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Ljung R, Matino D, Shapiro AD. Recombinant factor IX Fc for the treatment of hemophilia B. Eur J Haematol 2024; 112:678-691. [PMID: 38369860 DOI: 10.1111/ejh.14176] [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: 10/17/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/20/2024]
Abstract
Current hemophilia B treatment guidelines recommend routine prophylaxis with factor IX (FIX) replacement products, tailored to maintain plasma activity at levels that will prevent bleeds. However, plasma FIX activity may not be the primary determinant or best indicator of hemostatic efficacy due to its extravascular distribution. FIX replacement therapy has evolved to include extended half-life (EHL) products that provide effective bleed protection when administered at intervals of 7 days or longer. rFIXFc is a recombinant fusion protein with an extended circulation time. rFIXFc has a biodistribution profile consistent with distribution into extravascular space, where it may support hemostasis at sites of vessel injury independent of circulating plasma activity levels. The safety and efficacy of rFIXFc prophylaxis is well established in adults, adolescents and children including previously untreated patients with hemophilia B, with substantial evidence from clinical trials and real-world clinical practice. This review describes the pharmacokinetic characteristics of rFIXFc, summarizes available safety and efficacy data, and evaluates the use of rFIXFc in special populations. Current hemophilia B treatment challenges, including target FIX plasma levels, perioperative use, and management of patients with comorbidities, are discussed together with the potential role of EHL products in the future treatment landscape of hemophilia B.
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Affiliation(s)
- Rolf Ljung
- Department of Clinical Sciences-Pediatrics, Lund University, Lund, Sweden
| | - Davide Matino
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Amy D Shapiro
- Indiana Hemophilia & Thrombosis Center, Inc, Indianapolis, Indiana, USA
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2
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Zhang X, Zhuang X, Dong J, Fu B, Zhang G, Xu L. Clinical efficacy of conbercept injection on neovascular age-related macular degeneration under different levels of inflammation. ADV CLIN EXP MED 2024; 33:335-342. [PMID: 37747440 DOI: 10.17219/acem/168808] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/12/2022] [Accepted: 06/26/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Age-related macular degeneration (AMD) is considered one of the most common causes of irreversible blindness among elderly patients. Neovascular AMD, which accounts for 10% of all AMD cases, can cause devastating vision loss due to choroidal neovascularization (CNV). The clinical effects and safety of intravitreal injection of conbercept in patients suffering from neovascular AMD have not been fully evaluated. OBJECTIVES The aim of the study was to evaluate the efficacy and safety of intravitreal injection of conbercept in patients with neovascular AMD with different levels of inflammation. MATERIAL AND METHODS A total of 120 consecutive patients with neovascular AMD who underwent intravitreal injection of conbercept (3 injections per month + pro re nata (3 + PRN)) were included and stratified based on the intraocular level of high-sensitivity C-reactive protein (hs-CRP). The level of inflammation was defined as low, medium or high, based on the concentration of hs-CRP prior to injection. Before and after conbercept injections, best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were compared, respectively. Moreover, cytokine markers as well as the frequency of injections and adverse events (AEs) were measured. RESULTS There were significant differences in BCVA and CRT between low, medium and high tertiles. Compared to the baseline, improved BCVA was observed, and CRT declined significantly after operation. Adverse events were most observed in high tertiles. A significant decrease in vascular endothelial growth factor (VEGF), interleukin (IL)-6 and IL-8 was observed after 1 year. CONCLUSIONS The effectiveness of conbercept on neovascular AMD varies depending on the level of inflammation, which could be achieved by administering different injection frequencies at different levels of inflammation. Furthermore, conbercept is associated with the reduction of inflammatory factor (IL-6 and IL-8) levels after intravitreal injection, which suggests that suppressing inflammatory response might contribute to the clinical efficacy of anti-VEGF treatment. Our results provide a novel mechanism for conbercept in patients with neovascular AMD.
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Affiliation(s)
- Xinyue Zhang
- Department of Ophthalmology, Fourth People's Hospital of Shenyang, China
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaotong Zhuang
- Department of Ophthalmology, Fourth People's Hospital of Shenyang, China
| | - Jie Dong
- Department of Ophthalmology, Fourth People's Hospital of Shenyang, China
| | - Bo Fu
- Department of Ophthalmology, Fourth People's Hospital of Shenyang, China
| | - Genghua Zhang
- Department of Ophthalmology, Fourth People's Hospital of Shenyang, China
| | - Li Xu
- Department of Ophthalmology, Fourth People's Hospital of Shenyang, China
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Mitani K, Lee JW, Jang JH, Tomiyama Y, Miyazaki K, Nagafuji K, Usuki K, Uoshima N, Fujisaki T, Kosugi H, Matsumura I, Sasaki K, Kizaki M, Sawa M, Hidaka M, Kobayashi N, Ichikawa S, Yonemura Y, Murotani K, Shimizu M, Matsuda A, Ozawa K, Nakao S. Long-term efficacy and safety of romiplostim in refractory aplastic anemia: follow-up of a phase 2/3 study. Blood Adv 2024; 8:1415-1419. [PMID: 38134300 PMCID: PMC10950812 DOI: 10.1182/bloodadvances.2023010959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/14/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Affiliation(s)
- Kinuko Mitani
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Jong Wook Lee
- Division of Hematology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jun Ho Jang
- Department of Hematology, Sungkyunkwan University Samsung Medical Center, Seoul, Republic of Korea
| | - Yoshiaki Tomiyama
- Department of Blood Transfusion, Osaka University Hospital, Osaka, Japan
| | - Koji Miyazaki
- Department of Transfusion and Cell Transplantation, Kitasato University School of Medicine, Sagamihara, Japan
| | - Koji Nagafuji
- Department of Hematology, Kurume University Hospital, Kurume, Japan
| | - Kensuke Usuki
- Department of Hematology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Nobuhiko Uoshima
- Department of Hematology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Tomoaki Fujisaki
- Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Hiroshi Kosugi
- Department of Hematology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Itaru Matsumura
- Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Ko Sasaki
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Masahiro Kizaki
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Masashi Sawa
- Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan
| | - Michihiro Hidaka
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Naoki Kobayashi
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Satoshi Ichikawa
- Department of Hematology, Tohoku University Hospital, Sendai, Japan
| | - Yuji Yonemura
- Department of Transfusion Medicine and Cell Therapy, Kumamoto University Hospital, Kumamoto, Japan
| | | | - Mami Shimizu
- Department of Medical Affairs, Kyowa Kirin Co, Ltd, Tokyo, Japan
| | - Akira Matsuda
- Department of Hemato-Oncology, Saitama Medical University International Medical Center, Saitama Medical University, Saitama, Japan
| | - Keiya Ozawa
- Division of Hematology, Jichi Medical University, Tochigi, Japan
| | - Shinji Nakao
- Division of Hematology/Respiratory Medicine, Faculty of Medicine, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
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Lanzetta P, Korobelnik JF, Heier JS, Leal S, Holz FG, Clark WL, Eichenbaum D, Iida T, Xiaodong S, Berliner AJ, Schulze A, Schmelter T, Schmidt-Ott U, Zhang X, Vitti R, Chu KW, Reed K, Rao R, Bhore R, Cheng Y, Sun W, Hirshberg B, Yancopoulos GD, Wong TY. Intravitreal aflibercept 8 mg in neovascular age-related macular degeneration (PULSAR): 48-week results from a randomised, double-masked, non-inferiority, phase 3 trial. Lancet 2024; 403:1141-1152. [PMID: 38461841 DOI: 10.1016/s0140-6736(24)00063-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Intravitreal aflibercept 8 mg could improve treatment outcomes and provide sustained disease control in patients with neovascular age-related macular degeneration (nAMD), with extended dosing compared with aflibercept 2 mg. METHODS PULSAR is a phase 3, randomised, three-group, double-masked, non-inferiority, 96-week trial conducted across 223 sites worldwide. Adults with nAMD were randomised 1:1:1 to aflibercept 8 mg every 12 weeks (8q12), aflibercept 8 mg every 16 weeks (8q16), or aflibercept 2 mg every 8 weeks (2q8), following three initial monthly doses in all groups. From week 16, patients in the aflibercept 8 mg groups had their dosing interval shortened if pre-specified dose regimen modification criteria denoting disease activity were met. The primary endpoint was change from baseline in best-corrected visual acuity (BCVA) at week 48. All patients with at least one dose of study treatment were included in the efficacy and safety analyses. This trial is registered with ClinicalTrials.gov (NCT04423718) and is ongoing. FINDINGS Of 1011 patients randomised to aflibercept 8q12 (n=336), 8q16 (n=338), or 2q8 (n=337) between Aug 11, 2020, and July 30, 2021, 1009 patients received study treatment (aflibercept 8q12 n=335; aflibercept 8q16 n=338; and aflibercept 2q8 n=336). Aflibercept 8q12 and 8q16 showed non-inferior BCVA gains versus aflibercept 2q8 (mean BCVA change from baseline +6·7 [SD 12·6] and +6·2 [11·7] vs +7·6 [12·2] letters). The least squares mean differences between aflibercept 8q12 versus 2q8 and 8q16 versus 2q8, respectively, were -0·97 (95% CI -2·87 to 0·92) and -1·14 (-2·97 to 0·69) letters (non-inferiority margin at 4 letters). The incidence of ocular adverse events in the study eye was similar across groups (aflibercept 8q12 n=129 [39%]; aflibercept 8q16 n=127 [38%]; and aflibercept 2q8 n=130 [39%]). INTERPRETATION Aflibercept 8 mg showed efficacy and safety with extended dosing intervals, which has the potential to improve the management of patients with nAMD. FUNDING Bayer AG and Regeneron Pharmaceuticals.
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Affiliation(s)
- Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy; Istituto Europeo di Microchirurgia Oculare-IEMO, Udine, Italy
| | - Jean-François Korobelnik
- Service d'Ophtalmologie, CHU Bordeaux, Bordeaux, France; Bordeaux Population Health Research Center, INSERM, UMR1219, F-33000, University of Bordeaux, Bordeaux, France
| | | | | | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | | | - Tomohiro Iida
- Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | | | | | | | | | | | - Xin Zhang
- Bayer Consumer Care AG, Basel, Switzerland
| | | | - Karen W Chu
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | - Rohini Rao
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Rafia Bhore
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | - Wei Sun
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | | | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Tsinghua Medicine, Tsinghua University, Beijing, China
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Brown DM, Boyer DS, Do DV, Wykoff CC, Sakamoto T, Win P, Joshi S, Salehi-Had H, Seres A, Berliner AJ, Leal S, Vitti R, Chu KW, Reed K, Rao R, Cheng Y, Sun W, Voronca D, Bhore R, Schmidt-Ott U, Schmelter T, Schulze A, Zhang X, Hirshberg B, Yancopoulos GD, Sivaprasad S. Intravitreal aflibercept 8 mg in diabetic macular oedema (PHOTON): 48-week results from a randomised, double-masked, non-inferiority, phase 2/3 trial. Lancet 2024; 403:1153-1163. [PMID: 38461843 DOI: 10.1016/s0140-6736(23)02577-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 03/12/2024]
Abstract
BACKGROUND A high-dose formulation of intravitreal aflibercept (8 mg) could improve treatment outcomes in diabetic macular oedema (DMO) by requiring fewer injections than the standard comparator, aflibercept 2 mg. We report efficacy and safety results of aflibercept 8 mg versus 2 mg in patients with DMO. METHODS PHOTON was a randomised, double-masked, non-inferiority, phase 2/3 trial performed at 138 hospitals and specialty retina clinics in seven countries. Eligible patients were adults aged 18 years or older with type 1 or 2 diabetes and centre-involved DMO. Patients were randomly assigned (1:2:1) to intravitreal aflibercept 2 mg every 8 weeks (2q8), aflibercept 8 mg every 12 weeks (8q12), or aflibercept 8 mg every 16 weeks (8q16), following initial monthly dosing. From week 16, dosing intervals for the aflibercept 8 mg groups were shortened if patients met prespecified dose regimen modification criteria denoting disease activity. The primary endpoint was change from baseline in best-corrected visual acuity (BCVA) at week 48 (non-inferiority margin of 4 letters). Efficacy and safety analyses included all randomly assigned patients who received at least one dose of study treatment. This trial is registered with ClinicalTrials.gov (NCT04429503). FINDINGS Between June 29, 2020, and June 28, 2021, 970 patients were screened for eligibility. After exclusions, 660 patients were enrolled and randomly assigned to receive aflibercept 8q12 (n=329), 8q16 (n=164), or 2q8 (n=167); two patients were randomly assigned in error and did not receive treatment. 658 (99·7%) patients were treated and included in the full analysis set and safety analysis set (8q12 n=328, 8q16 n=163, and 2q8 n=167). Mean patient age was 62·3 years (SD 10·4). 401 (61%) patients were male. 471 (72%) patients were White. Aflibercept 8q12 and 8q16 demonstrated non-inferior BCVA gains to aflibercept 2q8 (BCVA mean change from baseline 8·8 letters [SD 9·0] in the 8q12 group, 7·9 letters [8·4] in the 8q16 group, and 9·2 letters [9·0] in the 2q8 group). The difference in least squares means was -0·57 letters (95% CI -2·26 to 1·13, p value for non-inferiority <0·0001) between 8q12 and 2q8 and -1·44 letters (-3·27 to 0·39, p value for non-inferiority 0·0031) between aflibercept 8q16 and 2q8. Proportions of patients with ocular adverse events in the study eye were similar across groups (8q12 n=104 [32%], 8q16 n=48 [29%], and 2q8 n=46 [28%]). INTERPRETATION Aflibercept 8 mg demonstrated efficacy and safety with extended dosing intervals and could decrease treatment burden in patients with DMO. FUNDING Regeneron Pharmaceuticals and Bayer.
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Affiliation(s)
- David M Brown
- Retina Consultants of Texas, Retina Consultants of America, Houston, TX, USA
| | | | - Diana V Do
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Charles C Wykoff
- Retina Consultants of Texas, Retina Consultants of America, Houston, TX, USA; Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University, Kagoshima, Japan
| | | | - Sunir Joshi
- Pinnacle Research Institute, Fort Lauderdale, FL, USA
| | - Hani Salehi-Had
- Retina Associates of Southern California, Huntington Beach, CA, USA
| | | | | | | | | | - Karen W Chu
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | - Rohini Rao
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | - Wei Sun
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | - Rafia Bhore
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | | | | | - Xin Zhang
- Bayer Consumer Care, Basel, Switzerland
| | | | | | - Sobha Sivaprasad
- National Institute for Health Research, Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK.
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Imazio M, Klein AL, Brucato A, Abbate A, Arad M, Cremer PC, Insalaco A, LeWinter MM, Lewis BS, Lin D, Luis SA, Nicholls SJ, Sutej P, Wasserstrum Y, Clair J, Agarwal I, Wang S, Paolini JF. Sustained Pericarditis Recurrence Risk Reduction With Long-Term Rilonacept. J Am Heart Assoc 2024; 13:e032516. [PMID: 38471825 PMCID: PMC11010039 DOI: 10.1161/jaha.123.032516] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/14/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Rilonacept, a once-weekly interleukin-1 alpha and beta cytokine trap, reduced pericarditis recurrence in the phase 3 study, RHAPSODY (Rilonacept Inhibition of Interleukin-1 Alpha and Beta for Recurrent Pericarditis: A Pivotal Symptomatology and Outcomes Study). The RHAPSODY long-term extension further explored recurrent pericarditis natural history and treatment duration decision-making during 24 additional months of open-label rilonacept treatment. METHODS AND RESULTS Seventy-four patients commenced the long-term extension, with a median (maximum) total rilonacept duration of 22 (35) months. Individually, 18 months after the most proximal pericarditis recurrence, investigators decided to continue rilonacept on study, suspend rilonacept for off-treatment observation (rescue allowed), or discontinue the study. The annualized incidence of pericarditis recurrence on rilonacept up to the 18-month decision milestone was 0.04 events/patient-year versus 4.4 events/patient-year prestudy while on oral therapies. At the 18-month decision milestone, 64% (33/52) continued rilonacept, 15% (8/52) suspended rilonacept for observation, and 21% (11/52) discontinued the study. Among the 33 patients (1/33; 3.0%) continuing rilonacept (median time to recurrence could not be estimated due to too few events), a single recurrence occurred 4 weeks after a treatment interruption. Among patients suspending rilonacept, 75% (6/8) experienced recurrence (median time to recurrence, 11.8 weeks [95% CI, 3.7 weeks to not estimable]). There was a 98% reduction in risk of pericarditis recurrence among patients continuing rilonacept treatment after the 18-month decision milestone versus those suspending treatment for observation (hazard ratio, 0.02; P<0.0001). CONCLUSIONS In the RHAPSODY long-term extension, continued rilonacept treatment resulted in continued response; treatment suspension at the 18-month decision milestone was associated with pericarditis recurrence. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03737110.
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Affiliation(s)
- Massimo Imazio
- Department of Medicine (DMED), University of Udine and Cardiothoracic DepartmentUniversity Hospital Santa Maria della Misericordia, ASUFCUdineItaly
| | | | | | - Antonio Abbate
- Berne Cardiovascular Research Center, School of MedicineUniversity of VirginiaCharlottesvilleVAUSA
| | - Michael Arad
- Leviev Heart Center, Ramat GanTel Aviv University School of MedicineRamat GanIsrael
| | | | - Antonella Insalaco
- Division of Rheumatology, Ospedale Pediatrico Bambino GesùIRCCS [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center]RomeItaly
| | | | - Basil S. Lewis
- Lady Davis Carmel Medical Center and Technion‐Israel Institute of TechnologyHaifaIsrael
| | - David Lin
- Abbott Northwestern HospitalMinneapolisMNUSA
| | | | | | | | - Yishay Wasserstrum
- Leviev Heart Center, Ramat GanTel Aviv University School of MedicineRamat GanIsrael
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Wong A, Ahuja T, Cirrone F, Xiang E. Antithrombotic and hemostatic stewardship: Evaluation of romiplostim for treatment of thrombocytopenia at a large academic medical center. J Oncol Pharm Pract 2024; 30:246-250. [PMID: 37132025 DOI: 10.1177/10781552231173138] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Romiplostim is indicated for immune thrombocytopenia (ITP), though is often used off-label for other indications such as chemotherapy-induced thrombocytopenia (CIT) and thrombocytopenia post hematopoietic stem cell transplantation (HSCT). Although romiplostim is FDA approved at a starting dose of 1 mcg/kg, it is often initiated at 2-4 mcg/kg depending on the severity of thrombocytopenia in clinical practice. Given the limited data, but interest in higher doses of romiplostim for indications other than ITP, we aimed to assess our inpatient romiplostim utilization at NYU Langone Health.This was a single-center, retrospective review of 84 adult patients from January 2019 to July 2021. The top three indications were ITP (51, 60.7%), CIT (13, 15.5%), and HSCT (10, 11.9%). The median initial romiplostim dose was 3.8 mcg/kg (range, 0.9-10.8). 51% of patients achieved a platelet count of ≥50 × 109/L by the end of week 1 of therapy. For patients achieving goal platelets by the end of week 1, the median dose of romiplostim was 2.4 mcg/kg (range, 0.9-10.8). There was 1 episode of thrombosis and 1 episode of stroke.We found that higher than FDA-recommended initial doses should be considered to achieve a platelet response. It appears to be safe to initiate romiplostim as higher doses, and to increase doses by greater increments than 1 mcg/kg in order to achieve a platelet response. Future prospective studies are needed to confirm the safety and efficacy of romiplostim in off-label indications and should evaluate clinical outcomes such as bleeding and need for transfusions.
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Affiliation(s)
- Adrian Wong
- NYU Langone Health - Department of Pharmacy, New York, NY, USA
| | - Tania Ahuja
- NYU Langone Health - Department of Pharmacy, New York, NY, USA
| | - Frank Cirrone
- Perlmutter Cancer Center - Department of Pharmacy, New York, NY, USA
| | - Elaine Xiang
- NYU Langone Health - Department of Pharmacy, New York, NY, USA
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Liao K, Mackenzie H, Ait-Oudhia S, Manimaran S, Zeng Y, Akers T, Yun T, de Oliveira Pena J. The Impact of Immunogenicity on the Pharmacokinetics, Efficacy, and Safety of Sotatercept in a Phase III Study of Pulmonary Arterial Hypertension. Clin Pharmacol Ther 2024; 115:478-487. [PMID: 38012534 DOI: 10.1002/cpt.3116] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023]
Abstract
Sotatercept, a soluble fusion protein comprising the extracellular domain of activin receptor type IIA linked to the Fc portion of human IgG1, is a first-in-class activin signaling inhibitor under development for the treatment of pulmonary arterial hypertension (PAH). We evaluated antidrug antibody (ADA) development and determined the effects of immunogenicity on the pharmacokinetics (PKs), efficacy, and safety of sotatercept in STELLAR, a multicenter, double-blind phase III trial (NCT04576988) wherein participants with PAH were randomized 1:1 to receive sotatercept (starting dose 0.3; target dose 0.7 mg/kg) or placebo subcutaneously every 3 weeks in combination with background therapies for ≤ 72 weeks. ADA-positive (ADA-POS) participants were identified and characterized for neutralizing antibodies (NAbs). PKs, efficacy, and safety were evaluated by ADA and NAb status. Of 162 evaluable participants, 42 (25.9%) were ADA-POS through week 24, of whom 11 (6.8%) were also NAb-POS. Median onset of ADAs was 3.29 weeks (interquartile range (IQR): 3.14-6.14), and median duration was 6 weeks (IQR: 3.14-17.86). No clinically meaningful differences were found across subgroups that were ADA-NEG, ADA-POS/NAb-NEG, and ADA-POS/NAb-POS, in terms of PKs (sotatercept trough concentration over time, mean postdose trough concentration at the end of treatment, and clearance), efficacy (changes from baseline in 6-minute walk distance, pulmonary vascular resistance, and N-terminal pro-B-type natriuretic peptide levels), and safety (incidence of hypersensitivity, anaphylactic reactions, and administration site reactions). We conclude that ADA incidence from sotatercept treatment was 25.9% and did not meaningfully affect the PKs, efficacy, or safety of sotatercept in participants with PAH.
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Affiliation(s)
- Karen Liao
- Merck & Co., Inc., Rahway, New Jersey, USA
| | | | | | | | | | - Tad Akers
- Merck & Co., Inc., Rahway, New Jersey, USA
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Zhou R, Lu P, He M, Chen J, Shi Y, Han F, Cai Y. A real-world disproportionality analysis of anti-VEGF drugs from the FDA Adverse Event Reporting System. Expert Opin Drug Saf 2024; 23:363-371. [PMID: 37665052 DOI: 10.1080/14740338.2023.2250717] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/10/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND The association between anti-vascular endothelial growth factor (VEGF) drugs and ocular adverse events (AEs) has been reported, but large real-world studies of their association with systemic AEs are still lacking. METHODS A disproportionality analysis of reports from the FDA Adverse Event Reporting System from January 2004 to September 2021 was conducted to detect the significant ADR signals with anti-VEGF drugs (including aflibercept, bevacizumab, brolucizumab, pegaptanib, and ranibizumab). RESULTS A total of 2980 reported cases with 7125 drug-AEs were included. Five drugs were all associated with eye disorders, and pegaptanib and ranibizumab were also associated with cardiac disorders. For ranibizumab, pegaptanib, bevacizumab and aflibercept, the proportions of cardiac AEs were 8.57%, 5.62%, 3.43% and 3.20%, respectively, and the proportions of central nervous AEs were 8.81%, 7.41, 5.86% and 5.68%, respectively. In multiple comparisons, ranibizumab was significantly higher than bevacizumab and aflibercept in the proportion of cardiac AEs (P < 0.001), and ranibizumab was significantly higher than aflibercept in central nervous AEs (P < 0.001). CONCLUSIONS Our findings support the associations between anti-VEGF drugs and ocular AEs, cardiac AEs, and central nervous AEs. After intravitreal injection, attention should not only be paid to ocular symptoms, but also to systemic symptoms.
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Affiliation(s)
- Ruishan Zhou
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Peiwen Lu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Mingxiu He
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Junheng Chen
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yiyang Shi
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Fangfang Han
- School of Medical Information and Engineering, Guangdong Pharmaceutical University, Guangzhou, China
- NMPA Key Laboratory for Technology Research and Evaluation of Pharmacovigilance, Guangzhou, China
| | - Yongming Cai
- School of Medical Information and Engineering, Guangdong Pharmaceutical University, Guangzhou, China
- NMPA Key Laboratory for Technology Research and Evaluation of Pharmacovigilance, Guangzhou, China
- Guangdong Provincial Traditional Chinese Medicine Precision Medicine Big Data Engineering Technology Research Center, Guangzhou, China
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10
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Shao Y, He L, Ding S, Fu R. Luspatercept for the treatment of congenital sideroblastic anemia: Two case reports. Curr Res Transl Med 2024; 72:103438. [PMID: 38244303 DOI: 10.1016/j.retram.2024.103438] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/02/2024] [Indexed: 01/22/2024]
Abstract
Congenital sideroblastic anemia (CSA) is a group of disorders caused by different genetic mutations that result in low iron utilization and ineffective erythropoiesis. Current treatments are limited, and some patients do not respond to vitamin B6 therapy. Luspatercept is a novel erythropoietic maturation agent approved for adult β-thalassemia and Myelodysplastic syndromes with ring sideroblasts (MDS-RS) associated with ineffective erythropoiesis. Here we report 2 patients with CSA due to mutations in ALAS2 and SLC25A38 genes who became unresponsive after a period of treatment with vitamin B6 and iron chelators but achieved transfusion independence and a markedly reduced spleen after combination with luspatercept.
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Affiliation(s)
- Yuanyuan Shao
- Department of Hematology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin 300052, China
| | - Li He
- Department of Hematology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin 300052, China
| | - Shaoxue Ding
- Department of Hematology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin 300052, China
| | - Rong Fu
- Department of Hematology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin 300052, China.
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11
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Tang CC, Lim J, Loo LS, Jung H, Konig M, Tham LS. Practical Applications of a Nausea and Vomiting Model in the Clinical Development of Additional Doses of Dulaglutide. J Clin Pharmacol 2024; 64:215-226. [PMID: 37853524 DOI: 10.1002/jcph.2373] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 10/16/2023] [Indexed: 10/20/2023]
Abstract
Dulaglutide 3.0 and 4.5 mg weekly doses were approved for additional glycemic control in adult patients with type 2 diabetes inadequately controlled with metformin and 0.75 or 1.5 mg weekly doses of dulaglutide. Effects such as nausea and vomiting are commonly reported with dulaglutide and other glucagon-like peptide-1 receptor agonist therapies. Based on a pharmacokinetic/pharmacodynamic model-informed approach, a stepwise dose-escalation scheme with 4-week intervals between dose increments was suggested to mitigate gastrointestinal events for dulaglutide. These gastrointestinal events are dose dependent and attenuate over time with repeated dosing. A Markov chain Monte Carlo pharmacokinetic/pharmacodynamic joint model was developed using AWARD-11 data (N = 1842) to optimize dulaglutide dose escalation to 3.0 and 4.5 mg to mitigate gastrointestinal events. Model simulations evaluated probabilities of nausea and vomiting events for various dosing scenarios in patients needing higher doses for additional glycemic control. The model indicated that patients may dose escalate from 1.5 to 3.0 mg, then 4.5 mg weekly after at least 4 weeks on each dose. No clinically meaningful differences in nausea or vomiting events were expected when patients escalated to 3.0 or 4.5 mg following initiation at 0.75 or 1.5 mg dulaglutide. Based on the findings of this model, a minimum 4-week duration at each dose before escalation was appropriate to reduce gastrointestinal events of dulaglutide, consistent with observed gastrointestinal events data from the AWARD-11 study and supporting the currently recommended dose-escalation regimen of dulaglutide doses of 3.0 and 4.5 mg for additional glycemic control.
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Affiliation(s)
- Cheng Cai Tang
- Lilly Centre for Clinical Pharmacology, Singapore, Singapore
| | - Jean Lim
- Lilly Centre for Clinical Pharmacology, Singapore, Singapore
| | | | - Heike Jung
- Lilly Deutschland GmbH, Bad Homburg, Germany
| | | | - Lai San Tham
- Lilly Centre for Clinical Pharmacology, Singapore, Singapore
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12
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Coleman N, Stephen B, Fu S, Karp D, Subbiah V, Ahnert JR, Piha‐Paul SA, Wright J, Fessahaye SN, Ouyang F, Yilmaz B, Meric‐Bernstam F, Naing A. Phase I study of sapanisertib (CB-228/TAK-228/MLN0128) in combination with ziv-aflibercept in patients with advanced solid tumors. Cancer Med 2024; 13:e6877. [PMID: 38400671 PMCID: PMC10891443 DOI: 10.1002/cam4.6877] [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: 09/05/2023] [Revised: 11/01/2023] [Accepted: 11/27/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Sapanisertib is a potent ATP-competitive, dual inhibitor of mTORC1/2. Ziv-aflibercept is a recombinant fusion protein comprising human VEGF receptor extracellular domains fused to human immunoglobulin G1. HIF-1α inhibition in combination with anti-angiogenic therapy is a promising anti-tumor strategy. This Phase 1 dose-escalation/expansion study assessed safety/ tolerability of sapanisertib in combination with ziv-aflibercept in advanced solid tumors. METHODS Fifty-five patients with heavily pre-treated advanced metastatic solid tumors resistant or refractory to standard treatment received treatment on a range of dose levels. RESULTS Fifty-five patients were enrolled and treated across a range of dose levels. Forty were female (73%), median age was 62 (range: 21-79), and ECOG PS was 0 (9, 16%) or 1 (46, 84%). Most common tumor types included ovarian (8), colorectal (8), sarcoma (8), breast (3), cervical (4), and endometrial (4). Median number of prior lines of therapy was 4 (range 2-11). Sapanisertib 4 mg orally 3 days on and 4 days off plus 3 mg/kg ziv-aflibercept IV every 2 weeks on a 28-day cycle was defined as the maximum tolerated dose. Most frequent treatment-related grade ≥2 adverse events included hypertension, fatigue, anorexia, hypertriglyceridemia, diarrhea, nausea, mucositis, and serum lipase increase. There were no grade 5 events. In patients with evaluable disease (n = 50), 37 patients (74%) achieved stable disease (SD) as best response, two patients (4%) achieved a confirmed partial response (PR); disease control rate (DCR) (CR + SD + PR) was 78%. CONCLUSION The combination of sapanisertib and ziv-aflibercept was generally tolerable and demonstrated anti-tumor activity in heavily pre-treated patients with advanced malignancies.
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Affiliation(s)
- Niamh Coleman
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Present address:
Department of Medical OncologyTrinity St. James' Cancer Institute, St. James's Hospital Trinity College MedicineDublinIreland
| | - Bettzy Stephen
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Siqing Fu
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Daniel Karp
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Vivek Subbiah
- Early Phase Drug DevelopmentSarah Cannon Research InstituteNashvilleTennesseeUSA
| | - Jordi Rodon Ahnert
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Sarina A. Piha‐Paul
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - John Wright
- National Cancer Institute (NCI), Cancer Therapy Evaluation Program (CTEP)BethesdaMarylandUSA
| | - Senait N. Fessahaye
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Fengying Ouyang
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Bulent Yilmaz
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Funda Meric‐Bernstam
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Khalifa Institute for Personalized Cancer TherapyMD Anderson Cancer CenterHoustonTexasUSA
- Department of Surgical OncologyMD Anderson Cancer CenterHoustonTexasUSA
| | - Aung Naing
- Department of Investigational Cancer TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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13
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Osonoi T, Oura T, Hirase T. Glycaemic control, body weight, and safety of tirzepatide versus dulaglutide by baseline glycated haemoglobin level in Japanese patients with type 2 diabetes: A subgroup analysis of the SURPASS J-mono study. Diabetes Obes Metab 2024; 26:126-134. [PMID: 37794628 DOI: 10.1111/dom.15296] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023]
Abstract
AIM To evaluate glycaemic control, body weight, and safety outcomes following treatment with tirzepatide or dulaglutide in patients with type 2 diabetes (T2D) with a baseline haemoglobin (HbA1c) level of ≤8.5% (≤69 mmol/mol) versus >8.5% (>69 mmol/mol). MATERIALS AND METHODS SURPASS J-mono was a 52-week, multicentre, randomized, double-blind, parallel, active-controlled, phase 3 study conducted in Japan. In this exploratory subgroup analysis of SURPASS J-mono, we examined mean change in HbA1c and body weight and the incidence of adverse events (AEs) in patients with a baseline HbA1c of ≤8.5% versus >8.5% after treatment with tirzepatide (5, 10 or 15 mg) or dulaglutide 0.75 mg. RESULTS Of 636 randomized participants, 203 had a baseline HbA1c of >8.5% and 433 had a baseline HbA1c of ≤8.5% (range ≥7.0% to ≤10.0%). Both subgroups showed significantly greater reductions in HbA1c and body weight with any-dose tirzepatide versus dulaglutide 0.75 mg, with greater HbA1c reductions observed in patients with a baseline HbA1c of >8.5% treated with tirzepatide (least squares mean [LSM] differences of -3.13% to -3.86%) or dulaglutide (LSM -1.81%) compared with patients with a baseline HbA1c of ≤8.5% (LSM -2.00% to -2.32%) or dulaglutide (LSM -1.05%; treatment-by-baseline HbA1c subgroup interaction P ≤ 0.001). For the tirzepatide treatment arms, LSM change from baseline in body weight ranged from -6.7 to -10.7 kg for the baseline HbA1c ≤8.5% subgroup and from -4.0 to -10.6 kg for the baseline HbA1c >8.5% subgroup, compared with -0.6 kg and -0.4 kg, respectively, for the dulaglutide arm. The incidence of hypoglycaemia was low, with no substantial difference in hypoglycaemia or treatment-emergent AEs between subgroups. CONCLUSIONS Regardless of baseline HbA1c (≤8.5% or >8.5%), tirzepatide at doses of 5, 10 and 15 mg is effective in Japanese patients with T2D compared with dulaglutide 0.75 mg in terms of glycaemic control and body weight reduction, with an adequate safety profile consistent with previous reports.
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Affiliation(s)
| | - Tomonori Oura
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K, Kobe, Japan
| | - Tetsuaki Hirase
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K, Kobe, Japan
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14
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Provan D. Real-world evidence confirms thrombopoietin receptor agonists are safe and effective for all stages of immune thrombocytopenia. Am J Hematol 2024; 99:4-5. [PMID: 38063326 DOI: 10.1002/ajh.27129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Drew Provan
- Centre for Immunology, Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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15
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McLaughlin V, Alsumali A, Liu R, Klok R, Martinez EC, Nourhussein I, Bernotas D, Chevure J, Pausch C, De Oliveira Pena J, Lautsch D, Hoeper MM. Population Health Model Predicting the Long-Term Impact of Sotatercept on Morbidity and Mortality in Patients with Pulmonary Arterial Hypertension (PAH). Adv Ther 2024; 41:130-151. [PMID: 37851297 PMCID: PMC10796519 DOI: 10.1007/s12325-023-02684-x] [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: 08/15/2023] [Accepted: 09/08/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) is a rare, progressive disease associated with significant morbidity and mortality. The phase 3 STELLAR trial tested sotatercept plus background therapy (BGT) versus placebo plus BGT. BGT was comprised of mono-, double-, or triple-PAH targeted therapy. Building on STELLAR findings, we employed a population health model to assess the potential long-term clinical impact of sotatercept. METHODS Based on the well-established ESC/ERS 4-strata risk assessment approach, we developed a six-state Markov-type model (low risk, intermediate-low risk, intermediate-high risk, high risk, lung/heart-lung transplant, and death) to compare the clinical outcomes of sotatercept plus BGT versus BGT alone over a lifetime horizon. State-transition probabilities were obtained from STELLAR. Risk stratum-adjusted mortality and lung/heart-lung transplant probabilities were based on COMPERA PAH registry data, and the post-transplant mortality probability was obtained from existing literature. Model outcomes were discounted at 3% annually. Sensitivity analyses were conducted to examine model robustness. RESULTS In the base case, sotatercept plus BGT was associated with longer life expectancy from model baseline (16.5 vs 5.1 years) versus BGT alone, leading to 11.5 years gained per patient. Compared with BGT alone, sotatercept plus BGT was further associated with a gain in infused prostacyclin-free life years per patient, along with 683 PAH hospitalizations and 4 lung/heart-lung transplant avoided per 1000 patients. CONCLUSIONS According to this model, adding sotatercept to BGT increased life expectancy by roughly threefold among patients with PAH while reducing utilization of infused prostacyclin, PAH hospitalizations, and lung/heart-lung transplants. Real-world data are needed to confirm these findings. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT04576988 (STELLAR).
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Affiliation(s)
- Vallerie McLaughlin
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
| | | | | | | | | | | | | | | | - Christine Pausch
- Innovation Center Real-World Evidence, GWT-TUD GmbH, Dresden, Germany
| | | | | | - Marius M Hoeper
- Department for Respiratory Medicine and Infectious Diseases and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany
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16
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Hassel JC, Piperno-Neumann S, Rutkowski P, Baurain JF, Schlaak M, Butler MO, Sullivan RJ, Dummer R, Kirkwood JM, Orloff M, Sacco JJ, Ochsenreither S, Joshua AM, Gastaud L, Curti B, Piulats JM, Salama AKS, Shoushtari AN, Demidov L, Milhem M, Chmielowski B, Kim KB, Carvajal RD, Hamid O, Collins L, Ranade K, Holland C, Pfeiffer C, Nathan P. Three-Year Overall Survival with Tebentafusp in Metastatic Uveal Melanoma. N Engl J Med 2023; 389:2256-2266. [PMID: 37870955 DOI: 10.1056/nejmoa2304753] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND Tebentafusp, a T-cell receptor-bispecific molecule that targets glycoprotein 100 and CD3, is approved for adult patients who are positive for HLA-A*02:01 and have unresectable or metastatic uveal melanoma. The primary analysis in the present phase 3 trial supported a long-term survival benefit associated with the drug. METHODS We report the 3-year efficacy and safety results from our open-label, phase 3 trial in which HLA-A*02:01-positive patients with previously untreated metastatic uveal melanoma were randomly assigned in a 2:1 ratio to receive tebentafusp (tebentafusp group) or the investigator's choice of therapy with pembrolizumab, ipilimumab, or dacarbazine (control group), with randomization stratified according to the lactate dehydrogenase level. The primary end point was overall survival. RESULTS At a minimum follow-up of 36 months, median overall survival was 21.6 months in the tebentafusp group and 16.9 months in the control group (hazard ratio for death, 0.68; 95% confidence interval, 0.54 to 0.87). The estimated percentage of patients surviving at 3 years was 27% in the tebentafusp group and 18% in the control group. The most common treatment-related adverse events of any grade in the tebentafusp group were rash (83%), pyrexia (76%), pruritus (70%), and hypotension (38%). Most tebentafusp-related adverse events occurred early during treatment, and no new adverse events were observed with long-term administration. The percentage of patients who discontinued treatment because of adverse events continued to be low in both treatment groups (2% in the tebentafusp group and 5% in the control group). No treatment-related deaths occurred. CONCLUSIONS This 3-year analysis supported a continued long-term benefit of tebentafusp for overall survival among adult HLA-A*02:01-positive patients with previously untreated metastatic uveal melanoma. (Funded by Immunocore; IMCgp100-202 ClinicalTrials.gov number, NCT03070392; EudraCT number, 2015-003153-18.).
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Affiliation(s)
- Jessica C Hassel
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Sophie Piperno-Neumann
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Piotr Rutkowski
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Jean-Francois Baurain
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Max Schlaak
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Marcus O Butler
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Ryan J Sullivan
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Reinhard Dummer
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - John M Kirkwood
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Marlana Orloff
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Joseph J Sacco
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Sebastian Ochsenreither
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Anthony M Joshua
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Lauris Gastaud
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Brendan Curti
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Josep M Piulats
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - April K S Salama
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Alexander N Shoushtari
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Lev Demidov
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Mohammed Milhem
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Bartosz Chmielowski
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Kevin B Kim
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Richard D Carvajal
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Omid Hamid
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Laura Collins
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Koustubh Ranade
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Chris Holland
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Constance Pfeiffer
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
| | - Paul Nathan
- From the University Hospital Heidelberg, Heidelberg (J.C.H.), the Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich (M.S.), and the Department of Dermatology, Venereology, and Allergology (M.S.) and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center (S.O.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Department of Hematology, Oncology, and Tumor Immunology and the Comprehensive Cancer Center, Berlin Institute of Health (S.O.), Berlin - all in Germany; Institut Curie, Paris (S.P.-N.), and Centre Antoine Lacassagne, Nice (L.G.) - both in France; Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (P.R.); Institut Roi Albert II Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels (J.-F.B.); Princess Margaret Cancer Centre, the Department of Medical Oncology and Hematology, and the Department of Immunology, University of Toronto, Toronto (M.O.B.); Massachusetts General Hospital and Dana-Farber Cancer Institute - both in Boston (R.J.S.); University of Zürich Hospital, Zürich, Switzerland (R.D.); University of Pittsburgh Medical Center, Pittsburgh (J.M.K.), Sidney Kimmel Cancer Center, Jefferson University, Philadelphia (M.O.), and Immunocore, Conshohocken (C.P.) - all in Pennsylvania; the Clatterbridge Cancer Centre NHS Foundation Trust, Wirral (J.J.S.), University of Liverpool, Liverpool (J.J.S.), Immunocore, Abingdon-on-Thames (L.C.), and Mount Vernon Cancer Centre, Northwood and UCLH, London (P.N.) - all in the United Kingdom; Kinghorn Cancer Centre, Saint Vincent's Hospital, Darlinghurst, NSW, Australia (A.M.J.); Providence Portland Medical Center, Portland, OR (B. Curti); Institut Català d'Oncologia and the Cancer Immunotherapy Group, OncoBell, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, and Centro de Investigación Biomédica en Red de Cáncer, Madrid - all in Spain (J.M.P.); Duke University, Durham, NC (A.K.S.S.); Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York (A.N.S.), and Northwell Health Cancer Institute, New Hyde Park (R.D.C.) - all in New York; N.N. Blokhin National Medical Research Center of Oncology, Moscow (L.D.); University of Iowa Hospitals and Clinics, Iowa City (M.M.); Jonsson Comprehensive Cancer Center, University of California (B. Chmielowski), and the Angeles Clinic and Research Institute, Cedars-Sinai Affiliate (O.H.), Los Angeles, and California Pacific Medical Center, San Francisco (K.B.K.); and Immunocore, Rockville, MD (K.R., C.H.)
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Grottke O, Rieg A, Ulmer F, Hein M. Bleeding management: rFVIIIFc in hemophilia A and liver transplantation. Anaesthesiologie 2023; 72:883-886. [PMID: 37563315 PMCID: PMC10692241 DOI: 10.1007/s00101-023-01320-1] [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] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND In patients with severe hemophilia A prolonged bleeding may occur even in cases of minor trauma or surgery. OBJECTIVE To investigate the feasibility and efficacy of a recombinant extended half-life (EHL) FVIII concentrate for perioperative bleeding management in a patient with severe hemophilia A undergoing liver transplantation. MATERIAL AND METHODS Prior to transplantation FVIII activity and perioperatively required FVIII supply were estimated. In an individualized approach efmoroctocog alfa was supplemented if the intrinsic clotting time in the thrombelastometry was > 170 s. RESULTS The patient perioperatively received a total of 28,000 IU efmoroctocog alfa. No signs of hemorrhage or complications were detected and no further intervention was necessary. CONCLUSION The present case demonstrates that the use of an EHL FVIII is suitable for a successful perioperative bleeding control even in hemophilia patients at a high bleeding risk during major surgery. Due to the EHL constant FVIII levels could be achieved with relatively few injections. In order to confirm the obtained results, more real-world data in different operative settings are essential. Further research is needed on the use of thrombelastometry to guide substitution of factor VIII perioperatively.
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Affiliation(s)
- Oliver Grottke
- Department of Anaesthesiology, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Annette Rieg
- Department of Anaesthesiology, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Florian Ulmer
- Department of Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Marc Hein
- Department of Anaesthesiology, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
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Guo L, Li L, Yu Q, Wang N, Chen J, Xi Y, Wang H, Wang Y, Xu J. Safety and effectiveness of dulaglutide in Chinese adults with type 2 diabetes mellitus in a real-world setting: A prospective, observational post-marketing study. Diabetes Obes Metab 2023; 25:3578-3588. [PMID: 37612876 DOI: 10.1111/dom.15252] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/25/2023] [Accepted: 08/02/2023] [Indexed: 08/25/2023]
Abstract
AIM To our knowledge, this is the first real-world study to investigate the safety and effectiveness of a glucagon-like peptide-1 receptor agonist in Chinese patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS This prospective, observational, post-marketing study conducted at 46 hospitals in China included adults with T2DM prescribed dulaglutide in routine clinical practice. The primary endpoint was the incidence of treatment-emergent adverse events (TEAEs) and serious AEs in patients who received ≥1 dose of dulaglutide, for up to 24 weeks. Exploratory endpoints included changes in patient-reported glycated haemoglobin (HbA1c) and body weight. Post hoc analyses and multivariate regression were also performed. RESULTS From 20 January 2020 to 24 November 2021, 3291 patients received dulaglutide and entered the safety analysis. TEAEs were reported in 1333 (40.5%) patients; the most commonly reported were nausea (n = 193, 5.9%), diarrhoea (n = 183, 5.6%) and decreased appetite (n = 179, 5.4%). serious AEs were reported in 160 (4.9%) patients. TEAEs led to treatment discontinuation in 212 (6.4%) patients. The mean absolute change in HbA1c from baseline to week 24 was -1.65% (p < .001). Greater reductions in HbA1c at week 24 were observed in patients with T2DM duration ≤5 years (p = .002), baseline HbA1c ≥8.5% (p < .001), and without atherosclerotic cardiovascular disease (p = .002). The mean absolute change in body weight from baseline at week 24 was -2.62 kg (p < .001). CONCLUSION Dulaglutide showed a safety profile consistent with previous reports and significantly reduced HbA1c in a real-world setting. These findings support the clinical use of dulaglutide and inform the individualized treatment of patients with T2DM in China.
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Affiliation(s)
- Lixin Guo
- Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Li Li
- Department of Endocrinology, Ningbo First Hospital, Zhejiang, China
| | - Qiurong Yu
- Department of Endocrinology, Changshu Second People's Hospital, Suzhou, China
| | - Na Wang
- Department of Endocrinology, Qingdao Endocrine and Diabetes Hospital, Qingdao, China
| | - Jun Chen
- Department of Endocrinology, Xiaoshan Affiliate Hospital of Wenzhou Medical University, Hangzhou, China
| | - Yue Xi
- Department of Endocrinology, The Third Affiliated Hospital of Jinzhou Medical University, Liaoning, China
| | - Huan Wang
- Eli Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
| | - Yihua Wang
- Eli Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
| | - Jiawei Xu
- Eli Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
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Al-Mashdali AF, Gulied A, Bakr MM, Yassin MA. Romiplostim use for thrombocytopenia following allogeneic hematopoietic stem cell transplantation: a case series from a single center in Qatar. Hematology 2023; 28:2280872. [PMID: 37961987 DOI: 10.1080/16078454.2023.2280872] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Thrombocytopenia is a common and serious complication that can occur following hematopoietic stem cell transplantation (HSCT), and it contributes to increased morbidity and mortality. The mechanisms of post-HSCT thrombocytopenia are multifactorial and complex. There are no clear consensus and guidelines for managing thrombocytopenia post-HSCT. Recently, there has been promising use of thrombopoietin receptor agonists (TPO-RAs), particularly eltrombopag and romiplostim, as treatments for post-HSCT thrombocytopenia. Notably, that this indication is considered off-label, and data in this use are limited. Based on the existing body of evidence, romiplostim emerges as a safe and effective option for individuals with transfusion-dependent thrombocytopenia after HSCT. In this context, we present a summary of our experience at a single center, where romiplostim was used in the management of post-HSCT thrombocytopenia due to poor graft function. Notably, all four cases responded positively to romiplostim treatment, and no significant adverse events were observed.
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Affiliation(s)
- Abdulrahman F Al-Mashdali
- National Center for Cancer Care and Research, Department of Oncology, Hematology and BMT Section, Hamad Medical Corporation, Doha, Qatar
| | - Amaal Gulied
- National Center for Cancer Care and Research, Department of Oncology, Hematology and BMT Section, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed M Bakr
- National Center for Cancer Care and Research, Department of Oncology, Hematology and BMT Section, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A Yassin
- National Center for Cancer Care and Research, Department of Oncology, Hematology and BMT Section, Hamad Medical Corporation, Doha, Qatar
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Catalano M, Lavacchi D, Giommoni E, Shabani S, Guidolin A, Brugia M, Petrioli R, Ramello M, Pillozzi S, Antonuzzo L, Roviello G. Prognostic role of sodium levels in colorectal cancer patients receiving aflibercept plus FOLFIRI. Future Oncol 2023; 19:2537-2546. [PMID: 38050741 DOI: 10.2217/fon-2023-0610] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
Aim: To investigate the impact of natremia in metastatic colorectal cancer (mCRC) patients treated with aflibercept plus folinic acid, 5-fluorouracil, oxaliplatin and irinotecan (FOLFIRI). Patients & methods: A total of 84 mCRC patients receiving aflibercept plus FOLFIRI as second-line treatment were enrolled and divided into two groups based on their median sodium value. Progression-free survival and overall survival were analyzed. Results: Patients with sodium levels ≥140 mEq/l had significantly longer median progression-free survival (4.1 vs 2 months; p < 0.01) and median overall survival (12 vs 7.3 months; p < 0.01) compared with those with lower levels. Conclusion: This study suggests that higher pretreatment serum sodium levels are associated with improved outcomes in mCRC patients receiving aflibercept and FOLFIRI, potentially serving as a prognostic marker to aid treatment management.
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Affiliation(s)
- Martina Catalano
- Department of Health Science, University of Florence, Florence, 50134, Italy
| | - Daniele Lavacchi
- Clinical Oncology Unit, Careggi University Hospital, Florence, 50134, Italy
| | - Elisa Giommoni
- Clinical Oncology Unit, Careggi University Hospital, Florence, 50134, Italy
| | - Sonia Shabani
- Clinical Oncology Unit, Careggi University Hospital, Florence, 50134, Italy
| | - Alessia Guidolin
- Clinical Oncology Unit, Careggi University Hospital, Florence, 50134, Italy
| | - Marco Brugia
- Clinical Oncology Unit, Careggi University Hospital, Florence, 50134, Italy
| | - Roberto Petrioli
- Oncology Unit, Azienda Ospedaliera Universitaria Senese, Siena, 53100, Italy
| | - Monica Ramello
- Oncology Unit, Department of Medical, Surgical & Health Sciences, University of Trieste, Trieste, 34129, Italy
| | - Serena Pillozzi
- Department of Experimental & Clinical Medicine, University of Florence, Florence, 34129, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, 50134, Italy
- Department of Experimental & Clinical Medicine, University of Florence, Florence, 34129, Italy
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Rottenstreich A, Bussel JB. Treatment of immune thrombocytopenia during pregnancy with thrombopoietin receptor agonists. Br J Haematol 2023; 203:872-885. [PMID: 37830251 DOI: 10.1111/bjh.19161] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/30/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023]
Abstract
The introduction of thrombopoietin receptor agonists (TPO-RAs) led to a paradigm shift in the management of immune thrombocytopenia (ITP). However, TPO-RAs are not approved for use during pregnancy due to the absence of evidence and concerns for possible effects on the fetus due to their expected transplacental transfer. This comprehensive review examines the safety and efficacy of TPO-RA in 45 pregnancies of women with ITP (romiplostim n = 22; eltrombopag n = 21; both in the same pregnancy n = 2). Mothers experienced failure of the median of three treatment lines during pregnancy prior to TPO-RA administration. A platelet response (>30 × 109 /L) was seen in 86.7% of cases (including a complete response >100 × 109 /L in 66.7%) and was similar between eltrombopag and romiplostim (87.0% and 83.3%, p = 0.99). The maternal safety profile was favourable, with no thromboembolic events encountered. Neonatal thrombocytopenia was noted in one third of cases, with one case of ICH grade 3, and neonatal thrombocytosis was observed in three cases. No other neonatal adverse events attributable to TPO-RAs were seen. This review suggests that the use of TPO-RA during pregnancy is associated with a high response rate and appears safe. Nevertheless, TPO-RA should not be routinely used in pregnancy and should be avoided in the first trimester until further evidence is accumulated.
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Affiliation(s)
- Amihai Rottenstreich
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
- Laboratory of Blood and Vascular Biology, Rockefeller University, New York, New York, USA
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - James B Bussel
- Division of Hematology/Oncology, Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
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Joerger M, Calvo E, Laubli H, Lopez J, Alonso G, Corral de la Fuente E, Hess D, König D, Sanchez Perez V, Bucher C, Jethwa S, Garralda E. Phase 1 first-in-human dose-escalation study of ANV419 in patients with relapsed/refractory advanced solid tumors. J Immunother Cancer 2023; 11:e007784. [PMID: 38243906 PMCID: PMC10668247 DOI: 10.1136/jitc-2023-007784] [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] [Accepted: 10/06/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND ANV419 is a stable antibody-cytokine fusion protein consisting of interleukin-2 (IL-2) fused to an anti-IL-2 monoclonal antibody that sterically hinders binding of IL-2 to the α subunit of its receptor but has selective affinity for the receptor βγ subunits. Thus, ANV419 preferentially stimulates CD8+ effector T cells and natural killer cells which are associated with tumor killing, while minimizing the activation of immunosuppressive regulatory T cells. METHODS ANV419-001 is an open-label, multicenter, phase 1 study to evaluate the safety, tolerability, maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D) of ANV419. Secondary objectives were to characterize the pharmacokinetics, pharmacodynamics and tumor response. Adult patients with advanced solid tumors and disease progression after ≥1 previous line of systemic therapy were enrolled. ANV419 was administered by intravenous infusion once every 2 weeks, with a planned treatment duration of 12 months. The dose escalation part of the study explored doses 3, 6 and 12 µg/kg as single patient cohorts followed by 24-364 µg/kg in a 3+3 design. Interim results are reported here (data cut-off: March 22, 2023). RESULTS Forty patients were enrolled and received at least one dose of ANV419. The MTD and RP2D were determined to be 243 µg/kg. The most common ANV419-related treatment-emergent adverse events were Grade 1 and 2 fever (31 (77.5%)), chills (23 (57.5%), vomiting (14 (35.0%)), cytokine release syndrome and nausea (12 (30.0%) each). Transient and self-limiting lymphopenia due to lymphocyte redistribution was observed in all patients. In the RP2D cohort, Grade ≥3 thrombocytopenia and fever were reported by one patient (12.5%) each. All events were manageable with standard supportive care. At doses of 243 µg/kg (RP2D/MTD), the estimated T1/2 was approximately 12 hours. At ANV419 doses ≥108 µg/kg, 64% of patients had a best response of at least SD (15 SD and 1 confirmed PR). CONCLUSIONS ANV419 at doses up to 243 µg/kg (the RP2D) was well tolerated and showed signs of antitumor activity in a heavily pretreated patient population with advanced solid tumors. TRIAL REGISTRATION NUMBER NCT04855929.
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Affiliation(s)
- Markus Joerger
- Department of Medical Oncology & Hematology, Cantonal Hospital, St. Gallen, Switzerland
| | - Emiliano Calvo
- START Madrid-CIOCC, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - Heinz Laubli
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Juanita Lopez
- Institute of Cancer Research, Royal Marsden Hospital, London, UK
| | - Guzmán Alonso
- Early Drug Development Unit, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Dagmar Hess
- Department of Medical Oncology & Hematology, Cantonal Hospital, St. Gallen, Switzerland
| | - David König
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | | | | | | | - Elena Garralda
- Early Drug Development Unit, Vall d'Hebron Institute of Oncology, Barcelona, Spain
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Tsao YC, Chen TY, Wang LA, Lee CC, Lee WJA, Hsu SM, Lai CC, Shao SC, Hung JH, Lai ECC. Acute Kidney Injury from Intravitreal Anti-vascular Endothelial Growth Factor Drugs: A Systematic Review and Meta-analysis of Randomized Controlled Trials. BioDrugs 2023; 37:843-854. [PMID: 37676536 DOI: 10.1007/s40259-023-00621-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Several observational studies have reported acute kidney injury from intravitreal anti-vascular endothelial growth factor (anti-VEGF) drugs for retinal diseases. However, systematic reviews and meta-analyses of randomized controlled trials on this critical topic are scant. OBJECTIVE To evaluate acute kidney injury risk associated with intravitreal anti-VEGF drugs in patients with retinal diseases. METHODS We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials on 12 July, 2023, and included randomized controlled trials reporting acute kidney injury between anti-VEGF drugs (e.g., aflibercept, bevacizumab, brolucizumab, and ranibizumab) and controls for retinal diseases (e.g., age-related macular degeneration, polypoidal choroidal vasculopathy, diabetic retinopathy/diabetic macular edema, retinal vein occlusion, and myopic choroidal neovascularization). Data were synthesized by a fixed-effects model for pooling odds ratios (ORs) using the Peto method. RESULTS We included 13 randomized controlled trials (four and nine trials for aflibercept and ranibizumab, respectively) with a total of 4282 participants. The meta-analysis indicated intravitreal anti-VEGF drugs did not increase the acute kidney injury risk, compared with controls (odds ratio [OR]: 1.00, 95% confidence interval [CI] 0.49-2.04, I2: 0%), and no differences in the acute kidney injury risk were observed between different anti-VEGF drugs (OR: 1.10, 95% CI 0.27-4.43, I2: 0% for aflibercept; OR: 0.97, 95% CI 0.42-2.22, I2: 0% for ranibizumab) and between different retinal diseases (OR: 4.61, 95% CI 0.07-284.13, I2: not applicable for age-related macular degeneration; OR: 0.90, 95% CI 0.42-1.93, I2: 0% for diabetic retinopathy/diabetic macular edema; OR: 1.57, 95% CI 0.16-15.88, I2: 0% for retinal vein occlusion). CONCLUSIONS Intravitreal anti-VEGF drugs were not associated with an acute kidney injury risk, regardless of which anti-VEGF drugs (aflibercept or ranibizumab) or retinal diseases (age-related macular degeneration, diabetic retinopathy/diabetic macular edema, or retinal vein occlusion) were involved. SYSTEMATIC REVIEW PROTOCOL REGISTRATION PROSPERO CRD42021267854.
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Affiliation(s)
- Yu-Chien Tsao
- College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ting-Ying Chen
- College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Li-An Wang
- College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Chun Lee
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wan-Ju Annabelle Lee
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Optometry, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Sheng-Min Hsu
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 1 University Road, Tainan, 701, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Chun Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shih-Chieh Shao
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, No. 222 Maijin Road, Keelung, 204, Taiwan.
| | - Jia-Horung Hung
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 1 University Road, Tainan, 701, Taiwan.
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Gong B, Bo Y, Zhang P, Wang J, Gao L. Efficacy and safety of different conbercept injection regimens in the treatment of choroidal neovascularization in pathological myopia: a retrospective study. Int Ophthalmol 2023; 43:4079-4086. [PMID: 37523104 DOI: 10.1007/s10792-023-02825-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 07/09/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE To investigate the clinical efficacy of conbercept 1 + pro re nata (PRN) (i.e., reinjection as needed after one injection) and 3 + PRN (reinjection as needed after 3 months of injection) regimens in choroidal neovascularization secondary to pathological myopia (PM-CNV). METHODS From 06/2019 to 06/2020, 65 patients (65 eyes) confirmed with PM-CNV were included in this retrospective study. Intravitreal injection of 0.5 mg conbercept was conducted either with the 1 + PRN or 3 + PRN strategy. Patients were followed up for 12 months. The best-corrected visual acuity (BCVA), central retinal thickness (CRT), CNV lesion leakage area, the number of injections, and postoperative adverse reactions were observed. RESULTS The mean age of the patients was 42.10 ± 4.69 years, and the average diopter was - 11.26 ± 2.97D. The BCVA at month 3 in the 3 + PRN (n = 30) group was lower than in the 1 + PRN (n = 35) group (P < 0.001). The CRT at month 3 in the 3 + PRN group was lower than in the 1 + PRN group (P < 0.001). After 12 months, there were no differences in the BCVA and CRT between the two groups (P > 0.05). The number of injections was less in 1 + PRN than in 3 + PRN (2.14 ± 1.06 vs. 3.37 ± 0.76, P < 0.001) at 12 months. No serious treatment-related ocular complications or serious systemic adverse events were found. CONCLUSION The 1 + PRN and 3 + PRN strategies of intravitreal injection of conbercept are effective in treating PM-CNV. The 1 + PRN regimen required fewer injections, and it might be more suitable for the treatment of PM-CNV.
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Affiliation(s)
- Bin Gong
- Department of Ophthalmology, Jinan 2Nd People's Hospital, Jinan, 250001, China
| | - Yuxia Bo
- Department of Ophthalmology, Wucheng Hospital of Traditional Chinese Medicine, Dezhou, 253300, China
| | - Peng Zhang
- Department of Ophthalmology, Jinan 2Nd People's Hospital, Jinan, 250001, China
| | - Jing Wang
- Department of Ophthalmology, Shandong Second Provincial General Hospital, Jinan, 250299, China.
| | - Lei Gao
- Department of Ophthalmology, Jinan 2Nd People's Hospital, Jinan, 250001, China.
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Piringer G, Thaler J, Anchisi S, Geffriaud-Ricouard C, Gueldner M, Scholten F, Derigs HG, Bohanes P, Grünberger B, Schwarz L, von Moos R, Hofheinz RD. Quality of life, effectiveness, and safety of aflibercept plus FOLFIRI in older patients with metastatic colorectal cancer: An analysis of the prospective QoLiTrap study. J Geriatr Oncol 2023; 14:101638. [PMID: 37776611 DOI: 10.1016/j.jgo.2023.101638] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/23/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) mainly affects older patients. The pivotal VELOUR phase III trial of aflibercept plus FOLFIRI in metastatic CRC (mCRC) included only 5.9% of patients aged ≥75 years. Herein, we report a preplanned analysis from QoLiTrap, a large prospective observational study evaluating the impact of age on quality of life (QoL), effectiveness, and safety of aflibercept plus FOLFIRI in daily clinical practice in Europe. MATERIALS AND METHODS Enrolled patients had progressive mCRC, had failed a prior oxaliplatin-based regimen, and had received aflibercept (4 mg/kg) plus FOLFIRI every two weeks until disease progression, death, unacceptable toxicity, or physician/patient decision. Analyses were performed by age classes (<60, 60-64, 65-69, 70-74, and ≥ 75 years). The primary endpoint was the percentage of patients whose global health status (GHS) of the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was maintained (i.e., no worsening from baseline by at least 5% over a 12-week treatment). Secondary endpoints included tumor objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and safety. RESULTS Overall, 1277 patients (<60 years, n = 327; 60-64 years, n = 231; 65-69 years, n = 227; 70-74 years, n = 259; and ≥ 75 years, n = 233) were treated, of whom 872 were evaluable for QoL. GHS was maintained in 36.5%, 41.6%, 38.9%, 41.8%, and 44.8% of patients aged <60, 60-64, 65-69, 70-74, and ≥ 75 years, respectively. Age did not influence PFS (median 7.8 months), OS (median 14.4 months), or ORR (20.8%). Number of cycles, dose delays for any cause, and dose reductions for adverse events (AEs) were comparable between age classes. Grade ≥ 3 AEs occurred in 47.7%, 51.9%, 51.5%, 55.2%, and 55.8% of patients aged <60, 60-64, 65-69, 70-74, and ≥ 75 years, respectively. The main grade ≥ 3 AEs were hypertension (11.2%) and diarrhea (9%) in patients aged ≥75 years. DISCUSSION The results suggest that aflibercept plus FOLFIRI maintains QoL and retains its activity, including a high objective tumor response, regardless of age and treatment line. In fit older patients, the safety profile seems manageable, with no new safety signals.
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Affiliation(s)
- Gudrun Piringer
- Department of Internal Medicine IV, Wels-Grieskirchen Hospital, Grieskirchner Str. 42, 4600 Wels, Austria; Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Josef Thaler
- Department of Internal Medicine IV, Wels-Grieskirchen Hospital, Grieskirchner Str. 42, 4600 Wels, Austria
| | - Sandro Anchisi
- Department of Oncology, Valais Romand Hospital Center, Valais Hospital, Av. Grand-Champsec 86, 1951 Sion, Switzerland
| | | | - Max Gueldner
- Sanofi-Aventis Deutschland GmbH, Luetzowstraße 107, 10785 Berlin, Germany
| | - Felicitas Scholten
- Department of Internal Medicine 3, Hematology, Oncology, Palliative Medicine and Pneumology, Frankfurt Höchst Clinic, Gotenstrasse 6-8, 65929 Frankfurt am Main, Germany
| | - Hans-Günter Derigs
- Department of Internal Medicine 3, Hematology, Oncology, Palliative Medicine and Pneumology, Frankfurt Höchst Clinic, Gotenstrasse 6-8, 65929 Frankfurt am Main, Germany
| | - Pierre Bohanes
- Department of Oncology and Internal Medicine, Center for Chemotherapy, 1004 Lausanne, Switzerland
| | - Birgit Grünberger
- Department of Internal Medicine, Hematology and Oncology, Hospital Wiener Neustadt, Corvinusring 3-5, 2700 Wiener Neustadt, Austria
| | - Leonora Schwarz
- Department of Biometry, Alcedis, Winchesterstr 3, 35394 Giessen, Germany
| | - Roger von Moos
- Department of Oncology, Cantonal Hospital Graubuenden, Loestrasse 170, 7000 Chur, Switzerland
| | - Ralf-Dieter Hofheinz
- Department of Oncology, University Hospital Mannheim, Theodor-Kutzer-Ufer 1, 68167 Mannheim, Germany.
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Makarenko I, Dorotenko A, Noskov S, Banko V, Saparova V, Khokhlov A, Zoreeva E, Nedorubov A, Zinnatulina B, Gefen M, Drai R. A randomized, double-blind, comparative study of the pharmacodynamics and pharmacokinetics of GP40141 (romiplostim biosimilar) and reference romiplostim in healthy male volunteers. Pharmacol Res Perspect 2023; 11:e01125. [PMID: 37740581 PMCID: PMC10517295 DOI: 10.1002/prp2.1125] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/15/2023] [Indexed: 09/24/2023] Open
Abstract
AIMS The pharmacodynamic (PD) similarity between GP40141, a proposed romiplostim biosimilar, and reference romiplostim was evaluated. Pharmacokinetics and safety were also assessed. METHODS In this phase 1, randomized, double-blind, single-dose, crossover comparative study with an adaptive design, 56 healthy male volunteers were randomized 1:1 to receive a 3 ug × kg-1 subcutaneous dose of GP40141 and reference romiplostim. The PD similarity between GP40141 and the reference romiplostim was determined using the standard equivalence criteria (80%-125%) for the area under the platelet count-time curve from time 0 to the time of the last sampling for PD (AUCplt ) and the maximum observed platelet count (Pmax ). RESULTS GP40141 and the reference romiplostim exhibited similar PD profiles. 90% CI for the geometric mean ratios for the primary PD parameters (AUCplt, Pmax ) for GP40141 (T) and the reference romiplostim (R) were fully contained within the predefined equivalence limits of 80%-125%: 98.13%-102.42% for AUCplt and 97.56%-105.80% for Pmax . The pharmacokinetic profiles of GP40141 and the reference romiplostim were well described. No adverse events were observed during the clinical trial after the administration of GP40141 and the reference romiplostim. CONCLUSION This study demonstrates the PD similarity of GP40141 to the reference romiplostim. Both treatments had comparable safety profiles (NCT05652595).
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Affiliation(s)
- Igor Makarenko
- R&D Center, GEROPHARMSaint PetersburgRussia
- Federal State Budgetary Educational Institution of Higher Education "A.I. Evdokimov Moscow State University of Medicine and Dentistry" of the Ministry of Healthcare of the Russian FederationMoscowRussia
| | - Artem Dorotenko
- R&D Center, GEROPHARMSaint PetersburgRussia
- Valdman Institute of PharmacologyPavlov First St. Petersburg State Medical UniversitySaint PetersburgRussia
| | | | | | - Valeria Saparova
- R&D Center, GEROPHARMSaint PetersburgRussia
- Federal State Budgetary Educational Institution of Higher Education "A.I. Evdokimov Moscow State University of Medicine and Dentistry" of the Ministry of Healthcare of the Russian FederationMoscowRussia
| | - Alexandr Khokhlov
- Federal State Budgetary Educational Institution of Higher Education"Yaroslavl State Medical University" of the Ministry of Health of the Russian FederationYaroslavlRussia
| | | | - Andrey Nedorubov
- Institute for Translational Medicine and BiotechnologyI.M. Sechenov First Moscow State Medical UniversityMoscowRussia
| | | | | | - Roman Drai
- R&D Center, GEROPHARMSaint PetersburgRussia
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Funding E, Lowe G, Poulsen LH, Shapiro S, Oldenburg J, Eriksson D, Falk A, Rich C. Real-World Effectiveness of rFIXFc Prophylaxis in Patients with Haemophilia B Switched from Standard Half-Life Therapy in Three European Countries. Adv Ther 2023; 40:3770-3783. [PMID: 37351812 PMCID: PMC10427542 DOI: 10.1007/s12325-023-02559-1] [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: 02/14/2023] [Accepted: 05/18/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION The current study describes real-world clinical outcomes and factor usage among patients with haemophilia B switching from standard half-life factor IX (SHL FIX) treatment to recombinant factor IX Fc fusion protein (rFIXFc) prophylaxis in European treatment centres. METHODS This non-interventional, retrospective, multicentre chart review evaluated medical records from adult and paediatric patients with haemophilia B in Denmark, Germany and the UK. Patients had documented SHL FIX treatment, on-demand or prophylaxis, for ≥ 6 months before starting rFIXFc prophylaxis, and subsequent data for ≥ 6 months afterwards (up to 24 months). Primary endpoints included annualised bleeding rates (ABRs), prophylactic factor consumption and injection frequency. RESULTS Data from 30 patients (24/30 [80.0%] with severe disease) showed overall mean (standard deviation, SD) ABRs of 4.7 (6.3) on SHL FIX treatment and 1.7 (2.3) after switching to rFIXFc prophylaxis. The reduction in mean (SD) ABRs was greater when switching from SHL FIX on-demand treatment (n = 6), with a decrease from 10.5 (9.9) to 2.6 (4.5), than when switching from SHL FIX prophylaxis (n = 24), with a decrease from 3.3 (4.3) to 1.5 (1.4). Among prior SHL FIX prophylaxis patients, switching to rFIXFc prophylaxis increased the proportion of those with zero bleeds from 21.7% to 45.8% during the 6 months before and after switching, respectively. In the total population, five of six target joints (83.3%) present when patients started rFIXFc prophylaxis subsequently resolved. In patients switching from SHL FIX prophylaxis to rFIXFc prophylaxis, mean (SD) weekly injection frequency was reduced by 1.0 (0.7) and mean (SD) factor consumption was reduced by 27.7 (49.6) IU/kg/week. CONCLUSION This study demonstrates the effectiveness of rFIXFc prophylaxis in real-world clinical practice. Improvements in both clinical effectiveness and factor usage associated with rFIXFc prophylaxis may potentially reduce patient burden and improve quality of life.
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Affiliation(s)
- Eva Funding
- Department of Hematology, University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gillian Lowe
- West Midlands Adult Comprehensive Care Haemophilia Centre, University Hospitals Birmingham, Birmingham, UK
| | - Lone H Poulsen
- The Haemophilia Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Susan Shapiro
- Oxford Haemophilia and Thrombosis Centre, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, Oxford University, Oxford, UK
| | - Johannes Oldenburg
- Institute for Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | | | | | - Carly Rich
- Sobi, Suite 2, Riverside 3, Granta Park, Great Abington, Cambridgeshire, CB21 6AD, UK.
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Wykoff CC, Brown DM, Reed K, Berliner AJ, Gerstenblith AT, Breazna A, Abraham P, Fein JG, Chu KW, Clark WL, Leal S, Schmelter T, Hirshberg B, Yancopoulos GD, Vitti R. Effect of High-Dose Intravitreal Aflibercept, 8 mg, in Patients With Neovascular Age-Related Macular Degeneration: The Phase 2 CANDELA Randomized Clinical Trial. JAMA Ophthalmol 2023; 141:834-842. [PMID: 37535382 DOI: 10.1001/jamaophthalmol.2023.2421] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 08/04/2023]
Abstract
Importance Aflibercept, 8 mg, may have greater therapeutic benefits compared with aflibercept, 2 mg, in patients with neovascular age-related macular degeneration (nAMD), including potentially improved outcomes and decreased treatment burden. Objective To assess safety and efficacy of aflibercept, 8 mg, in patients with nAMD. Design, Setting, and Participants The CANDELA trial was a phase 2, randomized, single-masked, open-label, 44-week clinical trial conducted in the US. Treatment-naive patients with active subfoveal choroidal neovascularization secondary to nAMD and a best-corrected visual acuity score of 78 to 24 letters (approximately 20/32 to 20/320) in the study eye were enrolled between November 2019 and November 2021. Interventions Eligible participants were randomized 1:1 to receive 3 monthly doses of 8 mg (70 μL) or 2 mg (50 μL) of aflibercept followed by doses at weeks 20 and 32. Main Outcomes and Measures Coprimary end points were the proportion of eyes without fluid (absence of intraretinal and subretinal fluid) in the central subfield at week 16 and safety. Results All 106 eligible eyes were randomized to receive aflibercept, 8 mg (n = 53), or aflibercept, 2 mg (n = 53). Overall, 66 participants (62.3%) were female. The proportion of eyes without fluid in the central subfield with 8-mg vs 2-mg aflibercept was 50.9% (n = 27) vs 34.0% (n = 18) (difference, 17.0 [95% CI, -1.6 to 35.5] percentage points; P = .08) at week 16 and 39.6% (n = 21) vs 28.3% (n = 15) (difference, 11.3 [95% CI, -6.6 to 29.2] percentage points; nominal P = .22) at week 44. At week 44, mean (SE) change in central retinal thickness was -159.4 (16.4) vs -137.2 (22.8) μm with 8 mg vs 2 mg of aflibercept, respectively (least squares mean difference, -9.5 [95% CI, -51.4 to 32.4]; nominal P = .65) and mean (SE) change in best-corrected visual acuity score was +7.9 (1.5) vs +5.1 (1.5) letters (least squares mean difference, +2.8 [95% CI, -1.4 to +7.0]; nominal P = .20). No differences in safety profiles between the groups were observed. Conclusions and Relevance Although aflibercept, 8 mg, did not achieve the primary efficacy end point at week 16 at the 2-sided significance level of 5%, the observed trends in anatomic and visual improvements over 44 weeks with aflibercept, 8 mg, indicate potential additional therapeutic benefit over aflibercept, 2 mg. No new safety signals were observed over 44 weeks. These findings support further evaluation of aflibercept, 8 mg, in pivotal trials of exudative retinal diseases including nAMD and diabetic macular edema. Trial Registration ClinicalTrials.gov Identifier: NCT04126317.
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Affiliation(s)
- Charles C Wykoff
- Retina Consultants of Texas, Retina Consultants of America, Blanton Eye Institute, Houston Methodist Hospital, Houston
| | - David M Brown
- Retina Consultants of Texas, Retina Consultants of America, Blanton Eye Institute, Houston Methodist Hospital, Houston
| | | | | | | | | | - Prema Abraham
- Black Hills Regional Eye Institute, Rapid City, South Dakota
| | | | - Karen W Chu
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York
| | | | | | | | | | | | - Robert Vitti
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York
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del Cura MP, Carballés MJC, Sastre-Ibáñez M. Risk of renal damage associated with intravitreal anti-VEGF therapy for diabetic macular edema in routine clinical practice. Indian J Ophthalmol 2023; 71:3091-3094. [PMID: 37530286 PMCID: PMC10538817 DOI: 10.4103/ijo.ijo_44_23] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/28/2023] [Accepted: 06/07/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose Vascular endothelial growth factor inhibitors (anti-VEGF) have been shown to be effective in the treatment of diabetic macular edema. However, there is little information about the systemic effects of intraocular administration of anti-VEGF drugs in patients with coexistent diabetic nephropathy because it can produce adverse renal effects. Methods This retrospective cohort study analyzed the effect of intravitreal anti-VEGF drugs (bevacizumab, ranibizumab, or aflibercept) on eFGR and microalbuminuria (MicA) in patients with diabetic macular edema and nonproliferative retinopathy without chronic kidney disease (CKD). Results Sixty-six patients were included, 54.5% male and 45.5% female, with a mean age of 66.70 ± 11.6 years. The mean follow-up of patients with antiangiogenic treatment was 42.5 ± 28.07 months, and the mean number of injections was 10.91 ± 7.54. In 12.1% of the cases, there was a worsening of the glomerular filtration rate (eFGR) and a 19.7% worsening of the microalbuminuria (MicA). The number of injections was not related to the worsening of the eFGR (P = 0.74) or the MicA (P = 0.239). No relationship was found between the type of drug and the deterioration of the GFR (P = 0.689) or the MicA (P = 0.53). Conclusions Based on the results, there is a small proportion of patients with increase in MicA and the decrease in eFGR after anti-VEGF therapy, and these was no associated with the number of injection or the drug type. Ophthalmologists should be aware of renal damage in order to do a close monitoring of renal function and proteinuria after intravitreal administration of anti-VEGF mainly in hypertensive patients.
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Crickx E, Ebbo M, Rivière E, Souchaud-Debouverie O, Terriou L, Audia S, Ruivard M, Asli B, Marolleau JP, Méaux-Ruault N, Gerfaud-Valentin M, Audeguy P, Hamidou M, Corm S, Delbrel X, Fontan J, Lebon D, Mausservey C, Moulis G, Limal N, Michel M, Godeau B, Mahévas M. Combining thrombopoietin receptor agonists with immunosuppressive drugs in adult patients with multirefractory immune thrombocytopenia, an update on the French experience. Br J Haematol 2023; 202:883-889. [PMID: 37247631 DOI: 10.1111/bjh.18893] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023]
Abstract
Combining drugs could be an effective option for treating multirefractory ITP, that is, patients not responding to rituximab, thrombopoietin receptor agonists (TPO-RA) and splenectomy. We conducted a retrospective, multicenter, observational study including multirefractory ITP patients who received a combination of a TPO-RA and an immunosuppressive drug. We included 39 patients (67% women, median age 59 years [range 21-96]), with a median ITP duration of 57 months [3-393] and a median platelet count at initiation of 10 × 109 /L [1-35]. The combination regimen was given for a median duration of 12 months [1-103] and included eltrombopag (51%) or romiplostim (49%), associated with mycophenolate mofetil (54%), azathioprine (36%), cyclophosphamide (5%), cyclosporin (3%) or everolimus (3%). Overall, 30 patients (77%) achieved at least a response (platelet count ≥30 × 109 /L and at least doubling baseline during at least 3 months), including 24 complete responses (platelet count >100 × 109 /L during at least 3 months) with a median time to response of 30 days [7-270] and a median duration of response of 15 months [4-63]. Severe adverse event related to ITP treatment was observed in 31%. In conclusion, this study confirms that some patients with multirefractory ITP can achieve long lasting response with this combination.
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Affiliation(s)
- Etienne Crickx
- Internal Medicine Department, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Imagine Institute, Université Paris Cité, INSERM UMR U1163, Paris, France
| | - Mikael Ebbo
- Internal Medicine Department, Hôpital la Timone, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Etienne Rivière
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, Pessac, France
- INSERM U1034, Bordeaux University, Pessac Cedex, France
| | | | - Louis Terriou
- Internal Medicine and Clinical Immunology Department, Centre de référence des maladies auto-immunes systémiques rares du nord et nord-ouest de France (CeRAINO), LIRIC INSERM U995, CHU LILLE, Lille, France
| | - Sylvain Audia
- Internal Medicine and Clinical Immunology Department, Centre de référence constitutif des cytopénies auto-immunes, Hôpital François Mitterrand, Centre Hospitalier Universitaire (CHU) Dijon-Bourgogne, Dijon, France
| | - Marc Ruivard
- Internal Medicine Department, Estaing University Hospital, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, Institut Pascal, Clermont-Ferrand, France
| | - Bouchra Asli
- Internal Medicine Department, Sauvegarde Clinic, Lyon, France
| | - Jean-Pierre Marolleau
- Clinical Hematology and Cellular Therapy Department, CHU Amiens-Picardie, EA4666 Equipe Hematim - CURS - UPJV, Amiens, France
| | - Nadine Méaux-Ruault
- Internal Medicine Department, Centre Hospitalier Universitaire Jean-Minjoz, Besançon, France
| | - Mathieu Gerfaud-Valentin
- Internal Medicine Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon1, Lyon, France
| | | | | | - Selim Corm
- Clinical Hematology Department, Médipole de Savoie, Challes-les-Eaux, France
| | - Xavier Delbrel
- Internal Medicine Department, Centre Hospitalier de Pau, Pau, France
| | - Jean Fontan
- Clinical Hematology Department, CHU Besançon, Besançon, France
| | - Delphine Lebon
- Clinical Hematology and Cellular Therapy Department, CHU Amiens-Picardie, EA4666 Equipe Hematim - CURS - UPJV, Amiens, France
| | - Christelle Mausservey
- Internal Medicine Department, Centre Hospitalier William-Morey, Chalon/Saône, France
| | - Guillaume Moulis
- Internal Medicine Department, CHU de Toulouse, Toulouse, France
- CIC 1436, équipe PEPSS, CHU de Toulouse, Toulouse, France
| | - Nicolas Limal
- Internal Medicine Department, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Marc Michel
- Internal Medicine Department, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Bertrand Godeau
- Internal Medicine Department, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Matthieu Mahévas
- Internal Medicine Department, Centre national de référence des cytopénies auto-immunes de l'adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
- Institut Necker Enfants Malades (INEM), INSERM U1151/CNRS UMS 8253, ATIP-Avenir Team AI2B, Université de Paris Cité, Université Paris-Est-Créteil, Créteil, France
- INSERM U955, équipe 2, Université Paris-Est Créteil (UPEC), Créteil, France
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Shapiro AD, Kulkarni R, Ragni MV, Chambost H, Mahlangu J, Oldenburg J, Nolan B, Ozelo MC, Foster MC, Willemze A, Barnowski C, Jain N, Winding B, Dumont J, Lethagen S, Barnes C, Pasi KJ. Post hoc longitudinal assessment of the efficacy and safety of recombinant factor IX Fc fusion protein in hemophilia B. Blood Adv 2023; 7:3049-3057. [PMID: 36848635 PMCID: PMC10331408 DOI: 10.1182/bloodadvances.2022009230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 03/01/2023] Open
Abstract
Long-term efficacy and safety of the extended half-life recombinant factor IX Fc fusion protein (rFIXFc) has been established among previously treated patients with severe hemophilia B in 2 phase 3 trials (B-LONG [#NCT01027364] and Kids B-LONG [#NCT01440946]) and a long-term extension study (B-YOND [#NCT01425723]). In this study, we report post hoc analyses of pooled longitudinal data for up to 6.5 years for rFIXFc prophylaxis. In the B-LONG study, subjects ≥12 years received weekly dose-adjusted prophylaxis (WP; starting dose, 50 IU/kg), individualized interval-adjusted prophylaxis (IP; initially, 100 IU/kg every 10 days), or on-demand dosing. In the Kids B-LONG study, subjects <12 years received 50 to 60 IU/kg every 7 days, adjusted as needed. In the B-YOND study, subjects received WP (20-100 IU/kg every 7 days), IP (100 IU/kg every 8-16 days), modified prophylaxis, or on-demand dosing; switching between treatment groups was permitted. A total of 123 subjects from B-LONG and 30 from Kids B-LONG study were included, of whom 93 and 27, respectively, enrolled in the B-YOND study. The median cumulative duration of treatment was 3.63 years (range, 0.003-6.48 years) in B-LONG/B-YOND and 2.88 years (range, 0.30-4.80 years) in Kids B-LONG/B-YOND group. Annualized bleed rates (ABRs) remained low, annualized factor consumption remained stable, and adherence remained high throughout treatment. Low ABRs were also maintained in subjects with dosing intervals ≥14 days or with target joints at baseline. Complete resolution of evaluable target joints and no recurrence in 90.2% of baseline target joints during follow-up were observed. rFIXFc prophylaxis was associated with sustained clinical benefits, including long-term bleed prevention and target joint resolution, for severe hemophilia B.
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Affiliation(s)
- Amy D. Shapiro
- Indiana Hemophilia & Thrombosis Center, Inc, Indianapolis, IN
| | - Roshni Kulkarni
- Department of Pediatrics and Human Development, Michigan State University, East Lansing, MI
| | - Margaret V. Ragni
- Department of Medicine, University of Pittsburgh, and Hemophilia Center of Western Pennsylvania, Pittsburgh, PA
| | - Hervé Chambost
- Assistance Publique–Hôpitaux de Marseille, Hemophilia Centre, Hospital La Timone, Marseille, France
- Aix Marseille Université, INSERM, INRA, C2VN, Marseille, France
| | - Johnny Mahlangu
- Haemophilia Comprehensive Care Center, Faculty of Health Sciences, University of Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Johannes Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany
| | - Beatrice Nolan
- Department of Paediatric Haematology, Children’s Health Ireland at Crumlin, Dublin, Ireland
| | | | | | | | | | | | | | | | | | - Chris Barnes
- Haematology Department, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - K. John Pasi
- Royal London Haemophilia Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Fang Q, Huang F, Liang J, Chen Y, Li C, Zhang M, Wu X, Luo W. Safety of romiplostim and eltrombopag for children with immune thrombocytopenia: a pharmacovigilance study of the FDA adverse event reporting system database. Expert Opin Drug Saf 2023; 22:707-714. [PMID: 36803342 DOI: 10.1080/14740338.2023.2182288] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/13/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Romiplostim and eltrombopag are thrombopoietin receptor agonists (TPORAs) that have been approved by the FDA on 22 August 2008 and 20 November 2008 for pediatric immune thrombocytopenia (ITP). However, postmarketing pharmacovigilance of TPORAs in children still attracts much attention. We aimed to evaluate the safety of the TPORAs romiplostim and eltrombopag using data from the Adverse Event Reporting System database of FDA (FAERS). RESEARCH DESIGN AND METHODS We conducted a disproportionality analysis and analyzed data from the FAERS database to characterize the key features of adverse events (AEs) associated with TPO-RAs approved for children under 18 years of age. RESULTS Since their approval in the market in 2008, 250 and 298 reports of romiplostim and eltrombopag use in children have been published in the FAERS database, respectively. The most frequent AE associated with romiplostim and eltrombopag was epistaxis. Neutralizing antibodies and vitreous opacities showed the strongest signals for romiplostim and eltrombopag, respectively. CONCLUSIONS The labeled AEs for romiplostim and eltrombopag in children were analyzed. Unlabeled AEs may reflect the potential of new clinical individuals. Early recognition and management of AEs that appear in children treated with romiplostim and eltrombopag are of key importance in clinical practice.
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Affiliation(s)
- Qiongtong Fang
- Department of Pharmacy, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Fuqiang Huang
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Jiabi Liang
- Department of Pharmacy, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Yishen Chen
- Department of Pharmacy, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Cheng Li
- Department of Pharmacy, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Meirong Zhang
- Department of Pharmacy, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Xinrong Wu
- Department of Pharmacy, General Hospital of Southern Theatre Command of PLA, Guangzhou, Guangdong, China
| | - Wenji Luo
- Department of Pharmacy, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
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Iijima T, Shibuya M, Ito Y, Terauchi Y. Effects of switching from liraglutide to semaglutide or dulaglutide in patients with type 2 diabetes: A randomized controlled trial. J Diabetes Investig 2023; 14:774-781. [PMID: 36871272 PMCID: PMC10204181 DOI: 10.1111/jdi.14000] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/02/2023] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Abstract
INTRODUCTION Few studies have examined the effects of glucagon-like peptide-1 receptor agonist switching, particularly in Japanese patients. Therefore, we aimed to investigate the effects of switching from liraglutide to semaglutide or dulaglutide on blood glucose, body weight, and the occurrence of adverse effects in clinical practice. MATERIALS AND METHODS This was an open-label, prospective, randomized, parallel-group controlled trial. Patients with type 2 diabetes treated with liraglutide (0.6 or 0.9 mg) at Yokosuka Kyosai Hospital in Japan were recruited from September 2020 to March 2022 and, after obtaining informed consent, randomly assigned to the semaglutide or dulaglutide group (1:1). Changes in the glycated hemoglobin level from baseline to weeks 8, 16, and 26 were evaluated post-treatment. RESULTS Initially, 32 participants were enrolled, of whom 30 completed the study. Glycemic control was significantly better in the semaglutide group than in the dulaglutide group (-0.42 ± 0.49% vs -0.00 ± 0.34%, P = 0.0120). Body weight significantly decreased in the semaglutide group (-2.6 ± 3.6 kg, P = 0.0153), whereas no change was observed in the dulaglutide group (-0.1 ± 2.7 kg, P = 0.8432). We found a significant difference in body weight between the groups (P = 0.0469). The proportion of participants who reported adverse events was 75.0% and 18.8% in the semaglutide and dulaglutide groups, respectively. One patient in the semaglutide group had difficulty continuing treatment due to severe vomiting and weight loss. CONCLUSIONS Switching from once-daily liraglutide to once-weekly semaglutide 0.5 mg significantly improved glycemic control and body weight compared with switching to once-weekly dulaglutide 0.75 mg.
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Affiliation(s)
- Takahiro Iijima
- Department of Endocrinology and MetabolismYokohama City University Graduate School of MedicineYokohamaJapan
- Department of Endocrinology, Diabetes and MetabolismYokosuka Kyosai HospitalYokosukaJapan
| | - Makoto Shibuya
- Department of Endocrinology, Diabetes and MetabolismYokosuka Kyosai HospitalYokosukaJapan
| | | | - Yasuo Terauchi
- Department of Endocrinology and MetabolismYokohama City University Graduate School of MedicineYokohamaJapan
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Gerstein HC, Lee SF, Paré G, Bethel MA, Colhoun HM, Hoover A, Lakshmanan M, Lin Y, Pirro V, Qian HR, Ruotolo G, Ryden L, Wilson JM, Duffin KL. Biomarker Changes Associated With Both Dulaglutide and Cardiovascular Events in the REWIND Randomized Controlled Trial: A Nested Case-Control Post Hoc Analysis. Diabetes Care 2023; 46:1046-1051. [PMID: 36897834 DOI: 10.2337/dc22-2397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/17/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE The glucagon-like peptide-1 receptor agonist dulaglutide reduced MACE in the Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) trial. This article expores the relationship of selected biomarkers to both dulaglutide and major adverse cardiovascular events (MACE). RESEARCH DESIGN AND METHODS In this post hoc analysis, stored fasting baseline and 2-year plasma samples from 824 REWIND participants with MACE during follow-up and 845 matched non-MACE participants were analyzed for 2-year changes in 19 protein biomarkers. Two-year changes in 135 metabolites were also analyzed in 600 participants with MACE during follow-up and in 601 matched non-MACE participants. Linear and logistic regression models were used to identify proteins that were associated with both dulaglutide treatment and MACE. Similar models were used to identify metabolites that were associated with both dulaglutide treatment and MACE. RESULTS Compared with placebo, dulaglutide was associated with a greater reduction or lesser 2-year rise from baseline in N-terminal prohormone of brain natriuretic peptide (NT-proBNP), growth differentiation factor 15 (GDF-15), high-sensitivity C-reactive protein, and a greater 2-year rise in C-peptide. Compared with placebo, dulaglutide was also associated with a greater fall from baseline in 2-hydroxybutyric acid and a greater rise in threonine (P < 0.001). Increases from baseline in two of the proteins (but neither metabolite) were associated with MACE, including NT-proBNP (OR 1.267; 95% CI 1.119, 1.435; P < 0.001) and GDF-15 (OR 1.937; 95% CI 1.424, 2.634; P < 0.001). CONCLUSIONS Dulaglutide was associated with a reduced 2-year rise from baseline of NT-proBNP and GDF-15. Higher rises of these biomarkers were also associated with MACE.
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Affiliation(s)
- Hertzel C Gerstein
- 1Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Shun-Fu Lee
- 1Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Guillaume Paré
- 1Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
- 2Thrombosis and Atherosclerosis Research Institute, Hamilton, Canada
| | | | | | | | | | - Yanzhu Lin
- 3Eli Lilly and Company, Indianapolis, IN
| | | | | | | | - Lars Ryden
- 5Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
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Zuo L, Zhu S, Gu S, Xu X. Anti-scarring effects of conbercept on human Tenon's fibroblasts: comparisons with bevacizumab. BMC Ophthalmol 2023; 23:183. [PMID: 37101202 PMCID: PMC10131424 DOI: 10.1186/s12886-023-02914-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 04/08/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Safely inhibiting the formation of scar in the glaucoma filtration surgery (GFS) has always been an issue for clinical glaucoma doctors. Anti-vascular endothelial growth factor (VEGF) agents can reduce angiogenesis, and anti-placental growth factor (PIGF) agents can affect reactive gliosis. However, the effect of conbercept, which can bind to both VEGF and PIGF, on human Tenon's fibroblasts (HTFs) is unknown. METHODS HTFs were cultured in vitro and treated with conbercept or bevacizumab (BVZ). No drug was added to the control group. The effects of drugs on cell proliferation were assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, and the collagen type I alpha1(Col1A1) mRNA expression level was measured using quantitative polymerase chain reaction (qPCR). HTF cell migration after drug interventions was evaluated using the scratch wound assay along with the measurement of the expression levels of VEGF and PIGF in human umbilical vein endothelial cells (HUVECs) using enzyme-linked immunosorbent assay, as well as the detection of the VEGF(R) mRNA expression level in HTFs using qPCR. RESULTS After the addition of conbercept (0.01, 0.1, and 1 mg/mL) to the cultured HTFs or HUVECs, no significant cytotoxicity was observed compared with the control group, while the cytotoxicity of 2.5 mg/mL BVZ on HTFs was obvious. Conbercept significantly inhibited HTF cell migration and Col1A1 mRNA expression level in HTFs. It was superior to BVZ in inhibiting HTF migration. After the intervention with conbercept, the expression level of PIGF and VEGF in HUVECs significantly decreased; and the inhibitory effect of conbercept on the expression level of VEGF in HUVECs was weaker than that of BVZ. Conbercept was more advantageous than BVZ in inhibiting the expression level of VEGFR-1 mRNA in HTFs. However, its effect in terms of inhibiting the expression level of VEGFR-2 mRNA in HTFs was weaker than that of BVZ. CONCLUSION The results suggested the low cytotoxicity and significant anti-scarring effect of conbercept in HTF with significant anti-PIGF and inferior anti-VEGF effects compared with BVZ, thus providing a better understanding of the role of conbercept in the GFS wound healing process.
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Affiliation(s)
- Lei Zuo
- Department of Ophthalmology, Shanghai Fourth People's Hospital, Tongji University School of Medicine, No. 1279, Sanmen road, Shanghai, 200434, China
| | - Shaopin Zhu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 85 / 86, Wujin road, Shanghai, 200080, China
| | - Shengjie Gu
- Department of Ophthalmology, Shanghai Fourth People's Hospital, Tongji University School of Medicine, No. 1279, Sanmen road, Shanghai, 200434, China
| | - Xun Xu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 85 / 86, Wujin road, Shanghai, 200080, China.
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Malec L, Van Damme A, Chan AKC, Spasova M, Jain N, Sensinger C, Dumont J, Lethagen S, Carcao M, Peyvandi F. Recombinant factor VIII Fc fusion protein for first-time immune tolerance induction: final results of the verITI-8 study. Blood 2023; 141:1982-1989. [PMID: 36735911 PMCID: PMC10646781 DOI: 10.1182/blood.2022017780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/28/2022] [Accepted: 12/13/2022] [Indexed: 02/05/2023] Open
Abstract
Inhibitor development remains a major challenge in factor VIII (FVIII) replacement therapy. verITI-8 is the first prospective study of a recombinant FVIII Fc fusion protein (rFVIIIFc; efmoroctocog alfa) for first-time immune tolerance induction (ITI) in males with severe hemophilia A and high-titer inhibitors (historical peak ≥5 Bethesda units [BU]/mL). In this single-arm, open-label, multicenter study, screening was followed by ITI (rFVIIIFc 200 IU/kg per day until tolerization or maximum of 48 weeks). Those who achieved ITI success entered a tapering period, returning to standard prophylaxis, and then entered follow-up. Primary end point was time to tolerization with rFVIIIFc defined by inhibitor titer <0.6 BU/mL, incremental recovery (IR) ≥66% of expected IR (IR ≥1.32 IU/dL per IU/kg), and half-life (t½) ≥7 hours within 48 weeks. Sixteen patients received ≥1 rFVIIIFc dose. Twelve (75%), 11 (69%), and 10 patients (63%), respectively, achieved negative inhibitor titers, an IR ≥66%, and a t½ ≥7 hours (ie, tolerance) within 48 weeks. Median times in weeks to achieve these markers of success were 7.4 (interquartile range [IQR], 2.2-17.8), 6.8 (IQR, 5.4-22.4), and 11.7 (IQR, 9.8-26.2), respectively. All patients experienced ≥1 treatment-emergent adverse event (TEAE), and 1 reported ≥1 related TEAE (injection site pain). Nine patients experienced ≥1 treatment-emergent serious AE. No thrombotic events, discontinuations because of AEs, or deaths were reported during the study. As the first extended half-life rFVIII with prospective data in ITI, rFVIIIFc offered short time to tolerization with durable responses in almost two-thirds of patients and was well tolerated. This trial was registered at www.clinicaltrials.gov as #NCT03093480.
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Affiliation(s)
- Lynn Malec
- Versiti Blood Research Institute, Milwaukee, WI
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - An Van Damme
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Anthony K. C. Chan
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | - Manuel Carcao
- Division of Haematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Tuttle KR, Wilson JM, Lin Y, Qian HR, Genovese F, Karsdal MA, Duffin KL, Botros FT. Indicators of Kidney Fibrosis in Patients with Type 2 Diabetes and Chronic Kidney Disease Treated with Dulaglutide. Am J Nephrol 2023; 54:74-82. [PMID: 36754023 DOI: 10.1159/000529374] [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: 11/22/2022] [Accepted: 01/11/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION In the AWARD-7 study in patients with type 2 diabetes and moderate-to-severe chronic kidney disease, once-weekly dulaglutide slowed the decline in estimated glomerular filtration rate (eGFR) and decreased the urine albumin/creatinine ratio compared to insulin glargine at the end of 52 weeks of treatment. In this exploratory post hoc analysis, changes in two fibrosis biomarkers, serum PRO-C6 (type VI collagen formation) and urine C3M (type III collagen degradation), were evaluated. METHODS In the groups treated with dulaglutide 1.5 mg or insulin glargine (N = 330), serum PRO-C6 and urine C3M were measured using competitive enzyme-linked immunosorbent assays. Biomarker changes were assessed by a mixed-effects model for repeated measures. Pearson correlation analyses were conducted to determine associations between changes in kidney fibrosis biomarkers and eGFR measures at 52 weeks. RESULTS At weeks 26 and 52 of treatment in the overall population, serum PRO-C6 levels were significantly lower in the dulaglutide group versus insulin glargine group with percent change from baseline of (least squares mean ± standard error) -4.6% ± 1.9 and -0.2% ± 2.2 versus 5.7% ± 2.0 and 8.0% ± 2.3 (p < 0.01), respectively, and urine C3M levels were significantly higher in the dulaglutide group versus insulin glargine group with percent change from baseline of 10.9% ± 8.2 and 20.7% ± 8.8 versus -10.0% ± 6.5 and -16.9% ± 6.4 (p < 0.05), respectively. These findings appeared greater in the subgroup with macroalbuminuria. Serum PRO-C6 negatively correlated with eGFR, while urine C3M positively correlated with eGFR. CONCLUSION Dulaglutide treatment was associated with biomarker changes that indicated lower type VI collagen formation and higher type III collagen degradation compared to treatment with insulin glargine, suggesting a potential drug effect to reduce kidney fibrosis.
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Affiliation(s)
- Katherine R Tuttle
- Providence Healthcare, University of Washington, Spokane, Washington, USA
| | | | - Yanzhu Lin
- Eli Lilly and Company, Indianapolis, Indiana, USA
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Yabe D, Kawamori D, Seino Y, Oura T, Takeuchi M. Change in pharmacodynamic variables following once-weekly tirzepatide treatment versus dulaglutide in Japanese patients with type 2 diabetes (SURPASS J-mono substudy). Diabetes Obes Metab 2023; 25:398-406. [PMID: 36184780 PMCID: PMC10092154 DOI: 10.1111/dom.14882] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 02/02/2023]
Abstract
AIM To evaluate the pharmacodynamic effects of tirzepatide, a novel dual glucagon-like peptide-1 receptor and glucose-dependent insulinotropic polypeptide receptor agonist, compared with dulaglutide in patients with type 2 diabetes. MATERIALS AND METHODS SURPASS J-mono was a 52-week, multicentre, randomized, double-blind, parallel, active-controlled, Phase 3 study, conducted in Japan. This substudy of SURPASS J-mono evaluated postprandial metabolic variables and appetite after a meal tolerance test, and body composition measured by bioelectrical impedance analysis. RESULTS Of 636 participants in SURPASS J-mono, 48 were included in this substudy and assigned to tirzepatide 5 mg (n = 9), tirzepatide 10 mg (n = 11), tirzepatide 15 mg (n = 9), or dulaglutide 0.75 mg (n = 19). Participants had a mean (standard deviation) age of 58.6 (7.5) years, duration of diabetes of 6.0 (6.3) years, and body mass index of 27.5 (3.5) kg/m2 . Mean glycated haemoglobin at baseline was 66 mmol/mol (8.22%). Following a standardized meal test, statistically significant differences in change from baseline in area under the concentration versus time curve from time zero to 6 h after dose for glucose, insulin, glucagon, C-peptide and triglycerides were observed in all tirzepatide treatment arms, except triglycerides at 10 mg, compared with dulaglutide at Week 32. For body composition, tirzepatide 10 mg and 15 mg resulted in a significant reduction in body weight, and all doses of tirzepatide resulted in a significant reduction in body fat mass at Week 52. CONCLUSIONS Compared with dulaglutide, tirzepatide showed greater potential for normalizing metabolic factors after a standardized meal. Tirzepatide reduced body weight and body fat mass.
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Affiliation(s)
- Daisuke Yabe
- Department of Diabetes, Endocrinology and Metabolism, Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Dan Kawamori
- Medical Education Center, Faculty of Medicine, Postgraduate Medical Training Center, Osaka University Hospital, and Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yusuke Seino
- Department of Endocrinology, Diabetes and Metabolism, Fujita Health University, Toyoake, Japan
| | - Tomonori Oura
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K, Kobe, Japan
| | - Masakazu Takeuchi
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K, Kobe, Japan
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He X, Ran N, Wang T, Shao Z. Efficacy and quality of life of Romiplostim in adults and children with immune thrombocytopenia: A review. Medicine (Baltimore) 2022; 101:e32345. [PMID: 36550870 PMCID: PMC9771258 DOI: 10.1097/md.0000000000032345] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To systematically evaluate the clinical efficacy, drug safety and health-related quality of life (HRQoL) of Romiplostim in adult and child immune thrombocytopenia (ITP) patients. METHODS PubMed, EMBASE and Cohrane library databases were searched for all randomized controlled trials published until 2022, and the Review Manager 5.3 was used for meta-analysis. RESULTS A total of 9 randomized controlled trials were included in this study. The results of meta-analysis showed that the total platelet response rate and long-term platelet response rate in treatment group were significantly higher than those in control group (P<0.05). There was no statistical significance in the side effects, serious side effects, bleeding events and serious bleeding events between 2 groups (P>0.05). Compared with control group, the HRQoL in ITP adults and children, and parents of ITP children had no statistical significance (P>0.05). CONCLUSION Romiplostim has a certain clinical efficacy in ITP adults and children, and relatively small adverse drug reactions. The improvement of Romiplostim on HRQoL in ITP adults and children is not clear.
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Affiliation(s)
- Xin He
- Department of Hematology, Tianjin Medical University General Hospital, Heping District, Tianjin, China
| | - Ningyuan Ran
- Department of Hematology, Tianjin Medical University General Hospital, Heping District, Tianjin, China
| | - Ting Wang
- Department of Hematology, Tianjin Medical University General Hospital, Heping District, Tianjin, China
| | - Zonghong Shao
- Department of Hematology, Tianjin Medical University General Hospital, Heping District, Tianjin, China
- * Correspondence: Zonghong Shao, Department of Hematology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China (e-mail: )
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Guerci B, Giorgino F, Sapin H, Boye K, Lebrec J, Federici MO, Heitmann E, Dib A, Füchtenbusch M, García‐Pérez L. The Real-World Observational Prospective Study of Health Outcomes with Dulaglutide and Liraglutide in Patients with Type 2 Diabetes (TROPHIES): Patient disposition, clinical characteristics and treatment persistence at 12 months. Diabetes Obes Metab 2022; 24:2373-2382. [PMID: 35876235 PMCID: PMC9804517 DOI: 10.1111/dom.14823] [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: 03/10/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 01/05/2023]
Abstract
AIMS The primary objective of the TROPHIES observational study is to estimate the duration of treatment on dulaglutide or liraglutide without a significant treatment change by 24 months in patients with type 2 diabetes (T2D) initiating their first injectable treatment with these glucagon-like peptide-1 receptor agonists (GLP-1 RAs). This manuscript presents 12-month interim data. MATERIALS AND METHODS TROPHIES is a prospective, non-comparative, observational study of patients with T2D in Europe, naïve to injectable antihyperglycaemic treatments and initiating dulaglutide or liraglutide. Data on clinical characteristics, GLP-1 RA persistence and treatment patterns of glucose-lowering medication were collected at initiation of first injectable therapy and by 12 months. RESULTS By 12 months, 1014 dulaglutide and 991 liraglutide patients were eligible across France, Germany and Italy. Both cohorts presented a high probability [95% confidence interval (CI)] of GLP-1 RA persistence [dulaglutide, 0.88 (0.86 to 0.90); liraglutide, 0.83 (0.80 to 0.85)] and reduction in mean glycated haemoglobin percentage (95% CI) from baseline [dulaglutide, -1.18 (-1.27 to -1.08); liraglutide, -1.15 (-1.26 to -1.05)] with 48.2% of dulaglutide and 41.2% of liraglutide patients reaching their individualized glycated haemoglobin percentage target set by the physician at baseline. Mean weight (95% CI) change from baseline was -3.2 kg (-3.6 to -2.8) for dulaglutide and -3.4 kg (-3.9 to -3.0) for liraglutide. Slight changes in concomitant medications were observed compared with baseline. CONCLUSIONS In the real-world setting, dulaglutide and liraglutide cohorts achieved good persistence with similarly improved glycaemic control that was accompanied by weight loss at 12 months, consistent with previous clinical trial results.
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Affiliation(s)
- Bruno Guerci
- Department of Endocrinology, Diabetology and NutritionUniversity Hospital of NancyVandoeuvre‐lès‐NancyFrance
| | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic DiseasesUniversity of Bari Aldo MoroBariItaly
| | - Hélène Sapin
- Statistics and Real World AnalyticsLilly France SASNeuilly‐sur‐SeineFrance
| | - Kristina Boye
- Value, Evidence, and OutcomesEli Lilly and CompanyIndianapolisIndianaUSA
| | - Jérémie Lebrec
- Real World Access and AnalyticsHaaPACS GmbHSchriesheimGermany
| | | | - Elke Heitmann
- Medical AffairsLilly Deutschland GmbHBad HomburgGermany
| | - Anne Dib
- Medical AffairsLilly France SASNeuilly‐sur‐SeineFrance
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Patil NS, Dhoot AS, Popovic MM, Kertes PJ, Muni RH. RISK OF INTRAOCULAR INFLAMMATION AFTER INJECTION OF ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR AGENTS: A Meta-analysis. Retina 2022; 42:2134-2142. [PMID: 36269802 DOI: 10.1097/iae.0000000000003582] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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
PURPOSE This meta-analysis investigates the incidence of intraocular inflammation (IOI) after intravitreal antivascular endothelial growth factor injections in neovascular age-related macular degeneration. METHODS A systematic search was performed on Ovid MEDLINE, Embase, and Cochrane Central from January 2005 to April 2021. Randomized controlled trials comparing IOI after intravitreal bevacizumab, ranibizumab, brolucizumab, or aflibercept in neovascular age-related macular degeneration were included. Primary outcomes were sight-threatening IOI, final best-corrected visual acuity, and change in best-corrected visual acuity from baseline. Secondary outcomes included the incidence of other IOI events. Meta-analysis was performed using a random-effects model. RESULTS Overall, 11,460 unique studies were screened, of which 14 randomized controlled trials and 6,759 eyes at baseline were included. There was no difference between agents for the risk of endophthalmitis and retinal vascular occlusion. Compared with aflibercept, brolucizumab had a higher incidence of generalized IOI (risk ratio = 6.24, 95% confidence interval = [1.40-27.90]) and vitreous haze/floaters (risk ratio = 1.64, 95% confidence interval = [1.00-2.67]). There were no significant differences between comparators for other secondary end points. CONCLUSION There was no difference in the risk of severe sight-threatening IOI outcomes between intravitreal antivascular endothelial growth factor agents. There was a significantly higher risk of generalized IOI after brolucizumab relative to aflibercept. Our results alongside other recent safety findings suggest the need for further investigation in the risk-benefit profile of brolucizumab for the treatment of neovascular age-related macular degeneration.
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Affiliation(s)
- Nikhil S Patil
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Arjan S Dhoot
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada ; and
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
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Senoo Y, Kami M. Once-Weekly Dulaglutide for Treatment of Youths with Type 2 Diabetes. N Engl J Med 2022; 387:1530-1531. [PMID: 36260804 DOI: 10.1056/nejmc2211623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Yuki Senoo
- Medical Governance Research Institute, Tokyo, Japan
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Uludag G, Hassan M, Matsumiya W, Pham BH, Chea S, Trong Tuong Than N, Doan HL, Akhavanrezayat A, Halim MS, Do DV, Nguyen QD. Efficacy and safety of intravitreal anti-VEGF therapy in diabetic retinopathy: what we have learned and what should we learn further? Expert Opin Biol Ther 2022; 22:1275-1291. [PMID: 35818801 PMCID: PMC10863998 DOI: 10.1080/14712598.2022.2100694] [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: 12/02/2021] [Accepted: 07/08/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Diabetic retinopathy (DR) is one of the most frequent microvascular complications of diabetes that can lead to blindness. Laser treatment has been the gold standard treatment for diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) for many years. Recently, the role of vascular endothelial growth factor (VEGF) has been established in the pathogenesis of DR, and the use of intravitreal anti-VEGF therapy has gained popularity for the management of DR. AREAS COVERED This review includes a brief overview of the efficacy and safety of currently available (bevacizumab, ranibizumab, and aflibercept) and potential future (brolucizumab, faricimab, and KSI-301) anti-VEGF agents in patients with DR based mainly on publicly available data from phase 1, 2 and 3 clinical trials. EXPERT OPINION Clinical trials investigating the efficacy of intravitreal bevacizumab, ranibizumab, and aflibercept injections demonstrated favorable functional and anatomical outcomes in patients with DME. Moreover, the use of these anti-VEGF agents showed a significant improvement in the severity of DR. Recent clinical research for future anti-VEGF molecules aims to provide higher target-protein binding affinity and prolonged therapeutic effect. Brolucizumab, faricimab, and KSI-301 are three novel anti-VEGF agents that demonstrate promising data for the management of DME and potentially DR.
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Affiliation(s)
- Gunay Uludag
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Muhammad Hassan
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Wataru Matsumiya
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Brandon Huy Pham
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
| | - Sophaktra Chea
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | | | - Hien Luong Doan
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | | | - Muhammad Sohail Halim
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Ocular Imaging Research and Reading Center, Sunnyvale, CA, USA
| | - Diana V Do
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
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Pasca S, Zanon E. Albumin-Fusion Recombinant FIX in the Management of People with Hemophilia B: An Evidence-Based Review. Drug Des Devel Ther 2022; 16:3109-3116. [PMID: 36132333 PMCID: PMC9484766 DOI: 10.2147/dddt.s236788] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/13/2022] [Indexed: 11/23/2022] Open
Abstract
Albutrepenonacog-alfa (Idelvion®, CSL Behring) is a recombinant fusion protein in which the recombinant FIX (rFIX) links a recombinant human albumin, extending the half-life of rFIX even beyond 100 hours. In 2016, this drug was approved worldwide for the treatment of pediatric and adult persons with hemophilia B (PWH-B). Its efficacy and safety were described in the PROLONG-9FP program and subsequently confirmed in the real-world practice, even if to date there are not many manuscripts that extensively and completely deal with the use of albutrepenonacog-alfa in daily practice, also evaluating its impact on the quality of life of patients treated with this drug; this review therefore aims to analyze all the publications currently available regarding the real-world use of this extended half-life concentrate, also noting which topics need further study and research.
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Affiliation(s)
- Samantha Pasca
- Biomedical Sciences Department (DSB) - Padua University Hospital, Padua, Italy
- Medicine Department (DIMED) - Padua University Hospital, Padua, Italy
| | - Ezio Zanon
- Hemophilia Center, General Medicine - Padua University Hospital, Padua, Italy
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Cox DA, Wang H, Nicolay C, Bethel MA. Effect of expanded dulaglutide weekly doses (3.0 mg and 4.5 mg) on cardiovascular disease risk factors in participants with type 2 diabetes at increased cardiovascular disease risk: a post hoc analysis of the AWARD-11 study. Diabetes Obes Metab 2022; 24:1770-1778. [PMID: 35546790 PMCID: PMC9543252 DOI: 10.1111/dom.14762] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/28/2022] [Accepted: 05/08/2022] [Indexed: 11/26/2022]
Abstract
AIMS This post hoc analysis investigated the effect of dulaglutide on cardiovascular disease (CVD) risk factors in subgroups of participants at increased CVD risk in the AWARD-11 study. METHODS Participants who received once weekly dulaglutide 1.5, 3.0 or 4.5 mg for 52 weeks were categorized according to their baseline Framingham CVD risk category [low (N = 295), medium (N = 481) and high (N = 1054) risk], as well as their baseline CVD risk according to the REWIND study eligibility criteria (N = 953). Serum lipids and vital signs were assessed at baseline and at 52 weeks. Data were analysed as least squares mean percentage change from baseline for lipids and least squares mean change from baseline for vital signs. RESULTS Demographic and baseline clinical characteristics were balanced across doses within the CVD risk groups. In the high Framingham CVD risk and REWIND-like groups, dulaglutide resulted in dose-related decreases in total cholesterol (≤6.0%), non-high-density lipoprotein cholesterol (≤8.8%), very-low-density lipoprotein cholesterol (≤19.4%) and triglycerides (≤21.5%), with little change in low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. Systolic and diastolic blood pressure decreased up to 5.6 mmHg and 1.6 mmHg, respectively, and heart rate increased up to 2 beats/min. CONCLUSIONS This post hoc analysis suggests the magnitude of the favourable effects of dulaglutide 3.0 mg and 4.5 mg on several cardiometabolic CVD risk factors was similar to, if not greater than, those of dulaglutide 1.5 mg among participants with type 2 diabetes and increased CVD risk. CLINICALTRIALS gov Identifier: NCT03495102.
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Affiliation(s)
| | - Hui Wang
- TechData Service CompanyKing of PrussiaPennsylvaniaUSA
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Franek E, Gerstein HC, Riddle MC, Nicolay C, Hickey A, Botros FT, Loo LS. Efficacy and safety outcomes of dulaglutide by baseline HbA1c: A post hoc analysis of the REWIND trial. Diabetes Obes Metab 2022; 24:1753-1761. [PMID: 35546279 PMCID: PMC9543284 DOI: 10.1111/dom.14760] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/27/2022] [Accepted: 05/08/2022] [Indexed: 11/27/2022]
Abstract
AIM To assess cardiovascular, glycaemic, weight and safety outcomes of long-term treatment with dulaglutide 1.5 mg compared with placebo in patients with a baseline HbA1c of less than 7% versus 7% or higher. MATERIALS AND METHODS Intention-to-treat analyses were performed on REWIND participants with a baseline HbA1c measurement, using Cox proportional hazards regression and mixed model for repeated measures. Subgroup analyses with factors for baseline HbA1c categories and their interaction with treatment group, as well as analyses within the HbA1c subgroups, were conducted. Additionally, sensitivity analyses were performed for baseline HbA1c subgroups of 6.5% or less and more than 6.5%. RESULTS Of the 9876 eligible participants, 3921 and 5955 had a baseline HbA1c of less than 7% and 7% or higher, respectively. Mean baseline HbA1c was 6.3% and 8.0% and the mean duration of diabetes was 9.0 and 11.6 years in the respective subgroups. The less than 7% subgroup was slightly older and less frequently insulin-treated. There was no evidence of a differential dulaglutide treatment effect on body mass index (BMI) reduction, cardiovascular or safety outcomes of interest between the baseline HbA1c subgroups. Treatment-by-baseline HbA1c group interaction was significant for HbA1c change from baseline (P < .001), with a greater reduction in the subgroup with higher baseline HbA1c values. Sensitivity analyses by baseline HbA1c subgroups of 6.5% or less and more than 6.5% showed similar results. CONCLUSIONS The reduced incidence of cardiovascular events, and the reduction in BMI in participants treated with once-weekly dulaglutide, were independent of the baseline HbA1c level. Conversely, participants with a higher baseline HbA1c level had greater reductions in HbA1c. Dulaglutide has a positive benefit-risk profile and can be considered in patients with comparatively well-controlled HbA1c levels seeking optimal metabolic control and cardiovascular benefits.
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Affiliation(s)
- Edward Franek
- Mossakowski Medical Research CentrePolish Academy of Sciences and Central Clinical Hospital MSWiAWarsawPoland
| | - Hertzel C. Gerstein
- Population Health Research InstituteMcMaster University and Hamilton Health SciencesHamiltonOntarioCanada
| | - Matthew C. Riddle
- Department of MedicineOregon Health & Science UniversityPortlandOregon
| | | | - Ana Hickey
- Eli Lilly and CompanyIndianapolisIndiana
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Huang K, Chu N, Ding Y, Que L, Qian Z, Shi Y, Qin W, He Q. Comparative Pharmacokinetics, Safety, and Immunogenicity Study of the Prefilled Syringe and Lyophilized Formulation of a Recombinant Human Tumor Necrosis Factor-α Receptor II:lgG Fc Fusion Protein in Healthy Chinese Male Subjects. Clin Pharmacol Drug Dev 2022; 11:1116-1123. [PMID: 35419986 DOI: 10.1002/cpdd.1091] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/20/2022] [Indexed: 01/26/2023]
Abstract
This study aimed to compare the pharmacokinetics, safety, and immunogenicity of the prefilled syringe (PFS) with lyophilized (LYO) recombinant human tumor necrosis factor-α receptor II:lgG Fc fusion protein (rhTNFR:Fc) in healthy Chinese male subjects. A single-center, randomized, open-label, 2-period, crossover study was performed in healthy Chinese male subjects. Subjects were randomly assigned into 2 sequences and received a subcutaneous injection of 25 mg rhTNFR:Fc PFS or rhTNFR:Fc LYO (Anbainuo), with a 35-day washout between the 2 periods. Blood samples were collected at specified time intervals, and then serum concentrations of rhTNFR:Fc were analyzed by enzyme-linked immunosorbent assay. The maximum serum concentration, area under the concentration-time curve (AUC) from time 0 to the last quantifiable concentration, and AUC from time 0 to infinity were all calculated and evaluated. Meanwhile, safety and immunogenicity were also assessed. A total of 82 subjects completed the study, and six subjects withdrew for various reasons. The 90%CIs for geometric mean ratios of maximum serum concentration, AUC from time 0 to the last quantifiable concentration, and AUC from time 0 to infinity were all within the equivalence range of 80% to 125%. Safety was comparable between the 2 formulations with low immunogenicity. rhTNFR:Fc PFS exhibited similar pharmacokinetic and safety profiles of rhTNFR:Fc LYO (Anbainuo) in healthy Chinese male subjects.
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Affiliation(s)
- Kai Huang
- Drug Clinical Trial Institution, Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Nannan Chu
- Drug Clinical Trial Institution, Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Ying Ding
- Drug Clinical Trial Institution, Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Linglin Que
- Drug Clinical Trial Institution, Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Zhenzhong Qian
- Drug Clinical Trial Institution, Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Yunfei Shi
- Drug Clinical Trial Institution, Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Wei Qin
- Drug Clinical Trial Institution, Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Qing He
- Drug Clinical Trial Institution, Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
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Jhaveri CD, Glassman AR, Ferris FL, Liu D, Maguire MG, Allen JB, Baker CW, Browning D, Cunningham MA, Friedman SM, Jampol LM, Marcus DM, Martin DF, Preston CM, Stockdale CR, Sun JK. Aflibercept Monotherapy or Bevacizumab First for Diabetic Macular Edema. N Engl J Med 2022; 387:692-703. [PMID: 35833805 PMCID: PMC9714135 DOI: 10.1056/nejmoa2204225] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND In eyes with diabetic macular edema, the relative efficacy of administering aflibercept monotherapy as compared with bevacizumab first with a switch to aflibercept if the eye condition does not improve sufficiently (a form of step therapy) is unclear. METHODS At 54 clinical sites, we randomly assigned eyes in adults who had diabetic macular edema involving the macular center and a visual-acuity letter score of 24 to 69 (on a scale from 0 to 100, with higher scores indicating better visual acuity; Snellen equivalent, 20/320 to 20/50) to receive either 2.0 mg of intravitreous aflibercept or 1.25 mg of intravitreous bevacizumab. The drug was administered at randomization and thereafter according to the prespecified retreatment protocol. Beginning at 12 weeks, eyes in the bevacizumab-first group were switched to aflibercept therapy if protocol-specified criteria were met. The primary outcome was the mean change in visual acuity over the 2-year trial period. Retinal central subfield thickness and visual acuity at 2 years and safety were also assessed. RESULTS A total of 312 eyes (in 270 adults) underwent randomization; 158 eyes were assigned to receive aflibercept monotherapy and 154 to receive bevacizumab first. Over the 2-year period, 70% of the eyes in the bevacizumab-first group were switched to aflibercept therapy. The mean improvement in visual acuity was 15.0 letters in the aflibercept-monotherapy group and 14.0 letters in the bevacizumab-first group (adjusted difference, 0.8 letters; 95% confidence interval, -0.9 to 2.5; P = 0.37). At 2 years, the mean changes in visual acuity and retinal central subfield thickness were similar in the two groups. Serious adverse events (in 52% of the patients in the aflibercept-monotherapy group and in 36% of those in the bevacizumab-first group) and hospitalizations for adverse events (in 48% and 32%, respectively) were more common in the aflibercept-monotherapy group. CONCLUSIONS In this trial of treatment of moderate vision loss due to diabetic macular edema involving the center of the macula, we found no evidence of a significant difference in visual outcomes over a 2-year period between aflibercept monotherapy and treatment with bevacizumab first with a switch to aflibercept in the case of suboptimal response. (Funded by the National Institutes of Health; Protocol AC ClinicalTrials.gov number, NCT03321513.).
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Affiliation(s)
- Chirag D Jhaveri
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Adam R Glassman
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Frederick L Ferris
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Danni Liu
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Maureen G Maguire
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - John B Allen
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Carl W Baker
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - David Browning
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Matthew A Cunningham
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Scott M Friedman
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Lee M Jampol
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Dennis M Marcus
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Daniel F Martin
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Carin M Preston
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Cynthia R Stockdale
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
| | - Jennifer K Sun
- From the Retina Consultants of Austin and the Austin Research Center for Retina - both in Austin, TX (C.D.J.); the Jaeb Center for Health Research, Tampa (A.R.G., D.L., M.G.M., C.M.P., C.R.S.), the Florida Retina Institute, Orlando (M.A.C.), and Florida Retina Consultants, Lakeland (S.M.F.) - all in Florida; Ophthalmic Research Consultants, Waxhaw (F.L.F.), and Southeast Clinical Research Associates (J.B.A.) and Charlotte Eye, Ear, Nose, and Throat Associates (D.B.), Charlotte - all in North Carolina; the Ophthalmology Group, Paducah, KY (C.W.B.); the Feinberg School of Medicine, Northwestern University, Chicago (L.M.J.); the Southeast Retina Center, Augusta, GA (D.M.M.); Cole Eye Institute, Cleveland Clinic, Cleveland (D.F.M.); and the Joslin Diabetes Center, Beetham Eye Institute, and the Department of Ophthalmology, Harvard Medical School, Boston (J.K.S.)
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49
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Seong HJ, Park YM, Kim J, Son KJ, Chung EJ. Incidence of Acute Endophthalmitis after Intravitreal Anti-Vascular Endothelial Growth Factor Injection in Age-Related Macular Degeneration. Korean J Ophthalmol 2022; 36:435-442. [PMID: 35989065 PMCID: PMC9582495 DOI: 10.3341/kjo.2022.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/14/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose Antivascular endothelial growth factor (anti-VEGF) agents are routinely intravitreously injected to treat neovascular age-related macular degeneration (AMD). Postoperative endophthalmitis, a side effect after intravitreal anti-VEGF injection, has been reported to have a low incidence but may threaten vision. In this study, we aimed to analyze the incidence of acute endophthalmitis after intravitreal anti-VEGF injection and associated risk factors in patients with neovascular AMD in South Korea. Methods Using the health claims data recorded in the Korean National Health Insurance System database, we identified newly developed neovascular AMD cases from 2010 through 2019. Acute endophthalmitis was defined as a case of invasive treatment for accompanying symptoms. All statistical analyses were performed with a significance level p < 0.05. To find risk factors, we used univariate and multivariable Poisson regression. Results The overall incidence of acute endophthalmitis was 0.019% (p = 0.21) during the 10-year period: 0.025% for aflibercept injection and 0.014% for ranibizumab injection. The incidence was higher in metropolitan city residents than in Seoul (incidence rate ratio [IRR], 1.96; 95% confidence interval [CI], 1.02–3.79; p = 0.04) and was higher for aflibercept injections than for ranibizumab injections (IRR, 1.82; 95% CI, 1.17–2.82; p = 0.01). However, in multivariate analysis, only aflibercept injections showed a significant effect on the incidence of acute endophthalmitis (IRR, 1.80; 95% CI, 1.16–2.79; p = 0.01). Conclusions The incidence of acute endophthalmitis after intravitreal anti-VEGF injections was generally low, and aflibercept was revealed as a significant risk factor.
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Affiliation(s)
- Hyo Jin Seong
- Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang,
Korea
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul,
Korea
| | - Young Min Park
- Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang,
Korea
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul,
Korea
| | - Jiwon Kim
- Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang,
Korea
| | - Kang Ju Son
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang,
Korea
| | - Eun Jee Chung
- Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang,
Korea
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50
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Stahl A, Sukgen EA, Wu WC, Lepore D, Nakanishi H, Mazela J, Moshfeghi DM, Vitti R, Athanikar A, Chu K, Iveli P, Zhao F, Schmelter T, Leal S, Koefuencue E, Azuma N. Effect of Intravitreal Aflibercept vs Laser Photocoagulation on Treatment Success of Retinopathy of Prematurity: The FIREFLEYE Randomized Clinical Trial. JAMA 2022; 328:348-359. [PMID: 35881122 PMCID: PMC9327573 DOI: 10.1001/jama.2022.10564] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [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: 01/28/2023]
Abstract
IMPORTANCE Laser photocoagulation, which is the standard treatment for retinopathy of prematurity (ROP), can have adverse events. Studies of anti-vascular endothelial growth factor injections have suggested efficacy in the treatment of ROP, but few studies have directly compared them with laser treatments. OBJECTIVE To compare intravitreal aflibercept vs laser photocoagulation in infants with ROP requiring treatment. DESIGN, SETTING, AND PARTICIPANTS This noninferiority, phase 3, 24-week, randomized clinical trial was conducted in 27 countries (64 hospital sites) throughout Asia, Europe, and South America. Overall, 118 infants (gestational age ≤32 weeks at birth or birth weight ≤1500 g) with ROP severity (zone I stage 1+ [stage 1 plus increased disease activity], zone I stage 2+, zone I stage 3, zone I stage 3+, zone II stage 2+, or zone II stage 3+) requiring treatment or with aggressive posterior ROP in at least 1 eye were enrolled between September 25, 2019, and August 28, 2020 (the last visit occurred on February 12, 2021). INTERVENTIONS Infants were randomized 2:1 to receive a 0.4-mg dose of intravitreal aflibercept (n = 75) or laser photocoagulation (n = 43) at baseline. Additional treatment was allowed as prespecified. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of infants without active ROP and unfavorable structural outcomes 24 weeks after starting treatment (assessed by investigators). The requirement for rescue treatment was considered treatment failure. Intravitreal aflibercept was deemed noninferior if the lower limit of the 1-sided 95% bayesian credible interval for the treatment difference was greater than -5%. RESULTS Among 118 infants randomized, 113 were treated (mean gestational age, 26.3 [SD, 1.9] weeks; 53 [46.9%] were female; 16.8% had aggressive posterior ROP, 19.5% had zone I ROP, and 63.7% had zone II ROP) and 104 completed the study. Treatment (intravitreal aflibercept: n = 75; laser photocoagulation: n = 38) was mostly bilateral (92.9%), and 82.2% of eyes in the intravitreal aflibercept group received 1 injection per eye. Treatment success was 85.5% with intravitreal aflibercept vs 82.1% with laser photocoagulation (between-group difference, 3.4% [1-sided 95% credible interval, -8.0% to ∞]). Rescue treatment was required in 4.8% (95% CI, 1.9% to 9.6%) of eyes in the intravitreal aflibercept group vs 11.1% (95% CI, 4.9% to 20.7%) of eyes in the laser photocoagulation group. The serious adverse event rates were 13.3% (ocular) and 24.0% (systemic) in the intravitreal aflibercept group compared with 7.9% and 36.8%, respectively, in the laser photocoagulation group. Three deaths, which occurred 4 to 9 weeks after intravitreal aflibercept treatment, were considered unrelated to aflibercept by the investigators. CONCLUSIONS AND RELEVANCE Among infants with ROP, intravitreal aflibercept compared with laser photocoagulation did not meet criteria for noninferiority with respect to the primary outcome of the proportion of infants achieving treatment success at week 24. Further data would be required for more definitive conclusions regarding the comparative effects of intravitreal aflibercept and laser photocoagulation in this population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04004208.
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Affiliation(s)
- Andreas Stahl
- Department of Ophthalmology, University Medicine Greifswald, Greifswald, Germany
| | - Emine A. Sukgen
- Department of Ophthalmology, Adana City Training and Research Hospital, Adana, Turkey
| | - Wei-Chi Wu
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Domenico Lepore
- Department of Geriatrics and Neuroscience, Catholic University of the Sacred Heart, A. Gemelli Foundation IRCSS, Rome, Italy
| | - Hidehiko Nakanishi
- Research and Development Center for New Medical Frontiers, Department of Advanced Medicine, Division of Neonatal Intensive Care Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Jan Mazela
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Darius M. Moshfeghi
- Byers Eye Institute, Stanford University School of Medicine, Stanford, California
| | | | | | - Karen Chu
- Regeneron Pharmaceuticals, Tarrytown, New York
| | | | - Fei Zhao
- Bayer Inc, Toronto, Ontario, Canada
| | | | | | | | - Noriyuki Azuma
- Department of Ophthalmology, National Center for Child Health and Development, Tokyo, Japan
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