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Wang W, Sun J, Aarabi G, Peters U, Fischer F, Klatt J, Gosau M, Smeets R, Beikler T. Effect of tetracycline hydrochloride application on dental pulp stem cell metabolism-booster or obstacle for tissue engineering? Front Pharmacol 2023; 14:1277075. [PMID: 37841936 PMCID: PMC10568071 DOI: 10.3389/fphar.2023.1277075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction: Stem cells and scaffolds are an important foundation and starting point for tissue engineering. Human dental pulp stem cells (DPSC) are mesenchymal stem cells with self-renewal and multi-directional differentiation potential, and are ideal candidates for tissue engineering due to their excellent biological properties and accessibility without causing major trauma at the donor site. Tetracycline hydrochloride (TCH), a broad-spectrum antibiotic, has been widely used in recent years for the synthesis of cellular scaffolds to reduce the incidence of postoperative infections. Methods: In order to evaluate the effects of TCH on DPSC, the metabolism of DPSC in different concentrations of TCH environment was tested. Moreover, cell morphology, survival rates, proliferation rates, cell migration rates and differentiation abilities of DPSC at TCH concentrations of 0-500 μg/ml were measured. Phalloidin staining, live-dead staining, MTS assay, cell scratch assay and real-time PCR techniques were used to detect the changes in DPSC under varies TCH concentrations. Results: At TCH concentrations higher than 250 μg/ml, DPSC cells were sequestered, the proportion of dead cells increased, and the cell proliferation capacity and cell migration capacity decreased. The osteogenic and adipogenic differentiation abilities of DPSC, however, were already inhibited at TCH con-centrations higher than 50 μg/ml. Here, the expression of the osteogenic genes, runt-related transcription factor 2 (RUNX2) and osteocalcin (OCN), the lipogenic genes lipase (LPL), as well as the peroxisome proliferator-activated receptor-γ (PPAR-γ) expression were found to be down-regulated. Discussion: The results of the study indicated that TCH in concentrations above 50 µg/ml negatively affects the differentiation capability of DPSC. In addition, TCH at concentrations above 250 µg/ml adversely affects the growth status, percentage of living cells, proliferation and migration ability of cells.
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Affiliation(s)
- Wang Wang
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jiangling Sun
- Department of Science and Education, Guiyang Stomatological Hospital, Guiyang, Guizhou, China
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ghazal Aarabi
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrike Peters
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Fischer
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Klatt
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Gosau
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Oral and Maxillofacial Surgery, Division of Regenerative Orofacial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Beikler
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Tepper SJ, Lipton RB, Silberstein SD, Kudrow D, Ashina M, Reuter U, Dodick DW, Wang A, Cheng S, Klatt J, Mikol DD. Long-term efficacy and safety of erenumab in patients with chronic migraine and acute medication overuse: A subgroup analysis. Headache 2023; 63:730-742. [PMID: 37313616 DOI: 10.1111/head.14536] [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: 11/17/2022] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Assess the long-term efficacy and safety of erenumab in patients with chronic migraine with acute medication overuse. BACKGROUND Overuse of acute medication in patients with chronic migraine has been linked to greater pain intensity and disability and may diminish the effectiveness of preventive therapies. METHODS This 52-week open-label extension study followed a 12-week double-blind placebo-controlled study in which patients with chronic migraine were randomized 3:2:2 to placebo or once-monthly erenumab 70 mg or 140 mg. Patients were stratified by region and medication overuse status. Patients received erenumab 70 mg or 140 mg throughout or switched from erenumab 70 to 140 mg (based on protocol amendment to augment safety data at higher dose). Efficacy was assessed in patients with and without medication overuse at parent study baseline. RESULTS Of 609 patients enrolled in the extension study, 252/609 (41.4%) met the criteria for medication overuse at parent study baseline. At Week 52, the mean change in monthly migraine days from parent study baseline was -9.3 (95% confidence interval: -10.4, -8.1 days) in the medication overuse subgroup versus -9.3 (-10.1, -8.5 days) in the non-medication overuse subgroup (combined erenumab doses); proportion of patients achieving ≥50% reduction in monthly migraine days at Week 52 was 55.9% (90/161; 48.2%, 63.3%) versus 61.3% (136/222; 54.7%, 67.4%), respectively. Among baseline users of acute migraine-specific medication, the mean change in monthly migraine-specific medication days at Week 52 was -7.4 (-8.3, -6.4 days) in the medication overuse subgroup versus -5.4 (-6.1, -4.7 days) in the non-medication overuse subgroup. Most patients (197/298; 66.1%) in the medication overuse subgroup transitioned to non-overuse status by Week 52. Erenumab 140 mg was associated with numerically greater efficacy than erenumab 70 mg across all endpoints. No new safety signals were identified. CONCLUSION Long-term erenumab treatment demonstrated sustained efficacy and safety in patients with chronic migraine with and without acute medication overuse.
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Affiliation(s)
- Stewart J Tepper
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | | | - Stephen D Silberstein
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David Kudrow
- California Medical Clinic for Headache, Santa Monica, California, USA
| | - Messoud Ashina
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Universitätsmedizin Greifswald, Greifswald, Germany
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
| | | | | | - Jan Klatt
- Novartis Pharma AG, Basel, Switzerland
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Lampl C, Kraus V, Lehner K, Loop B, Chehrenama M, Maczynska Z, Ritter S, Klatt J, Snellman J. Safety and tolerability of erenumab in individuals with episodic or chronic migraine across age groups: a pooled analysis of placebo-controlled trials. J Headache Pain 2022; 23:104. [PMID: 35978286 PMCID: PMC9386939 DOI: 10.1186/s10194-022-01470-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Erenumab, a fully human monoclonal antibody that targets the calcitonin gene-related peptide receptor, has demonstrated efficacy and safety in the prevention of episodic and chronic migraine. There exists an unmet need to establish the safety of erenumab in older individuals, in view of existing multiple comorbidities, polypharmacy, and age-related physiological changes. This pooled analysis of five large migraine-prevention studies examined the safety of erenumab stratified across age groups, particularly in older populations. METHODS Pooled and age-stratified analysis of safety data from the 12-week double-blind treatment phase (DBTP) of five randomized, placebo-controlled Phase 2 and 3 studies of erenumab in participants with episodic or chronic migraine across the age groups < 40 years, 40-49 years, 50-59 years, and ≥ 60 years was completed. The safety of erenumab across age groups was determined by assessing safety endpoints including treatment-emergent adverse events (AEs), serious AEs, and events leading to study drug discontinuation. RESULTS Overall, 3345 participants across five studies were randomized to receive either placebo (n = 1359), erenumab 70 mg (n = 1132) or erenumab 140 mg (n = 854); 3176 (94.9%) completed the DBTP, and 169 (5.1%) discontinued, mainly due to participant decision (110; 3.3%). Overall, 1349 (40.6%), 1122 (33.8%), and 850 (25.6%) participants received at least one dose of placebo, erenumab 70 mg, and erenumab 140 mg, respectively. Incidence of treatment-emergent AEs was similar across all age groups for both doses of erenumab (70 mg or 140 mg) and placebo (< 40 years, 44.0% vs 44.4%; 40-49 years, 42.5% vs 49.2%; 50-59 years, 46.5% vs 41.6%; ≥ 60 years, 43.8% vs 59.4%). Incidence of treatment-emergent serious AEs overall, and stratified by age groups for both doses and placebo was low (< 40 years, 0.9% vs 1.2%; 40-49 years, 1.7% vs 1.9%; and 50-59 years, 1.6% vs 1.1%), with no serious AEs reported in participants aged ≥ 60 years. No deaths were reported. CONCLUSIONS Erenumab (70 mg or 140 mg) exhibited a similar safety profile compared with placebo across age groups in individuals with episodic or chronic migraine, with no increased emergence of events due to age. Erenumab was well tolerated in older participants with multiple comorbidities, polypharmacy, and age-related physiological changes. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifiers: NCT02066415, NCT02456740, NCT02483585, NCT03096834, NCT03333109.
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Affiliation(s)
- Christian Lampl
- Department of Neurology, Konventhospital Barmherzige Brüder Linz, Seilerstätte 2, 4020, Linz, Austria.
| | - Viktoria Kraus
- Department of Neurology, Konventhospital Barmherzige Brüder Linz, Seilerstätte 2, 4020, Linz, Austria
| | - Katrina Lehner
- Department of Neurology, Konventhospital Barmherzige Brüder Linz, Seilerstätte 2, 4020, Linz, Austria
| | - Brett Loop
- Novartis Pharmaceuticals, Cambridge, MA, USA
| | | | | | - Shannon Ritter
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
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Ashina M, Tepper SJ, Brandes JL, Reuter U, Boudreau GP, Weatherall M, Gantenbein A, Doležil D, Klatt J, Wang A, Karanam AK, Cheng S, Mikol D. Long‐term efficacy and safety of erenumab in patients with chronic migraine in whom prior preventive treatments had failed: A subgroup analysis. Headache 2022; 62:624-633. [PMID: 35593783 PMCID: PMC9324861 DOI: 10.1111/head.14313] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022]
Abstract
Objective To assess the long‐term efficacy and safety of erenumab in the subgroup of patients with chronic migraine (CM) in whom prior preventive treatments had failed (TF) (≥1, ≥2, and ≥3 TF medication categories) and never failed (preventive naïve or prior preventive treatments had not failed), using the data from a 52‐week, open‐label treatment period (OLTP) of the parent study. Background Erenumab is a fully human monoclonal antibody that selectively binds to and inhibits the canonical calcitonin gene‐related peptide receptor. There are limited long‐term data evaluating the efficacy and safety of erenumab in patients with CM in whom prior preventive treatments had failed. Methods Patients who had completed the 12‐week double‐blind treatment period (DBTP) in the parent study were eligible to participate in the 52‐week OLTP, during which they received erenumab every 4 weeks. The TF subgroups (≥1, ≥2, and ≥3 TF medication categories) were not mutually exclusive; patients in whom prior preventive treatments from ≥3 medication categories had failed were also counted in the ≥2 and ≥1 medication categories. Endpoints included monthly migraine days (MMD), monthly acute migraine‐specific medication days (MSMD), achievement of ≥50%, ≥75%, and 100% reduction from baseline in MMD, and exposure‐adjusted patient incidence rates of adverse events (AEs; per 100 patient‐years). Results Erenumab treatment provided sustained mean reductions in MMD and MSMD relative to the parent study baseline throughout the 52 weeks of the OLTP across all TF subgroups. At Week 52, the mean MMD change was −8.6 (SD 6.6) (baseline: 18.4 [SD 4.5] days) in the ≥1 TF subgroup. A post hoc completer analysis (52 weeks [OLTP] erenumab) showed that compared with erenumab 70 mg, the 140 mg dose was associated with numerically greater reductions in the mean MMD (Week 40: −8.6 and −7.2 days; Week 52: −9.7 and −7.9 days [≥1 TF subgroup]) and a higher proportion of patients achieved ≥50%, ≥75%, and 100% response thresholds across all subgroups at Weeks 40 and 52. Overall the exposure‐adjusted patient incidence rates of AEs did not increase during the OLTP versus the DBTP (≥1 TF subgroup: 141.9/100 versus 317.9/100 patient‐years), and no new safety signals occurred. Conclusion The long‐term treatment with erenumab was well tolerated and showed sustained efficacy in patients with CM in whom prior preventive treatments had failed, with numerically greater treatment effects for 140 mg versus 70 mg.
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Affiliation(s)
- Messoud Ashina
- Department of Neurology Danish Headache Center Rigshospitalet Glostrup Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | | | - Jan Lewis Brandes
- Department of Neurology Vanderbilt University School of Medicine Nashville Neuroscience Group Nashville Tennessee USA
| | - Uwe Reuter
- Department of Neurology Charité Universitätsmedizin Berlin Germany
- Universitätsmedizin Greifswald Greifswald Germany
| | | | - Mark Weatherall
- Department of Neurology Stoke Mandeville Hospital Aylesbury UK
| | - Andreas R. Gantenbein
- Department for Neurology and Neurorehabilitation ZURZACH Care Bad Zurzach Switzerland
- Department of Neurology University Hospital Zurich Zürich Switzerland
| | - David Doležil
- Prague Headache Center DADO MEDICAL sro Prague Czech Republic
| | - Jan Klatt
- Novartis Pharma AG Basel Switzerland
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McAllister PJ, Turner I, Reuter U, Wang A, Scanlon J, Klatt J, Chou DE, Paiva da Silva Lima G. Timing and durability of response to erenumab in patients with episodic migraine. Headache 2021; 61:1553-1561. [PMID: 34841526 DOI: 10.1111/head.14233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/02/2021] [Accepted: 09/13/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We sought to evaluate temporal response patterns to erenumab treatment in patients with episodic migraine. BACKGROUND Although many patients treated with erenumab experience onset of efficacy as early as 1 week, clinical benefits of migraine preventive therapies may accrue with continued treatment. Furthermore, details about the maintenance of clinical responses have not been reported. METHODS This was a post hoc analysis of a 6-month, randomized, double-blind, placebo-controlled, phase 3 study of erenumab for the prevention of episodic migraine. We analyzed temporal responses to erenumab using a threshold of ≥50% reduction from baseline in monthly migraine days (MMDs). RESULTS During the 6-month treatment period, 73.7% (230/312) and 79.6% (253/318) of patients in the erenumab 70 mg (n = 312) and 140 mg (n = 318) groups, respectively, achieved a response in at least 1 month. In this group of responders, at least half reached first monthly response (first month with ≥50% reduction from baseline in MMDs) by month 2 and at least 75% of them by month 3. The remainder responded in months 4-6. Of patients in the erenumab 70 and 140 mg groups, 35.3% (110/312) and 41.8% (133/318), respectively, responded over months 1-3 (mean response over first 3 months). Of these patients, 81.8% (90/110) and 81.9% (109/133) maintained this response over months 4-6 (mean response over last 3 months) in the 70 and 140 mg groups, respectively. Many patients who did not achieve an initial response (≥50% reduction from baseline in MMDs during month 1) responded later with continued treatment, with approximately one-half or more of initial nonresponders responding by months 4-6. CONCLUSIONS These results support guidelines recommending at least 3 months following the initiation of erenumab for migraine prevention before the assessment of response.
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Affiliation(s)
- Peter J McAllister
- New England Institute for Neurology and Headache, Stamford, Connecticut, USA
| | - Ira Turner
- Island Neurological Associates, Plainview, New York, USA
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Reuter U, Ehrlich M, Gendolla A, Heinze A, Klatt J, Wen S, Hours-Zesiger P, Nickisch J, Sieder C, Hentschke C, Maier-Peuschel M. Erenumab versus topiramate for the prevention of migraine - a randomised, double-blind, active-controlled phase 4 trial. Cephalalgia 2021; 42:108-118. [PMID: 34743579 PMCID: PMC8793299 DOI: 10.1177/03331024211053571] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We compared the tolerability and efficacy of erenumab, a monoclonal antibody binding to the calcitonin gene-related peptide receptor, to topiramate for migraine prophylaxis in adults. METHODS HER-MES was a 24-week, randomised, double-blind, double-dummy, controlled trial conducted in 82 sites in Germany. Patients with ≥4 migraine days per month and naïve to study drugs were randomly assigned (1:1) to either subcutaneous erenumab (70 or 140 mg/month) plus topiramate placebo (erenumab group) or oral topiramate at the individual dose with optimal efficacy (50-100 mg/day) plus erenumab placebo (topiramate group).The primary endpoint was medication discontinuation due to an adverse event during the double-blind phase. The proportion of patients that achieved ≥50% reduction from baseline in monthly migraine days during the last 3 months of the double-blind phase was a secondary endpoint. RESULTS Seven hundred and seventy-seven patients were randomised (from 22 February 2019 to 29 July, 2020) and 95.1% completed the study. In the erenumab group, 10.6% discontinued medication due to adverse events compared to 38.9% in the topiramate group (odds ratio, 0.19; 95% confidence interval 0.13-0.27; p < 0.001). Significantly more patients achieved a ≥50% reduction in monthly migraine days from baseline with erenumab (55.4% vs. 31.2%; odds ratio 2.76; 95% confidence interval 2.06-3.71; p < 0.001). No new safety signals occurred. CONCLUSIONS Erenumab demonstrated a favourable tolerability and efficacy profile compared to topiramate.Trial registration: ClinicalTrials.gov NCT03828539, URL: https://clinicaltrials.gov/ct2/show/NCT03828539.
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Affiliation(s)
- Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Universitätsmedizin Greifswald, Greifswald, Germany
| | | | | | - Axel Heinze
- The Kiel Migraine and Headache Centre, Kiel, Germany
| | - Jan Klatt
- Novartis Pharma AG, Basel, Switzerland
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Tepper SJ, Lucas S, Ashina M, Schwedt TJ, Ailani J, Scanlon J, Klatt J, Chou DE, Wang A, Paiva da Silva Lima G. Timing and durability of response to erenumab in patients with chronic migraine. Headache 2021; 61:1255-1263. [PMID: 34363708 PMCID: PMC8519048 DOI: 10.1111/head.14193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/28/2021] [Accepted: 06/23/2021] [Indexed: 12/11/2022]
Abstract
Background Erenumab is a human anti‐calcitonin gene‐related peptide receptor monoclonal antibody approved for migraine prevention. We sought to further assess the temporal patterns of response to erenumab in patients with chronic migraine (CM), specifically the onset and sustainability of monthly migraine day (MMD) response. Methods This is a post hoc analysis of a 12‐week, randomized, double‐blind, placebo‐controlled study of erenumab for migraine prevention in patients with CM (≥15 headache days/month, including ≥8 migraine days/month). Onset and sustainability were assessed according to MMD reduction from baseline, with the following response categories: responders (≥50% reduction), partial responders (≥30% and <50%), or nonresponders (<30%). Results Among the erenumab 140 mg group (n = 187), 54.0% (101/187) achieved a response at any month during the study with a median time to onset of monthly response of 1 month. This improvement was maintained in most patients with continued treatment. An initial response was achieved at Month 1 by 28.3% (53/187) of patients; 69.8% (37/53) of whom maintained a response at Months 2 and 3. Although many patients responded early, some patients required longer treatment to achieve a response; 79.4% (27/34) of initial partial responders and 21.0% (21/100) of initial nonresponders subsequently achieved a response. Similar findings were observed for the erenumab 70mg group (n = 188). Conclusion A majority of erenumab‐treated patients with CM who achieved an initial response at Month 1 sustained this benefit. Many patients responded later with continued treatment. Our data support recommendations to assess outcomes after ≥3 months of preventive treatment with erenumab in CM.
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Affiliation(s)
| | - Sylvia Lucas
- University of Washington Medical Center, Seattle, WA, USA
| | - Messoud Ashina
- Danish Headache Center, University of Copenhagen, Copenhagen, Denmark
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Tepper SJ, Ashina M, Reuter U, Hallström Y, Broessner G, Bonner JH, Picard H, Cheng S, Chou DE, Zhang F, Klatt J, Mikol DD. Reduction in acute migraine-specific and non-specific medication use in patients treated with erenumab: post-hoc analyses of episodic and chronic migraine clinical trials. J Headache Pain 2021; 22:81. [PMID: 34301173 PMCID: PMC8299690 DOI: 10.1186/s10194-021-01292-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/10/2021] [Indexed: 01/13/2023] Open
Abstract
Background In patients with migraine, overuse of acute medication, including migraine-specific medication (MSM) such as triptans and ergots, can lead to adverse health outcomes, including development of medication overuse headache. Here, we examined the effect of erenumab on reducing acute medication use, in particular MSM, in patients with episodic migraine (EM) and chronic migraine (CM). Methods The current post-hoc analyses were based on data from the double-blind treatment phase (DBTP) of two erenumab studies, a pivotal EM (N = 955) and a pivotal CM (N = 667) trial, and their respective extensions. Patients were administered subcutaneous placebo or erenumab (70 or 140 mg) once monthly. Daily acute headache medication use (including MSM and non-MSM) was recorded using an electronic diary during a 4-week pretreatment baseline period until the end of the treatment period. Outcome measures included change in monthly acute headache medication days (HMD) in acute headache medication users at baseline, and changes in monthly MSM days (MSMD) in MSM users at baseline and non-MSMD in non-MSM users at baseline. Results In total, 60 and 78 % of patients (all acute headache medication users) with EM and CM used MSM at baseline, respectively. For acute headache medication users, the change in mean monthly acute HMD over Months 4, 5 and 6 compared with the pre-DBTP was 1.5, 2.5, and 3.0 for placebo, erenumab 70 mg and 140 mg, respectively for the EM study. The respective change in monthly MSMD in MSM users was 0.5, 2.1 and 2.8, and in monthly non-MSMD in non-MSM users was 2.3, 2.6, and 2.7. In the acute headache medication users at baseline, the change in monthly acute HMD at Month 3 compared with pre-DBTP was 3.4, 5.5, and 6.5 for placebo, erenumab 70 mg and 140 mg, respectively for the CM study. The respective change in monthly MSMD in MSM users was 2.1, 4.5, and 5.4, and in monthly non-MSMD in non-MSM users was 5.9, 6.4, and 6.6. Reductions in MSMD versus placebo were sustained in the extension periods of both studies. Erenumab was also associated with a higher proportion of MSM users achieving ≥ 50 %, ≥ 75 and 100 % reduction from baseline in monthly MSMD versus placebo in both EM and CM. Conclusions In both EM and CM, treatment with erenumab is associated with a significant and sustained reduction in the use of acute headache medication, in particular MSM. Trial registrations NCT02456740; NCT02066415; NCT02174861.
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Affiliation(s)
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Faculty of Health and Medical Sciences, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Gregor Broessner
- Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Jo H Bonner
- Mercy Clinic Neurology and Headache Centre, Saint Louis, MO, USA
| | | | | | | | | | - Jan Klatt
- Novartis Pharma AG, CH-4002, Basel, Switzerland
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Goadsby PJ, Reuter U, Lanteri-Minet M, Paiva da Silva Lima G, Hours-Zesiger P, Fernandes C, Wen S, Tenenbaum N, Kataria A, Ferrari MD, Klatt J. Long-term Efficacy and Safety of Erenumab: Results From 64 Weeks of the LIBERTY Study. Neurology 2021; 96:e2724-e2735. [PMID: 33910942 PMCID: PMC8205467 DOI: 10.1212/wnl.0000000000012029] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 03/05/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To report the efficacy and safety of erenumab among patients with episodic migraine (EM) who were unsuccessful on 2 to 4 preventive treatments observed at week 64 of the open-label extension phase (OLEP) of A Study Evaluating the Effectiveness of AMG 334 Injection in Preventing Migraines in Adults Having Failed Other Therapies (LIBERTY) study (ClinicalTrials.gov NCT03096834). METHODS The OLEP, evaluating monthly erenumab 140 mg for 3 years, enrolled 240 patients who completed the double-blind treatment phase (DBTP) of 12 weeks during which they received placebo or erenumab 140 mg subcutaneous injections every 4 weeks as monotherapy. Efficacy outcomes were evaluated through the initial 52 weeks of OLEP (from DBTP baseline to total 64 weeks) in the overall population, patients receiving erenumab in DBTP, and patients from the DBTP placebo arm who switched to erenumab in OLEP. Endpoints included reduction of ≥50% in monthly migraine days (MMD) from DBTP baseline and change in MMD from DBTP baseline, Headache Impact Test score, and Migraine Physical Function Impact Diary score (Physical Impairment and Everyday Activities). RESULTS Altogether, the week 52 visit of the OLEP was completed by 204 of 240 (85.0%) patients. Among patients continuing erenumab, the 50% responder rate increased from 29.9% at weeks 9 to 12 to 44.3% at weeks 61 to 64. The 50% responder rate in patients who initiated erenumab in the OLEP remained higher in the OLEP (50.0% at week 61-64) than during DBTP (14.2% at weeks 9-12) compared to patients in continuous erenumab arm. In the OLEP, the 50% responder rate for the overall population increased from weeks 13 to 16 until weeks 37 to 40 and then remained stable through weeks 61 to 64. Patients treated with erenumab in DBTP showed sustained effects on all efficacy outcomes; those initiating erenumab in the OLEP demonstrated continued improvement from week 13 onward. Adverse events (AEs) were reported, considering both treatment groups, by ≈80.8% (serious AEs by 6.7%), 76.3% (5.9%) in the continuing erenumab arm, and 85.2% (7.4%) in those starting erenumab in OLEP. No deaths were reported. CONCLUSIONS In patients with EM who were unsuccessful on 2 to 4 prior preventive treatments, the LIBERTY study demonstrated sustained efficacy on erenumab monotherapy treatment through 64 weeks in both treatment arms. Safety of erenumab was consistent with that observed in previous clinical trials. TRIAL REGISTRATION INFORMATION ClinicalTrials.govIdentifier: NCT03096834. CLASSIFICATION OF EVIDENCE The current study provides Class IV evidence on data from patients with EM that erenumab is safe and provides sustained efficacy at 52 weeks.
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Affiliation(s)
- Peter J Goadsby
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College London, UK; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Côte Azur Université, France; INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France; Amgen Inc (G.P.d.S.L.), Thousand Oaks, CA; Novartis Pharma AG (P.H.-Z., C.F., J.K.), Basel, Switzerland; Novartis Pharmaceutical Corp (S.W., N.T.), East Hanover, NJ; Novartis Healthcare Pvt. Ltd. Hyderabad (A.K.), India; and Department of Neurology (M.D.F.), Leiden University Medical Centre, the Netherlands.
| | - Uwe Reuter
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College London, UK; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Côte Azur Université, France; INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France; Amgen Inc (G.P.d.S.L.), Thousand Oaks, CA; Novartis Pharma AG (P.H.-Z., C.F., J.K.), Basel, Switzerland; Novartis Pharmaceutical Corp (S.W., N.T.), East Hanover, NJ; Novartis Healthcare Pvt. Ltd. Hyderabad (A.K.), India; and Department of Neurology (M.D.F.), Leiden University Medical Centre, the Netherlands
| | - Michel Lanteri-Minet
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College London, UK; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Côte Azur Université, France; INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France; Amgen Inc (G.P.d.S.L.), Thousand Oaks, CA; Novartis Pharma AG (P.H.-Z., C.F., J.K.), Basel, Switzerland; Novartis Pharmaceutical Corp (S.W., N.T.), East Hanover, NJ; Novartis Healthcare Pvt. Ltd. Hyderabad (A.K.), India; and Department of Neurology (M.D.F.), Leiden University Medical Centre, the Netherlands
| | - Gabriel Paiva da Silva Lima
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College London, UK; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Côte Azur Université, France; INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France; Amgen Inc (G.P.d.S.L.), Thousand Oaks, CA; Novartis Pharma AG (P.H.-Z., C.F., J.K.), Basel, Switzerland; Novartis Pharmaceutical Corp (S.W., N.T.), East Hanover, NJ; Novartis Healthcare Pvt. Ltd. Hyderabad (A.K.), India; and Department of Neurology (M.D.F.), Leiden University Medical Centre, the Netherlands
| | - Peggy Hours-Zesiger
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College London, UK; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Côte Azur Université, France; INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France; Amgen Inc (G.P.d.S.L.), Thousand Oaks, CA; Novartis Pharma AG (P.H.-Z., C.F., J.K.), Basel, Switzerland; Novartis Pharmaceutical Corp (S.W., N.T.), East Hanover, NJ; Novartis Healthcare Pvt. Ltd. Hyderabad (A.K.), India; and Department of Neurology (M.D.F.), Leiden University Medical Centre, the Netherlands
| | - Chrystel Fernandes
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College London, UK; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Côte Azur Université, France; INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France; Amgen Inc (G.P.d.S.L.), Thousand Oaks, CA; Novartis Pharma AG (P.H.-Z., C.F., J.K.), Basel, Switzerland; Novartis Pharmaceutical Corp (S.W., N.T.), East Hanover, NJ; Novartis Healthcare Pvt. Ltd. Hyderabad (A.K.), India; and Department of Neurology (M.D.F.), Leiden University Medical Centre, the Netherlands
| | - Shihua Wen
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College London, UK; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Côte Azur Université, France; INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France; Amgen Inc (G.P.d.S.L.), Thousand Oaks, CA; Novartis Pharma AG (P.H.-Z., C.F., J.K.), Basel, Switzerland; Novartis Pharmaceutical Corp (S.W., N.T.), East Hanover, NJ; Novartis Healthcare Pvt. Ltd. Hyderabad (A.K.), India; and Department of Neurology (M.D.F.), Leiden University Medical Centre, the Netherlands
| | - Nadia Tenenbaum
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College London, UK; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Côte Azur Université, France; INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France; Amgen Inc (G.P.d.S.L.), Thousand Oaks, CA; Novartis Pharma AG (P.H.-Z., C.F., J.K.), Basel, Switzerland; Novartis Pharmaceutical Corp (S.W., N.T.), East Hanover, NJ; Novartis Healthcare Pvt. Ltd. Hyderabad (A.K.), India; and Department of Neurology (M.D.F.), Leiden University Medical Centre, the Netherlands
| | - Aditi Kataria
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College London, UK; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Côte Azur Université, France; INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France; Amgen Inc (G.P.d.S.L.), Thousand Oaks, CA; Novartis Pharma AG (P.H.-Z., C.F., J.K.), Basel, Switzerland; Novartis Pharmaceutical Corp (S.W., N.T.), East Hanover, NJ; Novartis Healthcare Pvt. Ltd. Hyderabad (A.K.), India; and Department of Neurology (M.D.F.), Leiden University Medical Centre, the Netherlands
| | - Michel D Ferrari
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College London, UK; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Côte Azur Université, France; INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France; Amgen Inc (G.P.d.S.L.), Thousand Oaks, CA; Novartis Pharma AG (P.H.-Z., C.F., J.K.), Basel, Switzerland; Novartis Pharmaceutical Corp (S.W., N.T.), East Hanover, NJ; Novartis Healthcare Pvt. Ltd. Hyderabad (A.K.), India; and Department of Neurology (M.D.F.), Leiden University Medical Centre, the Netherlands
| | - Jan Klatt
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College London, UK; Department of Neurology (P.J.G.), University of California, Los Angeles; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Pain Department and FHU InovPain (M.L.-M.), CHU Nice-Côte Azur Université, France; INSERM U1107 Migraine and Trigeminal Pain (M.L.-M.), Auvergne University, Clermont-Ferrand, France; Amgen Inc (G.P.d.S.L.), Thousand Oaks, CA; Novartis Pharma AG (P.H.-Z., C.F., J.K.), Basel, Switzerland; Novartis Pharmaceutical Corp (S.W., N.T.), East Hanover, NJ; Novartis Healthcare Pvt. Ltd. Hyderabad (A.K.), India; and Department of Neurology (M.D.F.), Leiden University Medical Centre, the Netherlands
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Lipton RB, Burstein R, Buse DC, Dodick DW, Koukakis R, Klatt J, Cheng S, Chou DE. Efficacy of erenumab in chronic migraine patients with and without ictal allodynia. Cephalalgia 2021; 41:1152-1160. [PMID: 33982623 DOI: 10.1177/03331024211010305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Ictal cutaneous allodynia, common in chronic migraine, is associated with reduced responses to acute treatment with triptans. Allodynia's impact on the efficacy of newer preventive treatments such as erenumab is unknown. METHODS Post-hoc subgroup analysis of a double-blind, randomized, placebo-controlled 12-week study of erenumab in chronic migraine, contrasting those with no allodynia with those with moderate-severe allodynia assessed with the Allodynia Symptom Checklist-12, was undertaken. RESULTS Of 648 randomized individuals with baseline Allodynia Symptom Checklist-12 scores, 386 (59.6%) had no allodynia and 153 (23.6%) had moderate-to-severe allodynia. Mean (standard deviation) baseline monthly migraine days were 17.6 (4.8) and 18.9 (4.3), respectively. Compared to placebo, the erenumab group had greater reductions in monthly migraine days and monthly acute migraine-specific medication days in both no allodynia and allodynia subgroups. Mean (95% confidence interval) treatment differences in change from baseline for monthly migraine days at week 12 were -2.5 (-3.7, -1.4) in the no allodynia subgroup and -3.3 (-5.3, -1.3) in the moderate-severe allodynia subgroup. Change in acute migraine-specific medication days were -3.3 (-4.3, -2.3) and -2.5 (-4.3, -0.8), respectively. CONCLUSIONS Erenumab's efficacy in reducing monthly migraine days and acute migraine-specific medication days in chronic migraine was not impacted by the presence of moderate-severe ictal allodynia.Trial registration: ClinicalTrials.gov NCT02066415.
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Affiliation(s)
- Richard B Lipton
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA
| | | | - Dawn C Buse
- Albert Einstein College of Medicine, Bronx, NY, USA
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Lanteri-Minet M, Goadsby PJ, Reuter U, Wen S, Hours-Zesiger P, Ferrari MD, Klatt J. Effect of erenumab on functional outcomes in patients with episodic migraine in whom 2-4 preventives were not useful: results from the LIBERTY study. J Neurol Neurosurg Psychiatry 2021; 92:466-472. [PMID: 33402419 PMCID: PMC8053327 DOI: 10.1136/jnnp-2020-324396] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/10/2020] [Accepted: 12/08/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate the effect of erenumab on patient-reported, functional outcomes in patients with episodic migraine (EM) in whom 2-4 preventives were not useful from the Phase 3b LIBERTY study. METHODS As previously reported, 246 patients with EM with 2-4 prior failed preventives were randomised 1:1 to subcutaneous erenumab 140 mg or placebo every 4 weeks for 12 weeks. This analysis evaluated Migraine Physical Function Impact Diary (MPFID), Headache Impact Test (HIT-6) and Work Productivity and Activity Impairment (WPAI) scores at Week 12. P values were nominal without multiplicity adjustment. RESULTS Erenumab significantly improved MPFID-Physical Impairment (PI) and Everyday Activities (EA) scores versus placebo (treatment difference (TD) (95% CI) MPFID-PI: -3.5 (-5.7 to -1.2) (p=0.003); MPFID-EA: -3.9 (-6.1 to -1.7)) (p<0.001) at 12 weeks. Patients on erenumab were more likely to have a ≥5-point reduction in MPFID score (OR vs placebo (95% CI) MPFID-EA: 2.1 (1.2 to 3.6); MPFID-PI: 2.5 (1.4 to 4.5)). A similar trend was observed for HIT-6 (TD: -3.0; p<0.001); significantly higher proportions of patients on erenumab reported a ≥5-point reduction (OR (95% CI): 2.4 (1.4 to 4.1)). In three out of four WPAI domains, erenumab showed improvement versus placebo. CONCLUSION At 12 weeks, erenumab was efficacious on functional outcomes in patients with EM in whom 2-4 preventives were not useful. TRIAL REGISTRATION DETAILS ClinicalTrials.gov identifier: NCT03096834.
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Affiliation(s)
- Michel Lanteri-Minet
- Pain Department and FHU InovPain, CHU Nice - Côte Azur Université, Nice, France .,INSERM U1107 Migraine and Trigeminal Pain, Auvergne University, Clermont-Ferrand, France
| | - Peter J Goadsby
- King's College London, NIHR/Wellcome Trust King's CRF, London, London, UK
| | - Uwe Reuter
- Department of Neurology, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Shihua Wen
- Novartis Pharmaceuticals Corp, East Hanover, New Jersey, USA
| | | | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Klatt
- Novartis Pharma AG, Basel, Switzerland
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Ashina M, Doležil D, Bonner JH, Zhou L, Klatt J, Picard H, Mikol DD. A phase 2, randomized, double-blind, placebo-controlled trial of AMG 301, a pituitary adenylate cyclase-activating polypeptide PAC1 receptor monoclonal antibody for migraine prevention. Cephalalgia 2020; 41:33-44. [PMID: 33231489 PMCID: PMC7786389 DOI: 10.1177/0333102420970889] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective To assess the safety and efficacy of AMG 301, an inhibitor of the pituitary adenylate cyclase-activating polypeptide (PACAP)-1 (PAC1) receptor, for prevention of migraine. Methods In a double-blind trial, patients were randomized 4:3:3 to placebo, AMG 301 210 mg every 4 weeks, or AMG 301 420 mg every 2 weeks for 12 weeks. Effect on monthly migraine days and other secondary measures were assessed over weeks 9–12. Safety and tolerability were assessed. Results Of 343 randomized patients (mean age, 41.8–42.5 years), the majority were women (85.4–90.4%), white (94.1–96.2%), and had episodic migraine (62.5–67.9%). A total of 305 patients completed treatment (placebo, n = 124; AMG 301 210 mg, n = 94; AMG 301 420 mg, n = 87). Least squares mean reduction at week 12 in monthly migraine days from baseline was −2.5 (0.4) days for placebo and −2.2 (0.5) days for both AMG 301 treatment groups. No difference between AMG 301 and placebo on any measure of efficacy was observed; mean (95% confidence interval) treatment difference versus placebo for monthly migraine days for AMG 301 210 mg, 0.3 (−0.9 to 1.4); AMG 301 420 mg, 0.3 (−0.9 to 1.4). The incidence of adverse events was similar across groups. Conclusion AMG 301 offered no benefit over placebo for migraine prevention; further studies may be necessary to fully understand the role of PACAP isoforms and its receptors in migraine pathophysiology. Study Registration ClinicalTrials.gov: NCT03238781
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Affiliation(s)
- Messoud Ashina
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David Doležil
- Prague Headache Center, DADO MEDICAL sro, Prague, Czech Republic
| | | | | | - Jan Klatt
- Novartis Pharma AG, Basel, Switzerland
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Broessner G, Reuter U, Bonner JH, Dodick DW, Hallström Y, Picard H, Zhang F, Lenz RA, Klatt J, Mikol DD. The Spectrum of Response to Erenumab in Patients With Episodic Migraine and Subgroup Analysis of Patients Achieving ≥50%, ≥75%, and 100% Response. Headache 2020; 60:2026-2040. [PMID: 32851644 PMCID: PMC7590156 DOI: 10.1111/head.13929] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 01/03/2023]
Abstract
Objective To assess the efficacy of erenumab at the ≥50%, ≥75%, and 100% reduction in monthly migraine days (MMD) response thresholds, using data from the 6‐month double‐blind treatment phase (DBTP) of the Study to Evaluate the Efficacy and Safety of Erenumab in Migraine Prevention (STRIVE) pivotal clinical trial. Methods Enrolled patients with episodic migraine (EM; ≥4 MMD and <15 monthly headache days) were randomized (1:1:1) to erenumab 70 mg (n = 312), erenumab 140 mg (n = 318), or placebo (n = 316) once monthly. We determined the proportions of patients with ≥50%, ≥75% and 100% reduction in MMD over the last 3 months of the STRIVE DBTP (months 4 through 6) and conducted post hoc analyses to contextualize the treatment benefit in patient subgroups achieving, and not achieving, these response thresholds. Outcome measures included changes in MMD, acute migraine‐specific medication days (MSMD), and patient‐reported outcomes. Results The proportions of patients with a reduction in MMD from baseline were greater for erenumab than for placebo at all response thresholds. As previously reported for the ≥50% response threshold, 135/312 (43.3%) of patients on erenumab 70 mg and 159/318 (50.0%) on erenumab 140 mg responded, vs 84/316 (26.6%) for placebo. At months 4 through 6, 65/312 (20.8%) and 70/318 (22.0%) of those on erenumab 70 mg and erenumab 140 mg, respectively, achieved ≥75% reductions vs 25/316 (7.9%) on placebo. A reduction of 100% response, which required no migraine days over 3 consecutive months based on observed data, was achieved by 10/312 (3.2%) of patients treated with erenumab 70 mg and 16/318 (5.0%) for erenumab 140 mg, vs 9/316 (2.8%) for placebo. At all response thresholds, responders achieved numerically greater reductions in mean MMD and MSMD, and greater improvements in disability than did the overall population; importantly, these remarkable responses were noted early. Meanwhile, 60/312 (19.2%) and 53/318 (16.7%) patients on erenumab 70 and 140 mg, respectively, had no reduction in MMD from baseline in months 4 through 6, compared with 104/316 (32.9%) patients on placebo. Conclusions The responses at the ≥50%, ≥75%, and 100% thresholds provide context for establishing realistic patient and physician expectations regarding the magnitude of treatment benefit that may be achieved by patients with EM responding to erenumab (STRIVE, NCT02456740).
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Affiliation(s)
- Gregor Broessner
- Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jo H Bonner
- Mercy Clinic Neurology and Headache Centre, Saint Louis, MO, USA
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | | | | | - Jan Klatt
- Novartis Pharma AG, Basel, Switzerland
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Goadsby PJ, Reuter U, Hallström Y, Broessner G, Bonner JH, Zhang F, Wright IK, Chou DE, Klatt J, Picard H, Lenz RA, Mikol DD. One-year sustained efficacy of erenumab in episodic migraine: Results of the STRIVE study. Neurology 2020; 95:e469-e479. [PMID: 32636324 PMCID: PMC7455346 DOI: 10.1212/wnl.0000000000010019] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 06/01/2020] [Indexed: 01/03/2023] Open
Abstract
Objective To assess efficacy and tolerability of 1-year erenumab treatment in patients with episodic migraine. Methods Patients were randomized (n = 955; 1:1:1) during the 24-week double-blind treatment phase (DBTP) to monthly subcutaneous placebo or erenumab 70 or 140 mg. At week 24, 845 patients were rerandomized (1:1) to erenumab 70 or 140 mg during the 28-week dose-blinded active-treatment phase (ATP). Monthly migraine days (MMD), achieving ≥50%, ≥75%, and 100% reduction in MMD, and safety/tolerability were assessed. Results Mean MMD at DBTP baseline was 8.3. At week 52, mean changes (SE) from pre-DBTP baseline/week 24 (pre-ATP baseline) in MMD were −4.2 (0.2)/−1.1 (0.2) (70 mg) and −4.6 (0.2)/−1.8 (0.2) (140 mg) irrespective of treatment during the DBTP. For patients reducing dose from 140 (DBTP) to 70 mg (ATP), change in MMD from week 24 to 52 was −0.1 (0.3), and for those increasing from 70 (DBTP) to 140 mg (ATP), −1.8 (0.3). At week 52, 61.0%, 38.5%, and 19.8% of patients on erenumab 70 mg, and 64.9%, 40.8%, and 21.2% on erenumab 140 mg, achieved ≥50%, ≥75%, and 100% reduction in MMD from DBTP baseline, respectively. Among erenumab-treated patients in DBTP who showed ≥50% reduction in MMD during the last 3 months of DBTP and completed ATP, 86% showed sustained responses at ≥50% during the last 3 months of ATP. Safety of erenumab in ATP was similar to DBTP; exposure-adjusted incidence rates of adverse events were similar for either dose. Conclusion Over 52 weeks, erenumab provided sustained efficacy in episodic migraine; the safety profiles were similar between erenumab dose groups in the presence of dose blinding. Clinicaltrials.gov identifier NCT02456740. Classification of evidence Class II evidence that 52 weeks of treatment with erenumab 70 and 140 mg subcutaneously monthly results in sustained reductions in monthly migraine days and similar dose tolerability for patients with episodic migraine.
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Affiliation(s)
- Peter J Goadsby
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland.
| | - Uwe Reuter
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
| | - Yngve Hallström
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
| | - Gregor Broessner
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
| | - Jo H Bonner
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
| | - Feng Zhang
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
| | - Ian K Wright
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
| | - Denise E Chou
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
| | - Jan Klatt
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
| | - Hernan Picard
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
| | - Robert A Lenz
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
| | - Daniel D Mikol
- From the NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Neuro Center (Y.H.), St Görans Hospital, Stockholm, Sweden; Department of Neurology (G.B.), Headache Outpatient Clinic, Medical University of Innsbruck, Austria; Mercy Research (J.H.B.), St. Louis, MO; Amgen Inc. (F.Z., D.E.C., H.P., R.A.L., D.D.M.), Thousand Oaks, CA; Novartis Product Irl Ltd. (I.K.W.), Dublin, Ireland; and Novartis Pharma AG (J.K.), Basel, Switzerland
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Kudrow D, Pascual J, Winner PK, Dodick DW, Tepper SJ, Reuter U, Hong F, Klatt J, Zhang F, Cheng S, Picard H, Eisele O, Wang J, Latham JN, Mikol DD. Vascular safety of erenumab for migraine prevention. Neurology 2019; 94:e497-e510. [PMID: 31852816 PMCID: PMC7080286 DOI: 10.1212/wnl.0000000000008743] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 08/06/2019] [Indexed: 01/13/2023] Open
Abstract
Objective To examine the cardiovascular, cerebrovascular, and peripheral vascular safety of erenumab across migraine prevention studies. Methods Vascular adverse events (AEs) and blood pressure data were integrated across 4 double-blind, placebo-controlled studies of erenumab and their open-label extensions in patients with chronic or episodic migraine. Subgroup analyses were conducted by acute migraine-specific medication use and number of vascular risk factors at baseline. Standardized search terms were used to identify vascular AEs (cardiovascular, cerebrovascular, or peripheral). An independent committee adjudicated whether targeted events were vascular in origin. Results In placebo-controlled studies, 2,443 patients received placebo (n = 1,043), erenumab 70 mg (n = 893), or erenumab 140 mg (n = 507) subcutaneously once monthly. Regardless of acute migraine-specific medication use or vascular risk factors at baseline, AE incidence was similar across the placebo and erenumab treatment groups. Hypertension AEs were reported for 0.9% (placebo), 0.8% (erenumab 70 mg), and 0.2% (erenumab 140 mg) of patients. Vascular AEs, which were similar across double-blind and open-label treatment, generally were confounded, with plausible alternative etiologies. In 18 patients with events reviewed by the independent committee, 4 events were positively adjudicated as cardiovascular in origin: 2 deaths and 2 vascular events. All 4 positively adjudicated cardiovascular events occurred during open-label erenumab treatment. Conclusion Selective blockade of the canonical calcitonin gene-related peptide receptor with erenumab for migraine prevention had a vascular safety profile comparable to that of placebo over 12 weeks, with no increased emergence of events over time. Further study of long-term safety of erenumab in patients with migraine is needed. Clinicaltrials.gov identifiers NCT02066415, NCT02456740, NCT01952574, NCT02483585, NCT02174861, and NCT01723514. Classification of evidence This analysis provides Class II evidence that for patients with migraine, erenumab does not increase the risk of vascular AEs.
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Affiliation(s)
- David Kudrow
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA.
| | - Julio Pascual
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Paul K Winner
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - David W Dodick
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Stewart J Tepper
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Uwe Reuter
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Frank Hong
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Jan Klatt
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Feng Zhang
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Sunfa Cheng
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Hernan Picard
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Osa Eisele
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Julie Wang
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Jonathan N Latham
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
| | - Daniel D Mikol
- From California Medical Clinic for Headache (D.K.), Santa Monica, CA; Department of Neurology (J.P.), University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain; Premiere Research Institute (P.K.W.), Nova Southeastern University, West Palm Beach, FL; Department of Neurology (D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.J.T.), Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Neurology (U.R.), Charité Universitätsmedizin Berlin, Germany; Novartis, East Hanover, NJ (F.H.), and Basel, Switzerland (J.K.); Amgen Inc. (F.Z., S.C., H.P., O.E., J.W., D.D.M.), Thousand Oaks, CA; and PharmaScribe, LLC (J.N.L.), Atlanta, GA
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Brandes JL, Diener HC, Dolezil D, Freeman MC, McAllister PJ, Winner P, Klatt J, Cheng S, Zhang F, Wen S, Ritter S, Lenz RA, Mikol DD. The spectrum of response to erenumab in patients with chronic migraine and subgroup analysis of patients achieving ≥50%, ≥75%, and 100% response. Cephalalgia 2019; 40:28-38. [DOI: 10.1177/0333102419894559] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
ObjectiveTo assess the efficacy of erenumab across the spectrum of response thresholds (≥50%, ≥75%, 100%) based on monthly migraine days (MMD) reduction in patients with chronic migraine from a 12-week, randomized study (NCT02066415).MethodsPatients (n = 667) received (3:2:2) placebo or erenumab 70/140 mg once-monthly. The proportion of patients achieving a given response threshold was assessed. A post-hoc analysis was conducted to contextualize the actual treatment benefit in subgroups of patients achieving (or not) specified response thresholds. Outcome measures included MMD, acute migraine-specific medication treatment days (MSMD) and disability.ResultsThe proportion of patients responding to erenumab exceeded that of placebo at the ≥50% and ≥75% response thresholds. At month 3, 39.9% and 41.2% of patients on erenumab 70 and 140 mg, respectively, achieved ≥50% response versus placebo (23.5%). Similarly, at month 3, 17.0% and 20.9% of patients on erenumab 70 and 140 mg, respectively, achieved ≥75% response versus placebo (7.8%). Compared with the overall erenumab-treated population (change in MMD: −6.6 [both 70 and 140 mg]), ≥50% responders showed MMD reductions of −12.2/−12.5 for 70 mg/140 mg versus −2.6/−2.2 for those not achieving ≥50% response. ≥75% responders showed MMD reductions of −13.9/−14.8 for 70 mg/140 mg versus −5.0/−4.3 for those not achieving ≥75% response. Relative improvements in MSMD and disability were observed in responders versus overall erenumab-treated population.ConclusionFor erenumab-treated patients achieving ≥50% response, the actual reduction in MMD was almost twice that of the overall population. These findings provide context for setting realistic expectations regarding actual treatment benefit experienced by patients responding to treatment.
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Affiliation(s)
- Jan Lewis Brandes
- Nashville Neuroscience Group, NUMC, Vanderbilt University, Department of Neurology, Nashville, TN, USA
| | | | - David Dolezil
- Prague Headache Center, DADO MEDICAL s.r.o., Prague, Czech Republic
| | | | | | - Paul Winner
- Palm Beach Headache Center, West Palm Beach, FL, USA
| | - Jan Klatt
- Novartis Pharma AG, Basel, Switzerland
| | | | | | - Shihua Wen
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Shannon Ritter
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Ashina M, Kudrow D, Reuter U, Dolezil D, Silberstein S, Tepper SJ, Xue F, Picard H, Zhang F, Wang A, Zhou Y, Hong F, Klatt J, Mikol DD. Long-term tolerability and nonvascular safety of erenumab, a novel calcitonin gene-related peptide receptor antagonist for prevention of migraine: A pooled analysis of four placebo-controlled trials with long-term extensions. Cephalalgia 2019; 39:1798-1808. [PMID: 31707815 DOI: 10.1177/0333102419888222] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Efficacy and safety of erenumab have been evaluated in a comprehensive clinical development program resulting in approval for migraine prevention in over 40 countries to date. METHODS This integrated safety analysis included four double-blind randomized trials and their extensions (up to three-plus years). Safety endpoints included exposure-adjusted patient incidences of adverse events, serious adverse events, and anti-erenumab antibodies. RESULTS In all, 2375 of the patients randomized across the four studies received at least one dose of erenumab (70 mg or 140 mg), with cumulative exposure of 2641.2 patient-years. Exposure-adjusted adverse event rates during the double-blind treatment phase were similar to placebo, with the exception of injection-site reactions (17.1 vs. 10.8 per 100 patient-years), constipation (7.0 vs. 3.8 per 100 patient-years), and muscle spasm (2.3 vs. 1.2 per 100 patient-years). During the long-term extensions, adverse events reported were similar to those observed during the double-blind treatment phase, and rates of injection site reactions, constipation, and muscle spasm were reported at lower rates than in the double-blind treatment phase. There were two deaths reported, both confounded by pre-existing conditions. CONCLUSIONS This pooled safety analysis revealed a favorable and stable adverse event profile over time for erenumab with more than three years of exposure. TRIAL REGISTRATION ClinicalTrials.gov NCT01952574, NCT02483585, NCT02456740, NCT02066415, and NCT02174861.
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Affiliation(s)
- Messoud Ashina
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - David Kudrow
- California Medical Clinic for Headache, Santa Monica, CA, USA
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - David Dolezil
- Dado Medical sro, Prague Headache Center, Prague, Czech Republic
| | - Stephen Silberstein
- Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Fei Xue
- Amgen Inc, Thousand Oaks, CA, USA
| | | | | | | | | | | | - Jan Klatt
- Novartis Pharma AG, Basel, Switzerland
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Bechtold M, De Lannoy GJM, Koster RD, Reichle RH, Mahanama SP, Bleuten W, Bourgault MA, Brümmer C, Burdun I, Desai AR, Devito K, Grünwald T, Grygoruk M, Humphreys ER, Klatt J, Kurbatova J, Lohila A, Munir TM, Nilsson MB, Price JS, Röhl M, Schneider A, Tiemeyer B. PEAT-CLSM: A Specific Treatment of Peatland Hydrology in the NASA Catchment Land Surface Model. J Adv Model Earth Syst 2019; 11:2130-2162. [PMID: 33101595 PMCID: PMC7580791 DOI: 10.1029/2018ms001574] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/29/2019] [Indexed: 05/22/2023]
Abstract
Peatlands are poorly represented in global Earth system modeling frameworks. Here we add a peatland-specific land surface hydrology module (PEAT-CLSM) to the Catchment Land Surface Model (CLSM) of the NASA Goddard Earth Observing System (GEOS) framework. The amended TOPMODEL approach of the original CLSM that uses topography characteristics to model catchment processes is discarded, and a peatland-specific model concept is realized in its place. To facilitate its utilization in operational GEOS efforts, PEAT-CLSM uses the basic structure of CLSM and the same global input data. Parameters used in PEAT-CLSM are based on literature data. A suite of CLSM and PEAT-CLSM simulations for peatland areas between 40°N and 75°N is presented and evaluated against a newly compiled data set of groundwater table depth and eddy covariance observations of latent and sensible heat fluxes in natural and seminatural peatlands. CLSM's simulated groundwater tables are too deep and variable, whereas PEAT-CLSM simulates a mean groundwater table depth of -0.20 m (snow-free unfrozen period) with moderate temporal fluctuations (standard deviation of 0.10 m), in significantly better agreement with in situ observations. Relative to an operational CLSM version that simply includes peat as a soil class, the temporal correlation coefficient is increased on average by 0.16 and reaches 0.64 for bogs and 0.66 for fens when driven with global atmospheric forcing data. In PEAT-CLSM, runoff is increased on average by 38% and evapotranspiration is reduced by 19%. The evapotranspiration reduction constitutes a significant improvement relative to eddy covariance measurements.
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Affiliation(s)
- M. Bechtold
- Department of Earth and Environmental Sciences, KU Leuven, Heverlee, Belgium
- Department of Computer Science, KU Leuven, Heverlee, Belgium
| | - G. J. M. De Lannoy
- Department of Earth and Environmental Sciences, KU Leuven, Heverlee, Belgium
| | - R. D. Koster
- Global Modeling and Assimilation Office, NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - R. H. Reichle
- Global Modeling and Assimilation Office, NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - S. P. Mahanama
- Global Modeling and Assimilation Office, NASA Goddard Space Flight Center, Greenbelt, MD, USA
- Science Systems and Applications, Inc., Lanham, MD, USA
| | - W. Bleuten
- Department of Physical Geography, Utrecht University, Utrecht, The Netherlands
| | - M. A. Bourgault
- Département des sciences de la Terre et de l’atmosphère-GEOTOP Research Center, Université du Québec à Montréal, Montréal, Québec, Canada
| | - C. Brümmer
- Thünen Institute of Climate-Smart Agriculture, Braunschweig, Germany
| | - I. Burdun
- Department of Geography, Institute of Ecology and Earth Sciences, University of Tartu, Tartu, Estonia
| | - A. R. Desai
- Department of Atmospheric and Oceanic Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - K. Devito
- Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - T. Grünwald
- Institute of Hydrology and Meteorology, Technische Universität Dresden, Tharandt, Germany
| | - M. Grygoruk
- Faculty of Civil and Environmental Engineering, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - E. R. Humphreys
- Department of Geography and Environmental Studies, Carleton University, Ottawa, Ontario, Canada
| | - J. Klatt
- Institute for Meteorology and Climatology-Atmospheric Environmental Research (IMK-IFU), Karlsruhe Institute of Technology (KIT), Garmisch-Partenkirchen, Germany
| | - J. Kurbatova
- A. N. Severtsov Institute of Ecology and Evolution, Russian Academy of Sciences, Moscow, Russia
| | - A. Lohila
- Climate System Research, Finnish Meteorological Institute, Helsinki, Finland
- Institute for Atmospheric and Earth System Research/Physics, Faculty of Science, University of Helsinki, Helsinki, Finland
| | - T. M. Munir
- Department of Geography, University of Calgary, Calgary, Alberta, Canada
| | - M. B. Nilsson
- Department of Forest Ecology and Management, Swedish University of Agricultural Sciences, Umeå, Sweden
| | - J. S. Price
- Wetlands Hydrology Lab, University of Waterloo, Waterloo, Ontario, Canada
| | - M. Röhl
- Institute of Landscape and Environment, HfWU Nürtingen, Nürtingen, Germany
| | - A. Schneider
- Institute of Botany and Landscape Ecology, University of Greifswald, Greifswald, Germany
| | - B. Tiemeyer
- Thünen Institute of Climate-Smart Agriculture, Braunschweig, Germany
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Giles L, Reuter U, Goadsby P, Lanteri-Minet M, Hours-Zesiger P, Fernandes C, Ferrari M, Klatt J. 096 Assessment of the efficacy of erenumab during the open-label treatment (13–24 weeks) of subjects with episodic migraine who failed 2–4 prior preventive treatments: results of the LIBERTY study. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-anzan.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionTo assess efficacy of erenumab in the first three months of the open-label extension phase (OLEP; 13–24 weeks) of the LIBERTY study.MethodsIn the double-blind treatment phase (DBTP), 246 patients were randomized to placebo and erenumab 140 mg for 12 weeks, following which, patients completing that phase (N=240) were enrolled in OLEP, to receive monthly erenumab 140 mg. Outcomes measured monthly throughout to week 24 were achievement of at least 50%/75%/100% reduction in monthly migraine days (MMD), change from DBTP baseline in MMD, monthly acute migraine-specific medication days (MSMD), Headache Impact Test (HIT-6TM) total score, everyday activities (EA) and physical impairment (PI) as measured by the Migraine Physical Function Impact Diary (MPFID).ResultsOverall, 228/240(95.0%) patients completed the 24 week visit of the OLEP. In the overall population at Week 24, 39.2%, 15.9% and 7.0% patients achieved ≥50%/≥75%/100% reduction in MMD. The mean (standard deviation) change from DBTP baseline in MMD was −2.7(4.4) and −1.4(3.0) in MSMD; and −7.6(8.0), −2.5(9.2) and −4.0(9.0) in HIT-6TM, MPFID-PI and MPFID-EA scores respectively. Patients with continuous use of erenumab showed sustained efficacy in all outcomes assessed. Patients who switched from placebo to erenumab in the OLEP showed improvement from the first measurement at Week 16 on all outcomes assessed.ConclusionsEfficacy of erenumab was sustained throughout 24 weeks in a hard to treat patient population with multiple prior preventive treatment failures. Overall, efficacy data over 24 weeks (assessed over weeks 13–16,17–20 and 21–24) was generally in line with prior erenumab trials.
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Ashina M, Goadsby PJ, Reuter U, Silberstein S, Dodick D, Rippon GA, Klatt J, Xue F, Chia V, Zhang F, Cheng S, Mikol DD. Long-term safety and tolerability of erenumab: Three-plus year results from a five-year open-label extension study in episodic migraine. Cephalalgia 2019; 39:1455-1464. [PMID: 31146544 PMCID: PMC6779015 DOI: 10.1177/0333102419854082] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previously published three-month placebo-controlled and one-year open-label clinical trial data have provided information on the efficacy and safety of erenumab. METHODS Interim analysis was undertaken from an ongoing five-year open-label treatment phase after all patients completed three years in the open-label treatment phase or discontinued the study. Adult patients with episodic migraine enrolled in the open-label treatment phase initially received 70 mg erenumab monthly. A protocol amendment increased the dosage to 140 mg monthly to assess long-term safety of the higher dose. Safety and tolerability were assessed by monitoring adverse events, electrocardiograms, laboratory assessments, and vital signs. RESULTS Of 383 patients enrolled in the open-label treatment phase, at data cutoff 235 (61.3%) remained in the study, all received 140 mg for ≥1 year. Median (Q1, Q3) exposure (70 or 140 mg) for all patients enrolled was 3.2 (1.3, 3.4) years. The most frequent adverse events (≥4.0/100 patient-years) were reported as viral upper respiratory tract infection, sinusitis, influenza, and back pain. Exposure-adjusted serious adverse event rates were 4.2/100 patient-years. There was no increase in cardiovascular events over time. CONCLUSIONS In this long-term study of a CGRP-receptor antibody, erenumab was found to be safe and well-tolerated with a spectrum and rate of adverse events consistent with shorter-term placebo-controlled studies. TRIAL REGISTRATION ClinicalTrials.gov NCT01952574.
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Affiliation(s)
- Messoud Ashina
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter J Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, London, UK
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stephen Silberstein
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - David Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Jan Klatt
- Novartis Pharma AG, Basel, Switzerland
| | - Fei Xue
- Amgen Inc., Thousand Oaks, CA, USA
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Goadsby PJ, Paemeleire K, Broessner G, Brandes J, Klatt J, Zhang F, Picard H, Lenz R, Mikol DD. Efficacy and safety of erenumab (AMG334) in episodic migraine patients with prior preventive treatment failure: A subgroup analysis of a randomized, double-blind, placebo-controlled study. Cephalalgia 2019; 39:817-826. [PMID: 30982348 DOI: 10.1177/0333102419835459] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Erenumab was effective and well tolerated in a pivotal clinical trial of episodic migraine that included subjects both naïve to, and those who had failed, previous preventives. Here we evaluated the efficacy and safety of erenumab (70 mg or 140 mg) versus placebo in the subgroup of patients who had previously failed preventive treatment(s): ≥1 or ≥2 prior failed migraine preventive categories, and in patients who had never failed. METHODS Prespecified subgroup analyses evaluated change from baseline to months 4-6 (the primary endpoint of the blinded study phase) in monthly migraine days, achievement of ≥50% and ≥75% reduction in monthly migraine days, and change from baseline in acute migraine-specific medication days. Adverse events were also evaluated. RESULTS Treatment with both doses of erenumab resulted in greater reductions in monthly migraine days at months 4-6 (treatment difference versus placebo [95% CI], never failed subgroup: -0.9 [-1.5, -0.3] for 70 mg and -1.3 [-1.9, -0.7] for 140 mg; ≥1 prior failed medication categories subgroup: -2.0 [-2.8, -1.2] for 70 mg and -2.5 [-3.4, -1.7] for 140 mg; ≥2 prior failed medication categories subgroup: -1.3 [-2.6, 0.0] for 70 mg and -2.7 [-4.0, -1.4] for 140 mg). Similar results were observed in the monthly acute migraine-specific medication days endpoint, and in the achievement of ≥50% and ≥75% reduction in monthly migraine days. For the ≥50% reduction in monthly migraine day endpoint, placebo response in the no prior treatment failed group was 32.6%, in the ≥1 failed treatment 17.5%, and in the ≥2 failed treatments 11.1%. CONCLUSION Erenumab showed consistent efficacy in episodic migraine patients who had failed prior preventive treatments and was well tolerated across subgroups. The data suggest prior patients with prior treatment failures have lower placebo response rates.
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Affiliation(s)
- Peter J Goadsby
- 1 NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, UK.,2 SLaM Biomedical Research Centre, King's College London, UK
| | - Koen Paemeleire
- 3 Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Gregor Broessner
- 4 Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Jan Brandes
- 5 Nashville Neuroscience Group and Vanderbilt University School of Neurology, Nashville, TN, USA
| | - Jan Klatt
- 6 Novartis Pharma AG, Basel, Switzerland
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Zhao Y, Zheng Y, Eichhorn W, Klatt J, Henningsen A, Kluwe L, Friedrich RE, Gosau M, Smeets R. Enriching Stem/Progenitor Cells from Dental Pulp Cells by Low-density Culturing. In Vivo 2019; 33:23-29. [PMID: 30587598 DOI: 10.21873/invivo.11434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/02/2018] [Accepted: 11/07/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIM Clonogenicity is a key feature of stem/progenitor cells. The present study aimed to enrich stem/progenitor cells from dental pulp cells by means of culturing the cells at a low clonal density with spatial separation and the evaluate differentiation potential of the surviving cells. MATERIALS AND METHODS Pulp cells derived from wisdom teeth were seeded into wells of a 96-plate at a mean density of 1 cell/well and cultured for 2 weeks. Surviving cells were harvested, pooled together and subjected to differentiation into adipocytes, osteoblasts and neurons using respective inducing conditions for 3 weeks. The former two types of cells were examined by staining with Oil Red O and Alizarin Red, respectively. Neuron-like cells were inspected for their morphology and immunostained for microtubule-associated protein 2 and β-tubulin III. RESULTS Vital cells were obtained in eight wells of a 96-well plate, corresponding to a survival rate of 8%. Since fewer than two wells would be expected to contain more than four cells at seeding, the majority of surviving cells likely grew from 1-3 cells, which is a very low density. These cells differentiated into functional adipocytes and osteoblasts, and morphologically neuron-like cells. CONCLUSION Low-density seeding with spatial separation enables statistical estimation of cell number in wells and provides an effective strategy for enriching stem/progenitor cells and for isolating clonal dental pulp cells.
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Affiliation(s)
- Yao Zhao
- Department of Oral and Maxillofacial Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Yajie Zheng
- Department of Oral and Maxillofacial Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Eichhorn
- Department of Oral and Maxillofacial Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Klatt
- Department of Oral and Maxillofacial Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Anders Henningsen
- Division of Regenerative Orofacial Medicine, Department of Oral and Maxillofacial Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Lan Kluwe
- Department of Oral and Maxillofacial Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Reinhard E Friedrich
- Department of Oral and Maxillofacial Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Gosau
- Department of Oral and Maxillofacial Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.,Division of Regenerative Orofacial Medicine, Department of Oral and Maxillofacial Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Reuter U, Goadsby PJ, Lanteri-Minet M, Wen S, Hours-Zesiger P, Ferrari MD, Klatt J. Efficacy and tolerability of erenumab in patients with episodic migraine in whom two-to-four previous preventive treatments were unsuccessful: a randomised, double-blind, placebo-controlled, phase 3b study. Lancet 2018; 392:2280-2287. [PMID: 30360965 DOI: 10.1016/s0140-6736(18)32534-0] [Citation(s) in RCA: 281] [Impact Index Per Article: 46.8] [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: 09/21/2018] [Revised: 10/02/2018] [Accepted: 10/04/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND A substantial proportion of patients with migraine does not respond to, or cannot tolerate, oral preventive treatments. Erenumab is a novel CGRP-receptor antibody with preventive efficacy in migraine. We assessed its efficacy and tolerability in patients with episodic migraine in whom previous treatment with two-to-four migraine preventives had been unsuccessful. METHODS LIBERTY was a 12-week, double-blind, placebo-controlled randomised study at 59 sites in 16 countries. Eligible patients were aged 18-65 years and had a history of episodic migraine with or without aura for at least 12 months, had migraine for an average of 4-14 days per month during the 3 months before screening, and had been treated unsuccessfully (in terms of either efficacy or tolerability, or both) with between two and four preventive treatments. Eligible participants were randomly assigned (1:1) to receive either erenumab 140 mg (via two 70 mg injections) or placebo every 4 weeks subcutaneously for 12 weeks. Randomisation was by interactive response technology and was stratified by monthly frequency of migraine headache (4-7 vs 8-14 migraine days per month) during the baseline phase. Cenduit generated the randomisation list and assigned participants to groups. Participants, investigators, people doing various assessments, and the study sponsor were masked to treatment assignment. The primary endpoint was the proportion of patients achieving a 50% or greater reduction in the mean number of monthly migraine days during weeks 9-12. Efficacy was measured in the full analysis set, which included all randomly assigned patients who started their assigned treatment and completed at least one post-baseline monthly migraine day measurement. Safety and tolerability were assessed by recording adverse events and by physical examination, assessment of vital signs, clinical laboratory assessments, and electrocardiography. Safety was assessed in all randomly assigned patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, number NCT03096834. The trial is closed to new participants, but the open-label extension phase is ongoing. FINDINGS Between March 20, 2017, and Oct 27, 2017, 246 participants were randomly assigned, 121 to the erenumab group and 125 to the placebo group. 95 of 246 (39%) participants had previously unsuccessfully tried two preventive drugs, 93 (38%) had tried three, and 56 (23%) had tried four. At week 12, 36 (30%) patients in the erenumab had a 50% or greater reduction from baseline in the mean number of monthly migraine days, compared with 17 (14%) in the placebo group (odds ratio 2·7 [95% CI 1·4-5·2]; p=0·002). The tolerability and safety profiles of erenumab and placebo were similar. The most frequent treatment-emergent adverse event was injection site pain, which occurred in seven (6%) participants in both groups. INTERPRETATION Compared with placebo, erenumab was efficacious in patients with episodic migraine who previously did not respond to or tolerate between two and four previous migraine preventive treatments. Erenumab might be an option for patients with difficult-to-treat migraine who have high unmet needs and few treatment options. FUNDING Novartis Pharma.
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Affiliation(s)
- Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | - Peter J Goadsby
- NIHR-Wellcome Trust, King's Clinical Research Facility, King's College London, London, UK
| | - Michel Lanteri-Minet
- Pain Department and FHU InvoPain, CHU Nice-Université Côte d'Azur, Nice, France; INSERM U1107 Migraine and Trigeminal Pain, Auvergne University, Clermont-Ferrand, France
| | | | | | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
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Schwedt T, Reuter U, Tepper S, Ashina M, Kudrow D, Broessner G, Boudreau GP, McAllister P, Vu T, Zhang F, Cheng S, Picard H, Wen S, Kahn J, Klatt J, Mikol D. Early onset of efficacy with erenumab in patients with episodic and chronic migraine. J Headache Pain 2018; 19:92. [PMID: 30276500 PMCID: PMC6755616 DOI: 10.1186/s10194-018-0923-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/24/2018] [Indexed: 11/12/2022] Open
Abstract
Background Subcutaneous erenumab reduced monthly migraine days and increased the likelihood of achieving a ≥ 50% reduction at all monthly assessment points tested in 2 pivotal trials in episodic migraine (EM) and chronic migraine (CM). Early efficacy of migraine preventive medications is an important treatment characteristic to patients. Delays in achievement of efficacy can result in failed adherence. The objective of these post-hoc analyses were to evaluate efficacy in the first 4 weeks after initial subcutaneous administration of erenumab 70 mg, erenumab 140 mg, or placebo. Methods There is no generally accepted methodology to measure onset of action for migraine preventive medications. We used a comprehensive approach with data from both studies to evaluate change from baseline in weekly migraine days (WMD), achievement of ≥ 50% reduction in WMD, and proportion of patients experiencing migraine measured on a daily basis. The 7-day moving averages were overlaid with observed data. Results In both studies (EM: N = 955; CM: N = 667), there was evidence of onset of efficacy of erenumab vs. placebo during the first week of treatment, which in some cases reached nominal significance. For EM the changes in WMD were (least squares mean [LSM] [95% CI]): placebo, − 0.1 (− 0.3, 0.0); erenumab 70 mg, − 0.3 (− 0.5, − 0.2) p = 0.130; erenumab 140 mg, − 0.6 (− 0.7, − 0.4) p < 0.001. For CM the changes were: placebo, − 0.5 (− 0.8, − 0.3); erenumab 70 mg, − 0.9 (− 1.2, − 0.7) p = 0.047; erenumab 140 mg, − 0.8 (− 1.1, − 0.5) p = 0.18. Achievement of ≥ 50% reduction in WMD was observed as early as Week 1 (adjusted OR [95% CI] erenumab vs placebo) in EM: erenumab 70 mg, 1.3 (1.0, 1.9) p = 0.097; erenumab 140 mg, 2.0 (1.4, 2.7) p < 0.001. A similar outcome was observed for CM: erenumab 70 mg, 1.8 (1.1, 2.8) p = 0.011; erenumab 140 mg, 1.9 (1.2, 2.9) p = 0.009. Seven-day moving averages of observed data showed each treatment arm differed from placebo by Week 1 (OR [95% CI]): in EM Day 3 for erenumab 140 mg, 0.7 (0.5, 1.0) p = 0.031 and at Day 7 for 70 mg, 0.6 (0.4, 0.8) p = 0.002; in CM: Day 6 for erenumab 70 mg, 0.6 (0.4, 0.9) p = 0.022 and at Day 7 for 140 mg, 0.7 (0.4, 1.0); p = 0.038. Conclusion Erenumab showed early onset of efficacy with separation from placebo within the first week of treatment in both chronic and episodic migraine patients.
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Affiliation(s)
- Todd Schwedt
- Department of Neurology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA.
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stewart Tepper
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Messoud Ashina
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David Kudrow
- California Medical Clinic for Headache, Santa Monica, CA, USA
| | - Gregor Broessner
- Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Guy P Boudreau
- Clinique de la Migraine et Céphalées, Département de Neurologie, Centre Hospitalier de L'Université de Montréal, Hôpital Notre-Dame, Montréal, QC, Canada
| | - Peter McAllister
- New England Institute for Neurology & Headache, Stamford, CT, USA
| | - Thuy Vu
- Amgen Inc., Thousand Oaks, CA, USA
| | | | | | | | - Shihua Wen
- Novartis Pharmaceuticals Corp., East Hanover, NJ, USA
| | - Joseph Kahn
- Novartis Pharmaceuticals Corp., East Hanover, NJ, USA
| | - Jan Klatt
- Novartis Pharma AG, Basel, Switzerland
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Vo P, Wen S, Martel MJ, Mitsikostas D, Reuter U, Klatt J. Benefit-risk assessment of erenumab and current migraine prophylactic treatments using the likelihood of being helped or harmed. Cephalalgia 2018; 39:608-616. [DOI: 10.1177/0333102418801579] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective This study evaluated the benefit-risk profile of erenumab relative to other therapies approved for migraine prophylaxis and available in the majority of European countries. Methods Trials were identified via a published systematic literature review updated to December 2017 using MEDLINE. Erenumab’s pivotal trials study reports were also included (NCT02066415, NCT02456740). From these sources, ≥ 50% responder rates and discontinuations due to adverse events were extracted to generate numbers needed to treat and harm and likelihood of being helped or harmed, a quantitative benefit-risk measure. Results Eleven articles (nine randomized clinical trials) met the inclusion/exclusion criteria. Low numbers needed to treat (range: 4–13) were observed for most treatments, while numbers needed to harm showed substantial differences (erenumab’s higher numbers needed to harm indicating better tolerability). In chronic and episodic migraine, likelihoods of being helped or harmed for erenumab 70 mg were 143 and 167, and 42 and 167 for erenumab 140 mg. Likelihoods of being helped or harmed in chronic migraine were 2 and 3 for topiramate (two studies) and 4 for onabotulinumtoxinA. In episodic migraine, likelihoods of being helped or harmed were 2 for topiramate and 2 for propranolol. Conclusions While all prophylactic treatments were more likely to help than harm (likelihood of being helped or harmed > 1), erenumab showed a likelihood of being helped or harmed of high magnitude, supporting its favorable benefit-risk profile across the entire migraine frequency spectrum, in contrast with other prophylactic treatments.
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Affiliation(s)
- Pamela Vo
- Novartis Pharma AG, Basel, Switzerland
| | - Shihua Wen
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | - Dimos Mitsikostas
- 1st Neurology Department, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Uwe Reuter
- Department of Neurology, Charité Headache Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Klatt
- Novartis Pharma AG, Basel, Switzerland
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Ashina M, Tepper S, Brandes JL, Reuter U, Boudreau G, Dolezil D, Cheng S, Zhang F, Lenz R, Klatt J, Mikol DD. Efficacy and safety of erenumab (AMG334) in chronic migraine patients with prior preventive treatment failure: A subgroup analysis of a randomized, double-blind, placebo-controlled study. Cephalalgia 2018; 38:1611-1621. [DOI: 10.1177/0333102418788347] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background Erenumab was effective and well tolerated in a pivotal clinical trial of chronic migraine. Here, we evaluated efficacy and safety of monthly erenumab (70 mg or 140 mg) versus placebo in the subgroup of patients who had previously failed preventive treatment(s) (≥ 1, ≥ 2 prior failed medication categories) and in patients who had never failed. Methods Subgroup analyses evaluated change from baseline in monthly migraine days; achievement of ≥ 50% and ≥ 75% reduction in monthly migraine days; and change in monthly acute migraine-specific medication days. Adverse events were evaluated for each subgroup. Results Treatment with both doses of erenumab resulted in greater reductions in monthly migraine days (primary endpoint) at Month 3 (treatment difference [95% CI], never failed subgroup: −2.2 [−4.1, −0.3] for 70 mg and −0.5 [−2.4, 1.5] for 140 mg; ≥ 1 prior failed medication categories subgroup: −2.5 [−3.8, −1.2], for 70 mg and −3.3 [−4.6, −2.1] for 140 mg; ≥ 2 prior failed medication categories subgroup: −2.7 [−4.2, −1.2], for 70 mg and −4.3 [−5.8, −2.8] for 140 mg). Similar results were observed in the monthly acute migraine-specific medication days endpoint, and in the achievement of ≥ 50% and ≥ 75% reduction in monthly migraine days. There were no new or unexpected safety issues. Conclusion Erenumab showed consistent efficacy in chronic migraine patients who had failed prior preventive treatments and was well tolerated across subgroups.
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Affiliation(s)
- Messoud Ashina
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stewart Tepper
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Jan Lewis Brandes
- Nashville Neuroscience Group and Department of Neurology, Vanderbilt University, Nashville, TN, USA
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Guy Boudreau
- Headache Unit, Neurology Department, University Hospital Center of Montreal, Montreal, QC, Canada
| | - David Dolezil
- Prague Headache Center, DADO MEDICAL s.r.o., Prague, Czech Republic
| | | | | | | | - Jan Klatt
- Novartis Pharma AG, Basel, Switzerland
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Zimmermann C, Henningsen A, Henkel KO, Klatt J, Jürgens C, Seide K, Kienast B. Biomechanical comparison of a multidirectional locking plate and conventional plates for the osteosynthesis of mandibular angle fractures—A preliminary study. J Craniomaxillofac Surg 2017; 45:1913-1920. [DOI: 10.1016/j.jcms.2017.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 05/02/2017] [Accepted: 05/29/2017] [Indexed: 10/19/2022] Open
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Plümer L, Schön G, Klatt J, Hanken H, Schmelzle R, Pohlenz P. Nasal position of nasotracheal tubes: a retrospective analysis of intraoperatively generated three-dimensional X-rays during maxillofacial surgery. Eur J Med Res 2014; 19:55. [PMID: 25323943 PMCID: PMC4201921 DOI: 10.1186/s40001-014-0055-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 10/03/2014] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this retrospective investigation was to evaluate the position of the nasotracheal tube in the nose and to show its anatomical relationship with the maxillary sinus ostium. Methods Fifty data sets from patients who had undergone endonasal intubation were analyzed for tube positioning. There was a drop-out of eight data sets due to missing information concerning tube size and mode. Tube positioning was determined at the maxillary sinus ostium in the intraoperatively generated three-dimensional X-ray data sets. The type of tube, the tube size, and the presence of maxillary sinusitis were analyzed 30 minutes after intubation. Results The tube was positioned in the middle nasal meatus in 35 (83.3%) patients and not in the middle nasal meatus in 7 (16.7%) patients. The difference in comparison with equal distribution was significant (P <0.001). The test value was 83.3; the 95% confidence interval of the test value was 68.6 to 93.0%. Maxillary sinusitis was diagnosed as a chance finding in 17% of patients (n =7). Conclusions The majority of nasal tubes are positioned in the middle nasal meatus. This result can be part of the answer to the question of the causal relationship between position of the breathing tube and the onset of maxillary sinusitis. The indications for prolonged nasotracheal intubation instead of orotracheal intubation or early tracheostomy should be considered carefully.
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Affiliation(s)
- Lili Plümer
- Center for Anesthesiology and Intensive Care Medicine, Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Gerhard Schön
- Center for Experimental Medicine, Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Jan Klatt
- Own medical practice of Oral and Maxillofacial Surgery, Hamburg, Germany.
| | - Henning Hanken
- Center for Clinical Neurosciences, Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Rainer Schmelzle
- Own medical practice of Oral and Maxillofacial Surgery and of Plastic and Reconstructive Surgery, Hamburg, Germany.
| | - Philipp Pohlenz
- Department of Oral and Maxillofacial Surgery and of Plastic and Reconstructive Surgery, Red Cross Hospital, Bremen, Germany.
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Bakshi R, Bischof D, Klatt J. Comment on “Dimethyl Fumarate (Tecfidera): A New Oral Agent for Multiple Sclerosis”. Ann Pharmacother 2014; 48:944. [DOI: 10.1177/1060028014533090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Klatt J, Gerich CE, Gröbe A, Opitz J, Schreiber J, Hanken H, Salomon G, Heiland M, Kluwe L, Blessmann M. Fractal dimension of time-resolved autofluorescence discriminates tumour from healthy tissues in the oral cavity. J Craniomaxillofac Surg 2013; 42:852-4. [PMID: 24444757 DOI: 10.1016/j.jcms.2013.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 09/12/2013] [Accepted: 12/17/2013] [Indexed: 11/15/2022] Open
Abstract
Early detection and complete resection of oral carcinomas is of crucial importance for patient survival. This could be significantly improved by developing a non-invasive, sensitive and real-time detection technique. Time-resolved autofluorescence measurement is state-of-the-art technology originally developed for non-destructive inspection of material. In this study, we measured time-resolved autofluorescence in tumours and healthy tissues of the oral cavity ex vivo and calculated the corresponding fractal dimension which was significantly higher in tumours than in healthy tissues (1.8 vs. 1.6, P < 0.001, unpaired t-test) with non-overlapping 95% confidential intervals 1.88-1.84 and 1.57-1.69, respectively. Very high specificity (86%) could be reached at 100% sensitivity. The area under the curve was 99%, further suggesting the superior prediction potential of fractal dimension based on time-resolved autofluorescence spectra.
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Affiliation(s)
- Jan Klatt
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carola E Gerich
- Fraunhofer Institute for Non-Destructive Testing, Laboratory of Optical Diagnostics, Dresden, Germany
| | - Alexander Gröbe
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Opitz
- Fraunhofer Institute for Non-Destructive Testing, Laboratory of Optical Diagnostics, Dresden, Germany
| | - Jürgen Schreiber
- Fraunhofer Institute for Non-Destructive Testing, Laboratory of Optical Diagnostics, Dresden, Germany
| | - Henning Hanken
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Georg Salomon
- Martiniclinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lan Kluwe
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Marco Blessmann
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Pohlenz P, Klatt J, Schmelzle R, Li L. The importance of in-hospital mortality for patients requiring free tissue transfer for head and neck oncology. Br J Oral Maxillofac Surg 2013; 51:508-13. [PMID: 23369783 DOI: 10.1016/j.bjoms.2012.10.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 10/31/2012] [Indexed: 11/29/2022]
Abstract
Mortality is a rare but disastrous complication of microvascular head and neck reconstruction. The investigators attempt to identify the procedure-related mortality cases and analyse the causes of death. A retrospective analysis of 804 consecutive free flap procedures during a 19-year period was performed and fatal cases were identified (n=42 deaths). Multivariate logistic regression was employed to determine the association of in-hospital mortality with patient-related characteristics. The 30-day post-operative mortality rate was 1% (8 out of 804 patients), and the in-hospital mortality rate (post-operative deaths in-hospital before or after the 30th post-operative day without discharge) was 5.2% (42 out of 804 patients). Cancer recurrence and metastases related pneumonia were the most common causes of death (n=26, 62%), followed by cardiac, pulmonary, infectious and hepatic/renal aetiologies. Logistic regression analysis revealed that patients with stage IV disease and an operation time of >9h were significantly associated with post-operative mortality. Malignancy-related conditions were the most common causes of death following free flap transfer for head and neck reconstruction. For patients with stage IV head and neck cancer, this aggressive surgical approach should be cautiously justified due to its association with post-operative mortality. To shorten the operation time, experienced microsurgical operation teams are necessary.
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Affiliation(s)
- P Pohlenz
- Department of Plastic and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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Blessmann M, Al-Dam A, Hanken H, Assaf AT, Riecke B, Klatt J, Simon R, Sauter G, Heiland M, Kluwe L, Gröbe A. Amplification of the PPFIA1 gene region on 11q13 in oral squamous cell carcinomas (OSCC). J Craniomaxillofac Surg 2013; 41:845-9. [PMID: 23453270 DOI: 10.1016/j.jcms.2013.01.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 01/05/2013] [Accepted: 01/07/2013] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Analyzing chromosomal amplifications delivers valuable information for identification of oncogenes. For carcinomas of the oral cavity only few genes have been identified in amplified regions. The aim of this study was to search genes in amplified regions as possible biomarkers and targets for novel therapies. MATERIAL AND METHODS DNA from 10 carcinomas of the floor of the oral cavity was examined using a 500K Array GeneChip (Affymetrix 6.0) to detect chromosomal losses, gains or amplifications. Suspicious alterations were validated on tissue microarrays using fluorescence in situ hybridization (FISH) with respective probes. RESULTS FISH-validation on tissue arrays confirmed PPFIA1 amplifications as one of the most frequent events (32.6%). High (10-20 signals) and low (<10 signals) amplification of PPFIA1 was found in 10.9% (5/46) and 21.7% (10/46) tumours, respectively. Fine mapping with overlapping FISH probes showed co-amplification of PPFIA1 and the Cyclin D1 gene which are approximately 600 kb apart from each other, likely in the same amplicon. DISCUSSION PPFIA1 was frequently co-amplified with the Cyclin D1 gene in oral carcinomas and could present a biomarker as well as a novel target for specific gene therapy. Further studies are necessary to investigate the role of PPFIA1 in development and pathogenesis of oral carcinomas.
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Affiliation(s)
- Marco Blessmann
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Pohlenz P, Atac A, Catala-Lehnen P, Khakpour P, Li L, Klatt J, Schmelzle R. RETRACTED ARTICLE: Donor site morbidity of the vascularized fibula: the Hamburg experience. Clin Oral Investig 2012; 16:1333. [DOI: 10.1007/s00784-012-0717-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 03/05/2012] [Indexed: 11/29/2022]
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Pohlenz P, Klatt J, Schön G, Blessmann M, Li L, Schmelzle R. Microvascular free flaps in head and neck surgery: complications and outcome of 1000 flaps. Int J Oral Maxillofac Surg 2012; 41:739-43. [DOI: 10.1016/j.ijom.2012.02.012] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 12/21/2011] [Accepted: 02/15/2012] [Indexed: 11/17/2022]
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Abstract
OBJECTIVE Our purpose was to evaluate the antenatal incidence of single umbilical artery (SUA) in twin pregnancies according to chorionicity and to assess its relationship with outcome. METHODS Consecutive twin pregnancies undergoing ultrasound evaluation at our institutions were included. A targeted sonographic evaluation of the umbilical cord and vessels was performed in all cases. Chorionicity was determined according to standard ultrasound criteria. RESULTS A total of 174 twin pregnancies, 100 dichorionic (DC) and 74 monochorionic (MC), were included in the study. An SUA was identified in 17 (9.8%) pregnancies, and in 18 (5.2%) fetuses. No difference was found in the incidence of SUA in DC and MC twins. Among affected pregnancies, all but one DC twin pregnancy were discordant for SUA. Structural and/or chromosomal abnormalities were present in 27.8% of fetuses with SUA. The prevalence of small-for-gestational-age fetuses and of discordant birth weight (> 20% discordance) was higher in the SUA group than in the rest of the population, although these differences were not statistically significant. Twin pairs discordant for SUA had significantly higher weight discordance than those with normal umbilical cords. The sonographic cross-sectional area of the SUA did not appear to show the typical adaptive dilatation usually seen in singleton pregnancies with SUA. CONCLUSIONS The incidence of SUA in twins is higher than in singletons, with no difference between MC and DC twins. Intrapair discordance for SUA in identical twins provides evidence against an exclusively genetic origin of this anomaly. The apparent failure of compensatory dilatation of the umbilical artery in twins with SUA may explain in part the higher risk for fetal growth restriction in these cases.
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Affiliation(s)
- J Klatt
- Department of Obstetrics and Gynecology, Neue Frauenklinik Luzern, Luzern, Switzerland
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Klatt J, Heiland M, Gröbe A, Westphal M, Schmelzle R, Pohlenz P. A hematogenous spread brain abscess invading the right damaged temporomandibular joint. J Craniomaxillofac Surg 2012; 40:e307-9. [PMID: 22440320 DOI: 10.1016/j.jcms.2012.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 01/29/2012] [Accepted: 01/30/2012] [Indexed: 11/15/2022] Open
Abstract
We report a rare case of a brain abscess which drained spontaneously in a temporomandibular joint damaged by osteoarthritis. The female patient presented to our hospital with a severe headache and pain in the temporomandibular joint. She showed elevated inflammatory parameters with unknown cause. Magnetic resonance imaging of her whole body revealed a large temporal brain abscess extending into the glenoid fossa of the temporomandibular joint. The brain abscess was incised and drained by neurosurgeons in our hospital and in the same operation we resected the articular disc and the affected part of the right temporomandibular joint. Histological examination confirmed a chronic arthrosis in the resected bone of the temporomandibular joint and an inflammatory abscess in the resected brain tissue. The patient recovered well and the inflammation resolved as seen in postoperative investigations. Magnetic resonance imaging a month later confirmed local consolidation in the brain with no sign of residual inflammation.
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Affiliation(s)
- J Klatt
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Nilsson S, Zeindl HP, Krüger D, Klatt J, Kurps R. Surfactant-Mediated Growth of SiGe/Si Quantum-Well Structures Studied by Photoluminescence Technique and Secondary Ion Mass Spectrometry. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-399-197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACTIn this investigation, surfactant-mediated growth of SiGe/Si single quantum-well structures is studied by photoluminescence and secondary ion mass spectrometry. The samples were grown by molecular-beam epitaxy and Sb was used as a surfactant. The photon energy of the SiGe-related near-band-edge photoluminescence was used to probe the action of Sb as a surfactant to promote two-dimensional growth and to reduce segregation of Ge during growth. First, the "growth-temperature window" at which Sb acts preferentially as a surfactant was determined. Then, at this optimized temperature of 700°C, the influence of different Sb coverages was investigated and it was found that 0.5 monolayer was a sufficient coverage to obtain full surfactant action. Ge concentration depth profiles obtained by secondary ion mass spectrometry confirmed the effect of surfactant-mediated growth and, in addition, the unintentional incorporation of the Sb surfactant during growth was determined quantitatively. In a final experiment the effect of deposition of Sb on either the lower or the upper heterointerface is addressed.
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Schulz E, Fleischhaker C, Hennighausen K, Heiser P, Oehler KU, Linder M, Haessler F, Huss M, Warnke A, Schmidt M, Schulte-Markworth M, Sieder C, Klatt J, Tracik F. A double-blind, randomized, placebo/active controlled crossover evaluation of the efficacy and safety of Ritalin ® LA in children with attention-deficit/hyperactivity disorder in a laboratory classroom setting. J Child Adolesc Psychopharmacol 2010; 20:377-85. [PMID: 20973708 DOI: 10.1089/cap.2009.0106] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The primary objective of this study was to demonstrate efficacy of Ritalin(®) LA 20 mg by showing superiority to placebo and noninferiority to Medikinet(®) Retard in a laboratory classroom setting. Secondary objectives included safety/tolerability and further efficacy parameters. METHODS A total of 147 children with attention-deficit/hyperactivity disorder (ADHD) diagnosed by the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) and aged 6-14 (81% males) and known to be methylphenidate (MPH) responders were enrolled in this multicenter, double-blind, randomized, placebo/active-controlled, three-period (7 days each) crossover study. The Swanson, Kotlin, Agler, M-Flynn, and Pelham (SKAMP) scale was used for efficacy ratings. The mean of SKAMP Combined ratings performed at 10:30 a.m., at 12:00 a.m., and at 1:30 p.m. was defined as the primary parameter. RESULTS In all, 146 patients completed all treatment periods. Intensity and frequency of adverse events were comparable between the two formulations. Ritalin(®) LA demonstrated superiority compared to placebo (p<0.0001). The observed difference in the SKAMP scores between Ritalin(®) LA and Medikinet(®) Retard between the hours 1.5 until 4.5 did not exceed the noninferiority margin (p=0.0003); therefore, the difference is regarded as not clinically relevant. Similar results were obtained for the secondary efficacy variables. CONCLUSION Ritalin(®) LA is an efficacious, well-tolerated treatment option for children aged 6-14 with ADHD.
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Affiliation(s)
- Eberhard Schulz
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Freiburg, Freiburg, Germany.
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Schulz E, Fleischhaker C, Hennighausen K, Heiser P, Haessler F, Linder M, Stollhoff K, Warnke A, Baier M, Klatt J. A randomized, rater-blinded, crossover study comparing the clinical efficacy of Ritalin® LA (methylphenidate) treatment in children with attention-deficit hyperactivity disorder under different breakfast conditions over 2 weeks. ACTA ACUST UNITED AC 2010; 2:133-8. [DOI: 10.1007/s12402-010-0031-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 07/31/2010] [Indexed: 11/29/2022]
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Klatt J, Heiland M, Blessmann M, Blake F, Schmelzle R, Pohlenz P. Clinical indication for intraoperative 3D imaging during open reduction of fractures of the neck and head of the mandibular condyle. J Craniomaxillofac Surg 2010; 39:244-8. [PMID: 20675146 DOI: 10.1016/j.jcms.2010.06.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 06/13/2010] [Accepted: 06/16/2010] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study aimed to evaluate the use of intraoperative cone-beam computed tomography (CBCT) in monitoring the results of repositioning and osteosynthesis of condylar process and head (capitulum) fractures of the mandible to see if CBCT is beneficial for these patients. PATIENTS AND METHODS Sixty patients (22 females and 38 males, age range 16-79 years, average 36.5 years) with condylar process and head fractures according to the classification of Spiessl and Schroll were treated during the study period. Thirty-four of the 60 patients received a CBCT scan immediately after surgical treatment under aseptic conditions. RESULTS In all 34 cases, intraoperative CBCT provided high-quality imaging of the condylar process in all three planes. In four patients (11.8%), unsatisfactory reposition or unexpected complications were detected which could immediately be corrected with a surgical revision. CONCLUSION Intraoperative use of CBCT enables optimization of the surgical outcome for fractures of the condylar process and head of the mandible, reduces postoperative complications, and spares patients from repeated intervention. In addition, intraoperative CBCT enables safer treatment with minimally invasive approaches.
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Affiliation(s)
- J Klatt
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Gröbe A, Klatt J, Heiland M, Schmelzle R, Pohlenz P. Diagnostic and therapeutic aspects in the treatment of gunshot wounds of the viscerocranium. Eur J Trauma Emerg Surg 2010; 37:41-7. [PMID: 26814749 DOI: 10.1007/s00068-010-0023-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 01/26/2010] [Indexed: 01/12/2023]
Abstract
Gunshot wounds of the viscerocranium are a rare occurrence during times of peace in Europe. The removal of projectiles is recommended; in some cases, however, this is controversial. The material properties of projectiles and destruction of anatomical landmarks make it difficult to determine their precise location. Therefore, navigation systems and cone-beam computed tomography (CT) provide the surgeon with continuous intraoperative orientation in real-time. The aim of this study was to report our experiences for image-guided removal of projectiles, the use of cone-beam computed tomography and the resulting intra- and postoperative complications. We investigated 50 patients with gunshot wounds of the facial skeleton retrospectively, 32 had image-guided surgical removal of projectiles in the oral and maxillofacial region, 18 had surgical removal of projectiles without navigation assistance and in 28 cases we used cone-beam CT in the case of dislocated projectiles and fractured bones. There was a significant correlation (p = 0.0136) between the navigated versus not navigated surgery and complication rate (8 vs. 32%, p = 0.0132) including major bleeding, soft tissue infections and nerve damage. Furthermore, we could reduce operating time while using a navigation system and cone-beam CT (p = 0.038). A high tendency between operating time and navigated surgery (p = 0.1103) was found. In conclusion, there is a significant correlation between reduced intra- and postoperative complications including wound infections, nerve damage and major bleeding and the appropriate use of a navigation system. In all these cases we were able to present reduced operating time. Cone-beam CT plays a key role as a useful diagnostic tool in detecting projectiles or metallic foreign bodies intraoperatively.
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Affiliation(s)
- A Gröbe
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - J Klatt
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - M Heiland
- Department of Oral and Maxillofacial Surgery, General Hospital of Bremerhaven-Reinkenheide, Postbrookstr. 103, 27574, Bremerhaven, Germany.
| | - R Schmelzle
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - P Pohlenz
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Hartung HP, Tiel-Wilck K, Klatt J, Meergans M. Orales Fingolimod (FTYP720) versus Interferon β-1a im. bei schubförmiger Multiple Sklerose: Basisdemografie einer Phase III-Studie. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gröbe A, Weber C, Schmelzle R, Heiland M, Klatt J, Pohlenz P. The use of navigation (BrainLAB Vector vision(2)) and intraoperative 3D imaging system (Siemens Arcadis Orbic 3D) in the treatment of gunshot wounds of the maxillofacial region. Oral Maxillofac Surg 2009; 13:153-158. [PMID: 19669177 DOI: 10.1007/s10006-009-0166-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Gunshot wounds are a rare occurrence during times of peace. The removal of projectiles is recommended; in some cases, however, this is a controversy. The reproduction of a projectile image can be difficult if it is not adjacent to an anatomical landmark. Therefore, navigation systems give the surgeon continuous real-time orientation intraoperatively. The aim of this study was to report our experiences for image-guided removal of projectiles and the resulting intra- and postoperative complications. PATIENTS AND METHODS We investigated 50 patients retrospectively; 32 had image-guided surgical removal of projectiles in the oral and maxillofacial region. Eighteen had surgical removal of projectiles without navigation assistance. RESULTS There was a significant correlation (p = 0.0136) between the navigated surgery vs. not-navigated surgery and complication rate, including major bleeding (n = 4 vs. n = 1, 8% vs. 2%), soft tissue infections (n = 7 vs. n = 2, 14% vs. 4%), and nerval damage (n = 2 vs. n = 0, 4% vs. 0%; p = 0.038) and between the operating time and postoperative complications. A high tendency between operating time and navigated surgery (p = 0.1103) was shown. When using navigation system, we could reduce operating time. CONCLUSION In conclusion, there is a significant correlation between reduced intra- and postoperative complications, including wound infections, nerval damage, and major bleeding, and the appropriate use of a navigation system. In all these cases, we could present reduced operating time. Cone-beam computed tomography plays an important role in detecting projectiles or metallic foreign bodies intraoperatively.
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Affiliation(s)
- Alexander Gröbe
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
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Diener H, Hartung H, Bien C, Hacke W, Ringelstein E, Ludolph A, Deuschl G, Wiltfang J, Weller M, Steinhausen K, Stemper B, Klatt J, Drepper J, Griewing B, Meier U, Herschel M, Hummel K, Paar W, Dintsios C, Schade-Brittinger C, Weber R, Weimar C. Klinische Studien in der Neurologie in Deutschland 2008. Akt Neurol 2009. [DOI: 10.1055/s-0028-1090145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Klatt J, Hohlfeld R, Wiendl H, Hartung H. FTY720– eine neue orale, einmal täglich anzuwendende therapeutische Option für Multiple Sklerose: Update aus dem internationalen Studienprogramm. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
All currently available therapeutic options for multiple sclerosis have to be administered parenterally. Several oral substances are currently in the late clinical development stage. One of them, FTY720 (also known as fingolimod) is highlighted in this review. The biological effects of FTY720 are presented as well as animal data and first clinical data from a phase II trial in multiple sclerosis patients. The effects of FTY720 are based on an innovative approach and apparently target several key elements in the pathogenesis of multiple sclerosis. The first clinical data with FTY720 show very promising results, with a relapse reduction of over 50% compared to placebo and an acceptable safety profile. These results currently await confirmation in two international phase III studies which are recruiting patients worldwide.
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Affiliation(s)
- J Klatt
- Novartis Pharma GmbH Nürnberg
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Koethe D, Juelicher A, Nolden BM, Braunwarth WD, Klosterkötter J, Niklewski G, Wodarz N, Klatt J, Burtscheidt W, Gaebel W, Markus Leweke F. Oxcarbazepine--efficacy and tolerability during treatment of alcohol withdrawal: a double-blind, randomized, placebo-controlled multicenter pilot study. Alcohol Clin Exp Res 2007; 31:1188-94. [PMID: 17511748 DOI: 10.1111/j.1530-0277.2007.00419.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Alcohol withdrawal syndrome (AWS) is a serious complication of alcohol dependence and often requires intensive medical treatment. Antiepileptic drugs (AEDs) have been shown to be as efficacious in the treatment of AWS in several controlled trials as benzodiazepines and superior to placebo in relieving alcohol withdrawal symptoms. Oxcarbazepine (OXC), a newer anticonvulsive drug, has a favorable safety profile over carbamazepine (CBZ) and other older AEDs due to its excellent efficacy and better side-effect profile. METHODS The efficacy and tolerability of OXC versus placebo were investigated in 50 inpatients during a 6-day treatment of alcohol withdrawal in a 4-site, double-blind, randomized, placebo-controlled pilot study. The amount of rescue medication of clomethiazole (CLO) capsules needed was chosen as the primary variable. The data were collected between May 2003 and September 2004. RESULTS No initial differences were found regarding sociodemographic data and alcohol-related parameters, indicating successful randomization. No differences were found in the need for rescue medication CLO, decrease of withdrawal symptoms, or craving for alcohol between the OXC and the placebo group. Subjectively experienced side effects, normalization of vegetative parameters, craving, or improvement of psychopathological parameters were not different between the groups. CONCLUSION Despite the negative finding, which may be attributable to the design of the study, OXC still poses an interesting alternative to CBZ and other drugs because other studies have found it not only as efficient but also as having no addictive potential, while additionally possessing an anti-craving effect. Therefore, well-designed investigations with larger cohorts are required to further elucidate this issue.
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Affiliation(s)
- Dagmar Koethe
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
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Wiesemann E, Klatt J, Wenzel C, Heidenreich F, Windhagen A. Correlation of serum IL-13 and IL-5 levels with clinical response to Glatiramer acetate in patients with multiple sclerosis. Clin Exp Immunol 2003; 133:454-60. [PMID: 12930374 PMCID: PMC1808789 DOI: 10.1046/j.1365-2249.2003.02238.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [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: 11/20/2022] Open
Abstract
Glatiramer acetate (GA) is effective in the treatment of Multiple Sclerosis (MS) presumably by the induction of an immunoregulatory T-cell response. We have previously shown that GA directly induces the Th2 cytokines IL-13 and IL-5 in T-cells in vitro. In the present study we compared the in vitro response to GA in healthy controls, untreated and GA-treated MS patients and tested whether the induction of IL-13 and IL-5 secretion is also detectable in the serum of 25 MS patients treated with GA. Patients were grouped into clinical responders and nonresponders in order to determine a possible correlation with the immunological response. As a result we found a significant increase of IL-13 in the serum of clinical GA-responders whereas IL-13 was not detectable in controls, untreated MS (P < 0.001) and nonresponders (P = 0.015). Similarly, GA-treatment increased serum levels of IL-5 (P = 0.001). The correlation of serum IL-5 and clinical response was also significant (P = 0.039), however, there was an overlap between the different groups. The selective induction of IL-13 and IL-5 but not IL-4 by GA treatment suggests that the specific biological functions of these cytokines might be important for the therapeutic mechanism of GA. Measurement of serum IL-13 and IL-5 levels is a simple and inexpensive tool for monitoring the response to GA in MS patients.
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Affiliation(s)
- E Wiesemann
- Department of Neurology, Medical School Hannover, Hannover, Germany
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Abstract
In order to define possible mechanisms of immunomodulation by glatiramer acetate (GA), we investigated the primary in vitro cytokine response of peripheral blood mononuclear cells (PBMCs) and T-cell subpopulations. In PBMCs from healthy subjects and untreated patients with multiple sclerosis (MS) GA-induced T-cell proliferation and mRNA expression/cytokine, secretion of IL-13 and IL-5 but not of IL-10, TGF-beta or IL-12, IL-4 was detected at the mRNA level only. IFN-gamma was induced in a few subjects at very low concentrations. The response to GA was driven by the CD4(+)/CD45RA(+) T-cell subpopulation and was mediated by T-cell receptor (TCR) engagement as determined by anti-TCR blocking antibodies. The findings are compatible with the hypothesis that GA functions as partial or weak TCR-agonist activating naive T cells to produce the Th2 cytokines IL-13 and IL-5.
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Affiliation(s)
- E Wiesemann
- Department of Neurology, Medical School Hannover, Carl-Neuberg-Strasse 1, D-30623, Hannover, Germany
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Osten HJ, Klatt J, Lippert G, Dietrich B, Bugiel E. Surfactant-controlled solid phase epitaxy of germanium on silicon. Phys Rev Lett 1992; 69:450-453. [PMID: 10046942 DOI: 10.1103/physrevlett.69.450] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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