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Dobra R, Davies J, Elborn S, Kee F, Madge S, Boeri M. A discrete choice experiment to quantify the influence of trial features on the decision to participate in cystic fibrosis trials. J Cyst Fibros 2024; 23:73-79. [PMID: 38042750 DOI: 10.1016/j.jcf.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/20/2023] [Accepted: 04/09/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Patient-centred trial design optimises recruitment and retention, reduces trial failure rates and increases the diversity of trial cohorts. This allows safe and effective treatments to reach clinic more quickly. To achieve this, patients' views must be incorporated into trial design. METHODS A discrete choice experiment was used to quantify preferences of pwCF for trials features; medicine type, trial location, stipend, washout, drug access on trial completion and trial design. Respondents were presented pairs of hypothetical trial scenarios with different level combinations assigned through experimental design. Respondents were asked to pick their preferred option or decline both. The cross-sectional data were explored using a Random Parameters Logit model. RESULTS We received 207 eligible responses between Oct2020-Jan2021. The strongest influence on the decision to participate was trial location; pwCF favour participation at their usual clinical centre. Greater travel distances made respondents less willing to participate. Post-trial drug access ranked second. pwCF would rather participate in modulator trials than trials of other drugs. In general, pwCF did not favour a washout period, but were more prepared to washout non-modulators than modulators. Stipend provision was not ranked highly, but higher stipends increased intention to participate. Trial design (placebo vs open-label) had minimal influence on the decision to participate. There are complex interactions between placebos and washouts. CONCLUSIONS We used quantitative methods to systematically elicit preferences of pwCF for clinical trials' features. We explore the relevance of our findings to trial design and delivery in the current CF trials landscape.
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Affiliation(s)
- Rebecca Dobra
- National Heart and Lung Institute, Imperial College London, UK; Department of Paediatrics, Royal Brompton Hospital, London, UK.
| | - Jane Davies
- National Heart and Lung Institute, Imperial College London, UK; Department of Paediatrics, Royal Brompton Hospital, London, UK
| | - Stuart Elborn
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Frank Kee
- Centre for Public Health, Queen's University, Belfast, UK
| | - Susan Madge
- Department of Adult Cystic Fibrosis, Royal Brompton Hospital, London, UK
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2
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Raidt J, Maitre B, Pennekamp P, Altenburg J, Anagnostopoulou P, Armengot M, Bloemsma LD, Boon M, Borrelli M, Brinkmann F, Carr SB, Carroll MP, Castillo-Corullón S, Coste A, Cutrera R, Dehlink E, Destouches DMS, Di Cicco ME, Dixon L, Emiralioglu N, Erdem Eralp E, Haarman EG, Hogg C, Karadag B, Kobbernagel HE, Lorent N, Mall MA, Marthin JK, Martinu V, Narayanan M, Ozcelik U, Peckham D, Pifferi M, Pohunek P, Polverino E, Range S, Ringshausen FC, Robson E, Roehmel J, Rovira-Amigo S, Santamaria F, Schlegtendal A, Szépfalusi Z, Tempels P, Thouvenin G, Ullmann N, Walker WT, Wetzke M, Yiallouros P, Omran H, Nielsen KG. The disease-specific clinical trial network for Primary Ciliary Dyskinesia (PCD-CTN). ERJ Open Res 2022; 8:00139-2022. [PMID: 35983540 PMCID: PMC9379353 DOI: 10.1183/23120541.00139-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/12/2022] [Indexed: 11/12/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterised by impaired mucociliary clearance leading to irreversible lung damage. In contrast to other rare lung diseases like cystic fibrosis (CF), there are only few clinical trials and limited evidence-based treatments. Management is mainly based on expert opinions and treatment is challenging due to a wide range of clinical manifestations and disease severity. To improve clinical and translational research and facilitate development of new treatments, the clinical trial network for PCD (PCD-CTN) was founded in 2020 under the framework of the European Reference Network (ERN)-LUNG PCD Core. Applications from European PCD sites interested in participating in the PCD-CTN were requested. Inclusion criteria consisted of patient numbers, membership of ERN-LUNG PCD Core, use of associated standards of care, experience in PCD and/or CF clinical research, resources to run clinical trials, good clinical practice (GCP) certifications and institutional support. So far, applications from 22 trial sites in 18 European countries have been approved, including >1400 adult and >1600 paediatric individuals with PCD. The PCD-CTN is headed by a coordinating centre and consists of a steering and executive committee, a data safety monitoring board and committees for protocol review, training and standardisation. A strong association with patient organisations and industrial companies are further cornerstones. All participating trial sites agreed on a code of conduct. As CTNs from other diseases have demonstrated successfully, this newly formed PCD-CTN operates to establish evidence-based treatments for this orphan disease and to bring new personalised treatment approaches to patients. The disease-specific clinical trial network for primary ciliary dyskinesia (PCD-CTN) was built under the framework of the European Reference Network (ERN)-LUNG PCD Core, and operates to establish evidence-based and new personalised treatment for PCDhttps://bit.ly/3sLtC8o
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3
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Ratjen F, VanDevanter DR. Retracing changes in cystic fibrosis understanding and management over the past twenty years. J Cyst Fibros 2021; 21:3-9. [PMID: 34602342 DOI: 10.1016/j.jcf.2021.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Felix Ratjen
- Division of Respiratory Medicine, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Canada
| | - Donald R VanDevanter
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH USA.
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4
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Alton EWFW, Boyd AC, Davies JC, Gill DR, Griesenbach U, Harman TE, Hyde S, McLachlan G. Gene Therapy for Respiratory Diseases: Progress and a Changing Context. Hum Gene Ther 2020; 31:911-916. [PMID: 32746737 DOI: 10.1089/hum.2020.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Eric W F W Alton
- Gene Therapy Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom.,UK CF Gene Therapy Consortium, London, United Kingdom
| | - A Christopher Boyd
- UK CF Gene Therapy Consortium, London, United Kingdom.,Centre for Genomic and Experimental Medicine, IGMM, University of Edinburgh, Edinburgh, United Kingdom
| | - Jane C Davies
- Gene Therapy Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom.,UK CF Gene Therapy Consortium, London, United Kingdom
| | - Deborah R Gill
- UK CF Gene Therapy Consortium, London, United Kingdom.,Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Uta Griesenbach
- Gene Therapy Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom.,UK CF Gene Therapy Consortium, London, United Kingdom
| | - Tracy E Harman
- Gene Therapy Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom.,UK CF Gene Therapy Consortium, London, United Kingdom
| | - Stephen Hyde
- UK CF Gene Therapy Consortium, London, United Kingdom.,Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Gerry McLachlan
- UK CF Gene Therapy Consortium, London, United Kingdom.,The Roslin Institute & R(D)SVS, Easter Bush Campus, University of Edinburgh, Edinburgh, United Kingdom
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Bell SC, Mall MA, Gutierrez H, Macek M, Madge S, Davies JC, Burgel PR, Tullis E, Castaños C, Castellani C, Byrnes CA, Cathcart F, Chotirmall SH, Cosgriff R, Eichler I, Fajac I, Goss CH, Drevinek P, Farrell PM, Gravelle AM, Havermans T, Mayer-Hamblett N, Kashirskaya N, Kerem E, Mathew JL, McKone EF, Naehrlich L, Nasr SZ, Oates GR, O'Neill C, Pypops U, Raraigh KS, Rowe SM, Southern KW, Sivam S, Stephenson AL, Zampoli M, Ratjen F. The future of cystic fibrosis care: a global perspective. THE LANCET RESPIRATORY MEDICINE 2020; 8:65-124. [DOI: 10.1016/s2213-2600(19)30337-6] [Citation(s) in RCA: 351] [Impact Index Per Article: 87.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/19/2019] [Accepted: 08/14/2019] [Indexed: 02/06/2023]
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Dobra R, Madge S, Martin I, Weldon P, Simmonds N, Davies JC. "Fortunate are those who take the first steps"? The psychosocial impact of novel drug development. Paediatr Respir Rev 2019; 31:9-11. [PMID: 30975518 DOI: 10.1016/j.prrv.2019.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 11/27/2022]
Abstract
Novel drug development offers people with cystic fibrosis exciting opportunities but is not without challenges. Currently, there is an understandable emphasis on protecting patients' physical health when developing treatments. However, there appears to be little consideration of how novel drug development impacts on psychosocial wellbeing, or the downstream consequences of this. Using an illustrative case and reviewing the literature we explore themes regarding the psychosocial impact of trial participation and novel drug development and identify areas requiring further research. Through this, we hope to prepare healthcare professionals to better understand the needs of their patients in this rapidly evolving landscape.
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Affiliation(s)
- Rebecca Dobra
- Department of Cystic Fibrosis, Royal Brompton Hospital, London, UK; Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College, London, UK.
| | - Susan Madge
- Department of Cystic Fibrosis, Royal Brompton Hospital, London, UK
| | - Isaac Martin
- National Heart and Lung Institute, Imperial College, London, UK
| | - Paul Weldon
- Department of Psychological Medicine, Royal Brompton Hospital, London, UK
| | - Nicholas Simmonds
- Department of Cystic Fibrosis, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Jane C Davies
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College, London, UK
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7
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Martinez-Millana A, Zettl A, Floch J, Calvo-Lerma J, Sevillano JL, Ribes-Koninckx C, Traver V. The Potential of Self-Management mHealth for Pediatric Cystic Fibrosis: Mixed-Methods Study for Health Care and App Assessment. JMIR Mhealth Uhealth 2019; 7:e13362. [PMID: 30998222 PMCID: PMC6495294 DOI: 10.2196/13362] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/05/2019] [Accepted: 03/29/2019] [Indexed: 12/23/2022] Open
Abstract
Background Remote care services and patient empowerment have boosted mobile health (mHealth). A study of user needs related to mHealth for pediatric cystic fibrosis (PCF) identified the set of preferred features mobile apps should support; however, the potential use of PCF apps and their suitability to fit into PCF clinical management remains unexplored. Objective We examine whether PCF holds potential for the implementation of mHealth care. Methods The study is based on a literature review and qualitative analysis of content and was conducted in two parts: (1) we reviewed scientific and gray literature to explore how European countries manage PCF and conducted a qualitative study of 6 PCF units and (2) we performed a systematic review of apps available in the myhealthapps.net repository searching for cystic fibrosis (CF) management and nutrition apps, which we analyzed for characteristics, business models, number of downloads, and usability. Results European CF routine care guidelines are acknowledged in most European countries, and treatments are fully covered in almost all countries. The majority of teams in CF units are interdisciplinary. With respect to the systematic review of apps, we reviewed 12 apps for CF management and 9 for general nutrition management in the myhealthapps.net directory. All analyzed apps provided functionalities for recording aspects related to the disease and nutrition such as medication, meals, measurements, reminders, and educational material. None of the apps reviewed in this study supported pancreatic enzyme replacement therapy. CF apps proved to be less appealing and usable than nutrition apps (2.66 [SD 1.15] vs 4.01 [SD 0.90]; P<.001, z-value: –2.6). User needs detected in previous research are partially matched by current apps for CF management. Conclusions The health care context for PCF is a unique opportunity for the adoption of mHealth. Well-established clinical guidelines, heterogeneous clinical teams, and coverage by national health care systems provide a suitable scenario for the use of mHealth solutions. However, available apps for CF self-management do not cover essential aspects such as nutrition and education. To increase the adoption of mHealth for CF self-management, new apps should include these features. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2016-014931
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Affiliation(s)
- Antonio Martinez-Millana
- Instituto ITACA, Universitat Politècnica de València, Valencia, Spain.,Unidad Mixta de Reingeniería de Procesos Sociosanitarios, Instituto de Investigación Sanitaria del Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | | | | | | | - Jose Luis Sevillano
- Department of Architecture and Technology of Computers, University of Seville, Seville, Spain
| | | | - Vicente Traver
- Instituto ITACA, Universitat Politècnica de València, Valencia, Spain.,Unidad Mixta de Reingeniería de Procesos Sociosanitarios, Instituto de Investigación Sanitaria del Hospital Universitario y Politecnico La Fe, Valencia, Spain
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8
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Gipson DS, Selewski DT, Massengill SF, Modes MM, Desmond H, Lee L, Kamil E, Elliott MR, Adler SG, Oh G, Lafayette RA, Gipson PE, Sinha A, Bagga A, Pesenson A, Courtlandt C, Spino C, Eikstadt R, Pitter R, Attalla S, Waldo A, Winneker R, Carlozzi NE, Troost JP, Smokler I, Stone M. NephCure Accelerating Cures Institute: A Multidisciplinary Consortium to Improve Care for Nephrotic Syndrome. Kidney Int Rep 2017; 3:439-446. [PMID: 29725648 PMCID: PMC5932133 DOI: 10.1016/j.ekir.2017.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/14/2017] [Accepted: 11/21/2017] [Indexed: 01/08/2023] Open
Abstract
Introduction NephCure Accelerating Cures Institute (NACI) is a collaborative organization sponsored by NephCure Kidney International and the University of Michigan. The Institute is composed of 7 cores designed to improve treatment options and outcomes for patients with glomerular disease: Clinical Trials Network, Data Warehouse, Patient-Reported Outcomes (PRO) and Endpoints Consortium, Clinical Trials Consulting Team, Quality Initiatives, Education and Engagement, and Data Coordinating Center. Methods The Trials Network includes 22 community- and hospital-based nephrology practices, 14 of which are trial-only sites. Eight sites participate in the NACI Registry, and as of October 2017, 1054 patients are enrolled with diagnoses including but not limited to focal segmental glomerulosclerosis, minimal change disease, membranous nephropathy, IgA nephropathy, and childhood-onset nephrotic syndrome. By using electronic health record data extraction, robust and efficient clinical data are captured while minimizing the burden to site-based network staff. Results The Data Warehouse includes her-extracted data from registry patients, PRO development data, and data from completed observational studies and clinical trials. The Clinical Trial Consulting Team provides support for trial design in rare diseases leveraging these data. The PRO and Endpoints Consortium develops shorter-term endpoints while capturing the patient-reported significance of interventions under study. The Quality Initiatives and Education/Engagement cores elevate the level of care for patients. The Data Coordinating Center manages the analysis and operations of the Institute. Conclusion By engaging with patients, academia, industry, and patient advocate community representatives, including our Patient Advisory Board, NACI strives for better outcomes and treatments using evidence-based support for clinical trial design.
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Affiliation(s)
- Debbie S Gipson
- Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - David T Selewski
- Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan F Massengill
- Division of Pediatric Nephrology, Levine Children's Hospital, Charlotte, North Carolina, USA
| | | | - Hailey Desmond
- Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Lauren Lee
- NephCure Kidney International, King of Prussia, Pennsylvania, USA
| | - Elaine Kamil
- Division of Pediatric Nephrology, Department of Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at The University of California, Los Angeles, Los Angeles, California, USA
| | | | - Sharon G Adler
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, California, USA
| | - Gia Oh
- Division of Nephrology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Richard A Lafayette
- Division of Nephrology and Hypertension, Stanford University, Stanford, California, USA
| | - Patrick E Gipson
- Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | | | - Cheryl Courtlandt
- Division of Pediatric Nephrology, Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Cathie Spino
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard Eikstadt
- Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Renée Pitter
- Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Samara Attalla
- Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Anne Waldo
- Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard Winneker
- NephCure Kidney International, King of Prussia, Pennsylvania, USA
| | - Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan P Troost
- Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Irving Smokler
- NephCure Kidney International, King of Prussia, Pennsylvania, USA
| | - Mark Stone
- NephCure Kidney International, King of Prussia, Pennsylvania, USA
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Vahedi L, Jabarpoor-Bonyadi M, Ghojazadeh M, Vahedi A, Rafeey M. Gender Differences in Clinical Presentations of Cystic Fibrosis Patients in Azeri Turkish Population. Tuberc Respir Dis (Seoul) 2016; 79:267-273. [PMID: 27790278 PMCID: PMC5077730 DOI: 10.4046/trd.2016.79.4.267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/22/2015] [Accepted: 06/05/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cystic fibrosis (CF) is an autosomal recessive disorder with several clinical presentations. This study was undertaken in the Azeri Turkish population in Iran, to investigate gender differences in the age at onset and diagnosis, age of death, and duration of illness of CF. METHODS The data of 331 CF patients from 2001 to 2015 was surveyed. Parameters including age, sex, ΔF508 mutation, age at onset, age at diagnosis, age of death and clinical presentations were evaluated for both sexes, using descriptive analysis. The association of gender with these variables was studied using logistic regression, chi-square test and Mann-Whitney U test by SPSS version 18. Odds ratio with a confidence interval of 95% and p≤0.05 was considered statistically significant. RESULTS The study included 191 males (57.7%) and 140 females (42.3%), all showing statistically significant difference (p<0.001). Age duration differed between genders. Male and female patients were further under 9 and 4 years, respectively. The occurrence of ΔF508 mutation was 0.51 times more in females than in males. Age, diagnosis and sex were closely associated: males were diagnosed at a significantly later age than females (p=0.05). While this compression performed based on clinical presentations, males with respiratory disease had a later median age at diagnosis than females at lifespan (p=0.001). The risk of infertility in males was approximately two times greater than in females (p=0.02). CONCLUSION These findings indicate gender differences in CF patients. Future studies are needed to establish other differences and evaluate the causes for the gender variations.
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Affiliation(s)
- Leila Vahedi
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Jabarpoor-Bonyadi
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.; Department of Medical Genetic, Faculty of Natural Sciences, Center of Excellence for Biodiversity, University of Tabriz, Tabriz, Iran
| | - Morteza Ghojazadeh
- Department of Physiology, Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Vahedi
- Department of Pathology, Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mandana Rafeey
- Department of Pediatrics, Tabriz Children's Hospital, Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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10
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Lopes-Pacheco M. CFTR Modulators: Shedding Light on Precision Medicine for Cystic Fibrosis. Front Pharmacol 2016; 7:275. [PMID: 27656143 PMCID: PMC5011145 DOI: 10.3389/fphar.2016.00275] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/11/2016] [Indexed: 12/15/2022] Open
Abstract
Cystic fibrosis (CF) is the most common life-threatening monogenic disease afflicting Caucasian people. It affects the respiratory, gastrointestinal, glandular and reproductive systems. The major cause of morbidity and mortality in CF is the respiratory disorder caused by a vicious cycle of obstruction of the airways, inflammation and infection that leads to epithelial damage, tissue remodeling and end-stage lung disease. Over the past decades, life expectancy of CF patients has increased due to early diagnosis and improved treatments; however, these patients still present limited quality of life. Many attempts have been made to rescue CF transmembrane conductance regulator (CFTR) expression, function and stability, thereby overcoming the molecular basis of CF. Gene and protein variances caused by CFTR mutants lead to different CF phenotypes, which then require different treatments to quell the patients' debilitating symptoms. In order to seek better approaches to treat CF patients and maximize therapeutic effects, CFTR mutants have been stratified into six groups (although several of these mutations present pleiotropic defects). The research with CFTR modulators (read-through agents, correctors, potentiators, stabilizers and amplifiers) has achieved remarkable progress, and these drugs are translating into pharmaceuticals and personalized treatments for CF patients. This review summarizes the main molecular and clinical features of CF, emphasizes the latest clinical trials using CFTR modulators, sheds light on the molecular mechanisms underlying these new and emerging treatments, and discusses the major breakthroughs and challenges to treating all CF patients.
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Affiliation(s)
- Miquéias Lopes-Pacheco
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro Rio de Janeiro, Brazil
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11
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Vahedi L, Jabarpoor-Bonyadi M, Ghojazadeh M, Hazrati H, Rafeey M. Association Between Outcomes and Demographic Factors in an Azeri Turkish Population With Cystic Fibrosis: A Cross-Sectional Study in Iran From 2001 Through 2014. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e29615. [PMID: 27275400 PMCID: PMC4893412 DOI: 10.5812/ircmj.29615] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/08/2015] [Accepted: 07/02/2015] [Indexed: 12/03/2022]
Abstract
Background Outcomesforcystic fibrosis patients are improving rapidly. The demographic factors are notable variables inoutcomes, which can be evaluated and modified. Objectives This study was designed to investigate the association between outcome and demographic factors in patients with cystic fibrosis. Patients and Methods This was a cross-sectional study and data were gathered for 331 patients using the census method, from March 2001 to September 2014 in Iran. Data was analyzed using logistic regression analysis, chi-square test, and independent sample t test using SPSS 18. Odds ratio with confidence intervals of 95% and P < 0.05 were considered significant. Results There were 85 (25.7%) deceased patients and 246 (74.3%) living patients at the time of the study. Of the 246 living CF patients, 202 (82.2%) were less than nine years of age, and 77 (90.6%) out of the 85 deceased CF patients had died younger than four years of age. There was a significant difference between outcome and location of residence. The risk of mortality was 50% less in urban patients than in rural patients (P = 0.03). The risk of mortality was approximately two times higher in patients with a positive family history than in those with a negative family history (P = 0.02). The proportion of mortality was approximately two times, or 94%, higher for those in a consanguineous marriage than for those in a non-consanguineous marriage (P = 0.01). Conclusions The results demonstrated that the mortality rate was higher in CF patients with a positive family history, a consanguineous marriage, and residence in a rural area. Therefore, demographic factors play an important role in the outcome of cystic fibrosis. Unfortunately, these parameters, which can be managed easily and with low cost, have been overlooked.
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Affiliation(s)
- Leila Vahedi
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Morteza Jabarpoor-Bonyadi
- Faculty of Natural Sciences, Center of Excellence for Biodiversity, University of Tabriz, Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Morteza Ghojazadeh
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Hakimeh Hazrati
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Mandana Rafeey
- Tabriz Children’s Hospital, Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
- Corresponding Author: Mandana Rafeey, Tabriz Children’s Hospital, Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel: +98-9141146982, Fax: +41-33373741, E-mail:
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12
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Addy C, Downey DG, Elborn JS. Improvements in symptomatic treatment strategies for cystic fibrosis: delivering CF care in the 21st century. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2016.1107473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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13
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Affiliation(s)
- Scott C Bell
- QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; The Prince Charles Hospital, Brisbane, QLD, Australia.
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14
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Allegaert K, van den Anker J. Neonatal drug therapy: The first frontier of therapeutics for children. Clin Pharmacol Ther 2015; 98:288-97. [PMID: 26095519 DOI: 10.1002/cpt.166] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/08/2015] [Indexed: 02/06/2023]
Abstract
Knowledge about the safe and effective use of medicines in neonates has increased substantially but has resulted in few label changes. Drugs developed for use in adults are reshaped and tailored to specific neonatal indications. However, the use of drugs in neonates should not only mirror adult pharmacotherapy, but should be driven by their own specific needs. Therefore, building collaborative networks may assist to develop a newborn-driven research agenda addressing their clinical needs and diseases.
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Affiliation(s)
- K Allegaert
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU, Leuven, Belgium
| | - J van den Anker
- Division of Pediatric Clinical Pharmacology, Children's National Health System, Washington, DC, USA
- Departments of Pediatrics, Integrative Systems Biology, Pharmacology and Physiology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Intensive Care and Department of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Paediatric Pharmacology, University Children's Hospital Basel, Basel, Switzerland
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Samardzic J, Turner MA, Bax R, Allegaert K. Neonatal medicines research: challenges and opportunities. Expert Opin Drug Metab Toxicol 2015; 11:1041-52. [PMID: 25958820 DOI: 10.1517/17425255.2015.1046433] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The key feature of the newborn is its fast age-dependent maturation, resulting in extensive variability in pharmacokinetics and -dynamics, further aggravated by newly emerging covariates like treatment modalities, environmental issues or pharmacogenetics. This makes clinical research in neonates relevant and needed, but also challenging. AREAS COVERED To improve this knowledge, tailoring research tools as well as building research networks and clinical research skills for neonates are urgently needed. Tailoring of research tools is illustrated using the development of dried blood spot techniques and the introduction of micro-dosing and -tracer methodology in neonatal drug studies. Both techniques can be combined with sparse sampling techniques through population modeling. Building research networks and clinical research skills is illustrated by the initiatives of agencies to build and integrate knowledge on neonatal pharmacotherapy through dedicated working groups. EXPERT OPINION Challenges relating to neonatal medicine research can largely be overcome. Tailored tools and legal initiatives, combined with clever trial design will result in more robust information on neonatal pharmacotherapy. This necessitates collaborative efforts between clinical researchers, sponsors, regulatory authorities, and last but not least patient representatives and society.
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Affiliation(s)
- Janko Samardzic
- University of Belgrade, Institute of Pharmacology, Clinical Pharmacology and Toxicology, Medical Faculty, Belgrade, Serbia
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De Boeck K, Tiddens H, Elborn S, Fajac I. A new Clinical Trials Directive to boost academic trials? THE LANCET RESPIRATORY MEDICINE 2014; 1:99-101. [PMID: 24429080 DOI: 10.1016/s2213-2600(13)70041-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Kris De Boeck
- Paediatric Pulmonology, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Harm Tiddens
- Department of Paediatric Pulmonology and Allergology, Erasmus MS-Sophia, Rotterdam, The Netherlands
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A new era in the treatment of cystic fibrosis: correction of the underlying CFTR defect. THE LANCET RESPIRATORY MEDICINE 2013; 1:158-63. [PMID: 24429096 DOI: 10.1016/s2213-2600(12)70057-7] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cystic fibrosis is caused by dysfunction or deficiency of the cystic fibrosis transmembrane conductance regulator (CFTR) protein, an epithelial chloride channel that has a key role in maintaining homoeostasis of the airway surface liquid layer in the lungs. More than 1900 CFTR mutations that might result in a disease phenotype have been identified; these can be grouped into classes on the basis of their effect on CFTR protein production, trafficking, function, and stability. In the past 2 years, landmark clinical trials have shown that correction of CFTR function leads to substantial clinical benefit for individuals with cystic fibrosis. These findings are ushering in a new era of cystic fibrosis treatments designed to correct the underlying CFTR defect caused by different mutation classes. With analysis of continuing trials and available patient registries, here we assess mutation types and the number and geographical distribution of patients who are likely to benefit from CFTR-correcting treatment.
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Munck A, Roussey M. [Cystic fibrosis newborn screening: management issues]. Arch Pediatr 2012; 19 Suppl 1:S30-2. [PMID: 22682488 DOI: 10.1016/s0929-693x(12)71106-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Newborn screening (NBS) enables detection of pre-symptomatic cystic fibrosis (CF) patients. A major issue confronting the multidisciplinary team is that of implementing adequate follow-up care, thereby preventing nutritional and pulmonary complications. NBS may also identify newborns who do not fulfil the CF diagnosis criteria; the clinician and family are faced with the diagnostic and prognostic dilemma of atypical CF. Published recommendations are mainly a consensus of expert opinions on follow-up modalities and treatment to help families and primary care physicians, thus harmonizing current practices among CF care specialists. Well-designed clinical trials for these young children focusing on nutritional and pulmonary function are of crucial importance. Indeed, evaluation of pulmonary function is hampered by the absence of accurate, sensitive, reproducible outcome parameters. The European Cystic Fibrosis Society Clinical Trials Network is actively stimulating clinical research on these very young patients.
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Affiliation(s)
- A Munck
- Association Française pour le Dépistage et la Prévention des handicaps de l'Enfant (AFDPHE), 38 rue Cauchy, 75015 Paris, France.
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Abstract
With knowledge of the molecular behaviour of the cystic fibrosis transmembrane conductance regulator (CFTR), its physiological role and dysfunction in cystic fibrosis (CF), therapeutic strategies are now being developed that target the root cause of CF rather than disease symptoms. Here, we review progress towards the development of rational new therapies for CF. We highlight the discovery of small molecules that rescue the cell surface expression and defective channel gating of CF mutants, termed CFTR correctors and CFTR potentiators, respectively. We draw attention to alternative approaches to restore epithelial ion transport to CF epithelia, including inhibitors of the epithelial Na(+) channel (ENaC) and activators of the Ca(2+)-activated Cl(-) channel TMEM16A. The expertise required to translate small molecules identified in the laboratory to drugs for CF patients depends on our ability to coordinate drug development at an international level and our ability to provide pertinent biological information using suitable disease models.
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Sheppard DN. EuroCareCF: working together to improve patient care and therapy development. J Cyst Fibros 2011; 10 Suppl 2:S1-4. [PMID: 21658628 DOI: 10.1016/s1569-1993(11)00089-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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De Boeck K, Ashlock M. Introduction to Section I: the relevance of CF diagnostic tools for measuring restoration of CFTR function after therapeutic interventions in human clinical trials. Methods Mol Biol 2011; 741:3-11. [PMID: 21594774 DOI: 10.1007/978-1-61779-117-8_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The pilocarpine sweat test, and in vivo assessment of CFTR function via nasal potential difference or intestinal current measurement are important tools to confirm the diagnosis of CF in subjects with suggestive symptoms. Since these tests reflect CFTR function and thus relate to the basic disease process in CF, changes in these parameters are also being used to assess the pharmacologic effect of compounds aimed at restoring CFTR function. However, longitudinal data proving that changes in these measurements are associated with meaningful clinical improvements in the course of disease in CF patients are needed. Consequently, many CF clinical investigators need to be facile with these existing methods to measure CFTR-related outcomes. This introduction sets the stage for more in-depth discussion of existing strategies to measure changes in CFTR function generated by gene therapy or small molecule modulators of CFTR function such as correctors and potentiators. It is hoped that lessons learned through the use of these measures will inform the future development of other robust methods to assess novel therapeutic strategies uncovered by basic scientists.
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Affiliation(s)
- Kris De Boeck
- Department of Pediatrics, University of Leuven, Leuven, Belgium.
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