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Mai Y, Cao Z, Zhao L, Yu Q, Xu J, Liu W, Liu B, Tang J, Luo Y, Liao W, Fang W, Ruan Y, Lei M, Mok VCT, Shi L, Liu J. The role of visual rating and automated brain volumetry in early detection and differential diagnosis of Alzheimer's disease. CNS Neurosci Ther 2024; 30:e14492. [PMID: 37864441 PMCID: PMC11017425 DOI: 10.1111/cns.14492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 09/07/2023] [Accepted: 09/26/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Medial temporal lobe atrophy (MTA) is a diagnostic marker for mild cognitive impairment (MCI) and Alzheimer's disease (AD), but the accuracy of quantitative MTA (QMTA) in diagnosing early AD is unclear. This study aimed to investigate the accuracy of QMTA and its related components (inferior lateral ventricle [ILV] and hippocampus) with MTA in the early diagnosis of MCI and AD. METHODS This study included four groups: normal (NC), MCI stable (MCIs), MCI converted to AD (MCIs), and mild AD (M-AD) groups. Magnetic resonance image analysis software was used to quantify the hippocampus, ILV, and QMTA. MTA was rated by two experienced neurologists. Receiver operating characteristic area under the curve (AUC) analysis was performed to compare their capability in differentiating AD from NC and MCI, and optimal thresholds were determined using the Youden index. RESULTS QMTA distinguished M-AD from NC and MCI with higher diagnostic accuracy than MTA, hippocampus, and ILV (AUCNC = 0.976, AUCMCI = 0.836, AUCMCIs = 0.894, AUCMCIc = 0.730). The diagnostic accuracy of QMTA was superior to that of MTA, the hippocampus, and ILV in differentiating MCI from AD. The diagnostic accuracy of QMTA was found to remain the best across age, sex, and pathological subgroups analyzed. The sensitivity (92.45%) and specificity (90.64%) were higher in this study when a cutoff value of 0.635 was chosen for QMTA. CONCLUSIONS QMTA may be a better choice than the MTA scale or the associated quantitative components alone in identifying AD patients and MCI individuals with higher progression risk.
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Affiliation(s)
- Yingren Mai
- Department of NeurologyThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Zhiyu Cao
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Lei Zhao
- BrainNow Research InstituteShenzhenChina
| | - Qun Yu
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Jiaxin Xu
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Wenyan Liu
- BrainNow Research InstituteShenzhenChina
| | - Bowen Liu
- Department of Statistics, College of Liberal Art and SciencesUniversity of Illinois Urbana‐ChampaignUrbanaIllinoisUSA
| | - Jingyi Tang
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Yishan Luo
- BrainNow Research InstituteShenzhenChina
| | - Wang Liao
- Department of NeurologyThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Wenli Fang
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Yuting Ruan
- Department of RehabilitationThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Ming Lei
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Vincent C. T. Mok
- BrainNow Research InstituteShenzhenChina
- Division of Neurology, Department of Medicine and Therapeutics, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative MedicineThe Chinese University of Hong KongHong Kong, SARChina
| | - Lin Shi
- BrainNow Research InstituteShenzhenChina
- Department of Imaging and Interventional RadiologyThe Chinese University of Hong KongHong Kong, SARChina
| | - Jun Liu
- Department of NeurologyThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
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Crane PK, Groot C, Ossenkoppele R, Mukherjee S, Choi S, Lee M, Scollard P, Gibbons LE, Sanders RE, Trittschuh E, Saykin AJ, Mez J, Nakano C, Donald CM, Sohi H, Risacher S. Cognitively defined Alzheimer's dementia subgroups have distinct atrophy patterns. Alzheimers Dement 2024; 20:1739-1752. [PMID: 38093529 PMCID: PMC10984445 DOI: 10.1002/alz.13567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/16/2023] [Accepted: 11/03/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION We sought to determine structural magnetic resonance imaging (MRI) characteristics across subgroups defined based on relative cognitive domain impairments using data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) and to compare cognitively defined to imaging-defined subgroups. METHODS We used data from 584 people with Alzheimer's disease (AD) (461 amyloid positive, 123 unknown amyloid status) and 118 amyloid-negative controls. We used voxel-based morphometry to compare gray matter volume (GMV) for each group compared to controls and to AD-Memory. RESULTS There was pronounced bilateral lower medial temporal lobe atrophy with relative cortical sparing for AD-Memory, lower left hemisphere GMV for AD-Language, anterior lower GMV for AD-Executive, and posterior lower GMV for AD-Visuospatial. Formal asymmetry comparisons showed substantially more asymmetry in the AD-Language group than any other group (p = 1.15 × 10-10 ). For overlap between imaging-defined and cognitively defined subgroups, AD-Memory matched up with an imaging-defined limbic predominant group. DISCUSSION MRI findings differ across cognitively defined AD subgroups.
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Affiliation(s)
- Paul K. Crane
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Colin Groot
- Clinical Memory Research UnitLund UniversityLundSweden
- Alzheimer centerAmsterdam UMC ‐ VU Medical CenterAmsterdamNetherlands
| | - Rik Ossenkoppele
- Clinical Memory Research UnitLund UniversityLundSweden
- Alzheimer centerAmsterdam UMC ‐ VU Medical CenterAmsterdamNetherlands
| | | | - Seo‐Eun Choi
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Michael Lee
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Phoebe Scollard
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Laura E. Gibbons
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | | | - Emily Trittschuh
- Department of Psychiatry and Behavioral SciencesUniversity of Washington, and Geriatrics ResearchEducation, and Clinical CenterVA Puget Sound Health Care SystemSeattleUSA
| | - Andrew J. Saykin
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisUSA
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisUSA
| | - Jesse Mez
- Department of NeurologyBoston UniversityBostonMassachusettsUSA
| | - Connie Nakano
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | | | - Harkirat Sohi
- Department of Biomedical Informatics and Medical EducationUniversity of WashingtonSeattleUSA
- Now Pacific Northwest National LaboratoryRichlandUSA
| | | | - Shannon Risacher
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisUSA
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisUSA
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Maahs S, Leclair D, Gomez-Mancilla B, Kiluk BD, Muthusamy VS, Banerjee PS, Dasgupta S, Waye KM. Patient perspectives on current and potential therapies and clinical trial approaches for cocaine use disorder. Front Psychiatry 2024; 15:1230699. [PMID: 38487570 PMCID: PMC10937549 DOI: 10.3389/fpsyt.2024.1230699] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/30/2024] [Indexed: 03/17/2024] Open
Abstract
Background Cocaine use disorder (CUD) is characterized by the continued use of cocaine despite serious impacts on life. This study focused on understanding the perspective of individuals with current CUD, individuals in CUD remission, and their supporters regarding current therapies, future therapies, and views on clinical trials for CUD. Methods The online bulletin board (OBB) is a qualitative tool where participants engage in an interactive discussion on a virtual forum. Following completion of a screening questionnaire to determine eligibility, individuals in CUD remission and their supporters logged in to the OBB and responded to questions posed by the moderator. Individuals with current CUD participated in a one-time virtual focus group. Results All individuals with current CUD and 94% of those in CUD remission reported a diagnosis consistent with CUD or substance use disorder during screening. Individuals with current CUD and their supporters were recruited from the United States (US). Individuals in CUD remission were recruited from five countries, including the US. Individuals with current CUD reported hesitation about seeking treatment due to stigma, a lack of privacy, and being labeled as a drug seeker; barriers to therapy included time, cost, and a lack of privacy. Participants wanted a safe therapy to stop cravings and withdrawal symptoms. Seven clinical trial outcomes, including long-term abstinence and craving control, were suggested based on collected insights. Conclusion This study can help inform the design of clinical trials and emphasize the need for effective, safe, and accessible therapies. Recruiting participants will require significant trust building.
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Affiliation(s)
- Suzanne Maahs
- Novartis Biomedical Research, Cambridge, MA, United States
| | - Denise Leclair
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | - Baltazar Gomez-Mancilla
- Novartis Biomedical Research, Neuroscience Research, Basel, Switzerland
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
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Mittra ES, Wong RKS, Winters C, Brown A, Murley S, Kennecke H. Establishing a robust radioligand therapy program: A practical approach for North American centers. Cancer Med 2024; 13:e6780. [PMID: 38214130 PMCID: PMC10905220 DOI: 10.1002/cam4.6780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 01/13/2024] Open
Abstract
Radioligand therapy (RLT) is a targeted approach to treating cancer that has been shown to be safe and effective in a variety of disease states, including gastroenteropancreatic neuroendocrine tumors, lymphoma, and most recently, advanced prostate cancer. In the United States, patient access to this therapy is currently variable. Implementation of new RLT programs and expansion of existing programs are needed to broaden patient access to and standardize the delivery of RLT, especially as new therapies are introduced into clinical practice. Drawing from experience in establishing RLT programs in different settings, we have developed practical recommendations for building and implementing a robust RLT program. In this review, we present our recommendations for minimal requirements and optimal requirements, as well as system considerations, and special issues associated with implementing an RLT program in North American centers.
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Affiliation(s)
- Erik S. Mittra
- Department of Diagnostic RadiologyOregon Health & Science UniversityPortlandOregonUSA
| | - Rebecca K. S. Wong
- Department of Radiation Oncology, Princess Margaret Cancer CentreUniversity of TorontoTorontoOntarioCanada
| | - Celeste Winters
- Department of Diagnostic RadiologyOregon Health & Science UniversityPortlandOregonUSA
| | - Adam Brown
- Department of Diagnostic RadiologyOregon Health & Science UniversityPortlandOregonUSA
| | - Shondra Murley
- Department of Nuclear MedicineWest Tennessee HealthcareJacksonTennesseeUSA
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Playford D, Stewart S, Harris SA, Chan Y, Strange G. Pattern and Prognostic Impact of Regional Wall Motion Abnormalities in 255 697 Men and 236 641 Women Investigated with Echocardiography. J Am Heart Assoc 2023; 12:e031243. [PMID: 37947119 PMCID: PMC10727298 DOI: 10.1161/jaha.123.031243] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/03/2023] [Indexed: 11/12/2023]
Abstract
Background Regional wall motion abnormalities (WMAs) after myocardial infarction are associated with adverse remodeling and increased mortality in the short to medium term. Their long-term prognostic impact is less well understood. Methods and Results Via the National Echo Database of Australia (2000-2019), we identified normal wall motion versus WMA for each left ventricular wall among 492 338 individuals aged 61.9±17.9 years. The wall motion score index was also calculated. We then examined actual 1- and 5-year mortality, plus adjusted risk of long-term mortality according to WMA status. Overall, 39 346/255 697 men (15.4%) and 17 834/236 641 women (7.5%) had a WMA. The likelihood of a WMA was associated with increasing age and greater systolic/diastolic dysfunction. A defect in the inferior versus anterior wall was the most and least common WMA in men (8.0% and 2.5%) and women (3.3% and 1.1%), respectively. Any WMA increased 5-year mortality from 17.5% to 29.7% in men and from 14.9% to 30.8% in women. Known myocardial infarction (hazard ratio [HR], 0.86 [95% CI, 0.80-0.93]) or revascularization (HR, 0.87 [95% CI, 0.82-0.92]) was independently associated with a better prognosis, whereas men (1.22-fold increase) and those with greater systolic/diastolic dysfunction had a worse prognosis. Among those with any WMA, apical (HR, 1.08 [95% CI, 1.02-1.13]) or inferior (HR, 1.09 [95% CI, 1.04-1.15]) akinesis, dyskinesis or aneurysm, or a wall motion score index >3.0 conveyed the worst prognosis. Conclusions In a large real-world clinical cohort, twice as many men as women have a WMA, with inferior WMA the most common. Any WMA confers a poor prognosis, especially inferoapical akinesis/dyskinesis/aneurysm.
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Affiliation(s)
- David Playford
- Institute for Health Research, University of Notre DameFremantleWestern AustraliaAustralia
- School of MedicineThe University of Notre DameFremantleWestern AustraliaAustralia
| | - Simon Stewart
- Institute for Health Research, University of Notre DameFremantleWestern AustraliaAustralia
- School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowUnited Kingdom
| | - Sarah Ann Harris
- Institute for Health Research, University of Notre DameFremantleWestern AustraliaAustralia
| | - Yih‐Kai Chan
- Mary MacKillop Institute for Health Research, The Australian Catholic UniversityMelbourneVictoriaAustralia
| | - Geoff Strange
- Institute for Health Research, University of Notre DameFremantleWestern AustraliaAustralia
- Heart Research InstituteSydneyNew South WalesAustralia
- Department of CardiologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
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Xu S, Zhang N, Rinne ML, Sun H, Stein AM. Sabatolimab (MBG453) model-informed drug development for dose selection in patients with myelodysplastic syndrome/acute myeloid leukemia and solid tumors. CPT Pharmacometrics Syst Pharmacol 2023; 12:1653-1665. [PMID: 37186155 PMCID: PMC10681456 DOI: 10.1002/psp4.12962] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 05/17/2023] Open
Abstract
Sabatolimab is a novel immunotherapy with immuno-myeloid activity that targets T-cell immunoglobulin domain and mucin domain-3 (TIM-3) on immune cells and leukemic blasts. It is being evaluated for the treatment of myeloid malignancies in the STIMULUS clinical trial program. The objective of this analysis was to support the sabatolimab dose-regimen selection in hematologic malignancies. A population pharmacokinetic (PopPK) model was fit to patients with solid tumors and hematologic malignancies, which included acute myeloid leukemia, myelodysplastic syndrome (including intermediate-, high-, and very high-risk per Revised International Prognostic Scoring System), and chronic myelomonocytic leukemia. The PopPK model, together with a predictive model of sabatolimab distribution to the bone marrow and binding to TIM-3 was used to predict membrane-bound TIM-3 bone marrow occupancy. In addition, the total soluble TIM-3 (sTIM-3) kinetics and the pharmacokinetic (PK) exposure-response relationship in patients with hematologic malignancies were examined. At intravenous doses above 240 mg Q2w and 800 mg Q4w, we observed linear PK, a plateau in the accumulation of total sTIM-3, and a flat exposure-response relationship for both safety and efficacy. In addition, the model predicted membrane-bound TIM-3 occupancy in the bone marrow was above 95% in over 95% of patients. Therefore, these results support the selection of the 400 mg Q2w and 800 mg Q4w dosing regimens for the STIMULUS clinical trial program.
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Affiliation(s)
- Siyan Xu
- Novartis Institutes for BioMedical ResearchCambridgeMassachusettsUSA
| | - Na Zhang
- Novartis Institutes for BioMedical ResearchCambridgeMassachusettsUSA
| | | | - Haiying Sun
- Novartis Institutes for BioMedical ResearchCambridgeMassachusettsUSA
| | - Andrew M. Stein
- Novartis Institutes for BioMedical ResearchCambridgeMassachusettsUSA
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Mohebi R, Liu Y, Butler J, Felker GM, Ward JH, Prescott MF, Piña IL, Solomon SD, Januzzi JL. Importance of the 'area under the curve' from serial NT-proBNP measurements during treatment with sacubitril/valsartan. ESC Heart Fail 2023; 10:3133-3140. [PMID: 37632309 PMCID: PMC10567633 DOI: 10.1002/ehf2.14503] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/16/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
AIMS Serial assessment of natriuretic peptides is widely utilized in heart failure clinics. Uncertainty exists regarding the value of multiple natriuretic peptide measurements and how they might be best interpreted. METHODS AND RESULTS Six hundred thirty-two patients with heart failure with reduced ejection fraction (<40%) and complete biomarker data were enrolled to receive sacubitril/valsartan. Patients underwent periodic study visits during 1-year follow-ups. Echocardiographic data and cardiac biomarkers, including N-terminal pro-B-type natriuretic peptide (NT-proBNP) were collected during study visits. Patients were categorized into three groups based on tertiles of baseline NT-proBNP levels. The area under the curve (AUC) of NT-proBNP measurements across study visits was calculated. Compared with patients with higher AUC (and thus higher concentrations over a longer period of time), those with lower AUC were younger, had a lower prevalence of chronic kidney disease, prior coronary artery bypass graft, atrial fibrillation, and higher body-mass index. A significant interaction existed between baseline NT-proBNP and subsequent AUC for predicting LVEF change across visits (P-value < 0.001): among those with lower baseline NT-proBNP, similar improvements in left ventricular (LV) volumes LV ejection fraction, and LV mass index were observed across subsequent AUC (P-value > 0.1). However, among those with higher baseline NT-proBNP, those with lower subsequent AUC had a greater improvement in cardiac remodelling indices (P-value < 0.05). CONCLUSIONS Serial NT-proBNP monitoring (integrating the totality of measurements as an AUC) during treatment with sacubitril/valsartan informs unique information regarding the future changes in cardiac remodelling indices, especially among those with higher NT-proBNP levels at baseline.
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Affiliation(s)
- Reza Mohebi
- Massachusetts General HospitalBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | - Yuxi Liu
- Massachusetts General HospitalBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | - Javed Butler
- University of Mississippi Medical CenterJacksonMSUSA
- Baylor Scott and White HeathDallasTXUSA
| | - G. Michael Felker
- Duke University Medical Center and Duke Clinical Research InstituteDurhamNCUSA
| | | | | | - Ileana L. Piña
- Central Michigan UniversityMidlandMIUSA
- Population & Quantitative Health Sciences CenterCase Western UniversityClevelandOHUSA
- Center for Devices and Radiological Health, U.S. Food and Drug AdministrationSilver SpringMDUSA
| | - Scott D. Solomon
- Harvard Medical SchoolBostonMAUSA
- Brigham and Women's HospitalBostonMAUSA
| | - James L. Januzzi
- Massachusetts General HospitalBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
- Baim Institute for Clinical ResearchBostonMAUSA
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Ramos PM, Choi J, Campbell CD, Wang YA, Pallaud C, Dickinson M, Verma A, Mittelman M, Platzbecker U, Cherif H, Fenaux P. Next-generation sequencing of baseline genetic mutations and outcomes of eltrombopag and azacitidine therapy in patients with myelodysplastic syndromes and thrombocytopenia: Data from the SUPPORT clinical trial. EJHaem 2023; 4:876-881. [PMID: 37601870 PMCID: PMC10435669 DOI: 10.1002/jha2.694] [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] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 08/22/2023]
Abstract
Eltrombopag has been previously shown to be effective in reversing azacitidine-mediated thrombocytopenia. This was further investigated in the SUPPORT trial, a phase III study assessing the efficacy/safety of eltrombopag plus azacitidine in patients with intermediate- to high-risk myelodysplastic syndromes and thrombocytopenia. The results did not support a clinical benefit for the addition of eltrombopag to azacitidine. We investigated if the somatic mutational profiles in the patient cohort were associated with treatment outcomes. Based on the available data, we observed no imbalance in the mutational profiles between treatment arms or a clear association between identified somatic mutations and clinical outcomes.
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Affiliation(s)
| | - Jeea Choi
- Novartis Pharmaceuticals CorporationEast HanoverNew JerseyUSA
| | | | - Ying A. Wang
- Novartis Global Drug DevelopmentCambridgeMassachusettsUSA
- Present address:
Bayer Pharmaceuticals CorporationCambridgeMAUSA
| | | | - Michael Dickinson
- The Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneAustralia
| | - Amit Verma
- Division of Medical OncologyDepartment of MedicineAlbert Einstein College of MedicineNew YorkNew YorkUSA
| | - Moshe Mittelman
- Tel Aviv Sourasky Medical CenterTel Aviv UniversityTel AvivIsrael
| | - Uwe Platzbecker
- Medical Clinical and PoliclinicHematology and Cellular TherapyUniversity Hospital LeipzigLeipzigGermany
| | - Honar Cherif
- Department of Medical SciencesUppsala UniversityUppsalaSweden
| | - Pierre Fenaux
- Hôpital AvicenneAssistance Publique‐Hôpitaux de Paris/University Paris XIIIBobignyFrance
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Queiro R, Aurrecoechea E, Alonso Castro S, Villa Blanco I, Brandy-Garcia A, Linge R. Interleukin-17-targeted treatment in patients with spondyloarthritis and associated cardiometabolic risk profile. Front Immunol 2023; 14:1203372. [PMID: 37533855 PMCID: PMC10391638 DOI: 10.3389/fimmu.2023.1203372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/29/2023] [Indexed: 08/04/2023] Open
Abstract
Spondyloarthritis is a group of immune-mediated rheumatic disorders that significantly impact patients' physical function and quality of life. Patients with spondyloarthritis experience a greater prevalence of cardiometabolic disorders, such as obesity, hypertension, dyslipidemia and diabetes mellitus, and these comorbidities are associated with increased spondyloarthritis disease activity and risk of cardiovascular events. This narrative review summarizes the evidence for a physiological link between inflammatory status and cardiometabolic comorbidities in spondyloarthritis, as well as the impact of interleukin (IL)-17 blockade versus other molecular mechanisms in patients with cardiometabolic conditions. The IL-23/IL-17 axis plays a pivotal role in the pathophysiology of spondyloarthritis by promoting inflammation and tissue remodeling at the affected joints and entheses. The importance of the IL-23/IL-17 signaling cascade in underlying sub-clinical inflammation in common cardiometabolic disorders suggests the existence of shared pathways between these processes and spondyloarthritis pathophysiology. Thus, a bidirectional relationship exists between the effects of biologic drugs and patients' cardiometabolic profile, which must be considered during treatment decision making. Biologic therapy may induce changes in patients' cardiometabolic status and cardiometabolic conditions may conversely impact the clinical response to biologic therapy. Available evidence regarding the impact of IL-17 blockade with secukinumab on cardiometabolic parameters suggests this drug does not interfere with traditional cardiovascular risk markers and could be associated with a decreased risk of cardiovascular events. Additionally, the efficacy and retention rates of secukinumab do not appear to be negatively affected by obesity, with some studies reporting a positive impact on clinical outcomes, contrary to that described with other approaches, such as tumor necrosis factor blockade. In this article, we also review evidence for this bidirectional association with other treatments for spondyloarthritis. Current evidence suggests that IL-17-targeted therapy with secukinumab is highly effective in spondyloarthritis patients with cardiometabolic comorbidities and may provide additional cardiometabolic benefits.
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Affiliation(s)
- Rubén Queiro
- Rheumatology and Health Research Institute of the Principality of Asturias (ISPA) Translational Immunology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
- Oviedo University School of Medicine, Oviedo, Spain
| | - Elena Aurrecoechea
- Rheumatology Division, Hospital de Sierrallana, Torrelavega, Spain
- Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Sara Alonso Castro
- Rheumatology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ignacio Villa Blanco
- Rheumatology Division, Hospital de Sierrallana, Torrelavega, Spain
- Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
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Cuker A, Tkacz J, Manjelievskaia J, Haenig J, Maier J, Bussel JB. Overuse of corticosteroids in patients with immune thrombocytopenia (ITP) between 2011 and 2017 in the United States. EJHaem 2023; 4:350-357. [PMID: 37206283 PMCID: PMC10188501 DOI: 10.1002/jha2.684] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/04/2023] [Accepted: 03/17/2023] [Indexed: 05/21/2023]
Abstract
Corticosteroids (CSs) are standard first-line therapy for immune thrombocytopenia (ITP). Prolonged exposure is associated with substantial toxicity; thus guidelines recommend avoidance of prolonged CS treatment and early use of second-line therapies. However, real-world evidence on ITP treatment patterns remains limited. We aimed to assess real-world treatment patterns in patients with newly-diagnosed ITP, using two large US healthcare databases (Explorys and MarketScan) between January 1, 2011 and July 31, 2017. Adults with ITP, ≥12 months of database registration prior to diagnosis, ≥1 ITP treatment, and ≥1 month enrollment following initiation of first ITP treatment were included (n = 4066 Explorys; n = 7837 MarketScan). Information on lines of treatment (LoTs) was collected. As expected, CSs were the most common first-line treatment (Explorys, 87.9%; MarketScan, 84.5%). However, CSs remained by far the most common treatment (Explorys ≥77%; MarketScan ≥85%) across all subsequent LoTs. Second-line treatments such as rituximab (12.0% Explorys; 24.5% MarketScan), thrombopoietin receptor agonists (11.3% Explorys; 15.6% MarketScan), and splenectomy (2.5% Explorys; 8.1% MarketScan) were used much less frequently. CS use is widespread in the US in patients with ITP across all LoTs. Quality improvement initiatives are needed to reduce CS exposure and bolster use of second-line treatments.
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Affiliation(s)
- Adam Cuker
- Department of Medicine and Department of Pathology and Laboratory MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | | | | | | | - James B Bussel
- Pediatric Hematology/OncologyWeill Cornell MedicineNew YorkNew YorkUSA
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Fu J, Tzortzakakis A, Barroso J, Westman E, Ferreira D, Moreno R. Fast three-dimensional image generation for healthy brain aging using diffeomorphic registration. Hum Brain Mapp 2023; 44:1289-1308. [PMID: 36468536 PMCID: PMC9921328 DOI: 10.1002/hbm.26165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Predicting brain aging can help in the early detection and prognosis of neurodegenerative diseases. Longitudinal cohorts of healthy subjects scanned through magnetic resonance imaging (MRI) have been essential to understand the structural brain changes due to aging. However, these cohorts suffer from missing data due to logistic issues in the recruitment of subjects. This paper proposes a methodology for filling up missing data in longitudinal cohorts with anatomically plausible images that capture the subject-specific aging process. The proposed methodology is developed within the framework of diffeomorphic registration. First, two novel modules are introduced within Synthmorph, a fast, state-of-the-art deep learning-based diffeomorphic registration method, to simulate the aging process between the first and last available MRI scan for each subject in three-dimensional (3D). The use of image registration also makes the generated images plausible by construction. Second, we used six image similarity measurements to rearrange the generated images to the specific age range. Finally, we estimated the age of every generated image by using the assumption of linear brain decay in healthy subjects. The methodology was evaluated on 2662 T1-weighted MRI scans from 796 healthy participants from 3 different longitudinal cohorts: Alzheimer's Disease Neuroimaging Initiative, Open Access Series of Imaging Studies-3, and Group of Neuropsychological Studies of the Canary Islands (GENIC). In total, we generated 7548 images to simulate the access of a scan per subject every 6 months in these cohorts. We evaluated the quality of the synthetic images using six quantitative measurements and a qualitative assessment by an experienced neuroradiologist with state-of-the-art results. The assumption of linear brain decay was accurate in these cohorts (R2 ∈ [.924, .940]). The experimental results show that the proposed methodology can produce anatomically plausible aging predictions that can be used to enhance longitudinal datasets. Compared to deep learning-based generative methods, diffeomorphic registration is more likely to preserve the anatomy of the different structures of the brain, which makes it more appropriate for its use in clinical applications. The proposed methodology is able to efficiently simulate anatomically plausible 3D MRI scans of brain aging of healthy subjects from two images scanned at two different time points.
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Affiliation(s)
- Jingru Fu
- Division of Biomedical ImagingDepartment of Biomedical Engineering and Health Systems, KTH Royal Institute of TechnologyStockholmSweden
| | - Antonios Tzortzakakis
- Division of RadiologyDepartment for Clinical Science, Intervention and Technology (CLINTEC), Karolinska InstitutetStockholmSweden
- Medical Radiation Physics and Nuclear MedicineFunctional Unit of Nuclear Medicine, Karolinska University HospitalHuddingeStockholmSweden
| | - José Barroso
- Department of PsychologyFaculty of Health Sciences, University Fernando Pessoa CanariasLas PalmasSpain
| | - Eric Westman
- Division of Clinical GeriatricsCentre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska InstitutetStockholmSweden
- Department of NeuroimagingCentre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Daniel Ferreira
- Division of Clinical GeriatricsCentre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska InstitutetStockholmSweden
| | - Rodrigo Moreno
- Division of Biomedical ImagingDepartment of Biomedical Engineering and Health Systems, KTH Royal Institute of TechnologyStockholmSweden
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12
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Villaruz LC, Socinski MA, Weiss J. Guidance for clinicians and patients with non-small cell lung cancer in the time of precision medicine. Front Oncol 2023; 13:1124167. [PMID: 37077826 PMCID: PMC10107372 DOI: 10.3389/fonc.2023.1124167] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Abstract
Major advances in the diagnosis and treatment of non-small cell lung cancer (NSCLC) have resulted in a sharp decline in associated mortality rates, thereby propelling NSCLC to the forefront of precision medicine. Current guidelines recommend upfront comprehensive molecular testing for all known and actionable driver alterations/biomarkers (EGFR, ALK, ROS1, BRAF, KRAS, NTRK, MET, RET, HER2 [ERBB2], and PD-L1), especially in advanced disease stages, as they significantly influence response to therapy. In particular, hybrid capture-based next-generation sequencing (HC-NGS) with an RNA fusion panel to detect gene fusions is a veritable requirement at both diagnosis and progression (resistance) of any-stage non-squamous adenocarcinoma NSCLCs. This testing modality ensures selection of the most timely, appropriate, and personalized treatment, maximization of therapeutic efficacy, and prevention of use of suboptimal/contraindicated therapy. As a complement to clinical testing and treatment, patient, family, and caregiver education is also key to early screening and diagnosis, access to care, coping strategies, positive outcomes, and survival. The advent of social media and increased internet access has amplified the volume of educational and support resources, consequently changing the dynamics of patient care. This review provides guidance on integration of comprehensive genomic testing with an RNA fusion panel as a global diagnostic standard for all adenocarcinoma NSCLC disease stages and provides key information on patient and caregiver education and resources.
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Affiliation(s)
- Liza C. Villaruz
- Hillman Cancer Center, Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
- *Correspondence: Liza C. Villaruz,
| | | | - Jared Weiss
- Division of Oncology, Lineberger Comprehensive Cancer at the University of North Carolina, Chapel Hill, NC, United States
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13
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Desai NR, Farbaniec M, Karalis DG. Nonadherence to lipid-lowering therapy and strategies to improve adherence in patients with atherosclerotic cardiovascular disease. Clin Cardiol 2023; 46:13-21. [PMID: 36267039 PMCID: PMC9849440 DOI: 10.1002/clc.23935] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 01/26/2023] Open
Abstract
Despite the availability of effective therapies that lower low-density lipoprotein cholesterol (LDL-C) levels in patients with atherosclerotic cardiovascular disease, many eligible patients are inadequately treated and their LDL-C levels remain suboptimal. Patient nonadherence to lipid-lowering therapy (LLT) is a major contributor to the failure of LDL-C goal attainment. Several factors have been identified as contributing to LLT nonadherence, including healthcare disparities due to socioeconomic status, age, race, sex, and cost; limited access to healthcare; perceived side effects associated with LLT; health literacy; and the presence of comorbidities. Suboptimal LLT use has also been associated with clinician factors, including failure to identify patients who require LDL-C reassessment, insufficient LDL-C monitoring, and clinical inertia such as a lack of therapy intensification. Several strategies to enhance LLT adherence have been shown to be effective, including the implementation of educational initiatives and tools for both patients and physicians, the use of clinical protocols and algorithms to identify patients at risk and optimize treatment, and improvements in electronic healthcare records. Pharmacy-based programs designed to help patients with prescription refills, including reminders or the use of prescription delivery by mail, have also proven effective. Drugs requiring frequent administration can represent a barrier to treatment adherence; therefore, newer, more effective LLTs with lower frequency of administration and lower potential for polypharmacy may improve patient adherence to LLT. Implementation of strategies to identify patients at risk for LLT nonadherence and the use of flexible tools such as telemedicine to overcome geographical barriers may improve LLT adherence.
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Affiliation(s)
- Nihar R. Desai
- Yale School of Medicine, Cardiovascular Medicine SectionNew HavenConnecticutUSA
| | - Michael Farbaniec
- Heart and Vascular InstitutePenn State UniversityHersheyPennsylvaniaUSA
| | - Dean G. Karalis
- Department of CardiologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
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Chapman B, Hellkamp AS, Thomas LE, Albert NM, Butler J, Patterson JH, Hernandez AF, Williams FB, Shen X, Spertus JA, Fonarow GC, DeVore AD. Angiotensin Receptor Neprilysin Inhibition and Associated Outcomes by Race and Ethnicity in Patients With Heart Failure With Reduced Ejection Fraction: Data From CHAMP-HF. J Am Heart Assoc 2022; 11:e022889. [PMID: 35722989 PMCID: PMC9238653 DOI: 10.1161/jaha.121.022889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/29/2022] [Indexed: 12/11/2022]
Abstract
Background There are limited data on the use of angiotensin receptor neprilysin inhibitors (ARNIs) in minority populations with heart failure (HF) with reduced ejection fraction. We used data from the CHAMP-HF (Change the Management of Patients With Heart Failure) registry to evaluate ARNI initiation and associated changes in health status and clinical outcomes across different races and ethnicities. Methods and Results CHAMP-HF was a prospective, observational registry of US outpatients with chronic HF with reduced ejection fraction. We compared patients starting ARNI with patients not starting ARNI using a propensity-matched analysis. Patients were grouped as Hispanic, non-Hispanic Black, non-Hispanic White, or non-Hispanic other individuals, where "non-Hispanic other" consists of all patients who did not identify as Hispanic, Black, or White. Health status was assessed using the 12-item Kansas City Cardiomyopathy Questionnaire. Outcomes were analyzed with multivariable models that included race and ethnicity, ARNI initiation, and an interaction term between race and ethnicity and ARNI initiation. Cox proportional hazards models were used for death/HF hospitalization, and multiple regression was used for change in Kansas City Cardiomyopathy Questionnaire score. The analysis included 1516 patients, with 758 patients in each group (ARNI and no ARNI). Changes in Kansas City Cardiomyopathy Questionnaire score after ARNI initiation were similar among all race and ethnicity groups (mean [SD], non-Hispanic White individuals, 3.5 [19.0]; non-Hispanic Black individuals, 2.0 [17.0]; non-Hispanic other individuals, 5.5 [20.3]; and Hispanic individuals, 3.2 [20.1]), with no statistically significant interaction between race and ethnicity and ARNI initiation (P=0.21). There was similarly no statistically significant interaction between race and ethnicity and ARNI initiation for HF hospitalization (P=0.82) or all-cause mortality (P=0.92). Conclusions In a large registry of outpatients with HF with reduced ejection fraction, the association between ARNI initiation and outcomes did not differ by race and ethnicity. These data support the use of ARNI therapy for chronic HF with reduced ejection fraction irrespective of race and ethnicity.
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Affiliation(s)
- Brittany Chapman
- Department of MedicineDuke University School of MedicineDurhamNC
| | | | | | | | - Javed Butler
- University of Mississippi Medical CenterJacksonMS
| | | | - Adrian F. Hernandez
- Department of MedicineDuke University School of MedicineDurhamNC
- Duke Clinical Research InstituteDurhamNC
| | | | - Xian Shen
- Novartis Pharmaceuticals CorporationEast HanoverNJ
| | - John A. Spertus
- Saint Luke’s Mid America Heart Institute and the University of Missouri–Kansas CityKansas CityMO
| | - Gregg C. Fonarow
- Ahmanson‐UCLA Cardiomyopathy CenterRonald Reagan UCLA Medical CenterLos AngelesCA
| | - Adam D. DeVore
- Department of MedicineDuke University School of MedicineDurhamNC
- Duke Clinical Research InstituteDurhamNC
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Esser N, Schmidt C, Barrow BM, Cronic L, Hackney DJ, Mongovin SM, Hogan MF, Templin AT, Castillo JJ, Hull RL, Zraika S. Insulinotropic Effects of Neprilysin and/or Angiotensin Receptor Inhibition in Mice. Front Endocrinol (Lausanne) 2022; 13:888867. [PMID: 35733766 PMCID: PMC9207331 DOI: 10.3389/fendo.2022.888867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Treatment of heart failure with the angiotensin receptor-neprilysin inhibitor sacubitril/valsartan improved glycemic control in individuals with type 2 diabetes. The relative contribution of neprilysin inhibition versus angiotensin II receptor antagonism to this glycemic benefit remains unknown. Thus, we sought to determine the relative effects of the neprilysin inhibitor sacubitril versus the angiotensin II receptor blocker valsartan on beta-cell function and glucose homeostasis in a mouse model of reduced first-phase insulin secretion, and whether any beneficial effects are additive/synergistic when combined in sacubitril/valsartan. High fat-fed C57BL/6J mice treated with low-dose streptozotocin (or vehicle) were followed for eight weeks on high fat diet alone or supplemented with sacubitril, valsartan or sacubitril/valsartan. Body weight and fed glucose levels were assessed weekly. At the end of the treatment period, insulin release in response to intravenous glucose, insulin sensitivity, and beta-cell mass were determined. Sacubitril and valsartan, but not sacubitril/valsartan, lowered fasting and fed glucose levels and increased insulin release in diabetic mice. None of the drugs altered insulin sensitivity or beta-cell mass, but all reduced body weight gain. Effects of the drugs on insulin release were reproduced in angiotensin II-treated islets from lean C57BL/6J mice, suggesting the insulin response to each of the drugs is due to a direct effect on islets and mechanisms therein. In summary, sacubitril and valsartan each exert beneficial insulinotropic, glycemic and weight-reducing effects in obese and/or diabetic mice when administered alone; however, when combined, mechanisms within the islet contribute to their inability to enhance insulin release.
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Affiliation(s)
- Nathalie Esser
- Research Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Division of Metabolism, Endocrinology & Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States
- Laboratory of Immunometabolism and Nutrition, GIGA Infection, Immunity and Inflammation, University of Liège, Liège, Belgium
| | - Christine Schmidt
- Research Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| | - Breanne M. Barrow
- Research Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| | - Laura Cronic
- Division of Metabolism, Endocrinology & Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Daryl J. Hackney
- Research Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| | - Stephen M. Mongovin
- Research Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| | - Meghan F. Hogan
- Research Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Division of Metabolism, Endocrinology & Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Andrew T. Templin
- Research Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Division of Metabolism, Endocrinology & Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Joseph J. Castillo
- Research Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Division of Metabolism, Endocrinology & Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Rebecca L. Hull
- Research Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Division of Metabolism, Endocrinology & Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Sakeneh Zraika
- Research Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Division of Metabolism, Endocrinology & Nutrition, Department of Medicine, University of Washington, Seattle, WA, United States
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Ruiz-Falcó Rojas ML, Feucht M, Macaya A, Wilken B, Hahn A, Maamari R, Hirschberg Y, Ridolfi A, Kingswood JC. Real-World Evidence Study on the Long-Term Safety of Everolimus in Patients With Tuberous Sclerosis Complex: Final Analysis Results. Front Pharmacol 2022; 13:802334. [PMID: 35462939 PMCID: PMC9023743 DOI: 10.3389/fphar.2022.802334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/07/2022] [Indexed: 01/20/2023] Open
Abstract
The TuberOus SClerosis registry to increase disease Awareness (TOSCA) Post-Authorization Safety Study (PASS) was a non-interventional, multicenter, safety substudy that assessed the long-term safety of everolimus in patients with tuberous sclerosis complex (TSC) receiving everolimus for its licensed indications in the European Union (EU). This substudy also aimed to address TSC-associated neuropsychiatric disorders (TAND), sexual development, and male infertility. Eligible patients were enrolled from 39 sites across 11 countries in the EU. Outcomes of interest included the incidence of adverse events (AEs), serious adverse events (SAEs), treatment-related AEs (TRAEs), AEs leading to everolimus discontinuation, AEs of special interest (AESIs), the observed relationship between everolimus blood levels and incidence of AESIs, TAND, and reproductive clinical features. Herein, we present the final analysis results from this substudy (data cutoff date: 22 January 2020). At data cutoff, 179 patients were enrolled (female, 59.2%; age ≥18 years, 65.9%), of which the majority completed the study (76%). Overall, 121 patients (67.6%) had AEs regardless of causality. The most frequent TRAEs (≥5%) were stomatitis (7.8%), aphthous ulcer (6.7%), and hypercholesterolemia (6.1%). The most common treatment-related SAEs (>1%) were pneumonia (3.4%), influenza, pyelonephritis, aphthous ulcer, stomatitis, dyslipidemia, and hypercholesterolemia (1.1% each). Ten patients (5.6%) reported AEs leading to everolimus discontinuation. The common psychiatric disorders (N = 179) were autism spectrum disorder (21.8%), anxiety disorder (12.8%), “other” psychiatric disorders (8.9%), attention-deficit hyperactivity disorder, and depressive disorder (7.8% each). Of 179 patients, 88 (49.2%) had ≥1 behavioral problem. Of these (n = 88), the most common (>20%) were sleep difficulties (47.7%), anxiety (43.2%), mood swings (37.5%), depression mood (35.2%), impulsivity (30.7%), severe aggression (23.9%), and overactivity (22.7%). Of 179 patients, four (2.2%) reported abnormal puberty onset, and three (1.7%) reported other reproductive disorders. Of 106 females, 23 (21.7%) reported menstrual cycle disorders and 10 (9.4%) reported amenorrhea. Available data did not show delays in sexual maturation or an association between sexual development and infertility. The results demonstrate that everolimus has a manageable long-term safety profile in the TSC treatment setting. No new safety signals emerged. This substudy also contributed to the mapping of TAND and reproductive clinical features in patients with TSC.
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Affiliation(s)
| | - Martha Feucht
- Universitäts-Klinik für Kinder-und Jugendheilkunde Wien, Vienna, Austria
| | - Alfons Macaya
- Hospital Universitari Vall d’ Hebron, Barcelona, Spain
| | | | - Andreas Hahn
- Abteilung Kinderneurologie, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany
| | - Ricardo Maamari
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | - Yulia Hirschberg
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
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Asad Zadeh Vosta Kolaei F, Cai B, Kanakamedala H, Kim J, Doban V, Zhang S, Shi M. Biomarker Testing Patterns and Treatment Outcomes in Patients With Advanced Non-Small Cell Lung Cancer and MET Exon 14 Skipping Mutations: A Descriptive Analysis From the US. Front Oncol 2022; 12:786124. [PMID: 35280795 PMCID: PMC8915293 DOI: 10.3389/fonc.2022.786124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/27/2022] [Indexed: 12/19/2022] Open
Abstract
Background MET exon 14 skipping mutation (METex14) is observed in ~3% of non-small cell lung cancer (NSCLC) cases and has been shown to be an independent poor prognostic factor associated with shorter overall disease-specific survival. Broad molecular testing can identify this biomarker in patients with advanced NSCLC (aNSCLC) and allow patients to be matched with the appropriate targeted therapy. This study examines biomarker testing patterns and clinical outcomes of chemotherapy and immuno-oncology (IO) monotherapy in aNSCLC patients with METex14. Methods A descriptive retrospective study was conducted using the Flatiron Health-Foundation Medicine Inc. (FMI) clinico-genomic database. Patients with METex14 aNSCLC treated with systemic therapies were included in the biomarker testing analysis. The duration from specimen collection to reported results was assessed for PD-L1- and METex14-tested patients. Clinical outcomes were assessed in patients treated with chemotherapy or IO monotherapy. First-line (1L) and second-line (2L) real-world progression-free survival (rw-PFS) were estimated using Kaplan-Meier analysis. Results Of 91 METex14 patients eligible for the biomarker testing analysis, 77% and 60% received PD-L1 and FMI next-generation sequencing (NGS) testing within 3 months post aNSCLC diagnosis. Of those assessed for both PD-L1 and METex14 (n=9), the median duration between specimen collection and reporting was 1 week shorter for PD-L1 than for FMI NGS. Median 1L rw-PFS was 5.7 months (95% CI, 4.6-7.1) and 2.4 months (95% CI, 1.4-3.2) in patients receiving 1L chemotherapy (n=59) and IO monotherapy (n=18), with 3-month 1L rw-PFS rates of 78% and 33%. Median 2L rw-PFS was 3.5 months (95% CI, 1.9-11.1) and 4.7 months (95% CI, 2.8-12.9) in patients receiving 2L chemotherapy (n=16) and IO monotherapy (n=23), with 3-month 2L rw-PFS rates of 54% and 67%. Conclusions The median time from biopsy to test results appears 1 week shorter for PD-L1 than for FMI NGS. Chemotherapy and IO monotherapy were the most common regimens utilized but with limited PFS.
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Affiliation(s)
| | - Beilei Cai
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | | | - Julia Kim
- Genesis Research, Hoboken, NJ, United States
| | - Vitalii Doban
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | - Shiyu Zhang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | - Michael Shi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
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