The Value and Deliverables of Medical Affairs: Affiliate Perspectives and Future Expectations

The Medical Affairs (MA) function in pharmaceutical companies creates a unique opportunity to ensure the internal linkage between Research & Development (R&D) and Commercial/Marketing functions, in addition to managing external scientific engagements with multiple stakeholders across life-science ecosystems. In recognition of the strategic value of MA, the objective of this paper is to share a comprehensive set of practical examples of the main deliverables within the MA function in the affiliate and align these with the two distinct phases; pre- and post-launch, respectively. We believe that an information gap currently exists in the available literature on these matters addressing practical aspects and examples beyond visionary, strategic thinking. Based on this contribution, further opportunities within MA can be discussed. In addition, we share our thoughts and considerations on future advancements in the role.

Treatment Mode Preferences in Rheumatoid Arthritis: Moving Toward Shared Decision-Making

PURPOSE

Current knowledge of the reasons for patients' preference for rheumatoid arthritis (RA) treatment modes is limited. This study was designed to identify preferences for four treatment modes, and to obtain in-depth information on the reasons for these preferences.

PATIENTS AND METHODS

In this multi-national, cross-sectional, qualitative study, in-depth interviews were conducted with adult patients with RA in the United States, France, Germany, Italy, Spain, Switzerland, the United Kingdom, and Brazil. Patients' strength of preference was evaluated using a 100-point allocation task (0-100; 100=strongest) across four treatment modes: oral, self-injection, clinic-injection, and infusion. Qualitative descriptive analysis methods were used to identify, characterize, and summarize patterns found in the interview data relating to reasons for these preferences.

RESULTS

100 patients were interviewed (female, 75.0%; mean age, 53.9 years; mean 11.6 years since diagnosis). Among the four treatment modes, oral administration was allocated the highest mean (standard deviation) preference points (47.3 [33.1]) and was ranked first choice by the greatest percentage of patients (57.0%), followed by self-injection (29.7 [27.7]; 29.0%), infusion (15.4 [24.6]; 16.0%), and clinic-injection (7.5 [14.1]; 2.0%). Overall, 56.0% of patients had a "strong" first-choice preference (ie, point allocation ≥70); most of these patients chose oral (62.5%) vs self-injection (23.2%), infusion (10.7%), or clinic-injection (3.6%). Speed and/or ease of administration were the most commonly reported reasons for patients choosing oral (52.6%) or self-injection (55.2%). The most common reasons for patients not choosing oral or self-injection were not wanting to take another pill (37.2%) and avoiding pain due to needles (46.5%), respectively.

CONCLUSION

These data report factors important to patients regarding preferences for RA treatment modes. Patients may benefit from discussions with their healthcare professionals and/or patient support groups, regarding RA treatment modes, to facilitate shared decision-making.

Abstract P3-01-02: Trends in positive predictive values following transition from screen film to digital mammography

Purpose

Our health region converted from screen-film mammography (SFM) to digital mammography (DM) in 2005. DM has several advantages over SFM, including superior contrast resolution, less noise, and opportunities for image optimization through post-acquisition processing; although, the spatial resolution of DM is inferior to SFM. We sought to determine what effect this transition may have had on positive predictive values (PPVs) for malignant and premalignant lesions.

Methods

From our institution's breast biopsy database, we retrospectively reviewed core biopsy results for mammographic calcifications performed in the years 2001-2004 (SFM years) and 2009-2012 (DM years). We subsequently determined the PPV3 (detection of malignancy after biopsy) for each group of years (SFM and DM). We then performed subgroup analysis to calculate PPVs for each of ductal carcinoma in-situ (DCIS) without invasion, DCIS with invasion, and premalignant lesions. Premalignant lesions included atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in-situ.

Results

A total of 4787 biopsies in 4633 patients were reviewed. The comparative detection of cancer after biopsy performed for mammographic calcification between SFM and DM was not statistically significant (PPV3 = 23.5% and 24.0%, respectively; P=.71). Upon further analysis, however, PPV for premalignant lesions increased (SFM=6.6% and DM=8.9%; P<.01) and PPV for DCIS without invasion increased (SFM=15.5% and DM=18.2%; P=.015), while PPV for DCIS with invasion decreased (SFM=8.0% and DM=5.8%; P<.01).

Conclusion

We observed no significant impact on PPV3 for calcifications following the transition from SFM to DM; however, our subgroup analysis suggests that with digital mammography we are now detecting a statistically significantly lower proportion of DCIS with invasion but greater proportions of DCIS without invasion and premalignant lesions. As the natural history of these lower-grade lesions, particularly in the premalignant category, is still not entirely understood, the significance of potentially detecting more of these earlier cancers/precancers is uncertain.

Citation Format: Motiuk DA, Dahl P, Roy E, Docktor B-J, Burrowes P. Trends in positive predictive values following transition from screen film to digital mammography [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-01-02.

Efficacy and Safety of Tadalafil in Men With Erectile Dysfunction Following Spinal Cord Injury

OBJECTIVE

To determine the efficacy and safety of tadalafil when taken on demand by men with erectile dysfunction (ED) secondary to traumatic spinal cord injury (SCI).

DESIGN AND SETTING

Multicenter, randomized, double-blind, placebo-controlled, flexible dose-titration, parallel-group study in clinical practices in Europe. Patients Enrolled patients had ED secondary to SCI (all spinal levels) and sustained 6 months or longer before visit 1.

INTERVENTIONS

After a 4-week run-in period, patients were randomly assigned to tadalafil, 10 mg, (n = 142) or placebo (n = 44) for a 12-week, on-demand treatment period with assessments at 4-week intervals. The dose of tadalafil was maintained or titrated (10 or 20 mg) at 4 and 8 weeks.

MAIN OUTCOME MEASURES

Efficacy was measured using the International Index of Erectile Function (IIEF), Sexual Encounter Profile (SEP), and Global Assessment Question (GAQ). Treatment-emergent adverse events and vital signs were collected at each visit.

RESULTS

Mean age was 38 years. Mean baseline IIEF erectile function domain score was 13.4, and following 12 weeks of treatment, 22.6 for tadalafil and 13.6 for placebo (P < .001). After treatment, the tadalafil group compared with the placebo group was significantly greater (P < .001) in mean per-patient percentage of successful penetration attempts (SEP question 2; 75.4% vs 41.1%) and intercourse attempts (SEP question 3; 47.6% vs 16.8%); percentage of improved erections (GAQ question 1; 84.6% vs 19.5%); and ejaculatory frequency (IIEF question 9; P = .03). The 2 most common treatment-emergent adverse events in the tadalafil group compared with placebo were headache (8.5% vs 4.5%) and urinary tract infection (7.7% vs 6.8%).

CONCLUSIONS

Tadalafil (10 mg and 20 mg) improved erectile function and was well tolerated by men with ED secondary to traumatic SCI.

[Retrospective evaluation of the results of the microbiological meat examination (MFU) from calves and cows]

The microbiological meat examination (MFU), consisting of a bacteriological analysis and a testing for antibiotic residues, is one of several additional analyses used for an edibility rating of carcasses made during meat inspection. Reasons for performing a microbiological meat examination and procedures in the laboratory are defined in the Swiss ordinance for meat examination (FUV). The aim of this study was to analyze the data of 313 microbiological meat examinations from calves and 2882 microbiological meat examinations from cows carried out at the Institute for Food Safety and Hygiene during a period of 8 years. Reasons for microbiological meat examinations as reported by the meat inspectors were mainly classified to the category of "inflammation and necroses" (FUV, Annex 4, Pt 1.2; calves: 73%, cows: 48%). As declarations of the age of the pathological-anatomical changes (that influences directly the probability of detection of pathogens) were generally missing, it is not surprising that the compliance between a particular pathological-anatomical change and a specific detection of pathogens is poor (calves: 19%, cows: 18% of all MFU). About 18% (calves) and 45% (cows) of the reasons for microbiological meat examinations did not correspond to one of the reasons mentioned in the ordinance for meat examination. However, according to the data set, some reasons require a microbiological meat examination due to an often-found specific detection of pathogens. Otherwise, a remarkable number of reasons mentioned were missing the link to bacteriological etiology. Moreover, 14% (calf) and 7% (cow) of microbiological meat examinations with the declaration "no pretreatment" as well as 15% (calf) and 11% (cow) of microbiological meat examinations without declaration showed a positive result in the testing for antibiotic residues.

Case-control study on breast cancer and adipose tissue concentrations of congener specific polychlorinated biphenyls, DDE and hexachlorobenzene

In a case-control study on 43 patients operated for invasive breast cancer (cases) and 35 patients operated for benign breast disease (controls) adipose tissue concentrations of polychlorinated biphenyls (PCBs), 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE) and hexachlorobenzene (HCB) were investigated. Approximately 10 g of breast tissue free from tumour was taken and frozen until analysis. No significant difference for the sum of non co-planar PCBs or DDE was found between cases and controls. For postmenopausal women the odds ratio (OR) was increased for co-planar PCB #77 > 4.5 pg/g lipid (OR = 5.8, 95% confidence interval (CI) = 0.8-42), PCB #126 > 145 pg/g lipid (OR = 2.2, 95% CI = 0.2-18), PCB #169 > 90 pg/g lipid (OR = 7.8, 95% CI = 0.6-96), and for HCB > 40 ng/g lipid (OR = 1.9, 95% CI = 0.4-7.2) adjusted for age and parity. The risk increased further for postmenopausal women with oestrogen receptor positive tumours yielding for PCB #77 adjusted OR 33 (95% CI 1.8-588), PCB #126 OR not calculable (no unexposed cases), PCB #169 OR 8.6 (95% CI 0.5-136) and hexachlorobenzene OR 7.1 (95% CI 1.1-45). Also for the sum of PCB > 1230 ng/g lipid adjusted OR increased to 1.8 (95% CI 0.4-7.3) whereas the results were similar for DDE.

Increased concentrations of octachlorodibenzo-p-dioxin in cases with breast cancer--results from a case-control study

Organochlorines are persistent and highly lipophilic environmental contaminants which bioaccumulate in the food chain. Some of these chemicals, 2,2-bis(p-chlorophenyl)-1,1,1-trichloroethane (DDT) and polychlorinated biphenyls (PCBs), have been suggested to be of significance in the aetiology of breast cancer. 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) is an anti-oestrogen in animal studies and should be thus lower the risk of breast cancer. The other isomers of polychlorinated dibenzo-p-dioxins (PCDDs) or the chemically related polychlorinated dibenzofurans (PCDFs) have not been tested regarding carcinogenesis of the breast. The purpose of this study was to investigate whether PCDDs or PCDFs influence the risk for breast cancer. Consecutive patients who underwent surgery for a breast disease between 1993 and 1995 were recruited for the study. Cases were 22 patients with infiltrative breast cancer and controls were 19 patients operated for a benign breast disease during the same time period. Approximately 10 g of breast tissue free from tumour was taken from the specimen and frozen until analysis. Fat was extracted, cleaned and analysed with a high-resolution gas chromatograph coupled to a high-resolution mass spectrometer. Median concentrations of octachlorinated dibenzo-p-dioxin (OCDD) were 598 (170-14,880) and 396 (103-1,847) pg/g lipid in the cases and in the controls, respectively. In a multivariate logistic regression analysis controlling for other risk factors for breast cancer increased odds ratio (OR) was obtained for OCDD: 401-1000 pg/g lipid yielded OR 3.8, 95% confidence interval (CI) 0.4-39, > 1000 pg/g lipid gave OR 5.2, CI 0.4-72. When the lipid OCDD variable was examined as a continuous risk factor there was a 1.09 (9%), CI 0.95-1.25, increase in the adjusted OR for breast cancer per 100 unit (pg/g lipid) increase in OCDD. No differences were found between cases and controls for the other six tested PCDDs. Mean concentration of TCDD was in the cases 3.6 (1.0-7.9) and in the controls 3.3 (1.1-6.3) pg/g lipid. For PCDFs no significant differences were found between cases and controls. The results were not changed if oestrogen or progesterone receptor status, S-phase fraction and DNA ploidy were considered. Breast tissue concentration of OCDD was increased in cancer patients, whereas the concentrations of other PCDDs and PCDFs were equal in cases and controls.

Influence of perinatal ochratoxin A exposure on the immune system in mice

The mycotoxin ochratoxin A (OA) is a well-documented immunotoxic agent which affects both cellular and humoral immunity. In the present study, the effects of maternal exposure to single doses of OA during gestation or lactation were studied in Balb/c offspring. A single dose exposure of the dams to OA (500 micrograms/kg body weight) on day 16 of gestation resulted in decreased proliferation of splenic and thymic lymphocytes in response to mitogens in the pups at 15 days of age. Flow cytometry analysis of thymocyte subpopulations revealed lower percentages of mature CD4+ cells and higher percentages of immature, double-positive (CD4+CD8+) cells in the exposed pups. In contrast, a single exposure of the dams of OA on day 10 postpartum significantly increased the proliferative responsiveness of lymphocytes in the offspring when stimulated with B or T cell mitogens 3 days after the exposure. This effect was most prominent in the highest dose group (500 micrograms/kg body weight). The present results are in accordance with previous observations in rats, and show that the time of exposure significantly influences the immunotoxic effects of OA on the developing immune system in rodents.

A New Scleral Suction Trephine for Retrieval of Corneoscleral Donor Tissue

BACKGROUND

Removal of donor corneo-scleral shell from a cadaver, leaving the remainder of the eye in place, has become a popular technique. Manual removal can result in excessive trauma to the corneal endothelium or an uneven scleral rim.

METHODS

We describe a new technique for corneal retrieval using a sceral suction trephine.

RESULTS

The scleral suction trephine was cut evenly in our eyebank study. There was no additional trauma to the endothelium and the scleral rim was regular.

CONCLUSION

Suction trephination of the sclera in retrieval of corneal donor tissue appears to be safe and effective.

Benefits of specular microscopy in evaluating eye donors aged 66 and older

In the United States of America and worldwide, supplies of quality donor corneas continue to lag behind the demand. Some of what appears to be a shortage in the U.S.A. is really due to the custom of many surgeons to use only tissue from younger donors, thus creating an unnecessary waiting list. In reality, we do have a sizable pool of good donors in the older age group. With improved evaluation techniques, it is possible to identify these donors and to add their tissue to the supply of available corneas. This study shows that large numbers of corneas from donors over the age of 65 can be used successfully to restore vision. Specular microscopy provides valuable quantitative data to the surgeon, who ultimately makes the decision about the suitability of the donor tissue. For an eye bank, specular microscopy makes it easier to place older tissue, resulting in shorter waiting lists.

Absorption of polychlorinated biphenyls, dibenzo-p-dioxins and dibenzofurans by breast-fed infants

The absorption of polychlorinated biphenyls, dibenzo-p-dioxins and dibenzofurans was studied in four breast-fed infants. The absorption was measured by comparing the estimated total intake and the excretion in faeces, during 48 hours, at three different time points; 1, 2 and 3 months post parta. The levels of the analysed compounds in the human milk are typical for Sweden, i.e approximately 20 ppt toxic equivalents for the dibenzo-p-dioxins and dibenzofurans and for the polychlorinated biphenyls approximately 16 ppt toxic equivalents. For most of the congeners the absorption is found to be over 95%. Higher excretion is noticed for heptachlorinated and octachlorinated dioxins.

Supercritical fluid extraction of PCBs from human adipose tissue for HRGC/LRMS analysis

Supercritical fluid extraction (SFE) of 36 PCBs from human adipose is presented. Selective extraction of the PCBs is achieved using supercritical CO2 with a density of 0.9 g/ml (281 bar) at 40 degrees C and with AlOx as a fat retainer. Compared to the traditional liquid extraction method followed by further sample clean up, SFE is not only faster (2 hours compared to three days) but also utilises lower amounts of organic solvents (4 ml compared to over 500 ml). The recoveries of 7 added 13C labelled PCBs are 83-106%. The repeatability in the analysis of 36 PCBs in 6 identical samples is excellent, with an average R.S.D. of less than 10%.

An ultrasonic system for diameter pulse tracking in arteries: problems and pitfalls

Non-invasive ultrasonic techniques for measuring the mechanical behaviour of large arteries have a potential clinical application for physiological studies of the circulation and early detection of degenerative arterial disorders. A newly developed system for such purposes, comprising two double-echo trackers with zero-crossing phase-locked circuits and interfacing a B-mode real-time scanner, has been introduced for on-line recording of the diameter in a selected aortic segment. The aim of this report is to draw attention to the limitations of the technique in order to avoid misinterpretation of results. The various problems associated with the use of phase-locked echo followers for tracking sonic echoes of vessel pulse waves are summarized. The high spatial resolution of the measuring system is essential for estimating the elastic properties of the vessel, because the fractional changes of the diameter waveform during a heart cycle are small compared with the swings of intravascular pressure. Measuring errors may originate from either human or technical sources. From several viewpoints correct alignment of the ultrasonic beam vis-à-vis the vessel segment under consideration is crucial for obtaining valid measures. A thorough knowledge of the physics involved is essential for an adequate use of the instrument. With correct use, easily reproducible and reliable estimations are obtained of the mechanical properties of large vessel walls.

Norfloxacin treatment of salmonellosis does not shorten the carrier stage

In a prospective controlled study we evaluated the effect of early norfloxacin treatment on the duration of salmonella carriage after acute salmonellosis. The study was carried out during an outbreak of Salmonella typhimurium infection at a military base. 23 patients received norfloxacin 400 mg twice daily for 7 days while 29 patients served as untreated controls. A patient was considered to have ceased being a carrier on the date of the first of 3 negative consecutive cultures. Four weeks after diagnosis 30% of the treated patients and 31% in the control group were still carriers. The corresponding figures after 8 and 12 weeks were 17 and 3% and 4 and 0%, respectively. Thus, one week of norfloxacin treatment instituted at an early stage of salmonellosis did not shorten the duration of carriage.

Ultrasonography of the paranasal sinuses. A new computerized equipment using LCD-display and capture mode

Ultrasonography of the paranasal sinuses is a well established method. However, no technical development in this field has taken place during the last five years. In order to improve the method a new computerized equipment with a graphic liquid crystal display (LCD) and capture mode has been designed.

Pulse wave recording--development of a method for investigating foetal circulation in utero

The need to investigate the elastic properties of arterial vessels 'in situ' for the early recognition of degenerative disorders in arteries has long been apparent. Volume pulses in defined segments of arteries can be evaluated for this purpose, and the present paper contains a survey of earlier attempts to quantify volume pulses by means of ultrasound. A presentation is given of a recently developed digital system, comprising a phase-locked echo tracker, capable of monitoring non-invasively the diameter and its pulsatile changes of a selected artery along two chosen image lines of a linear array ultrasound scanner. The physical limitations of tracking fast-moving ultrasound echoes by means of phase-locked range gating are reported and the advantage is emphasized of using a gate length of one full period. This system has been calibrated, tested and applied in measurements of pulse wave pattern and propagation velocity in the descending aorta of human foetuses in the last trimester of gestation. The present high-resolution echo-tracking method has yielded reproducible results in the foetus and appears suitable also for screening studies on adult vessels.