1
|
Soong W, Chipps BE, O'Quinn S, Trevor J, Carr WW, Belton L, Trudo F, Ambrose CS. Health-Related Quality of Life and Productivity Among US Patients with Severe Asthma. J Asthma Allergy 2021; 14:713-725. [PMID: 34211280 PMCID: PMC8240863 DOI: 10.2147/jaa.s305513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/09/2021] [Indexed: 01/01/2023] Open
Abstract
Background Health-related quality of life (HRQoL) and productivity of patients with confirmed severe asthma (SA) have not been well characterized in large, real-world populations. Purpose To characterize SA impact on HRQoL, work productivity, and activity impairment in a large, real-world cohort in the United States (US). Methods CHRONICLE is an observational study of specialist-treated adults (≥18 years) in the US with SA receiving biologics or maintenance systemic corticosteroids (mSCS), or those persistently uncontrolled by high-dosage inhaled corticosteroids with additional controllers (HD ICS+). At enrollment, patients completed the St. George’s Respiratory Questionnaire (SGRQ) and Work Productivity and Activity Impairment (WPAI) questionnaire. Results were analyzed for those enrolled between February 2018 and February 2020. Results Among patients who completed enrollment questionnaires (n = 1109), mean age was 54 years and most were women (70%). Among SGRQ respondents (n = 960), mean (SD) total score was 43 (23); 51% reported good/very good health. Among WPAI respondents (n = 1057; 566 employed), mean (SD) overall work impairment was 21% (25). Patients receiving biologics (vs mSCS, HD ICS+ only) had better SGRQ total scores (38 vs 59, 48) and lower work impairment (17% vs 34%, 27%). Patients with better SGRQ activity scores relative to symptom scores had better SGRQ impacts scores, total scores, and reported better overall health. Conclusion SA significantly affects HRQoL, work productivity, and activity. The SGRQ is a valuable research instrument for evaluating HRQoL in SA. Due to its association with HRQoL and overall health, activity impairment should be a focus when monitoring patients’ disease control. Study Registration ClinicalTrials.gov Identifier: NCT03373045.
Collapse
Affiliation(s)
- Weily Soong
- Alabama Allergy & Asthma Center, Birmingham, AL, USA
| | - Bradley E Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, CA, USA
| | - Sean O'Quinn
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA
| | | | - Warner W Carr
- Allergy & Asthma Associates of Southern California, Mission Viejo, CA, USA
| | | | - Frank Trudo
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA
| | | |
Collapse
|
2
|
Harrison T, Pavord ID, Chalmers JD, Whelan G, Fagerås M, Rutgersson A, Belton L, Siddiqui S, Gustafson P. Variability in airway inflammation, symptoms, lung function and reliever use in asthma: anti-inflammatory reliever hypothesis and STIFLE study design. ERJ Open Res 2020; 6:00333-2019. [PMID: 32550224 PMCID: PMC7276524 DOI: 10.1183/23120541.00333-2019] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/24/2020] [Indexed: 11/05/2022] Open
Abstract
Asthma is a chronic inflammatory airway disease. Increase in airway inflammation is hypothesised to contribute to worsening of asthma symptoms and deterioration in lung function, resulting in the use of reliever medication. Short-acting β2-agonists only treat the symptoms, whereas an anti-inflammatory reliever is believed to treat both symptoms and the underlying inflammation, thereby arresting the progression to an exacerbation. As-needed budesonide/formoterol as an anti-inflammatory reliever reduces the risk of severe exacerbations. However, supporting mechanistic evidence has not yet been described, specifically the temporal dynamics of parameters including airway inflammation, over time and during asthma worsening. The STIFLE study aims to characterise daily variability in airway inflammation, symptoms, lung function and reliever use in people with asthma. This phase IV, open-label, parallel-group, multicentre, exploratory study will enrol 60-80 adult patients with asthma receiving low- or medium-dose inhaled corticosteroids/long-acting β2-agonists (EudraCT identifier number 2018-003467-64). Participants will be randomised 1:1 to either as-needed budesonide/formoterol dry-powder inhaler or salbutamol reliever for 24 weeks, in addition to their maintenance therapy. Daily data will be captured for fractional exhaled nitric oxide, spirometry, asthma symptoms and medication use using devices connected to a smartphone via the STIFLE application. STIFLE will thereby enable not only characterisation of the variability of airway inflammation and clinical outcomes in relation to asthma worsening, but also elucidate the effect of as-needed budesonide/formoterol on airway inflammation against a background of daily maintenance therapy.
Collapse
Affiliation(s)
- Tim Harrison
- Nottingham NIHR Biomedical Research Unit, University of Nottingham, Nottingham, UK
| | - Ian D Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | | | | | | | | | | | | |
Collapse
|
3
|
Tran TN, King E, Sarkar R, Nan C, Rubino A, O'Leary C, Muzwidzwa R, Belton L, Quint JK. Oral corticosteroid prescription patterns for asthma in France, Germany, Italy and the UK. Eur Respir J 2020; 55:13993003.02363-2019. [PMID: 32165402 PMCID: PMC7270349 DOI: 10.1183/13993003.02363-2019] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/27/2020] [Indexed: 01/01/2023]
Abstract
Oral corticosteroids (OCS) are used to manage asthma exacerbations and severe, uncontrolled asthma, but OCS use is associated with adverse effects. We aimed to describe the patterns of OCS use in the real-world management of patients with asthma in western Europe. We used electronic medical records from databases in France, Germany, Italy and the United Kingdom from July 2011 through February 2018. Patients aged ≥12 years with an asthma diagnosis, at least one non-OCS asthma medication within ±6 months of diagnosis, and available data ≥6 months prior to and ≥90 days after cohort entry were included. High OCS use was defined as OCS ≥450 mg prescribed in a 90-day window during follow-up. Baseline characteristics and OCS use during follow-up were described overall and by OCS use status. Of 702 685 patients with asthma, 14–44% were OCS users and 6–9% were high OCS users at some point during follow-up. Annual prevalence of high OCS use across all countries was ∼3%. High OCS users had a mean of between one and three annual OCS prescriptions, with an average daily OCS dosage of 1.3–2.2 mg. For patients who continued to meet the high-use definition, daily OCS exposure was generally stable at 5.5–7.5 mg for ≥2 years, increasing the risk of adverse effects. Our study demonstrates that OCS use is relatively common across the four studied European countries. Data from this study may provide decisive clinical insights to inform primary care physicians and specialists involved in the management of severe, uncontrolled asthma. This study gives a real-world snapshot of oral corticosteroid (OCS) use in western Europe, by highlighting an opportunity to shift towards corticosteroid-sparing therapies or safer alternatives that mitigate the risk of OCS-associated adverse effects http://bit.ly/3cB8kk8
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
| |
Collapse
|
4
|
Moore WC, Panettieri RA, Trevor J, Ledford DK, Lugogo N, Soong W, Chipps BE, Carr W, Belton L, Gandhi H, Trudo F, Ambrose CS. Biologic and maintenance systemic corticosteroid therapy among US subspecialist-treated patients with severe asthma. Ann Allergy Asthma Immunol 2020; 125:294-303.e1. [PMID: 32304877 DOI: 10.1016/j.anai.2020.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Severe asthma (SA) often requires subspecialist management and treatment with biologic therapies or maintenance systemic corticosteroids (mSCS). OBJECTIVE To describe contemporary, real-world biologic and mSCS use among US subspecialist-treated patients with SA. METHODS CHRONICLE is an ongoing, noninterventional study of US adults with SA treated by allergists/immunologists or pulmonologists. Eligible patients are receiving biologics or mSCS or are uncontrolled on high-dosage inhaled corticosteroids with additional controllers. Biologic and mSCS use patterns and patient characteristics were summarized for patients enrolled between February 2018 and February 2019. RESULTS Among protocol-eligible patients, 58% and 12% were receiving biologics and mSCS, respectively, with 7% receiving both. Among 796 enrolled, most were women (67%), non-Hispanic white (71%), of suburban residence (50%), and had elevated body mass index (median: 31). Respiratory and nonrespiratory comorbidities were highly prevalent. With biologics (n = 557), 51% were anti-immunoglobulin E and 48% were anti-interleukin (IL)-5/IL-5Rα; from May 2018, 76% of initiations were anti-IL-5/IL-5Rα. In patients receiving mSCS, median prednisone-equivalent daily dose was 10 mg. Multivariate logistic regression found that patients of hospital clinics, sites with fewer nonphysician staff, and with a recorded concurrent chronic obstructive pulmonary disease diagnosis were less likely to receive biologics and more likely to receive mSCS. CONCLUSION In this real-world sample of US subspecialist-treated patients with SA not controlled by high-dosage inhaled corticosteroids with additional controllers, mSCS use was infrequent and biologic use was common, with similar prevalence of anti-immunoglobulin E and anti-IL-5/IL-5Rα biologics. Treatment differences associated with patient and site characteristics should be investigated to ensure equitable access to biologics and minimize mSCS use. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03373045.
Collapse
Affiliation(s)
- Wendy C Moore
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | | | | | - Weily Soong
- Alabama Allergy & Asthma Center, Birmingham, Alabama
| | - Bradley E Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, California
| | - Warner Carr
- Allergy & Asthma Associates of Southern California, Mission Viejo, California
| | | | | | | | | |
Collapse
|
5
|
Chipps B, Ambrose C, Trevor J, Belton L, Gandhi H, Lugogo N, Soong W, Carr W, Moore W, Trudo F, Panettieri R. P204 FACTORS ASSOCIATED WITH BIOLOGIC OR MAINTENANCE SYSTEMIC CORTICOSTEROID TREATMENT AMONG UNITED STATES SEVERE ASTHMA PATIENTS. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.271] [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: 11/16/2022]
|
6
|
Song J, Ma Q, Gao W, Cong Z, Xie J, Zimmerman Z, Belton L, Franklin J, Palmer S. Matching-Adjusted Indirect Comparison of Blinatumomab vs. Inotuzumab Ozogamicin for Adults with Relapsed/Refractory Acute Lymphoblastic Leukemia. Adv Ther 2019; 36:950-961. [PMID: 30758745 PMCID: PMC6824351 DOI: 10.1007/s12325-019-0873-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 12/10/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION In the absence of head-to-head trials, this analysis aimed to provide a fair indirect comparison of the efficacy between blinatumomab and inotuzumab ozogamicin (InO), two treatments for adult patients with relapsed or refractory acute lymphoblastic leukemia (R/R ALL) who received no more than one prior salvage therapy, by adjusting for cross-trial differences. METHODS Patient-level data from the Phase 3 blinatumomab trial TOWER and published aggregated data from the Phase 3 InO trial INO-VATE-ALL were used to conduct matching-adjusted indirect comparisons. Patients with 2+ prior salvage therapies from TOWER were excluded because such patients were not included in INO-VATE-ALL. To ensure balance in the remaining patients, baseline characteristics for the TOWER patients were weighted to match the average baseline characteristics in INO-VATE-ALL, including sex, age, race, performance status, bone marrow blast, previous salvage therapy, previous allogeneic transplantation, complete remission with complete hematologic recovery (CR) to most recent induction therapy, and duration of first remission. Overall survival (OS), including median and restricted mean survival time (RMST) at 12 and 20.7 months, and CR were estimated and compared. RESULTS A total of 310 patients in TOWER were included (blinatumomab, n = 203; standard of care chemotherapy, n = 107). After matching the listed baseline characteristics, the median OS was 9.3 months for blinatumomab and 7.7 months for InO (weighted log-rank test p = 0.4). The relative RMST at 12 months was 1.6 months longer for blinatumomab than for InO [95% CI (0.1, 3.2); p = 0.04]; at 20.7 months the RMST was not significantly different. The CR rates were similar [anchor-based difference = - 2.8%, 95% CI (- 17.5%, 11.9%); p = 0.71]. CONCLUSIONS After adjusting for cross-trial differences, blinatumomab demonstrated a similar CR rate and potential OS benefit versus InO among adult patients with R/R ALL who received no more than one prior salvage therapy. Further studies are suggested to confirm this finding. FUNDING Amgen.
Collapse
Affiliation(s)
| | | | - Wei Gao
- Analysis Group, Inc., Boston, MA, USA.
| | - Ze Cong
- Amgen Inc., Thousand Oaks, CA, USA
| | - Jipan Xie
- Analysis Group, Inc., Los Angeles, CA, USA
| | | | | | | | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| |
Collapse
|
7
|
Song J, Ma Q, Gao W, Cong Z, Xie J, Zimmerman ZF, Belton L, Franklin J, Palmer S. Indirect treatment comparison of blinatumomab versus inotuzumab ozogamicin for the treatment of adult patients with relapsed or refractory acute lymphoblastic leukemia receiving zero or one prior salvage therapy. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e19000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Wei Gao
- Analysis Group, Inc., Boston, MA
| | - Ze Cong
- Amgen, Inc., Thousand Oaks, CA
| | | | | | | | | | - Stephen Palmer
- Centre for Health Economics, University of York, York, United Kingdom
| |
Collapse
|
8
|
Locatelli F, Zugmaier G, Vora A, Rossig C, Peters C, Brethon B, O'Brien MM, Belton L, Handgretinger R. Blinatumomab use in pediatric patients (pts) with relapsed/refractory B-precursor acute lymphoblastic leukemia (r/r ALL) from an open-label, multicenter, expanded access study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.10530] [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: 11/20/2022] Open
Abstract
10530 Background:Blinatumomab (blin), a bispecific T-cell engaging antibody construct, has shown antileukemia activity and tolerability in pts with r/r ALL. We further evaluated safety and efficacy of blin in the first 40 pediatric pts with r/r ALL enrolled in an expanded access study (NCT02187354). Methods: Eligible pts (28 d to < 18 yrs) had ≥ 5% blasts and r/r ALL (refractory, ≥ 2 relapses or relapse after transplant [HCT]). Blin was dosed by continuous infusion (4 wks on/2 wks off) for up to 5 cycles (≥ 5 to < 25% blasts: 15 µg/m2/d; ≥ 25% blasts: 5 µg/m2/d on d1−7 in cycle 1, then 15 µg/m2/d). The primary endpoint was incidence of treatment-emergent (TE) and treatment-related (TR) adverse events (AEs); key efficacy endpoints were complete response (CR) and minimal residual disease (MRD, by PCR or flow cytometry) in the first 2 cycles, relapse-free survival, overall survival and HCT rate. Results: Of the first40 treated pts (median age, 9 [range, 1−17] yrs), 24 (60%) had ≥ 2 relapses, 20 (50%) relapsed after HCT and 5 (13%) were primary refractory; 18 (45%) had ≥ 50% blasts and 21 (53%) had prior HCT. Safety and key efficacy outcomes are shown in the table, including 63% CR in the first 2 cycles. There were 8 relapses and 20 deaths after treatment. Regardless of causality, the most frequent TEAEs were pyrexia (78%), cytokine release syndrome (CRS; 23%) vomiting (23%) and anemia (20%); all 9 CRS events were grade (gr) 1 or 2 and 1 tumor lysis syndrome was gr 3. 10 (25%) pts interrupted treatment and 2 (5%) discontinued due to TRAEs; 13 (33%) pts had gr ≥ 3 TRAEs, including 2 of 3 neurologic events (depressed level of consciousness and headache; both gr 3); 2 fatal AEs were considered unrelated to blin. Conclusions:Here single-agent blin showed antileukemia activity in pediatric pts with high-risk r/r ALL including t(17;19) and AEs consistent with those previously reported for r/r ALL. Clinical trial information: NCT02187354. [Table: see text]
Collapse
Affiliation(s)
- Franco Locatelli
- Bambino Gesù Children’s Hospital, Rome; University of Pavia, Pavia, Italy
| | | | - Ajay Vora
- Sheffield Children's Hospital, Sheffield, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
9
|
Boccia RV, Henry DH, Belton L, Bohac C, Ghazal HH. Efficacy and safety of darbepoetin alfa initiated at hemoglobin ≤10 g/dL in patients with stage IV cancer and chemotherapy-induced anemia. Cancer Med 2016; 5:3445-3453. [PMID: 27882724 PMCID: PMC5224845 DOI: 10.1002/cam4.958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/10/2016] [Accepted: 10/13/2016] [Indexed: 01/26/2023] Open
Abstract
Data on efficacy and safety of darbepoetin alfa (DA) administered at hemoglobin (Hb) ≤10 g/dL are limited. In this analysis, we examined DA's efficacy and safety in patients with Stage IV cancers and chemotherapy‐induced anemia (CIA) initiated on DA at Hb ≤10 g/dL. Data for patients with Stage IV cancers and CIA and who initiated DA at Hb ≤10 g/dL were extracted from three phase 3 trials identified in a central database of Amgen‐sponsored DA studies in CIA. Efficacy outcomes were assessed by achievement of Hb increases of ≥1 g/dL and ≥2 g/dL and red blood cell (RBC) or whole blood transfusion requirements. Data were analyzed for all patients with baseline Hb ≤10 g/dL, and by the subgroups of patients with baseline Hb ≥9 to ≤10 g/dL versus <9 g/dL. Crude and Kaplan–Meier proportions of patients who experienced each outcome and time (days) to each outcome were summarized by treatment. Meta‐analysis (fixed‐effects inverse‐variance model) was performed to compare outcomes for DA versus placebo. Safety was assessed by occurrence of adverse events. Data from 213 patients were analyzed: DA, n = 115; placebo, n = 98. More patients in the DA versus the placebo subgroup achieved Hb increase of ≥1 g/dL (72% vs. 36%; HR: 2.92, 95% CI: 1.95, 4.39) and ≥2 g/dL (44% vs. 18%; HR: 2.98, 95% CI: 1.71, 5.21) during the first 12 treatment weeks. Median times to Hb increase of ≥1 g/dL and ≥2 g/dL were 36 days and 78 days for DA, respectively. RBC or whole blood transfusions were less common in patients in the DA versus the placebo subgroup (24% vs. 45%; HR: 0.44, 95% CI: 0.27, 0.73). No new safety issues were reported. Our results confirm that DA use in patients with Stage IV cancer and CIA is more effective than placebo at increasing Hb levels and at reducing transfusion needs when DA treatment is initiated at Hb ≤10 g/dL.
Collapse
Affiliation(s)
- Ralph V Boccia
- Center for Cancer and Blood Disorders, Bethesda, Maryland
| | - David H Henry
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | |
Collapse
|
10
|
Steurer M, Quittet P, Papadaki HA, Selleslag D, Viallard JF, Kaiafa G, Janssens A, Kozak T, Wadenvik H, Schoonen M, Belton L, Kreuzbauer G. A large observational study of patients with primary immune thrombocytopenia receiving romiplostim in European clinical practice. Eur J Haematol 2016; 98:112-120. [DOI: 10.1111/ejh.12807] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Michael Steurer
- Division of Haematology and Oncology; Innsbruck Medical University; Innsbruck Austria
| | | | - Helen A. Papadaki
- Department of Haematology; University of Crete School of Medicine; University Hospital of Heraklion; Crete Greece
| | | | | | - Georgia Kaiafa
- AHEPA University General Hospital; Medical Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Ann Janssens
- Department of Haematology; University Hospitals Leuven; Leuven Belgium
| | - Tomas Kozak
- 3rd Medical Faculty; Charles University; Prague Czech Republic
| | - Hans Wadenvik
- Section of Haematology; Sahlgrenska University Hospital; Gothenburg Sweden
| | | | | | - Georg Kreuzbauer
- International Medical Development and Research; Amgen (Europe) GmbH; Zug Switzerland
| |
Collapse
|
11
|
Mouysset JL, Freier B, van den Bosch J, Levaché CB, Bols A, Tessen HW, Belton L, Bohac GC, Terwey JH, Tonini G. Hemoglobin levels and quality of life in patients with symptomatic chemotherapy-induced anemia: the eAQUA study. Cancer Manag Res 2016; 8:1-10. [PMID: 26855598 PMCID: PMC4725626 DOI: 10.2147/cmar.s88110] [Citation(s) in RCA: 7] [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] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To assess hemoglobin (Hb) outcomes and fatigue-related quality-of-life (QoL) (electronic assessment) in patients with solid tumors and symptomatic chemotherapy-induced anemia receiving cytotoxic chemotherapy and darbepoetin alfa (DA) or another erythropoiesis-stimulating agent according to European indication. METHODS eAQUA was a Phase IV prospective observational study. The primary outcome (assessed in the primary analysis set [PAS]: patients receiving one or more DA dose who had baseline and week 9 assessments for Hb and QoL) was the proportion of patients receiving DA having both Hb increases ≥1 g/dL and improved QoL between baseline and week 9. Functional Assessment of Cancer Therapy-Fatigue (FACT-F) subscale scores were anchored to fatigue visual analog scale scores to determine the minimally important difference for improved QoL. Overall data/data over time are reported for the full analysis set (patients receiving one or more erythropoiesis-stimulating agent dose, n=1,158); week 9 data (ie, data relating to the primary and secondary outcomes) are reported for the PAS (n=510). Baseline and safety data are included for both the full analysis set and PAS. RESULTS In the PAS, 69% of patients had stage IV disease and 96% were fatigued. The minimally important difference in FACT-F change score for QoL improvement was 3.5. From baseline to week 9, 32% (95% confidence interval: 28%-36%) of patients had both improved QoL and an Hb increase ≥1 g/dL; proportions were similar across the most common tumor types. At week 9, 49% and 58% of patients had improved QoL or Hb increases ≥1 g/dL, respectively; 70% and 76% had QoL or Hb improvements between baseline and study end, respectively. In the PAS, 16% of patients required transfusions and 32% required iron supplementation. Few patients (<1%) reported adverse drug reactions. CONCLUSION In this study, patients with solid tumors receiving DA per European indication for symptomatic chemotherapy-induced anemia had clinically meaningful improvements in Hb and QoL.
Collapse
Affiliation(s)
- Jean-Loup Mouysset
- Department of Medical Oncology, Clinique Rambot Provencale, Aix en Provence, France
| | - Beata Freier
- Clinical Oncology, Wojewodzki Szpital Specjalistyczny, Wroclaw, Poland
| | - Joan van den Bosch
- Department of Internal Medicine/Oncology, Albert Schweitzer Ziekenhuis locatie Dordwijk, Dordrecht, the Netherlands
| | - Charles Briac Levaché
- Radiotherapy Service, Medical Oncology, Polyclinique Francheville, Périgueux, France
| | - Alain Bols
- Central Pharmacy, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | | | | | - G Chet Bohac
- Clinical Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Jan-Henrik Terwey
- Medical Development - Oncology, Amgen (Europe) GmbH, Zug, Switzerland
| | - Giuseppe Tonini
- Department of Medical Oncology, Università Campus Bio-Medico, Roma, Italy
| |
Collapse
|
12
|
Pirker R, Hedenus M, Vansteenkiste J, Hernandez E, Belton L, Terwey JH. Effectiveness of Darbepoetin Alfa for Chemotherapy-induced Anemia When Initiated at Hemoglobin ≤10 g/dL. Clin Ther 2015; 38:122-135.e6. [PMID: 26730453 DOI: 10.1016/j.clinthera.2015.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Limited data are available to describe the effectiveness of darbepoetin alfa (DA) in terms of hemoglobin (Hb) and transfusion outcomes when initiated at Hb ≤10 g/dL (the threshold specified in the summary of prescribing characteristics). We assessed DA, initiated according to current labeling (Hb ≤10 g/dL), in chemotherapy-induced anemia (CIA). METHODS Data for patients with cancer and CIA who initiated DA at Hb ≤10 g/dL were extracted from a database of Amgen-sponsored trials. A comparative analysis was limited to randomized, controlled trials in patients treated with DA or control (placebo/best supportive care). Data for the DA arm(s) of randomized, multiple-arm, or prospective, single-arm trials were also extracted (DA-only analysis; non-front-loaded studies only). Outcomes included Hb increase ≥1 g/dL or ≥2 g/dL during the first 12 weeks of treatment. Crude and Kaplan-Meier proportions of patients who experienced each outcome and time (days) to each outcome were summarized by treatment arm. Meta-analysis (fixed-effects inverse-variance method) was performed to compare outcomes for DA with control. FINDINGS The comparative analysis included 4 studies (2 in lung cancer, 1 in lymphoproliferative disease, and 1 in non-myeloid malignancy: DA, n = 261; control, n = 273). The DA-only analysis included 15 studies (n = 3768). In comparative analyses, more patients who received DA than placebo achieved Hb increase of ≥1 g/dL (fixed-effects hazard ratio [HR] = 2.07; 95% CI, 1.62-2.63) or ≥2 g/dL (HR = 2.91; 95% CI, 2.09-4.06). Median times to ≥1 g/dL or ≥2 g/dL increase were 43 or 78 days for DA (not evaluable for placebo). Transfusions were less common in patients who received DA (HR = 0.58; 95% CI, 0.44-0.77). Addition of 2 dose-finding studies did not change the findings of the main comparative analysis. Results were similar in the DA-only analyses. IMPLICATIONS This is the first patient-level meta-analysis, to our knowledge, to evaluate the efficacy in terms of Hb response of DA treatment when initiated according to current product labeling in patients with CIA. Limitations include the small number of studies and patients eligible for inclusion in the comparative analyses and the absence of non-Amgen trials of DA. The results of the comparative analysis confirm that DA is more effective than placebo at increasing serum Hb levels and at reducing the need for transfusion in patients with CIA when treatment is initiated at Hb ≤10 g/dL, as per current product labeling.
Collapse
Affiliation(s)
- Robert Pirker
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
| | - Michael Hedenus
- Department of Medicine, Sundsvall Hospital, Sundsvall, Sweden
| | - Johan Vansteenkiste
- Respiratory Oncology Unit (Pulmonology), University Hospital Ku Leuven, Leuven, Belgium
| | - Enrique Hernandez
- Obstetrics, Gynecology and Reproductive Sciences, Temple University Hospital, Philadelphia, Pennsylvania
| | - Laura Belton
- Biostatistics, Amgen Limited, Uxbridge, United Kingdom
| | | |
Collapse
|
13
|
Airoldi M, Spaeth D, Van den Bosch J, Christofyllakis C, Belton L, Bohac C, Terwey JH, Tonini G. Abstract P5-15-18: Hemoglobin levels and quality of life in patients with breast cancer and symptomatic chemotherapy-induced anemia enrolled in the eAQUA study. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p5-15-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Fatigue associated with chemotherapy-induced anemia (CIA) is common in patients with breast cancer, and can have adverse effects on quality of life (QoL). Erythropoiesis-stimulating agents (ESAs) reduce the need for transfusions and may improve QoL in patients with symptomatic CIA. Information on hemoglobin (Hb) levels and effects of fatigue on QoL in patients with breast cancer and CIA in real-world clinical practice is limited.
Methods: The Electronic Assessment of Quality of Life in Patients With Symptomatic CIA (eAQUA) study evaluated improvements in QoL for patients with CIA receiving ESAs who had an increase in Hb of ≥1 g/dL by week 9. This phase 4, international, longitudinal, prospective, observational study enrolled patients with solid tumors who received chemotherapy and had symptomatic anemia. Patients received ESA therapy for up to 13 weeks based on European indication. The primary outcome was the proportion of patients with increase in Hb ≥1 g/dL and improvement in fatigue-related QoL based on the Functional Assessment of Cancer Therapy-Fatigue (FACT-F; scale = 0 to 52 with lower scores indicating worse fatigue) subscale scores and fatigue Visual Analog Scale (VAS; scale = 0 to 100 with higher scores indicating worse fatigue) from baseline to week 9. FACT-F change scores were anchored to VAS change scores to determine the minimally important difference (MID) for improvements in QoL. Patients with a FACT-F change score that was ≥ the MID were considered to have an improvement in QoL. For Hb and QoL outcomes, week 9 data were those assessed closest to on-treatment day 57 (after initiation of ESA) and within on-treatment days 43 to 70 inclusive, to account for different ESA dosing schedules and the observational nature of the study. Secondary outcomes included rates of red blood cell (RBC) transfusions or iron supplementation during the study.
Results: Of 1262 patients enrolled in eAQUA, 289 had breast cancer and were included in the full analysis set (FAS; had at least one ESA dose); of these, 152 patients were eligible to be included in the primary analysis set (PAS; had QoL and Hb data available at baseline and week 9). At baseline, mean (standard deviation [SD]) Hb was 9.4 (0.6) g/dL; mean (SD) FACT-F and VAS scores were 27.1 (10.5) and 52.7 (22.8), respectively, in the FAS. Mean (SD) change from baseline at week 9 was 1.3 (1.3) g/dL for Hb; 4.1 (10.8) score change for FACT-F; and 4.7 (25.9) score change for VAS in the FAS. A total of 54 (18.7%) patients in the FAS required an RBC transfusion and 79 (27.3%) received iron supplementation. At week 9, 77 of 152 patients in the PAS had achieved improvement in fatigue-related QoL (50.7%; 95% confidence interval [CI] = 42.7%, 58.6%); 93 patients had increased Hb ≥1 g/dL (61.2%; 95% CI = 53.4%, 68.9%); and 59 patients (38.8%; 95% CI = 31.1%, 46.6%) had achieved both improvement in fatigue-related QoL and increased Hb ≥1 g/dL.
Conclusions: In this exploratory subgroup analysis, patients with breast cancer and symptomatic CIA treated with ESAs achieved clinically meaningful improvements in fatigue-related QoL and Hb levels.
Citation Format: Mario Airoldi, Dominique Spaeth, Joan Van den Bosch, Charalambos Christofyllakis, Laura Belton, Chet Bohac, Jan-Henrik Terwey, Giuseppe Tonini. Hemoglobin levels and quality of life in patients with breast cancer and symptomatic chemotherapy-induced anemia enrolled in the eAQUA study [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-15-18.
Collapse
Affiliation(s)
- Mario Airoldi
- 1Azienda Ospedaliera Universitaria S. Giovanni Battista Le Molinette
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Tonini G, Mouysset J, Rotarski M, Spaeth D, Airoldi M, Toganel C, Christofyllakis C, Belton L, Bohac C, Terwey J. Additional Haemoglobin (Hb) and Quality of Life (Qol) Analyses from Eaqua. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu356.30] [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
|
15
|
Tonini G, Mouysset J, Freier B, van den Bosch J, Levaché C, Bols A, Tessen H, Belton L, Bohac C, Terwey J. Haemoglobin (Hb) Levels and Quality of Life (Qol) in Patients (Pts) with Symptomatic Chemotherapy-Induced Anaemia (Cia): the Eaqua Study. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu356.29] [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
|
16
|
Pirker R, Vansteenkiste J, Hedenus M, Hernandez E, Belton L, Terwey J. Effectiveness of Darbepoetin Alfa (Da) for Chemotherapy-Induced Anaemia (Cia) When Initiated at Haemoglobin (Hb) ≤10 G/Dl. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu356.20] [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
|
17
|
Merlini L, Cartenì G, Iacobelli S, Stelitano C, Airoldi M, Balcke P, Keil F, Haslbauer F, Belton L, Pujol B. Anemia prevalence and treatment practice in patients with non-myeloid tumors receiving chemotherapy. Cancer Manag Res 2013; 5:205-14. [PMID: 23946669 PMCID: PMC3739422 DOI: 10.2147/cmar.s45236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To describe the prevalence and management of anemia in cancer patients. METHODS This cross-sectional, observational survey was conducted in Italy and Austria. Centers prespecified one day, during a 4-month enrollment window, to report specific data collected during normal clinical practice for patients with non-myeloid tumors attending for chemotherapy (±radiotherapy) treatment. The primary endpoint was the prevalence of anemia as determined using a prespecified algorithm: hemoglobin (Hb) ≤10 g/dL on/within 3 days prior to visit; ongoing anemia treatment; physician diagnosis of anemia, together with ≥1 anemia symptom. RESULTS Between November 18, 2010 and March 18, 2011, data for 1412 patients were collected (Italy n = 1130; Austria n = 282). Most patients (n = 1136; 80%) had solid tumors; 809 (57%) had received ≤3 chemotherapy cycles. The prevalence of anemia was 32% (95% confidence interval: 29.4%-34.2%); 196 patients (14%) were deemed anemic based on Hb ≤10 g/dL, 131 (9%) on ongoing anemia treatment, and 121 (9%) on physician diagnosis/anemia symptom. Overall, 1153 patients (82%) had Hb data; mean (standard deviation [SD]) Hb levels were 11.7 (1.7) g/dL. In total, 456 patients (32%) had anemia symptoms: fatigue (n = 392; 28%), depression (n = 122; 9%), and dyspnea (n = 107; 8%) were most common. Fifty-one patients (4%) had had their current chemotherapy cycle delayed due to anemia. On visit day, or ≤28 days prior, 91 (6%), 188 (13%), and 81 patients (6%) had evidence of whole blood/red blood cell transfusion, erythropoiesis-stimulating agent use, or iron use, respectively. CONCLUSION On the prespecified study day, one-third of patients with non-myeloid tumors undergoing chemotherapy were found to be anemic and 13% had evidence of erythropoiesis-stimulating agent use then or in the 28 days prior.
Collapse
Affiliation(s)
- Laura Merlini
- Department of Medical Oncology, Ospedale Civile S, Bortolo, Vicenza
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Merlini L, Carteni G, Iacobelli S, Stelitano C, Airoldi M, Balke P, Keil F, Haslbauer F, Belton L, Pujol B. Anemia Point Prevalence in Patients Receiving Chemotherapy in 56 Centers in Italy and Austria. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)34179-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
19
|
Bone I, Belton L, Walker AS, Darbyshire J. Intraventricular pentosan polysulphate in human prion diseases: an observational study in the UK. Eur J Neurol 2008; 15:458-64. [PMID: 18355301 DOI: 10.1111/j.1468-1331.2008.02108.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED BACKGROUND, PURPOSE AND METHODS: This observational study assessed the effect of continuous intraventricular infusion of pentosan polysulphate (PPS) in seven patients at different clinical centres in the UK. RESULTS Complications of intraventricular catheterization were frequent. PPS was well-tolerated over a wide dose range (11-110 microg/kg/day) during the 6-month study. Four patients were assessed for the entire study period: one remained stable, two showed minimal deterioration and one progressed significantly. CONCLUSION Mean survival of all patients was longer than reported values for natural history of specific prion disorders. Possible reasons for these findings are explored.
Collapse
Affiliation(s)
- I Bone
- Department of Medical and Cardiovascular Studies, Western Infirmary, Glasgow, UK.
| | | | | | | |
Collapse
|
20
|
Tessaro IA, Taylor S, Belton L, Campbell MK, Benedict S, Kelsey K, DeVellis B. Adapting a natural (lay) helpers model of change for worksite health promotion for women. Health Educ Res 2000; 15:603-614. [PMID: 11184219 DOI: 10.1093/her/15.5.603] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Social network interventions that utilize informal systems of helping can be an important strategy for health promotion change. This article describes the development, implementation and evaluation of a natural (lay) helping intervention for health promotion change, specifically designed for women in small rural blue-collar worksites. One hundred and four women in four intervention worksites were recruited as natural helpers, and received health and skill-building education over an 18-month period. Qualitative evaluation showed: (1) two patterns of natural helping for women, i.e. participation due to a specific health concern with either themselves or others in their personal networks, and participation due to a larger sense of the importance of health and prevention; (2) over time natural helpers expanded the diffusion of health promotion information from close network members to co-workers and were more likely to be approached by their co-workers for information; (3) group activities at the worksite, particularly around physical activity, increased over time; and (4) because of time constraints at the workplace, written materials were a major way of spreading information to co-workers. This study shows that women can be recruited and trained to diffuse health promotion information and provide support to co-workers for health behavior change.
Collapse
Affiliation(s)
- I A Tessaro
- Department of Community Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown 26506, USA
| | | | | | | | | | | | | |
Collapse
|
21
|
Campbell MK, Tessaro I, DeVellis B, Benedict S, Kelsey K, Belton L, Henriquez-Roldan C. Tailoring and targeting a worksite health promotion program to address multiple health behaviors among blue-collar women. Am J Health Promot 2000; 14:306-13. [PMID: 11009857 DOI: 10.4278/0890-1171-14.5.306] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study examined the relationship between health risks, health behaviors, stages-of-change, and behavior change priorities among blue-collar women participating in a worksite health promotion study. DESIGN Cross-sectional. SETTING Rural manufacturing worksites in North Carolina. SUBJECTS Participants were 859 women aged 18 and over. MEASURES The self-administered questionnaire assessed smoking, exercise, nutrition (fat, fruits, and vegetables), and breast and cervical cancer screening behaviors. In addition, demographics, body weight, perceived health, stages-of-change, and priority for behavior change were measured. Chi-square tests and regression analysis were used to assess statistical significance. RESULTS Overall, 28% of women smoked, 37% were completely sedentary, 82% consumed less than five daily servings of fruits and vegetables, and the majority were overweight. The dominant stage of change for each of the lifestyle behaviors was contemplation, whereas most women were in the action stage for cancer screening. When asked to prioritize the behavior they most wanted to change, the majority of women chose healthy eating and/or exercise. CONCLUSIONS The findings suggest that blue-collar women in this study had multiple health risks and were interested in changing multiple health behaviors. Allowing women to choose the behavior(s) on which they are ready to focus may be a promising approach to tailoring interventions for this population.
Collapse
Affiliation(s)
- M K Campbell
- Department of Nutrition, University of North Carolina, Chapel Hill 27599, USA
| | | | | | | | | | | | | |
Collapse
|