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Trevisan CLM, Carraro A, Baldari GLA. Treatment Satisfaction, Efficacy, and Tolerability of Low-Dose Diclofenac Epolamine Soft Capsules in Acute, Mild, or Moderate Musculoskeletal Pain: A Prospective Open-Label, Single-Arm Interventional Study. Pain Ther 2023; 12:1149-1163. [PMID: 37314686 PMCID: PMC10266308 DOI: 10.1007/s40122-023-00531-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/24/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION The use of oral nonsteroidal anti-inflammatory drugs (NSAIDs) for acute musculoskeletal pain should be at the lowest effective dosage and for the shortest duration to minimize potential adverse effects. This study evaluated treatment satisfaction, effectiveness, and tolerability of a low-dose diclofenac epolamine 12.5-mg soft capsule formulation (DHEP 12.5-mg capsules) using patient-reported outcome measures in a real-life setting over a short period (3 days) in subjects with mild-to-moderate acute musculoskeletal pain. METHODS A prospective, open-label, phase IV clinical study in adult outpatients at hospital clinic departments/general practitioner's clinics at eight sites in Italy. The primary efficacy variable was the degree of satisfaction with treatment at 72 ± 7 h after initiation of treatment, assessed using the Overall Satisfaction Question of the Pain Treatment Satisfaction Scale (PTSS) and described by classic descriptive statistics. Secondary objectives were to evaluate the analgesic effect after the first administration and over time; the time to and satisfaction with the onset of pain relief, amount of and duration of pain relief; pain intensity differences over time; and safety and tolerability. The investigator's satisfaction with the treatment was also assessed. Subjects initially took 1-2 capsules of the study treatment and then one or two soft capsules every 4-6 h according to their needs. Not more than six soft capsules were to be taken in any 24-h period. RESULTS A total of 182 subjects (mean age, 56.2 years; 54.4% female) took ≥ 1 dose of DHEP capsule and were included in the full analysis set. The most common musculoskeletal conditions were arthralgia (39.0%) and low back pain (23.1%). All subjects completed the study, and 165/182 (90.7%, 95% CI 0.86, 0.95) were satisfied or very satisfied with the treatment at 72 ± 7 h after the first dose (primary efficacy variable). Similar percentages were recorded for treatment satisfaction concerning other efficacy parameters. The onset of the analgesic effect was rapid, with complete pain relief reached after a mean of 49.45 min. Investigators rated their overall treatment satisfaction as 92.9%. Treatment was well tolerated. CONCLUSIONS The low-dose (12.5 or 25 mg) oral diclofenac epolamine soft capsules formulation exerted rapid, effective, and safe analgesic activity in patients with mild-to-moderate musculoskeletal pain, with subjects' overall satisfaction with treatment more than 90%. TRIAL REGISTRATION EudraCT Number: 2018-004886-15 (Study 18I-Fsg08). Registered 04/09/2018.
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Affiliation(s)
- Carlo L M Trevisan
- Orthopedic Department, Ospedale Bolognini Seriate ASST Bergamo Est, Seriate, Italy.
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Porras-Ramírez A, Sánchez-París R, López-Devia W, Moreno-Perilla Z, Jurado-Zambrano R, Luna-Jaspe Caina C, Sefair C, Ramos N, Otero-Cadena M, Lievano R. Confirmed cases of COVID-19 after vaccination against COVID in health personnel in Bogotá, Colombia. Vaccine 2023; 41:6072-6076. [PMID: 37661532 DOI: 10.1016/j.vaccine.2023.07.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE The present study aims to estimate the frequency of COVID 19 infections in vaccinated health personnel at a Los CObos Medical Center in Bogotá, Colombia. The percentage of people positive to the PCR test and their clinical characteristics were analyzed. METHODS We performed a cross-sectional study. The primary study variable was the COVID vaccination registry. We analyzed sex, age, signs, and symptoms. Multivariable logistic regression was applied to assess changes over time and to identify variables associated with vaccination in target groups. RESULTS A cohort of 999 people working at Los Cobos Medical Center and followed from March to August 2021. The average age of this cohort was 37.0 years (devest = 10.5 years), 67.7 % were women. Two hundred eleven physicians, 287 nurses, 305 assistants, and 196 clerks follows. In addition, 8.4 % to be PCR positive after vaccination. The average age was 36.0 (devest = 23.4 years), 59 women and 25 men. Of these, 15 were administrative, 14 were doctors, 29 nurses, and 26 nursing assistants. The vaccination status found that 21.4 % do not vaccinates, 7.1 % were partially vaccinated, and 71.4 % with a complete schedule. When questioned about symptoms in these patients, 4.0 % were symptomatic, and 5.9 % were asymptomatic. CONCLUSIONS A recent epidemiological study involving 12,364 health workers with a mean age of 38 years quantifies the protection in six months from the vaccine. The presence of antibodies was associated with 83 % protection against active SARS-CoV-2 infection (PCR positivity during the study period), which confirms the existence of protective Immunity at levels comparable to those obtained by the approved vaccines; our study found effectiveness of 92.6 %. Higher than that found in this study, possibly explained by the characteristics of the individuals included.
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Affiliation(s)
- Alexandra Porras-Ramírez
- Grupo de Medicina comunitaria y salud colectiva, Universidad El Bosque, Bogotá, Colombia; Los Cobos Medical Center, Bogotá, Colombia.
| | - Rafael Sánchez-París
- Grupo de Medicina comunitaria y salud colectiva, Universidad El Bosque, Bogotá, Colombia
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Montesinos P, Kota V, Brandwein J, Bousset P, Benner RJ, Vandendries E, Chen Y, McMullin MF. A phase IV study evaluating QT interval, pharmacokinetics, and safety following fractionated dosing of gemtuzumab ozogamicin in patients with relapsed/refractory CD33-positive acute myeloid leukemia. Cancer Chemother Pharmacol 2023; 91:441-446. [PMID: 36892676 PMCID: PMC9996548 DOI: 10.1007/s00280-023-04516-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/24/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Gemtuzumab ozogamicin (GO) is indicated for treatment of relapsed/refractory (R/R) acute myeloid leukemia (AML). The QT interval, pharmacokinetics (PK), and immunogenicity following the fractionated GO dosing regimen have not been previously assessed. This phase IV study was designed to obtain this information in patients with R/R AML. METHODS Patients aged ≥ 18 years with R/R AML received the fractionated dosing regimen of GO 3 mg/m2 on Days 1, 4, and 7 of each cycle, up to 2 cycles. The primary endpoint was mean change from baseline in QT interval corrected for heart rate (QTc). RESULTS Fifty patients received ≥ 1 dose of GO during Cycle 1. The upper limit of the 2-sided 90% confidence interval for least squares mean differences in QTc using Fridericia's formula (QTcF) was < 10 ms for all time points during Cycle 1. No patients had a post-baseline QTcF > 480 ms or a change from baseline > 60 ms. Treatment-emergent adverse events (TEAEs) occurred in 98% of patients; 54% were grade 3-4. The most common grade 3-4 TEAEs were febrile neutropenia (36%) and thrombocytopenia (18%). The PK profiles of both conjugated and unconjugated calicheamicin mirror that of total hP67.6 antibody. The incidence of antidrug antibodies (ADAs) and neutralizing antibodies was 12% and 2%, respectively. CONCLUSION Fractionated GO dosing regimen (3 mg/m2/dose) is not predicted to pose a clinically significant safety risk for QT interval prolongation in patients with R/R AML. TEAEs are consistent with GO's known safety profile, and ADA presence appears unassociated with potential safety issues. TRIAL REGISTRY Clinicaltrials.gov ID: NCT03727750 (November 1, 2018).
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Affiliation(s)
- Pau Montesinos
- Department of Hematology, Hospital Universitario y Politècnico La Fe, Avda. Fernando Abril Martorell, 106-Torre A, 4º planta, 46026, Valencia, Spain.
| | - Vamsi Kota
- Department of Medicine: Hematology and Oncology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Joseph Brandwein
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | | | | | - Ying Chen
- Pfizer Oncology, Pfizer Inc., La Jolla, CA, USA
| | - Mary Frances McMullin
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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Manchon E, Laplaud D, Vukusic S, Labauge P, Moreau T, Kobelt G, Grouin JM, Lotz M, Pau D, Christine LF. Efficacy, safety and patient reported outcomes in patients with active relapsing multiple sclerosis treated with ocrelizumab: Final results from the PRO-MSACTIVE study. Mult Scler Relat Disord 2022; 68:104109. [PMID: 36007299 DOI: 10.1016/j.msard.2022.104109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/03/2022] [Accepted: 08/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ocrelizumab, a humanized anti-CD20 monoclonal antibody, has been approved in Europe for the treatment of adult patients with active relapsing multiple sclerosis (RMS) and primary progressive multiple sclerosis (PPMS), on the basis of previous phase III studies. However, limited data were available on ocrelizumab efficacy in RMS according to the Lublin definition of activity (clinical and/or imaging features) used in the current drug label. The PRO-MSACTIVE study was thus designed to provide additional data on ocrelizumab efficacy according to this definition, and also on safety and patient reported outcomes (PROs). METHODS PRO-MSACTIVE is a national, multicenter, open-label, single-arm phase IV French study, conducted in patients with active RMS (relapsing-remitting multiple sclerosis, RRMS, or secondary progressive multiple sclerosis, SPMS). The primary endpoint, which was assessed at week (W) 48, was defined as the proportion of patients free of disease activity (defined by no relapses and no T1 gadolinium-enhancing nor new and/or enlarging T2 lesions using brain MRI). Disease activity, disability and PROs using 6 questionnaires for disease severity, quality of life, impact on work productivity, and treatment satisfaction were described at W24 and W48. Adverse events were described until W72. RESULTS Among the 422 analyzed patients (RRMS: 376, SPMS: 46), 63.3% (95% CI [58.5%; 67.9%]) were free of disease activity at W48 (RRMS: 62.2% [57.1%; 67.2%], SPMS: 71.7% [56.5%; 84.0%]). A total of 358 patients (84.8%; RRMS: 84.6%, SPMS: 87.0%) were relapse-free up to W48, and the overall adjusted annualized relapse rate was 0.14 (RRMS: 0.15, SPMS: 0.09). Overall, 67.8% of patients (RRMS: 66.8%, SPMS: 76.1%) had no evidence of MRI activity (no T1 gadolinium-enhancing lesions [83.4%] and no new/enlarging T2 lesions [75.1%]); 58.5% of patients (RRMS: 57.7%, SPMS: 65.2%) achieved No Evidence of Disease Activity (NEDA: no relapses, no confirmed disability progression, and no MRI activity) at W48. All PRO scores were stable between the first dose of ocrelizumab and W48 and better outcomes were seen for patients having an EDSS score ≥4. Overall, 89.3% of patients reported adverse events, 62.3% adverse events assessed as related to ocrelizumab, and 8.5% serious adverse events. No serious infusion-related reactions, opportunistic infections, progressive multifocal leukoencephalopathy, nor deaths were reported. No new safety signal was identified. CONCLUSION These data confirm the efficacy of ocrelizumab in a pragmatic setting and its favorable benefit-risk profile in patients with RMS. (ClinicalTrials.gov identifier: NCT03589105; EudraCT identifier: 2018-000780-91).
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Affiliation(s)
- Eric Manchon
- Centre Hospitalier de Gonesse, Service de Neurologie, Gonesse, France.
| | - David Laplaud
- Nantes Université, Service de Neurologie, Centre Hospitalier Universitaire de Nantes, CIC INSERM 1413, Center for Research in Transplantation and Translational Immunology, INSERM UMR 1064, Nantes, France
| | - Sandra Vukusic
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie, Centre de Recherche en Neurosciences de Lyon, OFSEP, INSERM 1028 et CNRS UMR 5292, Université Claude Bernard de Lyon, Eugène Devic EDMUS Foundation, Bron, France
| | - Pierre Labauge
- Centre Hospitalier Universitaire de Montpellier, Hôpital Gui de Chauliac, Service de Neurologie, Montpellier, France
| | - Thibault Moreau
- Centre Hospitalier Universitaire de Dijon Bourgogne, Hôpital François Mitterrand, Maladies Inflammatoires du Système Nerveux et Neurologie Générale, Service de Neurologie, Dijon, France
| | | | | | | | - David Pau
- Roche SAS, Boulogne-Billancourt, France
| | - Lebrun Frenay Christine
- Centre Hospitalier Universitaire Pasteur 2, Service de Neurologie, CRCSEP, Unitéde Recherche Clinique Côte d'Azur (UR2CA-URRIS), Nice, France
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Due A. Are ' phase IV' trials exploratory or confirmatory experiments? Stud Hist Philos Sci 2022; 95:126-133. [PMID: 36027655 DOI: 10.1016/j.shpsa.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 07/04/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
Exploratory experiments are widely characterized as experiments that do not test hypotheses. Experiments that do test hypotheses are characterized as confirmatory experiments. Philosophers have pointed out that research programmes can be both confirmatory and exploratory. However, these definitions preclude single experiments being characterized as both exploratory and confirmatory; how can an experiment test and not test a hypothesis? Given the intuition that some experiments are exploratory, some are confirmatory, and some are both, a recharacterization of the relationship between exploratory and confirmatory experimentation is needed. I discuss 'phase IV' trials to show what this recharacterization could look like. Phase IV trials can be exploratory and confirmatory insofar as they concurrently test hypotheses and explore for unforeseen phenomena. Even if it is uncontroversial that a single experiment can have multiple aims, the recharacterization of the relationship between exploratory and confirmatory experimentation is still required for these aims to be held together coherently. I offer an alternative characterization of the relationship between exploratory and confirmatory experimentation where the former remains a distinct kind of experimentation but is not characterized as non-hypothesis-testing.
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Affiliation(s)
- Austin Due
- Institute for the History and Philosophy of Science and Technology, University of Toronto, Canada.
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Maruszczyk K, Aiyegbusi OL, Cardoso VR, Gkoutos GV, Slater K, Collis P, Keeley T, Calvert MJ. Implementation of patient-reported outcome measures in real-world evidence studies: Analysis of ClinicalTrials.gov records (1999-2021). Contemp Clin Trials 2022; 120:106882. [PMID: 35973663 DOI: 10.1016/j.cct.2022.106882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/28/2022] [Accepted: 08/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Real-world evidence (RWE) plays an increasingly important role within global regulatory and reimbursement processes. RWE generation can be enhanced by collecting and using patient-reported outcomes (PROs), which can provide valuable information on the effectiveness, safety, and tolerability of health interventions from the patient perspective. This analysis aims to examine and summarise the utilisation of patient-reported outcomes measures (PROMs) in real-world studies. METHODS Descriptions of phase IV trials were downloaded on July 22, 2021 from the Clinicaltrials.gov database since its inception. An automated algorithm was built to detect trials utilising PROMs and composite measures including patient-reported components. Search terms were developed based on the PROQOLID database. RESULTS Of 27,976 phase IV clinical trials posted on Clinicaltrials.gov between 1999 and July 2021, 21% and 4% used PROMs and composite measures, respectively. Recent years demonstrated a steady increase in the utilisation of PROMs in phase IV trials. CONCLUSIONS The use of PROMs in phase IV trials seems to be lower than its use in earlier phases of clinical research. Increased uptake of PROMs in RWE studies can be facilitated in a number of ways including the development of standards for their collection, analysis and use.
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Affiliation(s)
- Konrad Maruszczyk
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK; NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK; NIHR Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK.
| | - Victor Roth Cardoso
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Georgios V Gkoutos
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Karin Slater
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Philip Collis
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; NIHR Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK; Patient partner, UK
| | - Thomas Keeley
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; GlaxoSmithKline (GSK), Patient Centered Outcome, Value Evidence and Outcomes, Brentford, UK
| | - Melanie J Calvert
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK; NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK; NIHR Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
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Sun X, Liu Q, Tang X, Yao K, Li Y, Yang J, Zhang M, Yuan H, Zheng Y, Li W, Peng H. Effectiveness and safety of tafluprost in primary open-angle glaucoma and ocular hypertension: a post-marketing phase IV study in China. BMC Ophthalmol 2022; 22:332. [PMID: 35932001 PMCID: PMC9356508 DOI: 10.1186/s12886-022-02553-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/22/2022] [Indexed: 11/20/2022] Open
Abstract
Background Prostaglandin analogs (PGAs) are the first-line treatment for primary open-angle glaucoma (POAG) and ocular hypertension (OH). This study aimed to confirm the effectiveness and safety of Tapros® (0.0015% tafluprost eye drops) in Chinese patients with POAG and OH. Methods This phase IV, multicenter, non-comparative, prospective study enrolled patients with POAG and OH in China between 12/27/2017 and 04/15/2020. Patients who were treatment-naïve or untreated within one month (group A) or with unreached intraocular pressure (IOP) target after previous monotherapy of other PGAs (group B) or non-PGA IOP-lowering drugs (group C) were treated with 0.0015% tafluprost for three months. The IOP reduction, response rate, and safety were observed. Results There were 165, 89, and 31 patients in groups A, B, and C, with baseline IOPs of 22.4 ± 4.7, 21.0 ± 3.5, and 22.5 ± 3.2 mmHg, respectively. The least-square means and percentages of IOP reduction at 3 months for groups A, B, and C were 4.7 (19.8%), 1.6 (6.1%), and 4.6 mmHg (20.3%), respectively. A significant reduction in IOP was observed at each visit compared with baseline (all P < 0.05). At the final visit, 57.0% of the participants in group A achieved an IOP reduction of ≥ 20%, while 40.4% and 77.4% in groups B and C achieved an IOP reduction of ≥ 10%. Fifty-eight treatment-related adverse events occurred in 46 participants (15.7%), of which the most common one was conjunctival hyperemia (34/293, 11.6%). Conclusions Tafluprost showed a sustained and significant effect with tolerable adverse events in Chinese patients with POAG and OH who were treatment-naïve or untreated within one month or received prior treatments with unsatisfying outcomes.
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Affiliation(s)
- Xinghuai Sun
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China.
| | - Qinghuai Liu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Xin Tang
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Ke Yao
- Eye Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang Province, China
| | - Yan Li
- Department of Ophthalmology, First Affiliated Hospital of Kunming Medical University, Kunming, 650031, Yunnan Province, China
| | - Jin Yang
- Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Tianjin, 300020, China
| | - Mingchang Zhang
- Department of Ophthalmology, Tongji Medical College, Union Hospital, Huazhong University of Science & Technology, Wuhan, 430030, Hubei Province, China
| | - Huiping Yuan
- Department of Ophthalmology, The Second Affiliated Hospital, Harbin Medical University, Harbin, 150001, Heilongjiang Province, China
| | - Yan Zheng
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Weining Li
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong Province, China
| | - Huacong Peng
- Department of Cataract and Glaucoma, Wuhan Eyegood Ophthalmic Hospital, Wuhan, 430064, Hubei Province, China
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Jenabian A, Ehsanpour A, Mortazavizadeh SMR, Raafat J, Razavi M, Khosravi A, Seifi S, Salimi B, Anjidani N, Kafi H. Evaluating the safety and effectiveness of PegaGen ® (pegfilgrastim) for the prevention of chemotherapy-induced febrile neutropenia: a post-marketing surveillance study. Support Care Cancer 2022; 30:8151-8158. [PMID: 35792924 DOI: 10.1007/s00520-022-07265-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/27/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Phase IV clinical trials are required to evaluate the real-world safety and effectiveness of drugs. This study aimed to evaluate the safety and effectiveness of once-per-cycle administration of PegaGen® (pegfilgrastim, CinnaGen, Iran) in cancer patients. METHODS In this open-label, multicenter, prospective, real-world, post-marketing surveillance study, patients with any type of cancer receiving chemotherapy regimens with a high risk of febrile neutropenia (FN) were included if they were prescribed pegfilgrastim for FN prophylaxis. The primary objective of this study was to assess the safety and the secondary objective was to assess the effectiveness of pegfilgrastim in the prevention of FN in cancer patients. RESULTS A total of 654 patients (51.73 ± 15.12 years of age) were enrolled and 3615 cycles of pegfilgrastim injections were recorded. The most common malignancies among the study patients were breast cancer (n = 192, 29.36%), lymphoma (n = 131, 20.03%), and gastric cancer (n = 65, 9.94%). The median (Q1, Q3) number of pegfilgrastim cycles per patient was 6 (4, 7). A single 6 mg dose was injected in 99.17% of the cycles. A total number of 816 adverse events (AEs) were reported in 246 patients (37.62%). Bone pain was recorded in 141 patients (21.56%) and in 440 cycles (12.17%). Among all patients, 45 patients (6.88%) experienced FN 51 times, and FN frequency was 1.4% among cycles. Moreover, 14 (2.14%) patients were hospitalized following FN. Antibiotics were administered to 24 patients (3.67%) for FN treatment. CONCLUSION The results from this post-marketing surveillance study support the safety and effectiveness of PegaGen® used for the prevention of chemotherapy-induced FN in patients with various types of cancer and treatment regimens. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT04460079.
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Affiliation(s)
- Arash Jenabian
- Department of Medical Oncology and Hematology, Booali Hospital, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
| | - Ali Ehsanpour
- Thalassemia and Hemoglobinopathy Research Center, Research Institute of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | - Mohsen Razavi
- Department of Oncology and Hematology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Adnan Khosravi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sharareh Seifi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Salimi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hamidreza Kafi
- Medical Department, Orchid Pharmed Company, Tehran, Iran
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Shahi F, Vafaeezadeh F, Ansarinejad N, Ahmadi A, Shahriari-Ahmadi A, Ghazizadeh A, Vahedian Ardakani H, Ravanbod MR, Seifi S, Foratyazdi M, Mousavi SA, Rajabi Vahid M, Rahimi H, Seghatoleslami M, Razavi SM, Pourkhani AH, Babakhani D, Anjidani N. A Post-Marketing Surveillance Study to Evaluate the Safety Profile of Alvotere Ⓡ (Docetaxel) in Iranian Patients Diagnosed with Different Types of Cancers Receiving Chemotherapy. Curr Ther Res Clin Exp 2022; 96:100659. [PMID: 35035631 PMCID: PMC8749121 DOI: 10.1016/j.curtheres.2021.100659] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/08/2021] [Indexed: 11/20/2022] Open
Abstract
Background Docetaxel is a clinically well established antimitotic chemotherapy medication. Labeled docetaxel indications are breast cancer, gastric cancer, head and neck cancer, non–small cell lung cancer, and prostate cancer. Objective This is a Phase IV study to evaluate the safety profile of docetaxel (Alvotere; NanoAlvand, Iran) in Iranian patients diagnosed with different types of cancers receiving chemotherapy regimens with docetaxel. Methods Patients who received Alvotere as a part of their chemotherapy regimen were enrolled in this Phase IV, observational, multicenter, open-label study. Alvotere was administrated as a single agent or in combination with other chemotherapy agents. Safety parameters in each cycle were assessed, and the related data were recorded in booklets. Findings A total of 411 patients with different types of cancers were enrolled from 25 centers in Iran. The most common malignancies among participants were breast cancer (49.88%), followed by gastric cancer (22.63%). Participants’ mean age was 53.33 years, and the mean total dose used in each cycle was 132 mg. According to the results, 341 patients experienced at least 1 adverse event, that the most common was alopecia (41.12%). In total, 92 (22.38%) patients had at least 1 adverse event of grade 3 or 4, and 25 (6.08%) patients showed 54 serious adverse events, which the causality assessment for all was possibly related to Alvotere. There was a significant difference between men and women in the incidence of skin and subcutaneous tissue disorders (55.63% in women vs 41.73% in men; P = 0.009). Also, the incidence of gastrointestinal disorders, nervous system disorders, skin and subcutaneous tissue disorders, hepatic enzymes increase, and fluid retention was significantly higher (P < 0.05) in patients receiving anthracyclines in their chemotherapy regimens. Conclusions The findings of this open-label, observational, multicenter, postmarketing surveillance showed that Alvotere appears to have an acceptable safety profile in Iranian cancer patients receiving chemotherapeutic regimens. (Curr Ther Res Clin Exp. 2022; 82:XXX–XXX) © 2022 Elsevier HS Journals, Inc. Totally 411 patients were enrolled from 25 centers in Iran. The most common adverse event was alopecia (41.12%). Only 25 (6.08%) patients experienced serious adverse events. Results of this study support the safety profile of Alvotere® in Iranian patients.
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Affiliation(s)
- Farhad Shahi
- Department of Medical Oncology, Tehran University of Medical Sciences, Tehran, Iran
| | - Farahnaz Vafaeezadeh
- Department of Medical Oncology, Tehran University of Medical Sciences, Tehran, Iran
| | - Nafiseh Ansarinejad
- Department of Hematology and Oncology, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Ahmadi
- Department of Oncology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Shahriari-Ahmadi
- Department of Hematology and Oncology, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Ghazizadeh
- Medicine Department of Hematology-Medical Oncology, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | | | - Mohammad Reza Ravanbod
- Department of Hematology and Oncology, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Sharareh Seifi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Foratyazdi
- Department of Oncology, Medicine Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Mansour Rajabi Vahid
- Department of Hematology and Oncology, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hossein Rahimi
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Seghatoleslami
- Health research institute, Research Center of Thalassemia & Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Mohsen Razavi
- Department of Hematology and Oncology, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Houshang Pourkhani
- Oncology and Hematology, Clinical Research Development Center, Sayad Shirazi Hospital, Golestan University Of Medical Sciences, Gorgan, Iran
| | - Davoud Babakhani
- Department of Medical Oncology, Tehran University of Medical Sciences, Tehran, Iran
| | - Nassim Anjidani
- Head of Medical Department, Orchid Pharmed Company, Tehran, Iran
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Shahi F, Gorji M, Payandeh M, Rezvani H, Vaezi M, Seifi S, Baari A, Khalili-Dizaji R, Hashemi SM, Salimi S, Kamranzadeh H, Shazad B, Salari S, Dameshghi DO, Sarkheil M, Mirzania M, Anjidani N. Post-Marketing Surveillance of a generic Oxaliplatin (Alvoxal Ⓡ) in Iranian Patients with Cancer. Curr Ther Res Clin Exp 2022; 96:100657. [PMID: 35024073 PMCID: PMC8732752 DOI: 10.1016/j.curtheres.2021.100657] [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: 02/08/2021] [Accepted: 11/23/2021] [Indexed: 12/24/2022] Open
Abstract
Background CRC is the second and third most common cancer in women and men, respectively. The national comprehensive cancer network guidelines recommend oxaliplatin-based chemotherapy as a preferred regimen for patients with advanced or metastatic colon cancer. Oxaliplatin is also used in the off-label treatment of gastric cancer. FDA uses post-marketing study commitments to gather additional information about a product's safety, efficacy, or optimal use. It is necessary to perform safety monitoring after marketing authorization is received; such monitoring can be done by means of characterizing the safety of drugs in patients being treated in real-world clinical practice settings. Objectives This Phase IV study aimed to evaluate the safety profile of a brand-name formulation of the generic drug oxaliplatin (AlvoxalⓇ, NanoAlvand, Tehran, Iran) in Iranian patients diagnosed with either colorectal or other, different types of cancer. Methods Patients with colorectal cancer, gastric cancer, or other malignancies receiving oxaliplatin as a part of their treatment were included in this open-label, multicenter, observational Phase IV study. This study aimed to assess the safety profile of oxaliplatin in patients diagnosed with different cancers. Findings A total of 483 patients from 16 cities in Iran were enrolled. The most common malignancy was colorectal cancer (55.49%), followed by gastric cancer (28.16%). Based on the results, 405 patients experienced at least 1 adverse event. Most of these adverse events were grade 1 or 2, and the most commonly reported adverse event was anemia (60.66%). During the study, 26 serious adverse events occurred in 15 (3.11%) patients, which were perhaps related to oxaliplatin. There were no remarkable differences in the incidences of adverse events in the system organ classes of blood and lymphatic system disorders, gastrointestinal disorders, or nervous system disorders among patients with different malignancies (ie, colorectal cancer, gastric cancer, and other malignancies) or between genders. The results of this open-label, multicenter, observational, postmarketing surveillance study demonstrated no unexpected safety findings from the use of this oxaliplatin product (AlvoxalⓇ) in Iranian patients diagnosed with different types of cancer. Conclusions This Phase IV study provides data on the safety profile of a number of chemotherapy regimens containing an oxaliplatin product given to Iranian patients diagnosed with different types of cancer.
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Affiliation(s)
- Farhad Shahi
- Department of Medical Oncology, Cancer Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Gorji
- Department of Internal Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mehrdad Payandeh
- Department of Hematology and Medical Oncology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hamid Rezvani
- Department of Medical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Vaezi
- Hematology, Oncology Research Center, Stem Cell Transplant, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Sharareh Seifi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Baari
- Hematology and Oncology Section, Internal Medicine Department, Ghaem Hospital, Mashhad, Iran
| | - Reza Khalili-Dizaji
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Mehdi Hashemi
- Zahedan University of Medical Sciences, Clinical Immunology Research Center, Zahedan, Iran
| | - Saeid Salimi
- Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hosein Kamranzadeh
- Hematology, Oncology Research Center, Stem Cell Transplant, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Babak Shazad
- Department of Hematology and Medical Oncology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sina Salari
- Department of Medical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Mehrzad Mirzania
- Department of Medical Oncology, Cancer Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Park MS, Youn JC, Kim EJ, Han KH, Lee SH, Kim SH, Kim BJ, Kwon SU, Ryu KH. Efficacy and Safety of Fenofibrate-Statin Combination Therapy in Patients With Inadequately Controlled Triglyceride Levels Despite Previous Statin Monotherapy: A Multicenter, Randomized, Double-blind, Phase IV Study. Clin Ther 2021; 43:1735-1747. [PMID: 34518033 DOI: 10.1016/j.clinthera.2021.08.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/21/2021] [Accepted: 08/10/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Residual cardiovascular risk reduction by fenofibrate in patients with high serum triglyceride (TG) levels despite previous statin monotherapy is not well characterized. The purpose of this study was to evaluate the efficacy and safety of a combination of choline fenofibrate and statin in patients with inadequately controlled TG levels despite previous statin monotherapy. METHODS This prospective, multicenter, randomized, double-blind study was conducted in Korea. A total of 133 patients with controlled LDL-C but elevated TG levels, already receiving statin monotherapy, were enrolled in the study, which was conducted from July 2018 to December 2019. Patients were randomly assigned to receive combination therapy with choline fenofibrate and statin or statin monotherapy in a 1:1 ratio. After 8 weeks of treatment, the lipid profiles and safety parameters of the patients in the 2 groups were compared. FINDINGS The study included 127 patients (64 in the combination group and 63 in the control group) older than 19 years. After 8 weeks of therapy, mean serum TG levels significantly decreased from 269.8 to 145.5 mg/dL (P < 0.0001) in the combination therapy group, whereas no significant changes occurred in the statin monotherapy group (from 271.1 to 280.5 mg/dL). Contrarily, the mean serum HDLC levels significantly increased from 45.0 to 50.4 mg/dL (P = 0.0004) in the combination therapy group, whereas there were no significant changes in the monotherapy group (from 44.3 to 44.7 mg/dL). There were no additional serious adverse events in the combination therapy group compared with the statin monotherapy group. IMPLICATIONS The combination therapy using choline fenofibrate and statin was found to be effective in serum TG control and likely tolerable in patients with high TG levels despite statin monotherapy. A larger study, conducted for a longer duration, is needed to evaluate the effectiveness of this combination in reducing cardiovascular risk. ClinicalTrials.gov identifier: NCT03874260.
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Affiliation(s)
- Myung Soo Park
- Department of Cardiology, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St Mary's Hospital, Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eung Ju Kim
- Department of Cardiology, Korea University, Guro Hospital, Seoul, Korea
| | - Ki Hoon Han
- Department of Internal Medicine, Ulsan University, Asan Medical Center, Seoul, Korea
| | - Sang Hak Lee
- Department of Cardiology and Cardiovascular Research Institute, Yonsei University, Severance Hospital, Seoul, Korea
| | - Sung Hea Kim
- Department of Cardiology, Konkuk University Medical Center, Seoul, Korea
| | - Byung Jin Kim
- Department of Internal Medicine, Sungkyunkwan University, Kangbuk Samsung Hospital, Seoul, Korea
| | - Sung Uk Kwon
- Department of Cardiology, Inje University, Ilsan Paik Hospital, Goyang, Korea
| | - Kyu-Hyung Ryu
- Department of Cardiology, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Korea.
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Miravalle AA, Katz J, Robertson D, Hayward B, Harlow DE, Lebson LA, Sloane JA, Bass AD, Fox EJ. CLICK-MS and MASTER-2 Phase IV trial design: cladribine tablets in suboptimally controlled relapsing multiple sclerosis. Neurodegener Dis Manag 2021; 11:99-111. [PMID: 33517769 DOI: 10.2217/nmt-2020-0059] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Cladribine tablets 10 mg (3.5 mg/kg cumulative dose over 2 years) are approved for the treatment of relapsing forms of multiple sclerosis (MS), including relapsing-remitting MS and active secondary progressive MS. However, real-world data on cladribine tablets are limited. CLICK-MS and MASTER-2 are single arm, observational, 30-month, Phase IV studies in the US evaluating the effectiveness and safety of cladribine tablets 3.5 mg/kg in patients with relapsing-remitting MS or active secondary progressive MS who had suboptimal response to prior injectable (CLICK-MS), or infusion/oral (MASTER-2) disease-modifying therapy. The primary end point is 24-month annualized relapse rate. Key secondary end points include patient-reported outcomes on quality of life measures, treatment adherence and adverse events. Studies began in 2019 and are expected to be completed in 2023. Trial registration number • CLICK-MS: NCT03933215 (ClinicalTrials.gov) Full title; CLadribine tablets: observational evaluation of effectIveness and patient-reported outcomes in suboptimally Controlled patients previously taKing injectable disease-modifying drugs for relapsing forms of Multiple Sclerosis • MASTER-2: NCT03933202 (ClinicalTrials.gov) Full title; Cladribine tablets: observational evaluation of effectiveness and patient-reported outcomes in suboptiMAlly controlled patientS previously Taking oral or infusion disEase-modifying dRugs for relapsing forms of multiple sclerosis.
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Affiliation(s)
- Augusto A Miravalle
- Advanced Neurology of Colorado, University of Colorado, Fort Collins, CO 80528, USA
| | - Joshua Katz
- Elliot Lewis Center for Multiple Sclerosis Care, Wellesley, MA 02481, USA
| | - Derrick Robertson
- Department of Neurology, Multiple Sclerosis Division, University of South Florida, Tampa, FL 33612, USA
| | - Brooke Hayward
- EMD Serono, Inc., Rockland, MA 02370, USA, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Danielle E Harlow
- EMD Serono, Inc., Rockland, MA 02370, USA, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Lori A Lebson
- EMD Serono, Inc., Rockland, MA 02370, USA, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Jacob A Sloane
- BIDMC Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Ann D Bass
- Neurology Center of San Antonio, San Antonio, TX 78258, USA
| | - Edward J Fox
- Central Texas Neurology Consultants, Round Rock, TX 78681, USA
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Mathieu C, Weisnagel SJ, Stella P, Bruhwyler J, Alexandre K. Impact of Switching from Twice-Daily Basal Insulin to Once-Daily Insulin Glargine 300 U/mL in People with Type 1 Diabetes on Basal-Bolus Insulin: Phase 4 OPTIMIZE Study. Diabetes Ther 2020; 11:495-507. [PMID: 31925722 PMCID: PMC6995801 DOI: 10.1007/s13300-019-00749-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 10/29/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION OPTIMIZE evaluated the efficacy, safety and treatment satisfaction of insulin glargine 300 U/mL once daily (Gla-300 OD) in people with type 1 diabetes mellitus (T1DM) previously uncontrolled on basal insulin twice daily (BID) as part of basal-bolus therapy. METHODS OPTIMIZE was a 28-week, prospective, interventional, single-arm phase 4 trial in adults with T1DM. At baseline, basal insulin BID treatment was switched to Gla-300 OD titrated to a fasting self-monitored blood glucose target of 4.4-7.2 mmol/L (80-130 mg/dL). The primary endpoint was the mean glycated haemoglobin (HbA1c) change from baseline to week 24. Secondary endpoints included self-monitored blood glucose, fasting-plasma glucose, hypoglycaemia and patient-reported outcomes including the Diabetes Treatment Satisfaction Questionnaire status version (DTSQs). RESULTS Switching to Gla-300 OD significantly improved mean HbA1c (8.54% at baseline and 8.27% at week 24 [last observation carried forward, N = 94, p < 0.0001]; mean difference 0.27% [95% CI 0.15, 0.40]). There was a statistically significant decrease in fasting self-monitored blood glucose during the study (analysis of variance for repeated measures, p = 0.014; N = 72). Eight-point self-monitored blood glucose was significantly improved between baseline and week 24 for post-breakfast (p = 0.009), post-dinner (p = 0.009) and bedtime (p = 0.049) values. The study did not allow for any significant effects on confirmed and/or severe hypoglycaemia at the ≤ 3.9 mmol/L [≤ 70 mg/dL] or < 3.0 mmol/L [< 54 mg/dL] blood glucose cut-offs to be observed. Statistically significant improvements were observed in DTSQs total scores from baseline (24.1) to week 24 (29.4, p < 0.0001). CONCLUSIONS A basal-bolus regimen including Gla-300 OD was associated with improvements in HbA1c and treatment satisfaction in people with uncontrolled T1DM previously receiving basal-bolus insulin including a basal insulin BID analogue. TRIAL REGISTRATION EudraCT number: 2015-001186-46.
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Affiliation(s)
| | - S John Weisnagel
- CHU de Québec Université Laval Research Center, Québec City, Canada
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Shore ND, Saltzstein D, Sieber P, Mehlhaff B, Gervasi L, Phillips J, Wong YN, Pei H, McGowan T. Results of a Real-world Study of Enzalutamide and Abiraterone Acetate With Prednisone Tolerability (REAAcT). Clin Genitourin Cancer 2019; 17:457-463.e6. [PMID: 31473120 DOI: 10.1016/j.clgc.2019.07.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/19/2019] [Accepted: 07/28/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The objective of this study was to evaluate differences in tolerability in patients with metastatic castration-resistant prostate cancer treated with enzalutamide (ENZA) or abiraterone acetate plus prednisone (AA+P). PATIENTS AND METHODS This was a phase IV, prospective, open-label, multicenter, real-world study. Patients were prescribed ENZA or AA+P at the treating physician's discretion. Computerized tests of 4 cognitive domains (Cogstate), patient-reported outcomes (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 [EORTC QLQ-30], Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-Fatigue], Functional Assessment of Cancer Therapy-Cognitive Function [FACT-Cog]), and patient/caregiver surveys were assessed at baseline and 2 months. Safety data were collected. RESULTS Of 100 treated patients, 92 were evaluable (46/arm). Baseline characteristics were similar, with mild cognitive impairment observed in ∼20% of patients. The FACIT-Fatigue demonstrated a statistically significant worsening from baseline of -4.00 (95% confidence interval, -6.61 to -1.39) for ENZA compared with AA+P, -0.01 (95% confidence interval, -2.40 to 2.38). Overall, more adverse events (AEs) and more AEs of fatigue were reported with ENZA versus AA+P (52% vs. 36% and 26% vs. 8%, respectively). Grade 3/4 AEs were similar (4% vs. 6%). Unique neuropsychiatric AEs reported with ENZA included amnesia, cognitive disorders, memory impairment, and confusional state; those for AA+P included cerebrovascular accident, presyncope, and spinal cord compression. Clinically meaningful cognitive decline was seen in 4 patients on ENZA versus 1 patient on AA+P. However, the overall mean changes from baseline for the Cogstate tests, the EORTC QLQ-C30, and the FACT-Cog assessment were similar and showed no meaningful change. Caregiver survey responses noted more fatigue with ENZA and more moodiness with AA+P compared with patient responses. CONCLUSIONS Although baseline values were similar, more fatigue and neurocognitive differences were observed with ENZA compared with AA+P.
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Cesana BM, Biganzoli EM. Phase IV Studies: Some Insights, Clarifications, and Issues. ACTA ACUST UNITED AC 2019; 13:14-20. [PMID: 29651962 DOI: 10.2174/1574884713666180412152949] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 12/19/2017] [Accepted: 04/05/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is an increasing need to face regulatory aspects as well as ethics and scientific ones in the pharmaceutical research phase after the authorization of a drug. Traditionally, Phase IV studies, after the authorization of a drug to be marketed by the Competent Authority like the Food and Drug Administration (FDA) (in Europe, European Medicine Agency - EMA- through National Procedures or Community Procedures) have been considered mainly aimed to the assessment of the new drug safety profile. However, the sample size calculation for such aim is still an open issue. Moreover, the benefit/risk assessment is a compelling global need. METHODS This editorial aims to give a fairly exhaustive overview of the main topics currently present in the pharmaceutical research phase after the authorization of a drug. FDA and EMA guidelines are considered under a comparative perspective with a focus on the perspective of "Post Authorization Safety Studies (PASS)" and "Post Authorization Efficacy Studies (PAES)" with critical considerations. Then, the approach of "Explanatory Trials" and "Pragmatic Trials" is proposed under the horizon of Health Technology Assessment (HTA). CONCLUSION Critical remarks are raised against the pure commercial perspective in the proposal of PASS and PAES and on the design of registries which should be planned with relevant objectives to be pursued by appropriate statistical analyses reported in the Statistical Analysis Plan (SAP) of the study protocol. Finally, a particular focus is placed on the work of the Ethical Committees regarding the approval of the observational studies on the safety and the efficacy of the drugs in their pragmatic clinical use.
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Affiliation(s)
- Bruno Mario Cesana
- Department of Molecular and Transactional Medicine, Statistics and Biomathematics Unit, Faculty of Medicine and Surgery, University of Brescia, Brescia, Italy.,Department of Clinical Sciences and Community Health, Unit of Medical Statistics, Biometry and Bioinformatics "Giulio A. Maccacaro", Faculty of Medicine and Surgery, University of Milano, Milano, Italy
| | - Elia Mario Biganzoli
- Department of Clinical Sciences and Community Health, Unit of Medical Statistics, Biometry and Bioinformatics "Giulio A. Maccacaro", Faculty of Medicine and Surgery, University of Milano, Milano, Italy.,Campus Cascina Rosa, Fondazione IRCCS Istituto Nazionale Tumori, Via A. Vanzetti 5, 20133 Milano, Italy
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Abstract
Pharmacoepidemiology is the study of interactions between drugs and human populations, investigating, in real conditions of life, benefits, risks and use of drugs. Pharmacoepidemiology applies to drugs and their pharmacological evaluations, the different methods also used in epidemiology to assess in real conditions of life, benefits, risks and use of drugs. Pharmacoepidemiologic studies are ad-hoc studies or studies on databases. Specific methods exist to measure drug exposure, as well as indicators of compliance and misuse of drugs. Various designs for descriptive and explanatory studies exist, in a context in which a growing proportion of studies are carried out using medico-administrative data. The limits traditionally affecting the study designs are modified in this context, almost any design selected for the conduct of a study from these databases then deriving from a cohort in whom the information has been recorded prospectively and exhaustively.
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Affiliation(s)
- Agnès Sommet
- Service de pharmacologie médicale et clinique, UMR Inserm 1027, CIC Inserm 1436, faculté de médecine, centre hospitalier universitaire, 31000 Toulouse, France.
| | - Antoine Pariente
- Inserm, Bordeaux population health research centre, team pharmacoepidemiology, UMR 1219, university of Bordeaux, 33076 Bordeaux, France; Pôle de santé publique, centre régional de pharmacovigilance de Bordeaux, service de pharmacologie médicale, CHU de Bordeaux, 33076 Bordeaux, France
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Cañete R, Brito K, Brito I, Semper A, Gonzalez ME. Effectiveness and Tolerability of 3-Day Mebendazole Treatment of Giardia duodenalis Infection in Adults and Children: Two Prospective, Open-Label Phase IV Trials. Curr Ther Res Clin Exp 2018; 89:43-47. [PMID: 30792825 PMCID: PMC6370949 DOI: 10.1016/j.curtheres.2018.11.002] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 11/19/2018] [Accepted: 11/28/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Giardia duodenalis is the most common intestinal pathogenic protozoan infection reported in humans. Both in vitro studies and 4 separate, sequential, comparative clinical trials conducted by our group in Cuba demonstrated mebendazole activity against G. duodenalis infection in both children and adults. OBJECTIVE The 2 additional, prospective, open-label, Phase IV follow-up studies reported here were performed to further assess the effectiveness and safety profile of mebendazole in the outpatient treatment of G. duodenalis infection. METHODS Assenting children (n = 522) whose guardians gave permission and consenting adults (n = 423) diagnosed with G. duodenalis infection were given mebendazole (200 mg 3 times daily for 3 days). Medical histories and stool samples were obtained and physical/laboratory examinations were performed pretreatment then repeated on days 3, 5, and 7 after treatment completion. The evaluation of efficacy (ie, cure) was based on parasitologic response to therapy. Participants were considered cured, if no Giardia trophozoites or cysts were found in any of the 3 posttreatment fecal specimens evaluated by direct wet mounts and/or after Ritchie concentration techniques. RESULTS No participant refused to be enrolled and all returned for follow-up examinations. At the end of the treatment, stool samples were negative in 450 out of 522 children (86.2%) and 392 of 423 adults (92.7%). Treatment was well tolerated. In adults, the only adverse effect reported was abdominal pain (6.2%). Side effects reported in children included abdominal pain (5.6%), nausea (2.9%), and vomiting (2.3%). Reported side effects were all mild, transient, and self-limited and did not require discontinuation of treatment or additional medication. CONCLUSIONS Mebendazole may be an effective alternative treatment of G. duodenalis infections in both children and adults.
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Affiliation(s)
- Roberto Cañete
- Council of Scientific Societies of Health, University of Medical Sciences, Matanzas City, Cuba
| | - Katia Brito
- Centre for Hygiene, Epidemiology, and Microbiology, Matanzas City, Cuba
| | - Inara Brito
- Ministry of Health, Regional Office, Matanzas City, Cuba
| | - Abel Semper
- University of Medical Sciences, Matanzas City, Cuba
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Hamre HJ, Pham VN, Kern C, Rau R, Klasen J, Schendel U, Gerlach L, Drabik A, Simon L. A 4-year non-randomized comparative phase-IV study of early rheumatoid arthritis: integrative anthroposophic medicine for patients with preference against DMARDs versus conventional therapy including DMARDs for patients without preference. Patient Prefer Adherence 2018; 12:375-397. [PMID: 29588576 PMCID: PMC5859899 DOI: 10.2147/ppa.s145221] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND While disease-modifying antirheumatic drugs (DMARDs) are a mainstay of therapy for rheumatoid arthritis (RA), some patients with early RA refuse DMARDs. In anthroposophic medicine (AM), a treatment strategy for early RA without DMARDs has been developed. Preliminary data suggest that RA symptoms and inflammatory markers can be reduced under AM, without DMARDs. PATIENTS AND METHODS Two hundred and fifty-one self-selected patients aged 16-70 years, starting treatment for RA of <3 years duration, without prior DMARD therapy, participated in a prospective, non-randomized, comparative Phase IV study. C-patients were treated in clinics offering conventional therapy including DMARDs, while A-patients had chosen treatment in anthroposophic clinics, without DMARDs. Both groups received corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs). Primary outcomes were intensity of RA symptoms measured by self-rating on visual analog scales, C-reactive protein, radiological progression, study withdrawals, serious adverse events (SAE), and adverse drug reactions in months 0-48. RESULTS The groups were similar in most baseline characteristics, while A-patients had longer disease duration (mean 15.1 vs 10.8 months, p<0.0001), slightly more bone destruction, and a much higher proportion of women (94.6% vs 69.7%, p<0.0001). In months 0-12, corticosteroids were used by 45.7% and 81.6% (p<0.0001) and NSAIDs by 52.8% and 68.5% (p=0.0191) of A- and C-patients, respectively. During follow-up, both groups not only had marked reduction of RA symptoms and C-reactive protein, but also some radiological disease progression. Also, 6.2% of A-patients needed DMARDs. Apart from adverse drug reactions (50.4% and 69.7% of A- and C-patients, respectively, p=0.0020), none of the primary outcomes showed any significant between-group difference. CONCLUSION Study results suggest that for most patients preferring anthroposophic treatment, satisfactory results can be achieved without use of DMARDs and with less use of corticosteroids and NSAIDs than in conventional care. LIMITATION Because of the non-randomized study design, with A-patients choosing anthroposophic treatment, one cannot infer how this treatment would have worked for C-patients.
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Affiliation(s)
- Harald J Hamre
- Institute for Applied Epistemology and Medical Methodology at the Witten/Herdecke University, Freiburg, Germany
- Correspondence: Harald J Hamre, Institute for Applied Epistemology and Medical Methodology at the University of Witten-Herdecke, Zechenweg 6, 79111 Freiburg, Germany, Tel +49 761 1560 307, Fax +49 761 6125 6125, Email
| | - Van N Pham
- Institute of Statistics in Medicine, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Christian Kern
- Department of Integrative Medicine, Asklepios Westklinikum, Hamburg, Germany
| | - Rolf Rau
- Department of Rheumatology, Evangelisches Fachkrankenhaus Ratingen, Ratingen, Germany
| | - Jörn Klasen
- Department of Integrative Medicine, Asklepios Westklinikum, Hamburg, Germany
| | - Ute Schendel
- Department of Rheumatology, m&i-Fachklinik Bad Pyrmont, Bad Pyrmont, Germany
| | - Lars Gerlach
- Department of Internal Medicine and Gastroenterology, Filderklinik, Filderstadt, Germany
| | - Attyla Drabik
- Institute of Statistics in Medicine, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Ludger Simon
- Department of Internal Medicine and Gastroenterology, Filderklinik, Filderstadt, Germany
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Pecchiari M, Radovanovic D, Santus P, D'Angelo E. Airway occlusion assessed by single breath N 2 test and lung P-V curve in healthy subjects and COPD patients. Respir Physiol Neurobiol 2016; 234:60-68. [PMID: 27612586 DOI: 10.1016/j.resp.2016.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 06/22/2016] [Revised: 09/01/2016] [Accepted: 09/06/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine whether the analysis of the slow expiratory transpulmonary pressure-volume (PL-V) curve provides an alternative to the single-breath nitrogen test (SBN) for the assessment of the closing volume (CV). METHODS SBN test and slow deflation PL-V curve were simultaneously recorded in 40 healthy subjects and 43 COPD patients. Onset of phase IV identified CV in SBN test (CVSBN), whereas in the PL-V curve CV was identified by: a) deviation from the exponential fit (CVexp), and b) inflection point of the interpolating sigmoid function (CVsig). RESULTS In the absence of phase IV, COPD patients exhibited a clearly discernible inflection in the PL-V curve. In the presence of phase IV, CVSBN and CVexp coincided (CVSBN/CVexp=1.04±0.04 SD), whereas CVsig was systematically larger (CVsig/CVexp=2.1±0.86). CONCLUSION The coincidence between CVSBN and CVexp, and the presence of the inflection in the absence of phase IV indicate that the deviation of the PL-V curve from the exponential fit reliably assesses CV.
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Affiliation(s)
- Matteo Pecchiari
- Dipartimento di Fisiopatologia e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
| | - Dejan Radovanovic
- Dipartimento di Scienze Biomediche, Università degli Studi di Milano, Milan, Italy.
| | - Pierachille Santus
- Dipartimento di Scienze Biomediche, Università degli Studi di Milano, Milan, Italy.
| | - Edgardo D'Angelo
- Dipartimento di Fisiopatologia e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
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Saida T, Kira JI, Ueno Y, Harada N, Hirakata T. Long-term efficacy and safety of intramuscular interferon beta-1a: Randomized postmarketing trial of two dosing regimens in Japanese patients with relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2016; 7:102-8. [PMID: 27237769 DOI: 10.1016/j.msard.2016.02.002] [Citation(s) in RCA: 6] [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: 06/04/2015] [Revised: 10/14/2015] [Accepted: 02/01/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of 2 years of treatment with intramuscular interferon beta-1a (IM IFN beta-1a) in Japanese patients with relapsing-remitting multiple sclerosis, with an exploratory analysis of the impact of initial dose titration on tolerability. METHODS Japanese patients with relapsing-remitting multiple sclerosis were randomized to receive IM IFN beta-1a at dosages of either 30mcg once weekly (full-dose group, n=50) or 15mcg once weekly for 2 weeks then 30mcg once weekly thereafter (titration group, n=50). Key outcomes included annualized relapse rate (ARR) at 2 years (primary endpoint), change in disability measured using the Expanded Disability Status Scale (EDSS), safety, and tolerability. RESULTS The ARR (95% CI) decreased from 1.540 (1.381-1.718) at baseline to 0.371 (0.240-0.571) at Year 1 and 0.351 (0.244-0.503) at Year 2. EDSS improvements were apparent from Week 24; the mean change from baseline EDSS score (2.1) at Year 2 was -0.34 (P=0.004). The most frequently reported adverse events were influenza-like illness (92%), nasopharyngitis (57%), relapse of multiple sclerosis (51%), and injection-site reaction (30%). The overall incidence and severity of influenza-like symptoms were similar in the full-dose group and titration group; only 1 participant, in the full-dose group (2%), experienced severe influenza-like symptoms. However, the incidence of influenza-like symptoms was slightly reduced at earlier timepoints in the titration group. CONCLUSIONS The results of this 2-year study demonstrate that IM IFN beta-1a can be used effectively and safely in Japanese patients with relapsing-remitting multiple sclerosis for an extended period of time.
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Affiliation(s)
- Takahiko Saida
- Kansai Multiple Sclerosis Center and Department of Neurology, Kyoto Min-iren Central Hospital, Kyoto, Japan.
| | - Jun-Ichi Kira
- Department of Neurology, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan.
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Hu X, Han B, Gu A, Zhang Y, Jiao SC, Wang CL, He J, Jia X, Zhang L, Peng J, Wu M, Ying K, Wang J, Ma K, Zhang S, You C, Tan F, Wang Y, Ding L, Sun Y. A single-arm, multicenter, safety-monitoring, phase IV study of icotinib in treating advanced non-small cell lung cancer (NSCLC). Lung Cancer 2014; 86:207-12. [PMID: 25261231 DOI: 10.1016/j.lungcan.2014.08.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [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: 06/03/2014] [Revised: 08/14/2014] [Accepted: 08/22/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND The phase 3 ICOGEN trial established the non-inferiority of icotinib to gefitinib in terms of progression-free survival (PFS) in non-small cell lung cancer (NSCLC) patients, and this led to the approval of icotinib for NSCLC by the China Food and Drug Administration. A phase 4 study was conducted to assess the safety and efficacy of icotinib in a broad range of patients with advanced NSCLC across China. METHODS This study retrospectively analyzed data from unresectable, recurrent, and/or advanced NSCLC patients who received oral icotinib 125 mg three times per day. The primary endpoint was safety. The secondary endpoints included objective response rate (ORR) and disease control rate (DCR), which were investigated overall and in subgroups such as patients with an EGFR mutation and elderly patients. RESULTS Between August, 2011 and August, 2012, a total of 6087 advanced NSCLC patients were registered in this study, of which 5549 were evaluable for safety and tumor response. The median age was 63 years (range 21-95 years), and 1571 (28.3%) patients were over the age of 70. The majority of patients were non-smokers, and had adenocarcinoma and stage IV disease. The overall incidence of adverse drug reactions (ADRs) of any grade was 31.5%. The most common ADRs included rash (17.4%) and diarrhea (8.5%), and three patients experienced interstitial lung disease (ILD). The ORR and DCR were 30.0% and 80.6%, respectively, for the overall population, and 33.4% and 81.2%, 30.3% and 80.3%, and 30.4% and 89.3%, for first-line, second-line, and third-line or multiple line subsets, respectively. In 665 EGFR-mutated patients who were evaluable for tumor response, the ORR and DCR were 49.2% (327/665) and 92.3% (614/665), respectively. CONCLUSIONS The data from over 6000 patients was consistent with the results of the ICOGEN study. Icotinib demonstrated a favorable toxicity profile and efficacy in the routine clinical setting.
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Affiliation(s)
- Xingsheng Hu
- Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Baohui Han
- Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Aiqin Gu
- Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yiping Zhang
- Department of Chemotherapy, Zhejiang Cancer Hospital, Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Hangzhou, China
| | - Shun Chang Jiao
- General Hospital of People's Liberation Army, Beijing, China
| | - Chang-Li Wang
- Department of Lung Cancer, Cancer Institute and Hospital, Tianjin Medical University, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Jintao He
- Sichuan Cancer Hospital and Institute, Chengdu, China
| | - Xueke Jia
- Baoding Hengxing Medicine Integrative Hospital, Baoding, China
| | - Li Zhang
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Jiewen Peng
- Department of Medical Oncology, Zhongshan City Pepole's Hospital, Zhongshan, China
| | - Meina Wu
- Department of Thoracic Medical Oncology Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, China
| | - Kejing Ying
- Zhejiang Sir Run Run Shaw Hospital, Department of Medicine, Zhejiang University, Hangzhou, China
| | - Junye Wang
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Kewei Ma
- Cancer Center of the First Hospital of Jilin University, Changchun, China
| | - Shucai Zhang
- Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Changxuan You
- Department of Medical Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fenlai Tan
- Betta Pharmaceuticals Co., Ltd, Hangzhou, China
| | | | | | - Yan Sun
- Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China.
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Camm AJ, Amarenco P, Haas S, Hess S, Kirchhof P, van Eickels M, Turpie AGG. XANTUS: rationale and design of a noninterventional study of rivaroxaban for the prevention of stroke in patients with atrial fibrillation. Vasc Health Risk Manag 2014; 10:425-34. [PMID: 25083135 PMCID: PMC4108256 DOI: 10.2147/vhrm.s63298] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 11/23/2022] Open
Abstract
Atrial fibrillation (AF) is associated with a fivefold increase in the risk of stroke. The Phase III ROCKET AF (Rivaroxaban Once-Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) trial showed that rivaroxaban, an oral, direct Factor Xa inhibitor, was noninferior to warfarin for the reduction of stroke or systemic embolism in patients with AF. Compared with warfarin, rivaroxaban significantly reduced rates of intracranial and fatal hemorrhages, although not rates of bleeding overall. XANTUS (Xarelto(®) for Prevention of Stroke in Patients with Atrial Fibrillation) is a prospective, international, observational, postauthorization, noninterventional study designed to collect safety and efficacy data on the use of rivaroxaban for stroke prevention in AF in routine clinical practice. The key goal is to determine whether the safety profile of rivaroxaban established in ROCKET AF is also observed in routine clinical practice. XANTUS is designed as a single-arm cohort study to minimize selection bias, and will enroll approximately 6,000 patients (mostly from Europe) with nonvalvular AF prescribed rivaroxaban, irrespective of their level of stroke risk. Overall duration of follow-up will be 1 year; the first patient was enrolled in June 2012. Similar studies (XANTUS-EL [Xarelto(®) for Prevention of Stroke in Patients with Nonvalvular Atrial Fibrillation, Eastern Europe, Middle East, Africa and Latin America] and XANAP [Xarelto(®) for Prevention of Stroke in Patients with Atrial Fibrillation in Asia-Pacific]) are ongoing in Latin America and Asia-Pacific. Data from these studies will supplement those from ROCKET AF and provide practical information concerning the use of rivaroxaban for stroke prevention in AF.
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Affiliation(s)
- A John Camm
- Division of Clinical Sciences, St George's, University of London, London, UK
| | - Pierre Amarenco
- Department of Neurology and Stroke Center, Paris-Diderot-Sorbonne University, Paris, France
| | | | - Susanne Hess
- Medical Affairs, Bayer HealthCare Pharmaceuticals, Berlin, Germany
| | - Paulus Kirchhof
- Centre for Cardiovascular Sciences, University of Birmingham and Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK ; Department of Cardiovascular Medicine, University of Münster, Münster, Germany
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Abstract
In the current modern and global society, social changes are in constant evolution due to scientific progress (technology, culture, customs, and hygiene) and produce the freedom in individuals to take decisions by themselves or with their doctors toward drug consumption. In the arena of marketed drug products which includes society, individual, administration, and pharmaceutical industry, the young discipline emerged is social pharmacology or sociopharmacology. This science arises from clinical pharmacology, and deals with different parameters, which are important in creating knowledge on marketed drugs. However, the scope of "social pharmacology" is not covered by the so-called "Phase IV" alone, but it is the science that handles the postmarketing knowledge of drugs. The social pharmacology studies the "life cycle" of any marketed pharmaceutical product in the social terrain, and evaluates the effects of the real environment under circumstances totally different in the drug development process. Therefore, there are far-reaching horizons, plural, and shared predictions among health professionals and other, for beneficial use of a drug, toward maximizing the benefits of therapy, while minimizing negative social consequences.
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Affiliation(s)
- Rituparna Maiti
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - José Luis Alloza
- Department of Biomedical Sciences, School of Medicine and Health Sciences, The University of Alcalá, E 28771 Alcalá de Henares, Madrid, Spain
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Lee MS, Ahn YM, Chung S, Walton R, Raskin J, Kim MS. The effect of initial duloxetine dosing strategy on nausea in korean patients with major depressive disorder. Psychiatry Investig 2012; 9:391-9. [PMID: 23251205 PMCID: PMC3521117 DOI: 10.4306/pi.2012.9.4.391] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 04/20/2012] [Accepted: 07/17/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the relative severity of nausea in patients from Korea with major depressive disorder (MDD) who were treated with duloxetine at low (30 mg) or high (60 mg) doses, with or without food, for the first week of an 8 week treatment. METHODS Adult patients (n=249), with MDD and a 17-item Hamilton Rating Scale for Depression (HAMD(17)) score of ≥15, received open-label once daily duloxetine. At Week 0, patients were randomized to 4 groups: 30 mg with food (n=63), 60 mg with food (n=59), 30 mg without food (n=64), and 60 mg without food (n=63). At Week 1, all patients switched to duloxetine 60 mg for 7 weeks. The primary outcome measure was item 112 (nausea) of the Association for Methodology and Documentation in Psychiatry adverse event scale. Effectiveness was assessed by change in HAMD(17) total score. RESULTS Overall, 94.4% (235/249) of patients completed Week 1 and 55.0% (137/249) of patients completed the study. For Week 1, nausea was significantly less severe for patients who received 30 mg compared with 60 mg duloxetine (p=0.003), regardless of food intake. In all groups, nausea severity was highest at Week 1 and declined throughout the study. HAMD(17) score was reduced in all groups and the most common adverse event reported was nausea (145/249; 58.2%). CONCLUSION To minimize nausea, Korean patients with MDD who require duloxetine treatment could be given 30 mg once daily, regardless of food, for the first week followed by 60 mg once daily for the course of therapy.
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Affiliation(s)
- Min-Soo Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yong Min Ahn
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seockhoon Chung
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Richard Walton
- Asia-Pacific Neuroscience, Eli Lilly Pty Ltd, Sydney, Australia
| | - Joel Raskin
- Lilly Research Laboratories, Eli Lilly Canada, Toronto, Canada
| | - Mun Sung Kim
- Neuroscience Medical, Quality and Regulatory Affairs, Eli Lilly Korea Ltd, Seoul, Republic of Korea
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Bönner G, Landers B, Bramlage P. Candesartan cilexetil/hydrochlorothiazide combination treatment versus high-dose candesartan cilexetil monotherapy in patients with mild to moderate cardiovascular risk (CHILI Triple T). Vasc Health Risk Manag 2011; 7:85-95. [PMID: 21415922 PMCID: PMC3049544 DOI: 10.2147/vhrm.s17004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Candesartan cilexetil has been shown to effectively reduce blood pressure and cardiovascular risk. Whether it is advantageous to combine candesartan cilexetil with low-dose hydrochlorothiazide (HCTZ) or uptitrate it in cases of insufficient blood pressure control has not been fully investigated under routine clinical conditions. METHODS CHILI Triple T is a prospective, noninterventional, observational study. Patients with uncontrolled hypertension and added cardiovascular risk received a fixed-dose combination of candesartan cilexetil 16 mg and HCTZ 12.5 mg (combination therapy group) or high-dose monotherapy with candesartan cilexetil 32 mg (high-dose monotherapy group). RESULTS A total of 4600 patients with a mean age of 63.1 ± 11.0 years, of which 44.7% were female, was included. The combination therapy group had 3337 patients, and the high-dose monotherapy group 1263 patients. Patients in both treatment groups were comparable with respect to age and gender, but patients receiving high-dose monotherapy had a slightly higher mean systolic blood pressure, more prior revascularizations, renal insufficiency, diabetic nephropathy, peripheral artery disease, and a lower ankle brachial index. The use of combination therapy resulted in a blood pressure reduction of -28.5 ± 13.8/-14.2 ± 9.4 mm Hg (P < 0.001 vs 160.2 ± 13.3/94.5 ± 8.2 mm Hg at baseline). The use of high-dose monotherapy reduced blood pressure by -29.73 ± 15.3/-14.1 ± 9.6 mm Hg (P < 0.001 vs 162.4 ± 14.7/94.7 ± 8.7 mm Hg at baseline). Differences in subgroups of patients defined by age, gender, body mass index, dyslipidemia, waist circumference, smoking, prior cardiovascular event, glomerular filtration rate, and microalbuminuria were minor, although partially significant. Tolerability was excellent, with only 28 out of 3358 patients (0.8%) in the combination therapy group and 15 out of 1273 patients (1.2%) in the high-dose monotherapy group experiencing any adverse event, of which one in each group was considered to be serious (<0.1%). CONCLUSIONS Both the fixed-dose combination of candesartan cilexetil 16 mg and HCTZ 12.5 mg and high-dose monotherapy with candesartan 32 mg were highly effective in lowering blood pressure in patients at increased cardiovascular risk. Tolerability was excellent. The choice of either strategy therefore largely depends on the principal aim: blood pressure reduction with pronounced volume restriction or pronounced additional end-organ protection.
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