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Larsson K, Rossen J, Norman Å, Johansson UB, Hagströmer M. Predictors associated with an increase in daily steps among people with prediabetes or type 2 diabetes participating in a two-year pedometer intervention. BMC Public Health 2024; 24:1290. [PMID: 38734659 PMCID: PMC11088056 DOI: 10.1186/s12889-024-18766-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND This study aimed to explore predictors associated with intermediate (six months) and post-intervention (24 months) increases in daily steps among people with prediabetes or type 2 diabetes participating in a two-year pedometer intervention. METHODS A secondary analysis was conducted based on data from people with prediabetes or type 2 diabetes from two intervention arms of the randomised controlled trial Sophia Step Study. Daily steps were measured with an ActiGraph GT1M accelerometer. Participants were divided into two groups based on their response to the intervention: Group 1) ≥ 500 increase in daily steps or Group 2) a decrease or < 500 increase in daily steps. Data from baseline and from six- and 24-month follow-ups were used for analysis. The response groups were used as outcomes in a multiple logistic regression together with baseline predictors including self-efficacy, social support, health-related variables, intervention group, demographics and steps at baseline. Predictors were included in the regression if they had a p-value < 0.2 from bivariate analyses. RESULTS In total, 83 participants were included. The mean ± SD age was 65.2 ± 6.8 years and 33% were female. At six months, a lower number of steps at baseline was a significant predictor for increasing ≥ 500 steps per day (OR = 0.82, 95% CI 0.69-0.98). At 24 months, women had 79% lower odds of increasing ≥ 500 steps per day (OR = 0.21, 95% CI 0.05-0.88), compared to men. For every year of increase in age, the odds of increasing ≥ 500 steps per day decreased by 13% (OR = 0.87, 95% CI 0.78-0.97). Also, for every step increase in baseline self-efficacy, measured with the Self-Efficacy for Exercise Scale, the odds of increasing ≥ 500 steps per day increased by 14% (OR = 1.14, 95% CI 1.02-1.27). CONCLUSIONS In the Sophia Step Study pedometer intervention, participants with a lower number of steps at baseline, male gender, lower age or higher baseline self-efficacy were more likely to respond to the intervention with a step increase above 500 steps per day. More knowledge is needed about factors that influence response to pedometer interventions. TRIAL REGISTRATION ClinicalTrials.gov, NCT02374788.
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Affiliation(s)
- Kristina Larsson
- Department of Health Promotion Science, Sophiahemmet University, Box 5605, Stockholm, 114 86, Sweden.
| | - Jenny Rossen
- Department of Health Promotion Science, Sophiahemmet University, Box 5605, Stockholm, 114 86, Sweden
| | - Åsa Norman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Unn-Britt Johansson
- Department of Health Promotion Science, Sophiahemmet University, Box 5605, Stockholm, 114 86, Sweden
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Maria Hagströmer
- Department of Health Promotion Science, Sophiahemmet University, Box 5605, Stockholm, 114 86, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Care Center, Region Stockholm, Stockholm, Sweden
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Moseley J, Leest T, Larsson K, Magrelli A, Stoyanova-Beninska V. Inherited retinal dystrophies and orphan designations in the European Union. Eur J Ophthalmol 2024:11206721241236214. [PMID: 38500388 DOI: 10.1177/11206721241236214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Inherited Retinal Dystrophies (IRD) are diverse rare diseases that affect the retina and lead to visual impairment or blindness. Research in this field is ongoing, with over 60 EU orphan medicinal products designated in this therapeutic area by the Committee for Orphan Medicinal Products (COMP) at the European Medicines Agency (EMA). Up to now, COMP has used traditional disease terms, like retinitis pigmentosa, for orphan designation regardless of the product's mechanism of action. The COMP reviewed the designation approach for IRDs taking into account all previous Orphan Designations (OD) experience in IRDs, the most relevant up to date scientific literature and input from patients and clinical experts. Following the review, the COMP decided that there should be three options available for orphan designation concerning the condition: i) an amended set of OD groups for therapies that might be used in a broad spectrum of conditions, ii) a gene-specific designation for targeted therapies, and iii) an occasional term for products that do not fit in the above two categories. The change in the approach to orphan designation in IRDs caters for different scenarios to allow an optimum approach for future OD applications including the option of a gene-specific designation. By applying this new approach, the COMP increases the regulatory clarity, efficiency, and predictability for sponsors, aligns EU regulatory tools with the latest scientific and medical developments in the field of IRDs, and ensures that all potentially treatable patients will be included in the scope of an OD.
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Affiliation(s)
- Jane Moseley
- European Medicines Agency, Amsterdam, The Netherlands
| | - Tim Leest
- Committee for Orphan Medicinal Products at the European Medicines Agency, Amsterdam, The Netherlands
- Federal Agency for Medicines and Health Products, Brussels, Belgium
| | | | - Armando Magrelli
- Committee for Orphan Medicinal Products at the European Medicines Agency, Amsterdam, The Netherlands
- National Center for Drug Research and Evaluation- Istituto Superiore di Sanità, Rome, Italy
| | - Violeta Stoyanova-Beninska
- Committee for Orphan Medicinal Products at the European Medicines Agency, Amsterdam, The Netherlands
- Medicines Evaluation Board (MEB), Utrecht, The Netherlands
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Kalland ME, Pose-Boirazian T, Palomo GM, Naumann-Winter F, Costa E, Matusevicius D, Duarte DM, Malikova E, Vitezic D, Larsson K, Magrelli A, Stoyanova-Beninska V, Mariz S. Advancing rare disease treatment: EMA's decade-long insights into engineered adoptive cell therapy for rare cancers and orphan designation. Gene Ther 2024:10.1038/s41434-024-00446-0. [PMID: 38480914 DOI: 10.1038/s41434-024-00446-0] [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] [Received: 12/01/2023] [Revised: 02/20/2024] [Accepted: 02/29/2024] [Indexed: 03/20/2024]
Abstract
Adoptive cell therapy (ACT), particularly chimeric antigen receptor (CAR)-T cell therapy, has emerged as a promising approach for targeting and treating rare oncological conditions. The orphan medicinal product designation by the European Union (EU) plays a crucial role in promoting development of medicines for rare conditions according to the EU Orphan Regulation.This regulatory landscape analysis examines the evolution, regulatory challenges, and clinical outcomes of genetically engineered ACT, with a focus on CAR-T cell therapies, based on the European Medicines Agency's Committee for Orphan Medicinal Products review of applications evaluated for orphan designation and maintenance of the status over a 10-year period. In total, 30 of 36 applications were granted an orphan status, and 14 subsequently applied for maintenance of the status at time of marketing authorisation or extension of indication. Most of the products were autologous cell therapies using a lentiviral vector and were developed for the treatment of rare haematological B-cell malignancies. The findings revealed that 80% (29/36) of the submissions for orphan designation were supported by preliminary clinical data showing a potential efficacy of the candidate products and an added clinical benefit over currently authorised medicines for the proposed orphan condition. Notably, in 89% (32/36) of the cases significant benefit of the new products was accepted based on a clinically relevant advantage over existing therapies. Twelve of fourteen submissions reviewed for maintenance of the status at time of marketing authorisation or extension of indication demonstrated significant benefit of the products over existing satisfactory methods of treatment within the approved therapeutic indications, but one of the applications was withdrawn during the regulatory evaluation.This article summarises the key findings related to the use of engineered ACT, primarily CAR-T cell therapies, in targeting and treating rare cancers in the EU. It emphasises the importance of use of clinical data in supporting medical plausibility and significant benefit at the stage of orphan designation and highlights the high success rate for these products in obtaining initial orphan designations and subsequent maintaining the status at the time of marketing authorisation or extension of indication.
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Affiliation(s)
- Maria Elisabeth Kalland
- Norwegian Medical Products Agency, Grensesvingen 26, 0663, Oslo, Norway.
- Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands.
| | - Tomas Pose-Boirazian
- Orphan Medicines Office, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
| | - Gloria Maria Palomo
- Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
- Agencia Española de Medicamentos y Productos Sanitarios, Calle Campezo n° 1, Edificio 8, 28022, Madrid, Spain
| | - Frauke Naumann-Winter
- Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
- Bundesinstitut für Arzneimittel und Medizinprodukte, Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany
| | - Enrico Costa
- Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
- Agenzia Italiana del Farmaco, Via del Tritone, 181, 00187, Rome, Italy
| | - Darius Matusevicius
- Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
- Swedish Medical Products Agency, Dag Hammarskjölds väg 42, 752 37, Uppsala, Sweden
| | - Dinah M Duarte
- INFARMED - National Authority of Medicines and Health Products, I.P., Avenida do Brasil 53, 1749-004, Lisbon, Portugal
- Universidade de Lisboa, Faculdade de Farmácia, Avenida Professor Gama Pinto, 1649-003, Lisbon, Portugal
| | - Eva Malikova
- Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
- State Institute for Drug Control, Kvetná 11, 825 08, Bratislava, Slovakia
- Department of Pharmacology and Toxicology, Comenius University, Odbojárov 10, 832 32, Bratislava, Slovakia
| | - Dinko Vitezic
- Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
- University of Rijeka, Faculty of Medicine, and University Hospital Centre Rijeka, Braće Branchetta 20/1, 51000, Rijeka, Croatia
| | - Kristina Larsson
- Orphan Medicines Office, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
| | - Armando Magrelli
- Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - Violeta Stoyanova-Beninska
- Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
- College ter Beoordeling van Geneesmiddelen, Graadt van Roggenweg 500, 3531 AH, Utrecht, The Netherlands
| | - Segundo Mariz
- Orphan Medicines Office, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
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Palomo GM, Pose-Boirazian T, Naumann-Winter F, Costa E, Duarte DM, Kalland ME, Malikova E, Matusevicius D, Vitezic D, Larsson K, Magrelli A, Stoyanova-Beninska V, Mariz S. The European landscape for gene therapies in orphan diseases: 6-year experience with the EMA Committee for Orphan Medicinal Products. Mol Ther 2023; 31:3414-3423. [PMID: 37794679 PMCID: PMC10727954 DOI: 10.1016/j.ymthe.2023.09.020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/04/2023] [Accepted: 09/29/2023] [Indexed: 10/06/2023] Open
Abstract
In 2000, the European Union (EU) introduced the orphan pharmaceutical legislation to incentivize the development of medicinal products for rare diseases. The Committee for Orphan Medicinal Products (COMP), the European Medicines Agency committee responsible for evaluation of applications for orphan designation (OD), received an increasing flow of applications in the field of gene therapies over the last years. Here, the COMP has conducted a descriptive analysis of applications regarding gene therapies in non-oncological rare diseases, with respect to (a) targeted conditions and their rarity, (b) characteristics of the gene therapy products proposed for OD, with a focus on the type of vector used, and (c) regulatory aspects pertaining to the type of sponsor and development, by examining the use of available frameworks offered in the EU such as protocol assistance and PRIME. It was noted that gene therapies are being developed by sponsors from different backgrounds. Most conditions being targeted are monogenic, the most common being lysosomal disorders, and with a very low prevalence. Generally, adeno-associated viral vectors were being used to deliver the transgene. Finally, sponsors are not frequently using the incentives that may support the development and the reasons for this are unclear.
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Affiliation(s)
- Gloria M Palomo
- Agencia Española de Medicamentos y Productos Sanitarios, Calle Campezo 1 Edificio 8, 28022 Madrid, Spain; Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS Amsterdam, the Netherlands.
| | - Tomas Pose-Boirazian
- Orphan Medicines Office, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS Amsterdam, the Netherlands
| | - Frauke Naumann-Winter
- Bundesinstitut für Arzneimittel und Medizinprodukte, Kurt-Georg-Kiesinger-Allee 3, 53175 Bonn, Germany; Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS Amsterdam, the Netherlands
| | - Enrico Costa
- Agenzia Italiana del Farmaco, Via del Tritone 181, 00187 Rome, Italy; Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS Amsterdam, the Netherlands
| | - Dinah M Duarte
- INFARMED - National Authority of Medicines and Health Products, I.P., Avenida do Brasil 53, 1749-004 Lisbon, Portugal; Universidade de Lisboa, Faculdade de Farmácia, Avenida Professor Gama Pinto, 1649-003 Lisbon, Portugal; Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS Amsterdam, the Netherlands
| | - Maria E Kalland
- Statens Legemiddelverk/The Norwegian Medicines Agency, Grensesvingen 26, 0663 Oslo, Norway; Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS Amsterdam, the Netherlands
| | - Eva Malikova
- State Institute for Drug Control, Kvetná 11, 825 08 Bratislava, Slovakia; Department of Pharmacology and Toxicology, Comenius University, Odbojárov 10, 832 32 Bratislava, Slovakia; Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS Amsterdam, the Netherlands
| | - Darius Matusevicius
- Läkemedelsverket, Dag Hammarskjölds väg 42, 75237 Uppsala, Sweden; Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS Amsterdam, the Netherlands
| | - Dinko Vitezic
- Rijeka University School of Medicine and University Hospital Centre Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia; Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS Amsterdam, the Netherlands
| | - Kristina Larsson
- Orphan Medicines Office, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS Amsterdam, the Netherlands
| | - Armando Magrelli
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy; Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS Amsterdam, the Netherlands
| | - Violeta Stoyanova-Beninska
- College ter Beoordeling van Geneesmiddelen, Graadt van Roggenweg 500, 3531 AH Utrecht, the Netherlands; Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS Amsterdam, the Netherlands
| | - Segundo Mariz
- Orphan Medicines Office, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS Amsterdam, the Netherlands.
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Larsson K, Hagströmer M, Rossen J, Johansson UB, Norman Å. Health care professionals' experiences of supporting persons with metabolic risk factors to increase their physical activity level - a qualitative study in primary care. Scand J Prim Health Care 2023; 41:116-131. [PMID: 36927270 DOI: 10.1080/02813432.2023.2187668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE To be regularly physically active is of major importance for the health of people with metabolic risk factors. Many of these persons are insufficiently active and in need of support. This study aimed to explore barriers and facilitators perceived by health care professionals' within Swedish primary care in their work to support persons with metabolic risk factors to increase their physical activity. DESIGN A qualitative design with focus group discussions was used. The data were analysed using qualitative content analysis with a manifest, inductive approach. SETTING Primary health care in five Swedish healthcare regions. SUBJECTS Nine physiotherapists, ten physicians and five nurses participated in six digital focus group discussions including two to six participants. RESULTS Barriers and facilitators to supporting persons with metabolic risk factors to increase their physical activity were found within four generic categories, where the barriers and facilitators related to each generic category: 'Patient readiness for change', 'Supporting the process of change', 'The professional role', and 'The organisation of primary care'. CONCLUSION The findings suggests that barriers and facilitators for supporting patients with metabolic risk factors can be found at several levels within primary care, from individual patient and the health care professionals to the organisational level. In the primary care setting, this should be highlighted when implementing support to increase physical activity in people with metabolic risk factors.KEY POINTSHealth care professionals within primary care are in a position to support people with metabolic risk factors to increase their physical activity.Barriers and facilitators to support the patients should be addressed at several levels within primary care.The study highlights factors on multiple levels such as professional responsibility, organisational prioritisation and resources, and the challenge to motivate behaviour change.
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Affiliation(s)
- Kristina Larsson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Maria Hagströmer
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Care Centre, Region Stockholm, Stockholm, Sweden
| | - Jenny Rossen
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Unn-Britt Johansson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Åsa Norman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Larsson K, Von Rosen P, Rossen J, Johansson UB, Hagströmer M. P10-11 The effect of a pedometer-based intervention across two years, in people with type 2 diabetes and prediabetes - a compositional data analysis. Eur J Public Health 2022. [PMCID: PMC9436208 DOI: 10.1093/eurpub/ckac095.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background For people with prediabetes and type 2 diabetes it is important to be regularly physical active. Increasing and maintaining physical activity (PA) can be challenging. The aim of this study was to evaluate the effects of a pedometer-based intervention on PA, with a compositional data analysis (CoDA) approach, in individuals with prediabetes or type 2 diabetes. Methods Longitudinal data on 188 participants with prediabetes and type 2 diabetes (40% female, mean age = 64.1 years) from a three-armed randomized controlled trail, the Sophia Step Study, was used. The three groups were a multi?component group (self?monitoring of steps with a pedometer, together with group (12 occasions) and individual counselling (10 occasions)), a single?component group (self?monitoring of steps with a pedometer, without counselling) and a standard care group. PA (moderate-to-vigorous PA (MVPA), light-intensity PA (LIPA) and sedentary behaviour (SB)) during the awake time were measured with ActiGraph GT1M accelerometer at baseline, 6, 12, 18 and 24 months. Relative time in MVPA, LIPA and SB for each participant at each measurement point was calculated by using the CoDA approach. Linear mixed models were used to evaluate the intervention effect between the three groups on the relative time in MVPA, LIPA and SB over the two-year period. Results In total, 41% had ≤30 min MVPA at baseline. Significant group by time interactions were found for the multi-component group and the standard care group for the relative time in MVPA, at 6, 18 and 24 months. Differences in predicted group means between the groups were 1.2% at 6 months, 1.3% at 18 months and 0.9% at 24 months. Significant group by time interactions were also found for the single-component group and the standard care group for the relative time in MVPA at 24 months, with a difference in predicted group means of 0.8%. No significant interactions for LIPA or SB were found. Conclusions The multi-component group and the single-component component group maintained their relative time in MVPA, while the standard care group decreased their relative time in MVPA over the two-year period. This indicate that the Sophia Step Study intervention can prevent a decrease in MVPA in people with prediabetes and type 2 diabetes.
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Larsson K, Onell C, Edlund K, Källberg H, Holm LW, Sundberg T, Skillgate E. Lifestyle behaviors in Swedish university students before and during the first six months of the COVID-19 pandemic: a cohort study. BMC Public Health 2022; 22:1207. [PMID: 35710368 PMCID: PMC9202972 DOI: 10.1186/s12889-022-13553-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background Changes in Swedish university students’ lifestyle behaviors during the COVID-19 pandemic are unknown. This study aimed to assess physical activity, sitting time, meal frequency and risk substance use (alcohol, tobacco, and illicit use of drugs) in Swedish university students before and during the first six months of the COVID-19 pandemic, for all and stratified by age and sex. Methods Data were obtained from the Sustainable University Life cohort study in which web-based surveys were sent to university students repeatedly for one year. Baseline assessment (before the pandemic) was between August 2019-March 2020, follow-up 1 (FU1) between March-June 2020, and follow-up 2 (FU2) between June–September 2020. Participants reported weekly minutes of physical activity, daily sitting hours, meal frequency by weekly intake of different meals, and motivation for eating irregularly, if so. Also, harmful use of alcohol, tobacco and illicit drugs was assessed. Population means and differences with 95% confidence intervals (95% CI) in lifestyle behaviors between time points were calculated with Generalized Estimating Equations. Results 1877 students (73% women, mean age 26.5 years) answered the baseline survey. Weekly exercise decreased by -5.7 min (95% CI: -10.0, -1.5) and -7.7 min (95% CI: -12.6, -2.8) between baseline and FU1 and FU2, respectively. Weekly daily activities increased by 5.6 min (95% CI: 0.3, 11.7) and 14.2 min (95% CI: 7.9, 20.5) between baseline and FU1 and FU2. Daily sitting time decreased by -1.4 h (95% CI: -1.7, -1.2) between baseline and FU2. Breakfast intake increased by 0.2 days per week (95% CI: 0.1, 0.3) between baseline and FU2. Lunch intake decreased by -0.2 days per week (95% CI: -0.2, -0.1) between baseline and FU1 and by -0.2 days per week (95% CI: -0.3, -0.0) between baseline and FU2. Dinner intake decreased by -0.1 days per week (95% CI: -0.2, -0.0) between baseline and both FU1 and FU2. Only minor differences in risk substance use were observed. Similar changes were observed in analyses stratified by age and sex. Conclusions Lifestyle behaviors in Swedish university students slightly improved during the first six months of the COVID-19 pandemic compared to before. Trial registration ClinicalTrials.gov, NCT04465435. 10/07/2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13553-7.
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Affiliation(s)
- Kristina Larsson
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | - Clara Onell
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.
| | - Klara Edlund
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.,Unit of Intervention and Implementation Research On Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Källberg
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | - Lena W Holm
- Unit of Intervention and Implementation Research On Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Sundberg
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | - Eva Skillgate
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.,Unit of Intervention and Implementation Research On Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Rossen J, Hagströmer M, Larsson K, Johansson UB, von Rosen P. Physical Activity Patterns among Individuals with Prediabetes or Type 2 Diabetes across Two Years-A Longitudinal Latent Class Analysis. Int J Environ Res Public Health 2022; 19:ijerph19063667. [PMID: 35329362 PMCID: PMC8949382 DOI: 10.3390/ijerph19063667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
Background: This study aimed to identify distinct profiles of physical activity (PA) patterns among individuals with prediabetes or type 2 diabetes participating in a two-year PA trial and to investigate predictors of the profiles. Methods: Data (n = 168, collected 2013–2020) from the cohort of a randomized trial aimed at increasing PA in individuals with prediabetes and type 2 diabetes were used. PA and sedentary behaviours were assessed by waist-worn ActiGraph GT1M accelerometers at baseline and at 6, 12, 18 and 24 months. Fifteen PA and sedentary variables were entered into a latent class mixed model for multivariate longitudinal outcomes. Multinominal regression analysis modelled profile membership based on baseline activity level, age, gender, BMI, disease status and group randomisation. Results: Two profiles of PA patterns were identified: “Increased activity” (n = 37, 22%) included participants increasing time in PA and decreasing sedentary time. “No change in activity” (n = 131, 78%) included participants with no or minor changes. “Increased activity” were younger (p = 0.003) and more active at baseline (p = 0.011), compared to “No change in activity”. No other predictor was associated with profile membership. Conclusions: A majority of participants maintained PA and sedentary patterns over two years despite being part of a PA intervention. Individuals improving PA patterns were younger and more active at baseline.
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Affiliation(s)
- Jenny Rossen
- Department of Health Promoting Science, Sophiahemmet University, Lindstedtsvägen 8, 114 86 Stockholm, Sweden; (M.H.); (K.L.); (U.-B.J.)
- Correspondence: ; Tel.: +46-8406-2985
| | - Maria Hagströmer
- Department of Health Promoting Science, Sophiahemmet University, Lindstedtsvägen 8, 114 86 Stockholm, Sweden; (M.H.); (K.L.); (U.-B.J.)
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 52 Huddinge, Sweden;
- Academic Primary Care Center, Region Stockholm, Solnavägen 1E, 104 31 Stockholm, Sweden
| | - Kristina Larsson
- Department of Health Promoting Science, Sophiahemmet University, Lindstedtsvägen 8, 114 86 Stockholm, Sweden; (M.H.); (K.L.); (U.-B.J.)
| | - Unn-Britt Johansson
- Department of Health Promoting Science, Sophiahemmet University, Lindstedtsvägen 8, 114 86 Stockholm, Sweden; (M.H.); (K.L.); (U.-B.J.)
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden
| | - Philip von Rosen
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 52 Huddinge, Sweden;
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9
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Sheean ME, Naumann-Winter F, Capovilla G, Kalland ME, Malikova E, Mariz S, Matusevicius D, Nistico R, Schwarzer-Daum B, Tsigkos S, Tzogani K, Larsson K, Magrelli A, Stoyanova-Beninska V. Defining Satisfactory Methods of Treatment in Rare Diseases When Evaluating Significant Benefit-The EU Regulator's Perspective. Front Med (Lausanne) 2021; 8:744625. [PMID: 34513895 PMCID: PMC8429787 DOI: 10.3389/fmed.2021.744625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
Since the implementation of the EU Orphan Regulation in 2000, the Committee for Orphan Medicinal Products at the European Medicines Agency has been evaluating the benefits of proposed orphan medicines vs. satisfactory treatment methods. This type of evaluation is foreseen in the Orphan Regulation as the orphan designation criterion called the "significant benefit." In this article, based on 20 years of experience, we provide a commentary explaining what is considered a satisfactory method of treatment in the context of the EU Orphan Regulation and for the purpose of the assessment of significant benefit. We discuss the challenges posed by continuously changing clinical practise, which is associated with the increasing number of treatment options, evolving nature of medicinal therapeutic indications and our understanding of them.
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Affiliation(s)
| | - Frauke Naumann-Winter
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, Netherlands.,Bundesinstitut für Arzneimittel und Medizinprodukte, Bonn, Germany
| | - Giuseppe Capovilla
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, Netherlands.,Carlo Poma Hospital, Mantova, Italy.,Fondazione Poliambulanza, Brescia, Italy
| | - Maria Elisabeth Kalland
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, Netherlands.,Statens Legemiddelverk, Oslo, Norway
| | - Eva Malikova
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, Netherlands.,State Institute for Drug Control, Bratislava, Slovakia.,Department of Pharmacology and Toxicology, Comenius University, Bratislava, Slovakia
| | | | - Darius Matusevicius
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, Netherlands.,Läkemedelsverket, Uppsala, Sweden
| | - Robert Nistico
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, Netherlands.,Malta Medicines Authority, San Gwann, Malta
| | - Brigitte Schwarzer-Daum
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, Netherlands.,Medical University of Vienna, Vienna, Austria
| | | | | | | | - Armando Magrelli
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, Netherlands.,National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Violeta Stoyanova-Beninska
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, Netherlands.,College ter Beoordeling van Geneesmiddelen, Utrecht, Netherlands
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10
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Rossen J, Larsson K, Hagströmer M, Yngve A, Brismar K, Ainsworth B, Åberg L, Johansson UB. Effects of a three-armed randomised controlled trial using self-monitoring of daily steps with and without counselling in prediabetes and type 2 diabetes-the Sophia Step Study. Int J Behav Nutr Phys Act 2021; 18:121. [PMID: 34496859 PMCID: PMC8424865 DOI: 10.1186/s12966-021-01193-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This aimed to evaluate the effects of self-monitoring of daily steps with or without counselling support on HbA1c, other cardiometabolic risk factors and objectively measured physical activity (PA) during a 2-year intervention in a population with prediabetes or type 2 diabetes. METHODS The Sophia Step Study was a three-armed parallel randomised controlled trial. Participants with prediabetes or type 2 diabetes were recruited in a primary care setting. Allocation (1:1:1) was made to a multi-component intervention (self-monitoring of steps with counselling support), a single-component intervention (self-monitoring of steps without counselling support) or standard care. Data were collected for primary outcome HbA1c at baseline and month 6, 12, 18 and 24. Physical activity was assessed as an intermediate outcome by accelerometer (ActiGraph GT1M) for 1 week at baseline and the 6-, 12-, 18- and 24-month follow-up visits. The intervention effects were evaluated by a robust linear mixed model. RESULTS In total, 188 subjects (64, 59, 65 in each group) were included. The mean (SD) age was 64 (7.7) years, BMI was 30.0 (4.4) kg/m2 and HbA1c was 50 (11) mmol/mol, 21% had prediabetes and 40% were female. The dropout rate was 11% at 24 months. Effect size (CI) for the primary outcome (HbA1c) ranged from -1.3 (-4.8 to 2.2) to 1.1 (-2.4 to 4.6) mmol/mol for the multi-component vs control group and from 0.3 (-3.3 to 3.9) to 3.1 (-0.5 to 6.7) mmol/mol for the single-component vs control group. Effect size (CI) for moderate-to-vigorous physical activity ranged from 8.0 (0.4 to 15.7) to 11.1 (3.3 to 19.0) min/day for the multi-component vs control group and from 7.6 (-0.4 to 15.6) to 9.4 (1.4 to 17.4) min/day for the single-component group vs control group. CONCLUSION This 2-year intervention, including self-monitoring of steps with or without counselling, prevented a decrease in PA but did not provide evidence for improved metabolic control and cardiometabolic risk factors in a population with prediabetes or type 2 diabetes. TRIAL REGISTRATION ClinicalTrials.gov, NCT02374788 . Registered 2 March 2015-Retrospectively registered.
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Affiliation(s)
- Jenny Rossen
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.
| | - Kristina Larsson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Maria Hagströmer
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Care Center, Region Stockholm, Stockholm, Sweden
| | - Agneta Yngve
- Department of Nutrition, Dietetics and Food Studies, Uppsala University, Uppsala, Sweden
- School of Health Sciences, Örebro University, Örebro, Sweden
| | - Kerstin Brismar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Rolf Luft Research Center for Diabetes and Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Barbara Ainsworth
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | | | - Unn-Britt Johansson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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11
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Tsigkos S, Mariz S, Sheean ME, Larsson K, Magrelli A, Stoyanova-Beninska V. Regulatory Standards in Orphan Medicinal Product Designation in the EU. Front Med (Lausanne) 2021; 8:698534. [PMID: 34249982 PMCID: PMC8268149 DOI: 10.3389/fmed.2021.698534] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/01/2021] [Indexed: 11/21/2022] Open
Abstract
Twenty years of orphan regulation in Europe have now elapsed, with almost 2,400 orphan designated medicinal products and more than 190 orphan products authorised in the EU. Alongside the evolution in understanding of rare diseases, considerable regulatory knowledge has also been accumulated regarding the level of evidence that would support inclusion of products into the framework. This article reviews publications and regulatory documents pertaining to orphan medicinal product designation in the EU and discusses the general expectations in submitted applications as reflected in the current regulatory practise. Important elements to recommend granting a European orphan designation are the key considerations of orphan condition, medical plausibility, seriousness, and prevalence, while significant benefit is also assessed when there are authorised medicinal products for the sought indication. This review attempts to clarify the specific concepts currently used in that regard and discusses how the available data can be used to justify the criteria for designation. Moving away from theoretical expectations or assumptions, it stresses that the applications have to be complemented with nosological and epidemiological justifications pertaining to the proposed condition, as well as relevant data in specific non-clinical in vivo models or in affected patients to support inclusion into the orphan scheme.
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Affiliation(s)
- Stelios Tsigkos
- Orphan Medicines Office, European Medicines Agency, Amsterdam, Netherlands
| | - Segundo Mariz
- Orphan Medicines Office, European Medicines Agency, Amsterdam, Netherlands
| | | | - Kristina Larsson
- Orphan Medicines Office, European Medicines Agency, Amsterdam, Netherlands
| | - Armando Magrelli
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy.,Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, Netherlands
| | - Violeta Stoyanova-Beninska
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, Netherlands.,Medicines Evaluation Board, Utrecht, Netherlands
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12
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Vreman RA, de Ruijter AS, Zawada A, Tafuri G, Stoyanova-Beninska V, O'Connor D, Naumann-Winter F, Wolter F, Mantel-Teeuwisse AK, Leufkens HGM, Sidiropoulos I, Larsson K, Goettsch WG. Assessment of significant benefit for orphan medicinal products by European regulators may support subsequent relative effectiveness assessments by health technology assessment organizations. Drug Discov Today 2020; 25:1223-1231. [PMID: 32344040 DOI: 10.1016/j.drudis.2020.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/08/2020] [Accepted: 04/15/2020] [Indexed: 11/26/2022]
Abstract
To maintain orphan drug status at the time of market authorization, orphan medicinal products (OMPs) need to be assessed for all criteria, including significant benefit, by the Committee for Orphan Medicinal Products (COMP) of the European Medicines Agency (EMA). Subsequently, health technology assessment (HTA) organizations evaluate the same OMPs in their relative effectiveness assessments (REAs). This review investigates the similarities and differences between the two frameworks for six HTA organizations, including the European Network for HTA. We discuss differences between both assessment frameworks within five domains (clinical evidence used, patient population, intervention, comparators, and outcome measures) for all drugs. Five illustrative cases studies were selected for a qualitative review.
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Affiliation(s)
- Rick A Vreman
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands; The National Health Care Institute (ZIN), Willem Dudokhof 1, 1112 ZA Diemen, The Netherlands
| | - Angela S de Ruijter
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Anna Zawada
- Medical University of Warsaw, Zwirki i Wigury St. 61, 02-091 Warsaw, Poland
| | - Giovanni Tafuri
- The National Health Care Institute (ZIN), Willem Dudokhof 1, 1112 ZA Diemen, The Netherlands
| | - Violeta Stoyanova-Beninska
- Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands; College ter Beoordeling van Geneesmiddelen/Medicines Evaluation Board (CBG-MEB), Graadt van Roggenweg 500, 3531 AH, Utrecht, The Netherlands
| | - Daniel O'Connor
- Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands; Medicines and Healthcare products Regulatory Agency (MHRA), 10 SC, Canary Wharf, London, UK
| | - Frauke Naumann-Winter
- Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands; Bundesinstitut für Arzneimittel und Medizinprodukte, Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany
| | - Franziska Wolter
- Bundesinstitut für Arzneimittel und Medizinprodukte, Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Hubert G M Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Iordanis Sidiropoulos
- Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
| | - Kristina Larsson
- Committee for Orphan Medicinal Products, European Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands
| | - Wim G Goettsch
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands; The National Health Care Institute (ZIN), Willem Dudokhof 1, 1112 ZA Diemen, The Netherlands.
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13
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Tambuyzer E, Vandendriessche B, Austin CP, Brooks PJ, Larsson K, Miller Needleman KI, Valentine J, Davies K, Groft SC, Preti R, Oprea TI, Prunotto M. Therapies for rare diseases: therapeutic modalities, progress and challenges ahead. Nat Rev Drug Discov 2019; 19:93-111. [PMID: 31836861 DOI: 10.1038/s41573-019-0049-9] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 12/26/2022]
Abstract
Most rare diseases still lack approved treatments despite major advances in research providing the tools to understand their molecular basis, as well as legislation providing regulatory and economic incentives to catalyse the development of specific therapies. Addressing this translational gap is a multifaceted challenge, for which a key aspect is the selection of the optimal therapeutic modality for translating advances in rare disease knowledge into potential medicines, known as orphan drugs. With this in mind, we discuss here the technological basis and rare disease applicability of the main therapeutic modalities, including small molecules, monoclonal antibodies, protein replacement therapies, oligonucleotides and gene and cell therapies, as well as drug repurposing. For each modality, we consider its strengths and limitations as a platform for rare disease therapy development and describe clinical progress so far in developing drugs based on it. We also discuss selected overarching topics in the development of therapies for rare diseases, such as approval statistics, engagement of patients in the process, regulatory pathways and digital tools.
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Affiliation(s)
- Erik Tambuyzer
- BioPontis Alliance for Rare Diseases Foundation fup/son, Brussels, Belgium. .,BioPontis Alliance Rare Disease Foundation, Inc, Raleigh, NC, USA.
| | - Benjamin Vandendriessche
- Byteflies, Antwerp, Belgium.,Department of Electrical, Computer, and Systems Engineering (ECSE), Case Western Reserve University, Cleveland, OH, USA
| | - Christopher P Austin
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Philip J Brooks
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Kristina Larsson
- Orphan Medicines Office, European Medicines Agency, Amsterdam, Netherlands
| | | | | | - Kay Davies
- MDUK Oxford Neuromuscular Centre, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Stephen C Groft
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Robert Preti
- Hitachi Chemical Regenerative Medicine Business Sector, Allendale, NJ, USA
| | - Tudor I Oprea
- Translational Informatics Division, Department of Internal Medicine, University of New Mexico Albuquerque, Albuquerque, NM, USA.,UNM Comprehensive Cancer Center, University of New Mexico Health Science Center, Albuquerque, NM, USA
| | - Marco Prunotto
- School of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.
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14
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Sheean ME, Malikova E, Duarte D, Capovilla G, Fregonese L, Hofer MP, Magrelli A, Mariz S, Mendez-Hermida F, Nistico R, Leest T, Sipsas NV, Tsigkos S, Vitezic D, Larsson K, Sepodes B, Stoyanova-Beninska V. Nonclinical data supporting orphan medicinal product designations in the area of rare infectious diseases. Drug Discov Today 2019; 25:274-291. [PMID: 31704277 DOI: 10.1016/j.drudis.2019.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/15/2019] [Accepted: 10/30/2019] [Indexed: 01/13/2023]
Abstract
This review provides an overview of nonclinical in vivo models that can be used to support orphan designation in selected rare infectious diseases in Europe, with the aim to inform and stimulate the planning of nonclinical development in this area of often neglected diseases.
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Affiliation(s)
- Maria E Sheean
- Orphan Medicines Office, European Medicines Agency, Amsterdam, The Netherlands; Max-Delbrück Center for Molecular Medicine in Helmholz Association, Berlin, Germany.
| | - Eva Malikova
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, The Netherlands; State Institute for Drug Control, Bratislava, Slovak Republic; Comenius University, Department of Pharmacology and Toxicology, Bratislava, Slovak Republic
| | - Dinah Duarte
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, The Netherlands; INFARMED - Autoridade Nacional do Medicamento, Lisbon, Portugal
| | - Giuseppe Capovilla
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, The Netherlands; C. Poma Hospital, Mantova, Italy; Fondazione Poliambulanza, Brescia, Italy
| | - Laura Fregonese
- Orphan Medicines Office, European Medicines Agency, Amsterdam, The Netherlands
| | - Matthias P Hofer
- Orphan Medicines Office, European Medicines Agency, Amsterdam, The Netherlands
| | - Armando Magrelli
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, The Netherlands; National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Segundo Mariz
- Orphan Medicines Office, European Medicines Agency, Amsterdam, The Netherlands
| | - Fernando Mendez-Hermida
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, The Netherlands; Agencia Española de Medicamentos y Productos Sanitarios, Madrid, Spain
| | - Robert Nistico
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, The Netherlands; Malta Medicines Authority, San Ġwann, Malta
| | - Tim Leest
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, The Netherlands; The Federal Agency for Medicines and Health Products, Brussels, Belgium
| | - Nikolaos V Sipsas
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, The Netherlands; Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stelios Tsigkos
- Orphan Medicines Office, European Medicines Agency, Amsterdam, The Netherlands
| | - Dinko Vitezic
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, The Netherlands; University of Rijeka Medical School and University Hospital Centre Rijeka, Rijeka, Croatia
| | - Kristina Larsson
- Orphan Medicines Office, European Medicines Agency, Amsterdam, The Netherlands
| | - Bruno Sepodes
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, The Netherlands; INFARMED - Autoridade Nacional do Medicamento, Lisbon, Portugal; Universidade de Lisboa - Faculdade de Farmácia, Lisbon, Portugal
| | - Violeta Stoyanova-Beninska
- Committee of Orphan Medicinal Products, European Medicines Agency, Amsterdam, The Netherlands; Medicines Evaluation Board, Utrecht, The Netherlands
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15
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Hampe CS, Radtke JR, Wester A, Carlsson A, Cedervall E, Jönsson B, Ivarsson SA, Elding Larsson H, Larsson K, Lindberg B, Neiderud J, Rolandsson O, Lernmark Å. Reduced display of conformational epitopes in the N-terminal truncated GAD65 isoform: relevance for people with stiff person syndrome or DQ8/8-positive Type 1 diabetes mellitus. Diabet Med 2019; 36:1375-1383. [PMID: 30264481 PMCID: PMC6437014 DOI: 10.1111/dme.13827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2018] [Indexed: 12/26/2022]
Abstract
AIMS To investigate whether the N-terminal truncated glutamic acid decarboxylase 65 (GAD65) isoform is as well recognized by people with stiff person syndrome as it is by people with Type 1 diabetes, and whether conformational GAD65 antibody epitopes are displayed properly by the isoform. METHODS GAD65 antibody-positive healthy individuals (n=13), people with stiff-person syndrome (n=15) and children with new-onset Type 1 diabetes (n=654) were analysed to determine binding to full-length GAD65 and the N-terminal truncated GAD65 isoform in each of these settings. GAD65 autoantibody epitope specificity was correlated with binding ratios of full-length GAD65/N-terminal truncated GAD65. RESULTS The N-terminal truncated GAD65 isoform was significantly less recognized in GAD65Ab-positive people with stiff-person syndrome (P=0.002) and in healthy individuals (P=0.0001) than in people with Type 1 diabetes. Moreover, at least two specific conformational GAD65Ab epitopes were not, or were only partially, presented by the N-terminal truncated GAD65 isoform compared to full-length GAD65. Finally, an N-terminal conformational GAD65Ab epitope was significantly less recognized in DQ8/8 positive individuals with Type 1 diabetes (P=0.02). CONCLUSIONS In people with stiff person syndrome preferred binding to the full-length GAD65 isoform over the N-terminal truncated molecule was observed. This binding characteristic is probably attributable to reduced presentation of two conformational epitopes by the N-terminal truncated molecule. These findings support the notion of disease-specific GAD65Ab epitope specificities and emphasize the need to evaluate the applicability of novel assays for different medical conditions.
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Affiliation(s)
- C S Hampe
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J R Radtke
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - A Wester
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmo, Sweden
| | - A Carlsson
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmo, Sweden
| | - E Cedervall
- Department of Paediatrics, Ängelholm Hospital, Ängelholm, Malmo, Sweden
| | - B Jönsson
- Department of Paediatrics, Ystad Hospital, Ystad, Sweden
| | - S A Ivarsson
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmo, Sweden
| | - H Elding Larsson
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmo, Sweden
| | - K Larsson
- Department of Paediatrics, Kristianstad Hospital, Kristianstad, Sweden
| | - B Lindberg
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmo, Sweden
| | - J Neiderud
- Department of Paediatrics, Helsingborg Hospital, Helsingborg, Sweden
| | - O Rolandsson
- Department of Public Health and Clinical Medicine, Section of Family Medicine, Umeå University, Umeå, Sweden
| | - Å Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmo, Sweden
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16
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Larsson K, Ekblom Ö, Kallings LV, Ekblom M, Blom V. Job Demand-Control-Support Model as Related to Objectively Measured Physical Activity and Sedentary Time in Working Women and Men. Int J Environ Res Public Health 2019; 16:ijerph16183370. [PMID: 31547253 PMCID: PMC6765997 DOI: 10.3390/ijerph16183370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 01/03/2023]
Abstract
A physically active lifestyle incurs health benefits and physically active individuals show reduced reactivity to psychosocial stressors. However, the findings are inconclusive and are based on self-reported physical activity and sedentary time. The present study aimed at studying the associations between psychological stressors (job demand, control, support, JD-C-S) and objectively measured physical activity (PA) on various intensities from sedentary (SED) to vigorous physical activity. The participants were 314 employees from a cross-sectional study. PA data were collected with the accelerometer ActiGraph GT3X (Pensacola, FL, USA), SED data with the inclinometer activPAL (PAL Technologies Ltd., Glasgow, Scotland, UK), and psychosocial stressors with a web questionnaire. Results showed that vigorous-intensity PA was negatively associated with demand (β -0.15, p < 0.05), even when adjusted for the covariates. SED was negatively associated to support (β -0.13, p < 0.05). Stress significantly moderated relations between support and sedentary time (β -0.12, p < 0.05). Moderate PA (MVPA) was negatively associated with demand, but only when controlling for overtime (β -0.13, p < 0.05). MVPA was also negatively associated with control (β -0.15, p < 0.05) but not when work engagement was included in the model. Being more physically active and spending less time sedentary may help to handle job situations with high demand and low support.
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Affiliation(s)
- Kristina Larsson
- The Swedish School of Sport and Health Sciences, 11486 Stockholm, Sweden.
- Sophiahemmet University, 11486 Stockholm, Sweden.
| | - Örjan Ekblom
- The Swedish School of Sport and Health Sciences, 11486 Stockholm, Sweden.
| | - Lena V Kallings
- The Swedish School of Sport and Health Sciences, 11486 Stockholm, Sweden.
| | - Maria Ekblom
- The Swedish School of Sport and Health Sciences, 11486 Stockholm, Sweden.
- The Department of Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden.
| | - Victoria Blom
- The Swedish School of Sport and Health Sciences, 11486 Stockholm, Sweden.
- The Department of Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden.
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17
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Turesson C, Börjesson O, Larsson K, Mohammad AJ, Knight A. Swedish Society of Rheumatology 2018 guidelines for investigation, treatment, and follow-up of giant cell arteritis. Scand J Rheumatol 2019; 48:259-265. [DOI: 10.1080/03009742.2019.1571223] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- C Turesson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - O Börjesson
- Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - K Larsson
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - AJ Mohammad
- Rheumatology, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
- Department of Rheumatology, Skåne University Hospital, Lund, Sweden
| | - A Knight
- Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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18
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Chin K, Grip Linden J, Kovacs A, Einbeigi Z, Larsson K, Olofsson Bagge R. A significant correlation between pathological complete response rate in breast and axilla after neoadjuvant chemotherapy in 109 breast cancer patients. Breast 2019. [DOI: 10.1016/s0960-9776(19)30266-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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19
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Larsson K, Kallings LV, Ekblom Ö, Blom V, Andersson E, Ekblom MM. Criterion validity and test-retest reliability of SED-GIH, a single item question for assessment of daily sitting time. BMC Public Health 2019; 19:17. [PMID: 30611226 PMCID: PMC6321678 DOI: 10.1186/s12889-018-6329-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/17/2018] [Indexed: 01/04/2023] Open
Abstract
Background Sedentary behaviour has been closely linked to metabolic and cardiovascular health and is therefore of importance in disease prevention. A user-friendly tool for assessment of sitting time is thus needed. Previous studies concluded that the present tools used to assess a number of sedentary behaviours are more likely to overestimate sitting than single-item questions which often underestimate sitting time, and that categorical answering options are recommended. In line with this, the single-item question with categorical answering options, SED-GIH, was developed. The aim of this study was to investigate the criterion validity of the SED-GIH question using activPAL3 micro as the criterion measure. The second aim was to evaluate the test-retest reliability of the SED-GIH questionnaire. Method In the validity section of this study, 284 middle-aged adults answered a web questionnaire, which included SED-GIH, wore activPAL and filled in a diary log for one week. Spearman’s rho assessed the relationship between the SED-GIH answers and the daily average sitting time as monitored by the activPAL (activPAL-SIT), a Weighted Kappa assessed the agreement, ANOVA assessed differences in activPAL-SIT between the SED-GIH answer categories, and a Chi2 compared the proportions of hazardous sitters between the different SED-GIH answer categories. In the reliability section, 95 elderly participants answered the SED-GIH question twice, with a mean interval of 5.2 days. The reliability was assessed with ICC and a weighted Kappa. Results The SED-GIH question correlated moderately with activPAL-SIT (rho = 0.31), with a poor agreement (weighted Kappa 0.12). In total, 40.8% underestimated and 22.2% overestimated their sitting time. The ANOVA showed significant differences in activPAL-SIT between the different SED-GIH answer categories (p < 0.001). The Chi2 showed a significant difference in proportion of individuals sitting more than 10 h per day within each SED-GIH answer category. ICC for the test-retest reliability of SED-GIH was excellent with ICC = 0.86, and the weighted Kappa showed an agreement of 0.77. Conclusions The unanchored single item SED-GIH question showed excellent reliability but poor validity in the investigated populations. Validity and reliability of SED-GIH is in line with other questionnaires that are commonly used when assessing sitting time.
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Affiliation(s)
- Kristina Larsson
- The Swedish School of Sport and Health Sciences (GIH), Box 5626, 11486, Stockholm, Sweden
| | - Lena V Kallings
- The Swedish School of Sport and Health Sciences (GIH), Box 5626, 11486, Stockholm, Sweden
| | - Örjan Ekblom
- The Swedish School of Sport and Health Sciences (GIH), Box 5626, 11486, Stockholm, Sweden
| | - Victoria Blom
- The Swedish School of Sport and Health Sciences (GIH), Box 5626, 11486, Stockholm, Sweden
| | - Eva Andersson
- The Swedish School of Sport and Health Sciences (GIH), Box 5626, 11486, Stockholm, Sweden
| | - Maria M Ekblom
- The Swedish School of Sport and Health Sciences (GIH), Box 5626, 11486, Stockholm, Sweden.
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20
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Day S, Jonker AH, Lau LPL, Hilgers RD, Irony I, Larsson K, Roes KC, Stallard N. Recommendations for the design of small population clinical trials. Orphanet J Rare Dis 2018; 13:195. [PMID: 30400970 PMCID: PMC6219020 DOI: 10.1186/s13023-018-0931-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 10/09/2018] [Indexed: 02/08/2023] Open
Abstract
Background Orphan drug development faces numerous challenges, including low disease prevalence, patient population heterogeneity, and strong presence of paediatric patient populations. Consequently, clinical trials for orphan drugs are often smaller than those of non-orphan drugs, and they require the development of efficient trial designs relevant to small populations to gain the most information from the available data. The International Rare Diseases Research Consortium (IRDiRC) is aimed at promoting international collaboration and advance rare diseases research worldwide, and has as one of its goals to contribute to 1000 new therapies for rare diseases. IRDiRC set up a Small Population Clinical Trials (SPCT) Task Force in order to address the shortcomings of our understanding in carrying out clinical trials in rare diseases. Results The IRDiRC SPCT Task Force met in March 2016 to discuss challenges faced in the design of small studies for rare diseases and present their recommendations, structured around six topics: different study methods/designs and their relation to different characteristics of medical conditions, adequate safety data, multi-arm trial designs, decision analytic approaches and rational approaches to adjusting levels of evidence, extrapolation, and patients’ engagement in study design. Conclusions Recommendations have been issued based on discussions of the Small Population Clinical Trials Task Force that aim to contribute towards successful therapy development and clinical use. While randomised clinical trials are still considered the gold standard, it is recommended to systematically take into consideration alternative trial design options when studying treatments for a rare disease. Combining different sources of safety data is important to give a fuller picture of a therapy’s safety profile. Multi-arm trials should be considered an opportunity for rare diseases therapy development, and funders are encouraged to support such trial design via international networks. Patient engagement is critical in trial design and therapy development, a process which sponsors are encouraged to incorporate when conducting trials and clinical studies. Input from multiple regulatory agencies is recommended early and throughout clinical development. Regulators are often supportive of new clinical trial designs, provided they are well thought through and justified, and they also welcome discussions and questions on this topic. Parallel advice for multiregional development programs should also be considered.
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Affiliation(s)
- Simon Day
- Clinical Trials Consulting & Training Limited, 53 Portway, North Marston, Buckingham, Buckinghamshire, MK18 3PL, UK.
| | | | | | | | - Ilan Irony
- Center for Biologics Evaluation and Research/ Office of Tissues and Advanced Therapies, US Food and Drug Administration, Silver Spring, USA
| | | | - Kit Cb Roes
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Nigel Stallard
- Statistics and Epidemiology, Warwick Medical School, University of Warwick, Coventry, UK
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21
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Fregonese L, Greene L, Hofer M, Magrelli A, Naumann-Winter F, Larsson K, Sheean M, Stoyanova-Beninska V, Tsigkos S, Westermark K, Sepodes B. Demonstrating significant benefit of orphan medicines: analysis of 15 years of experience in Europe. Drug Discov Today 2017; 23:90-100. [PMID: 29024805 DOI: 10.1016/j.drudis.2017.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/25/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
Abstract
In the European Union demonstration of 'significant benefit' is mandatory if satisfactory methods exist for a disease targeted by a new orphan medicinal product. Significant benefit is required at the time of orphan designation, when it can be supported by preclinical studies, and at the time of marketing authorization, when clinical data are needed. For the first time, our work has identified, defined and organized the scientific grounds on which significant benefit is granted in the European Union, based on a review of the orphan medicinal products authorized in the years 2000-2015, and on the working experience of the Committee of Orphan Medicinal Products. The resulting conceptual framework is a tool for medicine developers to reflect on potential areas of advantage of their candidate products, and for a broad range of stakeholders to stimulate the discussion on the added value of orphan medicines across the whole development lifecycle.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Bruno Sepodes
- Universidade de Lisboa, Faculdade de Farmácia, Lisboa, Portugal
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22
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Tsigkos S, Hofer MP, Sheean ME, Mariz S, Larsson K, Naumann-Winter F, Fregonese L, Sepodes B. Establishing rarity in the context of orphan medicinal product designation in the European Union. Drug Discov Today 2017. [PMID: 28647377 DOI: 10.1016/j.drudis.2017.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In the European Union (EU) legislative framework for orphan medicinal product designation, establishing that a condition affects not more than five in 10,000 people is a prerequisite for applications based on rarity. Demonstrating this requirement to the Committee of Orphan Medicinal Products (COMP) can be a particularly challenging task for sponsors. Here, we identify and examine three common issues with the estimation of prevalence in orphan drug applications in the EU (the discernment between diagnosed and undiagnosed cases; the duration of the disease; and the need for an explicit contemporary conclusion) as critical factors for acceptable prevalence estimation. These concerns are discussed in detail based on recent examples of applications, which are reflected in published European Medicines Agency (EMA) documents.
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Affiliation(s)
- Stelios Tsigkos
- Orphan Medicines Office, European Medicines Agency, 30 Churchill Place, Canary Wharf, London E14 5 EU, UK.
| | - Matthias Philipp Hofer
- Orphan Medicines Office, European Medicines Agency, 30 Churchill Place, Canary Wharf, London E14 5 EU, UK
| | - Maria Elzbieta Sheean
- Orphan Medicines Office, European Medicines Agency, 30 Churchill Place, Canary Wharf, London E14 5 EU, UK; Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Robert-Rössle-Straße 10, Berlin 13125, Germany
| | - Segundo Mariz
- Orphan Medicines Office, European Medicines Agency, 30 Churchill Place, Canary Wharf, London E14 5 EU, UK
| | - Kristina Larsson
- Orphan Medicines Office, European Medicines Agency, 30 Churchill Place, Canary Wharf, London E14 5 EU, UK
| | - Frauke Naumann-Winter
- Committee of Orphan Medicinal Products, European Medicines Agency, 30 Churchill Place, Canary Wharf, London E14 5 EU, UK; Bundesinstitut für Arzneimittel und Medizinprodukte Kurt-Georg-Kiesinger-Allee 3, Bonn 53175, Germany
| | - Laura Fregonese
- Orphan Medicines Office, European Medicines Agency, 30 Churchill Place, Canary Wharf, London E14 5 EU, UK
| | - Bruno Sepodes
- Committee of Orphan Medicinal Products, European Medicines Agency, 30 Churchill Place, Canary Wharf, London E14 5 EU, UK; University of Lisbon, Faculty of Pharmacy, Avenida Prof. Gama Pinto, Lisboa 1649-003, Portugal
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Farkas AM, Mariz S, Stoyanova-Beninska V, Celis P, Vamvakas S, Larsson K, Sepodes B. Advanced Therapy Medicinal Products for Rare Diseases: State of Play of Incentives Supporting Development in Europe. Front Med (Lausanne) 2017; 4:53. [PMID: 28560211 PMCID: PMC5432638 DOI: 10.3389/fmed.2017.00053] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/20/2017] [Indexed: 01/01/2023] Open
Abstract
In 2008, the European Union introduced the Advanced Medicines Regulation aiming to improve regulation of advanced therapy medicinal products (ATMPs). We applied the ATMPs classification definitions in this Regulation to understand the link of this emerging group of medicinal products and the use of the Orphan Regulation. A total of 185 products that can be classified as ATMPs based on this Regulation have been submitted for orphan designation. Prior to its introduction in 2008, 4.5% of the products submitted for orphan designation met these criteria. This percentage went up to 15% after 2008. We analyzed several parameters associated with active ATMP ODDs focusing on sponsor type and EU-Member State origin, therapeutic area targeted, and ATMP classification [i.e., somatic cell therapy medicinal product, tissue-engineered product (TEP), or gene therapy medicinal product (GTMP)] and the use of regulatory services linked to incentives such as the use of protocol assistance (PA) and other Committees [Committee for Advanced Therapies (CAT) and the Pediatric Committee]. The aim here was to gain insight on the use of different services. The UK submits the largest number of ATMPs for ODD representing ~30% of the total to date. Few submissions have been received from central and Eastern European Member States as well as some of the larger Member States such as Germany (3.6%). ATMPs ODDs were primarily GTMPs (48.7%) and SCTMPs (43.3%). TEPs only represented 8% of all submissions for this medicinal class. This is different from non-ODDs ATMPs where GTMPs make only 20% of ATMPs. A total of 11.7% of ATMP ODDs had received formal CAT classification. A total of 29.8% of all orphan drug (OD) ATMPs requested PA. A total of 71.8% did not have an agreed pediatric investigation plan (PIP). Four products (Glybera one PA; Zalmoxis two; Holoclar one; Strimvelis three) have received a marketing authorization (MAA) and a 10-year market exclusivity. Strimvelis also completed their PIP, which was compliant and received the additional 2-year extension to their 10-year market exclusivity. One OD ATMP (Cerepro) received a negative opinion for MAA. The use of services linked to incentives offered by different legislations for ATMP ODDs is low, indicating a need for increasing awareness.
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Affiliation(s)
- Andreas M Farkas
- Human Medicines Research and Development Support Division, Product Development Scientific Support Department, European Medicines Agency, London, UK
| | - Segundo Mariz
- Human Medicines Research and Development Support Division, Product Development Scientific Support Department, European Medicines Agency, London, UK
| | - Violeta Stoyanova-Beninska
- College ter Beoordeling van Geneesmiddelen, Utrecht, Netherlands.,Committee of Orphan Medicinal Products, European Medicines Agency, London, UK
| | - Patrick Celis
- Human Medicines Research and Development Support Division, Product Development Scientific Support Department, European Medicines Agency, London, UK
| | - Spiros Vamvakas
- Human Medicines Research and Development Support Division, Product Development Scientific Support Department, European Medicines Agency, London, UK
| | - Kristina Larsson
- Human Medicines Research and Development Support Division, Product Development Scientific Support Department, European Medicines Agency, London, UK
| | - Bruno Sepodes
- Committee of Orphan Medicinal Products, European Medicines Agency, London, UK.,Universidade de Lisboa - Faculdade de Farmácia, Lisboa, Portugal
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Pauwels K, Huys I, Casteels M, Larsson K, Voltz C, Penttila K, Morel T, Simoens S. Are products with an orphan designation for oncology indications different from products for other rare indications? A retrospective analysis of European orphan designations granted between 2002-2012. Orphanet J Rare Dis 2017; 12:36. [PMID: 28209180 PMCID: PMC5314481 DOI: 10.1186/s13023-017-0578-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 12/04/2016] [Accepted: 01/24/2017] [Indexed: 11/23/2022] Open
Abstract
Background Orphan designated medicinal products benefit from regulatory and economic incentives for orphan drug development. Approximately 40% of orphan designations target rare neoplastic disorders, referring to rare cancers. In order to provide more insights in drugs for rare neoplastic disorders that are under development and to better understand the role of orphan designation in the development of oncology drugs, this study investigates the characteristics of the product, the indication and the applicants as well as the stage of development of products with an orphan designation for rare neoplastic disorders and compares them with products with an orphan designation for other rare indications. Therefore, orphan designation application files and annual reports submitted by the applicant were reviewed at the premises of the European Medicines Agency. Results At the time of application, 41.6% of products with orphan designation for rare neoplastic disorders were in pre-clinical phase; this was 65.1% for other rare conditions (p < 0.05). Thirty percent of orphan designations for rare neoplastic disorders had reached phase 1; compared to 19.3% of orphan designations targeting other rare conditions (p < 0.05). The same trend was observed for the stage of development at the time of the latest annual report. Significant benefit was more often considered for orphan designations for rare neoplastic disorders compared to orphan designations for other rare conditions. Conclusion Orphan designations for rare neoplastic disorders involve products that are in a more advanced stages of development compared to orphan designations for other (non-oncology) rare conditions.
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Affiliation(s)
- Kim Pauwels
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000, Leuven, Belgium.
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000, Leuven, Belgium
| | - Minne Casteels
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000, Leuven, Belgium
| | | | | | - Karri Penttila
- Finnish Medicines Agency, Helsinki, Finland.,Savonlinna Central Hospital, Savonlinna, Finland
| | - Thomas Morel
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000, Leuven, Belgium
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000, Leuven, Belgium
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Pauwels K, Huys I, Casteels M, Larsson K, Simoens S, Morel T. A comparative analysis of orphan designations for rare neoplastic disorders versus other rare indications. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30460-4] [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: 11/17/2022]
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26
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Larsson K, Cullen TD, Mezyk SP, McDowell RG, Martin LR. Complications in complexation kinetics for lanthanides with DTPA using dye probe molecules in aqueous solution. RSC Adv 2017. [DOI: 10.1039/c7ra04755j] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Dye probe molecules were used to investigate lanthanide complexation and verify the viability of the ligand displacement methodology for measuring DTPA complexation rate constants. Results showed that dye probes underestimate the rate constants.
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Affiliation(s)
- K. Larsson
- Department of Chemistry and Biochemistry
- California State University Long Beach
- Long Beach
- USA
| | - T. D. Cullen
- Department of Chemistry and Biochemistry
- California State University Long Beach
- Long Beach
- USA
| | - S. P. Mezyk
- Department of Chemistry and Biochemistry
- California State University Long Beach
- Long Beach
- USA
| | - R. G. McDowell
- Aqueous Separations and Radiochemistry Department
- Idaho National Laboratory
- Idaho Falls
- USA
| | - L. R. Martin
- Aqueous Separations and Radiochemistry Department
- Idaho National Laboratory
- Idaho Falls
- USA
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Abstract
When facing dependency, the majority of elderly men receive care from spouses whereas elderly women more often rely on relatives or public elder care. This Swedish population-based study of persons between ages 81 and 100 concerns public elder care and informal support in relation to having a coresiding caregiver. Findings indicate that men had higher odds of receiving care when coresident and/or extraresident and/or public home help services were included, compared to women, after controlling for functional and cognitive impairment as well as self-reported need of assistance with instrumental activities of daily living. After controlling also for coresiding, the gender differences disappeared. The main distinction was found between persons living alone and persons coresiding, not between men and women. Thus, when studying use of public elder care and support from relatives or friends, it is vital to include household composition, and thereby the possibility of receiving care from a coresiding caregiver, in the analyses.
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Affiliation(s)
| | - Mats Thorslund
- Stockholm University/Stockholm Gerontology Research Center
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29
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Amiryarahmadi N, Kropp W, Larsson K. Identification of Low-Frequency Forces Induced by Footsteps on Lightweight Floors. ACTA ACUST UNITED AC 2016. [DOI: 10.3813/aaa.918923] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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30
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Amiryarahmadi N, Kropp W, Larsson K. Application of LMS Algorithm to Measure Low-Frequency Transient Forces from Human Walking. ACTA ACUST UNITED AC 2016. [DOI: 10.3813/aaa.918921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kanatsuna N, Delli A, Andersson C, Nilsson AL, Vaziri-Sani F, Larsson K, Carlsson A, Cedervall E, Jönsson B, Neiderud J, Elding Larsson H, Ivarsson SA, Törn C, Fex M, Lernmark Å. Doubly Reactive INS-IGF2 Autoantibodies in Children with Newly Diagnosed Autoimmune (type 1) Diabetes. Scand J Immunol 2015; 82:361-9. [PMID: 26073034 DOI: 10.1111/sji.12325] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 04/28/2015] [Indexed: 01/30/2023]
Abstract
The splice variant INS-IGF2 entails the preproinsulin signal peptide, the insulin B-chain, eight amino acids of the C-peptide and 138 unique amino acids from an ORF in the IGF2 gene. The aim of this study was to determine whether levels of specific INS-IGF2 autoantibodies (INS-IGF2A) were related to age at diagnosis, islet autoantibodies, HLA-DQ or both, in patients and controls with newly diagnosed type 1 diabetes. Patients (n = 676), 0-18 years of age, diagnosed with type 1 diabetes in 1996-2005 and controls (n = 363) were analysed for specific INS-IGF2A after displacement with both cold insulin and INS-IGF2 to correct for non-specific binding and identify double reactive sera. GADA, IA-2A, IAA, ICA, ZnT8RA, ZnT8WA, ZnT8QA and HLA-DQ genotypes were also determined. The median level of specific INS-IGF2A was higher in patients than in controls (P < 0.001). Irrespective of age at diagnosis, 19% (126/676) of the patients had INS-IGF2A when the cut-off was the 95th percentile of the controls (P < 0.001). The risk of INS-IGF2A was increased among HLA-DQ2/8 (OR = 1.509; 95th CI 1.011, 2.252; P = 0.045) but not in 2/2, 2/X, 8/8, 8/X or X/X (X is neither 2 nor 8) patients. The association with HLA-DQ2/8 suggests that this autoantigen may be presented on HLA-DQ trans-heterodimers, rather than cis-heterodimers. Autoantibodies reactive with both insulin and INS-IGF2A at diagnosis support the notion that INS-IGF2 autoimmunity contributes to type 1 diabetes.
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Affiliation(s)
- N Kanatsuna
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
| | - A Delli
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
| | - C Andersson
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
| | - A-L Nilsson
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden.,Department of Pediatrics, Östersund Hospital, Östersund, Sweden
| | - F Vaziri-Sani
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
| | - K Larsson
- Department of Pediatrics, Kristianstad Hospital, Kristianstad, Sweden
| | - A Carlsson
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
| | - E Cedervall
- Department of Pediatrics, Ängelholm Hospital, Ängelholm, Sweden
| | - B Jönsson
- Department of Pediatrics, Ystad Hospital, Ystad, Sweden
| | - J Neiderud
- Department of Pediatrics, Helsingborg Hospital, Helsingborg, Sweden
| | - H Elding Larsson
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
| | - S-A Ivarsson
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
| | - C Törn
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
| | - M Fex
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
| | - Å Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
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Andersén Å, Larsson K, Kristiansson P, Anderzén I. Effects of individual tailored vocational rehabilitation in young adults with disabilities. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.005] [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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Abstract
Pre-breeding survival, i.e. survival from fledging up to the third winter, of barnacle geese (Branta leucopsis) was analysed by using more than 45000 resightings of 1302 individually marked birds. Since observations from the wintering areas only were used, the survival estimates obtained were not confounded by natal dispersal. Post-fledging survival, i.e. survival from fledging to the start of the first winter, differed significantly among the 10 cohorts analysed. These differences were related to the mean body weight and mean tarsus length of cohorts just before fledging. In further analyses, when data from all cohorts were combined, body weight and tarsus length of individuals just before fledging were found to be positively related to Post-fledging survival. Post-fledging survival rates were, on average, lower than survival rates after the first winter. This age effect was largest in cohorts with low mean body weight at capture and was absent in cohorts with high mean body weight at capture. The age effect on survival could only partly be explained by individuals with low body weight having lower survival and successively disappearing from the cohort. It was therefore concluded that other factors must have contributed to the age effect as well. It is hypothesized that lightweight birds are more vulnerable to, for example, diseases, parasites and predation during the first months of their life. Once they have survived this critical period, the effects of characters related to low body weight at capture seem to disappear. Body size of juveniles just before fledging has previously been found to be greatly affected by weather factors and the availability of high quality food during the growth period. Hence, a considerable part of the observed variation in Pre-breeding survival appears to be outside the individual's control.
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Affiliation(s)
- H P Jeugd
- Department of Zoology, Uppsala University, Villavägen 9, S-752 36 Uppsala, Sweden
| | - K Larsson
- Department of Zoology, Uppsala University, Villavägen 9, S-752 36 Uppsala, Sweden
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Casteleyn L, Dumez B, Becker K, Kolossa-Gehring M, Den Hond E, Schoeters G, Castaño A, Koch HM, Angerer J, Esteban M, Exley K, Sepai O, Bloemen L, Horvat M, Knudsen LE, Joas A, Joas R, Biot P, Koppen G, Dewolf MC, Katsonouri A, Hadjipanayis A, Cerná M, Krsková A, Schwedler G, Fiddicke U, Nielsen JKS, Jensen JF, Rudnai P, Közepésy S, Mulcahy M, Mannion R, Gutleb AC, Fischer ME, Ligocka D, Jakubowski M, Reis MF, Namorado S, Lupsa IR, Gurzau AE, Halzlova K, Jajcaj M, Mazej D, Tratnik Snoj J, Posada M, López E, Berglund M, Larsson K, Lehmann A, Crettaz P, Aerts D. A pilot study on the feasibility of European harmonized human biomonitoring: Strategies towards a common approach, challenges and opportunities. Environ Res 2015; 141:3-14. [PMID: 25746298 DOI: 10.1016/j.envres.2014.10.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/21/2014] [Accepted: 10/27/2014] [Indexed: 06/04/2023]
Abstract
In 2004 the European Commission and Member States initiated activities towards a harmonized approach for Human Biomonitoring surveys throughout Europe. The main objective was to sustain environmental health policy by building a coherent and sustainable framework and by increasing the comparability of data across countries. A pilot study to test common guidelines for setting up surveys was considered a key step in this process. Through a bottom-up approach that included all stakeholders, a joint study protocol was elaborated. From September 2011 till February 2012, 17 European countries collected data from 1844 mother-child pairs in the frame of DEMOnstration of a study to COordinate and Perform Human Biomonitoring on a European Scale (DEMOCOPHES).(1) Mercury in hair and urinary cadmium and cotinine were selected as biomarkers of exposure covered by sufficient analytical experience. Phthalate metabolites and Bisphenol A in urine were added to take into account increasing public and political awareness for emerging types of contaminants and to test less advanced markers/markers covered by less analytical experience. Extensive efforts towards chemo-analytical comparability were included. The pilot study showed that common approaches can be found in a context of considerable differences with respect to experience and expertize, socio-cultural background, economic situation and national priorities. It also evidenced that comparable Human Biomonitoring results can be obtained in such context. A European network was built, exchanging information, expertize and experiences, and providing training on all aspects of a survey. A key challenge was finding the right balance between a rigid structure allowing maximal comparability and a flexible approach increasing feasibility and capacity building. Next steps in European harmonization in Human Biomonitoring surveys include the establishment of a joint process for prioritization of substances to cover and biomarkers to develop, linking biomonitoring surveys with health examination surveys and with research, and coping with the diverse implementations of EU regulations and international guidelines with respect to ethics and privacy.
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Affiliation(s)
| | | | - K Becker
- Federal Environment Agency (UBA), Germany
| | | | | | | | - A Castaño
- Instituto de Salud Carlos III, Spain
| | - H M Koch
- Ruhr Universität Bochum, Germany
| | | | - M Esteban
- Instituto de Salud Carlos III, Spain
| | - K Exley
- Public Health England, United Kingdom
| | - O Sepai
- Public Health England, United Kingdom
| | - L Bloemen
- Environmental Health Sciences International, The Netherlands
| | - M Horvat
- Jožef Stefan Institute, Slovenia
| | | | | | | | - P Biot
- Federal Public Service Health, Food chain safety and Environment, Belgium
| | | | - M-C Dewolf
- Hainaut Vigilance Sanitaire (HVS) and Hygiene Publique in Hainaut (HPH), Belgium
| | | | | | - M Cerná
- National Institute of Public Health, Czech Republic
| | - A Krsková
- National Institute of Public Health, Czech Republic
| | | | | | | | | | - P Rudnai
- National Institute of Environmental Health, Hungary
| | - S Közepésy
- National Institute of Environmental Health, Hungary
| | | | | | - A C Gutleb
- Centre de Recherche Public - Gabriel Lippmann, Luxembourg
| | | | - D Ligocka
- Nofer Institute of Occupational Medicine, Poland
| | - M Jakubowski
- Nofer Institute of Occupational Medicine, Poland
| | - M F Reis
- Faculdade de Medicina de Lisboa, Portugal
| | - S Namorado
- Faculdade de Medicina de Lisboa, Portugal
| | - I-R Lupsa
- Environmental Health Center, Romania
| | | | - K Halzlova
- Urad Verejneho Zdravotnictva Slovenskej Republiky, Slovakia
| | - M Jajcaj
- Urad Verejneho Zdravotnictva Slovenskej Republiky, Slovakia
| | - D Mazej
- Jožef Stefan Institute, Slovenia
| | | | - M Posada
- Instituto de Salud Carlos III, Spain
| | - E López
- Instituto de Salud Carlos III, Spain
| | - M Berglund
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - K Larsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - A Lehmann
- Federal Office of Public Health (FOPH), Switzerland
| | - P Crettaz
- Federal Office of Public Health (FOPH), Switzerland
| | - D Aerts
- Federal Public Service Health, Food chain safety and Environment, Belgium
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Smolders R, Den Hond E, Koppen G, Govarts E, Willems H, Casteleyn L, Kolossa-Gehring M, Fiddicke U, Castaño A, Koch HM, Angerer J, Esteban M, Sepai O, Exley K, Bloemen L, Horvat M, Knudsen LE, Joas A, Joas R, Biot P, Aerts D, Katsonouri A, Hadjipanayis A, Cerna M, Krskova A, Schwedler G, Seiwert M, Nielsen JKS, Rudnai P, Közepesy S, Evans DS, Ryan MP, Gutleb AC, Fischer ME, Ligocka D, Jakubowski M, Reis MF, Namorado S, Lupsa IR, Gurzau AE, Halzlova K, Fabianova E, Mazej D, Tratnik Snoj J, Gomez S, González S, Berglund M, Larsson K, Lehmann A, Crettaz P, Schoeters G. Interpreting biomarker data from the COPHES/DEMOCOPHES twin projects: Using external exposure data to understand biomarker differences among countries. Environ Res 2015; 141:86-95. [PMID: 25440294 DOI: 10.1016/j.envres.2014.08.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/13/2014] [Accepted: 08/14/2014] [Indexed: 06/04/2023]
Abstract
In 2011 and 2012, the COPHES/DEMOCOPHES twin projects performed the first ever harmonized human biomonitoring survey in 17 European countries. In more than 1800 mother-child pairs, individual lifestyle data were collected and cadmium, cotinine and certain phthalate metabolites were measured in urine. Total mercury was determined in hair samples. While the main goal of the COPHES/DEMOCOPHES twin projects was to develop and test harmonized protocols and procedures, the goal of the current paper is to investigate whether the observed differences in biomarker values among the countries implementing DEMOCOPHES can be interpreted using information from external databases on environmental quality and lifestyle. In general, 13 countries having implemented DEMOCOPHES provided high-quality data from external sources that were relevant for interpretation purposes. However, some data were not available for reporting or were not in line with predefined specifications. Therefore, only part of the external information could be included in the statistical analyses. Nonetheless, there was a highly significant correlation between national levels of fish consumption and mercury in hair, the strength of antismoking legislation was significantly related to urinary cotinine levels, and we were able to show indications that also urinary cadmium levels were associated with environmental quality and food quality. These results again show the potential of biomonitoring data to provide added value for (the evaluation of) evidence-informed policy making.
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Affiliation(s)
- R Smolders
- Flemish Institute of Technological Research (VITO), Environmental Risks and Health Unit, Boeretang 200, 2400 Mol, Belgium.
| | - E Den Hond
- Flemish Institute of Technological Research (VITO), Environmental Risks and Health Unit, Boeretang 200, 2400 Mol, Belgium
| | - G Koppen
- Flemish Institute of Technological Research (VITO), Environmental Risks and Health Unit, Boeretang 200, 2400 Mol, Belgium
| | - E Govarts
- Flemish Institute of Technological Research (VITO), Environmental Risks and Health Unit, Boeretang 200, 2400 Mol, Belgium
| | - H Willems
- Flemish Institute of Technological Research (VITO), Environmental Risks and Health Unit, Boeretang 200, 2400 Mol, Belgium
| | | | | | - U Fiddicke
- Federal Environment Agency (UBA), Germany
| | - A Castaño
- Instituto de Salud Carlos III, Spain
| | - H M Koch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance - Institute of the Ruhr-Universität Bochum (IPA), Germany
| | - J Angerer
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance - Institute of the Ruhr-Universität Bochum (IPA), Germany
| | - M Esteban
- Instituto de Salud Carlos III, Spain
| | - O Sepai
- Public Health England, United Kingdom
| | - K Exley
- Public Health England, United Kingdom
| | - L Bloemen
- Environmental Health Sciences International, The Netherlands
| | - M Horvat
- Jožef Stefan Institute, Slovenia
| | | | | | | | - P Biot
- FPS Health, Food Chain Safety and Environment, Belgium
| | - D Aerts
- FPS Health, Food Chain Safety and Environment, Belgium
| | - A Katsonouri
- State General Laboratory, Ministry of Health, Cyprus
| | | | - M Cerna
- National Institute of Public Health, Czech Republic
| | - A Krskova
- National Institute of Public Health, Czech Republic
| | | | - M Seiwert
- Federal Environment Agency (UBA), Germany
| | | | - P Rudnai
- National Institute of Environmental Health, Hungary
| | - S Közepesy
- National Institute of Environmental Health, Hungary
| | - D S Evans
- Health Service Executive (HSE), Ireland
| | - M P Ryan
- University College Dublin (UCD), Ireland
| | - A C Gutleb
- Centre de Recherche Public - Gabriel Lippmann, Luxembourg
| | | | - D Ligocka
- Nofer Institute of Occupational Medicine, Poland
| | - M Jakubowski
- Nofer Institute of Occupational Medicine, Poland
| | - M F Reis
- Faculdade de Medicina de Lisboa, Portugal
| | - S Namorado
- Faculdade de Medicina de Lisboa, Portugal
| | - I-R Lupsa
- Environmental Health Center, Romania
| | | | - K Halzlova
- Úrad verejného zdravotníctva Slovenskej republiky, Slovakia
| | - E Fabianova
- Úrad verejného zdravotníctva Slovenskej republiky, Slovakia
| | - D Mazej
- Jožef Stefan Institute, Slovenia
| | | | - S Gomez
- Instituto de Salud Carlos III, Spain
| | | | | | | | - A Lehmann
- Federal Office of Public Health (FOPH), Switzerland
| | - P Crettaz
- Federal Office of Public Health (FOPH), Switzerland
| | - G Schoeters
- Flemish Institute of Technological Research (VITO), Environmental Risks and Health Unit, Boeretang 200, 2400 Mol, Belgium; University of Antwerp, Belgium; Southern Denmark University, Odense, Denmark
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Fucic A, Plavec D, Casteleyn L, Aerts D, Biot P, Katsonouri A, Cerna M, Knudsen LE, Castano A, Rudnai P, Gutleb A, Ligocka D, Lupsa IR, Berglund M, Horvat M, Halzlova K, Schoeters G, Koppen G, Hadjipanayis A, Krskova A, Középesy S, Arendt M, Fischer ME, Janasik B, Gurzau AE, Gurzau ES, Grandér M, Larsson K, Jajcaj M, Kolossa-Gehring M, Sepai O, Exley K, Bartolome M, Cutanda F, Mazej D, Nielsen JKS, Snoj-Tratnik J, Schwedler G, Fiddicke U, Seiwert M, Govarts E, Den Hond E, Koch HM, Lopez A, Joas A, Joas R. Gender differences in cadmium and cotinine levels in prepubertal children. Environ Res 2015; 141:125-131. [PMID: 25529752 DOI: 10.1016/j.envres.2014.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 08/27/2014] [Accepted: 10/01/2014] [Indexed: 06/04/2023]
Abstract
Susceptibility to environmental stressors has been described for fetal and early childhood development. However, the possible susceptibility of the prepubertal period, characterized by the orchestration of the organism towards sexual maturation and adulthood has been poorly investigated and exposure data are scarce. In the current study levels of cadmium (Cd), cotinine and creatinine in urine were analyzed in a subsample 216 children from 12 European countries within the DEMOCOPHES project. The children were divided into six age-sex groups: boys (6-8 years, 9-10 years and 11 years old), and girls (6-7 years, 8-9 years, 10-11 years). The number of subjects per group was between 23 and 53. The cut off values were set at 0.1 µg/L for Cd, and 0.8 µg/L for cotinine defined according to the highest limit of quantification. The levels of Cd and cotinine were adjusted for creatinine level. In the total subsample group, the median level of Cd was 0.180 µg/L (range 0.10-0.69 µg/L), and for cotinine the median wet weight value was 1.50 µg/L (range 0.80-39.91 µg/L). There was no significant difference in creatinine and cotinine levels between genders and age groups. There was a significant correlation between levels of cadmium and creatinine in all children of both genders. This shows that even at such low levels the possible effect of cadmium on kidney function was present and measurable. An increase in Cd levels was evident with age. Cadmium levels were significantly different between 6-7 year old girls, 11 year old boys and 10-11 year old girls. As there was a balanced distribution in the number of subjects from countries included in the study, bias due to data clustering was not probable. The impact of low Cd levels on kidney function and gender differences in Cd levels needs further investigation.
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Affiliation(s)
- A Fucic
- Institute for Medical Research and Occupational Health, Ksaverska c 2, 10000 Zagreb, Croatia.
| | - D Plavec
- Children Hospital Srebrnjak, Croatia
| | | | - D Aerts
- Federal Public Service Health, Food Chain Safety and Environment - DG Environment, Belgium
| | - P Biot
- DG Environment, Multilateral and Strategic Affairs, Belgium
| | - A Katsonouri
- State General Laboratory, Ministry of Health, Cyprus
| | - M Cerna
- Laboratoire National de Sante, Luxembourg; National Institute of Public Health, Czech Republic
| | | | - A Castano
- Instituto de Salud Carlos III, Spain
| | - P Rudnai
- National Institute of Environmental Health, Hungary
| | - A Gutleb
- Centre de Recherche Public - Gabriel Lippmann, Luxembourg
| | - D Ligocka
- Nofer Institute of Occupational Medicine, Poland
| | - I-R Lupsa
- Environmental Health Center, Romania
| | - M Berglund
- Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - M Horvat
- Institute Josef Stefan, Slovenia
| | - K Halzlova
- Public Health Authority, Slovak Republic; State General Laboratory, Ministry of Health, Cyprus
| | - G Schoeters
- Flemish Institute for Technological Research (VITO), Environmental Risk and Health, Netherlands
| | - G Koppen
- Flemish Institute for Technological Research (VITO), Environmental Risk and Health, Netherlands
| | - A Hadjipanayis
- Larnaca General Hospital, Ministry of Health, Republic of Cyprus
| | - A Krskova
- Laboratoire National de Sante, Luxembourg; National Institute of Public Health, Czech Republic
| | - S Középesy
- National Institute of Environmental Health, Hungary
| | - M Arendt
- Initiativ Liewensufank, Luxembourg
| | - M E Fischer
- Laboratoire National de Sante, Luxembourg; National Institute of Public Health, Czech Republic
| | - B Janasik
- Nofer Institute of Occupational Medicine, Poland
| | | | | | - M Grandér
- Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - K Larsson
- Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - M Jajcaj
- Institute Josef Stefan, Slovenia
| | | | | | | | | | - F Cutanda
- Instituto de Salud Carlos III, Spain
| | - D Mazej
- Institute Josef Stefan, Slovenia
| | | | | | | | - U Fiddicke
- Federal Environment Agency (UBA), Germany
| | - M Seiwert
- Federal Environment Agency (UBA), Germany
| | - E Govarts
- Flemish Institute for Technological Research (VITO), Environmental Risk and Health, Netherlands
| | - E Den Hond
- Flemish Institute for Technological Research (VITO), Environmental Risk and Health, Netherlands
| | - H M Koch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance - Institute of the Ruhr-Universität Bochum (IPA), Germany
| | - A Lopez
- Instituto de Salud Carlos III, Spain
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Raouf J, Mobarrez F, Larsson K, Jakobsson PJ, Korotkova M. A2.1 The effect of mPGES-1 deletion on platelet function in mice. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-207259.36] [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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Ojala M, Rajala K, Polonen RP, Larsson K, Aalto-Setala K. P586Modeling hypertrophic cardiomyopathy with human induced pluripotent stem cells. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu098.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Wamers F, Marganiec J, Aksouh F, Aksyutina Y, Álvarez-Pol H, Aumann T, Beceiro-Novo S, Bertulani C, Boretzky K, Borge M, Chartier M, Chatillon A, Chulkov L, Cortina-Gil D, Egorova I, Emling H, Ershova O, Forssén C, Fraile L, Fynbo H, Galaviz D, Geissel H, Grigorenko L, Heil M, Hoffmann D, Hoffmann J, Johansson H, Jonson B, Karagiannis C, Karakoç M, Kiselev O, Kratz J, Kulessa R, Kurz N, Langer C, Lantz M, Larsson K, Bleis TL, Lemmon R, Litvinov Y, Mahata K, Müntz C, Nilsson T, Nociforo C, Nyman G, Ott W, Panin V, Parfenova Y, Paschalis S, Perea A, Plag R, Reifarth R, Richter A, Rodriguez-Tajes C, Rossi D, Riisager K, Savran D, Schrieder G, Shul’gina N, Simon H, Stroth J, Sümmerer K, Taylor J, Tengblad O, Tengborn E, Weick H, Wimmer C, Zhukov M. Exclusive measurements of nuclear breakup reactions of 17Ne. EPJ Web of Conferences 2014. [DOI: 10.1051/epjconf/20146603094] [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: 11/14/2022] Open
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Palmqvist E, Larsson K, Anell A, Hjalmarsson C. Prospective study of pain, quality of life and the economic impact of open inguinal hernia repair. Br J Surg 2013; 100:1483-8. [PMID: 24037569 DOI: 10.1002/bjs.9232] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND There are variations in quality of life (QoL) and reported risk of chronic pain after inguinal hernia repair. The aim of this study was to investigate the improvement in pain and QoL after open inguinal hernia repair, and the economic impact. METHODS Patients undergoing open mesh repair of a primary unilateral inguinal hernia were stratified depending on preoperative levels of symptoms and pain. Short Form 36 (SF-36®) and EQ-5D™ questionnaires were filled in before, and at 3 and 12 months after surgery. EQ-5D™ data, together with information on the mean value of a quality-adjusted life-year and the societal cost of hernia repair, were used to calculate the monetary value of QoL gained and the mean return on investment. RESULTS Of 225 patients who began the study, 184 completed follow-up at 12 months. Some 77·2 per cent reported improvement in pain and 5·4 per cent reported increased pain after surgery. Significant improvement in SF-36® scores, pain scores measured on a visual analogue scale (VAS), and symptoms were found in the majority of patients, even those with mild symptoms before surgery. For the whole group, the bodily pain score increased from 56·4 before surgery to 82·6 at 12 months after hernia repair (P < 0·050), and the VAS score decreased from a median of 4 to 0 (P < 0·050). The return on investment was positive for all groups of patients, including those with mild symptoms. CONCLUSION QoL improves after open inguinal hernia repair, with a good return on investment independent of symptom severity.
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Affiliation(s)
- E Palmqvist
- Departments of Surgery, Hospital of Halland, Halmstad, Lund, Sweden
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Jonker RM, Kraus RHS, Zhang Q, van Hooft P, Larsson K, van der Jeugd HP, Kurvers RHJM, van Wieren SE, Loonen MJJE, Crooijmans RPMA, Ydenberg RC, Groenen MAM, Prins HHT. Genetic consequences of breaking migratory traditions in barnacle geeseBranta leucopsis. Mol Ecol 2013; 22:5835-47. [DOI: 10.1111/mec.12548] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 09/18/2013] [Accepted: 09/20/2013] [Indexed: 11/27/2022]
Affiliation(s)
- R. M. Jonker
- Resource Ecology Group; Wageningen University; Droevendaalsesteeg 3a 6708 PB Wageningen The Netherlands
- Department of Animal Behaviour; University of Bielefeld; Morgenbreede 45 33615 Bielefeld Germany
| | - R. H. S. Kraus
- Resource Ecology Group; Wageningen University; Droevendaalsesteeg 3a 6708 PB Wageningen The Netherlands
- Conservation Genetics Group; Senckenberg Research Institute and Natural History Museum; Clamecystraße 12 63571 Gelnhausen Germany
| | - Q. Zhang
- Resource Ecology Group; Wageningen University; Droevendaalsesteeg 3a 6708 PB Wageningen The Netherlands
- Key Laboratory of Animal Ecology and Conservation Biology; Institute of Zoology; Chinese Academy of Sciences; Beijing 100101 China
| | - P. van Hooft
- Resource Ecology Group; Wageningen University; Droevendaalsesteeg 3a 6708 PB Wageningen The Netherlands
| | - K. Larsson
- Kalmar Maritime Academy; Linnaeus University; 391 82 Kalmar Sweden
| | - H. P. van der Jeugd
- Dutch Centre for Avian Migration and Demography; NIOO-KNAW; Droevendaalsesteeg 10 6708 PB Wageningen The Netherlands
| | - R. H. J. M. Kurvers
- Resource Ecology Group; Wageningen University; Droevendaalsesteeg 3a 6708 PB Wageningen The Netherlands
- Leibniz Institute of Freshwater Ecology and Inland Fisheries; Müggelseedamm 310 12587 Berlin Germany
| | - S. E. van Wieren
- Resource Ecology Group; Wageningen University; Droevendaalsesteeg 3a 6708 PB Wageningen The Netherlands
| | - M. J. J. E. Loonen
- Arctic Centre; University of Groningen; Aweg 30 9718 CW Groningen The Netherlands
| | - R. P. M. A. Crooijmans
- Animal Breeding and Genomics Centre; Wageningen University; P.O. Box 338 6700 AH Wageningen The Netherlands
| | - R. C. Ydenberg
- Resource Ecology Group; Wageningen University; Droevendaalsesteeg 3a 6708 PB Wageningen The Netherlands
- Department of Biological Sciences; Centre for Wildlife Ecology; Simon Fraser University; Burnaby BC Canada V5A 1S6
| | - M. A. M. Groenen
- Animal Breeding and Genomics Centre; Wageningen University; P.O. Box 338 6700 AH Wageningen The Netherlands
| | - H. H. T. Prins
- Resource Ecology Group; Wageningen University; Droevendaalsesteeg 3a 6708 PB Wageningen The Netherlands
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Ek A, Middelveld RJM, Bertilsson H, Bjerg A, Ekerljung L, Malinovschi A, Stjärne P, Larsson K, Dahlén SE, Janson C. Chronic rhinosinusitis in asthma is a negative predictor of quality of life: results from the Swedish GA(2)LEN survey. Allergy 2013; 68:1314-21. [PMID: 24107218 DOI: 10.1111/all.12222] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Asthma and chronic rhinosinusitis (CRS) both impair quality of life, but the quality-of-life impact of comorbid asthma and CRS is poorly known. The aim of this study was to evaluate the impact of CRS and other relevant factors on quality of life in asthmatic subjects. METHODS This Swedish cohort (age 17-76 years) consists of 605 well-characterized asthmatics with and without CRS, 110 individuals with CRS only, and 226 controls and is part of the Global Allergy and Asthma European Network (GA(2) LEN) survey. The Mini Asthma Quality of Life Questionnaire (mAQLQ), the Euro Quality of Life (EQ-5D) health questionnaire, spirometry, skin prick test (SPT), exhaled nitric oxide (FeNO), smell test, and peak nasal inspiratory flow were used. RESULTS Subjects having both asthma and CRS have lower mAQLQ scores in all domains (P < 0.001) and a lower EQ-5D index value and EQ-5D VAS value (P < 0.001) compared to those with asthma only. Asthmatics with CRS have significantly lower FEV1%pred and FVC%pred (88.4 [85.1-91.7] and 99.9 [96.7-103.0], respectively) compared with asthma only (91.9 [90.3-93.4] and 104.0 [102.5-105.5], respectively P < 0.05). Multiple regression analysis shows that low asthma quality of life is associated with having CRS (P < 0.0001), lower lung function (P = 0.008), current smoking (P = 0.01), BMI > 30 kg/m2 (P = 0.04), high age (P = 0.03), and a negative SPT (P = 0.04). CONCLUSIONS Comorbid CRS was a significant and independent negative predictor of quality of life in asthmatics. Other negative factors were lower lung function, current smoking, obesity, advanced age, and having nonatopic asthma.
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Affiliation(s)
- A. Ek
- Experimental Asthma and Allergy Research Unit; Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - R. J. M. Middelveld
- The Centre for Allergy Research and Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - H. Bertilsson
- Department of Public Health and Clinical Medicine: Occupational and Environmental Medicine; Umeå University; Umeå; Sweden
| | - A. Bjerg
- Krefting Research Centre; Department of Internal Medicine and Clinical Nutrition; Sahlgrenska Academy; University of Gothenburg; Göteborg; Sweden
| | - L. Ekerljung
- Krefting Research Centre; Department of Internal Medicine and Clinical Nutrition; Sahlgrenska Academy; University of Gothenburg; Göteborg; Sweden
| | - A. Malinovschi
- Department of Medical Sciences: Clinical Physiology; Uppsala University; Uppsala; Sweden
| | - P. Stjärne
- Department of Clinical Science; Intervention and Technology: Otorhinolaryngology; Karolinska Institutet; Stockholm; Sweden
| | - K. Larsson
- Lung and Allergy Research Unit; Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - S.-E. Dahlén
- Experimental Asthma and Allergy Research Unit; Institute of Environmental Medicine; Karolinska Institutet; Stockholm; Sweden
| | - C. Janson
- Department of Medical Sciences: Respiratory Medicine and Allergology; Uppsala University; Uppsala; Sweden
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Larsson K, Janson C, Lisspers K, Jørgensen L, Stratelis G, Telg G, Ställberg B, Johansson G. Combination of budesonide/formoterol more effective than fluticasone/salmeterol in preventing exacerbations in chronic obstructive pulmonary disease: the PATHOS study. J Intern Med 2013; 273:584-94. [PMID: 23495860 DOI: 10.1111/joim.12067] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Combinations of inhaled corticosteroids (ICSs) and long-acting β2 -agonists (LABAs) are recommended for patients with moderate and severe chronic obstructive pulmonary disease (COPD). However, it is not known whether different fixed combinations are equally effective. The aim of this study was to investigate exacerbation rates in primary care patients with COPD treated with budesonide/formoterol compared with fluticasone/salmeterol. METHODS Patients with physician-diagnosed COPD and a record of postdiagnosis treatment with a fixed combination of budesonide/formoterol or fluticasone/salmeterol were included. Data from primary care medical records were linked to those from Swedish national hospital, drug and cause of death registers. Pairwise (1 : 1) propensity score matching was carried out at the index date (first prescription) by prescribed fixed ICS/LABA combination. Exacerbations were defined as hospitalizations, emergency visits and collection of oral steroids or antibiotics for COPD. Yearly event rates were compared using Poisson regression. RESULTS Matching of 9893 patients (7155 budesonide/formoterol and 2738 fluticasone/salmeterol) yielded two cohorts of 2734 patients, comprising 19 170 patient-years. The exacerbation rates were 0.80 and 1.09 per patient-year in the budesonide/formoterol and fluticasone/salmeterol groups, respectively (difference of 26.6%; P < 0.0001); yearly rates for COPD-related hospitalizations were 0.15 and 0.21, respectively (difference of 29.1%; P < 0.0001). All other healthcare outcomes were also significantly reduced with budesonide/formoterol versus fluticasone/salmeterol. CONCLUSIONS Long-term treatment with fixed combination budesonide/formoterol was associated with fewer healthcare utilization-defined exacerbations than fluticasone/salmeterol in patients with moderate and severe COPD.
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Affiliation(s)
- K Larsson
- Unit of Lung and Allergy Research, National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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Abu Khamidakh A, Juuti-Uusitalo K, Larsson K, Skottman H, Hyttinen J. Intercellular Ca2+ wave propagation in human retinal pigment epithelium cells induced by mechanical stimulation. Exp Eye Res 2013; 108:129-39. [DOI: 10.1016/j.exer.2013.01.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 01/10/2013] [Accepted: 01/14/2013] [Indexed: 01/19/2023]
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46
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Eriksson J, Ekerljung L, Sundblad BM, Lötvall J, Torén K, Rönmark E, Larsson K, Lundbäck B. Cigarette smoking is associated with high prevalence of chronic rhinitis and low prevalence of allergic rhinitis in men. Allergy 2013; 68:347-54. [PMID: 23346908 DOI: 10.1111/all.12095] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2012] [Indexed: 01/17/2023]
Abstract
BACKGROUND The harmful effects of tobacco smoke on human health, including respiratory health, are extensive and well documented. Previous data on the effect of smoking on rhinitis and allergic sensitization are inconsistent. We sought to investigate how smoking correlates with prevalence of allergic and chronic rhinitis among adults in Sweden. METHODS The study population comprised 27 879 subjects derived from three large randomly selected cross-sectional population surveys conducted in Sweden between 2006 and 2008. The same postal questionnaire on respiratory health was used in the three surveys, containing questions about obstructive respiratory diseases, rhinitis, respiratory symptoms and possible determinants of disease, including smoking habits. A random sample from one of the cohorts underwent a clinical examination including skin prick testing. RESULTS Smoking was associated with a high prevalence of chronic rhinitis in both men and women and a low prevalence of allergic rhinitis in men. These associations were dose dependent and remained when adjusted for a number of possible confounders in multiple logistic regression analysis. Prevalence of chronic rhinitis was lowest in nonsmokers and highest in very heavy smokers (18.5% vs 34.5%, P < 0.001). Prevalence of sensitization to common airborne allergens was lower in current smokers (25.9%, P = 0.008) and ex-smokers (28.2%, P = 0.022) than in nonsmokers (38.5%). CONCLUSION We found that smoking was associated with a high prevalence of chronic rhinitis in both sexes and a low prevalence of allergic rhinitis in men. The associations were dose dependent and remained when adjusting for several possible confounders.
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Affiliation(s)
- J. Eriksson
- Krefting Research Centre / Department of Internal Medicine and Clinical Nutrition; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg; Sweden
| | - L. Ekerljung
- Krefting Research Centre / Department of Internal Medicine and Clinical Nutrition; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg; Sweden
| | - B.-M. Sundblad
- Lung and Allergy Research; National Institute of Environmental Medicine; Karolinska Institute; Stockholm; Sweden
| | - J. Lötvall
- Krefting Research Centre / Department of Internal Medicine and Clinical Nutrition; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg; Sweden
| | | | | | - K. Larsson
- Lung and Allergy Research; National Institute of Environmental Medicine; Karolinska Institute; Stockholm; Sweden
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Nilsson E, Larsson K, Rydevik B, Brisby H, Hammar I. Evoked thalamic neuronal activity following DRG application of two nucleus pulposus derived cell populations: an experimental study in rats. Eur Spine J 2013; 22:1113-8. [PMID: 23341046 DOI: 10.1007/s00586-013-2669-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 10/18/2012] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE To investigate the effects on evoked thalamic neuronal activity of application of notochordal cells and chondrocyte-like cells derived from nucleus pulposus (NP) onto a dorsal root ganglion (DRG) and to compare these effects with a previously reported increased thalamic activity induced by NP. METHODS Nucleus pulposus was harvested from tail discs of adult rats and the disc cells were separated into two cell populations, notochordal cells and chondrocyte-like cells. The two cell populations were applied separately, or in combination, to the L4 DRG of anaesthetised female Sprague-Dawley rats during acute electrophysiological experiments. In control experiments, cell suspension medium was applied on the DRG. Recordings from the contralateral thalamus were sampled for 40 min while electrically stimulating the ipsilateral sciatic nerve at above Aδ-fibre thresholds. RESULTS Application of notochordal cells resulted in a decrease in evoked thalamic activity within 10 min while chondrocyte-like cells did not induce any changes during the 40 min of recording. The difference in evoked thalamic activity 40 min after notochordal and chondrocyte-like cell application, respectively, was statistically significant. Neither an increased concentration of chondrocyte-like cells alone nor a combination of the two cell populations induced any changes in thalamic activity. CONCLUSIONS Separate exposure of the DRG to the two NP-derived cell populations induced different effects on evoked thalamic activity, but none of the tested cell samples induced an increase in neuronal activity similar to that previously observed with NP. This indicates a high complexity of the interaction between NP and nervous tissue.
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Affiliation(s)
- E Nilsson
- Department of Physiology, Institute of Neuroscience and Physiology, University of Gothenburg, PO Box 432, 405 30, Gothenburg, Sweden.
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Heiwe S, Nilsson-Kajermo K, Olsson M, Gåfvels C, Larsson K, Wengström Y. Evidence-based practice among Swedish medical social workers. Soc Work Health Care 2013; 52:947-958. [PMID: 24255977 DOI: 10.1080/00981389.2013.834029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We have explored Swedish medical social workers' attitudes, beliefs, knowledge, and behavior concerning evidence-based practice (EBP) and investigated the properties of a questionnaire to measure EBP. One hundred seventy-four Swedish medical social workers within university hospital care and primary care participated in a cross-sectional survey. Our results showed positive attitudes toward EBP and the use of evidence to support clinical decision making. EBP was seen as necessary and something that needed to be implemented more often. The main barriers to implementing EBP were lack of time (78%), the perception that EBP does not take into account the limitations of the clinical practice setting (78%), and lack of knowledge about relevant research (46%).
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Affiliation(s)
- Susanne Heiwe
- a Department of Medicine and Department of Clinical Sciences , Karolinska Institutet , Stockholm , Sweden
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Olofsson J, Pettersson M, Teuscher N, Heilmann A, Larsson K, Grandfield K, Persson C, Jacobson S, Engqvist H. Fabrication and evaluation of SixNy coatings for total joint replacements. J Mater Sci Mater Med 2012; 23:1879-1889. [PMID: 22689010 DOI: 10.1007/s10856-012-4625-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 03/17/2012] [Indexed: 06/01/2023]
Abstract
Wear particles from the bearing surfaces of joint implants are one of the main limiting factors for total implant longevity. Si(3)N(4) is a potential wear resistant alternative for total joint replacements. In this study, Si(x)N(y)-coatings were deposited on cobalt chromium-discs and Si-wafers by a physical vapour deposition process. The tribological properties, as well as surface appearance, chemical composition, phase composition, structure and hardness of these coatings were analysed. The coatings were found to be amorphous or nanocrystalline, with a hardness and coefficient of friction against Si(3)N(4) similar to that found for bulk Si(3)N(4). The low wear rate of the coatings indicates that they have a potential as bearing surfaces of joint replacements. The adhesion to the substrates remains to be improved.
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Affiliation(s)
- J Olofsson
- Applied Materials Science, Uppsala University, Uppsala, Sweden.
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Casper J, Holowiecki J, Trenschel R, Wandt H, Schaefer-Eckart K, Ruutu T, Volin L, Einsele H, Stuhler G, Uharek L, Blau I, Bornhaeuser M, Zander AR, Larsson K, Markiewicz M, Giebel S, Kruzel T, Mylius HA, Baumgart J, Pichlmeier U, Freund M, Beelen DW. Allogeneic hematopoietic SCT in patients with AML following treosulfan/fludarabine conditioning. Bone Marrow Transplant 2011; 47:1171-7. [PMID: 22158386 DOI: 10.1038/bmt.2011.242] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
An alternative reduced-toxicity conditioning regimen for allogeneic transplantation, based on treosulfan and fludarabine, has recently been identified. The safety and efficacy of this new conditioning regimen has been investigated prospectively in patients with AML. A total number of 75 patients with AML in CR were treated with 3 × 14 g/m(2) treosulfan and 5 × 30 mg/m(2) fludarabine, followed by matched sibling or unrelated SCT. Patients were evaluated for engraftment, adverse events, GVHD, and for non-relapse mortality, relapse incidence, overall and disease-free survival (DFS). All patients showed primary engraftment of neutrophils after a median of 20 days. Non-hematological adverse events grade III-IV in severity included mainly infections (59%) and gastrointestinal symptoms (7%). Acute GVHD grade II-IV occurred in 21% and extensive chronic GVHD occurred in 16% of the patients. After a median follow-up of 715 days, the 2-year overall and DFS estimates were 61% and 55%, respectively. The 2-year incidences of relapse and non-relapse mortality reached 34% and 11%, respectively. In summary, our data confirm promising safety and efficacy of the treosulfan-based conditioning therapy in AML patients, ClinicalTrials.gov Identifier: NCT01063660.
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Affiliation(s)
- J Casper
- Division of Hematology and Oncology, University of Rostock, Rostock, Germany.
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