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Bolton C, Harrison T, Lugogo N, Fuhlbrigge A, Hirsch I, Bengtsson T, Peterson S, Sidaway M, Garcia Gil E, Fagerås M, Da Silva CA. Use of CompEx in eosinophilic patients with severe, uncontrolled asthma on benralizumab. ERJ Open Res 2024; 10:01025-2023. [PMID: 38500798 PMCID: PMC10945385 DOI: 10.1183/23120541.01025-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/08/2024] [Indexed: 03/20/2024] Open
Abstract
Background CompEx Asthma, a composite end-point for asthma exacerbations, captures clinically relevant, diary-based acute worsening events (AWEs) (defined as deterioration in daily peak expiratory flow concurrent with deterioration in asthma symptoms and/or rescue therapy use) and severe exacerbations (SevEx) (defined by American Thoracic Society/European Respiratory Society guidelines). We hypothesised that CompEx and SevEx would show similar benralizumab treatment effects and correlations to blood eosinophil counts in patients with severe asthma. Methods This post hoc analysis of pooled 12-month data from two phase 3 studies included patients aged ≥16 years with severe, uncontrolled asthma who were randomised to benralizumab 30 mg or placebo. Annualised event rates were analysed using a negative binomial model. The impact of blood eosinophil count on treatment effect was assessed. Results Among patients with a blood eosinophil count ≥300 cells·µL-1 (n=913), benralizumab reduced the annualised event rate versus placebo for CompEx (1.57 versus 2.57; risk ratio 0.61, 95% CI 0.53-0.70, p<0.001), SevEx (0.94 versus 1.55; risk ratio 0.60, 95% CI 0.52-0.70, p<0.001) and AWE (0.92 versus 1.57; risk ratio 0.59, 95% CI 0.48-0.72, p<0.001), with greater treatment effects observed for higher blood eosinophil counts. In patients with blood eosinophil count ≥300 cells·µL-1, benralizumab was associated with shorter median event duration (CompEx: 10.5 days versus 17.0 days; SevEx: 10.0 days versus 15.0 days; AWE: 5.0 days versus 6.0 days). Conclusions Benralizumab reduced the risk of CompEx events with treatment effects similar to those for SevEx and AWEs across a range of blood eosinophil counts. Use of CompEx supports the evaluation of benralizumab and other novel drugs in clinical studies.
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Affiliation(s)
- Clare Bolton
- BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Tim Harrison
- BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
- Nottingham Respiratory NIHR BRC, University of Nottingham, Nottingham, UK
| | - Njira Lugogo
- Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Anne Fuhlbrigge
- Pulmonary Sciences and Critical Care, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ian Hirsch
- Late-stage Vaccine and Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Thomas Bengtsson
- StatMind Statistical and Mathematical Modelling, Innovation and Design AB, Lund, Sweden
| | - Stefan Peterson
- StatMind Statistical and Mathematical Modelling, Innovation and Design AB, Lund, Sweden
| | - Martin Sidaway
- Early Respiratory and Immunology Clinical Development, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | - Malin Fagerås
- BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Carla A. Da Silva
- Early Respiratory and Immunology Clinical Development, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
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Rein‐Hedin E, Sjöberg F, Ganslandt C, Skoog J, Zachrisson H, Bengtsson T, Dalsgaard C. Utilizing venous occlusion plethysmography to assess vascular effects: A study with buloxibutid, an angiotensin II type 2 receptor agonist. Clin Transl Sci 2024; 17:e13735. [PMID: 38344891 PMCID: PMC10859786 DOI: 10.1111/cts.13735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/22/2023] [Accepted: 01/21/2024] [Indexed: 02/15/2024] Open
Abstract
Buloxibutid (also known as C21) is a potent and selective angiotensin II type 2 receptor (AT2R) agonist, in development for oral treatment of fibrotic lung disease. This phase I, open-label, pharmacodynamic study investigated vascular effects of buloxibutid in five healthy male volunteers. Subjects were administered intra-arterial infusions of buloxibutid for 5 min in ascending doses of 3, 10, 30, 100, and 200 μg/min, infused sequentially in the forearm. Infusions of sodium nitroprusside (SNP) solution in doses of 0.8-3.2 μg/min were administered as a positive control. Forearm blood flow (FBF) was measured by venous occlusion plethysmography. Safety and tolerability of intra-arterial administrations of buloxibutid were evaluated. Following infusion of buloxibutid in doses of 3-200 μg/min, the range of increase in FBF was 27.8%, 17.2%, 37.0%, 28.5%, and 60.5%, compared to the respective baseline. The largest increase was observed in the highest dose group. Infusions of SNP as a positive control, increased FBF 230-320% compared to baseline. Three adverse events (AEs) of mild intensity, not related to buloxibutid or SNP, were reported for two subjects. Two of these AEs were related to study procedures. There were no clinically relevant changes in arterial blood pressure during the study period. Intra-arterial infusion of buloxibutid in low, ascending doses increased FBF, indicating that buloxibutid may be effective in conditions associated with endothelial dysfunction. Venous occlusion plethysmography was found to be a useful method to explore pharmacodynamic vascular effects of novel AT2R agonists, while avoiding systemic adverse effects.
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Affiliation(s)
- Erik Rein‐Hedin
- CTC Clinical Trial Consultants ABUppsalaSweden
- Department of Surgical Sciences, Plastic SurgeryUppsala UniversityUppsalaSweden
| | - Folke Sjöberg
- CTC Clinical Trial Consultants ABUppsalaSweden
- Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | | | - Johan Skoog
- Department of Clinical Physiology and Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Helene Zachrisson
- Department of Clinical Physiology and Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
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Anzueto A, Barjaktarevic IZ, Siler TM, Rheault T, Bengtsson T, Rickard K, Sciurba F. Reply to Gan et al., to Calzetta et al., and to Poor. Am J Respir Crit Care Med 2024; 209:226-228. [PMID: 37939377 PMCID: PMC10806414 DOI: 10.1164/rccm.202309-1657le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/08/2023] [Indexed: 11/10/2023] Open
Affiliation(s)
- Antonio Anzueto
- South Texas Veterans Health Care System, San Antonio, Texas
- University of Texas Health, San Antonio, Texas
| | - Igor Z. Barjaktarevic
- Division of Pulmonary and Critical Care, University of California Los Angeles, Los Angeles, California
| | | | - Tara Rheault
- Verona Pharma Plc, London, United Kingdom and Raleigh, North Carolina
| | | | - Kathleen Rickard
- Verona Pharma Plc, London, United Kingdom and Raleigh, North Carolina
| | - Frank Sciurba
- Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Anzueto A, Barjaktarevic IZ, Siler TM, Rheault T, Bengtsson T, Rickard K, Sciurba F. Ensifentrine, a Novel Phosphodiesterase 3 and 4 Inhibitor for the Treatment of Chronic Obstructive Pulmonary Disease: Randomized, Double-Blind, Placebo-controlled, Multicenter Phase III Trials (the ENHANCE Trials). Am J Respir Crit Care Med 2023; 208:406-416. [PMID: 37364283 PMCID: PMC10449067 DOI: 10.1164/rccm.202306-0944oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/26/2023] [Indexed: 06/28/2023] Open
Abstract
Rationale: Ensifentrine is a novel, selective, dual phosphodiesterase (PDE)3 and PDE4 inhibitor with bronchodilator and antiinflammatory effects. Replicate phase III trials of nebulized ensifentrine were conducted (ENHANCE-1 and ENHANCE-2) to assess these effects in patients with chronic obstructive pulmonary disease (COPD). Objectives: To evaluate the efficacy of ensifentrine compared with placebo for lung function, symptoms, quality of life, and exacerbations in patients with COPD. Methods: These phase III, multicenter, randomized, double-blind, parallel-group, placebo-controlled trials were conducted between September 2020 and December 2022 at 250 research centers and pulmonology practices in 17 countries. Patients aged 40-80 years with moderate to severe symptomatic COPD were enrolled. Measurements and Main Results: Totals of 760 (ENHANCE-1) and 789 (ENHANCE-2) patients were randomized and treated, with 69% and 55% receiving concomitant long-acting muscarinic antagonists or long-acting β2-agonists, respectively. Post-bronchodilator FEV1 percentage predicted values were 52% and 51% of predicted normal. Ensifentrine treatment significantly improved average FEV1 area under the curve at 0-12 hours versus placebo (ENHANCE-1, 87 ml [95% confidence interval, 55, 119]; ENHANCE-2, 94 ml [65, 124]; both P < 0.001). Ensifentrine treatment significantly improved symptoms (Evaluating Respiratory Symptoms) and quality of life (St. George's Respiratory Questionnaire) versus placebo at Week 24 in ENHANCE-1 but not in ENHANCE-2. Ensifentrine treatment reduced the rate of moderate or severe exacerbations versus placebo over 24 weeks (ENHANCE-1, rate ratio, 0.64 [0.40, 1.00]; P = 0.050; ENHANCE-2, rate ratio, 0.57 [0.38, 0.87]; P = 0.009) and increased time to first exacerbation (ENHANCE-1, hazard ratio, 0.62 [0.39, 0.97]; P = 0.038; ENHANCE-2, hazard ratio, 0.58 [0.38, 0.87]; P = 0.009). Adverse event rates were similar to those for placebo. Conclusions: Ensifentrine significantly improved lung function in both trials, with results supporting exacerbation rate and risk reduction in a broad COPD population and in addition to other classes of maintenance therapies. Clinical trial registered with www. CLINICALTRIALS gov and EudraCT (ENHANCE-1, www. CLINICALTRIALS gov identifier NCT04535986, EudraCT identifier 2020-002086-34; ENHANCE-2, www. CLINICALTRIALS gov identifier NCT04542057, EudraCT identifier 2020-002069-32).
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Affiliation(s)
- Antonio Anzueto
- South Texas Veterans Health Care System, San Antonio, Texas
- University of Texas Health, San Antonio, Texas
| | - Igor Z. Barjaktarevic
- Division of Pulmonary and Critical Care, University of California, Los Angeles, Los Angeles, California
| | | | | | | | | | - Frank Sciurba
- Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Donohue JF, Rheault T, MacDonald-Berko M, Bengtsson T, Rickard K. Ensifentrine as a Novel, Inhaled Treatment for Patients with COPD. Int J Chron Obstruct Pulmon Dis 2023; 18:1611-1622. [PMID: 37533771 PMCID: PMC10392818 DOI: 10.2147/copd.s413436] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023] Open
Abstract
Ensifentrine is a novel, potent, and selective dual inhibitor of phosphodiesterase (PDE)3 and PDE4 designed for delivery by inhalation that combines effects on airway inflammation, bronchodilation and ciliary function in bronchial epithelia. In Phase 2 studies in subjects with COPD, ensifentrine demonstrated clinically meaningful bronchodilation and improvements in symptoms and health-related quality of life when administered alone or in combination with current standard of care therapies. Ensifentrine is currently in late-stage clinical development for the maintenance treatment of patients with COPD. This review summarizes non-clinical data as well as Phase 1 and Phase 2 efficacy and safety results of nebulized ensifentrine relevant to the maintenance treatment of patients with COPD.
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Affiliation(s)
- James F Donohue
- Division of Pulmonary and Critical Care Medicine, University of North Carolina, School of Medicine, Chapel Hill, NC, USA
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Anegondi N, Gao SS, Steffen V, Spaide RF, Sadda SR, Holz FG, Rabe C, Honigberg L, Newton EM, Cluceru J, Kawczynski MG, Bengtsson T, Ferrara D, Yang Q. Deep Learning to Predict Geographic Atrophy Area and Growth Rate from Multimodal Imaging. Ophthalmol Retina 2023; 7:243-252. [PMID: 36038116 DOI: 10.1016/j.oret.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/04/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To develop deep learning models for annualized geographic atrophy (GA) growth rate prediction using fundus autofluorescence (FAF) images and spectral-domain OCT volumes from baseline visits, which can be used for prognostic covariate adjustment to increase power of clinical trials. DESIGN This retrospective analysis estimated GA growth rate as the slope of a linear fit on all available measurements of lesion area over a 2-year period. Three multitask deep learning models-FAF-only, OCT-only, and multimodal (FAF and OCT)-were developed to predict concurrent GA area and annualized growth rate. PARTICIPANTS Patients were from prospective and observational lampalizumab clinical trials. METHODS The 3 models were trained on the development data set, tested on the holdout set, and further evaluated on the independent test sets. Baseline FAF images and OCT volumes from study eyes of patients with bilateral GA (NCT02247479; NCT02247531; and NCT02479386) were split into development (1279 patients/eyes) and holdout (443 patients/eyes) sets. Baseline FAF images from study eyes of NCT01229215 (106 patients/eyes) and NCT02399072 (169 patients/eyes) were used as independent test sets. MAIN OUTCOME MEASURES Model performance was evaluated using squared Pearson correlation coefficient (r2) between observed and predicted lesion areas/growth rates. Confidence intervals were calculated by bootstrap resampling (B = 10 000). RESULTS On the holdout data set, r2 (95% confidence interval) of the FAF-only, OCT-only, and multimodal models for GA lesion area prediction was 0.96 (0.95-0.97), 0.91 (0.87-0.95), and 0.94 (0.92-0.96), respectively, and for GA growth rate prediction was 0.48 (0.41-0.55), 0.36 (0.29-0.43), and 0.47 (0.40-0.54), respectively. On the 2 independent test sets, r2 of the FAF-only model for GA lesion area was 0.98 (0.97-0.99) and 0.95 (0.93-0.96), and for GA growth rate was 0.65 (0.52-0.75) and 0.47 (0.34-0.60). CONCLUSIONS We show the feasibility of using baseline FAF images and OCT volumes to predict individual GA area and growth rates using a multitask deep learning approach. The deep learning-based growth rate predictions could be used for covariate adjustment to increase power of clinical trials. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Neha Anegondi
- Clinical Imaging Group, Genentech, Inc., South San Francisco, California; Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California
| | - Simon S Gao
- Clinical Imaging Group, Genentech, Inc., South San Francisco, California; Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California
| | - Verena Steffen
- Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California; Biostatistics, Genentech, Inc., South San Francisco, California
| | - Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Frank G Holz
- Department of Ophthalmology and GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Christina Rabe
- Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California; Biostatistics, Genentech, Inc., South San Francisco, California
| | - Lee Honigberg
- Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California; Biomarker Development, Genentech, Inc., South San Francisco, California
| | - Elizabeth M Newton
- Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California
| | - Julia Cluceru
- Clinical Imaging Group, Genentech, Inc., South San Francisco, California; Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California
| | - Michael G Kawczynski
- Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California; Data Science Imaging, Genentech, Inc., South San Francisco, California
| | - Thomas Bengtsson
- Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California; Data Science Imaging, Genentech, Inc., South San Francisco, California
| | - Daniela Ferrara
- Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California
| | - Qi Yang
- Roche Ophthalmology Personalized Healthcare, Genentech, Inc., South San Francisco, California; Data Science Imaging, Genentech, Inc., South San Francisco, California.
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Batta R, Tornling G, Rosendahl E, Bengtsson T, Raud J. Investigation of the effect of the angiotensin II type 2 receptor (AT2R) agonist C21 on plasma NT-proBNP, a diagnostic biomarker, in subjects hospitalised with COVID-19. Eur Heart J 2022. [PMCID: PMC9619693 DOI: 10.1093/eurheartj/ehac544.3044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The prohormone N-terminal pro-B-type natriuretic peptide (NT-proBNP) is released from stretched cardiac myocytes and is a diagnostic biomarker for heart failure and cardiac dysfunction as well as pulmonary embolism and pneumonia that are frequent complications to severe Coronavirus Disease 2019 (COVID-19). NT-proBNP is frequently elevated in COVID-19. In a recent publication, it was demonstrated that NT-proBNP was strongly associated with mortality in patients with COVID-19, and further investigation of its usefulness as a prognostic tool to predict disease outcomes in COVID-19 was suggested (1). In the recently completed phase 2 trial (angiotensin II type 2 receptor agonist COVID-19 trial [ATTRACT]; NCT04452435) in subjects hospitalised with COVID-19, it was investigated whether treatment with the AT2R agonist C21 for 7 days affected the release of the plasma biomarker NT-proBNP. ATTRACT was a randomised, double-blind, placebo-controlled, phase 2 trial that investigated the safety and efficacy of C21 treatment (100 mg twice daily) for 7 days in hospitalised subjects with COVID-19, not requiring mechanical ventilation. The results of the trial demonstrated that treatment with C21 on top of standard of care (vast majority of patients received glucocorticoids) significantly reduced the proportion of subjects requiring supplemental oxygen at Day 14, indicating faster recovery with C21 treatment compared to placebo. Blood samples for exploratory analysis were taken before and after 7 days of treatment with C21 or placebo. Plasma NT-proBNP was markedly elevated in both treatment groups before treatment, with average values of 357 and 438 pg/mL in the placebo and C21 groups, respectively, as compared to normal levels of approximately <100 pg/mL. After 7 days of treatment, the C21 group experienced a dramatic reduction in plasma NT-proBNP (by 259 pg/mL) as compared to the placebo group (63 pg/mL) (p=0.02). The results show that short-term C21 treatment decreased the release of NT-proBNP in subjects hospitalised with COVID-19. Further investigations are needed to elucidate whether this is related to effects on COVID-19-induced pulmonary damage or direct protective effects on the heart. We are currently conducting a global phase 3 trial (VP-C21–008) further investigating the effect of C21 in subjects hospitalised with COVID-19 including determination of NT-proBNP. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Vicore Pharma AB
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Affiliation(s)
- R Batta
- Vicore Pharma AB , Gothenburg , Sweden
| | - G Tornling
- Karolinska Institutet, 1) Respiratory Medicine Division, Department of Medicine Solna , Stockholm , Sweden
| | | | | | - J Raud
- Vicore Pharma AB , Gothenburg , Sweden
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Jemaa S, Paulson JN, Hutchings M, Kostakoglu L, Trotman J, Tracy S, de Crespigny A, Carano RAD, El-Galaly TC, Nielsen TG, Bengtsson T. Full automation of total metabolic tumor volume from FDG-PET/CT in DLBCL for baseline risk assessments. Cancer Imaging 2022; 22:39. [PMID: 35962459 PMCID: PMC9373298 DOI: 10.1186/s40644-022-00476-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/17/2022] [Indexed: 11/21/2022] Open
Abstract
Background Current radiological assessments of 18fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging data in diffuse large B-cell lymphoma (DLBCL) can be time consuming, do not yield real-time information regarding disease burden and organ involvement, and hinder the use of FDG-PET to potentially limit the reliance on invasive procedures (e.g. bone marrow biopsy) for risk assessment. Methods Our aim is to enable real-time assessment of imaging-based risk factors at a large scale and we propose a fully automatic artificial intelligence (AI)-based tool to rapidly extract FDG-PET imaging metrics in DLBCL. On availability of a scan, in combination with clinical data, our approach generates clinically informative risk scores with minimal resource requirements. Overall, 1268 patients with previously untreated DLBCL from the phase III GOYA trial (NCT01287741) were included in the analysis (training: n = 846; hold-out: n = 422). Results Our AI-based model comprising imaging and clinical variables yielded a tangible prognostic improvement compared to clinical models without imaging metrics. We observed a risk increase for progression-free survival (PFS) with hazard ratios [HR] of 1.87 (95% CI: 1.31–2.67) vs 1.38 (95% CI: 0.98–1.96) (C-index: 0.59 vs 0.55), and a risk increase for overall survival (OS) (HR: 2.16 (95% CI: 1.37–3.40) vs 1.40 (95% CI: 0.90–2.17); C-index: 0.59 vs 0.55). The combined model defined a high-risk population with 35% and 42% increased odds of a 4-year PFS and OS event, respectively, versus the International Prognostic Index components alone. The method also identified a subpopulation with a 2-year Central Nervous System (CNS)-relapse probability of 17.1%. Conclusion Our tool enables an enhanced risk stratification compared with IPI, and the results indicate that imaging can be used to improve the prediction of central nervous system relapse in DLBCL. These findings support integration of clinically informative AI-generated imaging metrics into clinical workflows to improve identification of high-risk DLBCL patients. Trial Registration Registered clinicaltrials.gov number: NCT01287741. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40644-022-00476-0.
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Affiliation(s)
- S Jemaa
- 1PHC Imaging, Genentech, Inc, South San Francisco, CA, USA
| | - J N Paulson
- Biostatistics, Genentech, Inc, South San Francisco, CA, USA
| | - M Hutchings
- Department of HaematologyRigshospitalet, Copenhagen, Denmark
| | - L Kostakoglu
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - J Trotman
- Department of Haematology, Concord Repatriation General Hospital, University of Sydney, Concord, NSW, Australia
| | - S Tracy
- Biostatistics, Genentech, Inc, South San Francisco, CA, USA
| | - A de Crespigny
- Clinical Imaging Group, Genentech, Inc, South San Francisco, CA, USA
| | - R A D Carano
- 1PHC Imaging, Genentech, Inc, South San Francisco, CA, USA
| | - T C El-Galaly
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - T G Nielsen
- Pharmaceutical Development Clinical Oncology, F. Hoffmann-La Roche Ltd, Bldg 1, Grenzarcherstrasse 124m, CH-4070, Basel, Switzerland.
| | - T Bengtsson
- 1PHC Imaging, Genentech, Inc, South San Francisco, CA, USA.,Department of Statistics, University of California-Berkeley, Berkeley, CA, USA
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Song Z, Krishnan A, Gaetano L, Tustison NJ, Clayton D, de Crespigny A, Bengtsson T, Jia X, Carano RAD. Deformation-based morphometry identifies deep brain structures protected by ocrelizumab. Neuroimage Clin 2022; 34:102959. [PMID: 35189455 PMCID: PMC8861820 DOI: 10.1016/j.nicl.2022.102959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/02/2022] [Accepted: 02/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite advancements in treatments for multiple sclerosis, insidious disease progression remains an area of unmet medical need, for which atrophy-based biomarkers may help better characterize the progressive biology. METHODS We developed and applied a method of longitudinal deformation-based morphometry to provide voxel-level assessments of brain volume changes and identified brain regions that were significantly impacted by disease-modifying therapy. RESULTS Using brain MRI data from two identically designed pivotal trials of relapsing multiple sclerosis (total N = 1483), we identified multiple deep brain regions, including the thalamus and brainstem, where volume loss over time was reduced by ocrelizumab (p < 0.05), a humanized anti-CD20 + monoclonal antibody approved for the treatment of multiple sclerosis. Additionally, identified brainstem shrinkage, as well as brain ventricle expansion, was associated with a greater risk for confirmed disability progression (p < 0.05). CONCLUSIONS The identification of deep brain structures has a strong implication for developing new biomarkers of brain atrophy reduction to advance drug development for multiple sclerosis, which has an increasing focus on targeting the progressive biology.
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Affiliation(s)
- Zhuang Song
- Personalized Healthcare Imaging, Genentech, Inc., South San Francisco, CA 94080, USA.
| | - Anithapriya Krishnan
- Personalized Healthcare Imaging, Genentech, Inc., South San Francisco, CA 94080, USA
| | - Laura Gaetano
- Product Development Medical Affair, F. Hoffmann-La Roche Ltd, CH-4070 Basel, Switzerland
| | - Nicholas J Tustison
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22904, USA
| | - David Clayton
- Clinical Imaging Group, Genentech, Inc., South San Francisco, CA 94080, USA
| | - Alex de Crespigny
- Clinical Imaging Group, Genentech, Inc., South San Francisco, CA 94080, USA
| | - Thomas Bengtsson
- Personalized Healthcare Imaging, Genentech, Inc., South San Francisco, CA 94080, USA
| | - Xiaoming Jia
- Biomarker Development, Genentech, Inc., South San Francisco, CA 94080, USA
| | - Richard A D Carano
- Personalized Healthcare Imaging, Genentech, Inc., South San Francisco, CA 94080, USA
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Wang X, Jemaa S, Fredrickson J, Coimbra AF, Nielsen T, De Crespigny A, Bengtsson T, Carano RAD. Heart and bladder detection and segmentation on FDG PET/CT by deep learning. BMC Med Imaging 2022; 22:58. [PMID: 35354384 PMCID: PMC8977865 DOI: 10.1186/s12880-022-00785-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/22/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose Positron emission tomography (PET)/ computed tomography (CT) has been extensively used to quantify metabolically active tumors in various oncology indications. However, FDG-PET/CT often encounters false positives in tumor detection due to 18fluorodeoxyglucose (FDG) accumulation from the heart and bladder that often exhibit similar FDG uptake as tumors. Thus, it is necessary to eliminate this source of physiological noise. Major challenges for this task include: (1) large inter-patient variability in the appearance for the heart and bladder. (2) The size and shape of bladder or heart may appear different on PET and CT. (3) Tumors can be very close or connected to the heart or bladder. Approach A deep learning based approach is proposed to segment the heart and bladder on whole body PET/CT automatically. Two 3D U-Nets were developed separately to segment the heart and bladder, where each network receives the PET and CT as a multi-modal input. Data sets were obtained from retrospective clinical trials and include 575 PET/CT for heart segmentation and 538 for bladder segmentation. Results The models were evaluated on a test set from an independent trial and achieved a Dice Similarity Coefficient (DSC) of 0.96 for heart segmentation and 0.95 for bladder segmentation, Average Surface Distance (ASD) of 0.44 mm on heart and 0.90 mm on bladder. Conclusions This methodology could be a valuable component to the FDG-PET/CT data processing chain by removing FDG physiological noise associated with heart and/or bladder accumulation prior to image analysis by manual, semi- or automated tumor analysis methods.
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Beasley R, Harrison T, Peterson S, Gustafson P, Hamblin A, Bengtsson T, Fagerås M. Evaluation of Budesonide-Formoterol for Maintenance and Reliever Therapy Among Patients With Poorly Controlled Asthma: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e220615. [PMID: 35230437 PMCID: PMC8889464 DOI: 10.1001/jamanetworkopen.2022.0615] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE The Global Initiative for Asthma (GINA) recommends 2 alternative treatments for patients receiving treatment at steps 3 to 5: single inhaler combination inhaled corticosteroid-formoterol as both maintenance and reliever (SMART) or inhaled corticosteroid-long-acting β2-agonist as maintenance plus short-acting β2-agonist as reliever. OBJECTIVE To assess whether switching to SMART is associated with longer time to first severe asthma exacerbation compared with a step up or continuation of GINA treatment step with maintenance inhaled corticosteroid-long-acting β2-agonist plus short-acting β2-agonist reliever among patients with poorly controlled asthma. DATA SOURCES For this systematic review and meta-analysis, the literature, internal study databases at AstraZeneca and the Medical Research Institute of New Zealand, and references from a previous systematic review and meta-analysis on SMART were searched to identify randomized clinical trials published from January 1990 to February 2018, that compared budesonide-formoterol by SMART with maintenance inhaled corticosteroid-long-acting β2-agonist plus short-acting β2-agonist reliever. STUDY SELECTION Trials of at least 24 weeks' duration were included if they reported baseline data on GINA treatment step, asthma control status, and efficacy measures of severe exacerbations. Included patients were adults and adolescents with asthma and baseline Asthma Control Questionnaire 5-item version scores of 1.5 or higher. DATA EXTRACTION AND SYNTHESIS Patient-level data were identified by independent extraction, and analyses were performed using a fixed-effect model. Data analysis was performed from August 2018 to November 2021. MAIN OUTCOMES AND MEASURES The primary outcome was time to first severe asthma exacerbation associated with each treatment, analyzed by Cox proportional hazards regression. RESULTS Overall, 4863 patients were included (3034 [62.4%] female; mean [SD] age, 39.8 [16.3] years). Switching patients with uncontrolled asthma at GINA step 3 (n = 1950) to SMART at either step 3 or 4 was associated with a prolonged time to first severe asthma exacerbation, with a 29% reduced risk compared with stepping up to step 4 inhaled corticosteroid-long-acting β2-agonist maintenance plus short-acting β2-agonist reliever (hazard ratio, 0.71; 95% CI, 0.52-0.97). For patients with uncontrolled asthma at step 3 and step 4 (n = 2913), switching to SMART was associated with a prolonged time to first severe asthma exacerbation and a 30% reduced risk compared with remaining at the same treatment step (hazard ratio, 0.70; 95% CI, 0.58-0.85). CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, for patients with poorly controlled asthma, SMART was associated with longer time to first severe asthma exacerbation compared with a step up or continuation of GINA step with maintenance inhaled corticosteroid-long-acting β2-agonist plus short-acting β2-agonist reliever. These findings suggest that if an adult or adolescent receiving treatment at GINA step 3 or 4 has poorly controlled asthma, it is preferable to switch to the SMART regimen rather than to step up or continue the GINA treatment step with maintenance inhaled corticosteroid-long-acting β2-agonist plus short-acting β2-agonist reliever therapy.
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Affiliation(s)
- Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Capital and Coast District Health Board, Wellington, New Zealand
- Victoria University Wellington, Wellington, New Zealand
| | - Tim Harrison
- Nottingham National Institute for Health Research Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
- Digital Health Research & Development, AstraZeneca, Cambridge, United Kingdom
| | | | - Per Gustafson
- BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Angus Hamblin
- BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| | | | - Malin Fagerås
- BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
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12
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Brennan MT, Madsen LS, Saunders DP, Napenas JJ, McCreary C, Ni Riordain R, Pedersen AML, Fedele S, Cook RJ, Abdelsayed R, Llopiz MT, Sankar V, Ryan K, Culton DA, Akhlef Y, Castillo F, Fernandez I, Jurge S, Kerr AR, McDuffie C, McGaw T, Mighell A, Sollecito TP, Schlieve T, Carrozzo M, Papas A, Bengtsson T, Al-Hashimi I, Burke L, Burkhart NW, Culshaw S, Desai B, Hansen J, Jensen P, Menné T, Patel PB, Thornhill M, Treister N, Ruzicka T. Efficacy and Safety of a Novel Mucoadhesive Clobetasol Patch for Treatment of Erosive Oral Lichen Planus. J Oral Pathol Med 2021; 51:86-97. [PMID: 34907617 DOI: 10.1111/jop.13270] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 11/10/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Oral lichen planus (OLP) is a chronic inflammatory disorder of the oral mucosa. Currently there is no approved treatment for oral lichen planus (OLP). We report on the efficacy and safety of a novel mucoadhesive clobetasol patch (Rivelin® -CLO) for the treatment of OLP. METHODS Patients with confirmed OLP and measurable symptomatic ulcer(s) participated in a randomized, double-blind, placebo-controlled, multicenter clinical trial testing a novel mucoadhesive clobetasol patch (Rivelin® -CLO) in OLP across Europe, Canada and USA. Patients were randomized to placebo (non-medicated), 1, 5, 20 µg Clobetasol/patch, twice daily, for 4 weeks. The primary endpoint was change in total ulcer area compared to baseline. Secondary endpoints included improvement from baseline in pain, disease activity, and quality of life. RESULTS Data were analyzed and expressed as mean [SD]. One hundred thirty-eight (138) patients were included in the study; 99 females and 39 males, mean age was 61.1 [11.6] years. Statistical analyses revealed that treatment with 20-μg Rivelin® -CLO patches demonstrated significant improvement with ulcer area (P=0.047), symptom severity (P=0.001), disease activity (P=0.022), pain (P=0.012), and quality of life (P=0.003) as compared with placebo. Improvement in OLP symptoms from beginning to the end of the study was reported as very much better (best rating) in the 20-µg group (25/32) patients compared to the placebo group (11/30), (P=0.012). Adverse events were mild/moderate. Candidiasis incidence was low (2%). CONCLUSIONS Rivelin® -CLO patches were superior to placebo demonstrating statistically significant, clinically relevant efficacy in objective and subjective improvement and, with a favorable safety profile.
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Affiliation(s)
- Michael T Brennan
- Atrium Health Carolinas Medical Center, Department of Oral Medicine, Charlotte, NC, USA
| | | | - Deborah P Saunders
- Health Sciences North, Northeast Cancer Centre, Sudbury, Ontario, Canada; Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Joel J Napenas
- Atrium Health Carolinas Medical Center, Department of Oral Medicine, Charlotte, NC, USA
| | - Christine McCreary
- Cork University Dental School and Hospital, College of Medicine and Health, University College Cork, Ireland
| | - Richeal Ni Riordain
- Cork University Dental School and Hospital, College of Medicine and Health, University College Cork, Ireland
| | | | - Stefano Fedele
- University College London, UCL Eastman Dental Institute and UCLH NIHR Biomedical Research Centre, London, UK
| | - Richard J Cook
- King´s College London, Faculty of Dentistry Oral & Craniofacial Sciences, Oral Medicine & Oral Clinical Research Unit, Guy's Hospital Campus, London, UK
| | - Rafik Abdelsayed
- The Dental College of Georgia, Augusta University, Augusta, GA, USA
| | | | - Vidya Sankar
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Tufts University School of Dental Medicine, Boston, MA, USA
| | - Kevin Ryan
- University of Glasgow Hospital & Dental School, Glasgow, UK
| | - Donna A Culton
- University of North Carolina at Chapel Hill, Department of Dermatology, Chapel Hill, NC, USA
| | - Yousra Akhlef
- Department of Oral & Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | | | | | - Sabine Jurge
- University of Sheffield School of Clinical Dentistry, Sheffield, UK
| | | | | | - Tim McGaw
- Kaye Edmonton Clinic, Edmonton, Alberta, Canada
| | - Alan Mighell
- School of Dentistry, The University of Leeds, Leeds, UK
| | - Thomas P Sollecito
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Marco Carrozzo
- School of Dental Sciences, Newcastle University, Newcastle, UK
| | - Athena Papas
- Tufts University School of Dental Medicine, Boston, MA, USA
| | | | - Ibtisam Al-Hashimi
- UT Southwestern Medical Center, Dallas, TX, USA.,Currently Scientific Consultant
| | | | - Nancy W Burkhart
- The International Oral Lichen Planus Support Group, Texas A&M University College of Dentistry, Dallas, TX, USA
| | - Shauna Culshaw
- University of Glasgow Hospital & Dental School, Glasgow, UK
| | - Bhavik Desai
- TMJ & Orofacial Treatment Centers of Wisconsin, WI, USA
| | | | - Pia Jensen
- Afyx Therapeutics A/S, Copenhagen, Denmark
| | | | - Paras B Patel
- Texas A&M University College of Dentistry, Dallas, TX, USA
| | - Martin Thornhill
- Atrium Health Carolinas Medical Center, Department of Oral Medicine, Charlotte, NC, USA.,University of Sheffield School of Clinical Dentistry, Sheffield, UK
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA
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Krishnan AP, Song Z, Clayton D, Gaetano L, Jia X, de Crespigny A, Bengtsson T, Carano RAD. Joint MRI T1 Unenhancing and Contrast-enhancing Multiple Sclerosis Lesion Segmentation with Deep Learning in OPERA Trials. Radiology 2021; 302:662-673. [PMID: 34904871 DOI: 10.1148/radiol.211528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Deep learning-based segmentation could facilitate rapid and reproducible T1 lesion load assessments, which is crucial for disease management in multiple sclerosis (MS). T1 unenhancing and contrast-enhancing lesions in MS are those that enhance or do not enhance after administration of a gadolinium-based contrast agent at T1-weighted MRI. Purpose To develop deep learning models for automated assessment of T1 unenhancing and contrast-enhancing lesions; to investigate if joint training improved performance; to reproduce a known ocrelizumab treatment response; and to evaluate the association of baseline T1-weighted imaging metrics with clinical outcomes in relapsing MS clinical trials. Materials and Methods Joint and individual deep learning models (U-Nets) were developed retrospectively on multimodal MRI data sets from large multicenter OPERA trials of relapsing MS (August 2011 to May 2015). The joint model included cross-network connections and a combined loss function. Models were trained on OPERA I data sets with three-fold cross-validation. OPERA II data sets were the internal test set. Dice coefficients, lesion true-positive and false-positive rates, and areas under the receiver operating characteristic curve (AUCs) were used to evaluate model performance. Association of baseline imaging metrics with clinical outcomes was assessed with Cox proportional hazards models. Results A total of 796 patients (3030 visits; mean age, 37 years ± 9; 521 women) from the OPERA II trial were evaluated. The joint model achieved a mean Dice coefficient of 0.77 and 0.74, lesion true-positive rate of 0.88 and 0.86, and lesion false-positive rate of 0.04 and 0.19 for T1 contrast-enhancing and T1 unenhancing lesion segmentation, respectively. Joint training improved performance for smaller T1 contrast-enhancing lesions (≤0.06 mL; individual training AUC: 0.75; joint training AUC: 0.87; P < .001). A significant ocrelizumab treatment effect (P < .001) was seen in reducing the mean number of T1 contrast-enhancing lesions at 24, 48, and 96 weeks (manual assessment at 24 weeks: 10 lesions in 366 patients with ocrelizumab, 141 lesions in 355 patients with interferon, 93% reduction; manual assessment at 48 weeks: six lesions in 355 patients with ocrelizumab, 150 lesions in 317 patients with interferon, 96% reduction; manual assessment at 96 weeks: five lesions in 340 patients with ocrelizumab, 157 lesions in 294 patients with interferon, 97% reduction; joint model assessment at 24 weeks: 19 lesions in 365 patients with ocrelizumab, 128 lesions in 354 patients with interferon, 86% reduction; joint model assessment at 48 weeks: 14 lesions in 355 patients with ocrelizumab, 121 lesions in 317 patients with interferon, 90% reduction; joint model assessment at 96 weeks: 10 lesions in 340 patients with ocrelizumab, 144 lesions in 294 patients with interferon, 94% reduction) and the mean number of new T1 unenhancing lesions across all follow-up examinations (manual assessment: 504 lesions in 1060 visits for ocrelizumab-treated patients, 1438 lesions in 965 visits for interferon-treated patients, 68% reduction; joint model assessment: 205 lesions in 1053 visits for ocrelizumab-treated patients, 661 lesions in 957 visits for interferon-treated patients, 78% reduction). Baseline T1 unenhancing total lesion volume was associated with clinical outcomes (manual hazard ratio [HR]: 1.12, P = .02; joint model HR: 1.11, P = .03). Conclusion Joint architecture and training improved segmentation of MRI T1 contrast-enhancing multiple sclerosis lesions, and both deep learning models had sufficiently high performance to detect an ocrelizumab treatment response consistent with manual assessments. ClinicalTrials.gov: NCT01247324 and NCT01412333 © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Talbott in this issue.
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Affiliation(s)
- Anitha Priya Krishnan
- From the Department of Product Development-Personalized HealthCare Imaging (A.P.K., Z.S., T.B., R.A.D.C.), Clinical Imaging Group, gRED (D.C., A.d.C.), and DevSci OMNI-Biomarker Development (X.J.), Genentech, 600 E Grand Ave, South San Francisco, CA 94080; and Global Product Development Medical Affairs, Neuroscience, F. Hoffmann-La Roche, Basel, Switzerland (L.G.)
| | - Zhuang Song
- From the Department of Product Development-Personalized HealthCare Imaging (A.P.K., Z.S., T.B., R.A.D.C.), Clinical Imaging Group, gRED (D.C., A.d.C.), and DevSci OMNI-Biomarker Development (X.J.), Genentech, 600 E Grand Ave, South San Francisco, CA 94080; and Global Product Development Medical Affairs, Neuroscience, F. Hoffmann-La Roche, Basel, Switzerland (L.G.)
| | - David Clayton
- From the Department of Product Development-Personalized HealthCare Imaging (A.P.K., Z.S., T.B., R.A.D.C.), Clinical Imaging Group, gRED (D.C., A.d.C.), and DevSci OMNI-Biomarker Development (X.J.), Genentech, 600 E Grand Ave, South San Francisco, CA 94080; and Global Product Development Medical Affairs, Neuroscience, F. Hoffmann-La Roche, Basel, Switzerland (L.G.)
| | - Laura Gaetano
- From the Department of Product Development-Personalized HealthCare Imaging (A.P.K., Z.S., T.B., R.A.D.C.), Clinical Imaging Group, gRED (D.C., A.d.C.), and DevSci OMNI-Biomarker Development (X.J.), Genentech, 600 E Grand Ave, South San Francisco, CA 94080; and Global Product Development Medical Affairs, Neuroscience, F. Hoffmann-La Roche, Basel, Switzerland (L.G.)
| | - Xiaoming Jia
- From the Department of Product Development-Personalized HealthCare Imaging (A.P.K., Z.S., T.B., R.A.D.C.), Clinical Imaging Group, gRED (D.C., A.d.C.), and DevSci OMNI-Biomarker Development (X.J.), Genentech, 600 E Grand Ave, South San Francisco, CA 94080; and Global Product Development Medical Affairs, Neuroscience, F. Hoffmann-La Roche, Basel, Switzerland (L.G.)
| | - Alex de Crespigny
- From the Department of Product Development-Personalized HealthCare Imaging (A.P.K., Z.S., T.B., R.A.D.C.), Clinical Imaging Group, gRED (D.C., A.d.C.), and DevSci OMNI-Biomarker Development (X.J.), Genentech, 600 E Grand Ave, South San Francisco, CA 94080; and Global Product Development Medical Affairs, Neuroscience, F. Hoffmann-La Roche, Basel, Switzerland (L.G.)
| | - Thomas Bengtsson
- From the Department of Product Development-Personalized HealthCare Imaging (A.P.K., Z.S., T.B., R.A.D.C.), Clinical Imaging Group, gRED (D.C., A.d.C.), and DevSci OMNI-Biomarker Development (X.J.), Genentech, 600 E Grand Ave, South San Francisco, CA 94080; and Global Product Development Medical Affairs, Neuroscience, F. Hoffmann-La Roche, Basel, Switzerland (L.G.)
| | - Richard A D Carano
- From the Department of Product Development-Personalized HealthCare Imaging (A.P.K., Z.S., T.B., R.A.D.C.), Clinical Imaging Group, gRED (D.C., A.d.C.), and DevSci OMNI-Biomarker Development (X.J.), Genentech, 600 E Grand Ave, South San Francisco, CA 94080; and Global Product Development Medical Affairs, Neuroscience, F. Hoffmann-La Roche, Basel, Switzerland (L.G.)
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Tornling G, Batta R, Porter JC, Williams B, Bengtsson T, Parmar K, Kashiva R, Hallberg A, Cohrt AK, Westergaard K, Dalsgaard CJ, Raud J. Seven days treatment with the angiotensin II type 2 receptor agonist C21 in hospitalized COVID-19 patients; a placebo-controlled randomised multi-centre double-blind phase 2 trial. EClinicalMedicine 2021; 41:101152. [PMID: 34723163 PMCID: PMC8542174 DOI: 10.1016/j.eclinm.2021.101152] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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] [Received: 07/15/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND COVID-19 morbidity and mortality remains high and the need for safe and effective drugs continues despite vaccines. METHODS Double-blind, placebo-controlled, multi-centre, randomised, parallel group phase 2 trial to evaluate safety and efficacy of oral angiotensin II type 2 receptor agonist C21 in hospitalized patients with COVID-19 and CRP ≥ 50-150 mg/L conducted at eight sites in India (NCT04452435). Patients were randomly assigned 100 mg C21 bid or placebo for 7 days in addition to standard of care. Primary endpoint: reduction in CRP. The study period was 21 July to 13 October 2020. FINDINGS 106 patients were randomised and included in the analysis (51 C21, 55 placebo). There was no significant group difference in reduction of CRP, 81% and 78% in the C21 and placebo groups, respectively, with a treatment effect ratio of 0.85 [90% CI 0.57, 1.26]. In a secondary analysis in patients requiring supplemental oxygen at randomisation, CRP was reduced in the C21 group compared to placebo. At the end of the 7-day treatment, 37 (72.5%) and 30 (54.5%) of the patients did not require supplemental oxygen in the C21 and placebo group, respectively (OR 2.20 [90% CI 1.12, 4.41]). A post hoc analysis showed that at day 14, the proportion of patients not requiring supplemental oxygen was 98% and 80% in the C21 group compared to placebo (OR 12.5 [90% CI 2.9, 126]). Fewer patients required mechanical ventilation (one C21 patient; four placebo patients), and C21 was associated with a numerical reduction in the mortality rate (one vs three in the C21 and placebo group, respectively). Treatment with C21 was safe and well tolerated. INTERPRETATION Among hospitalised patients with COVID-19 receiving C21 for 7 days there was no reduction in CRP compared to placebo. However, a post-hoc analysis indicated a marked reduction of requirement for oxygen at day 14. The day 14 results from this study justify further evaluation in a Phase 3 study and such a trial is currently underway. FUNDING Vicore Pharma AB and LifeArc, UK.
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Affiliation(s)
- Göran Tornling
- Respiratory Medicine Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Joanna C. Porter
- UCL Respiratory, Univeristy College London and Department of Thoracic Medicine, University College Hospital, London, UK
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London and National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, London, UK
| | | | - Kartikeya Parmar
- B J Medical College and Department of Medicine, Civil Hospital, Asarwa, Ahmedabad Gujarat, India
| | - Reema Kashiva
- Department of Medicine, Noble Hospitals Pvt. Ltd, Hadapsar, Pune, Maharashtra, India
| | - Anders Hallberg
- Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | | | | | - Carl-Johan Dalsgaard
- Vicore Pharma AB, Gothenburg, Sweden
- Correspondence to: Dr Carl-Johan Dalsgaard, Vicore Pharma AB, Kronhusgatan 11, SE-411 05 Gothenburg, Sweden
| | - Johan Raud
- Vicore Pharma AB, Gothenburg, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Ferguson GT, Kerwin EM, Rheault T, Bengtsson T, Rickard K. A Dose-Ranging Study of the Novel Inhaled Dual PDE 3 and 4 Inhibitor Ensifentrine in Patients with COPD Receiving Maintenance Tiotropium Therapy. Int J Chron Obstruct Pulmon Dis 2021; 16:1137-1148. [PMID: 33911859 PMCID: PMC8075181 DOI: 10.2147/copd.s307160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/08/2021] [Indexed: 12/05/2022] Open
Abstract
PURPOSE Ensifentrine is an inhaled dual inhibitor of phosphodiesterase (PDE) 3 and 4 that has shown bronchodilatory effects and symptom improvement in clinical studies in patients with chronic obstructive pulmonary disease (COPD), and anti-inflammatory effects in healthy volunteers in a model of COPD-like inflammation. This manuscript reports on the results of the clinical study examining if ensifentrine provides meaningful improvements in lung function when added on to tiotropium over 4 weeks in patients with COPD who have impaired lung function and symptoms despite treatment with tiotropium. PATIENTS AND METHODS This randomized, double-blind, placebo-controlled, parallel-group, dose-ranging study recruited patients with moderate-to-severe COPD. Patients were randomized to open-label tiotropium once daily (QD) plus (+) blinded escalating doses of ensifentrine or placebo twice daily (BID). Effects on lung function, symptoms and quality of life (QoL) were assessed over 4 weeks. RESULTS A total of 416 COPD patients were randomized and 413 received at least one dose of blinded study medication + tiotropium. All ensifentrine doses produced a significant and dose-dependent increase in peak forced expiratory volume in 1 second (FEV1) from baseline to Week 4, with placebo-corrected differences of 77.5 mL when added to tiotropium (0.375 mg; 95% CI: 4.8, 150.1 mL; p=0.037) to 124.2 mL (3 mg; 95% CI: 51.0, 196.8 mL; p<0.001). A significant increase in average FEV1 (0-12h) was shown at Week 4 with the 3 mg dose (87.3 mL; 95% CI: 20.0, 154.5 mL; p=0.011). Clinically meaningful and statistically significant improvements in the St. George's Respiratory Questionnaire - COPD (SGRQ-C) additive to tiotropium were observed at Week 4, exceeding the minimally clinically important difference of 4 units with the 1.5 and 3 mg doses. Adverse events were similar in frequency between the ensifentrine and placebo arms. CONCLUSION This clinical study demonstrated that nebulized ensifentrine added on to tiotropium produced clinically important improvements in lung function and QoL over 4 weeks in COPD patients receiving tiotropium who demonstrated symptoms and lung function impairment, with a safety profile similar to placebo.
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Affiliation(s)
- Gary T Ferguson
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, USA
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Ramakrishnan S, Nicolau DV, Langford B, Mahdi M, Jeffers H, Mwasuku C, Krassowska K, Fox R, Binnian I, Glover V, Bright S, Butler C, Cane JL, Halner A, Matthews PC, Donnelly LE, Simpson JL, Baker JR, Fadai NT, Peterson S, Bengtsson T, Barnes PJ, Russell REK, Bafadhel M. Inhaled budesonide in the treatment of early COVID-19 (STOIC): a phase 2, open-label, randomised controlled trial. Lancet Respir Med 2021; 9:763-772. [PMID: 33844996 PMCID: PMC8040526 DOI: 10.1016/s2213-2600(21)00160-0] [Citation(s) in RCA: 250] [Impact Index Per Article: 83.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 01/08/2023]
Abstract
Background Multiple early reports of patients admitted to hospital with COVID-19 showed that patients with chronic respiratory disease were significantly under-represented in these cohorts. We hypothesised that the widespread use of inhaled glucocorticoids among these patients was responsible for this finding, and tested if inhaled glucocorticoids would be an effective treatment for early COVID-19. Methods We performed an open-label, parallel-group, phase 2, randomised controlled trial (Steroids in COVID-19; STOIC) of inhaled budesonide, compared with usual care, in adults within 7 days of the onset of mild COVID-19 symptoms. The trial was done in the community in Oxfordshire, UK. Participants were randomly assigned to inhaled budsonide or usual care stratified for age (≤40 years or >40 years), sex (male or female), and number of comorbidities (≤1 and ≥2). Randomisation was done using random sequence generation in block randomisation in a 1:1 ratio. Budesonide dry powder was delivered using a turbohaler at a dose of 400 μg per actuation. Participants were asked to take two inhalations twice a day until symptom resolution. The primary endpoint was COVID-19-related urgent care visit, including emergency department assessment or hospitalisation, analysed for both the per-protocol and intention-to-treat (ITT) populations. The secondary outcomes were self-reported clinical recovery (symptom resolution), viral symptoms measured using the Common Cold Questionnare (CCQ) and the InFLUenza Patient Reported Outcome Questionnaire (FLUPro), body temperature, blood oxygen saturations, and SARS-CoV-2 viral load. The trial was stopped early after independent statistical review concluded that study outcome would not change with further participant enrolment. This trial is registered with ClinicalTrials.gov, NCT04416399. Findings From July 16 to Dec 9, 2020, 167 participants were recruited and assessed for eligibility. 21 did not meet eligibility criteria and were excluded. 146 participants were randomly assigned—73 to usual care and 73 to budesonide. For the per-protocol population (n=139), the primary outcome occurred in ten (14%) of 70 participants in the usual care group and one (1%) of 69 participants in the budesonide group (difference in proportions 0·131, 95% CI 0·043 to 0·218; p=0·004). For the ITT population, the primary outcome occurred in 11 (15%) participants in the usual care group and two (3%) participants in the budesonide group (difference in proportions 0·123, 95% CI 0·033 to 0·213; p=0·009). The number needed to treat with inhaled budesonide to reduce COVID-19 deterioration was eight. Clinical recovery was 1 day shorter in the budesonide group compared with the usual care group (median 7 days [95% CI 6 to 9] in the budesonide group vs 8 days [7 to 11] in the usual care group; log-rank test p=0·007). The mean proportion of days with a fever in the first 14 days was lower in the budesonide group (2%, SD 6) than the usual care group (8%, SD 18; Wilcoxon test p=0·051) and the proportion of participants with at least 1 day of fever was lower in the budesonide group when compared with the usual care group. As-needed antipyretic medication was required for fewer proportion of days in the budesonide group compared with the usual care group (27% [IQR 0–50] vs 50% [15–71]; p=0·025) Fewer participants randomly assigned to budesonide had persistent symptoms at days 14 and 28 compared with participants receiving usual care (difference in proportions 0·204, 95% CI 0·075 to 0·334; p=0·003). The mean total score change in the CCQ and FLUPro over 14 days was significantly better in the budesonide group compared with the usual care group (CCQ mean difference −0·12, 95% CI −0·21 to −0·02 [p=0·016]; FLUPro mean difference −0·10, 95% CI −0·21 to −0·00 [p=0·044]). Blood oxygen saturations and SARS-CoV-2 load, measured by cycle threshold, were not different between the groups. Budesonide was safe, with only five (7%) participants reporting self-limiting adverse events. Interpretation Early administration of inhaled budesonide reduced the likelihood of needing urgent medical care and reduced time to recovery after early COVID-19. Funding National Institute for Health Research Biomedical Research Centre and AstraZeneca.
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Affiliation(s)
- Sanjay Ramakrishnan
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, UK; School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Dan V Nicolau
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia; School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Beverly Langford
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, UK
| | - Mahdi Mahdi
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, UK
| | - Helen Jeffers
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, UK
| | - Christine Mwasuku
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, UK
| | - Karolina Krassowska
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, UK
| | - Robin Fox
- Bicester Health Centre, Bicester, UK; NIHR, Thames Valley and South Midlands, UK
| | | | | | | | - Christopher Butler
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Jennifer L Cane
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, UK
| | - Andreas Halner
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Philippa C Matthews
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | | | - Jodie L Simpson
- Priority Research Centre for Healthy Lungs, School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | | | - Nabil T Fadai
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
| | | | | | - Peter J Barnes
- National Heart and Lung Institute, Imperial College, London, UK
| | - Richard E K Russell
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, UK; Southernhealth NHS Foundation Trust, Hampshire, UK
| | - Mona Bafadhel
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, UK.
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Rickard K, Bengtsson T, Rheault T. ENSIFENTRINE ADDED TO TIOTROPIUM OVER 4 WEEKS PROVIDES ADDITIONAL IMPROVEMENT IN COPD QUALITY OF LIFE. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Watz H, Rickard K, Rheault T, Bengtsson T, Singh D. Symptom Improvement Following Treatment with the Inhaled Dual Phosphodiesterase 3 and 4 Inhibitor Ensifentrine in Patients with Moderate to Severe COPD - A Detailed Analysis. Int J Chron Obstruct Pulmon Dis 2020; 15:2199-2206. [PMID: 32982212 PMCID: PMC7502392 DOI: 10.2147/copd.s263025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/20/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction Ensifentrine is an inhaled first-in-class dual inhibitor of phosphodiesterase (PDE) 3 and 4. In a four-week randomized, double-blind, placebo-controlled, parallel-group study in patients with chronic obstructive pulmonary disease (COPD), nebulized ensifentrine 0.75 to 6mg twice daily significantly improved bronchodilation and symptoms, with all doses being well tolerated. Here, we report data for a number of prespecified exploratory and post hoc endpoints from this study that help to further profile the effect of ensifentrine on symptoms. Methods Eligible patients were males or females aged 40-75 years with COPD, post-bronchodilator forced expiratory volume in 1 second 40-80% predicted. Other than being clinically stable for at least four weeks prior to entry, there were no symptomatic inclusion or exclusion criteria. The outcome measures reported in this manuscript are the Evaluating Respiratory Symptoms [E-RS™:COPD] questionnaire total score and subscales (breathlessness, cough/sputum and chest symptoms) at Weeks 1-4, Transition Dyspnea Index (TDI) focal score at Weeks 2 and 4, and St George's Respiratory Questionnaire - COPD Specific (SGRQ-C) total score and domain data (symptoms, activity and impacts) at Week 4. Results There was a gradual improvement versus placebo with all ensifentrine doses for all three E-RS™:COPD subscales from Week 1 to Week 4, with the greatest ensifentrine effect on the breathlessness subscale, and all four doses superior to placebo from Week 2 onwards (p<0.05). For TDI focal score, all ensifentrine doses were superior to placebo at Weeks 2 and 4 (p<0.05). In the individual SGRQ-C domains at Week 4, ensifentrine had the greatest effect on the symptoms domain, with ensifentrine 6mg superior to placebo (p<0.05). Conclusion In these analyses, ensifentrine demonstrated a notable early and meaningful effect on dyspnea, with this effect observed across two different assessment tools.
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Affiliation(s)
- Henrik Watz
- Pulmonary Research Institute at Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | | | | | | | - Dave Singh
- Medicines Evaluation Unit, University of Manchester & Manchester University NHS Foundation Trust, Manchester, UK
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Kawczynski MG, Bengtsson T, Dai J, Hopkins JJ, Gao SS, Willis JR. Development of Deep Learning Models to Predict Best-Corrected Visual Acuity from Optical Coherence Tomography. Transl Vis Sci Technol 2020; 9:51. [PMID: 32974088 PMCID: PMC7488630 DOI: 10.1167/tvst.9.2.51] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 08/03/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To develop deep learning (DL) models to predict best-corrected visual acuity (BCVA) from optical coherence tomography (OCT) images from patients with neovascular age-related macular degeneration (nAMD). Methods Retrospective analysis of OCT images and associated BCVA measurements from the phase 3 HARBOR trial (NCT00891735). DL regression models were developed to predict BCVA at the concurrent visit and 12 months from baseline using OCT images. Binary classification models were developed to predict BCVA of Snellen equivalent of <20/40, <20/60, and ≤20/200 at the concurrent visit and 12 months from baseline. Results The regression model to predict BCVA at the concurrent visit had R2 = 0.67 (root-mean-square error [RMSE] = 8.60) in study eyes and R2 = 0.84 (RMSE = 9.01) in fellow eyes. The best classification model to predict BCVA at the concurrent visit had an area under the receiver operating characteristic curve (AUC) of 0.92 in study eyes and 0.98 in fellow eyes. The regression model to predict BCVA at month 12 using baseline OCT had R2 = 0.33 (RMSE = 14.16) in study eyes and R2 = 0.75 (RMSE = 11.27) in fellow eyes. The best classification model to predict BCVA at month 12 had AUC = 0.84 in study eyes and AUC = 0.96 in fellow eyes. Conclusions DL shows promise in predicting BCVA from OCTs in nAMD. Further research should elucidate the utility of models in clinical settings. Translational Relevance DL models predicting BCVA could be used to enhance understanding of structure–function relationships and develop more efficient clinical trials.
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Affiliation(s)
| | | | - Jian Dai
- Genentech, Inc., South San Francisco, CA, USA
| | | | - Simon S Gao
- Genentech, Inc., South San Francisco, CA, USA
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20
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Jemaa S, Fredrickson J, Carano RAD, Nielsen T, de Crespigny A, Bengtsson T. Tumor Segmentation and Feature Extraction from Whole-Body FDG-PET/CT Using Cascaded 2D and 3D Convolutional Neural Networks. J Digit Imaging 2020; 33:888-894. [PMID: 32378059 PMCID: PMC7522127 DOI: 10.1007/s10278-020-00341-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
18F-Fluorodeoxyglucose-positron emission tomography (FDG-PET) is commonly used in clinical practice and clinical drug development to identify and quantify metabolically active tumors. Manual or computer-assisted tumor segmentation in FDG-PET images is a common way to assess tumor burden, such approaches are both labor intensive and may suffer from high inter-reader variability. We propose an end-to-end method leveraging 2D and 3D convolutional neural networks to rapidly identify and segment tumors and to extract metabolic information in eyes to thighs (whole body) FDG-PET/CT scans. The developed architecture is computationally efficient and devised to accommodate the size of whole-body scans, the extreme imbalance between tumor burden and the volume of healthy tissue, and the heterogeneous nature of the input images. Our dataset consists of a total of 3664 eyes to thighs FDG-PET/CT scans, from multi-site clinical trials in patients with non-Hodgkin's lymphoma (NHL) and advanced non-small cell lung cancer (NSCLC). Tumors were segmented and reviewed by board-certified radiologists. We report a mean 3D Dice score of 88.6% on an NHL hold-out set of 1124 scans and a 93% sensitivity on 274 NSCLC hold-out scans. The method is a potential tool for radiologists to rapidly assess eyes to thighs FDG-avid tumor burden.
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21
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Singh D, Martinez FJ, Watz H, Bengtsson T, Maurer BT. A dose-ranging study of the inhaled dual phosphodiesterase 3 and 4 inhibitor ensifentrine in COPD. Respir Res 2020; 21:47. [PMID: 32041601 PMCID: PMC7011474 DOI: 10.1186/s12931-020-1307-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/27/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many patients with chronic obstructive pulmonary disease (COPD) still experience daily symptoms, exacerbations, and accelerated lung function decline, even when receiving maximal combined treatment with inhaled long-acting bronchodilators and corticosteroids. Novel treatment options are needed for these patients. Phosphodiesterases (PDEs) are enzymes that impact a range of cellular functions by modulating levels of cyclic nucleotides, and there is evidence to suggest that combined inhibition of PDE3 and PDE4 can have additive (or perhaps synergistic) effects. This study investigated the efficacy and safety of ensifentrine, a first-in-class dual inhibitor of PDE 3 and 4, in patients with COPD. METHODS This randomised, double-blind, placebo-controlled, parallel-group, dose-ranging study recruited patients with COPD, post-bronchodilator forced expiratory volume in 1 s (FEV1) 40-80% predicted and FEV1/forced vital capacity ratio ≤ 0.7. Patients were randomised equally to inhale nebulised ensifentrine 0.75, 1.5, 3 or 6 mg or placebo, all twice daily. PRIMARY OUTCOME placebo-adjusted difference in peak FEV1 (assessed over 3 h) at Week 4. RESULTS The study took place between July 2017 and February 2018. Of 405 patients randomly assigned to medication, 375 (92.6%) completed the study. For peak FEV1 at Week 4, all four ensifentrine doses were superior to placebo (p ≤ 0.0001) with least squares mean differences of 146 (95% CI 75-216), 153 (83-222), 200 (131-270) and 139 (69-210) mL for ensifentrine 0.75, 1.5, 3 and 6 mg, respectively. Respiratory symptoms (assessed using the Evaluating Respiratory Symptoms questionnaire) were also significantly improved with all ensifentrine doses at Week 4. Adverse events were reported by 33.3, 44.4, 35.4 and 36.3% patients with ensifentrine 0.75, 1.5, 3 and 6 mg, respectively, and 39.2% with placebo. CONCLUSIONS In this four-week Phase IIb study, all four ensifentrine doses significantly improved bronchodilation and symptoms, with a dose-ranging effect from 0.75 to 3 mg twice daily, and all doses well tolerated. The study supports the continuing development of ensifentrine in COPD. TRIAL REGISTRATION EudraCT 2016-005205-40, registered 30 May 2017.
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Affiliation(s)
- Dave Singh
- Medicines Evaluation Unit, University of Manchester & Manchester University NHS Foundation Trust, Manchester, UK.
| | - Fernando J Martinez
- Weill Cornell Medical College, New York, New York, and University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Henrik Watz
- Pulmonary Research Institute at Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
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22
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Bafadhel M, Singh D, Jenkins C, Peterson S, Bengtsson T, Wessman P, Fagerås M. Reduced risk of clinically important deteriorations by ICS in COPD is eosinophil dependent: a pooled post-hoc analysis. Respir Res 2020; 21:17. [PMID: 31924197 PMCID: PMC6954504 DOI: 10.1186/s12931-020-1280-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinically Important Deterioration (CID) is a novel composite measure to assess treatment effect in chronic obstructive pulmonary disease (COPD). We examined the performance and utility of CID in assessing the effect of inhaled corticosteroids (ICS) in COPD. METHODS This post-hoc analysis of four budesonide/formoterol (BUD/FORM) studies comprised 3576 symptomatic moderate-to-very-severe COPD patients with a history of exacerbation. Analysis of time to first CID event (exacerbation, deterioration in forced expiratory volume in 1 second [FEV1] or worsening St George's Respiratory Questionnaire [SGRQ] score) was completed using Cox proportional hazards models. RESULTS The proportion of patients with ≥1 CID in the four studies ranged between 63 and 77% and 69-84% with BUD/FORM and FORM, respectively, with an average 25% reduced risk of CID with BUD/FORM. All components contributed to the CID event rate. Experiencing a CID during the first 3 months was associated with poorer outcomes (lung function, quality of life, symptoms and reliever use) and increased risk of later CID events. The effect of BUD/FORM versus FORM in reducing CID risk was positively associated with the blood eosinophil count. CONCLUSIONS Our findings suggest that BUD/FORM offers protective effects for CID events compared with FORM alone, with the magnitude of the effect dependent on patients' eosinophil levels. CID may be an important tool for evaluation of treatment effect in a complex, multifaceted, and progressive disease like COPD, and a valuable tool to allow for shorter and smaller future outcome predictive trials in early drug development.
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Affiliation(s)
- Mona Bafadhel
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Dave Singh
- Medicines Evaluation Unit, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Christine Jenkins
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Sanabria Bohórquez S, Marik J, Ogasawara A, Tinianow JN, Gill HS, Barret O, Tamagnan G, Alagille D, Ayalon G, Manser P, Bengtsson T, Ward M, Williams SP, Kerchner GA, Seibyl JP, Marek K, Weimer RM. [ 18F]GTP1 (Genentech Tau Probe 1), a radioligand for detecting neurofibrillary tangle tau pathology in Alzheimer's disease. Eur J Nucl Med Mol Imaging 2019; 46:2077-2089. [PMID: 31254035 DOI: 10.1007/s00259-019-04399-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 06/11/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Neurofibrillary tangles (NFTs), consisting of intracellular aggregates of the tau protein, are a pathological hallmark of Alzheimer's disease (AD). Here we report the identification and initial characterization of Genentech Tau Probe 1 ([18F]GTP1), a small-molecule PET probe for imaging tau pathology in AD patients. METHODS Autoradiography using human brain tissues from AD donors and protein binding panels were used to determine [18F]GTP1 binding characteristics. Stability was evaluated in vitro and in vivo in mice and rhesus monkey. In the clinic, whole-body imaging was performed to assess biodistribution and dosimetry. Dynamic [18F]GTP1 brain imaging and input function measurement were performed on two separate days in 5 β-amyloid plaque positive (Aβ+) AD and 5 β-amyloid plaque negative (Aβ-) cognitive normal (CN) participants. Tracer kinetic modeling was applied and reproducibility was evaluated. SUVR was calculated and compared to [18F]GTP1-specific binding parameters derived from the kinetic modeling. [18F]GTP1 performance in a larger cross-sectional group of 60 Aβ+ AD participants and ten (Aβ- or Aβ+) CN was evaluated with images acquired 60 to 90 min post tracer administration. RESULTS [18F]GTP1 exhibited high affinity and selectivity for tau pathology with no measurable binding to β-amyloid plaques or MAO-B in AD tissues, or binding to other tested proteins at an affinity predicted to impede image data interpretation. In human, [18F]GTP1 exhibited favorable dosimetry and brain kinetics, and no evidence of defluorination. [18F]GTP1-specific binding was observed in cortical regions of the brain predicted to contain tau pathology in AD and exhibited low (< 4%) test-retest variability. SUVR measured in the 60 to 90-min interval post injection correlated with tracer-specific binding (slope = 1.36, r2 = 0.98). Furthermore, in a cross-sectional population, the degree of [18F]GTP1-specific binding increased with AD severity and could differentiate diagnostic cohorts. CONCLUSIONS [18F]GTP1 is a promising PET probe for the study of tau pathology in AD.
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Affiliation(s)
| | - Jan Marik
- Department of Biomedical Imaging, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Annie Ogasawara
- Department of Biomedical Imaging, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Jeff N Tinianow
- Department of Biomedical Imaging, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Herman S Gill
- Department of Biomedical Imaging, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Olivier Barret
- Invicro LLC, 60 Temple St, Suite 8A, New Haven, CT, 06510, USA
| | - Gilles Tamagnan
- Invicro LLC, 60 Temple St, Suite 8A, New Haven, CT, 06510, USA
- XingImaging, LLC, 760 Chapel Street, New Haven, CT, 06510, USA
| | - David Alagille
- Invicro LLC, 60 Temple St, Suite 8A, New Haven, CT, 06510, USA
- XingImaging, LLC, 760 Chapel Street, New Haven, CT, 06510, USA
| | - Gai Ayalon
- Department of Neuroscience, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Paul Manser
- Clinical Biostatistics, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Thomas Bengtsson
- Clinical Biostatistics, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Michael Ward
- Early Clinical Development, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
- Alector, Inc., 151 Oyster Point Blvd, South San Francisco, CA, 94080, USA
| | - Simon-Peter Williams
- Department of Biomedical Imaging, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Geoffrey A Kerchner
- Early Clinical Development, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - John P Seibyl
- Invicro LLC, 60 Temple St, Suite 8A, New Haven, CT, 06510, USA
| | - Kenneth Marek
- Invicro LLC, 60 Temple St, Suite 8A, New Haven, CT, 06510, USA
| | - Robby M Weimer
- Department of Biomedical Imaging, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA.
- Department of Neuroscience, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA.
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Darlison J, Mieli M, Bengtsson T, Hartmann R, Mogren L, Vågsholm I, Karlsson M, Alsanius BW. Plant species affects establishment of Escherichia coli O157:H7 gfp+ on leafy vegetables. J Appl Microbiol 2019; 127:292-305. [PMID: 31054164 DOI: 10.1111/jam.14299] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/18/2019] [Accepted: 04/29/2019] [Indexed: 01/25/2023]
Abstract
AIMS Greenhouse trials were conducted with different cultivars of baby leaf spinach, rocket and Swiss chard and inoculation of Escherichia coli O157:H7 gfp+, to determine whether plant species and cultivar have an impact on the establishment of this strain. METHODS AND RESULTS Three cultivars each of spinach, rocket and Swiss chard were spray inoculated with E. coli O157:H7 gfp+ at doses of log 7 CFU per ml. Due to the different lengths of growing period spinach and Swiss chard were spray inoculated three times and rocket five times, with final inoculation performed 3 days prior to harvest. After a growing period of 26-33 days, E. coli O157:H7 gfp+ was recovered from the leaf surface in mean populations between log 1 and 6 CFU per gram. The lowest occurrence of E. coli O157:H7 gfp+ was found on rocket leaves and the highest on spinach. There was no significant difference in the establishment of E. coli O157:H7 gfp+ between cultivars, but there were differences between plant species. Indigenous phyllosphere bacteria were pure cultured and identified with 16S rRNA gene sequencing. CONCLUSIONS Despite the same high inoculation dose of E. coli O157:H7 gfp+ on leaves, the establishment rate differed between plant species. However, plant cultivar did not affect establishment. Pantoea agglomerans dominated the identified bacterial isolates. SIGNIFICANCE AND IMPACT OF THE STUDY As previous studies are inconclusive on choice of model plant species and cultivar, we studied whether plant species or cultivar determines the fate of E. coli O157:H7 gfp+ on leafy vegetables. The findings indicate that plant species is a key determinant in the establishment of E. coli O157:H7 gfp+.
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Affiliation(s)
- J Darlison
- Department of Biosystems and Technology, Microbial Horticulture Laboratory, Swedish University of Agricultural Sciences, Alnarp, Sweden
| | - M Mieli
- Department of Biosystems and Technology, Microbial Horticulture Laboratory, Swedish University of Agricultural Sciences, Alnarp, Sweden
| | - T Bengtsson
- Department of Biosystems and Technology, Microbial Horticulture Laboratory, Swedish University of Agricultural Sciences, Alnarp, Sweden
| | - R Hartmann
- Department of Biosystems and Technology, Microbial Horticulture Laboratory, Swedish University of Agricultural Sciences, Alnarp, Sweden.,Department of Horticultural Production Systems, Wilhelm Leibniz University, Hannover, Germany
| | - L Mogren
- Department of Biosystems and Technology, Microbial Horticulture Laboratory, Swedish University of Agricultural Sciences, Alnarp, Sweden
| | - I Vågsholm
- Department of Biomedical Sciences and Veterinary Health, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - M Karlsson
- Department of Biosystems and Technology, Microbial Horticulture Laboratory, Swedish University of Agricultural Sciences, Alnarp, Sweden
| | - B W Alsanius
- Department of Biosystems and Technology, Microbial Horticulture Laboratory, Swedish University of Agricultural Sciences, Alnarp, Sweden
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Singh D, Abbott-Banner K, Bengtsson T, Newman K. The short-term bronchodilator effects of the dual phosphodiesterase 3 and 4 inhibitor RPL554 in COPD. Eur Respir J 2018; 52:13993003.01074-2018. [PMID: 30166326 PMCID: PMC6214575 DOI: 10.1183/13993003.01074-2018] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 06/08/2018] [Accepted: 08/22/2018] [Indexed: 02/04/2023]
Abstract
We investigated the short-term bronchodilator effects of RPL554 (an inhaled dual phosphodiesterase 3 and 4 inhibitor) combined with other bronchodilators in chronic obstructive pulmonary disease patients with reversibility (>150 mL to short-acting bronchodilators). Study 1 was a six-way, placebo-controlled crossover study (n=36) with single doses of RPL554 (6 mg), salbutamol (200 µg), ipratropium (40 µg), RPL554 (6 mg)+salbutamol (200 µg), RPL554 (6 mg)+ipratropium (40 µg) or placebo. Study 2 was a three-way crossover study (n=30) of tiotropium (18 µg) combined with RPL554 (1.5 or 6 mg) or placebo for 3 days. Forced expiratory volume in 1 s (FEV1), lung volumes and specific airway conductance (sGaw) were measured. In study 1, peak FEV1 change compared with placebo was similar with RPL554, ipratropium and salbutamol (mean 223, 199 and 187 mL, respectively). The peak FEV1 was higher for RPL554+ipratropium versus ipratropium (mean difference 94 mL; p<0.0001) and RPL554+salbutamol versus salbutamol (mean difference 108 mL; p<0.0001). In study 2 (day 3), both RPL554 doses caused greater peak FEV1 effects than placebo. The average FEV1(0–12 h) increase was greater with RPL554 6 mg only versus placebo (mean difference 65 mL; p=0.0009). In both studies, lung volumes and sGaw showed greater RPL554 combination treatment effects versus monotherapy. RPL554 combined with standard bronchodilators caused additional bronchodilation and hyperinflation reduction. The dual PDE3 and PDE4 inhibitor RPL554 causes additional bronchodilation when combined with commonly used short- or long-acting bronchodilatorshttp://ow.ly/CUYi30lDcYW
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Affiliation(s)
- Dave Singh
- Medicines Evaluation Unit, University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
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Lönn J, Ljunggren S, Klarström-Engström K, Demirel I, Bengtsson T, Karlsson H. Lipoprotein modifications by gingipains of Porphyromonas gingivalis. J Periodontal Res 2018; 53:403-413. [PMID: 29341140 PMCID: PMC5969291 DOI: 10.1111/jre.12527] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Several studies have shown an association between periodontitis and cardiovascular disease (CVD). Atherosclerosis is the major cause of CVD, and a key event in the development of atherosclerosis is accumulation of lipoproteins within the arterial wall. Bacteria are the primary etiologic agents in periodontitis and Porphyromonas gingivalis is the major pathogen in the disease. Several studies support a role of modified low-density lipoprotein (LDL) in atherogenesis; however, the pathogenic stimuli that induce the changes and the mechanisms by which this occur are unknown. This study aims to identify alterations in plasma lipoproteins induced by the periodontopathic species of bacterium, P. gingivalis, in vitro. MATERIAL AND METHODS Plasma lipoproteins were isolated from whole blood treated with wild-type and gingipain-mutant (lacking either the Rgp- or Kgp gingipains) P. gingivalis by density/gradient-ultracentrifugation and were studied using 2-dimensional gel electrophoresis followed by matrix-assisted laser desorption/ionization mass spectrometry. Porphyromonas gingivalis-induced lipid peroxidation and antioxidant levels were measured by thiobarbituric acid-reactive substances and antioxidant assay kits, respectively, and lumiaggregometry was used for measurement of reactive oxygen species (ROS) and aggregation. RESULTS Porphyromonas gingivalis exerted substantial proteolytic effects on the lipoproteins. The Rgp gingipains were responsible for producing 2 apoE fragments, as well as 2 apoB-100 fragments, in LDL, and the Kgp gingipain produced an unidentified fragment in high-density lipoproteins. Porphyromonas gingivalis and its different gingipain variants induced ROS and consumed antioxidants. Both the Rgp and Kgp gingipains were involved in inducing lipid peroxidation. CONCLUSION Porphyromonas gingivalis has the potential to change the expression of lipoproteins in blood, which may represent a crucial link between periodontitis and CVD.
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MESH Headings
- Adhesins, Bacterial/blood
- Adhesins, Bacterial/genetics
- Adhesins, Bacterial/metabolism
- Antioxidants/analysis
- Apolipoprotein A-I/metabolism
- Apolipoprotein B-100/metabolism
- Cysteine Endopeptidases/blood
- Cysteine Endopeptidases/genetics
- Cysteine Endopeptidases/metabolism
- Cysteine Endopeptidases/pharmacokinetics
- Gingipain Cysteine Endopeptidases
- Humans
- Lipid Peroxidation
- Lipoproteins/blood
- Lipoproteins/drug effects
- Lipoproteins/metabolism
- Lipoproteins, HDL/blood
- Lipoproteins, HDL/metabolism
- Lipoproteins, LDL/blood
- Lipoproteins, LDL/drug effects
- Lipoproteins, LDL/metabolism
- Methionine/metabolism
- Periodontitis/metabolism
- Periodontitis/microbiology
- Porphyromonas gingivalis/metabolism
- Porphyromonas gingivalis/pathogenicity
- Reactive Oxygen Species/metabolism
- Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
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Affiliation(s)
- J Lönn
- Department of Oral Biology, Institute of Odontology, Malmö University, Malmö, Sweden
- PEAS Institute AB, Linköping, Sweden
| | - S Ljunggren
- Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine Center, Linköping University, Linköping, Sweden
| | | | - I Demirel
- Department of Medical Sciences, Örebro University, Örebro, Sweden
| | - T Bengtsson
- Department of Medical Sciences, Örebro University, Örebro, Sweden
| | - H Karlsson
- Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine Center, Linköping University, Linköping, Sweden
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Wildsmith KR, Bohorquez SS, Manser PT, Höglund K, Blennow K, Brug MP, Bengtsson T, Marik J, Ayalon G, Ward M, Kerchner GA, Weimer R. [P2–367]: CROSS‐SECTIONAL CORRELATION BETWEEN GTP1‐TAU‐PET AND CSF TAU AS MEASURES OF TAU BURDEN IN ALZHEIMER's DISEASE. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.1022] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | | | - Kina Höglund
- Institute of Neuroscience and PhysiologyThe Sahlgrenska Academy at University of Gothenburg, MölndalMölndalSweden
| | - Kaj Blennow
- Institute of Neuroscience and PhysiologyThe Sahlgrenska Academy at University of GothenburgMölndalSweden
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Fosså SD, Bengtsson T, Borre M, Ahlgren G, Rannikko A, Dahl AA. Reduction of quality of life in prostate cancer patients: experience among 6200 men in the Nordic countries. Scand J Urol 2016; 50:330-7. [PMID: 27398736 DOI: 10.1080/21681805.2016.1201859] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Although many studies have dealt with adverse effects (AEs) and quality of life (QoL) in prostate cancer (PCa) patients, the quantification of the patients' perspective on AE-related reduction in QoL has been less studied. This study describes the impact of self-reported local (erectile, bowel, urinary dysfunction) or systemic (mental distress, fatigue, virility loss) AEs on QoL reduction. MATERIALS AND METHODS Nordic PCa patients completed a questionnaire containing 84 multiple-choice questions. The main outcome variable of the survey was patient-reported PCa-induced QoL reduction, assessed by descriptive and regression analyses. The level of significance was p < 0.05. RESULTS Among 6200 patients, 39% described their QoL as reduced owing to the PCa trajectory: radical prostatectomy group (RPGroup): 42%, radiotherapy without hormones (RADGroup): 27%, hormones (HormGroup): 47% and no treatment (NoTrtGroup): 19%. Except for the NoTrtGroup, urinary leakage and fatigue doubled the risk of QoL reduction, while virility loss and erectile dysfunction tripled the risk. Significant intergroup differences emerged for the age-adjusted odds of QoL reduction: RPGroup (0.66), RADGroup (0.40), HormGroup (0.95) and NoTrtGroup (0.22). CONCLUSIONS After RP, RAD or hormone treatment of PCa, systemic AEs, in particular loss of virility, significantly reduce PCa patients' QoL similarly to or more than local AEs. The probability of reduced QoL is highest during hormone treatment and lowest in patients without anticancer therapy, and seems lower in patients treated with RAD without hormones than after RP. The treatment-related risk of reduced QoL due to systemic AEs should become a part of the pretreatment counselling of patients.
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Affiliation(s)
- Sophie D Fosså
- a National Advisory Unit on Late Effects after Cancer Treatment , Oslo University Hospital, The Norwegian Radium Hospital , Oslo , Norway
| | - Thomas Bengtsson
- b StatMind Statistical & Mathematical Modelling Innovation & Design AB , Lund , Sweden
| | - Michael Borre
- c Department of Urology , Aarhus University Hospital , Aarhus , Denmark
| | - Göran Ahlgren
- d Department of Urology , SUS Malmö , Region Skåne, Malmö , Sweden
| | - Antti Rannikko
- e Department of Urology , Helsinki University Hospital , Helsinki , Finland
| | - Alv A Dahl
- a National Advisory Unit on Late Effects after Cancer Treatment , Oslo University Hospital, The Norwegian Radium Hospital , Oslo , Norway ;,f Faculty of Medicine, University of Oslo , Oslo , Norway
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Coimbra AJF, Rimola J, O'Byrne S, Lu TT, Bengtsson T, de Crespigny A, Luca D, Rutgeerts P, Bruining DH, Fidler JL, Sandborn WJ, Santillan CS, Higgins PDR, Al-Hawary MM, Vermeire S, Vanbeckevoort D, Vanslembrouck R, Peyrin-Biroulet L, Laurent V, Herrmann KA, Panes J. Magnetic resonance enterography is feasible and reliable in multicenter clinical trials in patients with Crohn's disease, and may help select subjects with active inflammation. Aliment Pharmacol Ther 2016; 43:61-72. [PMID: 26548868 DOI: 10.1111/apt.13453] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [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] [Received: 07/09/2015] [Revised: 07/23/2015] [Accepted: 10/09/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Reliable tools for patient selection are critical for clinical drug trials. AIM To evaluate a consensus-based, standardised magnetic resonance enterography (MRE) protocol for selecting patients for inclusion in Crohn's disease (CD) multicenter clinical trials. METHODS This study recruited 20 patients [Crohn's Disease Activity Index (CDAI) scores: <150 (n = 8); 150-220 (n = 4); 220-450 (n = 8)], to undergo ileocolonoscopy and two MREs (with and without colonic contrast) within a 14-day period. Procedures were scored centrally using, Magnetic Resonance Index of Activity (MaRIA), and both Crohn's Disease Endoscopic Index of Severity (CDEIS) and Simplified Endoscopic Score (SES-CD). RESULTS 37 MREs were acquired. Both MREs were evaluable in 16 patients for calculation of test-retest and inter-reader reliability scores. The MaRIA scores for the terminal ileum had excellent test-retest and inter-reader reliability, with correlations >0.9. The proximal ileum showed strong within-reader agreement (0.90-0.96), and fair between-reader agreement (0.59-0.72). MRE procedures were tolerable. MaRIA scores correlated with CDEIS and SES-CD (0.63 and 0.71), but not with CDAI (0.34). MRE identified 3 patients with intra-abdominal complications, who would otherwise have been included in clinical trials. Furthermore, both MRE and ileocolonoscopy identified active bowel wall inflammation in 2 patients with CDAI <150, and none in 1 patient with CDAI > 220. Data quality was good/excellent in 85% of scans, and fair or better in 96%. CONCLUSIONS Magnetic resonance enterography of high-quality and reproducibility was feasible in a global multi- centre setting, with evidence for improved selectivity over CDAI and ileocolonoscopy in identifying appropriate CD patients for inclusion in therapeutic intervention trials.
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Affiliation(s)
| | - J Rimola
- Hospital Clínic de Barcelona, Catalonia, Spain
| | - S O'Byrne
- Genentech, Inc., South San Francisco, CA, USA
| | - T T Lu
- Genentech, Inc., South San Francisco, CA, USA
| | - T Bengtsson
- Genentech, Inc., South San Francisco, CA, USA
| | | | - D Luca
- Genentech, Inc., South San Francisco, CA, USA
| | - P Rutgeerts
- University Hospitals Leuven, Leuven, Belgium
| | | | | | - W J Sandborn
- University of California San Diego, La Jolla, CA, USA
| | - C S Santillan
- University of California San Diego, La Jolla, CA, USA
| | | | | | | | | | | | - L Peyrin-Biroulet
- University Hospital of Nancy-Brabois, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - V Laurent
- Adults University, Nancy University, Vandoeuvre-lès-Nancy, France
| | - K A Herrmann
- University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - J Panes
- Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
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Bengtsson T, Sanabria-Bohorquez SM, McCarthy TJ, Binns DS, Hicks RJ, de Crespigny AJ. STatistically Assigned Response Criteria in Solid Tumors (STARCIST). Cancer Imaging 2015; 15:9. [PMID: 26231380 PMCID: PMC4522098 DOI: 10.1186/s40644-015-0042-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/14/2015] [Indexed: 11/19/2022] Open
Abstract
Background Several reproducibility studies have established good test-retest reliability of FDG-PET in various oncology settings. However, these studies are based on relatively short inter-scan periods of 1–3 days while, in contrast, response assessments based on FDG-PET in early phase drug trials are typically made over an interval of 2–3 weeks during the first treatment cycle. With focus on longer, on-treatment scan intervals, we develop a data-driven approach to calculate baseline-specific cutoff values to determine patient-level changes in glucose uptake that are unlikely to be explained by random variability. Our method takes into account the statistical nature of natural fluctuations in SUV as well as potential bias effects. Methods To assess variability in SUV over clinically relevant scan intervals for clinical trials, we analyzed baseline and follow-up FDG-PET scans with a median scan interval of 21 days from 53 advanced stage cancer patients enrolled in a Phase 1 trial. The 53 patients received a sub-pharmacologic drug dose and the trial data is treated as a ’test-retest’ data set. A simulation-based tool is presented which takes as input baseline lesion SUVmax values, the variance of spurious changes in SUVmax between scans, the desired Type I error rate, and outputs lesion and patient based cut-off values. Bias corrections are included to account for variations in tracer uptake time. Results In the training data, changes in SUVmax follow an approximately zero-mean Gaussian distribution with constant variance across levels of the baseline measurements. Because of constant variance, the coefficient of variation is a decreasing function of the magnitude of baseline SUVmax. This finding is consistent with published results, but our data shows greater variability. Application of our method to NSCLC patients treated with erlotinib produces results distinct from those based on the EORTC criteria. Based on data presented here as well as previous repeatability studies, the proposed method has greater statistical power to detect a significant %-decrease on SUVmax compared to published criteria relying on symmetric thresholds. Conclusions Defining patient-specific, baseline dependent cut-off values based on the (null) distribution of naturally occurring fluctuations in glucose uptake enable identification of statistically significant changes in SUVmax. For lower baseline values, the produced cutoff values are notably asymmetric with relatively large changes (e.g. >50 %) required for statistical significance. For use with prospectively defined endpoints, the developed method enables the use of one-armed trials to detect pharmacodynamic drug effects based on FDG-PET. The clinical importance of changes in SUVmax is likely to remain dependent on both tumor biology and the type of treatment.
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Affiliation(s)
- Thomas Bengtsson
- Biostatistics, Genentech Inc, 1 DNA Way, South San Francisco, CA, 94080, USA.
| | | | | | - David S Binns
- The Sir Peter MacCallum Department of Oncology, the University of Melbourne, Parkville, VIC, Australia.
| | - Rodney J Hicks
- The Sir Peter MacCallum Department of Oncology, the University of Melbourne, Parkville, VIC, Australia. .,Cancer Imaging, the Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
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31
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Mackey HM, Bengtsson T. Personalized medicine and needs for predictive biomarkers that produce non-linear treatment interactions. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e14000] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mackey HM, Bengtsson T. When investigating predictive biomarkers, beware of the qualitative interaction. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.2575] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Jayaprakash K, Demirel I, Khalaf H, Bengtsson T. The role of phagocytosis, oxidative burst and neutrophil extracellular traps in the interaction between neutrophils and the periodontal pathogenPorphyromonas gingivalis. Mol Oral Microbiol 2015; 30:361-75. [DOI: 10.1111/omi.12099] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2015] [Indexed: 01/11/2023]
Affiliation(s)
- K. Jayaprakash
- School of Health and Medical Sciences; Örebro University; Örebro Sweden
| | - I. Demirel
- School of Health and Medical Sciences; Örebro University; Örebro Sweden
| | - H. Khalaf
- School of Health and Medical Sciences; Örebro University; Örebro Sweden
| | - T. Bengtsson
- School of Health and Medical Sciences; Örebro University; Örebro Sweden
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Bjermer L, Kuna P, Jorup C, Bengtsson T, Rosenborg J. Clinical pharmacokinetics of AZD3199, an inhaled ultra-long-acting β2-adrenoreceptor agonist (uLABA). Drug Des Devel Ther 2015; 9:753-62. [PMID: 25709399 PMCID: PMC4330041 DOI: 10.2147/dddt.s66049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective The clinical pharmacokinetics of AZD3199, an ultra-long-acting β2-agonist, were investigated in healthy volunteers and patients with asthma or chronic obstructive pulmonary disease (COPD). Materials and methods Five studies are presented: one single ascending dose study in healthy Caucasian males; two multiple ascending dose studies in healthy males, one in Caucasians and one in Japanese; a Phase IIA asthma study; and a Phase IIB COPD study. Subjects received AZD3199 via a Spira nebulizer (Turbuhaler; equivalent delivered doses 5–3200 μg) or Turbuhaler (single delivered doses of 120–1920 μg or repeated delivered once-daily doses 240–1,680 μg). AZD3199 pharmacokinetics were assessed using total plasma concentration and urinary excretion, and tolerability using adverse events, clinical laboratory tests, and physical examinations. Results AZD3199 appeared rapidly in the systemic circulation following single and multiple dosing in healthy volunteers and patients (maximum plasma concentration within 30 minutes), with dose-proportional time-independent pharmacokinetics. Plasma exposure to unmetabolized drug was similar in healthy volunteers and patients with asthma, but relatively lower in patients with COPD. Estimated terminal half-life was up to 142 hours in healthy Caucasian males. AZD3199 was well tolerated and showed no or at most mild systemic effects. Conclusion AZD3199 plasma exposure in healthy volunteers and patients suggested linear pharmacokinetics and a long half-life. Systemic availability was similar in healthy subjects and patients with asthma, but was lower in patients with COPD. These clinical trials suggest that AZD3199 is well-tolerated in healthy male volunteers and patients, with no safety concerns identified to preclude further evaluation.
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Affiliation(s)
- Leif Bjermer
- Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden
| | - Piotr Kuna
- Department of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
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Klarström Engström K, Khalaf H, Kälvegren H, Bengtsson T. The role of Porphyromonas gingivalis gingipains in platelet activation and innate immune modulation. Mol Oral Microbiol 2014; 30:62-73. [PMID: 25043711 DOI: 10.1111/omi.12067] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2014] [Indexed: 12/31/2022]
Abstract
Platelets are considered to have important functions in inflammatory processes and as actors in the innate immunity. Several studies have shown associations between cardiovascular disease and periodontitis, where the oral anaerobic pathogen Porphyromonas gingivalis has a prominent role in modulating the immune response. Porphyromonas gingivalis has been found in atherosclerotic plaques, indicating spreading of the pathogen via the circulation, with an ability to interact with and activate platelets via e.g. Toll-like receptors (TLR) and protease-activated receptors. We aimed to evaluate how the cysteine proteases, gingipains, of P. gingivalis affect platelets in terms of activation and chemokine secretion, and to further investigate the mechanisms of platelet-bacteria interaction. This study shows that primary features of platelet activation, i.e. changes in intracellular free calcium and aggregation, are affected by P. gingivalis and that arg-gingipains are of great importance for the ability of the bacterium to activate platelets. The P. gingivalis induced a release of the chemokine RANTES, however, to a much lower extent compared with the TLR2/1-agonist Pam3 CSK4 , which evoked a time-dependent release of the chemokine. Interestingly, the TLR2/1-evoked response was abolished by a following addition of viable P. gingivalis wild-types and gingipain mutants, showing that both Rgp and Kgp cleave the secreted chemokine. We also demonstrate that Pam3 CSK4 -stimulated platelets release migration inhibitory factor and plasminogen activator inhibitor-1, and that also these responses were antagonized by P. gingivalis. These results supports immune-modulatory activities of P. gingivalis and further clarify platelets as active players in innate immunity and in sensing bacterial infections, and as target cells in inflammatory reactions induced by P. gingivalis infection.
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Affiliation(s)
- K Klarström Engström
- Department of Biomedicine, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
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Palm E, Khalaf H, Bengtsson T. Suppression of inflammatory responses of human gingival fibroblasts by gingipains fromPorphyromonas gingivalis. Mol Oral Microbiol 2014; 30:74-85. [DOI: 10.1111/omi.12073] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2014] [Indexed: 12/13/2022]
Affiliation(s)
- E. Palm
- Department of Biomedicine; School of Health and Medical Sciences; Örebro University; Örebro Sweden
| | - H. Khalaf
- Department of Biomedicine; School of Health and Medical Sciences; Örebro University; Örebro Sweden
| | - T. Bengtsson
- Department of Biomedicine; School of Health and Medical Sciences; Örebro University; Örebro Sweden
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Jorup C, Bengtsson T, Strandgården K, Sjöbring U. Transient paradoxical bronchospasm associated with inhalation of the LAMA AZD9164: analysis of two Phase I, randomised, double-blind, placebo-controlled studies. BMC Pulm Med 2014; 14:52. [PMID: 24669829 PMCID: PMC3976047 DOI: 10.1186/1471-2466-14-52] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 03/19/2014] [Indexed: 11/23/2022] Open
Abstract
Background AZD9164 has demonstrated potential as an inhaled, long-acting, muscarinic antagonist (LAMA) bronchodilator. However, in patients with COPD, but not in healthy subjects, a transient initial drop in FEV1 was observed following inhalation of nebulised doses of AZD9164 in citrate buffer. Two additional studies were conducted to further assess the safety and tolerability of multiple ascending doses of AZD9164 in 27 white and 18 Japanese healthy subjects and in 4 patients with COPD. In these studies, AZD9164 was inhaled via Turbuhaler™. Methods These were Phase I, randomised, double-blind, placebo-controlled, multiple ascending dose (MAD) studies conducted in Sweden and UK. Healthy subjects (mean age 25.9 yrs) and patients with COPD (mean age 66 yrs, mean post-bronchodilator FEV1 60.1% predicted normal value) were randomised 2:1 to active treatment (400, 1000 or 2800 μg delivered doses of AZD9164) or placebo. Results No safety or tolerability concerns were identified in the healthy subjects at doses up to and including 2800 μg and both studies confirmed the bronchodilator effect of AZD9164. However, the first 3 patients in the COPD cohort who received AZD9164 (1000 μg) experienced a transient fall in FEV1 5 to 15 minutes after inhalation of AZD9164 while the patient receiving placebo did not. The study safety review process then resulted in cessation of further activities on AZD9164. Retrospective analysis showed that two healthy subjects had also had transient falls in FEV1 shortly after inhalation of AZD9164 400 and 2800 μg respectively, although neither reported any related respiratory symptoms or other AEs. Conclusions These results show that transient paradoxical bronchoconstriction can occur in some healthy subjects, in addition to patients with COPD, following inhalation of AZD9164 and that the citrate buffer used in the nebulised formulation cannot have been the only cause of the drop in FEV1 in previous studies. As preclinical data do not provide an explanation, the reasons for this brief post-dose drop in FEV1 remain unclear. However, these results highlight the importance of monitoring lung function immediately post-dose when investigating novel inhaled treatments, even when a rapid onset of effect is not expected. Trial registration Clinicaltrials.gov NCT01016951 and NCT01096563.
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Affiliation(s)
- Carin Jorup
- AstraZeneca R&D Mölndal, Pepparedsleden 1, 431 83 Mölndal, Sweden.
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Mackey HM, Bengtsson T. Sample size and threshold estimation for clinical trials with predictive biomarkers. Contemp Clin Trials 2013; 36:664-72. [PMID: 24064355 DOI: 10.1016/j.cct.2013.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 09/10/2013] [Accepted: 09/16/2013] [Indexed: 02/06/2023]
Abstract
With the increasing availability of newly discovered biomarkers personalized drug development is becoming more commonplace. Unless evidence of the dependence of clinical benefit on biomarker classification is a priori unequivocal, personalized drug development needs to jointly investigate treatments and biomarkers in clinical trials. Motivated by the development of contemporary cancer treatments, we propose targeting three main questions sequentially in order to determine (1) whether a drug is efficacious, (2) whether a biomarker can personalize treatment, and (3) how to define personalization. For time-to-event data satisfying the Cox proportional hazards model, we show that (1) and (2) may not directly involve the variance of an interaction term but of a contrast with smaller variance. An asymptotically exact covariance matrix for the parameter vector in the CPH model is derived to construct sample size formulae and an inference approach for thresholds of continuous biomarkers. The covariance matrix also reveals strategies for greater efficiency in trial design, for example, when the biomarker is binary or does not modulate the effect of treatment in the control arm. We motivate our approach by studying the outcome of a contemporary cancer study.
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Bjermer L, Rosenborg J, Bengtsson T, Lötvall J. Comparison of the bronchodilator and systemic effects of AZD3199, an inhaled ultra-long-acting β₂-adrenoceptor agonist, with formoterol in patients with asthma. Ther Adv Respir Dis 2013; 7:264-71. [PMID: 23907810 DOI: 10.1177/1753465813497527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Pharmacologically mediated bronchodilation is important in the management of asthma, and is primarily achieved with β₂-agonists. Novel compounds should preferably have a longer duration of action and a better systemic side effect profile than established alternatives at comparable peak bronchodilation. This single-dose crossover study was conducted to investigate and compare with formoterol the bronchodilatory and systemic effects, tolerability and safety of AZD3199, a novel ultra-long-acting β₂-agonist (uLABA). METHODS Patients with asthma (n = 37) were randomized to receive AZD3199 (120, 480, 1920 µg), formoterol (9, 36 µg) or placebo inhaled via a Turbuhaler™. Bronchodilation was evaluated by maximum (E(max)) and average 22-26 h (E₂₂₋₂₆) forced expiratory volume in 1 second (FEV1). Serum potassium was evaluated by minimum (E(min)) and 0-4 h average (E(av)) determined from serial measurements. AZD3199 and formoterol were compared on the basis of relative dose potency. Adverse events, clinical laboratory tests and physical examinations were markers for safety and tolerability, with plasma AZD3199 as the indicator of drug exposure. RESULTS All active treatments dose-dependently increased E(max) and AZD3199 (480 and 1920 µg) and formoterol (36 µg) significantly increased E(₂₂₋₂₆) versus placebo. Relative dose potency between AZD3199 and formoterol was 50-fold on the microgram scale with respect to E max and 11-fold with respect to E(₂₂₋₂₆). Small, dose-dependent effects on potassium, heart rate and QTc were seen after administration of AZD3199 compared with placebo. These well-known dose-related class effects of β₂-agonists were mild. Notably, serum potassium suppression was less pronounced after AZD3199 compared with formoterol at similar bronchodilation. Overall, AZD3199 was well tolerated. CONCLUSIONS AZD3199 480 µg and 1920 µg produced 24-hour bronchodilation. At comparable peak bronchodilator effect, AZD3199 was associated with a lower level of systemic side effects than formoterol. AZD3199 was well tolerated, with no safety concerns identified to preclude further investigation. ClinicalTrials.gov study identifier: NCT00736489.
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Affiliation(s)
- Leif Bjermer
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Getingevägen 4, 22185 Lund, Sweden
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Kuna P, Ivanov Y, Trofimov VI, Saito T, Beckman O, Bengtsson T, Jorup C, Maltais F. Efficacy and safety of AZD3199 vs formoterol in COPD: a randomized, double-blind study. Respir Res 2013; 14:64. [PMID: 23731768 PMCID: PMC3691744 DOI: 10.1186/1465-9921-14-64] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 05/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We investigated the efficacy and safety of AZD3199, a novel inhaled ultra-LABA, with the main aim of establishing a dose that would maintain 24-hour bronchodilation in patients with COPD. METHODS Patients (n = 329) were randomized to AZD3199 (200, 400 or 800 μg o.d.), formoterol (9 μg b.i.d.) or placebo via Turbuhaler® in a parallel group study. The primary objective of the study was to compare the clinical efficacy of three doses of AZD3199 inhaled once daily with 9 μg formoterol twice daily and placebo, over a 4-week treatment period in adults with moderate-to-severe COPD. After 4 weeks, peak (0-4 h) and trough (24-26 h) forced expiratory volume in 1 second (FEV1) were assessed as the primary efficacy outcome variables. RESULTS All AZD3199 doses significantly increased mean peak and trough FEV1 versus placebo (106-171 ml and 97-110 ml increases, respectively), but with no clear dose-response; the level of bronchodilation was comparable to or greater than that achieved with formoterol. Forced vital capacity (FVC) at peak bronchodilation also significantly increased with AZD3199 versus placebo (153-204 ml). COPD symptom scores and reliever use were reduced with AZD3199, while FEV1 reversibility was unaltered. Adverse events were mild-to-moderate, with no safety concerns identified. Drug exposure was dose-proportional, but lower than predicted from healthy volunteers. CONCLUSIONS All three doses of AZD3199 produced 24-hour bronchodilation, but with no clear dose-response, suggesting that doses of 200 μg or less may be sufficient to maintain bronchodilation over 24 hours in patients with COPD. No safety concerns were identified. Further studies are required to determine the once-daily AZD3199 dose for COPD. TRIAL REGISTRATION Clinicaltrials.gov, NCT00929708.
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Affiliation(s)
- Piotr Kuna
- Barlicki University Hospital, Medical University of Lodz, Kopcińskiego 22, Lodz, 90-153 Łódź, ul., Poland
| | | | | | - Takefumi Saito
- National Hospital Organization Ibaraki-Higashi National Hospital, Naka-gun, Japan
| | | | | | | | - François Maltais
- Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada
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Fridlyand J, Yeh RF, Mackey H, Bengtsson T, Delmar P, Spaniolo G, Lieberman G. An industry statistician's perspective on PHC drug development. Contemp Clin Trials 2013; 36:624-35. [PMID: 23648396 DOI: 10.1016/j.cct.2013.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 04/11/2013] [Accepted: 04/25/2013] [Indexed: 10/26/2022]
Abstract
In the past decade, the cost of drug development has increased significantly. The estimates vary widely but frequently quoted numbers are staggering-it takes 10-15 years and billions of dollars to bring a drug to patients. To a large extent this is due to many long, expensive and ultimately unsuccessful drug trials. While one approach to combat the low yield on investment could be to continue searching for new blockbusters, an alternative method would lead us to focus on testing new targeted treatments that have a strong underlying scientific rationale and are more likely to provide enhanced clinical benefit in population subsets defined by molecular diagnostics. Development of these new treatments, however, cannot follow the usual established path; new strategies and approaches are required for the co-development of novel therapeutics and the diagnostic. In this paper we will review, from the point of view of industry, the approaches to, and challenges of drug development strategies incorporating predictive biomarkers into clinical programs. We will outline the basic concepts behind co-development with predictive biomarkers and summarize the current regulatory paradigm. We will present guiding principles of personalized health care (PHC) development and review the statistical, strategic, regulatory and operational challenges that statisticians regularly encounter on development programs with a PHC component. Some practical recommendations for team statisticians involved in PHC drug development are included. The majority of the examples and recommendations are drawn from oncology but broader concepts apply across all therapeutic areas.
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Bjermer L, Bengtsson T, Jorup C, Lötvall J. Local and systemic effects of inhaled AZD9164 compared with tiotropium in patients with COPD. Respir Med 2012; 107:84-90. [PMID: 23098686 DOI: 10.1016/j.rmed.2012.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/18/2012] [Accepted: 09/20/2012] [Indexed: 12/15/2022]
Abstract
There is still a need for new agents which improve upon the therapeutic index of tiotropium, the current standard of care for many patients with chronic obstructive pulmonary disease (COPD). We examined in patients with COPD the efficacy of single doses of AZD9164, an M(3)-selective muscarinic antagonist, to identify an appropriate dose-range for future studies. COPD patients (n = 28) inhaled AZD9164 (100, 400 and 1200 μg), tiotropium (18 μg) and placebo at 5 study centre visits (Clinicaltrials.gov identifier NCT00939211). The effects of these test drugs on average (E(av)), peak (E(max)) and trough (E(22-26)) forced expiratory volume in one second (FEV(1)) were assessed, as were systemically-mediated effects and the safety and exposure of single doses of AZD9164. AZD9164 100, 400 and 1200 μg caused increases in FEV(1) to peak effects of 12, 17 and 12% above baseline respectively, following an initial transient and dose-related fall in FEV(1) and associated increase in mild respiratory symptoms such as cough. Bronchodilation was maintained overnight, with minimal FEV(1) decline. AZD9164 400 and 1200 μg produced larger effects than tiotropium on E(22-26) (p < 0.05; both doses) while AZD9164 400 μg also had larger effects on E(max) (p = 0.001) and E(av) (p < 0.05). There were no serious adverse events and statistically significant systemic effects were observed only with AZD9164 1200 μg. AZD9164 may improve upon the therapeutic index of tiotropium, increasing the magnitude and duration of lung function improvements without increasing systemically-mediated adverse events. The initial bronchoconstrictor effect of AZD9164 requires further investigation.
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Affiliation(s)
- Leif Bjermer
- Department of Respiratory Medicine and Allergology, University Hospital, Getingevägen 4, SE-221 85 Lund, Sweden.
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Williams SP, Flores-Mercado JE, Baudy AR, Port RE, Bengtsson T. The power of FDG-PET to detect treatment effects is increased by glucose correction using a Michaelis constant. EJNMMI Res 2012; 2:35. [PMID: 22738240 PMCID: PMC3472222 DOI: 10.1186/2191-219x-2-35] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 06/15/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND We recently showed improved between-subject variability in our [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) experiments using a Michaelis-Menten transport model to calculate the metabolic tumor glucose uptake rate extrapolated to the hypothetical condition of glucose saturation: MRglucmax=Ki*(KM+[glc]), where Ki is the image-derived FDG uptake rate constant, KM is the half-saturation Michaelis constant, and [glc] is the blood glucose concentration. Compared to measurements of Ki alone, or calculations of the scan-time metabolic glucose uptake rate (MRgluc = Ki * [glc]) or the glucose-normalized uptake rate (MRgluc = Ki*[glc]/(100 mg/dL), we suggested that MRglucmax could offer increased statistical power in treatment studies; here, we confirm this in theory and practice. METHODS We compared Ki, MRgluc (both with and without glucose normalization), and MRglucmax as FDG-PET measures of treatment-induced changes in tumor glucose uptake independent of any systemic changes in blood glucose caused either by natural variation or by side effects of drug action. Data from three xenograft models with independent evidence of altered tumor cell glucose uptake were studied and generalized with statistical simulations and mathematical derivations. To obtain representative simulation parameters, we studied the distributions of Ki from FDG-PET scans and blood [glucose] values in 66 cohorts of mice (665 individual mice). Treatment effects were simulated by varying MRglucmax and back-calculating the mean Ki under the Michaelis-Menten model with KM = 130 mg/dL. This was repeated to represent cases of low, average, and high variability in Ki (at a given glucose level) observed among the 66 PET cohorts. RESULTS There was excellent agreement between derivations, simulations, and experiments. Even modestly different (20%) blood glucose levels caused Ki and especially MRgluc to become unreliable through false positive results while MRglucmax remained unbiased. The greatest benefit occurred when Ki measurements (at a given glucose level) had low variability. Even when the power benefit was negligible, the use of MRglucmax carried no statistical penalty. Congruent with theory and simulations, MRglucmax showed in our experiments an average 21% statistical power improvement with respect to MRgluc and 10% with respect to Ki (approximately 20% savings in sample size). The results were robust in the face of imprecise blood glucose measurements and KM values. CONCLUSIONS When evaluating the direct effects of treatment on tumor tissue with FDG-PET, employing a Michaelis-Menten glucose correction factor gives the most statistically powerful results. The well-known alternative 'correction', multiplying Ki by blood glucose (or normalized blood glucose), appears to be counter-productive in this setting and should be avoided.
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Affiliation(s)
- Simon-Peter Williams
- Department of Biomedical Imaging, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Judith E Flores-Mercado
- Department of Biomedical Imaging, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Andreas R Baudy
- Department of Biomedical Imaging, Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Ruediger E Port
- Department of Pharmacokinetics and Pharmacodynamics, Genentech, Inc., South San Francisco, CA, 94080, USA
| | - Thomas Bengtsson
- Department of Biostatistics, Genentech, Inc., South San Francisco, CA, 94080, USA
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Pereira L, Ruiz-Hurtado G, Morel E, Dominguez A, Benitah JP, Bers DM, Lezoualc'h F, Gomez A, Collins TP, Sikkel MB, O' Gara P, Lyon AR, Harding SE, Macleod KT, Wantha S, Alard JE, Doering Y, Drechsler M, Megens RT, Hackeng T, Weber C, Soehnlein O, Dietel B, Cicha I, Altendorf R, Daniel WG, Garlichs CD, Mukherjee U, Ong SB, Davidson SM, Szabadkai G, Yellon DM, Hausenloy DJ, Neary MT, Hall AR, Hirst E, Ong SB, Mohun TJ, Hausenloy DJ, Breckenridge RA, Akhmedov A, Camici GG, Stivala S, Holy EW, Breitenstein A, Lohmann C, Beer JH, Tanner FC, Matter CM, Luescher TF, Hulsmans M, Geeraert B, Arnould T, Tsatsanis C, Holvoet P, Hermida N, Markl A, Hamelet J, Herijgers P, Horman S, Noppe G, Beauloye C, Van Bilsen M, Dessy C, Balligand JL, Del Giorno R, Moreno Velasquez I, Leander K, Frumento P, Vikstrom M, Pirro M, Mannarino MR, Mannarino E, De Faire U, Gigante B, Chaudhry B, Chrystal P, Henderson DJ, Fulcoli FG, Chen L, Martucciello S, Illingworth E, Baldini A, Mavroidis M, Davos C, Psarras S, Varela A, Kostavasili I, Capetanaki Y, Engstrom Klarstrom K, Skoglund C, Kalvegren H, Bengtsson T, Drawnel F, Wachten D, Molkentin JD, Sjaastad I, Liu N, Mikoshiba K, Bootman MD, Roderick HL, Di Gregoli K, Salter R, Johnson JL. Oral abstract presentations. Cardiovasc Res 2012. [DOI: 10.1093/cvr/cvr331] [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: 11/14/2022] Open
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Bengtsson T, Hicks RJ, Peterson A, Port RE. 18F-FDG PET as a surrogate biomarker in non-small cell lung cancer treated with erlotinib: newly identified lesions are more informative than standardized uptake value. J Nucl Med 2012; 53:530-7. [PMID: 22414632 DOI: 10.2967/jnumed.111.092544] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
UNLABELLED This study assesses the predictive value of (18)F-FDG PET for overall survival in lung cancer patients treated with a targeted drug. METHODS (18)F-FDG PET was performed in 125 second- or third-line non-small cell lung cancer (NSCLC) patients with a baseline Eastern Cooperative Oncology Group performance status less than 3 before treatment with erlotinib (150 mg daily) and 2 wk into treatment. The predictive value of (18)F-FDG PET, clinical parameters, and epithelial growth factor receptor (EGFR) mutation status for survival duration was evaluated by fitting accelerated failure time models. RESULTS New lesions on PET at 2 wk, EGFR mutation status, performance status, and baseline tumor burden were independent and significant predictors of overall survival. Reduction of maximum standardized uptake value by at least 35% was predictive of survival only when EGFR mutation status was not accounted for. CONCLUSION (18)F-FDG PET in second- or third-line NSCLC patients at 2 wk after starting treatment with erlotinib carries information about overall survival. Parametric survival modeling enables a quantitative assessment of the predictive value of (18)F-FDG PET in the context of clinical and laboratory information. New-lesion status by (18)F-FDG PET at 2 wk is a potential surrogate biomarker for survival in NSCLC.
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Williams SP, Flores-Mercado JE, Port RE, Bengtsson T. Quantitation of glucose uptake in tumors by dynamic FDG-PET has less glucose bias and lower variability when adjusted for partial saturation of glucose transport. EJNMMI Res 2012; 2:6. [PMID: 22297096 PMCID: PMC3395842 DOI: 10.1186/2191-219x-2-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 02/01/2012] [Indexed: 11/10/2022] Open
Abstract
Background A retrospective analysis of estimates of tumor glucose uptake from 1,192 dynamic 2-deoxy-2-(18F)fluoro-D-glucose-positron-emission tomography [FDG-PET] scans showed strong correlations between blood glucose and both the uptake rate constant [Ki] and the metabolic rate of glucose [MRGluc], hindering the interpretation of PET scans acquired under conditions of altered blood glucose. We sought a method to reduce this glucose bias without increasing the between-subject or test-retest variability and did this by considering that tissue glucose transport is a saturable yet unsaturated process best described as a nonlinear function of glucose levels. Methods Patlak-Gjedde analysis was used to compute Ki from 30-min dynamic PET scans in tumor-bearing mice. MRGluc was calculated by factoring in the blood glucose level and a lumped constant equal to unity. Alternatively, we assumed that glucose consumption is saturable according to Michaelis-Menten kinetics and estimated a hypothetical maximum rate of glucose consumption [MRGlucMAX] by multiplying Ki and (KM + [glucose]), where KM is a half-saturation Michaelis constant for glucose uptake. Results were computed for 112 separate studies of 8 to 12 scans each; test-retest statistics were measured in a suitable subset of 201 mice. Results A KM value of 130 mg/dL was determined from the data based on minimizing the average correlation between blood glucose and the uptake metric. Using MRGlucMAX resulted in the following benefits compared to using MRGluc: (1) the median correlation with blood glucose was practically zero, and yet (2) the test-retest coefficient of variation [COV] was reduced by 13.4%, and (3) the between-animal COVs were reduced by15.5%. In statistically equivalent terms, achieving the same reduction in between-animal COV while using the traditional MRGluc would require a 40% increase in sample size. Conclusions MRGluc appeared to overcorrect tumor FDG data for changing glucose levels. Applying partial saturation correction using MRGlucMAX offered reduced bias, reduced variability, and potentially increased statistical power. We recommend further investigation of MRGlucMAX in quantitative studies of tumor FDG uptake.
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Affiliation(s)
- Simon-Peter Williams
- Department of Biomedical Imaging, Genentech, Inc,, South San Francisco, CA, 94080, USA.
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Kuna P, Rosenborg J, Bengtsson T, Jorup C, Bjermer L. Clinical Pharmacokinetics and Tolerability of AZD3199, a New Inhaled Ultra Long-acting β2-adrenoreceptor Agonist (uLABA) Bronchodilator. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.607] [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: 11/16/2022]
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Bjermer L, Bengtsson T, Jorup C. A Comparison of the Local and Systemic Effects of AZD3199, an Inhaled Ultra-long-acting β2-adrenoceptor Agonist (uLABA), With Formoterol in Patients With Asthma. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.037] [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: 10/14/2022]
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Lönn J, Starkhammar Johansson C, Kälvegren H, Brudin L, Skoglund C, Garvin P, Särndahl E, Ravald N, Richter A, Bengtsson T, Nayeri F. Hepatocyte growth factor in patients with coronary artery disease and its relation to periodontal condition. Results Immunol 2011; 2:7-12. [PMID: 24371561 DOI: 10.1016/j.rinim.2011.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 12/21/2011] [Accepted: 12/22/2011] [Indexed: 12/24/2022]
Abstract
Hepatocyte growth factor (HGF) is an angiogenic, cardioprotective factor important for tissue and vascular repair. High levels of HGF are associated with chronic inflammatory diseases, such as coronary artery disease (CAD) and periodontitis, and are suggested as a marker of the ongoing atherosclerotic event in patients with CAD. Periodontal disease is more prevalent among patients with CAD than among healthy people. Recent studies indicate a reduced biological activity of HGF in different chronic inflammatory conditions. Biologically active HGF has high affinity to heparan sulfate proteoglycan (HSPG) on cell-membrane and extracellular matrix. The aim of the study was to investigate the serum concentration and the biological activity of HGF with ELISA and surface plasmon resonance (SPR), respectively, before and at various time points after percutaneous coronary intervention (PCI) in patients with CAD, and to examine the relationship with periodontal condition. The periodontal status of the CAD patients was examined, and the presence of P. gingivalis in periodontal pockets was analyzed with PCR. The HGF concentration was significantly higher, at all time-points, in patients with CAD compared to the age-matched controls (P< 0.001), but was independent of periodontal status. The HGF concentration and the affinity to HSPG adversely fluctuated over time, and the biological activity increased one month after intervention in patients without periodontitis. We conclude that elevated concentration of HGF but with reduced biological activity might indicate a chronic inflammatory profile in patients with CAD and periodontitis.
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Affiliation(s)
- J Lönn
- Division of Clinical Medicine, School of Health and Medical Sciences, Örebro University, Örebro, Sweden ; PEAS Institute, Linköping, Sweden
| | - C Starkhammar Johansson
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Centre for Oral Rehabilitation, Public Dental Health Care, County Council of Östergötland, Linköping, Sweden
| | - H Kälvegren
- Division of Clinical Pathology and Clinical Genetics, Linköping University, Faculty of Health Sciences, Linköping, Sweden
| | - L Brudin
- Department of Medical and Health Sciences, University Hospital, Linköping, Sweden
| | - C Skoglund
- Department of Medical and Health and Sciences, Division of Drug Research, Faculty of Health Sciences, Linköping University, Linköping, Sweden ; Department of Physics, Chemistry and Biology, Division of Molecular Physics and Nanoscience, Linköping University, Linköping, Sweden
| | - P Garvin
- Division of Community Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - E Särndahl
- Division of Clinical Medicine, School of Health and Medical Sciences, Örebro University, Örebro, Sweden ; Department of Cardiology, Örebro University Hospital, SE-701 85 Örebro, Sweden
| | - N Ravald
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Centre for Oral Rehabilitation, Public Dental Health Care, County Council of Östergötland, Linköping, Sweden
| | - A Richter
- Department of Cardiology, Heart Center, Linköping University Hospital, Linköping, Sweden
| | - T Bengtsson
- Division of Clinical Medicine, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - F Nayeri
- PEAS Institute, Linköping, Sweden ; Department of Molecular and Clinical Medicine, Division of Infectious Diseases, University Hospital, Linköping, Sweden
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Abstract
OBJECTIVE To investigate true adherence with a dry powder inhaler, the Turbuhaler (TBH), in children with asthma. True adherence was calculated by multiplying adherence to treatment with inhaler competence, that is correct use of the inhaler. PATIENTS AND DESIGN In an 18-month study, children aged 5-10 years with asthma received twice daily budesonide via a TBH. Parents and children were trained in the correct use of the inhaler before the study started. For each inhalation, peak inspiratory flow through the TBH (PIF(TBH)) was recorded with an electronic pneumotachograph. The PIF(TBH) recordings were used to calculate true adherence for the first and last 45-day periods in the study by multiplying adherence in using the device (percentage of days with PIF(TBH) recordings) with inhaler competence (correct use of inhaler defined as PIF(TBH) values >40 l/min). MAIN OUTCOME MEASURES True adherence, adherence, inhaler competence and PIF(TBH). RESULTS 115 children were treated. The mean (morning and evening) true adherence during the first 45 days was 81.6% (range 78.1-86.4%) and during the last 45 days 57.4% (44.0-66.9%). Mean adherence was 86.0% and 59.3%, whereas mean inhaler competence was 94.7% and 96.2%, respectively. Thus the decline in true adherence was due to the decline in adherence. The largest decline in true adherence occurred in older children. CONCLUSIONS True adherence with budesonide TBH treatment decreased significantly during the 18-month study due to a decrease in adherence. Inhaler competence with the correct use of the budesonide TBH was high and unchanged over the study period.
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Affiliation(s)
- K Nikander
- Department of Allergy, Helsinki University Hospital, Finland.
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