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Benatar M, Wiendl H, Nowak R, Zheng Y, Macias W. Batoclimab as induction and maintenance therapy in patients with myasthenia gravis: rationale and study design of a phase 3 clinical trial. BMJ Neurol Open 2024; 6:e000536. [PMID: 38268752 PMCID: PMC10806862 DOI: 10.1136/bmjno-2023-000536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/08/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Batoclimab, a fully human monoclonal antibody that inhibits the neonatal fragment crystallisable receptor, has shown promising phase 2 clinical trial results in patients with generalised myasthenia gravis (gMG). Methods and analysis In this phase 3, randomised, quadruple-blind, placebo-controlled study, adults with gMG will be randomised 1:1:1 to induction therapy with batoclimab 680 mg, batoclimab 340 mg, or placebo, administered once weekly (QW) for 12 weeks as a subcutaneous injection. The primary endpoint is the change from baseline to week 12 on the Myasthenia Gravis Activities of Daily Living (MG-ADL) score. Batoclimab-treated patients achieving a ≥2-point improvement from baseline on MG-ADL at week 10 or week 12 will be re-randomised to maintenance treatment with batoclimab 340 mg QW, batoclimab 340 mg every other week (Q2W), or placebo for 12 weeks; batoclimab-treated patients with a <2-point improvement at week 10 and week 12 will be switched to placebo for the maintenance period and discontinued thereafter. Placebo-treated patients from the induction period will be re-randomised to batoclimab 340 mg QW or Q2W in the maintenance period. All patients who complete the maintenance period and achieve a ≥2-point improvement from baseline in MG-ADL during ≥1 of the final 2 visits of the induction and/or maintenance periods will continue their current batoclimab dose (or switch to batoclimab 340 mg QW for those on placebo) for a 52-week long-term extension (LTE-1). Patients who complete LTE-1 may enter a second, optional 52-week LTE (LTE-2). Ethics and dissemination This trial is being conducted in accordance with the International Council for Harmonisation Guideline for Good Clinical Practice, the Declaration of Helsinki, and each site's Institutional Review Board/Independent Ethics Committee. All patients must provide written informed consent. Results from this study will be published in peer-reviewed journals and presented at national and global conferences. Trial registration number NCT05403541.
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Affiliation(s)
- Michael Benatar
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Nordrhein-Westfalen, Germany
| | - Richard Nowak
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Yan Zheng
- Immunovant, Inc, New York, New York, USA
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Peterfy C, DiCarlo J, Emery P, Genovese MC, Keystone EC, Taylor PC, Schlichting DE, Beattie SD, Luchi M, Macias W. MRI and Dose Selection in a Phase II Trial of Baricitinib with Conventional Synthetic Disease-modifying Antirheumatic Drugs in Rheumatoid Arthritis. J Rheumatol 2019; 46:887-895. [PMID: 30647190 DOI: 10.3899/jrheum.171469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) was used in a phase IIb study of baricitinib in patients with RA to support dose selection for the phase III program. METHODS Three hundred one patients with active RA who were taking stable methotrexate were randomized 2:1:1:1:1 to placebo or once-daily baricitinib (1, 2, 4, or 8 mg) for up to 24 weeks. One hundred fifty-four patients with definitive radiographic erosion had MRI of the hand/wrist at baseline and at weeks 12 and 24. Two expert radiologists, blinded to treatment and visit order, scored images for synovitis, osteitis, bone erosion, and cartilage loss. Combined inflammation (osteitis + 3× synovitis score) and total joint damage (erosion + 2.5× cartilage loss score) scores were calculated. Treatment groups were compared using ANCOVA adjusting for baseline scores. RESULTS Mean changes from baseline to Week 12 for synovitis were -0.10, -1.50, and -1.60 for patients treated with placebo, baricitinib 4 mg, and baricitinib 8 mg, respectively (p = 0.003 vs placebo for baricitinib 4 and 8 mg). Mean changes for osteitis were 0.00, -3.20, and -2.10 (p = 0.001 vs placebo for baricitinib 4 mg and p = 0.037 for 8 mg), respectively. Mean changes for bone erosion were 0.90, 0.10, and 0.40 (p = 0.089 for 4 mg and p = 0.275 for 8 mg), respectively, in these treatment groups. CONCLUSION MRI findings in this subgroup of patients suggest suppression of synovitis, osteitis, and combined inflammation by baricitinib 4 and 8 mg. This corroborates previously demonstrated clinical efficacy of baricitinib and increases confidence that baricitinib 4 mg could reduce the radiographic progression in phase III studies. [Clinical trial registration number (www.ClinicalTrials.gov): NCT01185353].
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Affiliation(s)
- Charles Peterfy
- From Spire Sciences Inc., Boca Raton, Florida; Division of Immunology and Rheumatology, Stanford University, Stanford, California; Eli Lilly and Co., Indianapolis, Indiana; Incyte Corporation, Wilmington, Delaware, USA; The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; Botnar Research Centre, University of Oxford, Oxford, UK; Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada. .,C. Peterfy, MD, PhD, Spire Sciences Inc.; J. DiCarlo, PhD, Spire Sciences Inc.; P. Emery, MD, FRCP, The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University; E.C. Keystone, MD, FRCP, Department of Rheumatology, University of Toronto; P.C. Taylor, MA, PhD, FRCP, Botnar Research Centre, University of Oxford; D.E. Schlichting, RN, PhD, Eli Lilly and Co.; S.D. Beattie, PhD, Eli Lilly and Co.; M. Luchi, MD, FACR, MBA, Incyte Corp.; W. Macias, MD, PhD, Eli Lilly and Co.
| | - Julie DiCarlo
- From Spire Sciences Inc., Boca Raton, Florida; Division of Immunology and Rheumatology, Stanford University, Stanford, California; Eli Lilly and Co., Indianapolis, Indiana; Incyte Corporation, Wilmington, Delaware, USA; The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; Botnar Research Centre, University of Oxford, Oxford, UK; Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada.,C. Peterfy, MD, PhD, Spire Sciences Inc.; J. DiCarlo, PhD, Spire Sciences Inc.; P. Emery, MD, FRCP, The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University; E.C. Keystone, MD, FRCP, Department of Rheumatology, University of Toronto; P.C. Taylor, MA, PhD, FRCP, Botnar Research Centre, University of Oxford; D.E. Schlichting, RN, PhD, Eli Lilly and Co.; S.D. Beattie, PhD, Eli Lilly and Co.; M. Luchi, MD, FACR, MBA, Incyte Corp.; W. Macias, MD, PhD, Eli Lilly and Co
| | - Paul Emery
- From Spire Sciences Inc., Boca Raton, Florida; Division of Immunology and Rheumatology, Stanford University, Stanford, California; Eli Lilly and Co., Indianapolis, Indiana; Incyte Corporation, Wilmington, Delaware, USA; The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; Botnar Research Centre, University of Oxford, Oxford, UK; Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada.,C. Peterfy, MD, PhD, Spire Sciences Inc.; J. DiCarlo, PhD, Spire Sciences Inc.; P. Emery, MD, FRCP, The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University; E.C. Keystone, MD, FRCP, Department of Rheumatology, University of Toronto; P.C. Taylor, MA, PhD, FRCP, Botnar Research Centre, University of Oxford; D.E. Schlichting, RN, PhD, Eli Lilly and Co.; S.D. Beattie, PhD, Eli Lilly and Co.; M. Luchi, MD, FACR, MBA, Incyte Corp.; W. Macias, MD, PhD, Eli Lilly and Co
| | - Mark C Genovese
- From Spire Sciences Inc., Boca Raton, Florida; Division of Immunology and Rheumatology, Stanford University, Stanford, California; Eli Lilly and Co., Indianapolis, Indiana; Incyte Corporation, Wilmington, Delaware, USA; The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; Botnar Research Centre, University of Oxford, Oxford, UK; Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada.,C. Peterfy, MD, PhD, Spire Sciences Inc.; J. DiCarlo, PhD, Spire Sciences Inc.; P. Emery, MD, FRCP, The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University; E.C. Keystone, MD, FRCP, Department of Rheumatology, University of Toronto; P.C. Taylor, MA, PhD, FRCP, Botnar Research Centre, University of Oxford; D.E. Schlichting, RN, PhD, Eli Lilly and Co.; S.D. Beattie, PhD, Eli Lilly and Co.; M. Luchi, MD, FACR, MBA, Incyte Corp.; W. Macias, MD, PhD, Eli Lilly and Co
| | - Edward C Keystone
- From Spire Sciences Inc., Boca Raton, Florida; Division of Immunology and Rheumatology, Stanford University, Stanford, California; Eli Lilly and Co., Indianapolis, Indiana; Incyte Corporation, Wilmington, Delaware, USA; The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; Botnar Research Centre, University of Oxford, Oxford, UK; Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada.,C. Peterfy, MD, PhD, Spire Sciences Inc.; J. DiCarlo, PhD, Spire Sciences Inc.; P. Emery, MD, FRCP, The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University; E.C. Keystone, MD, FRCP, Department of Rheumatology, University of Toronto; P.C. Taylor, MA, PhD, FRCP, Botnar Research Centre, University of Oxford; D.E. Schlichting, RN, PhD, Eli Lilly and Co.; S.D. Beattie, PhD, Eli Lilly and Co.; M. Luchi, MD, FACR, MBA, Incyte Corp.; W. Macias, MD, PhD, Eli Lilly and Co
| | - Peter C Taylor
- From Spire Sciences Inc., Boca Raton, Florida; Division of Immunology and Rheumatology, Stanford University, Stanford, California; Eli Lilly and Co., Indianapolis, Indiana; Incyte Corporation, Wilmington, Delaware, USA; The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; Botnar Research Centre, University of Oxford, Oxford, UK; Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada.,C. Peterfy, MD, PhD, Spire Sciences Inc.; J. DiCarlo, PhD, Spire Sciences Inc.; P. Emery, MD, FRCP, The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University; E.C. Keystone, MD, FRCP, Department of Rheumatology, University of Toronto; P.C. Taylor, MA, PhD, FRCP, Botnar Research Centre, University of Oxford; D.E. Schlichting, RN, PhD, Eli Lilly and Co.; S.D. Beattie, PhD, Eli Lilly and Co.; M. Luchi, MD, FACR, MBA, Incyte Corp.; W. Macias, MD, PhD, Eli Lilly and Co
| | - Doug E Schlichting
- From Spire Sciences Inc., Boca Raton, Florida; Division of Immunology and Rheumatology, Stanford University, Stanford, California; Eli Lilly and Co., Indianapolis, Indiana; Incyte Corporation, Wilmington, Delaware, USA; The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; Botnar Research Centre, University of Oxford, Oxford, UK; Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada.,C. Peterfy, MD, PhD, Spire Sciences Inc.; J. DiCarlo, PhD, Spire Sciences Inc.; P. Emery, MD, FRCP, The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University; E.C. Keystone, MD, FRCP, Department of Rheumatology, University of Toronto; P.C. Taylor, MA, PhD, FRCP, Botnar Research Centre, University of Oxford; D.E. Schlichting, RN, PhD, Eli Lilly and Co.; S.D. Beattie, PhD, Eli Lilly and Co.; M. Luchi, MD, FACR, MBA, Incyte Corp.; W. Macias, MD, PhD, Eli Lilly and Co
| | - Scott D Beattie
- From Spire Sciences Inc., Boca Raton, Florida; Division of Immunology and Rheumatology, Stanford University, Stanford, California; Eli Lilly and Co., Indianapolis, Indiana; Incyte Corporation, Wilmington, Delaware, USA; The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; Botnar Research Centre, University of Oxford, Oxford, UK; Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada.,C. Peterfy, MD, PhD, Spire Sciences Inc.; J. DiCarlo, PhD, Spire Sciences Inc.; P. Emery, MD, FRCP, The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University; E.C. Keystone, MD, FRCP, Department of Rheumatology, University of Toronto; P.C. Taylor, MA, PhD, FRCP, Botnar Research Centre, University of Oxford; D.E. Schlichting, RN, PhD, Eli Lilly and Co.; S.D. Beattie, PhD, Eli Lilly and Co.; M. Luchi, MD, FACR, MBA, Incyte Corp.; W. Macias, MD, PhD, Eli Lilly and Co
| | - Monica Luchi
- From Spire Sciences Inc., Boca Raton, Florida; Division of Immunology and Rheumatology, Stanford University, Stanford, California; Eli Lilly and Co., Indianapolis, Indiana; Incyte Corporation, Wilmington, Delaware, USA; The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; Botnar Research Centre, University of Oxford, Oxford, UK; Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada.,C. Peterfy, MD, PhD, Spire Sciences Inc.; J. DiCarlo, PhD, Spire Sciences Inc.; P. Emery, MD, FRCP, The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University; E.C. Keystone, MD, FRCP, Department of Rheumatology, University of Toronto; P.C. Taylor, MA, PhD, FRCP, Botnar Research Centre, University of Oxford; D.E. Schlichting, RN, PhD, Eli Lilly and Co.; S.D. Beattie, PhD, Eli Lilly and Co.; M. Luchi, MD, FACR, MBA, Incyte Corp.; W. Macias, MD, PhD, Eli Lilly and Co
| | - William Macias
- From Spire Sciences Inc., Boca Raton, Florida; Division of Immunology and Rheumatology, Stanford University, Stanford, California; Eli Lilly and Co., Indianapolis, Indiana; Incyte Corporation, Wilmington, Delaware, USA; The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; Botnar Research Centre, University of Oxford, Oxford, UK; Department of Rheumatology, University of Toronto, Toronto, Ontario, Canada.,C. Peterfy, MD, PhD, Spire Sciences Inc.; J. DiCarlo, PhD, Spire Sciences Inc.; P. Emery, MD, FRCP, The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University; E.C. Keystone, MD, FRCP, Department of Rheumatology, University of Toronto; P.C. Taylor, MA, PhD, FRCP, Botnar Research Centre, University of Oxford; D.E. Schlichting, RN, PhD, Eli Lilly and Co.; S.D. Beattie, PhD, Eli Lilly and Co.; M. Luchi, MD, FACR, MBA, Incyte Corp.; W. Macias, MD, PhD, Eli Lilly and Co
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Takeuchi T, Genovese MC, Haraoui B, Li Z, Xie L, Klar R, Pinto-Correia A, Otawa S, Lopez-Romero P, de la Torre I, Macias W, Rooney TP, Smolen JS. Dose reduction of baricitinib in patients with rheumatoid arthritis achieving sustained disease control: results of a prospective study. Ann Rheum Dis 2018; 78:171-178. [PMID: 30194275 PMCID: PMC6352419 DOI: 10.1136/annrheumdis-2018-213271] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 07/25/2018] [Accepted: 08/10/2018] [Indexed: 12/22/2022]
Abstract
Objectives This study investigated the effects of dose step-down in patients with rheumatoid arthritis (RA) who achieved sustained disease control with baricitinib 4 mg once a day. Methods Patients who completed a baricitinib phase 3 study could enter a long-term extension (LTE). In the LTE, patients who received baricitinib 4 mg for ≥15 months and maintained CDAI low disease activity (LDA) or remission (REM) were blindly randomised to continue 4 mg or taper to 2 mg. Patients could rescue (to 4 mg) if needed. Efficacy and safety were assessed through 48 weeks. Results Patients in both groups maintained LDA (80% 4 mg; 67% 2 mg) or REM (40% 4 mg; 33% 2 mg) over 48 weeks. However, dose reduction resulted in small, statistically significant increases in disease activity at 12, 24 and 48 weeks. Dose reduction also produced earlier and more frequent relapse (loss of step-down criteria) over 48 weeks compared with 4 mg maintenance (23% 4 mg vs 37% 2 mg, p=0.001). Rescue rates were 10% for baricitinib 4 mg and 18% for baricitinib 2 mg. Dose reduction was associated with a numerically lower rate of non-serious infections (30.6 for baricitinib 4 mg vs 24.9 for 2 mg). Rates of serious adverse events and adverse events leading to discontinuation were similar across groups. Conclusions In a large randomised, blinded phase 3 study, maintenance of RA control following induction of sustained LDA/REM with baricitinib 4 mg was greater with continued 4 mg than after taper to 2 mg. Nonetheless, most patients tapered to 2 mg could maintain LDA/REM or recapture with return to 4 mg if needed.
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Affiliation(s)
- Tsutomu Takeuchi
- Division of Rheumatology, Keio University School of Medicine, Tokyo, Japan
| | - Mark C Genovese
- Rheumatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Boulos Haraoui
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Zhanguo Li
- Peking University People's Hospital, Beijing, China
| | - Li Xie
- Eli Lilly & Company, Indianapolis, Indiana, USA
| | | | | | - Susan Otawa
- Eli Lilly & Company, Indianapolis, Indiana, USA
| | | | | | | | | | - Josef S Smolen
- Division of Rheumatology, Department of Internal Medicine 3, Medical University of Vienna, Vienna, Austria
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Ronco C, Levin A, Warnock D, Mehta R, Kellum J, Shah S, Molitoris B, Bagga A, Bakkaloglu A, Bonventre JV, Burdmann EA, Chen Y, Devarajan P, D'Intini V, Dobb G, Durbin CG, Eckardt KU, Guerin C, Herget-Rosenthal S, Hoste E, Joannidis M, Kellum JA, Kirpalani A, Lassnigg A, Le Gall JR, Levin A, Lombardi R, Macias W, Manthous C, Mehta RL, Molitoris BA, Ronco C, Schetz M, Schortgen F, Shah SV, Tan PSK, Wang H, Warnock DG, Webb S. Improving Outcomes from Acute Kidney Injury (AKI): Report on an Initiative. Int J Artif Organs 2018. [DOI: 10.1177/039139880703000503] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Acute Kidney Injury (AKI) is a complex disorder for which currently there is no accepted definition. We describe an initiative to develop uniform standards for defining and classifying AKI and establish a forum for multidisciplinary interaction to improve care for patients with, or at risk for AKI. Members representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI participated in a 2-day conference in Amsterdam in September 2005 to draft consensus recommendations for diagnosing and staging AKI. This report describes the proposed diagnostic and staging criteria for AKI and the formation of a multidisciplinary collaborative network (Acute Kidney Injury Network (AKIN) focused on improving outcomes from AKI.
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Affiliation(s)
- C. Ronco
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza - Italy
| | - A. Levin
- Department of Medicine, University of British Columbia, St Pauls Hospital, Vancouver - Canada
| | - D.G. Warnock
- Department of Medicine, University of Alabama, Birmingham, AL - USA
| | - R.L. Mehta
- Department of Medicine, University of California San Diego Medical Center, San Diego, CA - USA
| | - J.A. Kellum
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA - USA
| | - S. Shah
- Division of Nephrology, UAMS College of Medicine, Little Rock, AR - USA
| | - B.A. Molitoris
- Department of Medicine, Indiana University, Indianapolis, IN - USA
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Zhang X, Chua L, Ernest C, Macias W, Rooney T, Tham LS. Dose/Exposure-Response Modeling to Support Dosing Recommendation for Phase III Development of Baricitinib in Patients with Rheumatoid Arthritis. CPT Pharmacometrics Syst Pharmacol 2017; 6:804-813. [PMID: 28891251 PMCID: PMC5744177 DOI: 10.1002/psp4.12251] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 01/05/2023]
Abstract
Baricitinib is an oral inhibitor of Janus kinases (JAKs), selective for JAK1 and 2. It demonstrated dose‐dependent efficacy in patients with moderate‐to‐severe rheumatoid arthritis (RA) in a phase IIb study up to 24 weeks. Population pharmacokinetic/pharmacodynamic (PopPK/PD) models were developed to characterize concentration‐time profiles and dose/exposure‐response (D/E‐R) relationships for the key efficacy (proportion of patients achieving American College of Rheumatology 20%, 50%, or 70% response rate) and safety endpoints (incidence of anemia) for the phase IIb study. The modeling suggested that 4 mg q.d. was likely to offer the optimum risk/benefit balance, whereas 2 mg q.d. had the potential for adequate efficacy. In addition, at the same total daily dose, a twice‐daily regimen is not expected to provide an advantage over q.d. dosing for the efficacy or safety endpoints. The model‐based simulations formed the rationale for key aspects of dosing, such as dose levels and dosing frequency for phase III development.
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Affiliation(s)
- Xin Zhang
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Laiyi Chua
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | | | - Lai San Tham
- Eli Lilly and Company, Indianapolis, Indiana, USA
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Fleischmann R, Schiff M, van der Heijde D, Ramos-Remus C, Spindler A, Stanislav M, Zerbini CAF, Gurbuz S, Dickson C, de Bono S, Schlichting D, Beattie S, Kuo WL, Rooney T, Macias W, Takeuchi T. Baricitinib, Methotrexate, or Combination in Patients With Rheumatoid Arthritis and No or Limited Prior Disease-Modifying Antirheumatic Drug Treatment. Arthritis Rheumatol 2017; 69:506-517. [PMID: 27723271 PMCID: PMC5347954 DOI: 10.1002/art.39953] [Citation(s) in RCA: 272] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/05/2016] [Indexed: 12/14/2022]
Abstract
Objective We undertook this phase III study to evaluate baricitinib, an orally administered JAK‐1/JAK‐2 inhibitor, as monotherapy or combined with methotrexate (MTX) compared to MTX monotherapy in patients with active rheumatoid arthritis (RA) who had received no or minimal conventional synthetic disease‐modifying antirheumatic drugs (DMARDs) and who were naive to biologic DMARDs. Methods A total of 588 patients were randomized 4:3:4 to receive MTX monotherapy (once weekly), baricitinib monotherapy (4 mg once daily), or the combination of baricitinib and MTX for 52 weeks. The primary end point assessment was a noninferiority comparison of baricitinib monotherapy to MTX monotherapy based on the proportion of patients meeting the American College of Rheumatology 20% improvement criteria (achieving an ACR20 response) at week 24. Results The study met its primary objective. Moreover, baricitinib monotherapy was found to be superior to MTX monotherapy at week 24, with a higher ACR20 response rate (77% versus 62%; P ≤ 0.01). Similar results were observed for combination therapy. Compared to MTX monotherapy, significant improvements in disease activity and physical function were observed for both baricitinib groups as early as week 1. Radiographic progression was reduced in both baricitinib groups compared to MTX monotherapy; the difference was statistically significant for baricitinib plus MTX. The rates of serious adverse events (AEs) were similar across treatment groups, while rates of some treatment‐emergent AEs, including infections, were increased with baricitinib plus MTX. Three deaths were reported, all occurring in the MTX monotherapy group. Malignancies, including nonmelanoma skin cancer, were reported in 1 patient receiving MTX monotherapy, 1 receiving baricitinib monotherapy, and 4 receiving baricitinib plus MTX. Conclusion Baricitinib alone or in combination with MTX demonstrated superior efficacy with acceptable safety compared to MTX monotherapy as initial therapy for patients with active RA.
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Affiliation(s)
| | | | - Désirée van der Heijde
- Leiden University Medical Center, Leiden, The Netherlands, and Imaging Rheumatology BV, Meerssen, The Netherlands
| | - Cesar Ramos-Remus
- Unidad de Investigacion en Enfermedades Cronico-Degenerativas, Guadalajara, Mexico
| | | | - Marina Stanislav
- Scientific Research Institute of Rheumatology, Russian Academy of Medical Sciences, Moscow, Russia
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Tanaka Y, Ishii T, Cai Z, Schlichting D, Rooney T, Macias W. Efficacy and safety of baricitinib in Japanese patients with active rheumatoid arthritis: A 52-week, randomized, single-blind, extension study. Mod Rheumatol 2017; 28:20-29. [DOI: 10.1080/14397595.2017.1307899] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Yoshiya Tanaka
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Taeko Ishii
- Medicines Development Unit Japan, Eli Lilly Japan K.K, Kobe, Japan
| | - Zhihong Cai
- Medicines Development Unit Japan, Eli Lilly Japan K.K, Kobe, Japan
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Papp K, Menter M, Raman M, Disch D, Schlichting D, Gaich C, Macias W, Zhang X, Janes J. A randomized phase 2b trial of baricitinib, an oral Janus kinase (
JAK
) 1/JAK2 inhibitor, in patients with moderate‐to‐severe psoriasis. Br J Dermatol 2016; 174:1266-76. [DOI: 10.1111/bjd.14403] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2016] [Indexed: 01/01/2023]
Affiliation(s)
- K.A. Papp
- K.A. Papp Clinical Research and Probity Medical Research 135 Union Street East Waterloo ON N2J 1C4 Canada
| | - M.A. Menter
- Baylor University Medical Center Dallas TX U.S.A
| | - M. Raman
- Centre for Dermatology and Probity Medical Research Richmond Hill ON Canada
| | - D. Disch
- Eli Lilly and Company Indianapolis IN U.S.A
| | | | - C. Gaich
- Eli Lilly and Company Indianapolis IN U.S.A
| | - W. Macias
- Eli Lilly and Company Indianapolis IN U.S.A
| | - X. Zhang
- Eli Lilly and Company Indianapolis IN U.S.A
| | - J.M. Janes
- Eli Lilly and Company Indianapolis IN U.S.A
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Tanaka Y, Emoto K, Cai Z, Aoki T, Schlichting D, Rooney T, Macias W. Efficacy and Safety of Baricitinib in Japanese Patients with Active Rheumatoid Arthritis Receiving Background Methotrexate Therapy: A 12-week, Double-blind, Randomized Placebo-controlled Study. J Rheumatol 2016; 43:504-11. [PMID: 26834213 DOI: 10.3899/jrheum.150613] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate efficacy and safety, baricitinib [Janus kinase (JAK) 1/JAK2 inhibitor] was compared with placebo in Japanese patients with active rheumatoid arthritis (RA) despite background treatment with methotrexate (MTX). METHODS This was a phase IIB, double-blind, randomized, placebo-controlled study (clinicaltrials.gov: NCT01469013). Patients had moderate to severe active adult-onset RA despite stable treatment with MTX. Patients (n = 145) were randomized in a 2:1:1:1:1 ratio to placebo or 1 mg, 2 mg, 4 mg, or 8 mg oral baricitinib daily for 12 weeks. The primary analysis compared the combined 4/8-mg dose groups with placebo for the American College of Rheumatology (ACR) 20 response rate at 12 weeks. Other outcomes included additional measures of disease activity, physical function, laboratory abnormalities, and adverse events. RESULTS A significantly higher proportion of patients in the combined 4/8-mg baricitinib group (37/48, 77%) compared with the placebo group (15/49, 31%) had at least an ACR20 response after 12 weeks of treatment (p < 0.001). Significant improvements in disease activity, remission, and physical function were observed as early as Week 2 of treatment with baricitinib, particularly with daily doses of ≥ 4 mg. Only 1 patient receiving baricitinib discontinued because of an adverse event. Adverse event rates with baricitinib doses ≤ 4 mg daily were similar to placebo, but there was a higher incidence of adverse events and laboratory abnormalities in the 8-mg group. CONCLUSION In this phase II study, baricitinib was well tolerated and rapidly improved the signs, symptoms, and physical function of Japanese patients with active RA, supporting continued development of baricitinib (clinicaltrials.gov NCT01469013).
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Affiliation(s)
- Yoshiya Tanaka
- From the First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Eli Lilly and Co., Tokyo; Eli Lilly Japan K.K., Kobe, Japan; Eli Lilly and Co., Indianapolis, Indiana, USA.Sponsored by Eli Lilly Japan K.K. and Eli Lilly and Co., manufacturer/licensee of baricitinib. Eli Lilly Japan K.K. and Eli Lilly and Co. were involved in the study design, data collection, data analysis, and preparation of the manuscript. Medical writing assistance was provided by Janelle Keys, PhD, CMPP, and Rebecca Lew, PhD, CMPP, of ProScribe, part of the Envision Pharma Group, and was funded by Eli Lilly Japan K.K. ProScribe's services complied with international guidelines for Good Publication Practice (GPP2). ZC and TA are employees of Eli Lilly Japan K.K. KE, DS, TR, and WM are employees of Eli Lilly and Co. and KE owns stock in the company.Y. Tanaka, MD, PhD, Professor, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health; K. Emoto, MD, PhD, Medical Advisor, Eli Lilly and Co.; Z. Cai, PhD, Senior Associate, Eli Lilly Japan K.K.; T. Aoki, PhD, Senior Associate, Eli Lilly Japan K.K.; D. Schlichting, RN, MS, Principal Research Scientist, Eli Lilly and Co.; T. Rooney, MD, Medical Director, Eli Lilly and Co.; W. Macias, MD, PhD, Distinguished Medical Fellow, Eli Lilly and Co
| | - Kahaku Emoto
- From the First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Eli Lilly and Co., Tokyo; Eli Lilly Japan K.K., Kobe, Japan; Eli Lilly and Co., Indianapolis, Indiana, USA.Sponsored by Eli Lilly Japan K.K. and Eli Lilly and Co., manufacturer/licensee of baricitinib. Eli Lilly Japan K.K. and Eli Lilly and Co. were involved in the study design, data collection, data analysis, and preparation of the manuscript. Medical writing assistance was provided by Janelle Keys, PhD, CMPP, and Rebecca Lew, PhD, CMPP, of ProScribe, part of the Envision Pharma Group, and was funded by Eli Lilly Japan K.K. ProScribe's services complied with international guidelines for Good Publication Practice (GPP2). ZC and TA are employees of Eli Lilly Japan K.K. KE, DS, TR, and WM are employees of Eli Lilly and Co. and KE owns stock in the company.Y. Tanaka, MD, PhD, Professor, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health; K. Emoto, MD, PhD, Medical Advisor, Eli Lilly and Co.; Z. Cai, PhD, Senior Associate, Eli Lilly Japan K.K.; T. Aoki, PhD, Senior Associate, Eli Lilly Japan K.K.; D. Schlichting, RN, MS, Principal Research Scientist, Eli Lilly and Co.; T. Rooney, MD, Medical Director, Eli Lilly and Co.; W. Macias, MD, PhD, Distinguished Medical Fellow, Eli Lilly and Co.
| | - Zhihong Cai
- From the First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Eli Lilly and Co., Tokyo; Eli Lilly Japan K.K., Kobe, Japan; Eli Lilly and Co., Indianapolis, Indiana, USA.Sponsored by Eli Lilly Japan K.K. and Eli Lilly and Co., manufacturer/licensee of baricitinib. Eli Lilly Japan K.K. and Eli Lilly and Co. were involved in the study design, data collection, data analysis, and preparation of the manuscript. Medical writing assistance was provided by Janelle Keys, PhD, CMPP, and Rebecca Lew, PhD, CMPP, of ProScribe, part of the Envision Pharma Group, and was funded by Eli Lilly Japan K.K. ProScribe's services complied with international guidelines for Good Publication Practice (GPP2). ZC and TA are employees of Eli Lilly Japan K.K. KE, DS, TR, and WM are employees of Eli Lilly and Co. and KE owns stock in the company.Y. Tanaka, MD, PhD, Professor, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health; K. Emoto, MD, PhD, Medical Advisor, Eli Lilly and Co.; Z. Cai, PhD, Senior Associate, Eli Lilly Japan K.K.; T. Aoki, PhD, Senior Associate, Eli Lilly Japan K.K.; D. Schlichting, RN, MS, Principal Research Scientist, Eli Lilly and Co.; T. Rooney, MD, Medical Director, Eli Lilly and Co.; W. Macias, MD, PhD, Distinguished Medical Fellow, Eli Lilly and Co
| | - Takehiro Aoki
- From the First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Eli Lilly and Co., Tokyo; Eli Lilly Japan K.K., Kobe, Japan; Eli Lilly and Co., Indianapolis, Indiana, USA.Sponsored by Eli Lilly Japan K.K. and Eli Lilly and Co., manufacturer/licensee of baricitinib. Eli Lilly Japan K.K. and Eli Lilly and Co. were involved in the study design, data collection, data analysis, and preparation of the manuscript. Medical writing assistance was provided by Janelle Keys, PhD, CMPP, and Rebecca Lew, PhD, CMPP, of ProScribe, part of the Envision Pharma Group, and was funded by Eli Lilly Japan K.K. ProScribe's services complied with international guidelines for Good Publication Practice (GPP2). ZC and TA are employees of Eli Lilly Japan K.K. KE, DS, TR, and WM are employees of Eli Lilly and Co. and KE owns stock in the company.Y. Tanaka, MD, PhD, Professor, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health; K. Emoto, MD, PhD, Medical Advisor, Eli Lilly and Co.; Z. Cai, PhD, Senior Associate, Eli Lilly Japan K.K.; T. Aoki, PhD, Senior Associate, Eli Lilly Japan K.K.; D. Schlichting, RN, MS, Principal Research Scientist, Eli Lilly and Co.; T. Rooney, MD, Medical Director, Eli Lilly and Co.; W. Macias, MD, PhD, Distinguished Medical Fellow, Eli Lilly and Co
| | - Douglas Schlichting
- From the First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Eli Lilly and Co., Tokyo; Eli Lilly Japan K.K., Kobe, Japan; Eli Lilly and Co., Indianapolis, Indiana, USA.Sponsored by Eli Lilly Japan K.K. and Eli Lilly and Co., manufacturer/licensee of baricitinib. Eli Lilly Japan K.K. and Eli Lilly and Co. were involved in the study design, data collection, data analysis, and preparation of the manuscript. Medical writing assistance was provided by Janelle Keys, PhD, CMPP, and Rebecca Lew, PhD, CMPP, of ProScribe, part of the Envision Pharma Group, and was funded by Eli Lilly Japan K.K. ProScribe's services complied with international guidelines for Good Publication Practice (GPP2). ZC and TA are employees of Eli Lilly Japan K.K. KE, DS, TR, and WM are employees of Eli Lilly and Co. and KE owns stock in the company.Y. Tanaka, MD, PhD, Professor, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health; K. Emoto, MD, PhD, Medical Advisor, Eli Lilly and Co.; Z. Cai, PhD, Senior Associate, Eli Lilly Japan K.K.; T. Aoki, PhD, Senior Associate, Eli Lilly Japan K.K.; D. Schlichting, RN, MS, Principal Research Scientist, Eli Lilly and Co.; T. Rooney, MD, Medical Director, Eli Lilly and Co.; W. Macias, MD, PhD, Distinguished Medical Fellow, Eli Lilly and Co
| | - Terence Rooney
- From the First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Eli Lilly and Co., Tokyo; Eli Lilly Japan K.K., Kobe, Japan; Eli Lilly and Co., Indianapolis, Indiana, USA.Sponsored by Eli Lilly Japan K.K. and Eli Lilly and Co., manufacturer/licensee of baricitinib. Eli Lilly Japan K.K. and Eli Lilly and Co. were involved in the study design, data collection, data analysis, and preparation of the manuscript. Medical writing assistance was provided by Janelle Keys, PhD, CMPP, and Rebecca Lew, PhD, CMPP, of ProScribe, part of the Envision Pharma Group, and was funded by Eli Lilly Japan K.K. ProScribe's services complied with international guidelines for Good Publication Practice (GPP2). ZC and TA are employees of Eli Lilly Japan K.K. KE, DS, TR, and WM are employees of Eli Lilly and Co. and KE owns stock in the company.Y. Tanaka, MD, PhD, Professor, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health; K. Emoto, MD, PhD, Medical Advisor, Eli Lilly and Co.; Z. Cai, PhD, Senior Associate, Eli Lilly Japan K.K.; T. Aoki, PhD, Senior Associate, Eli Lilly Japan K.K.; D. Schlichting, RN, MS, Principal Research Scientist, Eli Lilly and Co.; T. Rooney, MD, Medical Director, Eli Lilly and Co.; W. Macias, MD, PhD, Distinguished Medical Fellow, Eli Lilly and Co
| | - William Macias
- From the First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Eli Lilly and Co., Tokyo; Eli Lilly Japan K.K., Kobe, Japan; Eli Lilly and Co., Indianapolis, Indiana, USA.Sponsored by Eli Lilly Japan K.K. and Eli Lilly and Co., manufacturer/licensee of baricitinib. Eli Lilly Japan K.K. and Eli Lilly and Co. were involved in the study design, data collection, data analysis, and preparation of the manuscript. Medical writing assistance was provided by Janelle Keys, PhD, CMPP, and Rebecca Lew, PhD, CMPP, of ProScribe, part of the Envision Pharma Group, and was funded by Eli Lilly Japan K.K. ProScribe's services complied with international guidelines for Good Publication Practice (GPP2). ZC and TA are employees of Eli Lilly Japan K.K. KE, DS, TR, and WM are employees of Eli Lilly and Co. and KE owns stock in the company.Y. Tanaka, MD, PhD, Professor, First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health; K. Emoto, MD, PhD, Medical Advisor, Eli Lilly and Co.; Z. Cai, PhD, Senior Associate, Eli Lilly Japan K.K.; T. Aoki, PhD, Senior Associate, Eli Lilly Japan K.K.; D. Schlichting, RN, MS, Principal Research Scientist, Eli Lilly and Co.; T. Rooney, MD, Medical Director, Eli Lilly and Co.; W. Macias, MD, PhD, Distinguished Medical Fellow, Eli Lilly and Co
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Genovese M, Kremer J, Zamani O, Ludivico C, Krogulec M, Xie L, Beattie S, Koch A, Cardillo T, Rooney T, Macias W, Schlichting D, Smolen J. OP0029 Baricitinib, An Oral Janus Kinase (JAK)1/JAK2 Inhibitor, in Patients with Active Rheumatoid Arthritis (RA) and an Inadequate Response to TNF Inhibitors: Results of the Phase 3 RA-Beacon Study:. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Taylor P, Genovese M, Keystone E, Weinblatt M, Rancourt J, Nantz E, Schlichting D, Zuckerman S, Macias W. THU0175 Effects of Baricitinib on Multibiomarker Disease Activity Scores and Their Components in a Phase 2B Study in Moderate-to-Severe Rheumatoid Arthritis Patients: Table 1. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1628] [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: 11/04/2022]
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Tanaka Y, Emoto K, Tsujimoto M, Schlichting D, Macias W. THU0149 Efficacy and Safety of Baricitinib in Japanese Rheumatoid Arthritis Patients at 12 Weeks: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Taylor P, Genovese MC, Keystone E, Schlichting D, Beattie S, Macias W. OP0047 Baricitinib, an Oral Janus Kinase Inhibitor, in the Treatment of Rheumatoid Arthritis: Safety and Efficacy in Open-Label, Long-Term Extension Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fleischmann R, van Vollenhoven RF, Smolen J, Emery P, Florentinus S, Rathmann S, Kupper H, Kavanaugh A, Taylor P, Genovese M, Keystone EC, Drescher E, Berclaz PY, Lee C, Fidelus-Gort R, Schlichting D, Beattie S, Luchi M, Macias W, Kavanaugh A, Emery P, van Vollenhoven RF, Dikranian AH, Alten R, Klearman M, Musselman D, Agarwal S, Green J, Gabay C, Weinblatt ME, Schiff MH, Fleischmann R, Valente R, van der Heijde D, Citera G, Zhao C, Maldonado MA, Rakieh C, Nam JL, Hunt L, Villeneuve E, Bissell LA, Das S, Conaghan P, McGonagle D, Wakefield RJ, Emery P, Wright HL, Thomas HB, Moots R, Edwards SW, Hamann P, Heward J, McHugh N, Lindsay MA, Haroon M, Giles JT, Winchester R, FitzGerald O, Karaderi T, Cohen CJ, Keidel S, Appleton LH, Macfarlane GJ, Siebert S, Evans D, Paul Wordsworth B, Plant D, Bowes J, Orozco G, Morgan AW, Wilson AG, Isaacs J, Barton A, Williams FM, Livshits G, Spector T, MacGregor A, Williams FM, Scollen S, Cao D, Memari Y, Hyde CL, Zhang B, Sidders B, Ziemek D, Shi Y, Harris J, Harrow I, Dougherty B, Malarstig A, McEwen R, Stephens JL, Patel K, Shin SY, Surdulescu G, He W, Jin X, McMahon SB, Soranzo N, John S, Wang J, Spector TD, Baker J, Litherland GJ, Rowan AD, Kite KA, Bayley R, Yang P, Smith JP, Williams J, Harper L, Kitas GD, Buckley C, Young SP, Fitzpatrick MA, Young SP, McGettrick HM, Filer A, Raza K, Nash G, Buckley C, Muthana M, Davies H, Khetan S, Adeleke G, Hawtree S, Tazzyman S, Morrow F, Ciani B, Wilson G, Quirke AM, Lugli E, Wegner N, Charles P, Hamilton B, Chowdhury M, Ytterberg J, Potempa J, Fisher B, Thiele G, Mikuls T, Venables P, Adebajo AO, Kavanaugh A, Mease P, Gomez-Reino JJ, Wollenhaupt J, Hu C, Stevens R, Sieper J, van der Heijde D, Dougados M, Van den Bosch F, Goupille P, Rathmann SS, Pangan AL, van der Heijde D, Sieper J, Maksymowych WP, Brown MA, Rathmann S, Pangan AL, Sieper J, van der Heijde D, Elewaut D, Pangan AL, Anderson J, Haroon M, Ramasamy P, O'Rourke M, Murphy C, Fitzgerald O, Jani M, Moore S, Mirjafari H, Macphie E, Chinoy H, Rao C, McLoughlin Y, Preeti S. Oral Abstracts 7: RA Clinical * O37. Long-Term Outcomes of Early RA Patients Initiated with Adalimumab Plus Methotrexate Compared with Methotrexate Alone Following a Targeted Treatment Approach. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mega JL, Close SL, Wiviott SD, Shen L, Hockett RD, Brandt JT, Walker JR, Antman EM, Macias W, Braunwald E, Sabatine MS. Cytochrome p-450 polymorphisms and response to clopidogrel. N Engl J Med 2009; 360:354-62. [PMID: 19106084 DOI: 10.1056/nejmoa0809171] [Citation(s) in RCA: 1713] [Impact Index Per Article: 114.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Clopidogrel requires transformation into an active metabolite by cytochrome P-450 (CYP) enzymes for its antiplatelet effect. The genes encoding CYP enzymes are polymorphic, with common alleles conferring reduced function. METHODS We tested the association between functional genetic variants in CYP genes, plasma concentrations of active drug metabolite, and platelet inhibition in response to clopidogrel in 162 healthy subjects. We then examined the association between these genetic variants and cardiovascular outcomes in a separate cohort of 1477 subjects with acute coronary syndromes who were treated with clopidogrel in the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis in Myocardial Infarction (TRITON-TIMI) 38. RESULTS In healthy subjects who were treated with clopidogrel, carriers of at least one CYP2C19 reduced-function allele (approximately 30% of the study population) had a relative reduction of 32.4% in plasma exposure to the active metabolite of clopidogrel, as compared with noncarriers (P<0.001). Carriers also had an absolute reduction in maximal platelet aggregation in response to clopidogrel that was 9 percentage points less than that seen in noncarriers (P<0.001). Among clopidogrel-treated subjects in TRITON-TIMI 38, carriers had a relative increase of 53% in the composite primary efficacy outcome of the risk of death from cardiovascular causes, myocardial infarction, or stroke, as compared with noncarriers (12.1% vs. 8.0%; hazard ratio for carriers, 1.53; 95% confidence interval [CI], 1.07 to 2.19; P=0.01) and an increase by a factor of 3 in the risk of stent thrombosis (2.6% vs. 0.8%; hazard ratio, 3.09; 95% CI, 1.19 to 8.00; P=0.02). CONCLUSIONS Among persons treated with clopidogrel, carriers of a reduced-function CYP2C19 allele had significantly lower levels of the active metabolite of clopidogrel, diminished platelet inhibition, and a higher rate of major adverse cardiovascular events, including stent thrombosis, than did noncarriers.
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Affiliation(s)
- Jessica L Mega
- Thrombolysis in Myocardial Infarction Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Antman EM, Wiviott SD, Murphy SA, Voitk J, Hasin Y, Widimsky P, Chandna H, Macias W, McCabe CH, Braunwald E. Early and Late Benefits of Prasugrel in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention. J Am Coll Cardiol 2008; 51:2028-33. [DOI: 10.1016/j.jacc.2008.04.002] [Citation(s) in RCA: 193] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 03/07/2008] [Accepted: 04/07/2008] [Indexed: 01/09/2023]
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Williams MD, Macias W, Rustige J. Safety of drotrecogin alfa (activated): a fair comparison requires consistent definitions. Intensive Care Med 2007; 33:1487-8; author reply 1489-91. [PMID: 17563878 DOI: 10.1007/s00134-007-0709-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2007] [Indexed: 11/29/2022]
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Laterre PF, Nelson DR, Macias W, Abraham E, Sashegyi A, Williams MD, Levy M, Levi M, Utterback B, Vincent JL. International integrated database for the evaluation of severe sepsis and drotrecogin alfa (activated) therapy: 28-day survival and safety. J Crit Care 2007; 22:142-52. [PMID: 17548026 DOI: 10.1016/j.jcrc.2006.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Accepted: 09/26/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To enhance the understanding of severe sepsis, a database of patients from multiple clinical trials spanning a 6-year period was constructed. Initial analyses evaluated the 28-day survival in the placebo group and further assessed the treatment effect of drotrecogin alfa (activated) (DrotAA). METHODS Five severe sepsis studies with similar entry criteria were combined, and baseline characteristics and 28-day mortality were evaluated (4459 severe sepsis patients; placebo, n = 1231; DrotAA, n = 3228). An integrated data analysis with propensity score adjustment was performed. Twenty-one variables selected by stepwise logistic regression were included in a propensity score of differences between the 2 groups of patients. RESULTS Over the 6-year period of these trials, there was no change in placebo mortality rates overall (P = .67), nor in subgroups of Acute Physiology and Chronic Health Evaluation score >/=25 (P = .73) or multiple organ dysfunction (P = .38). The adjusted relative hazard risk for DrotAA patients was 0.84 (95% confidence interval, 0.73-0.95; P = .007). Serious bleeding (0.8% in placebo vs 3.5% in DrotAA, P < .0001) was increased during the DrotAA infusion period. CONCLUSIONS Initial analyses indicate that placebo mortality remained unchanged over a recent 6-year period. These analyses also further substantiate that treatment with DrotAA is associated with improved survival.
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Affiliation(s)
- Pierre-Francois Laterre
- Department of Critical Care Medicine, Hôpital St Luc, Université Catholique de Louvain, B-1200 Brussels, Belgium.
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Sashegyi A, Trzaskoma BL, Nelson DR, Williams MD, Macias W. International INtegrated Database for the Evaluation of severe sePsis and drotrecogin alfa (activated) THerapy: component trials and statistical methods for INDEPTH. Curr Med Res Opin 2006; 22:1001-12. [PMID: 16709322 DOI: 10.1185/030079906x104713] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To better understand the effects of drotrecogin alfa (activated) (DrotAA) in severe sepsis patients, and the natural progression of severe sepsis, by creating a database of severe sepsis patients using the appropriate statistical analysis methods to integrate data from various trials. PATIENTS AND METHODS Patient-level data from five severe sepsis trials, conducted by the same sponsor (Eli Lilly and Company, Indianapolis, IN, USA), were combined in an integrated database. Patients from various studies were included and received either DrotAA at 24 microg/kg/h for 96 hours (n = 3228) or placebo (n = 1231), in addition to standard supportive care. The following adjustments to the analyses were made to allow for the combined, and thus non-randomized, nature of the data: (1) differences in observed outcomes between studies were investigated to assess the extent of study-to-study variation before combining study-level data across trials for statistical analysis; (2) random study effects were included in models for patient-level data to capture potential extraneous study-to-study variation; and (3) propensity scores were computed and included as covariates in models for patient-level data to adjust for the nonrandomized nature of the data. RESULTS Baseline characteristics were similar across the studies, supporting the combination of study-level data across trials. Comparing aggregate event rates between the two treatment arms yielded a relative risk for mortality (DrotAA versus placebo) of 0.79 (95% confidence interval [CI] 0.71-0.88), p < 0.0001. For patient-level analyses, after adjustment for 13 independent variables and random study effects, the odds ratio for mortality in the DrotAA versus placebo patients was 0.71 (95% CI 0.59-0.86), p = 0.0003. With adjustment for 13 independent variables and propensity score, the odds ratio was 0.79 (95% CI 0.67-0.93), p = 0.006. Limitations of this integrated database include the modest total number of the trials in the database and the fact that only one component trial in the database contributed data from both placebo and DrotAA-treated patients. SUMMARY A robust severe sepsis database was developed which will be suitable for future studies on the progression of severe sepsis and the mechanism of action of DrotAA. Initial analysis of data from INDEPTH provides additional evidence that treatment of severe sepsis patients with DrotAA is associated with a sustained survival advantage throughout 28-day follow-up.
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Affiliation(s)
- Andreas Sashegyi
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN 46285, USA.
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Vincent JL, Bernard GR, Beale R, Doig C, Putensen C, Dhainaut JF, Artigas A, Fumagalli R, Macias W, Wright T, Wong K, Sundin DP, Turlo MA, Janes J. Drotrecogin alfa (activated) treatment in severe sepsis from the global open-label trial ENHANCE: further evidence for survival and safety and implications for early treatment. Crit Care Med 2005; 33:2266-77. [PMID: 16215381 DOI: 10.1097/01.ccm.0000181729.46010.83] [Citation(s) in RCA: 268] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To provide further evidence for the efficacy and safety of drotrecogin alfa (activated) treatment in severe sepsis. DESIGN Single-arm, open-label, trial of drotrecogin alfa (activated) treatment in severe sepsis patients. Enrollment began in March 2001 and day-28 follow-up completed in January 2003. SETTING ENHANCE took place in 25 countries at 361 sites. PATIENTS Patients with known or suspected infection, three or four systemic inflammatory response syndrome criteria, and one or more sepsis-induced organ dysfunctions. Of 2,434 adults entered, 2,378 received drotrecogin alfa (activated), and of these, 2,375 completed the protocol. INTERVENTIONS Drotrecogin alfa (activated) was infused at a dose of 24 mug/kg/hr for 96 hrs. MEASUREMENTS AND MAIN RESULTS The 28-day all-cause mortality approximated that observed in PROWESS (25.3% vs. 24.7%). Although patients in ENHANCE had increased serious bleeding rates compared with patients in the drotrecogin alfa (activated) arm of PROWESS (during infusion, 3.6% vs. 2.4%; postinfusion, 3.2% vs. 1.2%; 28-day, 6.5% vs. 3.5%), increased postinfusion bleeding suggested a higher background bleeding rate. Intracranial hemorrhage was more common in ENHANCE than PROWESS (during infusion, 0.6% vs. 0.2%; 28-day, 1.5% vs. 0.2%). The incidence of fatal intracranial hemorrhage was the same during infusion (0.2%) and higher at 28 days (0.5% vs. 0.2%). ENHANCE patients treated within 0-24 hrs from their first sepsis-induced organ dysfunction had lower observed mortality rate than those treated after 24 hrs (22.9% vs. 27.4%, p = .01). CONCLUSIONS ENHANCE provides supportive evidence for the favorable benefit/risk ratio observed in PROWESS and suggests that more effective use of drotrecogin alfa (activated) might be obtained by initiating therapy earlier.
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Affiliation(s)
- Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital and University of Brussels, Brussels, Belgium
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Abstract
PURPOSE OF REVIEW In this review, we describe our current understanding of various aspects of secondary renal injury and its prevention. Secondary renal injury indicates any injury to the kidney, which occurs after an initial event has already triggered injury to the organ. RECENT FINDINGS Analysis of the literature reveals several important fields of possible intervention. First, blood pressure is considered important and hypotension is associated with renal injury. Avoiding hypotension is an important mechanism of renal protection from secondary injury. Similarly, a low cardiac output state should be promptly treated or prevented. Adequate volume resuscitation is also considered important although strong direct evidence for this intervention is not available. There is insufficient evidence to suggest that any drug can specifically increase renal blood flow in man independent of an effect on blood pressure or cardiac output. Specific kidney protective approaches have not yet been identified. Intensive insulin therapy possibly delivers renal protection and deserves further investigation. Modulation of the stress response appears attractive in experimental models but it has not been shown effective in man. Ischemic preconditioning is a useful strategy for renal protection in the experimental setting. An understanding of the mechanisms involved in ischemic preconditioning might assist in developing novel and effective interventions in man. SUMMARY The pillars of protection from secondary renal injury are similar to those needed to protect the kidney from primary injury: maintenance of adequate intravascular volume, cardiac output, and arterial blood pressure. Novel protective strategies such as intensive insulin therapy require further investigation.
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Affiliation(s)
- Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, Australia.
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Williams MD, Macias W, Nelson D. Patterns of Survival in Patients with Severe Sepsis Treated with Drotrecogin alfa (activated). Chest 2004. [DOI: 10.1378/chest.126.4_meetingabstracts.723s-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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23
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Macias W, Yan SB. Antithrombin and heparin may limit the activation of Protein C. Acta Anaesthesiol Scand 2004; 48:385. [PMID: 14982578 DOI: 10.1111/j.0001-5172.2004.0320b.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Vincent J, Bernard G, Dhainaut J, Levy M, Wheeler A, Macias W. Crit Care 2004; 8:P114. [DOI: 10.1186/cc2581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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25
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Doig C, Bernard G, Levy M, Macias W. Crit Care 2004; 8:P118. [DOI: 10.1186/cc2585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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26
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Abraham E, Naum C, Bandi V, Gervich D, Lowry SF, Wunderink R, Schein RM, Macias W, Skerjanec S, Dmitrienko A, Farid N, Forgue ST, Jiang F. Efficacy and safety of LY315920Na/S-5920, a selective inhibitor of 14-kDa group IIA secretory phospholipase A2, in patients with suspected sepsis and organ failure. Crit Care Med 2003; 31:718-28. [PMID: 12626975 DOI: 10.1097/01.ccm.0000053648.42884.89] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Concentrations of group IIA secretory phospholipase A, an inflammatory response mediator, are increased in the plasma of patients with sepsis and septic shock, and the extent of elevation is correlated with mortality. LY315920Na/S-5920 is a selective inhibitor of group IIA secretory phospholipase A that has been shown to inhibit serum group IIA secretory phospholipase A enzyme activity in patients with severe sepsis. The primary objectives of this study were to determine whether there was a dose-response relationship between two doses of LY315920Na/S-5920 compared with placebo in the reduction of 28-day all-cause mortality in patients with severe sepsis and to determine whether LY315920Na/S-5920 had an acceptable safety profile.(2) (2) (2) DESIGN Multicenter, double-blind, placebo-controlled trial of two doses of LY315920Na/S-5920 in a parallel design. PATIENTS A total of 586 patients with severe sepsis at 72 institutions in the United States. INTERVENTIONS Patients enrolled within 72 hrs from onset of first sepsis-induced organ failure were randomized (1:1:1) to low-dose LY315920Na/S-5920 (target plasma concentration of 200 ng/mL, n = 196), high-dose LY315920Na/S-5920 (800 ng/mL, n = 194), or placebo (n = 196). Study medication was administered as a constant-rate intravenous infusion for 168 hrs. MEASUREMENTS AND MAIN RESULTS The study was stopped prematurely because it was unlikely that a statistically significant difference in mortality between LY315920Na/S-5920 and placebo would be found. There was no effect of LY315920Na/S-5920 on the primary end point of 28-day all-cause mortality across the entire study population. The 28-day all-cause mortality was distributed as follows: placebo group, 33.2% (65/196 patients); low-dose LY315920Na/S-5920, 37.2% (73/196); and high-dose LY315920Na/S-5920, 36.1% (70/194); p = .525. However, in a prospectively planned analysis, there was a favorable overall dose-response effect on 28-day all-cause mortality in patients administered LY315920Na/S-5920 within 18 hrs of onset of the first sepsis-induced organ failure. Among these patients, 28-day all-cause mortality was distributed as follows: placebo group, 43.5% (20/46 patients); low-dose LY315920Na/S-5920, 31.4% (16/51); and high-dose LY315920Na/S-5920, 20.8% (10/48); p = .018. CONCLUSIONS Administration of LY315920Na/S-5920 had an acceptable safety profile in patients with severe sepsis. There was no overall survival benefit associated with the use of LY315920Na/S-5920 in this study. However, prospectively planned secondary analyses suggested that treatment with LY315920Na/S-5920 was associated with an improvement in survival in patients treated within 18 hrs of the first sepsis-induced organ failure.
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Affiliation(s)
- Edward Abraham
- University of Colorado Health Sciences Center, Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, Denver 80262, USA
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Murphey ED, Fessler JF, Bottoms GD, Latshaw H, Johnson M, Mueller B, Clark W, Macias W. Effects of continuous venovenous hemofiltration on cardiopulmonary function in a porcine model of endotoxin-induced shock. Am J Vet Res 1997; 58:408-13. [PMID: 9099389] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine whether continuous venovenous hemofiltration, proposed to remove inflammatory mediators from circulation, would resolve cardiopulmonary derangements in a model of established endotoxic shock. ANIMALS 16 clinically normal pigs. PROCEDURE Endotoxin was infused, IV, into anesthetized pigs for a total of 50 minutes. Thirty minutes after termination of the infusion period, extracorporeal circulation was initiated through a 50-kd diafilter, or past the filter without ultrafiltrate formation. Cardiac and respiratory variables were monitored for a period of 4 hours. RESULTS Infusion of lipopolysaccharide resulted in a severe hypodynamic circulatory state, with significant decreases in mean arterial pressure and cardiac output concurrent with a significant increase in pulmonary arterial pressure. Hemofiltration was not associated with any correction of lipopolysaccharide-induced cardiopulmonary derangements. CONCLUSIONS Continuous venovenous hemofiltration, as used in this acute experiment, did not improve cardiopulmonary dysfunction during endotoxic shock. CLINICAL RELEVANCE Continuous venovenous hemofiltration needs further investigation before it can be recommended as a clinically effective treatment.
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Affiliation(s)
- E D Murphey
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
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Bottoms G, Fessler J, Murphey E, Johnson M, Latshaw H, Mueller B, Clark W, Macias W. Efficacy of convective removal of plasma mediators of endotoxic shock by continuous veno-venous hemofiltration. Shock 1996; 5:149-54. [PMID: 8705393 DOI: 10.1097/00024382-199602000-00011] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Continuous veno-venous hemofiltration (CVVH) has been reported to provide beneficial effects during endotoxic shock. This experiment was designed to determine if selective removal of plasma mediators occurs during CVVH and if plasma concentrations of these mediators are reduced. A swine endotoxic-shock model with three groups was used (lipopolysaccharide (LPS) only (n = 6); LPS followed by CVVH (n = 6); and LPS followed by sham CVVH (n = 4). Plasma and filtrate samples were collected at frequent intervals for 5 h. Lactic acid (LA), eicosanoids [prostacyclin (6-keto PGF1 alpha), thromboxane (TxB2), and prostaglandin E2 (PGE2)] and tumor necrosis factor (TNF) were measured in plasma and filtrate. Plasma concentrations of 6-keto PGF1 alpha, TxB2, TNF, and LA were not significantly different in any group. LA, PGE2, 6-keto PGF1 alpha, and TXB2 concentrations were similar in filtrate and plasma. TNF did not move across the membrane into the filtrate, CVVH, as used in this experiment, did not significantly reduce plasma concentrations of any of these mediators.
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Affiliation(s)
- G Bottoms
- Purdue University School of Veterinary Medicine, W. Lafayette, Indiana 47907, USA
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