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Le K, Soth MJ, Cross JB, Liu G, Ray WJ, Ma J, Goodwani SG, Acton PJ, Buggia-Prevot V, Akkermans O, Barker J, Conner ML, Jiang Y, Liu Z, McEwan P, Warner-Schmidt J, Xu A, Zebisch M, Heijnen CJ, Abrahams B, Jones P. Discovery of IACS-52825, a Potent and Selective DLK Inhibitor for Treatment of Chemotherapy-Induced Peripheral Neuropathy. J Med Chem 2023. [PMID: 37436942 DOI: 10.1021/acs.jmedchem.3c00788] [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: 07/14/2023]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a major unmet medical need with limited treatment options. Despite different mechanisms of action, diverse chemotherapeutics can cause CIPN through a converged pathway─an active axon degeneration program that engages the dual leucine zipper kinase (DLK). DLK is a neuronally enriched kinase upstream in the MAPK-JNK cascade, and while it is dormant under physiological conditions, DLK mediates a core mechanism for neuronal injury response under stress conditions, making it an attractive target for treatment of neuronal injury and neurodegenerative diseases. We have developed potent, selective, brain penetrant DLK inhibitors with excellent PK and activity in mouse models of CIPN. Lead compound IACS-52825 (22) showed strongly effective reversal of mechanical allodynia in a mouse model of CIPN and was advanced into preclinical development.
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Affiliation(s)
- Kang Le
- Institute for Applied Cancer Science (IACS), The University of Texas MD Anderson Cancer Center, Houston, Texas 77054, United States
| | - Michael J Soth
- Institute for Applied Cancer Science (IACS), The University of Texas MD Anderson Cancer Center, Houston, Texas 77054, United States
| | - Jason B Cross
- Institute for Applied Cancer Science (IACS), The University of Texas MD Anderson Cancer Center, Houston, Texas 77054, United States
| | - Gang Liu
- Institute for Applied Cancer Science (IACS), The University of Texas MD Anderson Cancer Center, Houston, Texas 77054, United States
| | - William J Ray
- Neurodegenerative Consortium (NDC), The University of Texas MD Anderson Cancer Center, Houston, Texas 77054, United States
| | - Jiacheng Ma
- Neurodegenerative Consortium (NDC), The University of Texas MD Anderson Cancer Center, Houston, Texas 77054, United States
| | - Sunil G Goodwani
- Neurodegenerative Consortium (NDC), The University of Texas MD Anderson Cancer Center, Houston, Texas 77054, United States
| | - Paul J Acton
- Neurodegenerative Consortium (NDC), The University of Texas MD Anderson Cancer Center, Houston, Texas 77054, United States
| | - Virginie Buggia-Prevot
- Neurodegenerative Consortium (NDC), The University of Texas MD Anderson Cancer Center, Houston, Texas 77054, United States
| | | | | | - Michael L Conner
- Institute for Applied Cancer Science (IACS), The University of Texas MD Anderson Cancer Center, Houston, Texas 77054, United States
| | - Yongying Jiang
- Institute for Applied Cancer Science (IACS), The University of Texas MD Anderson Cancer Center, Houston, Texas 77054, United States
| | - Zhen Liu
- Institute for Applied Cancer Science (IACS), The University of Texas MD Anderson Cancer Center, Houston, Texas 77054, United States
| | | | - Jennifer Warner-Schmidt
- Alexandria Center for Life Science, Magnolia Neurosciences Corporation, New York, New York 10016, United States
| | - Alan Xu
- Institute for Applied Cancer Science (IACS), The University of Texas MD Anderson Cancer Center, Houston, Texas 77054, United States
| | | | - Cobi J Heijnen
- Laboratories of Neuroimmunology, Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, United States
- Department of Psychological Sciences, Rice University, Houston, Texas 77005, United States
| | - Brett Abrahams
- Alexandria Center for Life Science, Magnolia Neurosciences Corporation, New York, New York 10016, United States
| | - Philip Jones
- Institute for Applied Cancer Science (IACS), The University of Texas MD Anderson Cancer Center, Houston, Texas 77054, United States
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McEwan P, Qin L, Jhund P, Docherty K, McMurray J. Assessing the impact of cardiovascular events on health-related quality of life outcomes in DAPA-HF. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Heart failure (HF) patients are at increased risk of cardiovascular (CV) events, including hospitalisation for HF (hHF), myocardial infarction (MI) and stroke, imposing a significant burden on health related quality of life (HRQoL). DAPA-HF was a multinational clinical trial (NCT03036124) investigating the efficacy and safety of dapagliflozin for the treatment of HF with reduced ejection fraction. Patient reported outcomes were collected. The objective of this study was to estimate the impact of CV events on patient HRQoL over time, as assessed through EQ-5D-5L and Kansas City Cardiomyopathy Questionnaire (KCCQ) total symptom score (TSS) and clinical symptom score (CSS).
Methods
Mixed effects regression models were developed based on pooled individual patient data from DAPA-HF to estimate the impact of hHF, MI and stroke on patient utility (EQ-5D-5L questionnaire responses weighted according to the societal value placed on given health states), and KCCQ TSS score. Utility was estimated using UK-specific tariffs after mapping EQ-5D-5L to EQ-5D-3L values in line with NICE guidance. A subject-specific intercept was incorporated, and estimates were adjusted for the incidence of events occurring within one month prior, two to four months prior, and 4 to 12 months prior to questionnaire completion.
Results
Mean patient baseline utility was 0.716 (95% CI: 0.711, 0.722), with KCCQ TSS 73.6 (73.0, 74.2). The incidence of CV events was consistently associated with reduced patient HRQoL, assessed through either EQ-5D or KCCQ TSS. In the first month following the event, hHF was associated with a 0.083 (0.06, 0.107) reduction in patient utility, and 16.9 (14.5, 19.4) reduction in KCCQ TSS (Fig. 1). Comparing measures, the disease specific measure KCCQ appeared more sensitive than EQ-5D to changes in HRQoL following hHF events and less sensitive to changes following MI and stroke events. Comparing events using the generic EQ-5D measure, at two months post-event, patients with MI and stroke returned to baseline utility; patients with hHF remained below baseline utility at each assessment point for 12 months (Fig. 2); where patients had a mean reduction of 0.02 (0.005, 0.035) utility and 0.5 (−1.1, 2.1) KCCQ-TSS compared to those without an hHF event.
Conclusion
The incidence of cardiovascular events imposes a considerable burden on HRQoL in patients with HFrEF. HF specific events may be better characterised with a disease specific tool, whereas for wider CV events a generic tool may be preferable. The impact of hHF on HRQoL was noteworthy in its persistence across the measures used up to one year. Interventions that reduce the risk of these events have the potential to significantly improve patient quality of life.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): AstraZeneca
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Affiliation(s)
- P McEwan
- Health Economics and Outcomes Research Ltd., Cardiff, United Kingdom
| | - L Qin
- AstraZeneca, Health Economics and Payer Analytics, Gaithersburg, United States of America
| | - P.S Jhund
- University of Glasgow, Glasgow, United Kingdom
| | | | - J.J.V McMurray
- Health Economics and Outcomes Research Ltd., Cardiff, United Kingdom
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3
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McEwan P, McMurray J, Jhund P, Docherty K, Qin L. Evaluating the key predictors of health-related quality of life in patients with heart failure and reduced ejection fraction: results from the DAPA-HF trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The DAPA-HF trial demonstrated that dapagliflozin was superior to placebo at preventing cardiovascular death and hospitalisation for heart failure (hHF) events in patients with chronic heart failure with reduced ejection fraction (HFrEF). The trial also demonstrated a clinically important benefit of dapagliflozin on health-related quality of life (HRQoL). However, key predictors of HRQoL in HFrEF patients remain uncertain. The objective of this study was to determine, using DAPA-HF trial data, the patient characteristics and disease-related events associated with patient HRQoL, measured by health state utility values.
Methods
Mixed effects regression models were developed based on pooled individual patient data from DAPA-HF to determine patient utility estimated from responses to the EQ-5D-5L questionnaire, incorporating a subject specific random intercept. In line with NICE guidance, utility estimates were derived using UK-specific utility tariffs after mapping EQ-5D-5L data to EQ-5D-3L values. Univariable analysis was first undertaken to assess candidate predictors of utility; followed by a multivariable model including statistically significant predictors, e.g. Kansas City Cardiomyopathy Questionnaire Total Symptom Score (KCCQ-TSS) and the incidence hHF events, and controlling for differences in baseline characteristics. All variables were included in a single model to provide independent (adjusted) estimates for each covariable.
Results
19,983 EQ-5D-5L questionnaires from 4,744 patients were included. Mean patient utility at baseline was 0.716 (95% CI: 0.711, 0.722). Univariable analysis demonstrated NYHA, KCCQ-TSS, T2DM, BMI, age, geographic location, non-ischaemic/unknown aetiology and atrial fibrillation were statistically significant in their association with patient utility while prior hHF, race, eGFR and left ventricular ejection fraction were not.
Multivariable analysis results are summarised in Fig. 1. The baseline characteristic with the greatest impact on EQ-5D was KCCQ-TSS quartile, with EQ-5D increasing with KCCQ-TSS and the difference in utility between patients in quartile 1 (lowest score) and quartile 4 (highest score) estimated at 0.233 (0.226, 0.240).
When controlled for baseline characteristics, being post-event was significantly associated with HRQoL; patients who experienced hospitalisation for HF had 0.036 (0.014, 0.058) lower utility on average within one month of the event and 0.025 (0.011, 0.039) lower utility up to one-year after the event. For patients who had stroke or myocardial infarction events there were reductions in utility of 0.206 (0.141, 0.272) and 0.108 (0.039, 0.177) respectively at 1 month.
Conclusion
HF symptoms, measured by the KCCQ, were strongly associated with patient health utility. Therapeutic interventions that can improve HF symptoms have the potential to improve HRQoL and reduce the burden of HF.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): AstraZeneca
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Affiliation(s)
- P McEwan
- Health Economics and Outcomes Research Ltd., Cardiff, United Kingdom
| | | | - P.S Jhund
- University of Glasgow, Glasgow, United Kingdom
| | | | - L Qin
- AstraZeneca, Health Economics and Payer Analytics, Gaithersburg, United States of America
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McEwan P, Hurst M, Hoskin L, Badora K, Sugrue D, James G, Tafesse E. The relationship between duration of heart failure, serum potassium concentration and adverse clinical outcomes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0943] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Hyper- and hypokalaemia are frequent complications in patients with heart failure (HF). The association between all-cause mortality (ACM), major adverse cardiovascular events (MACE) and serum potassium (K+) has previously been characterised in a UK incident HF population, with hypo- and hyperkalaemic patients being at increased risk of adverse clinical outcomes.
Purpose
This study aimed to assess the generalisability and findings of previously published risk equations in a broader HF population, spanning both incident and prevalent HF cases regardless of chronic kidney disease (CKD), and to explore the relationship between duration of HF and elevated risk associated with hypo- or hyperkalaemia.
Methods
A retrospective cohort study was conducted using linked UK Clinical Practice Research Datalink (CPRD) GOLD and Hospital Episode Statistics (HES) data. Eligible patients included individuals ≥18 years with HF (identified using READ codes) during the study period (January 2008 to June 2018) or five-year lookback period (2003 to 2007). Patients' index date was set to 1st January 2008 for prevalent patients or date of HF diagnosis for incident patients. Adverse clinical outcomes included ACM and MACE, a composite of arrhythmia, HF, myocardial infarction and stroke. Published risk equations for ACM and MACE for incident HF without CKD were refitted to this broader study population using original covariates and model forms. Coefficient values were adjusted for the inclusion of HF duration (≤5 and >5 years). Incidence rate ratios (IRRs) were recalculated with K+ concentration 4.5 to <5.0 mmol/L as the reference category.
Results
The HF cohort consisted of 84,210 patients with a mean follow-up of 5.01 years. The cohort was predominantly male (53.0%), with a mean age of 77.3 years at index. Ischaemic heart disease, hypertension, atrial fibrillation and type 2 diabetes were present in 42.24%, 61.39%, 40.89% and 20.38% of the population, respectively. CKD stage 3+ was present in 39.13% of patients, with a cohort mean estimated glomerular filtration rate of 56.9 mL/min/1.73m2 at index. Crude ACM and MACE event rates were 159.5 (95% confidence interval (CI): 157.9–161.0) and 575.8 (95% CI: 572.8–578.7) per 1,000 patient years, respectively. Hypo- and hyperkalaemia were generally associated with increased risk of ACM and MACE in comparison with patients with K+ concentrations of 4.5 to <5.0 mmol/L (figure 1); these associations were maintained irrespective of the duration of HF.
Conclusion
A real-world analysis of UK patients suggests that previously published associations between hypo- and hyperkalaemia and increased risk of adverse clinical outcomes in an incident HF population are generalisable to a cohort of incident and prevalent HF patients, irrespective of HF duration and the presence of comorbid CKD. Improved monitoring and management of K+ may have the potential to improve outcomes in these patients.
Figure 1. IRRs of ACM and MACE
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): AstraZeneca
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Affiliation(s)
- P McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - M Hurst
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - L Hoskin
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - K Badora
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - D Sugrue
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - G James
- AstraZeneca, Global Medical Affairs, Cambridge, United Kingdom
| | - E Tafesse
- AstraZeneca, Global Health Economics, Gaithersburg, United States of America
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McEwan P, Badora K, Sugrue D, James G, Hurst M, Hoskin L, Tafesse E. Assessing the relationship between serum potassium variability and the risk of hyperkalaemia and adverse clinical outcomes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Serum potassium (SK+) is a vital electrolyte, which level is maintained by adjusting renal K+ excretion. Variability in SK+ has been linked to increased risk of mortality and other adverse clinical events in patients in intensive care and/or receiving haemodialysis, prompting a similar investigation in cardiovascular patients.
Purpose
To examine the effect of SK+ variability on all-cause mortality (ACM) and the incidence of major adverse cardiovascular events (MACE), comprising arrhythmia, [subsequent records of] HF, myocardial infarction, or stroke, in patients with heart failure (HF) or resistant hypertension (RHTN).
Methods
Patients aged ≥18 years with HF or RHTN were identified from the UK Clinical Practice Research Datalink (CPRD, primary care data) and linked Hospital Episode Statistics (HES, secondary care data). HF and RHTN were defined through READ codes recorded during the study period (2008-June 2018) or the five-year look-back period (2003–2007). Index date was set to 1st January 2008 or initial diagnosis; whichever occurred later. Mean SK+ and variability of measurements (quantified as standard deviation [SD] and each patient categorised as low or highly variable based on the median SD of the cohort), and crude incidence rates of ACM and MACE were estimated over a follow-up period from index date to event or end of follow-up (death, loss to follow-up or end of study, whichever was earlier).
Results
The eligible population included 317,135 RHTN patients and 84,210 HF patients with a mean follow-up of 6.37 (SD 3.06) and 5.01 (SD 3.20) years, respectively. In both cohorts, higher mean SK+ ≥5.0 mmol/L was associated with increased rates of ACM and MACE relative to a mean SK+ of 3.5–5 mmol/L (Table 1). High SK+ variability was associated with increased incidence of adverse outcomes, with rates consistently higher in the high SK+ variability group compared to low-variability patients with the same diagnosis and mean SK+ category (Table 1); all comparisons were statistically significant except for ACM in HF patients with mean SK+ ≥5 mmol/L.
Conclusion
Independently of mean SK+, increased variability in SK+ levels was associated with an increased rate of mortality and MACE in patients with RHTN or HF. Careful SK+ monitoring and management to maintain SK+ concentrations may improve the outcomes of patients with RHTN and HF.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): AstraZeneca
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Affiliation(s)
- P McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - K Badora
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - D Sugrue
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - G James
- AstraZeneca, Global Medical Affairs, Cambridge, United Kingdom
| | - M Hurst
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - L Hoskin
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - E Tafesse
- AstraZeneca, Global Health Economics, Gaithersburg, United States of America
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McEwan P, Hoskin L, Badora K, Sugrue D, James G, Hurst M, Tafesse E. Estimating the burden of hyperkalaemia in the UK in high-risk patient populations. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with chronic kidney disease (CKD), heart failure (HF), resistant hypertension (RHTN) and diabetes are at an increased risk of hyperkalaemia (HK) which can be potentially life-threatening, as a result of cardiac arrhythmias, cardiac arrest leading to sudden death. In these patients, renin-angiotensin-aldosterone system inhibitors (RAASi), are used to manage several cardiovascular and renal conditions, and are associated with an increased risk of HK. Assessing the burden of HK in real-world clinical practice may concentrate relevant care on those patients most in need, potentially improving patient outcomes and efficiency of the healthcare system.
Purpose
To assess the burden of HK in a real-world population of UK patients with at least one of: RHTN, Type I or II diabetes, CKD stage 3+, dialysis, HF, or in receipt of a prescription for RAASi.
Methods
Primary and secondary care data for this retrospective study were obtained from the UK Clinical Practice Research Datalink (CPRD) and linked Hospital Episode Statistics (HES). Eligible patients were identified using READ codes defining the relevant diagnosis, receipt of indication-specific medication, or, in the case of CKD, an estimated glomerular filtration rate (eGFR) ≤60 ml/min/1.73m2 within the study period (01 January 2008 to 30 June 2018) or in the five-year lookback period (2003–2007). The index date was defined as 01 January 2008 or first diagnosis of an eligible condition or RAASi prescription, whichever occurred latest. HK was defined as K+ ≥5.0 mmol/L; thresholds of ≥5.5 mmol/L and ≥6.0 mmol/L were explored as sensitivity analyses. Incidence rates of HK were calculated with 95% confidence intervals (CI).
Results
The total eligible population across all cohorts was 931,460 patients. RHTN was the most prevalent comorbidity (n=317,135; 34.0%) and dialysis the least prevalent (n=4,415; 0.5%). The majority of the eligible population were prescribed RAASi during follow-up (n=754,523; 81.0%). At a K+ threshold of ≥5.0 mmol/L, the dialysis cohort had the highest rate of HK (501.0 events per 1,000 patient-years), followed by HF (490.9), CKD (410.9), diabetes (355.0), RHTN (261.4) and the RAASi cohort (211.2) (Figure 1). This pattern was still observed at alternative threshold definitions of HK.
Conclusion
This large real-world study of UK patients demonstrates the burden of hyperkalaemia in high-risk patient populations from the UK. There is a need for effective prevention and treatment of HK, particularly in patients with CKD, dialysis or HF where increased incidence rates are observed which in turn will improve patient outcomes and healthcare resource usage.
Figure 1. Rates of HK by condition
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): AstraZeneca
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Affiliation(s)
- P McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - L Hoskin
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - K Badora
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - D Sugrue
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - G James
- AstraZeneca, Global Medical Affairs, Cambridge, United Kingdom
| | - M Hurst
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - E Tafesse
- AstraZeneca, Global Health Economics, Gaithersburg, United States of America
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Darlington O, GARCIA SANCHEZ J, Sörstadius E, Parker B, McEwan P. SAT-142 THE ECONOMIC AND PATIENT BURDEN OF CHRONIC KIDNEY DISEASE (CKD): RESULTS FROM AN INTERNATIONAL CKD POLICY EVALUATION. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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8
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Feng JA, Lee P, Alaoui MH, Barrett K, Castanedo G, Godemann R, McEwan P, Wang X, Wu P, Zhang Y, Harris SF, Staben ST. Structure Based Design of Potent Selective Inhibitors of Protein Kinase D1 (PKD1). ACS Med Chem Lett 2019; 10:1260-1265. [PMID: 31531194 DOI: 10.1021/acsmedchemlett.8b00658] [Citation(s) in RCA: 4] [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: 12/31/2018] [Accepted: 07/24/2019] [Indexed: 12/20/2022] Open
Abstract
We previously disclosed a series of type I 1/2 inhibitors of NF-κB inducing kinase (NIK). Inhibition of NIK by these compounds was found to be strongly dependent on the inclusion and absolute stereochemistry of a propargyl tertiary alcohol as it forms critical hydrogen bonds (H-bonds) with NIK. We report that inhibition of protein kinase D1 (PKD1) by this class of compounds is not dependent on H-bond interactions of this tertiary alcohol. This feature was leveraged in the design of highly selective inhibitors of PKD1 that no longer inhibit NIK. A structure-based hypothesis based on the position and flexibility of the α-C-helix of PKD1 vs NIK is presented.
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Affiliation(s)
- Jianwen A. Feng
- Genentech, 1 DNA way, South San Francisco, California 94080, United States
| | - Patrick Lee
- Genentech, 1 DNA way, South San Francisco, California 94080, United States
| | | | - Kathy Barrett
- Genentech, 1 DNA way, South San Francisco, California 94080, United States
| | | | - Robert Godemann
- Evotec AG, Manfred Eigen Campus, Essener Bogen, Hamburg, Germany 22419
| | - Paul McEwan
- Evotec (U.K.) Ltd, 114 Innovation Drive, Milton Park, Abingdon OX14 4Rz, U.K
| | - Xiaolu Wang
- Evotec AG, Manfred Eigen Campus, Essener Bogen, Hamburg, Germany 22419
| | - Ping Wu
- Genentech, 1 DNA way, South San Francisco, California 94080, United States
| | - Yamin Zhang
- Pharmaron Beijing Co., Ltd. 6 Taihe Road, BDA, Beijing, P.R. China, 100176
| | - Seth F. Harris
- Genentech, 1 DNA way, South San Francisco, California 94080, United States
| | - Steven T. Staben
- Genentech, 1 DNA way, South San Francisco, California 94080, United States
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9
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Linde C, McEwan P, Bakhai A, Furuland H, Evans M, Ayoubkhani D, Grandy S, Palaka E, Qin L. P5671Real-world dosing of renin-angiotensin-aldosterone system inhibitors in heart failure patients, and associations between hyperkalaemia and down-titration or discontinuation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Linde
- Karolinska University Hospital, Heart and Vascular Theme, Stockholm, Sweden
| | - P McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - A Bakhai
- Royal Free Hospital, Department of Cardiology, London, United Kingdom
| | - H Furuland
- Uppsala University Hospital, Department of Nephrology, Uppsala, Sweden
| | - M Evans
- University Hospital Llandough, Diabetes Resource Centre, Cardiff, United Kingdom
| | - D Ayoubkhani
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - S Grandy
- AstraZeneca, Global Health Economics, Gaithersburg, United States of America
| | - E Palaka
- AstraZeneca, Global Health Economics, Cambridge, United Kingdom
| | - L Qin
- AstraZeneca, Global Health Economics, Gaithersburg, United States of America
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10
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Qin L, McEwan P, Ayoubkhani D, Reeve L, Grandy S, Palaka E, Evans M. P1810The association between renin-angiotensin-aldosterone system inhibitors dose reduction and risk of mortality and major adverse cardiovascular events in heart failure patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Qin
- AstraZeneca, Global Health Economics, Gaithersburg, United States of America
| | - P McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - D Ayoubkhani
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - L Reeve
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - S Grandy
- AstraZeneca, Global Health Economics, Gaithersburg, United States of America
| | - E Palaka
- AstraZeneca, Global Health Economics, Cambridge, United Kingdom
| | - M Evans
- University Hospital Llandough, Diabetes Resource Centre, Cardiff, United Kingdom
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11
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McEwan P, Bennett H, Bolin K, Evans M, Bergenheim K. Assessing the economic value of maintained improvements in Type 1 diabetes management, in terms of HbA 1c , weight and hypoglycaemic event incidence. Diabet Med 2018; 35:557-566. [PMID: 29377320 PMCID: PMC5947585 DOI: 10.1111/dme.13590] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 01/01/2023]
Abstract
AIMS Insulin therapy is indicated for people with Type 1 diabetes mellitus; however, treatment-related weight gain and hypoglycaemia represent barriers to optimal glycaemic management. This study assessed the health economic value of maintained reductions in HbA1c , BMI and hypoglycaemia incidence among the UK Type 1 diabetes population. METHODS The Cardiff Type 1 Diabetes Model was used to estimate lifetime costs, life-years and quality-adjusted life-years (QALYs) for individuals with Type 1 diabetes at different baseline HbA1c , BMI and hypoglycaemic event rates. Results were discounted at 3.5%, and the net monetary benefit associated with improving Type 1 diabetes management was derived at £20 000/QALY gained. Per-person outputs were inflated to national levels using UK Type 1 diabetes prevalence estimates. RESULTS Modelled subjects with an HbA1c of 86 mmol/mol (10.0%) were associated with discounted lifetime per-person costs of £23 795; £12 649 of which may be avoided by maintaining an HbA1c of 42 mmol/mol (6.0%). Combined with estimated QALY gains of 2.80, an HbA1c of 42 mmol/mol (6.0%) vs. 86 mmol/mol (10.0%) was associated with a £68 621 per-person net monetary benefit. Over 1 year, unit reductions in BMI produced £120 per-person net monetary benefit, and up to £197 for the avoidance of one non-severe hypoglyceamic event. CONCLUSIONS Maintained reductions in HbA1c significantly alleviate the burden associated with Type 1 diabetes in the UK. Given the influence of weight and hypoglycaemia on health economic outcomes, they must also be key considerations when assessing the value of Type 1 diabetes technologies in clinical practice.
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Affiliation(s)
- P. McEwan
- School of Human and Health SciencesSwansea UniversitySwansea
- Health Economics and Outcomes Research LtdCardiffUK
| | - H. Bennett
- Health Economics and Outcomes Research LtdCardiffUK
| | - K. Bolin
- Centre for Health EconomicsUniversity of GothenburgSweden
| | - M. Evans
- Diabetes Resource CentreLlandough HospitalCardiffUK
| | - K. Bergenheim
- Global Payer Evidence and PricingAstraZeneca PharmaceuticalsGothenburgSweden
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12
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Gibson EJ, Begum N, Koblbauer I, Dranitsaris G, Liew D, McEwan P, Tahami Monfared AA, Yuan Y, Juarez-Garcia A, Tyas D, Lees M. Modeling the economic outcomes of immuno-oncology drugs: alternative model frameworks to capture clinical outcomes. Clinicoecon Outcomes Res 2018; 10:139-154. [PMID: 29563820 PMCID: PMC5848668 DOI: 10.2147/ceor.s144208] [Citation(s) in RCA: 11] [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] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Economic models in oncology are commonly based on the three-state partitioned survival model (PSM) distinguishing between progression-free and progressive states. However, the heterogeneity of responses observed in immuno-oncology (I-O) suggests that new approaches may be appropriate to reflect disease dynamics meaningfully. MATERIALS AND METHODS This study explored the impact of incorporating immune-specific health states into economic models of I-O therapy. Two variants of the PSM and a Markov model were populated with data from one clinical trial in metastatic melanoma patients. Short-term modeled outcomes were benchmarked to the clinical trial data and a lifetime model horizon provided estimates of life years and quality adjusted life years (QALYs). RESULTS The PSM-based models produced short-term outcomes closely matching the trial outcomes. Adding health states generated increased QALYs while providing a more granular representation of outcomes for decision making. The Markov model gave the greatest level of detail on outcomes but gave short-term results which diverged from those of the trial (overstating year 1 progression-free survival by around 60%). CONCLUSION Increased sophistication in the representation of disease dynamics in economic models is desirable when attempting to model treatment response in I-O. However, the assumptions underlying different model structures and the availability of data for health state mapping may be important limiting factors.
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Affiliation(s)
| | - N Begum
- Wickenstones Ltd, Didcot, UK
| | | | - G Dranitsaris
- Augmentium Pharma Consulting Inc, Toronto, ON, Canada
| | - D Liew
- Department of Epidemiology and Preventive Medicine, Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - P McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - AA Tahami Monfared
- Bristol-Myers Squibb Canada, Saint-Laurent, QC Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Y Yuan
- Bristol-Myers Squibb, Princeton, NJ, USA
| | | | - D Tyas
- Bristol-Myers Squibb, Uxbridge, UK
| | - M Lees
- Bristol-Myers Squibb, Rueil-Malmaison, France
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13
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Qin L, McEwan P, Evans M, Bergenheim K, Horne L, Grandy S. P4901Association between serum potassium and clinical outcomes in UK patients with heart failure. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p4901] [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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14
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Muth A, Subramanian V, Beaumont E, Nagar M, Kerry P, McEwan P, Srinath H, Clancy K, Parelkar S, Thompson PR. Development of a Selective Inhibitor of Protein Arginine Deiminase 2. J Med Chem 2017; 60:3198-3211. [PMID: 28328217 DOI: 10.1021/acs.jmedchem.7b00274] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Protein arginine deiminase 2 (PAD2) plays a key role in the onset and progression of multiple sclerosis, rheumatoid arthritis, and breast cancer. To date, no PAD2-selective inhibitor has been developed. Such a compound will be critical for elucidating the biological roles of this isozyme and may ultimately be useful for treating specific diseases in which PAD2 activity is dysregulated. To achieve this goal, we synthesized a series of benzimidazole-based derivatives of Cl-amidine, hypothesizing that this scaffold would allow access to a series of PAD2-selective inhibitors with enhanced cellular efficacy. Herein, we demonstrate that substitutions at both the N-terminus and C-terminus of Cl-amidine result in >100-fold increases in PAD2 potency and selectivity (30a, 41a, and 49a) as well as cellular efficacy (30a). Notably, these compounds use the far less reactive fluoroacetamidine warhead. In total, we predict that 30a will be a critical tool for understanding cellular PAD2 function and sets the stage for treating diseases in which PAD2 activity is dysregulated.
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Affiliation(s)
- Aaron Muth
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School , 364 Plantation Street, Worcester, Massachusetts 01605, United States.,Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University , Queens, New York 11439, United States
| | - Venkataraman Subramanian
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School , 364 Plantation Street, Worcester, Massachusetts 01605, United States
| | | | - Mitesh Nagar
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School , 364 Plantation Street, Worcester, Massachusetts 01605, United States
| | - Philip Kerry
- Evotec , Milton Park, Abingdon, Oxfordshire OX14 4RZ, U.K
| | - Paul McEwan
- Evotec , Milton Park, Abingdon, Oxfordshire OX14 4RZ, U.K
| | - Hema Srinath
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School , 364 Plantation Street, Worcester, Massachusetts 01605, United States
| | - Kathleen Clancy
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School , 364 Plantation Street, Worcester, Massachusetts 01605, United States
| | - Sangram Parelkar
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School , 364 Plantation Street, Worcester, Massachusetts 01605, United States
| | - Paul R Thompson
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School , 364 Plantation Street, Worcester, Massachusetts 01605, United States.,Program in Chemical Biology, University of Massachusetts Medical School , 364 Plantation Street, Worcester, Massachusetts 01605, United States
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15
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Castanedo GM, Blaquiere N, Beresini M, Bravo B, Brightbill H, Chen J, Cui HF, Eigenbrot C, Everett C, Feng J, Godemann R, Gogol E, Hymowitz S, Johnson A, Kayagaki N, Kohli PB, Knüppel K, Kraemer J, Krüger S, Loke P, McEwan P, Montalbetti C, Roberts DA, Smith M, Steinbacher S, Sujatha-Bhaskar S, Takahashi R, Wang X, Wu LC, Zhang Y, Staben ST. Structure-Based Design of Tricyclic NF-κB Inducing Kinase (NIK) Inhibitors That Have High Selectivity over Phosphoinositide-3-kinase (PI3K). J Med Chem 2017; 60:627-640. [PMID: 28005357 DOI: 10.1021/acs.jmedchem.6b01363] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We report here structure-guided optimization of a novel series of NF-κB inducing kinase (NIK) inhibitors. Starting from a modestly potent, low molecular weight lead, activity was improved by designing a type 11/2 binding mode that accessed a back pocket past the methionine-471 gatekeeper. Divergent binding modes in NIK and PI3K were exploited to dampen PI3K inhibition while maintaining NIK inhibition within these series. Potent compounds were discovered that selectively inhibit the nuclear translocation of NF-κB2 (p52/REL-B) but not canonical NF-κB1 (REL-A/p50).
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Affiliation(s)
| | - Nicole Blaquiere
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, United States
| | - Maureen Beresini
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, United States
| | - Brandon Bravo
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, United States
| | - Hans Brightbill
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, United States
| | - Jacob Chen
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, United States
| | - Hai-Feng Cui
- Pharmaron Beijing Co., Ltd . 6 Taihe Road, BDA, Beijing 100176, P.R. China
| | - Charles Eigenbrot
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, United States
| | - Christine Everett
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, United States
| | - Jianwen Feng
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, United States
| | - Robert Godemann
- Manfred Eigen Campus, Evotec AG , Essener Bogen, 22419 Hamburg, Germany
| | - Emily Gogol
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, United States
| | - Sarah Hymowitz
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, United States
| | - Adam Johnson
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, United States
| | - Nobuhiko Kayagaki
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, United States
| | - Pawan Bir Kohli
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, United States
| | - Kathleen Knüppel
- Manfred Eigen Campus, Evotec AG , Essener Bogen, 22419 Hamburg, Germany
| | - Joachim Kraemer
- Manfred Eigen Campus, Evotec AG , Essener Bogen, 22419 Hamburg, Germany
| | - Susan Krüger
- Manfred Eigen Campus, Evotec AG , Essener Bogen, 22419 Hamburg, Germany
| | - Pui Loke
- Evotec (U.K.) Ltd , 114 Innovation Drive, Milton Park, Abingdon OX14 4Rz, U.K
| | - Paul McEwan
- Evotec (U.K.) Ltd , 114 Innovation Drive, Milton Park, Abingdon OX14 4Rz, U.K
| | | | - David A Roberts
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, United States
| | - Myron Smith
- Evotec (U.K.) Ltd , 114 Innovation Drive, Milton Park, Abingdon OX14 4Rz, U.K
| | - Stefan Steinbacher
- Proteros Biostructures GmbH , Bunsenstrasse 7a, D-82152 Martinsried, Germany
| | | | - Ryan Takahashi
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, United States
| | - Xiaolu Wang
- Manfred Eigen Campus, Evotec AG , Essener Bogen, 22419 Hamburg, Germany
| | - Lawren C Wu
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, United States
| | - Yamin Zhang
- Pharmaron Beijing Co., Ltd . 6 Taihe Road, BDA, Beijing 100176, P.R. China
| | - Steven T Staben
- Genentech, Inc. 1 DNA Way, South San Francisco, California 94080, United States
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16
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Gordon J, McEwan P, Sabale U, Kartman B, Wolffenbuttel BHR. The cost-effectiveness of exenatide twice daily (BID) vs insulin lispro three times daily (TID) as add-on therapy to titrated insulin glargine in patients with type 2 diabetes. J Med Econ 2016; 19:1167-1174. [PMID: 27356188 DOI: 10.1080/13696998.2016.1208207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of exenatide twice daily (BID) vs bolus insulin lispro three times daily (TID) as add-on therapy when glycemic control is sub-optimal with titrated basal insulin glargine and metformin. METHODS The analysis was based on the recent 4B Study, which compared exenatide BID and lispro TID as add-on therapies in subjects with type 2 diabetes insufficiently controlled, despite titrated insulin glargine. The Cardiff Diabetes Model was used to simulate patient costs and health benefits beyond the 4B Study. The Swedish healthcare perspective was adopted for this analysis; costs are reported in €EUR to aid interpretation. The main outcome measure was the cost per quality-adjusted life-year (QALY) gained with exenatide BID compared to lispro TID. RESULTS Exenatide BID was associated with an incremental cost of €1,270 and a QALY increase of +0.64 compared with lispro TID over 40 years. The cost per QALY gained with exenatide BID compared with lispro TID was €1,971, which is within conventional limits of cost-effectiveness. Cost-effectiveness results were generally robust to alternative assumptions and values for key model parameters. LIMITATIONS Extrapolation of trial data over the longer term can be influenced by modeling and parameter uncertainty. Cost-effectiveness results were generally insensitive to alternative values of key model input parameters and across scenarios. CONCLUSIONS The addition of exenatide BID rather than insulin lispro to basal insulin is associated with similar or better clinical outcomes. Illustrated from the Swedish healthcare perspective, analysis with the Cardiff Diabetes Model demonstrated that exenatide BID represents a cost-effective treatment alternative to lispro TID as add-on therapy in type 2 diabetes patients insufficiently controlled on basal insulin.
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Affiliation(s)
- J Gordon
- a Health Economics and Outcomes Research Ltd , Cardiff , UK
- b Public Health, University of Adelaide , Adelaide , Australia
- c School of Medicine, University of Nottingham , UK
| | - P McEwan
- a Health Economics and Outcomes Research Ltd , Cardiff , UK
- d Swansea Centre for Health Economics, Swansea University , UK
| | - U Sabale
- e AstraZeneca Nordic-Baltic , Sweden
| | - B Kartman
- f AstraZeneca Gothenburg , Mölndal , Sweden
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17
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Ward T, Gordon J, Bennett H, Webster S, Sugrue D, Jones B, Brenner M, McEwan P. Tackling the burden of the hepatitis C virus in the UK: characterizing and assessing the clinical and economic consequences. Public Health 2016; 141:42-51. [PMID: 27932014 DOI: 10.1016/j.puhe.2016.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 08/03/2016] [Accepted: 08/05/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The hepatitis C virus (HCV) remains a significant public health issue. This study aimed to quantify the clinical and economic burden of chronic hepatitis C in the UK, stratified by disease severity, age and awareness of infection, with concurrent assessment of the impact of implementing a treatment prioritization approach. STUDY DESIGN AND METHODS A previously published back projection, natural history and cost-effectiveness HCV model was adapted to a UK setting to estimate the disease burden of chronic hepatitis C and end-stage liver disease (ESLD) between 1980 and 2035. A published meta-regression analysis informed disease progression, and UK-specific data informed other model inputs. RESULTS At 2015, prevalence of chronic hepatitis C is estimated to be 241,487 with 22.20%, 33.72%, 17.22%, 16.67% and 10.19% of patients in METAVIR stages F0, F1, F2, F3 and F4, respectively, but is estimated to fall to 193,999 by 2035. ESLD incidence is predicted to peak in 2031. Assuming all patients are diagnosed and treatment is prioritized in F3 and F4 using highly efficacious direct-acting antiviral (DAA) regimens, a 69.85% reduction in ESLD incidence is predicted between 2015 and 2035, and the cumulative discounted medical expenditure associated with the lifetime management of incident ESLD events is estimated to be £1,202,827,444. CONCLUSIONS The prevalence of chronic hepatitis C is expected to fall in coming decades; however, the ongoing financial burden is expected to be high due to an increase in ESLD incidence. This study highlights the significant costs of managing ESLD that are likely to be incurred without the employment of effective treatment approaches.
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Affiliation(s)
- T Ward
- Health Economics and Outcomes Research Ltd, Cardiff, UK.
| | - J Gordon
- Health Economics and Outcomes Research Ltd, Cardiff, UK; Department of Public Health, University of Adelaide, Australia; School of Medicine, University of Nottingham, UK
| | - H Bennett
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - S Webster
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - D Sugrue
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - B Jones
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - M Brenner
- UK HEOR, Bristol-Myers Squibb Pharmaceuticals Ltd, Uxbridge, UK
| | - P McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, UK; School of Human & Health Sciences, Swansea University, Swansea, UK
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18
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Charokopou M, Sabater FJ, Townsend R, Roudaut M, McEwan P, Verheggen BG. Methods applied in cost-effectiveness models for treatment strategies in type 2 diabetes mellitus and their use in Health Technology Assessments: a systematic review of the literature from 2008 to 2013. Curr Med Res Opin 2016; 32:207-18. [PMID: 26473650 DOI: 10.1185/03007995.2015.1102722] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify and compare health-economic models that were developed to evaluate the cost-effectiveness of treatments for type 2 diabetes mellitus (T2DM), and their use within Health Technology Assessments (HTAs). METHODS In total, six commonly used databases were searched for articles published between October 2008 and January 2013, using a protocolized search strategy and inclusion criteria. The websites of HTA organizations in nine countries, and proceedings from five relevant conferences, were also reviewed. The identified new health-economic models were qualitatively assessed using six criteria that were developed based on technical components, and characteristics related to the disease or the treatments being assessed. Finally, the number of times the models were applied within HTA reports, published literature, and/or major conferences was determined. RESULTS Thirteen new models were identified and reviewed in depth. Most of these were based on identical key data sources, and applied a similar model structure, either using Markov modeling or microsimulation techniques. The UKPDS equations and panel regressions were frequently used to estimate the occurrence of diabetes-related complications and the probability of developing risk factors in the long term. The qualitative assessment demonstrated that the CARDIFF, Sheffield T2DM and ECHO T2DM models seem technically equipped to appropriately assess the long-term health-economic consequences of chronic treatments for patients with T2DM. It was observed that the CORE model is the most widely described in literature and conferences, and the most often applied model within HTA submissions, followed by the CARDIFF and UKPDS models. CONCLUSION This research provides an overview of T2DM models that were developed between 2008 and January 2013. The outcomes of the qualitative assessments, combined with frequent use in local reimbursement decisions, prove the applicability of the CORE, CARDIFF and UKPDS models to address decision problems related to the long-term clinical and economic consequences of new and existing T2DM treatments.
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Affiliation(s)
- M Charokopou
- a a Pharmerit International , Rotterdam , the Netherlands (at the time of the research)
| | - F J Sabater
- b b Bristol-Myers Squibb , Rueil-Malmaison , France
| | - R Townsend
- c c AstraZeneca , Brussels , Belgium (at the time of the research)
| | - M Roudaut
- d d Bristol-Myers Squibb , Rueil-Malmaison , France (at the time of the research)
| | - P McEwan
- e e Centre for Health Economics, Swansea University , Wales , UK
- f f Health Economics & Outcomes Research Ltd , Wales , UK
| | - B G Verheggen
- g g Pharmerit International , Rotterdam , the Netherlands
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Charokopou M, McEwan P, Lister S, Callan L, Bergenheim K, Tolley K, Postema R, Townsend R, Roudaut M. Cost-effectiveness of dapagliflozin versus DPP-4 inhibitors as an add-on to Metformin in the Treatment of Type 2 Diabetes Mellitus from a UK Healthcare System Perspective. BMC Health Serv Res 2015; 15:496. [PMID: 26541516 PMCID: PMC4635987 DOI: 10.1186/s12913-015-1139-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 10/09/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a chronic, progressive condition where the primary treatment goal is to maintain control of glycated haemoglobin (HbA1c). In order for healthcare decision makers to ensure patients receive the highest standard of care within the available budget, the clinical benefits of each treatment option must be balanced against the economic consequences. The aim of this study was to assess the cost-effectiveness of dapagliflozin, the first-in-class sodium-glucose co-transporter 2 (SGLT2) inhibitor, compared with a dipeptidyl peptidase-4 inhibitor (DPP-4i), when added to metformin for the treatment of patients with T2DM inadequately controlled on metformin alone. METHODS The previously published and validated Cardiff diabetes model was used as the basis for this economic evaluation, with treatment effect parameters sourced from a systematic review and network meta-analysis. Costs, derived from a UK healthcare system perspective, and quality-adjusted life years (QALYs), were used to present the final outcome as an incremental cost-effectiveness ratio (ICER) over a lifetime horizon. Univariate and probabilistic sensitivity analyses (PSA) were carried out to assess uncertainty in the model results. RESULTS Compared with DPP-4i, dapagliflozin was associated with a mean incremental benefit of 0.032 QALYs (95% confidence interval [CI]: -0.022, 0.140) and with an incremental cost of £216 (95% CI: £-258, £795). This resulted in an ICER point estimate of £6,761 per QALY gained. Sensitivity analysis determined incremental costs to be insensitive to variation in most parameters, with only the treatment effect on weight having a notable impact on the incremental QALYs; however, there were no scenarios which raised the ICER above £15,000 per QALY. The PSA estimated that dapagliflozin had an 85% probability of being cost-effective at a willingness-to-pay threshold of £20,000 per QALY gained. CONCLUSIONS Dapagliflozin in combination with metformin was shown to be a cost-effective treatment option from a UK healthcare system perspective for patients with T2DM who are inadequately controlled on metformin alone.
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Affiliation(s)
- M Charokopou
- Pharmerit International, Rotterdam, Netherlands.
| | - P McEwan
- Centre for Health Economics, Swansea University, Swansea, UK. .,HEOR, Monmouth, UK.
| | - S Lister
- Bristol-Myers Squibb Pharmaceuticals Ltd, Uxbridge, UK.
| | | | | | - K Tolley
- Tolley Health Economics Ltd., Buxton, UK.
| | - R Postema
- Bristol-Myers Squibb, Rueil-Malmaison, France.
| | | | - M Roudaut
- Bristol-Myers Squibb, Rueil-Malmaison, France.
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20
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Charokopou M, McEwan P, Lister S, Callan L, Bergenheim K, Tolley K, Postema R, Townsend R, Roudaut M. The cost-effectiveness of dapagliflozin versus sulfonylurea as an add-on to metformin in the treatment of Type 2 diabetes mellitus. Diabet Med 2015; 32:890-8. [PMID: 25817050 DOI: 10.1111/dme.12772] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2015] [Indexed: 12/11/2022]
Abstract
AIMS To assess the cost-effectiveness of dapagliflozin, a sodium-glucose co-transporter-2 (SGLT-2) inhibitor, compared with a sulfonylurea, when added to metformin for treatment of UK people with Type 2 diabetes mellitus inadequately controlled on metformin alone. METHODS Clinical inputs sourced from a head-to-head randomized controlled trial (RCT) informed the Cardiff diabetes decision model. Risk equations developed from the United Kingdom Prospective Diabetes Study (UKPDS) were used in conjunction with the clinical inputs to predict disease progression and the incidence of micro- and macrovascular complications over a lifetime horizon. Cost and utility data were generated to present the incremental cost-effectiveness ratio (ICER) for both treatment arms, and sensitivity and scenario analyses were conducted to assess the impact of uncertainty on the final model results. RESULTS The dapagliflozin treatment arm was associated with a mean incremental benefit of 0.467 quality-adjusted life years (QALYs) [95% confidence interval (CI): 0.420; 0.665], with an incremental cost of £1246 (95% CI: £613; £1637). This resulted in an ICER point estimate of £2671 per QALY gained. Incremental costs were shown to be insensitive to parameter variation, with only treatment-related weight change having a significant impact on the incremental QALYs. Probabilistic sensitivity analysis determined that dapagliflozin had a 100% probability of being cost-effective at a willingness-to-pay threshold of £20,000 per QALY. CONCLUSIONS Dapagliflozin in combination with metformin was shown to be a cost-effective treatment option compared with sulfonylurea from a UK healthcare perspective for people with Type 2 diabetes mellitus who are inadequately controlled on metformin monotherapy.
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Affiliation(s)
- M Charokopou
- Pharmerit International, Rotterdam, The Netherlands
| | - P McEwan
- Centre for Health Economics, Swansea University, Monmouth, UK
- HEOR, Monmouth, UK
| | - S Lister
- Bristol-Myers Squibb Pharmaceuticals, Uxbridge, UK
| | | | | | - K Tolley
- Tolley Health Economics, Buxton, UK
| | - R Postema
- Bristol-Myers Squibb, Rueil-Malmaison, France
| | | | - M Roudaut
- Bristol-Myers Squibb, Rueil-Malmaison, France
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Robinson P, McEwan P, Ong A, Ørskov B, Sandford R, Scolari F, Walz G, Bennet-Wilton H, O'Reilly K. FP064ASSESSING THE LONG TERM OUTCOMES OF AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE (ADPKD) USING THE ADPKD OUTCOMES MODEL: A UK CASE STUDY. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv167.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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O'Reilly K, McEwan P, Bennett Wilton H, Robinson P. FP055EXPLORING THE IMPACT OF TOLVAPTAN ON THE LONG TERM RATE OF RENAL FUNCTION DECLINE USING THE ADPKD OUTCOMES MODEL. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv167.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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McEwan P, Bennett H, Ward T, Bergenheim K. Refitting of the UKPDS 68 risk equations to contemporary routine clinical practice data in the UK. Pharmacoeconomics 2015; 33:149-161. [PMID: 25344660 DOI: 10.1007/s40273-014-0225-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Economic evaluations of new diabetes therapies rely heavily upon the UK Prospective Diabetes Study (UKPDS) equations for prediction of cardiovascular events; however, concerns persist regarding their relevance to current clinical practice and appropriate use in populations other than newly diagnosed patients. This study refits the UKPDS 68 event equations, using contemporary data describing low- and intermediate-risk patients. RESEARCH DESIGN AND METHODS Anonymized patient data describing demographics, risk factors and incidence of cardiovascular and microvascular events were extracted from The Health Improvement Network (THIN) database over the 10-year period from 1 January 2000 to 31 December 2009. Following multiple imputation of missing values, accelerated failure-time Weibull regression equations were refitted to produce new coefficients for each risk group. Discriminatory performance was assessed and compared with both UKPDS 68 and UKPDS 82 risk equations, and the implication of coefficient choice within an economic evaluation was assessed using the Cardiff type 2 diabetes model. RESULTS When applied to patient-level data, the three sets of coefficients (UKPDS, THIN low-risk and intermediate-risk) lead to fairly consistent predictions of the 5-year risk of events. Exceptions include lower predicted rates of myocardial infarction and higher rates of ischaemic heart disease, congestive heart failure and end-stage renal disease with both sets of revised THIN coefficients compared with UKPDS. Over a modelled lifetime, the coefficients derived from the low-risk data predict fewer total cardiovascular events compared with UKPDS, while those from the intermediate-risk data predict a greater number. The areas under the receiver-operating characteristic curves demonstrated a marginal improvement in the discriminatory performance of the refitted equations. The incremental cost-effectiveness ratio associated with dapagliflozin versus sulphonylurea in addition to metformin changed from £7,708 to £7,519 and £6,906 per QALY gained, using the THIN intermediate- and low-risk coefficients, respectively. CONCLUSION The results suggest that while the UKPDS equations perform best in newly diagnosed patients, they may overpredict the lifetime risk in this group and underpredict it in patients with more advanced diabetes. Implementation of the revised coefficients will result in different absolute numbers of predicted diabetes-related events; however, they are not expected to significantly affect the conclusions of economic modelling.
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Affiliation(s)
- P McEwan
- Swansea Centre for Health Economics, Swansea University, Wales, UK
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Gordon J, McEwan P, Sabale U, Kartman B. The Cost-Effectiveness of Exenatide Bid Versus Insulin Lispro Tid As Add-On Therapy to Titrated Insulin Glargine in Patients With Type 2 Diabetes - An Analysis From The Swedish Health Care Perspective. Value Health 2014; 17:A344. [PMID: 27200645 DOI: 10.1016/j.jval.2014.08.693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- J Gordon
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - P McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - U Sabale
- AstraZeneca Nordic-Baltic, Södertälje, Sweden
| | - B Kartman
- AstraZeneca Nordic-Baltic, Södertälje, Sweden
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Foos V, McEwan P, Lamotte M, Grant D. All-Cause Mortality Validation of the Core Diabetes Model Against Predictions of the Charlson Comorbidity Index. Value Health 2014; 17:A558. [PMID: 27201836 DOI: 10.1016/j.jval.2014.08.1839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- V Foos
- IMS Health, Basel, Switzerland
| | - P McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - M Lamotte
- IMS Health Consulting, Brussels, Belgium
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McEwan P, Ward T, Bennett H, Bergenheim K. Comparing the Event Prediction Capability of the Ukpds68 and Hong Kong Diabetes Risk Equations within A Type 2 Diabetes Simulation Model. Value Health 2014; 17:A729-A730. [PMID: 27202601 DOI: 10.1016/j.jval.2014.08.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- P McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - T Ward
- Health Economics and Outcomes Research Ltd, Monmouth, UK
| | - H Bennett
- Health Economics and Outcomes Research Ltd, Monmouth, UK
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Pockett RD, McEwan P, Beckham C, Shutler S, Martin S, Yousef Z, Bakhai A. Health Utility in Patients Following Cardiovascular Events. Value Health 2014; 17:A328. [PMID: 27200555 DOI: 10.1016/j.jval.2014.08.598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - P McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - C Beckham
- Roche Products Ltd, Welwyn Garden City, UK
| | - S Shutler
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - S Martin
- Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, UK
| | - Z Yousef
- University Hospital of Wales, Cardiff, UK
| | - A Bakhai
- Barnet and Chase Farm Hospitals NHS Trust, Barnet, UK
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McEwan P, Gordon J, Evans M, Puelles J. Factors Associated With Weight Gain and Hypoglycaemia and The Impact Upon Hospitalisation in Type 2 Diabetes Patients Managed With Metformin Plus Sulphonylurea. Value Health 2014; 17:A360. [PMID: 27200733 DOI: 10.1016/j.jval.2014.08.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- P McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - J Gordon
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - M Evans
- University Hospital Llandough, Cardiff, UK
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McEwan P, Grant D, Foos V. Assessing the Relationship between Improved Life Expectancy Due to Better Cardiovascular Risk Factor Management and the Likelihood of Microvascular Complications in Type 2 Diabetes Mellitus. Value Health 2014; 17:A333. [PMID: 27200583 DOI: 10.1016/j.jval.2014.08.633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- P McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | | | - V Foos
- IMS Health, Basel, Switzerland
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McEwan P, Bennett H, Ward T, Bergenheim K. Comparing the Use of Patient-Level Data to An Average Patient Profile Within a Type 2 Diabetes Simulation Model. Value Health 2014; 17:A546. [PMID: 27201770 DOI: 10.1016/j.jval.2014.08.1768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- P McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - H Bennett
- Health Economics and Outcomes Research Ltd, Monmouth, UK
| | - T Ward
- Health Economics and Outcomes Research Ltd, Monmouth, UK
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Foos V, McEwan P, Grant D. Impact of Single Risk Factor Changes on Long Term Outcomes and Cost in a Type 2 Diabetes Modeling Study Contrasting Projections With UKPDS 68 Versus UKPDS 82 Risk Equations. Value Health 2014; 17:A547. [PMID: 27201774 DOI: 10.1016/j.jval.2014.08.1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- V Foos
- IMS Health, Basel, Switzerland
| | - P McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, UK
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Bennett H, McEwan P, Ward T, Kalsekar A, Yuan Y. Modelling the Relationship between Sustained Virologic Response and Treatment Uptake Rates on Future Prevalence and Incidence of Hepatitis C in the UK. Value Health 2014; 17:A682. [PMID: 27202526 DOI: 10.1016/j.jval.2014.08.2547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- H Bennett
- Health Economics and Outcomes Research Ltd, Monmouth, UK
| | - P McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - T Ward
- Health Economics and Outcomes Research Ltd, Monmouth, UK
| | - A Kalsekar
- Bristol-Myers Squibb, Princeton, NJ, USA
| | - Y Yuan
- Bristol-Myers Squibb, Princeton, NJ, USA
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McEwan P, Grant D, Lamotte M, Foos V. Quantifying Nonlinear Effects in Stochastic Markov Simulation Using UKPDS 68 and Ukpds 82 Equations in Type 2 Diabetes Modeling Analysis With the IMS Core Diabetes Model (CDM). Value Health 2014; 17:A546. [PMID: 27201771 DOI: 10.1016/j.jval.2014.08.1769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- P McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | | | - M Lamotte
- IMS Health Consulting, Brussels, Belgium
| | - V Foos
- IMS Health, Basel, Switzerland
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McEwan P, Bennett Wilton H, Robinson P, Hadimeri H, Ong A, Ørskov B, Peces R, Sandford R, Scolari F, Walz G, Woon C, O'Reilly K. Development Of A Model To Predict Disease Progression In Autosomal Dominant Polycystic Kidney Disease (ADPKD). Value Health 2014; 17:A564. [PMID: 27201867 DOI: 10.1016/j.jval.2014.08.1870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- P McEwan
- Swansea Centre for Health Economics, Swansea, UK
| | | | - P Robinson
- Otsuka Pharmaceutical Europe Ltd, Wexham, UK
| | - H Hadimeri
- Department of Nephrology, Kärnsjukhuset, Skövde, Sweden
| | - A Ong
- Academic Nephrology Unit, Department of Infection and Immunity, The University of Sheffield Medical School, UK
| | - B Ørskov
- Department of Medicine, Renal Division, Copenhagen University Hospital, Roskilde, Denmark
| | - R Peces
- Hospital Universitario La Paz, Madrid, Spain
| | - R Sandford
- Academic Laboratory of Medical Genetics, Addenbrooke's Treatment Centre, Cambridge, UK
| | - F Scolari
- Department of Nephrology, University of Brescia, Italy
| | - G Walz
- Department of Nephrology, University Medical Centre Freiburg, Zentrale Klinische Forschung, Freiburg, Germany
| | - C Woon
- McCann Complete Medical, Macclesfield, UK
| | - K O'Reilly
- Otsuka Pharmaceutical Europe Ltd, Wexham, UK
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Cabrera-Lopez C, Ars E, Marti T, Harris PC, Torra R, Clerckx C, Migeon T, Chen Z, Ronco P, Plaisier E, Lamers IJ, Van Reeuwijk J, Azam M, Boldt K, Maria M, Koster-Kamphuis L, Qamar R, Ueffing M, Cremers FP, Roepman R, Arts HH, Papizh S, Dlin V, Leontieva I, Tutelman K, Perrone RD, Bae KT, Chapman AB, Devuyst O, Gansevoort RT, Grantham JJ, Higashihara E, Torres VE, Sergeyeva O, Zhou W, Blais JD, Czerwiec FS, Liu F, Liao Y, Fu P, Casteleijn N, Zittema D, Bakker S, Boertien W, Gaillard C, Meijer E, Spithoven E, Struck J, Gansevoort R, Robinson P, McEwan P, Hadimeri H, Ong ACM, Orskov B, Peces R, Sandford R, Scolari F, Walz G, Cooke C, O'Reilly K, Riwanto M, Kapoor S, Rodriguez D, Edenhofer I, Segerer S, Wuthrich RP, De Rechter S, Bacchetta J, Van Dyck M, Evenepoel P, De Schepper J, Levtchenko E, Mekahli D, Carr A, Makin A, Baker A, Obeidova L, Stekrova J, Seeman T, Puchmajerova A, Reiterova J, Kohoutova M, Tesar V, Treille S, Bailly JM, Guillaume B, Tuta L, Stanigut A, Botea F, Jo HA, Park HC, Kim H, Han M, Huh H, Jeong JC, Oh KH, Yang J, Koo TY, Hwang YH, Ahn C, Pisani A, Remuzzi G, Ruggenenti P, Riccio E, Visciano B, Spinelli L, Kim JI, Park KM, Liu FX, Rutherford P, Smoyer-Tomic K, Martinez Jimenez V, Comas J, Arcos E, Diaz JM, Muray S, Cabezuelo J, Ballarin J, Ars E, Torra R, Miyaoka T, Morimoto S, Kataoka H, Mochizuki T, Tsuchiya K, Ichihara A, Nitta K. RENAL DEVELOPMENT AND CYSTIC DISEASES. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu141] [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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Pockett RD, Castellano D, McEwan P, Oglesby A, Barber BL, Chung K. The hospital burden of disease associated with bone metastases and skeletal-related events in patients with breast cancer, lung cancer, or prostate cancer in Spain. Eur J Cancer Care (Engl) 2011; 19:755-60. [PMID: 19708928 PMCID: PMC3035821 DOI: 10.1111/j.1365-2354.2009.01135.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
POCKETT R.D., CASTELLANO D., MCEWAN P., OGLESBY A., BARBER B.L. & CHUNG K. (2010) European Journal of Cancer Care19, 755–760 The hospital burden of disease associated with bone metastases and skeletal-related events in patients with breast cancer, lung cancer, or prostate cancer in Spain Metastatic bone disease (MBD) is the most common cause of cancer pain and of serious skeletal-related events (SREs) reducing quality of life. Management of MBD involves a multimodal approach aimed at delaying the first SRE and reducing subsequent SREs. The objective of the study was to characterise the hospital burden of disease associated with MBD and SREs following breast, lung and prostate cancer in Spain. Patients admitted into a participating hospital, between 1 January 2003 and 31 December 2003, with one of the required cancers were identified and selected for inclusion into the study. The index admission to hospital, incidence of patients admitted and hospital length of stay were analysed. There were 28 162 patients identified with breast, lung and prostate cancer. The 3 year incidence rates of hospital admission due to MBD were 95 per 1000 for breast cancer, 156 per 1000 for lung cancer and 163 per 1000 for prostate cancer. For patients admitted following an SRE, the incidence rates were 211 per 1000 for breast cancer, 260 per 1000 for lung cancer and 150 per 1000 for prostate cancer. This study has shown that cancer patients consume progressively more hospital resources as MBD and subsequent SREs develop.
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Affiliation(s)
- R D Pockett
- Cardiff Research Consortium, the MediCentre, Cardiff, UK.
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Gordon J, Pockett RD, Tetlow AP, McEwan P, Home PD. A comparison of intermediate and long-acting insulins in people with type 2 diabetes starting insulin: an observational database study. Int J Clin Pract 2010; 64:1609-18. [PMID: 20946269 PMCID: PMC3036815 DOI: 10.1111/j.1742-1241.2010.02520.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIMS Insulin is normally added to oral glucose-lowering drugs in people with type 2 diabetes when glycaemic control becomes suboptimal. We evaluated outcomes in people starting insulin therapy with neutral protamine Hagedorn (NPH), detemir, glargine or premixed insulins. METHODS Insulin-naïve people with type 2 diabetes (n = 8009), ≥ 35 years old, HbA(1c) ≥ 6.5% and begun on NPH (n = 1463), detemir (n = 357), glargine (n = 2197) or premix (n = 3992), were identified from a UK database of primary care records (The Health Improvement Network). Unadjusted and multivariate-adjusted analyses were conducted, with persistence of insulin therapy assessed by survival analysis. RESULTS In the study population (n = 4337), baseline HbA(1c) was 9.5 ± 1.6%, falling to 8.4 ± 1.5% over 12 months (change -1.1 ± 1.8%, p < 0.001). Compared with NPH, people taking detemir, glargine and premix had an adjusted reduction in HbA(1c) from baseline, of 0.00% (p = 0.99), 0.19% (p < 0.001) and 0.03% (p = 0.51). Body weight increased by 2.8 kg overall (p < 0.001), and by 2.3, 1.7, 1.9, and 3.3 kg on NPH, detemir, glargine and premix (p < 0.001 for all groups); insulin dose at 12 months was 0.70 (overall), 0.64, 0.61, 0.56 and 0.76 U/kg/day. After 36 months, 57% of people on NPH, 67% on glargine and 83% on premix remained on their initially prescribed insulin. DISCUSSION AND CONCLUSION In routine clinical practice, people with type 2 diabetes commenced on NPH experienced a modest disadvantage in glycaemic control after 12 months compared with other insulins. When comparing the insulins, glargine achieved best HbA(1c) reduction, while premix showed greatest weight gain and the highest dose requirement, but had the best persistence of therapy.
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Affiliation(s)
- J Gordon
- School of Population Health and Clinical Practice, University of Adelaide, Adelaide, SA, Australia.
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Morgan CL, Griffin A, Chamberlain GH, Turkiendorf A, McEwan P, Evans LM, Owens DR. A longitudinal study into the new and long-term use of self-monitoring blood glucose strips in the UK. Diabetes Ther 2010; 1:1-9. [PMID: 22127668 PMCID: PMC3118273 DOI: 10.1007/s13300-010-0001-9] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2010] [Indexed: 11/28/2022] Open
Abstract
AIMS To determine the impact of self-monitoring blood glucose (SMBG) strip use in patients with type 2 diabetes in the UK. METHODS The study period was April 1, 2004 to July 31, 2005. Data from primary care was extracted from The Health Improvement Network database. Patients identified with diabetes and matching the inclusion criteria were defined as new users of SMBG, prevalent users, or non-users. Patients were also defined as treated with insulin, with oral agents (OA), or not pharmacologically treated. Change in glycosylated hemoglobin (HbA(1c)) at baseline and after 12 months was compared. RESULTS 2559 patients met the inclusion criteria. For new users, HbA(1c) fell by 0.59% (P=0.399) for those treated with insulin, 1.52% (P<0.001) for those treated with OA, and 0.51% (P<0.001) for no treatment. In prevalent users, changes were 0.31% (P<0.001), 0.34% (P<0.001), and 0.09% (P=0.456), respectively. In non-users, changes were 0.28% (P=0.618), 0.42% (P<0.001), and an increase of 0.05% (P=0.043), respectively. A significant decrease in mean HbA(1c) was associated with increasing strip use in OA patients newly initiated on strips. CONCLUSION This observational study showed a significant decrease in HbA(1c) for new users of SMBG treated either non-pharmacologically or with OA, and for prevalent users treated with insulin or OA. Reduced HbA(1c) with increasing strip use was observed but was only significant for OA-treated new users. This suggests that SMBG use has a role in the treatment of non-insulin treated patients with type 2 diabetes.
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Affiliation(s)
- C L Morgan
- Cardiff Research Consortium, Cardiff, Medicentre, Cardiff, CF14 4UJ, UK,
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McEwan P, Evans M, Bergenheim K. A population model evaluating the costs and benefits associated with different oral treatment strategies in people with type 2 diabetes. Diabetes Obes Metab 2010; 12:623-30. [PMID: 20590737 DOI: 10.1111/j.1463-1326.2010.01198.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The attainment of near-normal glycaemia is an important feature in reducing complications in people with type 2 diabetes. Current treatment pathways advocate a failure-driven therapy algorithm for blood-glucose lowering that leads to the sequential addition of therapies. The addition and combination of multiple blood-glucose lowering agents may be associated with significant side effects, such as weight gain and hypoglycaemia, resulting in a detrimental quality of life. The objective of this study is to quantify the overall costs and quality-adjusted life years (QALY) associated with therapy escalation via oral only treatment strategies with different adverse event profiles as a function of target HbA1c achievement. METHODS A previously published model was adapted to run as a non-terminating simulation model. The model is designed to evaluate the cost utility of treatment strategies in a population of type 2 diabetes mellitus patients. Model outputs include incidence of micro- and macrovascular complications, hypoglycaemia and diabetes-specific and all-cause mortality. RESULTS The total number of vascular events predicted by the model varied little across the four treatment strategies because of the glycaemic profile associated with each therapy strategy being similar. The strategy with sequential addition of thiazolidinediones (TZDs) and sulphonylureas (SUs) to metformin (MF) was associated with greatest predicted hypoglycaemia burden. The addition of SU and dipeptidyl peptidase (DPP-4) inhibitors to MF was associated with the highest estimated QALYs. CONCLUSIONS A treatment strategy involving the sequential addition of SU and TZD to first-line MF therapy is associated with the lowest cost and lowest gain across a population, whereas addition of TZD and SU sequentially to first-line MF therapy resulted in the highest cost and incrementally less QALY gain when compared with treatment strategies involving the addition of a DPP-4 inhibitor and SU to first-line MF (irrespective of the treatment sequence) that were associated with both less cost and greatest QALY gain.
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Affiliation(s)
- P McEwan
- Cardiff Research Consortium, Cardiff, UK.
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McEwan P, Evans M, Kan H, Bergenheim K. Understanding the inter-relationship between improved glycaemic control, hypoglycaemia and weight change within a long-term economic model. Diabetes Obes Metab 2010; 12:431-6. [PMID: 20415691 DOI: 10.1111/j.1463-1326.2009.01184.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Current guidelines for the management of type 2 diabetes advocate the attainment of sustained near normal glycaemia levels. Metformin is widely accepted as the treatment of choice for the initiation of pharmacotherapy; however, secondary failure of oral monotherapy occurs in 60% of patients resulting in the need for multiple pharmacotherapies. Therapy-related consequences of treatment, such as weight gain and hypoglycaemia impact on the cost-effectiveness profile of various agents. We therefore sought to ascertain the respective contribution of hypoglycaemia, weight change and improved blood glucose control on second-line therapy options added to metformin. METHODS This study uses a simulation model designed to evaluate the cost utility of new therapies in a population of patients with type 2 diabetes mellitus. Standard model outputs include incidence of micro- and macrovascular complications and diabetes-specific and all-cause mortality. RESULTS The mean discounted quality-adjusted life year (QALY) predicted by the model was 12.31 years. Reducing Glycosylated haemoglobin (HbA1c) by 1% gave a predicted gain of 0.413 QALYs per patient. A 3-kg weight loss and 30% reduction in hypoglycaemia frequency produced a combined QALY gain of 0.355, whereas the reverse gave a QALY decrement of 0.356. CONCLUSIONS The results of this analysis quantify the QALY decrement that may result from adverse therapy effects. The beneficial effects of improved glycaemic control on QALYs may be offset by characteristic treatment-specific adverse effects, such as weight gain and hypoglycaemia frequency.
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Affiliation(s)
- P McEwan
- Cardiff Research Consortium, Cardiff, Wales, UK.
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Abstract
There is increasing evidence that preterm birth is a risk factor for the development of adiposity associated disease, although the pathophysiological basis is unclear. We have previously shown that preterm infants have increased internal abdominal (visceral) adiposity by term. In adults increased internal adiposity is associated with elevated intrahepatocellular lipid (IHCL). We measured IHCL using (1)H NMR spectroscopy in 26 infants (eight healthy preterm-at-term and 18 term-born) and compared values with a reference group of 32 adults. There was no significant difference between adult and term-born IHCL content. In preterm-at-term infants IHCL was significantly elevated when compared with term-born infants and with adults (IHCL CH2/water median (interquartile range): preterm 1.69 (1.04-3.53), term 0.21 (0-0.54) and adult 0.55 (0.08-1.57).
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Affiliation(s)
- E L Thomas
- Molecular Imaging Group, MRC Clinical Sciences Centre, Imperial College London, London, UK
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44
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Abstract
BACKGROUND Enteral feeding tubes for preterm infants may be placed in the stomach (gastric tube feeding) or in the upper small bowel (transpyloric tube feeding). There are potential advantages and disadvantages to both routes. OBJECTIVES To determine the effect of feeding via the transpyloric route versus feeding via the gastric route on feeding tolerance, growth and development and adverse consequences in preterm infants who require enteral tube feeding. SEARCH STRATEGY The standard search strategy of the Cochrane Neonatal Review Group was used. This included electronic searches of MEDLINE and EMBASE (up to March 2007) and of The Cochrane Controlled Trials Register in The Cochrane Library (Issue 1, 2007), and searches of the references in previous reviews including cross references. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing transpyloric with gastric tube feeding in preterm infants. DATA COLLECTION AND ANALYSIS Data were extracted using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by each author and synthesis of data using relative risk (RR) and weighted mean difference (WMD). MAIN RESULTS Data from nine trials were available. No evidence of an effect on short term growth rates was found: weight: WMD -0.7 g/week (95% confidence interval (CI) -25.2, 23.8); crown heel length: WMD -0.7 mm/week (95% CI -2.4, 1.0); head circumference: WMD 0.6 mm/week (95% CI -0.9, 2.1). Longer term growth was reported in one study. There were not any statistically significant differences between the groups in the mean body weight or occipitofrontal head circumference at three months or at six months corrected age. None of the included studies provided data on neurodevelopmental outcomes. Transpyloric feeding was associated with a greater incidence of gastro-intestinal disturbance (RR 1.45, 95% CI 1.05, 2.09). There was some evidence that feeding via the transpyloric route increased mortality (RR 2.46, 95% CI 1.36, 4.46). However, the outcomes of the study that contributed most to this finding were likely to have been affected by selective allocation of the less mature and sicker infants to transpyloric feeding. No statistically significant differences in the incidence of other adverse events, including necrotising enterocolitis, intestinal perforation, and aspiration pneumonia was found. AUTHORS' CONCLUSIONS No evidence of any beneficial effect of transpyloric feeding in preterm infants was found. However, evidence of adverse effects was noted. Feeding via the transpyloric route cannot be recommended for preterm infants.
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Affiliation(s)
- W McGuire
- Australian National University Medical School, Department of Paediatrics and Child Health, Canberra Hospital Campus, Canberra, ACT 2606, Australia.
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Morgan CL, McEwan P, Morrissey M, Peters JR, Poole C, Currie CJ. Characterization and comparison of health-related utility in people with diabetes with various single and multiple vascular complications. Diabet Med 2006; 23:1100-5. [PMID: 16978374 DOI: 10.1111/j.1464-5491.2006.01936.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To characterize and compare health-related utility in a large cohort of patients treated in hospital with diabetes and with single and multiple comorbidities. METHODS The study was conducted in Cardiff and the Vale of Glamorgan, UK. Health-related utility was measured using the EQ5D(index), a standardized instrument for measuring health outcome. Patients from the Health Outcomes Data Repository (HODaR) were surveyed by postal questionnaire 6 weeks post discharge for in-patients and during clinics for patients attending as out-patients between January 2002 and July 2005. Patients with diabetes were identified by a previous history of in-patient admission with diabetes or as an out-patient with diabetes recorded as a coexisting diagnosis. RESULTS We identified 4502 patients with diabetes. Mean ages were 65.4 and 64.2 years for males and females, respectively. Of these, 2003 (45%) had no recorded vascular complication. Overall, the EQ5D(index) was 0.584 (sd 0.325) for males and 0.533 (sd 0.351) for females. For those without any vascular complications the mean EQ5D(index) was 0.735 (sd 0.288). In a general linear model, the presence of single and multiple complications had a detrimental impact on the EQ5D(index). CONCLUSION The results of this study provide an indication of the true impact of diabetes in terms of health-related utility. There was a decrease in the mean EQ5D(index) for those with vascular complications. Economic models of diabetes that have used additive or multiplicative methods to assess utility in individuals with several complications may be unreliable, and direct measurements, such as this, are recommended.
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Affiliation(s)
- C Ll Morgan
- Department of Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Emsley J, McEwan P, Papagrigoriou E, Walsh P. Factor XI structure reveals a novel receptor mediated activation pathway. Acta Crystallogr A 2005. [DOI: 10.1107/s0108767305097527] [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: 11/10/2022] Open
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Biswas M, Smith J, Jadon D, McEwan P, Rees DA, Evans LM, Scanlon MF, Davies JS. Long-term remission following withdrawal of dopamine agonist therapy in subjects with microprolactinomas. Clin Endocrinol (Oxf) 2005; 63:26-31. [PMID: 15963057 DOI: 10.1111/j.1365-2265.2005.02293.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Reports suggest that up to 70% of patients with microprolactinomas treated with dopamine agonist therapy may achieve long-term normoprolactinaemic remission following drug withdrawal. Yet, there is no consensus on the duration of therapy nor is therapeutic interruption universally practised. We have assessed remission rates in a large cohort of treatment-naive subjects with microprolactinomas. Subjects received dopamine agonist (DA) therapy with either cabergoline or bromocriptine for a period of 2 to 3 years in the majority of cases, followed by a trial of treatment withdrawal. DESIGN Retrospective analysis of clinic records of 89 patients (mean age 32.7 +/- 8.4 years, 84 women and 5 men) who had received either cabergoline (n = 67) (0.5-3 mg weekly) or bromocriptine (n = 22) (2.5-10 mg daily) for a mean duration of 3.1 years. RESULTS Following withdrawal of therapy, 57 subjects developed recurrence (64%) and the mean time to recurrence was 9.6 months (range 1-44 months), while 32 subjects (36%) remained in remission beyond 1 year (mean 3.6 years, range 1-7 years). There was no difference in remission rates between subjects treated with cabergoline (n = 21) and bromocriptine (n = 11), but a direct relationship between pretreatment prolactin concentration and risk of recurrent symptomatic hyperprolactinaemia was observed. No subjects developed clinical features to suggest tumour expansion following therapeutic discontinuation. CONCLUSIONS This study confirms that abrupt withdrawal of chronic dopamine agonist therapy, following 2 to 3 years of treatment is safe and associated with long-term remission in 30-40% of subjects with microprolactinomas. This therapeutic strategy is convenient and applicable in clinical practice.
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Affiliation(s)
- M Biswas
- Department of Endocrinology, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
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Currie CJ, Jones M, Goodfellow J, McEwan P, Morgan CL, Emmas C, Peters JR. Evaluation of survival and ischaemic and thromboembolic event rates in patients with non-valvar atrial fibrillation in the general population when treated and untreated with warfarin. Heart 2005; 92:196-200. [PMID: 15883133 PMCID: PMC1860757 DOI: 10.1136/hrt.2004.058339] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To compare survival and adverse outcome of patients with non-valvar atrial fibrillation (NVAF) treated with or without warfarin. DESIGN Record linkage method to identify patients with a previous hospital diagnosis of atrial fibrillation and to link these patients to international normalised ratio (INR) test results and mortality data. SETTING Cardiff and the Vale of Glamorgan, Wales. MAIN OUTCOME MEASURES Mortality, specifically from ischaemic and thromboembolic events. RESULTS 6108 patients were identified with NVAF, of whom 36.4% received warfarin. Mean survival in the warfarin and non-warfarin groups was 52.0 months and 38.2 months, respectively (p < 0.001), and 14.4 months (p < 0.001) after adjustment for confounding factors. Warfarin treated patients in the upper quartile of INR control had significantly longer survival (57.5 months) than did those in the lowest quartile of control (38.1 months, p < 0.001). The risk of stroke in the warfarin group when treated was lower than that in the non-warfarin group (relative rate (RR) 0.74, p < 0.001). The risk of death from ischaemic stroke was lower in the warfarin group (RR 0.43, p < 0.001). The risk of all ischaemic and embolic events in the warfarin group was lower when they were taking warfarin (RR 0.74, p < 0.001). The risk of bleeding in the warfarin group when treated was greater (RR 1.78, p = 0.001). CONCLUSIONS Patients with NVAF within the recommended target INR range of 2.0-3.0 survive longer and have reduced morbidity. Probably too few people are anticoagulated with warfarin in NVAF.
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Affiliation(s)
- C J Currie
- School of Medicine, Cardiff University, Cardiff, UK.
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Jones M, McEwan P, Morgan CL, Peters JR, Goodfellow J, Currie CJ. Evaluation of the pattern of treatment, level of anticoagulation control, and outcome of treatment with warfarin in patients with non-valvar atrial fibrillation: a record linkage study in a large British population. Heart 2005; 91:472-7. [PMID: 15772203 PMCID: PMC1768813 DOI: 10.1136/hrt.2004.042465] [Citation(s) in RCA: 248] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate how well patients with non-valvar atrial fibrillation (NVAF) were maintained within the recommended international normalised ratio (INR) target of 2.0-3.0 and to explore the relation between achieved INR control and clinical outcomes. DESIGN Record linkage study of routine activity records and INR measurements. SETTING Cardiff and the Vale of Glamorgan, South Wales, UK. PARTICIPANTS 2223 patients with NVAF, no history of heart valve replacement, and with at least five INR measurements. MAIN OUTCOME MEASURES Mortality, ischaemic stroke, all thromboembolic events, bleeding events, hospitalisation, and patterns of INR monitoring. RESULTS Patients treated with warfarin were outside the INR target range 32.1% of the time, with 15.4% INR values > 3.0 and 16.7% INR values < 2.0. However, the quartile with worst control spent 71.6% of their time out of target range compared with only 16.3% out of range in the best controlled quartile. The median period between INR tests was 16 days. Time spent outside the target range decreased as the duration of INR monitoring increased, from 52% in the first three months of monitoring to 30% after two years. A multivariate logistic regression model showed that a 10% increase in time out of range was associated with an increased risk of mortality (odds ratio (OR) 1.29, p < 0.001) and of an ischaemic stroke (OR 1.10, p = 0.006) and other thromboembolic events (OR 1.12, p < 0.001). The rate of hospitalisation was higher when INR was outside the target range. CONCLUSIONS Suboptimal anticoagulation was associated with poor clinical outcomes, even in a well controlled population. However, good control was difficult to achieve and maintain. New measures are needed to improve maintenance anticoagulation in patients with NVAF.
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Affiliation(s)
- M Jones
- School of Mathematics, Cardiff University, Cardiff, UK
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Jaillon O, Aury JM, Brunet F, Petit JL, Stange-Thomann N, Mauceli E, Bouneau L, Fischer C, Ozouf-Costaz C, Bernot A, Nicaud S, Jaffe D, Fisher S, Lutfalla G, Dossat C, Segurens B, Dasilva C, Salanoubat M, Levy M, Boudet N, Castellano S, Anthouard V, Jubin C, Castelli V, Katinka M, Vacherie B, Biémont C, Skalli Z, Cattolico L, Poulain J, De Berardinis V, Cruaud C, Duprat S, Brottier P, Coutanceau JP, Gouzy J, Parra G, Lardier G, Chapple C, McKernan KJ, McEwan P, Bosak S, Kellis M, Volff JN, Guigó R, Zody MC, Mesirov J, Lindblad-Toh K, Birren B, Nusbaum C, Kahn D, Robinson-Rechavi M, Laudet V, Schachter V, Quétier F, Saurin W, Scarpelli C, Wincker P, Lander ES, Weissenbach J, Roest Crollius H. Genome duplication in the teleost fish Tetraodon nigroviridis reveals the early vertebrate proto-karyotype. Nature 2004; 431:946-57. [PMID: 15496914 DOI: 10.1038/nature03025] [Citation(s) in RCA: 1398] [Impact Index Per Article: 69.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2004] [Accepted: 09/08/2004] [Indexed: 12/16/2022]
Abstract
Tetraodon nigroviridis is a freshwater puffer fish with the smallest known vertebrate genome. Here, we report a draft genome sequence with long-range linkage and substantial anchoring to the 21 Tetraodon chromosomes. Genome analysis provides a greatly improved fish gene catalogue, including identifying key genes previously thought to be absent in fish. Comparison with other vertebrates and a urochordate indicates that fish proteins have diverged markedly faster than their mammalian homologues. Comparison with the human genome suggests approximately 900 previously unannotated human genes. Analysis of the Tetraodon and human genomes shows that whole-genome duplication occurred in the teleost fish lineage, subsequent to its divergence from mammals. The analysis also makes it possible to infer the basic structure of the ancestral bony vertebrate genome, which was composed of 12 chromosomes, and to reconstruct much of the evolutionary history of ancient and recent chromosome rearrangements leading to the modern human karyotype.
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Affiliation(s)
- Olivier Jaillon
- UMR 8030 Genoscope, CNRS and Université d'Evry, 2 rue Gaston Crémieux, 91057 Evry Cedex, France
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