Optimal age and outcome measures for Alzheimer's disease prevention trials in people with Down syndrome

INTRODUCTION

People with Down syndrome (DS) typically develop Alzheimer's disease (AD) neuropathology before age 40, but a lack of outcome measures and longitudinal data have impeded their inclusion in randomized controlled trials (RCTs).

METHODS

Cohort study. Event-based and dose-response Emax models were fitted to longitudinal cognitive data, to stage AD and determine the earliest ages of decline. Results informed sample size estimations for hypothetical RCTs of disease-modifying treatments that reduced decline by 35% or 75%.

RESULTS

Seventy-five percent of participants progressed or remained stable in the AD staging model; effect sizes varied by age group and tests. Varied treatment effects could be detected with 50-200 people per arm when using sensitive cognitive outcome measures and targeting recruitment to ages 36 to 45 years.

DISCUSSION

Efficient RCTs of AD preventative treatments can be conducted in the DS population using sensitive outcome measures to monitor early decline. Dose-response models could help tailor future RCTs.

Improved survival trend of patients with hepatocellular carcinoma at an Australian tertiary hospital between 1995-2009

AIM

To evaluate trends in survival of patients with hepatocellular carcinoma (HCC) at The Alfred over a 15-year period from 1995-2009

METHODS

A retrospective cohort study of patients with HCC comparing epidemiology, clinical presentation, treatment parameters and overall survival of those diagnosed between 1995-2001 and 2002-2009. Overall survival of patients with primary liver cancer.

RESULTS

The study population consisted of 215 patients; 110 diagnosed between 1995-2001 (Cohort A) and 105 between 2002-2009 (Cohort B). Overall survival increased significantly between 1995-2010 (P = 0.016); median survival was 365 days in Cohort A compared with 665 in Cohort B. The improvement in survival was associated with an increase in the proportion of cases detected at an asymptomatic stage (P = 0.012), a decline in the severity of liver disease at diagnosis (P = 0.002) and increased utilisation of loco-regional therapy (P = 0.001) over the same period. Survival of patients detected through screening was significantly higher than those detected through non-screening methods (1309 vs 233 days, P < 0.001).

CONCLUSIONS

The survival of patients with HCC managed at a tertiary referral centre has improved over the period 1995-2009. This improvement may relate to the increased detection of the disease at an asymptomatic stage (e.g. through screening) as well as increased utilisation of effective loco-regional therapies for HCC.