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Mulinari-Santos G, dos Santos JS, Kitagawa IL, de Souza Batista FR, Botacin PR, Antoniali C, Lisboa-Filho PN, Okamoto R. Estrogen Deficiency Impairs Osseointegration in Hypertensive Rats Even Treated with Alendronate Coated on the Implant Surface. J Funct Biomater 2023; 14:471. [PMID: 37754885 PMCID: PMC10532300 DOI: 10.3390/jfb14090471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/03/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023] Open
Abstract
Hypertension and estrogen deficiency can affect bone metabolism and therefore increase the risk of osseointegration. Antihypertensive drugs such as losartan not only control blood pressure but also enhance bone healing. In addition, alendronate sodium is widely used to treat postmenopausal osteoporosis. Hence, we evaluated the effect of systemic antihypertensive and local alendronate coted on implants on osseointegration under hypertensive and estrogen-deficiency conditions. A total of 64 spontaneously hypertensive rats (SHRs) treated with losartan were randomly divided according to the estrogen-deficiency induction by ovariectomy (OVX) or not (SHAM), and whether the implant surface was coated with sodium alendronate (ALE) or not, resulting in four groups: SHR SHAM, SHR SHAM ALE, SHR OVX, and SHR OVX ALE. The removal torque, microcomputed tomography, and epifluorescence microscopy were the adopted analyses. The hypertensive and estrogen-deficiency animals presented a lower removal torque even when treated with alendronate on implant surface. The microcomputed tomography revealed a higher bone volume and bone-to-implant contact in the SHRs than the SHR OVX rats. Epifluorescence showed a decreased mineral apposition ratio in the SHR OVX ALE group. The data presented indicate that estrogen deficiency impairs osseointegration in hypertensive rats; in addition, alendronate coated on the implant surface does not fully reverse this impaired condition caused by estrogen deficiency.
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Affiliation(s)
- Gabriel Mulinari-Santos
- Department of Diagnostic and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba, SP, Brazil
| | - Jaqueline Silva dos Santos
- Department of Basic Science, School of Dentistry, São Paulo State University (UNESP), Araçatuba, SP, Brazil
| | - Igor Lebedenco Kitagawa
- Federal Institute of Education, Science and Technology of São Paulo (IFSP), Birigui, SP, Brazil
| | | | - Paulo Roberto Botacin
- Department of Basic Science, School of Dentistry, São Paulo State University (UNESP), Araçatuba, SP, Brazil
| | - Cristina Antoniali
- Department of Basic Science, School of Dentistry, São Paulo State University (UNESP), Araçatuba, SP, Brazil
| | | | - Roberta Okamoto
- Department of Basic Science, School of Dentistry, São Paulo State University (UNESP), Araçatuba, SP, Brazil
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Franklin JM, Liaw KL, Iyasu S, Critchlow CW, Dreyer NA. Real-world evidence to support regulatory decision making: New or expanded medical product indications. Pharmacoepidemiol Drug Saf 2021; 30:685-693. [PMID: 33675248 DOI: 10.1002/pds.5222] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 12/28/2022]
Abstract
There is increasing interest in utilizing real-world data (RWD) to produce real-world evidence (RWE) on the benefits and risks of medical products that could support regulatory approval decisions. The field of pharmacoepidemiology has a long history of focusing on data and evidence that would now be termed "real-world," including evidence from healthcare claims, registries, and electronic health records. However, several emerging trends over the past decade are converging to support the use of these and other RWD sources for approval decisions, and there are several recent examples and ongoing research that demonstrate how RWE may be used to support regulatory approval of new or expanded indications. The goal of this article is to review the current landscape and future directions of the use of RWE in this context. This manuscript is endorsed by the International Society for Pharmacoepidemiology (ISPE).
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Affiliation(s)
- Jessica M Franklin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kai-Li Liaw
- Center for Observational and Real-world Evidence, Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Solomon Iyasu
- Center for Observational and Real-world Evidence, Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Cathy W Critchlow
- Research & Development Strategy and Operations, Amgen, Thousand Oaks, California, USA
| | - Nancy A Dreyer
- Real World Solutions, IQVIA, Cambridge, Massachusetts, USA
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Comparative safety and effectiveness of alendronate versus raloxifene in women with osteoporosis. Sci Rep 2020; 10:11115. [PMID: 32632237 PMCID: PMC7338498 DOI: 10.1038/s41598-020-68037-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 06/16/2020] [Indexed: 12/14/2022] Open
Abstract
Alendronate and raloxifene are among the most popular anti-osteoporosis medications. However, there is a lack of head-to-head comparative effectiveness studies comparing the two treatments. We conducted a retrospective large-scale multicenter study encompassing over 300 million patients across nine databases encoded in the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). The primary outcome was the incidence of osteoporotic hip fracture, while secondary outcomes were vertebral fracture, atypical femoral fracture (AFF), osteonecrosis of the jaw (ONJ), and esophageal cancer. We used propensity score trimming and stratification based on an expansive propensity score model with all pre-treatment patient characteritistcs. We accounted for unmeasured confounding using negative control outcomes to estimate and adjust for residual systematic bias in each data source. We identified 283,586 alendronate patients and 40,463 raloxifene patients. There were 7.48 hip fracture, 8.18 vertebral fracture, 1.14 AFF, 0.21 esophageal cancer and 0.09 ONJ events per 1,000 person-years in the alendronate cohort and 6.62, 7.36, 0.69, 0.22 and 0.06 events per 1,000 person-years, respectively, in the raloxifene cohort. Alendronate and raloxifene have a similar hip fracture risk (hazard ratio [HR] 1.03, 95% confidence interval [CI] 0.94–1.13), but alendronate users are more likely to have vertebral fractures (HR 1.07, 95% CI 1.01–1.14). Alendronate has higher risk for AFF (HR 1.51, 95% CI 1.23–1.84) but similar risk for esophageal cancer (HR 0.95, 95% CI 0.53–1.70), and ONJ (HR 1.62, 95% CI 0.78–3.34). We demonstrated substantial control of measured confounding by propensity score adjustment, and minimal residual systematic bias through negative control experiments, lending credibility to our effect estimates. Raloxifene is as effective as alendronate and may remain an option in the prevention of osteoporotic fracture.
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Saka N, Nomura K, Amano H, Fujimoto K, Watanabe Y, Kawano H, Tanihara S. Coding and prescription rates of osteoporosis are low among distal radius fracture patients in Japan. J Bone Miner Metab 2020; 38:363-370. [PMID: 31792609 DOI: 10.1007/s00774-019-01067-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION This study aimed to clarify the coding and prescription rates for osteoporosis in distal radius fracture patients and to investigate the associated factors to help prevent subsequent osteoporotic fracture. MATERIALS AND METHODS Between 2014-2015, among 294,374 eligible individuals (42% female) aged 50-75 years in a health insurance claims database, we identified 192 individuals (mean age: 59.8 years, 74% female), counted the coding of distal radius fracture (International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) code: S525, S526), and determined if the patient had been assigned the code for osteoporosis and been prescribed osteoporosis medications. Logistic regression was performed to identify factors related to each rate. RESULTS The osteoporosis coding rate and osteoporosis medication prescription rate were 17.2% (n = 33) and 10.9% (n = 21), respectively. Most codes were assigned ≤ 3 months after injury (88%) at the distal radius fracture treatment facilities (84.8%). Patients who were assigned the code for osteoporosis or treated with osteoporosis medications were older (p = 0.08, p = 0.02, respectively), female (p = 0.05, p = 0.06, respectively) and having comorbidity (p = 0.02, p = 0.07, respectively). After adjustment, being female and having comorbidity remained the independent factors for the assignment of the code for osteoporosis (OR: 3.30, 95%, CI: 1.08-10.07, OR: 2.77, 95% CI: 1.24-6.12, respectively). No factor remained significant for the osteoporosis prescription. Active vitamin D analogues were most frequently prescribed medication (67%) followed by bisphosphonates (48%). CONCLUSION The overall coding and prescription rates for osteoporosis after distal radius fracture were low, which suggested that physician adherence to the osteoporosis guideline was low.
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Affiliation(s)
- Natsumi Saka
- Department of Orthopaedics, Teikyo University School of Medicine, 1-2-11, Kaga, Itabashi, Tokyo, Japan
| | - Kyoko Nomura
- Department of Public Health, Akita University School of Medicine, 1-1 Tegatagakuenmachi, Akita, 010-8502, Japan
- Graduate School of Public Health, Teikyo University, 1-2-11, Kaga, Itabashi, Tokyo, Japan
| | - Hoichi Amano
- Graduate School of Public Health, Teikyo University, 1-2-11, Kaga, Itabashi, Tokyo, Japan
- Department of Social and Behavioral Sciences, Harvard. T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Kenichi Fujimoto
- Graduate School of Public Health, Teikyo University, 1-2-11, Kaga, Itabashi, Tokyo, Japan
| | - Yoshinobu Watanabe
- Department of Orthopaedics, Teikyo University School of Medicine, 1-2-11, Kaga, Itabashi, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedics, Teikyo University School of Medicine, 1-2-11, Kaga, Itabashi, Tokyo, Japan
| | - Shinichi Tanihara
- Graduate School of Public Health, Teikyo University, 1-2-11, Kaga, Itabashi, Tokyo, Japan.
- Department of Public Health, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan.
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Li B, Wu P, Fu W, Xiong Y, Zhang L, Gao Y, Deng G, Zong S, Zeng G. The Role and Mechanism of miRNA-1224 in the Polygonatum sibiricum Polysaccharide Regulation of Bone Marrow-Derived Macrophages to Osteoclast Differentiation. Rejuvenation Res 2019; 22:420-430. [DOI: 10.1089/rej.2018.2126] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Bo Li
- Department of Nutrition and Food Hygiene, College of Public Hygiene of Guangxi Medical University, Nanning, Guangxi, China
| | - Pingping Wu
- Department of Nutrition and Food Hygiene, College of Public Hygiene of Guangxi Medical University, Nanning, Guangxi, China
| | - Wenwen Fu
- Department of Nutrition and Food Hygiene, College of Public Hygiene of Guangxi Medical University, Nanning, Guangxi, China
| | - Yin Xiong
- Department of Nutrition and Food Hygiene, College of Public Hygiene of Guangxi Medical University, Nanning, Guangxi, China
| | - Lei Zhang
- Department of Nutrition and Food Hygiene, College of Public Hygiene of Guangxi Medical University, Nanning, Guangxi, China
| | - Yunbing Gao
- Department of Osteopathia, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, Guangxi, China
| | - GuiYing Deng
- Department of Osteopathia, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, Guangxi, China
| | - Shaohui Zong
- Department of Osteopathia, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, Guangxi, China
- Research Centre for Regenerative Medicine and Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Gaofeng Zeng
- Department of Nutrition and Food Hygiene, College of Public Hygiene of Guangxi Medical University, Nanning, Guangxi, China
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Khosla S, White R, Medina J, Ouwens M, Emmas C, Koder T, Male G, Leonard S. Real world evidence (RWE) - a disruptive innovation or the quiet evolution of medical evidence generation? F1000Res 2018; 7:111. [PMID: 30026923 PMCID: PMC6039945 DOI: 10.12688/f1000research.13585.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2018] [Indexed: 11/08/2023] Open
Abstract
Stakeholders in healthcare are increasingly turning to real world evidence (RWE) to inform their decisions, alongside evidence from randomized controlled trials. RWE is generated by analysing data gathered from routine clinical practice, and can be used across the product lifecycle, providing insights into areas including disease epidemiology, treatment effectiveness and safety, and health economic value and impact. Recently, the US Food and Drug Administration and the European Medicines Agency have stated their ambition for greater use of RWE to support applications for new indications, and are now consulting with their stakeholders to formalize standards and expected methods for generating RWE. Pharmaceutical companies are responding to the increasing demands for RWE by developing standards and processes for each stage of the evidence generation pathway. Some conventions are already in place for assuring quality, whereas other processes are specific to the research question and data sources available. As evidence generation increasingly becomes a core role of medical affairs divisions in large pharmaceutical companies, standards of rigour will continue to evolve and improve. Senior pharmaceutical leaders can drive this change by making RWE a core element of their corporate strategy, providing top-level direction on how their respective companies should approach RWE for maximum quality. Here, we describe the current and future areas of RWE application within the pharmaceutical industry, necessary access to data to generate RWE, and the challenges in communicating RWE. Supporting and building on viewpoints from industry and publicly funded research, our perspective is that at each stage of RWE generation, quality will be critical to the impact that RWE has on healthcare decision-makers; not only where RWE is an established and evolving tool, but also in new areas that have the potential to disrupt and to improve drug development pathways.
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Affiliation(s)
- Sajan Khosla
- AstraZeneca Academy House, Cambridge, CB2 1PG, UK
| | | | | | | | | | - Tim Koder
- Oxford PharmaGenesis, Tubney Warren Barn, Tubney, Abingdon, OX13 5QJ, UK
| | - Gary Male
- Oxford PharmaGenesis, Tubney Warren Barn, Tubney, Abingdon, OX13 5QJ, UK
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Khosla S, White R, Medina J, Ouwens M, Emmas C, Koder T, Male G, Leonard S. Real world evidence (RWE) - a disruptive innovation or the quiet evolution of medical evidence generation? F1000Res 2018; 7:111. [PMID: 30026923 PMCID: PMC6039945 DOI: 10.12688/f1000research.13585.2] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2018] [Indexed: 12/12/2022] Open
Abstract
Stakeholders in healthcare are increasingly turning to real world evidence (RWE) to inform their decisions, alongside evidence from randomized controlled trials. RWE is generated by analysing data gathered from routine clinical practice, and can be used across the product lifecycle, providing insights into areas including disease epidemiology, treatment effectiveness and safety, and health economic value and impact. Recently, the US Food and Drug Administration and the European Medicines Agency have stated their ambition for greater use of RWE to support applications for new indications, and are now consulting with their stakeholders to formalize standards and expected methods for generating RWE. Pharmaceutical companies are responding to the increasing demands for RWE by developing standards and processes for each stage of the evidence generation pathway. Some conventions are already in place for assuring quality, whereas other processes are specific to the research question and data sources available. As evidence generation increasingly becomes a core role of medical affairs divisions in large pharmaceutical companies, standards of rigour will continue to evolve and improve. Senior pharmaceutical leaders can drive this change by making RWE a core element of their corporate strategy, providing top-level direction on how their respective companies should approach RWE for maximum quality. Here, we describe the current and future areas of RWE application within the pharmaceutical industry, necessary access to data to generate RWE, and the challenges in communicating RWE. Supporting and building on viewpoints from industry and publicly funded research, our perspective is that at each stage of RWE generation, quality will be critical to the impact that RWE has on healthcare decision-makers; not only where RWE is an established and evolving tool, but also in new areas that have the potential to disrupt and to improve drug development pathways.
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Affiliation(s)
- Sajan Khosla
- AstraZeneca Academy House, Cambridge, CB2 1PG, UK
| | | | | | | | | | - Tim Koder
- Oxford PharmaGenesis, Tubney Warren Barn, Tubney, Abingdon, OX13 5QJ, UK
| | - Gary Male
- Oxford PharmaGenesis, Tubney Warren Barn, Tubney, Abingdon, OX13 5QJ, UK
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Raloxifene but not alendronate can compensate the impaired osseointegration in osteoporotic rats. Clin Oral Investig 2017; 22:255-265. [DOI: 10.1007/s00784-017-2106-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 03/16/2017] [Indexed: 10/19/2022]
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