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Dai Z, Saksena SD, Horny G, Banholzer C, Ewert S, Gifford DK. Ultra-high-diversity factorizable libraries for efficient therapeutic discovery. Genome Res 2022; 32:gr.276593.122. [PMID: 35738900 PMCID: PMC9528983 DOI: 10.1101/gr.276593.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 06/22/2022] [Indexed: 01/13/2023]
Abstract
The successful discovery of novel biological therapeutics by selection requires highly diverse libraries of candidate sequences that contain a high proportion of desirable candidates. Here we propose the use of computationally designed factorizable libraries made of concatenated segment libraries as a method of creating large libraries that meet an objective function at low cost. We show that factorizable libraries can be designed efficiently by representing objective functions that describe sequence optimality as an inner product of feature vectors, which we use to design an optimization method we call stochastically annealed product spaces (SAPS). We then use this approach to design diverse and efficient libraries of antibody CDR-H3 sequences with various optimized characteristics.
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Affiliation(s)
- Zheng Dai
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Sachit D Saksena
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Geraldine Horny
- Novartis Institutes for BioMedical Research (NIBR), CH-4056 Basel, Switzerland
| | - Christine Banholzer
- Novartis Institutes for BioMedical Research (NIBR), CH-4056 Basel, Switzerland
| | - Stefan Ewert
- Novartis Institutes for BioMedical Research (NIBR), CH-4056 Basel, Switzerland
| | - David K Gifford
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
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Zilli F, Marques Ramos P, Auf der Maur P, Jehanno C, Sethi A, Coissieux M, Eichlisberger T, Sauteur L, Rouchon A, Bonapace L, Pinto Couto J, Rad R, Jensen MR, Banfi A, Stadler MB, Bentires‐Alj M. The NFIB-ERO1A axis promotes breast cancer metastatic colonization of disseminated tumour cells. EMBO Mol Med 2021; 13:e13162. [PMID: 33751828 PMCID: PMC8033524 DOI: 10.15252/emmm.202013162] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022] Open
Abstract
Metastasis is the main cause of deaths related to solid cancers. Active transcriptional programmes are known to regulate the metastatic cascade but the molecular determinants of metastatic colonization remain elusive. Using an inducible piggyBac (PB) transposon mutagenesis screen, we have shown that overexpression of the transcription factor nuclear factor IB (NFIB) alone is sufficient to enhance primary mammary tumour growth and lung metastatic colonization. Mechanistically and functionally, NFIB directly increases expression of the oxidoreductase ERO1A, which enhances HIF1α-VEGFA-mediated angiogenesis and colonization, the last and fatal step of the metastatic cascade. NFIB is thus clinically relevant: it is preferentially expressed in the poor-prognostic group of basal-like breast cancers, and high expression of the NFIB/ERO1A/VEGFA pathway correlates with reduced breast cancer patient survival.
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Affiliation(s)
- Federica Zilli
- Department of BiomedicineDepartment of SurgeryUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Friedrich Miescher Institute for Biomedical ResearchBaselSwitzerland
| | - Pedro Marques Ramos
- Friedrich Miescher Institute for Biomedical ResearchBaselSwitzerland
- Novartis Institutes for Biomedical ResearchBaselSwitzerland
| | - Priska Auf der Maur
- Department of BiomedicineDepartment of SurgeryUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - Charly Jehanno
- Department of BiomedicineDepartment of SurgeryUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - Atul Sethi
- Department of BiomedicineDepartment of SurgeryUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Friedrich Miescher Institute for Biomedical ResearchBaselSwitzerland
- Swiss Institute of BioinformaticsBaselSwitzerland
| | - Marie‐May Coissieux
- Department of BiomedicineDepartment of SurgeryUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Friedrich Miescher Institute for Biomedical ResearchBaselSwitzerland
| | | | - Loïc Sauteur
- Department of BiomedicineDepartment of SurgeryUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - Adelin Rouchon
- Department of BiomedicineDepartment of SurgeryUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - Laura Bonapace
- Novartis Institutes for Biomedical ResearchBaselSwitzerland
| | - Joana Pinto Couto
- Department of BiomedicineDepartment of SurgeryUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Friedrich Miescher Institute for Biomedical ResearchBaselSwitzerland
- Novartis Institutes for Biomedical ResearchBaselSwitzerland
| | - Roland Rad
- Department of Medicine IITUM School of MedicineInstitute of Molecular Oncology and Functional GenomicsCenter for Translational Cancer Research (TranslaTUM)Technische Universität MünchenMünchenGermany
- German Cancer Consortium (DKTK)German Cancer Research Center (DKFZ)HeidelbergGermany
| | | | - Andrea Banfi
- Department of BiomedicineDepartment of SurgeryUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - Michael B Stadler
- Friedrich Miescher Institute for Biomedical ResearchBaselSwitzerland
- Swiss Institute of BioinformaticsBaselSwitzerland
| | - Mohamed Bentires‐Alj
- Department of BiomedicineDepartment of SurgeryUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Friedrich Miescher Institute for Biomedical ResearchBaselSwitzerland
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Frey BM, Petersen M, Schlemm E, Mayer C, Hanning U, Engelke K, Fiehler J, Borof K, Jagodzinski A, Gerloff C, Thomalla G, Cheng B. White matter integrity and structural brain network topology in cerebral small vessel disease: The Hamburg city health study. Hum Brain Mapp 2021; 42:1406-1415. [PMID: 33289924 PMCID: PMC7927298 DOI: 10.1002/hbm.25301] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 11/08/2020] [Accepted: 11/16/2020] [Indexed: 12/13/2022] Open
Abstract
Cerebral small vessel disease is a common finding in the elderly and associated with various clinical sequelae. Previous studies suggest disturbances in the integration capabilities of structural brain networks as a mediating link between imaging and clinical presentations. To what extent cerebral small vessel disease might interfere with other measures of global network topology is not well understood. Connectomes were reconstructed via diffusion weighted imaging in a sample of 930 participants from a population based epidemiologic study. Linear models were fitted testing for an association of graph-theoretical measures reflecting integration and segregation with both the Peak width of Skeletonized Mean Diffusivity (PSMD) and the load of white matter hyperintensities of presumed vascular origin (WMH). The latter were subdivided in periventricular and deep for an analysis of localisation-dependent correlations of cerebral small vessel disease. The median WMH volume was 0.6 mL (1.4) and the median PSMD 2.18 mm2 /s x 10-4 (0.5). The connectomes showed a median density of 0.880 (0.030), the median values for normalised global efficiency, normalised clustering coefficient, modularity Q and small-world propensity were 0.780 (0.045), 1.182 (0.034), 0.593 (0.026) and 0.876 (0.040) respectively. An increasing burden of cerebral small vessel disease was significantly associated with a decreased integration and increased segregation and thus decreased small-worldness of structural brain networks. Even in rather healthy subjects increased cerebral small vessel disease burden is accompanied by topological brain network disturbances. Segregation parameters and small-worldness might as well contribute to the understanding of the known clinical sequelae of cerebral small vessel disease.
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Affiliation(s)
- Benedikt M. Frey
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Marvin Petersen
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Eckhard Schlemm
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Carola Mayer
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Uta Hanning
- Department of Diagnostic and Interventional NeuroradiologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Kristin Engelke
- Department of Diagnostic and Interventional NeuroradiologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Jens Fiehler
- Department of Diagnostic and Interventional NeuroradiologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Katrin Borof
- Epidemiological study centerUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Annika Jagodzinski
- Epidemiological study centerUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Department of General and Interventional CardiologyUniversity Heart and Vascular CenterHamburgGermany
| | - Christian Gerloff
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Götz Thomalla
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Bastian Cheng
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
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Okunrintemi V, Tibuakuu M, Virani SS, Sperling LS, Volgman AS, Gulati M, Cho L, Leucker TM, Blumenthal RS, Michos ED. Sex Differences in the Age of Diagnosis for Cardiovascular Disease and Its Risk Factors Among US Adults: Trends From 2008 to 2017, the Medical Expenditure Panel Survey. J Am Heart Assoc 2020; 9:e018764. [PMID: 33161825 PMCID: PMC7955360 DOI: 10.1161/jaha.120.018764] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/26/2020] [Indexed: 12/23/2022]
Abstract
Background Sex differences in the trends for control of cardiovascular disease (CVD) risk factors have been described, but temporal trends in the age at which CVD and its risk factors are diagnosed and sex-specific differences in these trends are unknown. Methods and Results We used the Medical Expenditure Panel Survey 2008 to 2017, a nationally representative sample of the US population. Individuals ≥18 years, with a diagnosis of hypercholesterolemia, hypertension, coronary heart disease, or stroke, and who reported the age when these conditions were diagnosed, were included. We included 100 709 participants (50.2% women), representing 91.9 million US adults with above conditions. For coronary heart disease and hypercholesterolemia, mean age at diagnosis was 1.06 and 0.92 years older for women, compared with men, respectively (both P<0.001). For stroke, mean age at diagnosis for women was 1.20 years younger than men (P<0.001). The mean age at diagnosis of CVD risk factors became younger over time, with steeper declines among women (annual decrease, hypercholesterolemia [women, 0.31 years; men 0.24 years] and hypertension [women, 0.23 years; men, 0.20 years]; P<0.001). Coronary heart disease was not statistically significant. For stroke, while age at diagnosis decreased by 0.19 years annually for women (P=0.03), it increased by 0.22 years for men (P=0.02). Conclusions The trend in decreasing age at diagnosis for CVD and its risk factors in the United States appears to be more pronounced among women. While earlier identification of CVD risk factors may provide opportunity to initiate preventive treatment, younger age at diagnosis of CVD highlights the need for the prevention of CVD earlier in life, and sex-specific interventions may be needed.
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Affiliation(s)
| | - Martin Tibuakuu
- Ciccarone Center for the Prevention of Cardiovascular DiseaseJohns Hopkins UniversityBaltimoreMD
| | | | | | | | - Martha Gulati
- Division of CardiologyUniversity of Arizona School of MedicinePhoenixAZ
| | - Leslie Cho
- Department of Cardiovascular MedicineCleveland ClinicClevelandOH
| | - Thorsten M. Leucker
- Ciccarone Center for the Prevention of Cardiovascular DiseaseJohns Hopkins UniversityBaltimoreMD
| | - Roger S. Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular DiseaseJohns Hopkins UniversityBaltimoreMD
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular DiseaseJohns Hopkins UniversityBaltimoreMD
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Wang T, Huang S, Wang C, Lin F, Chen H, Hsiao F. Nationwide trends in incidence, healthcare utilization, and mortality in hospitalized heart failure patients in Taiwan. ESC Heart Fail 2020; 7:3653-3666. [PMID: 32924330 PMCID: PMC7755001 DOI: 10.1002/ehf2.12892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/28/2020] [Accepted: 06/24/2020] [Indexed: 12/30/2022] Open
Abstract
AIMS The objective of this study was to estimate the nationwide annual incidence, healthcare utilization, and mortality among hospitalized heart failure (HF) patients in Taiwan. METHODS AND RESULTS People aged 20 years or older and having been newly admitted for HF between 2010 and 2015 were identified from Taiwan's National Health Insurance Research Database. For 124 816 patients with incident HF hospitalizations between 2010 and 2012, we further analysed their treatment patterns, healthcare utilizations, and mortality during index hospitalization and within 3 years following discharge from the index hospitalization. The age-stratified incidences were declined by 10-20% in people aged 55 years or older, but increased by ~4% among people younger than 44 years old between 2010 and 2015. For all incident hospitalized HF patients, the percentages of patients visiting the emergency room, were rehospitalized, and treated with guideline-directed medical therapy were highest in the first year. Approximately two-thirds of subsequent hospitalizations were due to non-HF and non-cardiovascular causes. The all-cause mortality rate during index hospitalization was 8.5%, whereas the mortality rates at 30 days, 90 days, 180 days, 1 year, 2 years, and 3 years following discharge were 3.5%, 8.9%, 14.4%, 22.5%, 33.9%, and 42.8%, respectively, for those surviving index HF hospitalization. Non-cardiovascular disease-related deaths accounted for nearly 60% of all deaths. CONCLUSIONS Our study reveals that, in contemporary Taiwan, the >10% annual mortality following the first year of hospitalization, 30% deaths occurring outside the hospital, and 60% non-cardiovascular-related deaths, along with the decreasing use of guideline-directed medical therapy, highlight sectors requiring more attention.
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Affiliation(s)
- Tzung‐Dau Wang
- Cardiovascular Center and Division of Cardiology, Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Shih‐Tsung Huang
- Graduate Institute of Clinical Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- School of Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Chen‐Yu Wang
- Graduate Institute of Clinical Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- School of Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Fang‐Ju Lin
- Graduate Institute of Clinical Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- School of Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- Department of PharmacyNational Taiwan University HospitalTaipeiTaiwan
| | - Ho‐Min Chen
- Health Data Research CenterNational Taiwan UniversityTaipeiTaiwan
| | - Fei‐Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- School of Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- Department of PharmacyNational Taiwan University HospitalTaipeiTaiwan
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Montis R, Davey RJ, Wright SE, Woollam GR, Cruz‐Cabeza AJ. Transforming Computed Energy Landscapes into Experimental Realities: The Role of Structural Rugosity. Angew Chem Int Ed Engl 2020; 59:20357-20360. [PMID: 32730676 PMCID: PMC7693212 DOI: 10.1002/anie.202006939] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Indexed: 11/14/2022]
Abstract
We exploit the possible link between structural surface roughness and difficulty of crystallisation. Polymorphs with smooth surfaces may nucleate and crystallise more readily than polymorphs with rough surfaces. The concept is applied to crystal structure prediction landscapes and reveals a promising complementary way of ranking putative crystal structures.
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Affiliation(s)
- Riccardo Montis
- Department of Chemical Engineering and Analytical ScienceThe University of ManchesterOxford RoadManchesterM13 9PLUK
| | - Roger J. Davey
- Department of Chemical Engineering and Analytical ScienceThe University of ManchesterOxford RoadManchesterM13 9PLUK
| | - Sarah E. Wright
- Department of Chemical Engineering and Analytical ScienceThe University of ManchesterOxford RoadManchesterM13 9PLUK
| | | | - Aurora J. Cruz‐Cabeza
- Department of Chemical Engineering and Analytical ScienceThe University of ManchesterOxford RoadManchesterM13 9PLUK
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Malachias MVB, Jhund PS, Claggett BL, Wijkman MO, Bentley‐Lewis R, Chaturvedi N, Desai AS, Haffner SM, Parving H, Prescott MF, Solomon SD, De Zeeuw D, McMurray JJV, Pfeffer MA. NT-proBNP by Itself Predicts Death and Cardiovascular Events in High-Risk Patients With Type 2 Diabetes Mellitus. J Am Heart Assoc 2020; 9:e017462. [PMID: 32964800 PMCID: PMC7792415 DOI: 10.1161/jaha.120.017462] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background NT-proBNP (N-terminal pro-B-type natriuretic peptide) improves the discriminatory ability of risk-prediction models in type 2 diabetes mellitus (T2DM) but is not yet used in clinical practice. We assessed the discriminatory strength of NT-proBNP by itself for death and cardiovascular events in high-risk patients with T2DM. Methods and Results Cox proportional hazards were used to create a base model formed by 20 variables. The discriminatory ability of the base model was compared with that of NT-proBNP alone and with NT-proBNP added, using C-statistics. We studied 5509 patients (with complete data) of 8561 patients with T2DM and cardiovascular and/or chronic kidney disease who were enrolled in the ALTITUDE (Aliskiren in Type 2 Diabetes Using Cardiorenal Endpoints) trial. During a median 2.6-year follow-up period, 469 patients died and 768 had a cardiovascular composite outcome (cardiovascular death, resuscitated cardiac arrest, nonfatal myocardial infarction, stroke, or heart failure hospitalization). NT-proBNP alone was as discriminatory as the base model for predicting death (C-statistic, 0.745 versus 0.744, P=0.95) and the cardiovascular composite outcome (C-statistic, 0.723 versus 0.731, P=0.37). When NT-proBNP was added, it increased the predictive ability of the base model for death (C-statistic, 0.779 versus 0.744, P<0.001) and for cardiovascular composite outcome (C-statistic, 0.763 versus 0.731, P<0.001). Conclusions In high-risk patients with T2DM, NT-proBNP by itself demonstrated discriminatory ability similar to a multivariable model in predicting both death and cardiovascular events and should be considered for risk stratification. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00549757.
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Affiliation(s)
- Marcus V. B. Malachias
- Cardiovascular DivisionBrigham & Women’s HospitalHarvard Medical SchoolBostonMA
- Faculdade Ciências Médicas de Minas GeraisFundação Educacional Lucas MachadoBelo HorizonteMinas GeraisBrazil
| | - Pardeep S. Jhund
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
| | - Brian L. Claggett
- Cardiovascular DivisionBrigham & Women’s HospitalHarvard Medical SchoolBostonMA
| | - Magnus O. Wijkman
- Cardiovascular DivisionBrigham & Women’s HospitalHarvard Medical SchoolBostonMA
- Department of Internal Medicine and Department of Health, Medicine and Caring SciencesLinköping UniversityNorrköpingSweden
| | | | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCLInstitute for Cardiovascular SciencesUniversity College LondonLondonUnited Kingdom
| | - Akshay S. Desai
- Cardiovascular DivisionBrigham & Women’s HospitalHarvard Medical SchoolBostonMA
| | - Steven M. Haffner
- Department of Medicine and Clinical EpidemiologyUniversity of Texas Health Science CenterSan AntonioTX
| | - Hans‐Henrik Parving
- Department of Medical EndocrinologyRigshospitaletUniversity of CopenhagenDenmark
| | | | - Scott D. Solomon
- Cardiovascular DivisionBrigham & Women’s HospitalHarvard Medical SchoolBostonMA
| | - Dick De Zeeuw
- Department of Clinical Pharmacy and PharmacologyUniversity Medical Center GroningenUniversity of Groningenthe Netherlands
| | - John J. V. McMurray
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
| | - Marc A. Pfeffer
- Cardiovascular DivisionBrigham & Women’s HospitalHarvard Medical SchoolBostonMA
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Shigeoka T, Nomiyama T, Kawanami T, Hamaguchi Y, Horikawa T, Tanaka T, Irie S, Motonaga R, Hamanoue N, Tanabe M, Nabeshima K, Tanaka M, Yanase T, Kawanami D. Activation of overexpressed glucagon-like peptide-1 receptor attenuates prostate cancer growth by inhibiting cell cycle progression. J Diabetes Investig 2020; 11:1137-1149. [PMID: 32146725 PMCID: PMC7477521 DOI: 10.1111/jdi.13247] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 12/17/2022] Open
Abstract
AIMS/INTRODUCTION Incretin therapy is a common treatment for type 2 diabetes mellitus. We have previously reported an anti-prostate cancer effect of glucagon-like peptide-1 receptor (GLP-1R) agonist exendin-4. The attenuation of cell proliferation in the prostate cancer cell line was dependent on GLP-1R expression. Here, we examined the relationship between human prostate cancer severity and GLP-1R expression, as well as the effect of forced expression of GLP-1R using a lentiviral vector. MATERIALS AND METHODS Prostate cancer tissues were extracted by prostatectomy and biopsy. GLP-1R was overexpressed in ALVA-41 cells using a lentiviral vector (ALVA-41-GLP-1R cells). GLP-1R expression was detected by immunohistochemistry and quantitative polymerase chain reaction. Cell proliferation was examined by growth curves and bromodeoxyuridine incorporation assays. Cell cycle distribution and regulators were examined by flow cytometry and western blotting. In vivo experiments were carried out using a xenografted model. RESULTS GLP-1R expression levels were significantly inversely associated with the Gleason score of human prostate cancer tissues. Abundant GLP-1R expression and functions were confirmed in ALVA-41-GLP-1R cells. Exendin-4 significantly decreased ALVA-41-GLP-1R cell proliferation in a dose-dependent manner. DNA synthesis and G1-to-S phase transition were inhibited in ALVA-41-GLP-1R cells. SKP2 expression was decreased and p27Kip1 protein was subsequently increased in ALVA-41-GLP-1R cells treated with exendin-4. In vivo experiments carried out by implanting ALVA-41-GLP-1R cells showed that exendin-4 decreased prostate cancer growth by activation of GLP-1R overexpressed in ALVA41-GLP-1R cells. CONCLUSIONS Forced expression of GLP-1R attenuates prostate cancer cell proliferation by inhibiting cell cycle progression in vitro and in vivo. Therefore, GLP-1R activation might be a potential therapy for prostate cancer.
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Affiliation(s)
- Toru Shigeoka
- Department of Endocrinology and Diabetes MellitusSchool of MedicineFukuoka UniversityFukuokaJapan
| | - Takashi Nomiyama
- Department of Endocrinology and Diabetes MellitusSchool of MedicineFukuoka UniversityFukuokaJapan
- Research institute for Islet BiologyFukuoka UniversityFukuokaJapan
| | - Takako Kawanami
- Department of Endocrinology and Diabetes MellitusSchool of MedicineFukuoka UniversityFukuokaJapan
| | - Yuriko Hamaguchi
- Department of Endocrinology and Diabetes MellitusSchool of MedicineFukuoka UniversityFukuokaJapan
| | - Tsuyoshi Horikawa
- Department of Endocrinology and Diabetes MellitusSchool of MedicineFukuoka UniversityFukuokaJapan
| | - Tomoko Tanaka
- Department of Endocrinology and Diabetes MellitusSchool of MedicineFukuoka UniversityFukuokaJapan
| | - Shinichiro Irie
- Department of UrologySchool of MedicineFukuoka UniversityFukuokaJapan
| | - Ryoko Motonaga
- Department of Endocrinology and Diabetes MellitusSchool of MedicineFukuoka UniversityFukuokaJapan
| | - Nobuya Hamanoue
- Department of Endocrinology and Diabetes MellitusSchool of MedicineFukuoka UniversityFukuokaJapan
| | - Makito Tanabe
- Department of Endocrinology and Diabetes MellitusSchool of MedicineFukuoka UniversityFukuokaJapan
| | - Kazuki Nabeshima
- Department of PathologySchool of MedicineFukuoka UniversityFukuokaJapan
| | - Masatoshi Tanaka
- Department of UrologySchool of MedicineFukuoka UniversityFukuokaJapan
| | - Toshihiko Yanase
- Research institute for Islet BiologyFukuoka UniversityFukuokaJapan
- Muta HospitalFukuokaJapan
| | - Daiji Kawanami
- Department of Endocrinology and Diabetes MellitusSchool of MedicineFukuoka UniversityFukuokaJapan
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Ayisi‐Boateng NK, Mohammed A, Opoku DA, Sarfo FS. Frequency & factors associated with apparent resistant hypertension among Ghanaians in a multicenter study. J Clin Hypertens (Greenwich) 2020; 22:1594-1602. [PMID: 32815641 PMCID: PMC8029809 DOI: 10.1111/jch.13974] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/23/2020] [Accepted: 05/31/2020] [Indexed: 12/14/2022]
Abstract
Apparent resistant hypertension (ARH) is rife among people living with hypertension and is associated with significant morbidity and mortality. There is however paucity of data from sub-Saharan Africa on the burden of ARH. We sought to report on the frequency and factors associated with ARH among a cohort of Ghanaians with hypertension. A cross-sectional study involving 2912 participants with hypertension enrolled at five health facilities in Ghana. ARH was defined as either office BP ≥ 140/90 mm Hg on 3 or more antihypertensive medications or on 4 or more antihypertensive medications regardless of BP. Factors associated with ARH were evaluated in a multivariate logistic regression model. We found 550 out of 2,912 (18.9%) of study participants had ARH. Out of these 550 subjects, 511 (92.9%) were on 3 or more antihypertensive medications with BP ≥ 140/90 mm Hg and 39 (7.1%) were on 4 or more antihypertensive medications with BP ≥ 140/90 mm Hg. The prevalence of ARH was 15.5% among elderly aged 75 + years (n = 341), 20.7% among 65-74 years (n = 588), and 18.9% among those ≤ 64 years (n = 1983). The adjusted odds ratio (95% CI) of factors independently associated with ARH was duration of hypertension, 1.05 (1.03-1.06) for each year rise; eGFR < 60 mL/min, 1.73 (1.33-2.25); and diabetes mellitus, 0.59 (0.46-0.76). Attaining secondary level education and residence in a peri-urban setting were significantly associated with ARH though not in a dose-dependent manner. ARH is rife among Ghanaians and may negatively impact on cardiovascular outcomes in the long term.
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Affiliation(s)
- Nana Kwame Ayisi‐Boateng
- Department of MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
- University HospitalKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Aliyu Mohammed
- School of Public HealthKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Douglas Aninng Opoku
- School of Public HealthKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Fred Stephen Sarfo
- Department of MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
- Komfo Anokye Teaching HospitalKumasiGhana
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Wong LP, Alias H, Bhoo-Pathy N, Chung I, Chong YC, Kalra S, Shah ZUBS. Impact of migraine on workplace productivity and monetary loss: a study of employees in banking sector in Malaysia. J Headache Pain 2020; 21:68. [PMID: 32513174 PMCID: PMC7282083 DOI: 10.1186/s10194-020-01144-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/OBJECTIVE Productivity and monetary loss due to migraine in the workplace may be substantial. This study aimed to determine the impact of migraine on productivity and monetary lost among employees in the banking sectors, in a multiethnic middle income country. METHODS A cross-sectional online survey was conducted among employees in two multinational banks in Malaysia between April and July 2019. Screening for migraine was conducted using the self-administered ID-Migraine™ questionnaire. Migraine-related disability (MIDAS) and headache frequency were recorded. Impact of migraine on work productivity and activities were evaluated using the Work Productivity and Activity Impairment (WPAI) questionnaire. RESULTS Of the 1268 employees who submitted complete responses, 47.2% (n = 598) were screened positive for migraine. Strikingly, the mean percent productivity loss at work (presenteeism) was almost 20-fold higher than the mean percent work time missed due to migraine (absenteeism) (39.1% versus 1.9%). The mean percent productivity loss in regular activity (activity impairment) and overall work productivity loss (work impairment) was 38.4% and 39.9%, respectively. It was also found that the costs related to presenteeism (MYR 5392.6) (US$1296) was 3.5-fold higher than absenteeism (MYR1,548.3) (US$370). Highest monetary loss related to presenteeism was reported in migraineurs with frequency of headache of above 3 days (MYR 25,691.2) (US$6176), whereas highest monetary loss related to absenteeism was reported in migraineurs with MIDAS grade IV (MYR 12,369.1) (US$2973). Only 30% of migraineurs of MIDAS grade IV reported taking prescribed medication. Notably, a vast majority (96%) of migraineurs who had three or lower episodes of migraine per month did not seek treatment. CONCLUSION The significant impact of migraine on work productivity and regular activity, appears to lead to substantial monetary loss attributed to not only absenteeism, but more importantly to presenteeism. This study also highlights the unmet needs in migraine management among employees in the banking sector.
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Affiliation(s)
- Li Ping Wong
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya 50603, Kuala Lumpur, Malaysia.
| | - Haridah Alias
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya 50603, Kuala Lumpur, Malaysia
| | - Nirmala Bhoo-Pathy
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya 50603, Kuala Lumpur, Malaysia
| | - Ivy Chung
- Department of Pharmacology, Faculty of Medicine, University of Malaya 50603, Kuala Lumpur, Malaysia
| | - Yew Ching Chong
- Novartis Corporation (Malaysia) Sdn. Bhd., Plaza 33, Petaling Jaya, Malaysia
| | - Sonesh Kalra
- Novartis Corporation (Malaysia) Sdn. Bhd., Plaza 33, Petaling Jaya, Malaysia
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Bays HE, Kozlovski P, Shao Q, Proot P, Keefe D. Licogliflozin, a Novel SGLT1 and 2 Inhibitor: Body Weight Effects in a Randomized Trial in Adults with Overweight or Obesity. Obesity (Silver Spring) 2020; 28:870-881. [PMID: 32187881 PMCID: PMC7217021 DOI: 10.1002/oby.22764] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/15/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of this study was to explore the dose response of licogliflozin, a dual inhibitor of sodium/glucose cotransporter 1 (SGLT1) and 2 (SGLT2), by evaluating change in body weight in adults with overweight or obesity. METHODS This dose-response analysis evaluated change in body weight following 24 weeks with four once-daily and twice-daily licogliflozin doses (2.5-150 mg) versus placebo (primary end point). A further 24-week analysis evaluated the efficacy and safety of two once-daily licogliflozin doses in maintaining initial weight reduction. RESULTS Licogliflozin once daily or twice daily produced a significant dose-response signal for weight loss versus placebo (P < 0.0001). However, mean adjusted percent changes in body weight after 24 weeks were modest, ranging from -0.45% to -3.83% (in the 50 mg twice daily group [95% CI: -5.26% to -2.48%]; n = 75). Responder analysis of ≥ 5% weight loss at week 24 revealed significant differences versus placebo, which were most pronounced with highest doses of 50 mg twice daily (45.3%) and 150 mg once daily (42.9%) (both P < 0.01). While weight loss was greater at higher doses, gastrointestinal adverse events were also more frequent. The 50-mg once-daily dose had perhaps the best balance between efficacy and tolerability. CONCLUSIONS Licogliflozin produced significant reductions in body weight versus placebo. However, the magnitude of weight reduction was modest.
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Affiliation(s)
- Harold E. Bays
- Louisville Metabolic and Atherosclerosis Research CenterLouisvilleKentuckyUSA
| | | | - Qing Shao
- Novartis Pharmaceuticals CorporationEast HanoverNew JerseyUSA
| | | | - Deborah Keefe
- Novartis Pharmaceuticals CorporationEast HanoverNew JerseyUSA
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12
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van der Zee H, Longcore M, Geng Z, Garg A. Weekly adalimumab treatment decreased disease flare in hidradenitis suppurativa over 36 weeks: integrated results from the phase 3 PIONEER trials. J Eur Acad Dermatol Venereol 2020; 34:1050-1056. [PMID: 31630445 PMCID: PMC7318582 DOI: 10.1111/jdv.16023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/25/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic skin disease characterized by inflammatory lesions that flare unpredictably. The impact of weekly adalimumab (ADAew) on HS flare is not well-characterized. OBJECTIVE To evaluate the impact of disease flare on health-related quality of life (HRQOL) in moderate-to-severe HS patients and to determine the effect of ADAew on disease flare using integrated data from two phase 3 trials over 36 weeks. METHODS In period A (12 weeks), Dermatology Life Quality Index (DLQI) score change from baseline was compared in patients who flared and those who did not, regardless of treatment. The proportion of patients experiencing flare, duration of flare and time to flare was evaluated for ADAew vs. placebo (PBO). In period B (24 weeks), proportion of patients experiencing flare who received continuous ADAew treatment through 36 weeks was assessed. RESULTS HRQOL was markedly improved among those who did not experience flare. In period A, the proportion of patients who experienced flare was significantly lower with ADAew vs. PBO (12.3% vs. 35.3%, P < 0.001). ADAew patients also had longer time to first flare (101 days vs. 57 days; P < 0.001) and shorter flare duration (18.9 days vs. 32.0 days, respectively; P = 0.001) vs. PBO. Through 36 weeks of treatment, 20.2% of ADAew patients flared, and for those who achieved at least a partial clinical response to ADAew at 12 weeks, only 5.7% flared. CONCLUSIONS Flare reduction is an important measure in HS that correlates with clinically meaningful improvement in HRQOL. ADAew reduces HS flare through 12 and subsequent 36 weeks of treatment.
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Affiliation(s)
- H.H. van der Zee
- Department of DermatologyErasmus Medical CenterRotterdamThe Netherlands
| | | | - Z. Geng
- AbbVie IncNorth ChicagoILUSA
| | - A. Garg
- Department of DermatologyZucker School of Medicine at Hofstra/NorthwellNew Hyde ParkNYUSA
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Walker BB, Shashank A, Gasevic D, Schuurman N, Poirier P, Teo K, Rangarajan S, Yusuf S, Lear SA. The Local Food Environment and Obesity: Evidence from Three Cities. Obesity (Silver Spring) 2020; 28:40-45. [PMID: 31774254 PMCID: PMC6972660 DOI: 10.1002/oby.22614] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/10/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to identify the association between the food environment and obesity. METHODS BMI and waist circumference (WC) were measured in 8,076 participants from three cities. The number of fast-food restaurants, full-service restaurants, bars/pubs, markets, and liquor stores within 500 m of each participant was documented. The association between the food environment (ratio of fast-food to full-service restaurants, ratio of bars/pubs to liquor stores, and presence of markets) with obesity (BMI ≥ 30 kg/m2 ) and abdominal obesity (WC ≥ 102 cm for males or WC ≥ 88 cm for females) was investigated, adjusted for age, sex, education level, neighborhood deprivation, neighborhood type, and total hours per week of walking and taking into account city-level clustering. RESULTS The ratios of fast-food to full-service restaurants and of bars/pubs to liquor stores were positively associated with obesity (OR = 1.05 [CI: 1.02-1.09] and OR = 1.08 [CI: 1.04-1.13], respectively). The ratio of bars/pubs to liquor stores was positively associated with abdominal obesity (OR = 1.10 [CI: 1.05-1.14]). There was no association between markets and either obesity or abdominal obesity. CONCLUSIONS Features of the food environment have varying associations with obesity. These features have an additive effect, and future studies should not focus on only one feature in isolation.
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Affiliation(s)
| | - Aateka Shashank
- Department of GeographySimon Fraser UniversityBurnabyBritish ColumbiaCanada
| | - Danijela Gasevic
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Nadine Schuurman
- Department of GeographySimon Fraser UniversityBurnabyBritish ColumbiaCanada
| | - Paul Poirier
- Institut de cardiologie et de pneumologie de QuébecUniversité LavalQuébec CityQuébecCanada
| | - Koon Teo
- Population Health Research InstituteHamiltonOntarioCanada
| | | | - Salim Yusuf
- Population Health Research InstituteHamiltonOntarioCanada
| | - Scott A. Lear
- Faculty of Health SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada
- Division of CardiologyProvidence Health CareVancouverBritish ColumbiaCanada
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Troldborg A, Thiel S, Mistegaard CE, Hansen A, Korsholm T, Stengaard‐Pedersen K, Loft AG. Plasma levels of H- and L-ficolin are increased in axial spondyloarthritis: improvement of disease identification. Clin Exp Immunol 2020; 199:79-87. [PMID: 31518441 PMCID: PMC6904737 DOI: 10.1111/cei.13374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2019] [Indexed: 12/15/2022] Open
Abstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that primarily affects the axial skeleton. A predominance of innate versus adaptive immune responses have been reported in axSpA, indicating a prominent autoinflammatory component of the disease. Little is known about the lectin pathway proteins (LPPs) of the complement system in relation to axSpA. We have investigated LPPs in patients with axSpA and control individuals. Plasma samples were obtained from a cross-sectional cohort of 120 patients with a clinical diagnosis of axSpA and from 144 age- and gender-matched controls. The plasma concentrations of 11 LPPs were measured, using sandwich-type time-resolved immunofluorometric assays in patients and controls, and related to clinical diagnosis and disease activity. Three LPPs [H-ficolin (ficolin-3), L-ficolin (ficolin-2) and collectin liver 1 (CL-L1)] were significantly higher in axSpA patients than in controls (P < 0·0001) and one LPP, collectin kidney 1 (CL-K1), was significantly lower (P < 0·0001). Further, combining H- or L-ficolin concentrations above the 75th percentile of the respective H- or L-ficolin concentration measured in controls with human leucocyte antigen (HLA)-B27 positivity yielded axSpA diagnostic specificities of 99/99% and positive likelihood ratios of 68/62, respectively. H-ficolin and L-ficolin plasma concentrations were found to be elevated in axSpA patients regardless of time since diagnosis. H-ficolin and L-ficolin may represent diagnostic biomarkers for patients with axSpA and should be further evaluated. Our results showed no association between disease activity and the measured LPP concentrations. This result might be due to the cross-sectional design, and should be further investigated.
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Affiliation(s)
- A. Troldborg
- Department of RheumatologyAarhus University HospitalAarhusDenmark
- Department of BiomedicineAarhus UniversityAarhusDenmark
- Department of Clinical MedicineAarhusDenmark
| | - S. Thiel
- Department of BiomedicineAarhus UniversityAarhusDenmark
| | - C. E. Mistegaard
- Department of RheumatologyAarhus University HospitalAarhusDenmark
| | - A. Hansen
- Department of BiomedicineAarhus UniversityAarhusDenmark
| | | | | | - A. G. Loft
- Department of RheumatologyAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhusDenmark
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Morita Y, Murayama H, Odawara M, Bauer M. Treatment patterns of drug-naive patients with type 2 diabetes mellitus: a retrospective cohort study using a Japanese hospital database. Diabetol Metab Syndr 2019; 11:90. [PMID: 31695754 PMCID: PMC6824122 DOI: 10.1186/s13098-019-0486-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/22/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Guidelines for Type 2 diabetes mellitus (T2DM) management in Japan provide physicians the discretion to select treatment options based on patient pathophysiology of the disease. There exists a wide variation of preference for initial antidiabetes drugs (AD). The current database analysis aimed to understand the real world treatment patterns in drug-naive patients with T2DM in Japan. METHODS We analyzed data of patients (≥ 18 years) diagnosed with T2DM between October 2012 and September 2016 from the Medical Data Vision, a Diagnosis Procedure Combination database. The primary objective was to determine the proportion of T2DM patients receiving each type of treatment as first-line therapy among the drug-naive cohort. RESULTS Of the 436,546 drug-naive patients, 224,761 received their first-line T2DM treatment in the outpatient setting. The mean age of the patient population was 65.6 years at index date. Dipeptidyl peptidase-4 (DPP-4) inhibitor was the most prescribed (56.8%) outpatient AD monotherapy, followed by metformin (15.4%). DPP-4 inhibitors were prescribed over metformin in patients with renal disease (odds ratio [OR]: 4.20; p < 0.0001), coronary heart disease and stroke (OR: 2.22; p < 0.0001). Male (OR: 1.03; p = 0.0026), presence of diabetic complications [retinopathy (OR: 1.33; p < 0.0001), neuropathy (OR: 1.05; p = 0.0037), nephropathy (OR: 1.08; p < 0.0001)] and a high baseline HbA1c (OR: 1.45; p < 0.0001) received treatment intensification during 180 days. CONCLUSION DPP-4 inhibitors were the most prevalent first-line T2DM treatment followed by metformin in Japan. The findings from this retrospective analysis also support the previously published web survey results and can help understand the real world utilization of T2DM treatment.Trial registration Retrospectively registered.
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Affiliation(s)
- Yohei Morita
- Medical Division, Novartis Pharma K.K, Toranomon Hills, Mori Tower 23-1, Toranomon 1-Chome, Minato-ku, Tokyo, 105-6333 Japan
| | - Hiroki Murayama
- Medical Division, Novartis Pharma K.K, Toranomon Hills, Mori Tower 23-1, Toranomon 1-Chome, Minato-ku, Tokyo, 105-6333 Japan
| | - Masato Odawara
- Department of Diabetes, Endocrinology, Metabolism and Rheumatology, Tokyo Medical University, 6-1-1, Shinjuku, Shinjuku-ku, Tokyo, Japan
| | - Melissa Bauer
- Real World Data Analytics, Novartis Global Service Center, Vista Building, Elm Park Business Campus, Merrion Road, Dublin, Ireland
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Evans M, Kozlovski P, Paldánius PM, Foley JE, Bhosekar V, Serban C, Avogaro A. Factors that may Account for Cardiovascular Risk Reduction with a Dipeptidyl Peptidase-4 Inhibitor, Vildagliptin, in Young Patients with Type 2 Diabetes Mellitus. Diabetes Ther 2018; 9:27-36. [PMID: 29134608 PMCID: PMC5801217 DOI: 10.1007/s13300-017-0329-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION In a meta-analysis, we observed a significant 37% relative risk reduction in prospectively adjudicated major adverse cardiac events [MACEs, comprising of non-fatal myocardial infarction, non-fatal stroke, cardiovascular (CV) death] with vildagliptin vs. comparators in younger (< 65 years) patients with type 2 diabetes mellitus (T2DM), while the risk was similar in older patients (≥ 65 years). We carried out an exploratory analysis to identify the patient characteristics and on-treatment effects that may have contributed to the different outcomes in the two age groups. METHODS On-treatment differences (vildagliptin vs. comparators) for the change from baseline in CV risk factors were analyzed using an analysis of covariance model with the baseline value for each variable of interest, treatment and study as covariates. Additional adjustments for background antihypertensive and statin use were performed when analyzing changes in blood pressure and lipids, respectively. Baseline characteristics and patient demographics were analyzed using descriptive statistics. RESULTS Patients aged < 65 years had shorter diabetes duration (4.4 vs. 8.2 years) and slightly higher glycated hemoglobin (HbA1c) at baseline (8.3% vs. 8.0%) than patients aged ≥ 65 years. More patients in the ≥ 65 year age group had hypertension (73.1% vs. 51.3%), dyslipidemia (53.3% vs. 43.9%) and a history of CV events (32.2% vs. 12.9%). There were small, but statistically significant differences in the change in HbA1c and total cholesterol in favor of vildagliptin relative to comparators, which were similar in both age groups. Significant differences were observed in the reduction in systolic blood pressure (SBP) (- 0.52 mmHg; 95% CI - 0.97, - 0.07; p = 0.023), low-density lipoprotein (LDL cholesterol) (- 0.12 mmol/l; 95% CI - 0.19, - 0.04; p = 0.002) and weight (- 0.48 kg; 95% CI - 0.95, - 0.01; p < 0.047) in patients < 65 years, but not in patients ≥ 65 years. The incidence of hypoglycemic events was lower in patients treated with vildagliptin [2.1 and 3.5 per 100 subject years exposure (SYEs) in < 65 and ≥ 65 years, respectively] than with comparators (5.8 and 7.5 per 100 SYEs, respectively). CONCLUSION Based on our findings, it can be hypothesized that the positive effects of vildagliptin on SBP, LDL cholesterol, hypoglycemia and weight observed in younger, but not in older patients could be associated with the lower risk of MACE in younger patients with T2DM. FUNDING Novartis.
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Affiliation(s)
- Marc Evans
- Diabetes Resource Centre, University Hospital Llandough, Cardiff, UK.
| | | | | | - James E Foley
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Angelo Avogaro
- Department of Medicine, University of Padova, Padua, Italy
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