thornton A, Vila-Rodriguez F, Paquet F, Barr A, Vertinsky T, Lang D, Honer W, Hart J, Lavach J, Hietpas-Wilson T, Pella R, McCoy K, VanBuren K, Hilsabeck R, James S, Robillard R, Holder C, Long M, Sandhu K, Padua M, Moses J, Lutz J, Mazur-Mosiewicz A, Dean R, Olivier T, Nemeth D, Whittington L, May N, Hamilton J, Steger A, Roberg B, Hancock L, Jacobson J, Tyrer J, Lynch S, Bruce J, Sordahl J, Hertza J, Bell C, Estes B, Schiff W, Sousa J, Jerram M, Wiebe-Moore D, Susmaras T, Gansler D, Vertinski M, Smith L, Thaler N, Mayfield J, Allen D, Buscher L, Jared B, Hancock L, Roberg B, Tyrer J, Lynch S, Choi W, Lai S, Lau E, Li A, Covassin T, Elbin R, Kontos A, Larson E, Hubley A, Lazarus G, Puente A, Ojeda C, Mazur-Mosiewicz A, Trammell B, Dean R, Patwardhan S, Fitzgerald K, Meyers C, Wefel J, Poole J, Gray M, Utley J, Lew H, Riordan P, Sawyer J, Buscemi J, Lombardo T, Barney S, Allen D, Stolberg P, Mayfield J, Brown S, Tussey C, Barrow M, Marcopulos B, Kingma J, Heinly M, Fazio R, Griswold S, Denney R, Corney P, Crossley M, Edwards M, O'Bryant S, Hobson V, Hall J, Barber R, Zhang S, Johnson L, Diaz-Arrastia R, Hall J, Johnson L, Barber R, Cullum M, Lacritz L, O'Bryant S, Lena P, Robbins J, Martin P, Stewart J, Golden C, Martin P, Prinzi L, Robbins J, Golden C, Ruchinskas R, West S, Fonseca F, Rice J, McCue R, Golden C, Fischer A, Yeung S, Thornton W, Rossetti H, Bernardo K, Weiner M, Cullum C, Lacritz L, Yeung S, Fischer A, Thornton W, Zec R, Kohlrus S, Fritz S, Robbs R, Ala T, Cummings T, Webbe F, Srinivasan V, Gavett B, Kowall N, Qiu W, Jefferson A, Green R, Stern R, Hill B, Su T, Correia S, O'Bryant S, Gong G, Spallholz J, Boylan M, Edwards M, Hargrave K, Johnson L, Stewart J, Golden C, Broennimann A, Wisniewski A, Austin B, Bens M, Carroll C, Knee K, Mittenberg W, Zimmerman A, Mazur-Mosiewicz A, Roberds E, Dean R, Anderson C, Parmenter B, Blackwell E, Silverberg N, Douglas K, Gassermar M, Kranzler H, Chan G, Gelenter J, Arias A, Farrer L, Giummarra J, Bowden S, Cook M, Murphy M, Hancock L, Bruce J, Peterson S, Tyrer J, Murphy M, Jacobson J, Lynch S, Holder C, Mauseth T, Robillard R, Langill M, Roberts R, Iverson G, Appel-Cresswell S, Stoessl A, Macleod L, Bowden S, Partridge R, Webster B, Heinrichs R, Baade L, Sandhu K, Padua M, Long M, Moses J, Schmitt A, Werry A, Hu S, Stewart R, Livingston R, Deitrick S, Doyle K, Smernoff E, Schoenberg M, Rinehardt E, Mattingly M, Borzog A, Rodgers-Neame N, Vale F, Frontera A, Benbadis S, Ukueberuwa D, Arnett P, Vargas G, Riordan P, Arnett P, Lipinski D, Sawyer J, Brewer V, Viner K, Lee G, Walker L, Berrigan L, Ress L, Cheng A, Freedma M, Hellings J, Whiteside D, Brown J, Singer R, Woods S, Weber E, Cameron M, Dawson M, Grant I, Frisch D, Brzinski B, Golden C, Hutton J, Vidal O, Puente A, Klaver J, Lee S, Kibby M, Mireles G, Anderson B, Davis J, Rosen S, Scarisbrick D, Brzinski B, Golden C, Simek A, Vaughn C, Wahlberg A, Yoon H, Riccio C, Steger A, Nemeth D, Thorgusen S, Suchy Y, Rau H, Williams P, Wahlberg A, Yoon V, Simek A, Vaughn C, Riccio C, Whitman L, Bender H, Granader Y, Freshman A, MacAllister W, Freshman A, Bender H, Whitman L, Granader Y, MacAllister W, Yoon V, Simek A, Vaughn C, Wahlberg A, Riccio C, Noll K, Cullum C, O'Bryant S, Hall J, Simpson C, Padua M, Long M, Sandhu K, Moses J, Scarisbrick D, Holster J, Corsun-Ascher C, Golden C, Stang B, Trettin L, Rogers E, Saleh M, Che A, Tennakoon L, Keller J, Schatzberg A, Gomez R, Tayim F, Moses J, Morris R, Thaler N, Lechuga D, Cross C, Salinas C, Reynolds C, Mayfield J, Allen D, Webster B, Partridge R, Heinrichs R, Badde L, Weiss E, Antoniello D, McGinley J, Gomes W, Masur D, Brooks B, Holdnack J, Iverson G, Banville F, Nolin P, Henry M, Lalonde S, Dery M, Cloutier J, Green J, Sokol D, Lowery K, Hole M, Helmus A, Teat R, DelMastro C, Paquette B, Grosch M, Hynan L, Graham L, Parikh M, Weiner M, Cullum M, Hubley A, Lutz J, Dean R, Paterson T, O'Rourke N, Thornton W, Randolph J, Suffiield J, Crockett D, Spreen O, Trammell B, Mazur-Mosiewicz A, Holcomb M, Dean R, Busse M, Wald D, Whiteside D, Breisch A, Fieldstone S, Vannorsda T, Lassen-Greene C, Gordon B, Schretlen D, Launeanu M, Hubley A, Maruyama R, Cuesta G, Davis J, Takahashi T, Shinoda H, Gregg N, Davis J, Cheung S, Takahashi T, Shinoda H, Gregg N, Holcomb M, Mazur A, Trammell B, Dean R, Perna R, Jackson A, Villar R, Ager D, Ellicon B, Als L, Nadel S, Cooper M, Pierce C, Hau S, Vezir S, Picouto M, Sahakian B, Garralda E, Mucci G, Barber B, Semrud-Clikeman M, Goldenring J, Bledsoe J, Vroman L, Crow S, Zimmerman A, Mazur-Mosiewicz A, Roberds E, Dean R, Sokol D, Hole M, Teat R, Paquett B, Albano J, Broshek D, Elias J, Brennan L, Chakravarti P, Schultheis L, Kibby M, Weisser V, Hynd G, Ang J, Crockett D, Puente A, Weiss E, Longman R, Antoniello D, Axelrod B, McGinley J, Gomes W, Masur D, Davis A, Lutz J, Roberds E, Williams R, Gupta A, Estes B, Dennison A, Schiff W, Hertza J, Ferrari M. Grand Rounds. Arch Clin Neuropsychol 2010. [DOI: 10.1093/arclin/acq056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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D'Addio A, Curti A, Worel N, Douglas K, Motta MR, Rizzi S, Dan E, Taioli S, Giudice V, Agis H, Kopetzky G, Soutar R, Casadei B, Baccarani M, Lemoli RM. The addition of plerixafor is safe and allows adequate PBSC collection in multiple myeloma and lymphoma patients poor mobilizers after chemotherapy and G-CSF. Bone Marrow Transplant 2010; 46:356-63. [PMID: 20577218 DOI: 10.1038/bmt.2010.128] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We report 13 multiple myeloma (MM) or lymphoma patients who were failing PBSC mobilization after disease-specific chemotherapy and granulocyte-CSF (G-CSF), and received plerixafor to successfully collect PBSCs. Patients were considered poor mobilizers when the concentration of PB CD34(+) cells was always lower than 10 cells/μL, during the recovery phase after chemotherapy and/or were predicted to have inadequate PBSC collection to proceed to autologous transplantation. Plerixafor (0.24 mg/kg) was administered subcutaneously for up to three consecutive days, while continuing G-CSF, 10-11 h before the planned leukapheresis. Plerixafor administration was safe and no significant adverse events were recorded. We observed a 4.7 median fold-increase in the number of circulating CD34(+) cells after plerixafor as compared with baseline CD34(+) cell concentration (from a median of 6.2 (range 1-12) to 21.5 (range 9-88) cells/μL). All patients collected >2 × 10(6) CD34(+) cells/kg in 1-3 leukaphereses. In all, 5/13 patients have already undergone autograft with plerixafor-mobilized PBSCs, showing a rapid and durable hematological recovery. Our results suggest that the pre-emptive addition of plerixafor to G-CSF after chemotherapy is safe and may allow the rescue of lymphoma and MM patients, who need autologous transplantation but are failing PBSC mobilization.
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Affiliation(s)
- A D'Addio
- Department of Hematology and Oncological Sciences L and A Seràgnoli, Institute of Hematology, University of Bologna and Stem Cell Research Center, S Orsola-Malpighi Hospital, Bologna, Italy
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Shukla S, Lawrence A, Aggarwal A, Naik S, Gullick NJ, Evans HG, Jayaraj D, Kirkham BW, Taams LS, Judah SM, Nixon N, Dawes P, Mattey DL, Yeo L, Schmutz C, Toellner KM, Salmon M, Filer AD, Buckley C, Raza K, Scheel-Toellner D, Hashizume M, Yoshida H, Koike N, Suzuki M, Mihara M, Stavropoulos-Kalinoglou A, Metsios GS, Douglas KM, Panoulas VF, Koutedakis Y, Kitas GD, Church LD, Filer AD, Hildago E, Howlett K, Thomas A, Rapecki S, Scheel-Toellner D, Buckley CD, Raza K, Juarez M, Kolasinski J, Govindan J, Quilter A, Williamson L, Collins DA, Price EJ, Gasparyan AY, Stavropoulos-Kalinoglou A, Toms TE, Douglas K, Kitas GD, Lachmann HJ, Kuemmerle-Deschner JB, Hachulla E, Hoyer J, Smith J, Leslie K, Kone-Paut I, Braun J, Widmer A, Patel N, Preiss R, Hawkins PN. Cytokines and Inflammatory Mediators [30-39]: 30. The LPS Stimulated Production of Interleukin-10 is not Associated with -819C/T and -592C/A Promoter Polymorphisms in Healthy Indian Subjects. Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq715] [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: 11/13/2022] Open
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Junninen H, Mønster J, Rey M, Cancelinha J, Douglas K, Duane M, Forcina V, Müller A, Lagler F, Marelli L, Borowiak A, Niedzialek J, Paradiz B, Mira-Salama D, Jimenez J, Hansen U, Astorga C, Stanczyk K, Viana M, Querol X, Duvall RM, Norris GA, Tsakovski S, Wåhlin P, Horák J, Larsen BR. Quantifying the impact of residential heating on the urban air quality in a typical European coal combustion region. Environ Sci Technol 2009; 43:7964-70. [PMID: 19921921 DOI: 10.1021/es8032082] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The present investigation, carried out as a case study in a typical major city situated in a European coal combustion region (Krakow, Poland), aims at quantifying the impact on the urban air quality of residential heating by coal combustion in comparison with other potential pollution sources such as power plants, industry, and traffic. Emissions were measured for 20 major sources, including small stoves and boilers, and the particulate matter (PM) was analyzed for 52 individual compounds together with outdoor and indoor PM10 collected during typical winter pollution episodes. The data were analyzed using chemical mass balance modeling (CMB) and constrained positive matrix factorization (CMF) yielding source apportionments for PM10, B(a)P, and other regulated air pollutants namely Cd, Ni, As, and Pb. The results are potentially very useful for planning abatement strategies in all areas of the world, where coal combustion in small appliances is significant. During the studied pollution episodes in Krakow, European air quality limits were exceeded with up to a factor 8 for PM10 and up to a factor 200 for B(a)P. The levels of these air pollutants were accompanied by high concentrations of azaarenes, known markers for inefficient coal combustion. The major culprit for the extreme pollution levels was demonstrated to be residential heating by coal combustion in small stoves and boilers (>50% for PM10 and >90% B(a)P), whereas road transport (<10% for PM10 and <3% for B(a)P), and industry (4-15% for PM10 and <6% for B(a)P) played a lesser role. The indoor PM10 and B(a)P concentrations were at high levels similar to those of outdoor concentrations and were found to have the same sources as outdoors. The inorganic secondary aerosol component of PM10 amounted to around 30%, which for a large part may be attributed to the industrial emission of the precursors SO2 and NOx.
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Affiliation(s)
- Heikki Junninen
- European Commission, Joint Research Centre, Ispra (VA), Italy
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Phillips M, Haines M, Peck E, Lee H, Phillips B, Wein B, Bekenstein J, O'Grady J, Schoenberg M, Ogrocki P, Maddux B, Whitney C, Gould D, Riley D, Maciunas R, Espe-Pfeifer P, Arguello J, Taber S, Duff K, Fields A, Newby R, Weissgerber K, Epping A, Panepinto J, Scott P, Reesman J, Zabel A, Wodka E, Ferenc L, Comi A, Cohen N, Bigelow S, McCrea Jones L, Sandoval R, Vilar-Lopez R, Puente N, Hidalgo-Ruzante N, Bure A, Ojeda C, Puente A, Zolten A, Mallory L, Heyanka D, Golden C, McCue R, Heyanka D, Mackelprang J, Reuther B, Golden C, Odland A, Scarisbrick D, Heyanka D, Martin P, Golden C, Mazur-Mosiewicz A, Holcomb M, Dean R, Schneider J, Morgan D, Scott J, Leber W, Adams R, Marceaux J, Triebel K, Griffith H, Gifford K, Potter E, Webbe F, Barker W, Loewenstein D, Duara R, Gifford K, Mahaney T, Srinivasan V, Cummings T, Frankl M, Bayan R, Webbe F, Mulligan K, Duncan N, Greenaway M, Sakamoto M, Spiers M, Libon D, Pimontel M, Gavett B, Jefferson A, Nair A, Green R, Stern R, Mahaney T, Frankl M, Cummings T, Mulligan K, Webbe F, Lou K, Gavett B, Jefferson A, Nair A, Green R, Morere D, Gifford K, Ferro J, Ezrine G, Kiefel J, Hinton V, Greco S, Corradino G, Pantone J, MacLeod R, Stern R, Hart J, Lavach J, Pick L, Szymanski C, Ilardi D, Marcus D, Burns T, Mahle W, Jenkins P, Davis A, McDermott A, Pierson E, Freeman Floyd E, McIntosh D, Dixon F, Davis A, Boseck J, Berry K, Whited A, Gelder B, Davis A, Dodd J, Berry K, Boseck J, Koehn E, Gelder B, Riccio C, Kahn D, Perez E, Reynolds C, Scott M, Nguyen-Driver M, Ruchinskas R, Lennen D, Steiner R, Sikora D, Freeman K, Carboni J, Fong G, Fong G, Carboni J, Whigham K, O'Toole K, Schneider B, Burns T, Olivier T, Nemeth D, Whittington L, Moreau A, Webb N, Weimer M, Gontier J, Labrana J, Rioseco F, Lichtenberg P, Puente A, Puente A, Bure A, Buddin H, Teichner G, Golden C, Pacheco E, Chong J, Gold S, Mittenberg W, Miller A, Bruce J, Hancock L, Peterson S, Jacobson J, Guse E, Tyrer J, Lasater J, Fritz J, Lynch S, Yarger L, Bryant K, Zychowski L, Nippoldt-Baca L, Lehman C, Arffa S, Marceaux J, Dilks L, Arthur A, Myers B, Levy J, Blancett S, Martincin K, Thrasher A, Koushik N, McArthur S, Baird A, Foster P, Drago V, Yung R, Crucian G, Heilman K, Castellon S, Livers E, Oppenheim A, Carter C, Ganz P, San Miguel-Montes L, Escabi-Quiles Y, Allen D, Gavett B, Stern R, Nowinski C, Cantu R, Martukovich R, McKee A, Davis A, Roberds E, Lutz J, Williams R, Gupta A, Schoenberg M, Werz M, Maciunas R, Koubeissi M, Poreh A, Luders H, Barwick F, Arnett P, Morse C, Gonzalez-Heydrich J, Luna L, Rao S, McClendon J, Rotelle P, Waber D, Holland A, Boyer K, Faraone S, Whitney J, Guild D, Biederman J, Baerwald J, Ryan G, Baerwald J, Ryan G, Guerrero J, Carmona J, Parsons T, Rizzo A, Lance B, Courtney C, Baerwald J, Ryan G, Perna R, Jackson A, Luton L, O'Toole K, Harrison D, Alosco M, Emerson K, Hill B, Bauer L, Tremont G, Zychowski L, Yarger L, Kegel N, Arffa S, Crockett D, Hunt S, Parks R, Vernon-Wilkinsion R, Hietpas-Wilson T, Zartman A, Gordon S, Krueger K, VanBuren K, Yates A, Hilsabeck R, Campbell J, Riner B, Crowe S, Noggle C, Thompson J, Barisa M, Maulucci A, Noggle C, Thompson J, Barisa M, Maulucci A, Noggle C, Latham K, Thompson J, Barisa M, Maulucci A, Sumowski J, Chiaravalloti N, Lengenfelder J, DeLuca J, Iturriaga L, Henry G, Heilbronner R, Carmona J, Mittenberg W, Enders C, Stevens A, Dux M, Henry G, Heilbronner R, Mittenberg W, Enders C, Myers A, Arffa S, Holland A, Nippoldt-Baca L, Yarger L, Acocella-Stollerman J, Lee E, Peck E, Lee H, Khawaja S, Phillips B, Crockett A, Greve K, Comer C, Ord J, Etherton J, Bianchini K, Curtis K, Harrison A, Edwards M, Harrison A, Edwards M, Cottingham M, Goldberg H, Harrison D, Victor T, Perry L, Pazienza S, Boone K, Bowers T, Triebel K, Denney R, Halfaker D, Tussey C, Barber A, Martin P, Denney R, Deal W, Bailey C, Denney R, Marcopulos B, Schaefer L, Rabin L, Kakkanatt T, Popalzai A, Chantasi K, Heyanka D, Magyar Y, Cruz R, Weiss L, Schatz P, Gibney B, Lietner D, Koushik N, Brooks B, Iverson G, Horton A, Odland A, Reynolds C, Horton A, Reynolds C, Davis A, Finch W, Skierkiewicz A, Rothlisberg B, McIntosh D, Davis A, Finch W, Golden C, Chang M, McIntosh D, Rothlisberg B, Paulson S, Davis A, Starling J, Whited A, Chang M, Roberds E, Dodd J, Martin P, Goldstein G, DeFilippis N, Carlozzi N, Tulsky D, Kurkowski R, Browne K, Wortman K, Gershon R, Heyanka D, Odland A, Golden C, Rodriguez M, Myers A, West S, Golden C, Holster J, Bolanos J, Corsun-Ascher C, Golden C, Robbins J, Restrepo L, Prinzi L, Garcia J, Golden C, Holster J, Bolanos J, Garcia J, Golden C, Osgood J, Trice A, Ernst W, Mahaney T, Gifford K, Oelschlager J, Gurrea J, Tourgeman I, Odland A, Golden C, Tourgeman I, Gurrea J, Stack M, Boddy R, Demsky Y, Golden C, Judd T, Jurecska D, Holmes J, Aguerrevere L, Greve K, Capps D, Izquierdo R, Feldman C, Boddy R, Scarisbrick D, Rice J, Tourgeman I, Golden C, Scarisbrick D, Boddy R, Corsun-Ascher C, Heyanka D, Golden C, Woon F, Hedges D, Odland A, Heyanka D, Martin P, Golden C, Yamout K, Heinrichs R, Baade L, Soetaert D, Perle J, Odland A, Martin P, Golden C, Armstrong C, Bello D, Randall C, Allen D, McLaren T, Konopacki K, Peery S, Miranda F, Saleh M, Moise F, Mendoza J, Mak E, Gomez R, Mihaila E, Parrella M, White L, Harvey P, Marshall D, Gomez R, Keller J, Rogers E, Misa J, Che A, Tennakoon L, Schatzberg A, Sutton G, Allen D, Strauss G, Bello D, Armstrong C, Randall C, Duke L, Ross S, Randall C, Bello D, Armstrong C, Sutton G, Ringdahl E, Thaler N, McMurray J, Sanders L, Isaac H, Allen D, Rumble S, Klonoff P, Wilken J, Sullivan C, Fratto T, Sullivan A, McKenzie T, Ensley M, Saunders C, Quig M, Kane R, Simsarian J, Restrepo L, Rodriguez M, Robbins J, Morrow J, Golden C, Yung R, Sullivan W, Stringer K, Ferguson B, Drago V, Foster P, Lanting S, Brooks B, Iverson G, Horton A, Reynolds C, Scarisbrick D, Odland A, Perle J, Golden C, West S, Collins K, Frisch D, Golden C, Guerrero J, Baerwald J, Yung R, Sullivan W, Stringer K, Ferguson B, Drago V, Foster P, Mackelprang J, Heyanka D, Lennertz L, Morin I, Marker C, Collins M, Dodd J, Goldstein G, DeFilippis N, Holcomb M, Kimball T, Luther E, Belsher B, Botelho V, Reed R, Hernandez B, Noda A, Yesavage J, Kinoshita L, Kakos L, Gunstad J, Hughes J, Spitznagel M, Potter V, Stanek K, Szabo A, Waechter D, Josephson R, Rosneck J, Schofield H, Getz G, Magnuson S, Bryant K, Miller A, Martincin K, Pastel D, Poreh A, Davis J, Ramos C, Sherer C, Bertram D, Wall J, Bryant K, Poreh A, Magnuson S, Miller A, Martincin K, Pastel D, Gow C, Francis J, Olson L, Sautter S, Ord J, Capps D, Greve K, Bianchini K, Stettler T, Daniel M, Kleman V, Etchells M, Rabinowitz A, Barwick F, Arnett P, Proto D, Barker A, Gouvier W, Jones K, Williams J, Lockwood C, Mansoor Y, Homer-Smith E, Moses J, Stolberg P, Jones W, Krach S, Loe S, Mortimer J, Avirett E, Maricle D, Miller D, Avirett E, Mortimer J, Maricle D, Miller D, Avirett E, Mortimer J, Miller D, Maricle D, McGill C, Moneta L, Gioia G, Isquith P, Lazarus G, Puente A, Ahern D, Faust D, Bridges A, Ahern D, Faust D, Bridges A, Hobson V, Hall J, Harvey M, Spering C, Cullum M, Lacritz L, Massman P, Waring S, O'Bryant S, Frisch D, Morrow J, West S, Golden C, West S, Dougherty M, Rice J, Golden C, Morrow J, Frisch D, Pearlson J, Golden C, Thorgusen S, Watson J, Miller A, Kesner R, Levy J, Lambert A, Fazeli P, Marceaux J, Vance D, Marceaux J, Fazeli P, Vance D, Frankl M, Cummings T, Mahaney T, Webbe F, Spering C, Cooper J, Hobson V, O'Bryant S, Bolanos J, Holster J, Metoyer K, Garcia J, Golden C, Brown C, O'Toole K, Brown C, O'Toole K, Granader Y, Keller S, Bender H, Rathi S, Nass R, MacAllister W, Maehr A, Kiefel J, Bigras C, Slick D, Dewey L, Tao R, Motes M, Emslie G, Rypma B, Kahn D, Riccio C, Reynolds C, Eberle N, Mucci G, Chase A, Boyle M, Gallaway M, Bowyer S, Lajiness-O'Neill R, Gifford K, Mahaney T, Cohen R, Gorman P, Levin Allen S, O'Hara E, LeGoff D, Chute D, Barakat L, Laboy G, San Miguel-Montes L, Rios-Motta M, Pita-Garcia I, Van Horn H, Cuevas M, Ross P, Kinjo C, Basanez T, Patel S, Dinishak D, Zhou W, Ortega M, Zareie R, Lane B, Rosen A, Myers A, Domboski K, Ireland S, Mittenberg W, Mazur-Mosiewicz A, Holcomb M, Dean R, Myerson C, Katzen H, Mittel A, McClendon M, Guevara A, Nahab F, Gallo B, Levin B, Fay T, Brooks B, Sherman E, Szabo A, Gunstad J, Spitznagel M, McCaffery J, McGeary J, Paul R, Sweet L, Cohen R, Hancock L, Bruce J, Peterson S, Jacobson J, Tyrer J, Guse E, Lasater J, Fritz J, Lynch S, O'Rourke J, Queller S, Whitlock K, Beglinger L, Stout J, Duff K, Paulsen J, Kim M, Jang J, Chung J, Zukerman J, Miller S, Waterman G, Sadek J, Singer E, Heaton R, van Gorp W, Castellon S, Hinkin C, Yamout K, Baade L, Panos S, Becker B, Kim M, Foley J, Jang J, Chung J, Castellon S, Hinkin C, Kim M, Jang J, Foley J, Chung J, Miller S, Castellon S, Marcotte T, Hinkin C, Merrick E, Kazakov D, Duke L, Field R, Allen D, Mayfield J, Barney S, Thaler N, Allen D, Donohue B, Mayfield J, Mauro C, Shope C, Riber L, Dhami S, Citrome L, Tremeau F, Heyanka D, Corsun-Ascher C, Englebert N, Golden C, Block C, Sautter S, Stolberg P, Terranova J, Jones W, Allen D, Mayfield J, Ramanathan D, Medaglia J, Chiou K, Wardecker B, Slocomb J, Vesek J, Wang J, Hills E, Good D, Hillary F, Kimpton T, Kirshenbaum A, Madathil R, Trontel H, Hall S, Chiou K, Slocomb J, Ramanathan D, Medaglia J, Wardecker B, Vesek J, Wang J, Hills E, Good D, Hillary F, Salinas C, Tiedemann S, Webbe F, Williams C, Wood R, Ringdahl E, Thaler N, Hodges T, Mayfield J, Allen D, Kazakov D, Haderlie M, Terranova J, Martinez A, Allen D, Mayfield J, Medaglia J, Ramanathan D, Chiou K, Wardecker B, Franklin R, Genova H, Deluca J, Hillary F, Pastrana F, Wurst L, Zeiner H, Garcia A, Bender H, Rice J, West S, Dougherty M, Boddy R, Golden C, Tyrer J, Bruce J, Hancock L, Guse E, Jacobson J, Lynch S, Yung R, Sullivan W, Stringer K, Ferguson B, Drago V, Foster P, Scarisbrick D, Heyanka D, Frisch D, Golden C, Prinzi L, Morrow J, Robbins J, Golden C, Fallows R, Amin K, Virden T, Borgaro S, Hubel K, Miles G, Gomez R, Nazarian S, Mucci G, Moreno-Torres M, San Miguel-Montes L, Otero-Zeno T, Rios M, Douglas K, McGhee R, Sakamoto M, Spiers M, Vanderslice-Barr J, Elbin R, Covassin T, Kontos A, Larson E, Stiller-Ostrowski J, McLain M, Serina N, John S, Rautiola M, Waldstein S, Che A, Gomez R, Keller J, Tennakoon L, Marshall D, Rogers E, Misa J, Schatzberg A, Stiles M, Ericson R, Earleywine M, Ericson R, Earleywine M, Tourgeman I, Boddy R, Gurrea J, Buddin H, Golden C, Holcomb M, Mazur-Mosiewicz A, Dean R, Miele A, Lynch J, McCaffrey R, Miele A, Vanderslice-Barr J, Lynch J, McCaffrey R, Wershba R, Stevenson M, Thomas M, Sturgeon J, Youngjohn J, Morgan D, Bello D, Hollimon M, Schneider J, Edgington C, Scott J, Adams R, Morgan D, Bello D, Hollimon M, Schneider J, Edgington C, Scott J, Adams R, Heinrichs R, Baade L, Soetaert D, Barisa M, Noggle C, Thompson J, Barisa M, Noggle C, Thompson J, Barisa M, Noggle C, Thompson J, Pimental P, Riedl K, Kimsey M, Sartori A, Griffith H, Okonkwo O, Marson D, Bertisch H, Schaefer L, McKenzie S, Mittelman M, Hibbard M, Sherr R, Diller L, McTaggart A, Williams R, Troster A, Clark J, Owens T, O'Jile J, Schmitt A, Livingston R, Smernoff E, Galusha J, Piazza J, Gutierrez M, Yeager C, Hyer L, Vaughn E, LaPorte D, Schoenberg M, Werz M, Pedigo T, Lavach J, Hart J, Vyas S, Dorta N, Granader Y, Roberts E, Hill B, Musso M, Pella R, Barker A, Proto D, Gouvier W, Gibson K, Bowers T, Bowers T, Gibson K, Hinkle S, Barisa M, Noggle C, Thompson J, Thompson J, Noggle C, Barisa M, Maulucci A, Thompson J, Noggle C, Barisa M, Maulucci A, Thompson J, Noggle C, Barisa M, Maulucci A, Benitez A, Gunstad J, Spitznagel M, Szabo A, Rogers E, Gomez R, Keller J, Marshall D, Tennakoon L, Che A, Misa J, Schatzber A, Strauss G, Ringdahl E, Barney S, Jetha S, Duke L, Ross S, Watrous B, Allen D, Maucieri L, Noggle C, Barisa M, Thompson J, Maulucci A, Noggle C, Barisa M, Thompson J, Maulucci A, Noggle C, Barisa M, Thompson J, Maulucci A, Noggle C, Thompson J, Barisa M, Maulucci A, Noggle C, Thompson J, Barisa M, Maulucci A, Getz G, Dandridge A, Klein R, La Point S, Holcomb M, Mazur-Mosiewicz A, Dean R, Bailey C, Samples H, Broshek D, Barth J, Freeman J, Schatz P, Neidzwski K, Moser R, Reesman J, Suli-Moci E, Wells C, Moneta L, Dean P, Gioia G, Belsher B, Hutson L, Greenberg L, Sullivan C, Hull A, Poole J, Schatz P, Pardini J, Lovell M, Strauser E, Parish R, Carr W, Paggi M, Anderson-Barnes V, Kelly M, Hutson L, Loughlin J, Sullivan C, Kelley E, Poole J, Hutson L, Loughlin J, Sullivan C, Belsher B, Hull A, Greenberg L, Poole J, Carr W, Parish R, Paggi M, Anderson-Barnes V, Ahlers S, Roebuck Spencer T, O'Neill D, Carter J, Bleiberg J, Lange R, Brubacher J, Iverson G, Madler B, Heran M, MacKay A, Andolfatto G, Krol A, Mrazik M, Lebby P, Johnson W, Sweatt J, Turitz M, Greenawald K, Lesser S, Ormonde A, Lavach J, Hart J, Demakis G, Rimland C, Lengenfelder J, Sumowski J, Smith A, Chiaravalloti N, DeLuca J, Pierson E, Koehn E, Lajiness-O'Neill R, Hyer L, Yeager C, Manatan K, Sherman S, Atkinson M, Massey-Connolly S, Gugnani M, Stack R, Carson A, Mirza N, Johnson E, Lovell M, Perna R, Jackson A, Roy S, Zebeigly A, Larochette A, Bowie C, Harrison A, Nippoldt-Baca L, Bleil J, Arffa S, Thompson J, Noggle C, Mark B, Maulucci A, Umaki T, Denney R, Greenberg L, Hull A, Belsher B, Lee H, Sullivan C, Poole J, Abrigo E, Hurewitz F, Kounios J, Noggle C, Barisa M, Thompson J, Maulucci A, Greve K, Aguerrevere L, Bianchini K, Etherton J, Heinly M, Kontos A, Covassin T, Elbin R, Larson E, Stearne D, Johnson D, Gilliland K, Vincent A, Chafetz M, Herkov M, Morais H, Schwait A, Mangiameli L, Greenhill T. Grand Rounds. Arch Clin Neuropsychol 2009. [DOI: 10.1093/arclin/acp045] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Scarisbrick J, Taylor P, Holtick U, Makar Y, Douglas K, Berlin G, Juvonen E, Marshall S. U.K. consensus statement on the use of extracorporeal photopheresis for treatment of cutaneous T-cell lymphoma and chronic graft-versus-host disease. Br J Dermatol 2008; 158:659-78. [DOI: 10.1111/j.1365-2133.2007.08415.x] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [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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Mathur K, McGarvey M, Taylor S, Sinclair J, Lawrie J, McPhelim A, Douglas K. P21 Therapeutic Efficacy of Plasmapheresis for the Treatment of Refractory Pruritis of Primary Billiary Cirrhosis: 2 Case Reports. Transfus Med 2006. [DOI: 10.1111/j.1365-3148.2006.00694_21.x] [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: 11/29/2022]
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Abstract
BACKGROUND In addition to well-established secondary prevention benefits for atherosclerotic coronary artery disease, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) are hypothesized to have short-term benefit in acute coronary syndrome (ACS), yet the data are inconsistent, with some trials underpowered to demonstrate therapeutic benefit. Our objective was to determine the effects of early, intensive statin therapy for ACS. DATA SOURCES Studies found in the PubMed, MEDLINE, EMBASE, BIOSIS, SciSearch, PASCAL, and International Pharmaceutical Abstracts (IPA) databases and the Cochrane Controlled Trials Register published between January 1974 and May 2006. STUDY SELECTION Randomized controlled trials of statins begun within 14 days of hospitalization for ACS were included. DATA EXTRACTION Two investigators independently abstracted study quality, characteristics, and outcomes. DATA SYNTHESIS Thirteen randomized controlled trials published before May 2006 were available, involving 17 963 adults (median number of patients, 135; median follow-up, 6 months). Early, intensive statin therapy for ACS decreased the rate of death and cardiovascular events over 2 years of follow-up (hazard ratio, 0.81 [95% confidence interval, 0.77-0.87]) (Q(3) = 58.54; P<.001; I(2) = 95%). Survival curves revealed that this benefit begins to occur between 4 and 12 months, achieving statistical significance by 12 months. There was no evidence of publication bias, and sensitivity analyses did not identify a dominating study or study characteristic. CONCLUSIONS Early, intensive statin therapy reduces death and cardiovascular events after 4 months of treatment. The validity of this finding would be strengthened by an analysis of individual patient data.
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Affiliation(s)
- Eddie Hulten
- Department of Internal Medicine, General Internal Medicine, and Cardiology, Walter Reed Army Medical Center, Washington, DC, USA.
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Abstract
BACKGROUND Albuminuria is an independent risk factor for cardiovascular and renal disease with limited therapeutic options. Data on the effects of statins on albuminuria are conflicting. PURPOSE To determine whether and to what degree statins affect albuminuria. DATA SOURCES English-language and non-English-language studies found in PubMed, MEDLINE, EMBASE, BIOSIS, SciSearch, PASCAL, and International Pharmaceutical Abstracts (IPA) databases and the Cochrane Central Register of Controlled Trials that were published between January 1974 and November 2005. STUDY SELECTION Randomized, placebo-controlled trials of statins reporting baseline and follow-up measurements of albuminuria or proteinuria measured by 24-hour urine collection or the urinary albumin-to-creatinine ratio. DATA EXTRACTION Two investigators independently abstracted study quality, characteristics, and outcomes. DATA SYNTHESIS Fifteen studies involving a total of 1384 patients and averaging 24 weeks in duration were included. Meta-analysis of the proportional reduction in proteinuria showed that statins reduced albuminuria (11 studies) and proteinuria (4 studies) in 13 of 15 studies. The reduction in excretion was greater among studies with greater baseline albuminuria or proteinuria: change of 2% (95% CI, -32% to 35%) for those with excretion less than 30 mg/d, -48% (CI, -71% to -25%) for those with excretion of 30 to 300 mg/d, and -47% (CI, -67% to -26%) for those with excretion more than 300 mg/d. Statistical heterogeneity was evident only in the group with excretion greater than 300 mg/d (excretion < 30 mg/d, I2 = 23% [P = 0.27]; excretion of 30 to 299 mg/d, I2 = 0% [P = 0.64]; excretion > or = 300 mg/d, I2 = 63% [P = 0.020]). LIMITATIONS Published studies were not of high quality on average and varied markedly in effect size, as well as in characteristics of the cohorts. Unpublished studies showing no effect could impact these results. CONCLUSION Statins may have a beneficial effect on pathologic albuminuria. The validity of this finding, and whether this effect translates into reduction of cardiovascular or end-stage renal disease, requires larger studies.
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Affiliation(s)
- Kevin Douglas
- Walter Reed Army Medical Center, Washington, DC 20307, USA
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Abstract
Type II heparin-induced thrombocytopenia (HIT) is a rare but well-recognised and potentially life-threatening complication of unfractionated heparin therapy, and has been reported in association with heparin locks for central venous lines. We report a case of type II HIT complicated by iliofemoral deep venous thrombosis and pulmonary embolism in a 43-year-old woman in the course of plasma exchange for myasthenia gravis. A Gamcath central venous line had been inserted femorally due to poor peripheral venous access, and this was locked with heparin 5000 U/ml between procedures. Twelve days after initial heparin exposure, she presented with new-onset thrombocytopenia, a painfully swollen right leg, and pleuritic pain. Deep venous thrombosis and pulmonary embolism were confirmed radiologically, and serology for heparin/PF4 antibodies was unequivocally positive. The line was removed, and she was successfully managed with intravenous lepirudin, switching to warfarin on platelet recovery. This case demonstrates that Type II HIT can occur in association with heparin line locks in the course of plasmapheresis, despite previous reports of successful use of plasma exchange to treat Type II HIT.
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Affiliation(s)
- J H Laird
- S.N.B.T.S. Clinical Apheresis Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom
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Abstract
OBJECTIVE To determine the current disease-modifying anti-rheumatic drug (DMARD) preferences of UK consultant rheumatologists. METHODS A questionnaire was sent in May 2002. We asked which DMARD(s) was most frequently preferred first and sought the most typical sequence of DMARDs, including DMARD combinations. Also we determined the extent to which prognostic and other factors influenced treatment choices. Comments were invited, written responses abstracted and key themes identified. RESULTS After two mailings, 331 (of 460; 72%) suitable questionnaires were returned. Ninety-five per cent (315/331) preferred methotrexate (154, 46.5%) or sulphasalazine (144, 43.5%) or either of these two (17, 5%) as first-choice agent. Of those who chose methotrexate first, 80% (123/154) ranked sulphasalazine second, 45% (55/123) combined sulphasalazine and methotrexate and 49% (27/55) then added hydroxychloroquine to this combination, in active disease. Of those who chose sulphasalazine first, 95% (137/144) ranked methotrexate second, 75% (113/150) preferring methotrexate monotherapy and 12% (18/150) the combination with sulphasalazine. Rheumatologists who preferred sulphasalazine first more commonly used subsequent DMARDs singly than those who started with methotrexate (P < 0.0001). Leflunomide was more commonly preferred than intramuscular gold as third choice (52/145 vs 29/145; P < 0.003). The most popular sequence of DMARDs was methotrexate or sulphasalazine, singly or in combination, leflunomide, intramuscular gold and anti-tumour necrosis factor therapy. Poor prognostic factors influenced DMARD choice, but patient occupation and drug costs did not. CONCLUSION Methotrexate has displaced other DMARDs, especially sulphasalazine, as agent of first choice and newer agents have displaced older DMARDs. Whether the expressed preference for particular DMARDs accurately reflects actual use, and is optimal in rheumatoid arthritis, remains to be determined.
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Affiliation(s)
- P Jobanputra
- Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham, UK.
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Yee CS, Filer A, Pace A, Douglas K, Situnayake D, Rowe IF. The prevalence of patients with rheumatoid arthritis in the West Midlands fulfilling the BSR criteria for anti-tumour necrosis factor therapy: an out-patient study. Rheumatology (Oxford) 2003; 42:856-9. [PMID: 12730544 DOI: 10.1093/rheumatology/keg231] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [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: 11/14/2022] Open
Abstract
OBJECTIVES There are currently two anti-tumour necrosis factor (anti-TNF) therapies licensed for treatment of rheumatoid arthritis (RA). A British Society for Rheumatology (BSR) working party defined criteria for patients that would be suitable for such treatment. The aim of this study was to determine the prevalence of these patients attending rheumatology out-patient departments across the West Midlands. METHODS Data were collected over a 2-week period in adult out-patient departments of 12 centres. A questionnaire was completed at each patient review. Disease activity scores (DAS-28) were recorded for those who had failed methotrexate treatment and at least one other disease-modifying anti-rheumatic drug (DMARD) in the absence of contraindications to anti-TNF therapy. Information was also collected on the number of DMARDs failed and the use of steroid therapy. RESULTS A total of 1441 patients with RA were assessed; 177 (12.3%) patients had failed methotrexate and at least one other DMARD. Of these, 19 had contraindications to the use of anti-TNF therapy. In the remaining 158 patients (11%), 80 (5.6%) had a DAS-28 score of >5.1, thus fulfilling BSR criteria for use of anti-TNF therapy. Those with a DAS-28 score of < or = 5.1 were significantly more likely to have been taking steroids compared with those with a DAS-28 score >5.1 (68.2 and 49.3%, respectively, P=0.024). CONCLUSIONS Of patients with RA attending adult rheumatology out-patient clinics in the West Midlands, 5.6% would meet BSR criteria for use of anti-TNF therapy. Eligibility may be affected by steroid use.
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