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Agustí A, Cereza G, de Abajo FJ, Maciá MA, Sacristán JA. Clinical pharmacology facing the real-world setting: Pharmacovigilance, pharmacoepidemiology and the economic evaluation of drugs. Pharmacol Res 2023; 197:106967. [PMID: 37865127 DOI: 10.1016/j.phrs.2023.106967] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 10/23/2023]
Abstract
Traditionally, clinical pharmacology has focused its activities on drug-organism interaction, from an individual or collective perspective. Drug efficacy assessment by performing randomized clinical trials and analysis of drug use in clinical practice by carrying out drug utilization studies have also been other areas of interest. From now on, Clinical pharmacology should move from the analysis of the drug-individual interaction to the analysis of the drug-individual-society interaction. It should also analyze the clinical and economic consequences of the use of drugs in the conditions of normal clinical practice, beyond clinical trials. The current exponential technological development that facilitates the analysis of real-life data offers us a golden opportunity to move to all these other areas of interest. This review describes the role that clinical pharmacology has played at the beginning and during the evolution of pharmacovigilance, pharmacoepidemiology and economic drug evaluations in Spain. In addition, the challenges that clinical pharmacology is going to face in the following years in these three areas are going to be outlined too.
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Affiliation(s)
- Antonia Agustí
- Clinical Pharmacology Service, Vall Hebron University Hospital and Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Gloria Cereza
- Catalan Centre of Pharmacovigilance. Directorate-General for Healthcare Planning and Regulation, Ministry of Health, Government of Catalonia, and Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Francisco J de Abajo
- Department of Biomedical Sciences, University of Alcalá (IRYCIS) and Unit of Clinical Pharmacology, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Miguel A Maciá
- Division of Pharmacoepidemology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices, Spain
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Sánchez-Velasco S, Midaglia L, Vidal-Jordana A, Castillo F, Horno R, Carreras E, Serrano B, Bosch M, Agustí A, Montalban X, Tintoré M. [Esclerosis multiple. Lactancia. Lactante. Planificacion familiar. Posparto. Tratamiento modificador de la enfermedad.]. Rev Neurol 2023; 76:21-30. [PMID: 36544373 PMCID: PMC10364020 DOI: 10.33588/rn.7601.2022404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Multiple sclerosis mainly affects women of childbearing age, and the pregnancy and postpartum period is of special interest because of the peculiarities of the disease course and the therapeutic consequences that derive from it. During the period of breastfeeding (BF), the choice of treatment strategy must weigh up the well-established benefits of BF for both the newborn and the mother against the safety profile and potential adverse effects on the infant resulting from exposure to disease-modifying drugs transferred through breast milk. DEVELOPMENT The study reviews the current evidence on the safety of disease-modifying drugs available for the treatment of multiple sclerosis during the BF period, and gathers data on the transfer of the different drugs into breast milk, as well as the potential adverse effects described in the infant. The drugs of first choice during this period are interferon beta and glatiramer acetate. The rest of the disease modifying drugs are not accepted for use in the BF period according to their summary of product characteristics. However, in recent years, data from studies of clinical practice and case series have been published suggesting that some of these drugs could be used safely during this period. CONCLUSIONS Given the recognised health benefits of BF for both mother and infant, exclusive breastfeeding is recommended whenever possible. It is essential to carry out an individualised assessment prior to pregnancy and to evaluate the different treatment options depending on each patient.
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Affiliation(s)
| | - L Midaglia
- Centre d'esclerosi múltiple de Catalunya, Barcelona, España.,Hospital Universitari Vall d'Hebron-UAB, Barcelona, España
| | - A Vidal-Jordana
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España.,Centre d'esclerosi múltiple de Catalunya, Barcelona, España
| | - F Castillo
- Hospital Universitari Vall d'Hebron-UAB, Barcelona, España
| | - R Horno
- Hospital Universitari Vall d'Hebron-UAB, Barcelona, España
| | - E Carreras
- Hospital Universitari Vall d'Hebron-UAB, Barcelona, España
| | - B Serrano
- Hospital Universitari Vall d'Hebron-UAB, Barcelona, España
| | - M Bosch
- Hospital Universitari Vall d'Hebron-UAB, Barcelona, España
| | - A Agustí
- Hospital Universitari Vall d'Hebron-UAB, Barcelona, España
| | - X Montalban
- Centre d'esclerosi múltiple de Catalunya, Barcelona, España.,Hospital Universitari Vall d'Hebron-UAB, Barcelona, España
| | - M Tintoré
- Centre d'esclerosi múltiple de Catalunya, Barcelona, España.,Hospital Universitari Vall d'Hebron-UAB, Barcelona, España
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Selva-O’Callaghan A, Trallero-Araguás E, Ros J, Gil-Vila A, Lostes J, Agustí A, Riera-Arnau J, Alvarado-Cárdenas M, Pinal-Fernandez I. Management of Cancer-Associated Myositis. Curr Treat Options in Rheum 2022; 8:91-104. [PMID: 36313478 PMCID: PMC9589595 DOI: 10.1007/s40674-022-00197-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 12/01/2022]
Abstract
Purpose of the Review Cancer-associated myositis (CAM) is defined as when cancer appears within 3 years of myositis onset. Dermatomyositis and seronegative immune–mediated necrotizing myopathy are the phenotypes mostly related to cancer. In general, treatment principles in myositis patients with and without CAM are similar. However, some aspects of myositis management are particular to CAM, including (a) the need for a multidisciplinary approach and a close relationship with the oncologist, (b) the presence of immunosuppressive and antineoplastic drug interactions, and (c) the role of the long-term immunosuppressive therapy as a risk factor for cancer relapse or development of a second neoplasm. In this review, we will also discuss immunotherapy in patients treated with checkpoint inhibitors as a treatment for their cancer. Recent Findings Studies on cancer risk in patients treated with long-term immunosuppressive drugs, in autoimmune diseases such as systemic lupus erythematosus or rheumatoid arthritis, and in solid organ transplant recipients have shed some light on this topic. Immunotherapy, which has been a great advance for the treatment of some types of malignancy, may be also of interest in CAM, given the special relationship between both disorders. Summary Management of CAM is a challenge. In this complex scenario, therapeutic decisions must consider both diseases simultaneously. Supplementary Information The online version contains supplementary material available at 10.1007/s40674-022-00197-2.
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Affiliation(s)
- Albert Selva-O’Callaghan
- Systemic Autoimmune Diseases Unit, Internal Medicine Dept, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Javier Ros
- Medical Oncology Department, Vall d’Hebron General Hospital, Barcelona, Spain
| | - Albert Gil-Vila
- Systemic Autoimmune Diseases Unit, Internal Medicine Dept, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julia Lostes
- Medical Oncology Department, Vall d’Hebron General Hospital, Barcelona, Spain
| | - Antonia Agustí
- Clinical Pharmacology Service, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Judit Riera-Arnau
- Clinical Pharmacology Service, Vall d’Hebron University Hospital, Barcelona, Spain
| | | | - Iago Pinal-Fernandez
- National Institutes of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, MD USA
- Johns Hopkins University School of Medicine, Baltimore, MD USA
- Faculty of Health Sciences and Faculty of Computer Science, Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
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García-Pérez J, González-Pérez M, Castillo de la Osa M, Borobia AM, Castaño L, Bertrán MJ, Campins M, Portolés A, Lora D, Bermejo M, Conde P, Hernández-Gutierrez L, Carcas A, Arana-Arri E, Tortajada M, Fuentes I, Ascaso A, García-Morales MT, Erick de la Torre-Tarazona H, Arribas JR, Imaz-Ayo N, Mellado-Pau E, Agustí A, Pérez-Ingidua C, Gómez de la Cámara A, Ochando J, Belda-Iniesta C, Frías J, Alcamí J, Pérez-Olmeda M. Immunogenic dynamics and SARS-CoV-2 variant neutralisation of the heterologous ChAdOx1-S/BNT162b2 vaccination: Secondary analysis of the randomised CombiVacS study. EClinicalMedicine 2022; 50:101529. [PMID: 35795713 PMCID: PMC9249304 DOI: 10.1016/j.eclinm.2022.101529] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The CombiVacS study was designed to assess immunogenicity and reactogenicity of the heterologous ChAdOx1-S/BNT162b2 combination, and 14-day results showed a strong immune response. The present secondary analysis addresses the evolution of humoral and cellular response up to day 180. METHODS Between April 24 and 30, 2021, 676 adults primed with ChAdOx1-S were enrolled in five hospitals in Spain, and randomised to receive BNT162b2 as second dose (interventional group [IG]) or no vaccine (control group [CG]). Individuals from CG received BNT162b2 as second dose and also on day 28, as planned based on favourable results on day 14. Humoral immunogenicity, measured by immunoassay for SARS-CoV-2 receptor binding domain (RBD), antibody functionality using pseudovirus neutralisation assays for the reference (G614), Alpha, Beta, Delta, and Omicron variants, as well as cellular immune response using interferon-γ and IL-2 immunoassays were assessed at day 28 after BNT162b2 in both groups, at day 90 (planned only in the interventional group) and at day 180 (laboratory data cut-off on Nov 19, 2021). This study was registered with EudraCT (2021-001978-37) and ClinicalTrials.gov (NCT04860739). FINDINGS In this secondary analysis, 664 individuals (441 from IG and 223 from CG) were included. At day 28 post vaccine, geometric mean titres (GMT) of RBD antibodies were 5616·91 BAU/mL (95% CI 5296·49-5956·71) in the IG and 7298·22 BAU/mL (6739·41-7903·37) in the CG (p < 0·0001). RBD antibodies titres decreased at day 180 (1142·0 BAU/mL [1048·69-1243·62] and 1836·4 BAU/mL [1621·62-2079·62] in the IG and CG, respectively; p < 0·0001). Neutralising antibodies also waned from day 28 to day 180 in both the IG (1429·01 [1220·37-1673·33] and 198·72 [161·54-244·47], respectively) and the CG (1503·28 [1210·71-1866·54] and 295·57 [209·84-416·33], respectively). The lowest variant-specific response was observed against Omicron-and Beta variants, with low proportion of individuals exhibiting specific neutralising antibody titres (NT50) >1:100 at day 180 (19% and 22%, respectively). INTERPRETATION Titres of RBD antibodies decay over time, similar to homologous regimes. Our findings suggested that delaying administration of the second dose did not have a detrimental effect after vaccination and may have improved the response obtained. Lower neutralisation was observed against Omicron and Beta variants at day 180. FUNDING Funded by Instituto de Salud Carlos III (ISCIII).
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Affiliation(s)
- Javier García-Pérez
- Unidad de Inmunopatología del SIDA, Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - María González-Pérez
- Laboratorio de Referencia en Inmunología, Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - María Castillo de la Osa
- Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Alberto M. Borobia
- Servicio de Farmacología Clínica, Departamento de Farmacología y Terapéutica, Facultad de Medicina, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Luis Castaño
- Biocruces Bizkaia, Hospital Universitario Cruces, CIBERDEM, CIBERER, Endo-ERN, UPV-EHU, Barakaldo, Spain
| | - María Jesús Bertrán
- Servicio de Medicina Preventiva y Epidemiologia, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Magdalena Campins
- Servicio de Medicina Preventiva y Epidemiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Portolés
- Servicio de Farmacología Clínica, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
- Spanish Clinical Research Network – SCReN – ISCIII, Madrid, Spain
| | - David Lora
- Instituto de Investigación Sanitaria Hospital 12 de octubre (imas12), Facultad de Medicina, Universidad Complutense de Madrid (UCM)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Spanish Clinical Research Network – SCReN – ISCIII, Madrid, Spain
- Facultad de Estudios Estadísticos, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Mercedes Bermejo
- Unidad de Inmunopatología del SIDA, Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Patricia Conde
- Laboratorio de Referencia en Inmunología, Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Lourdes Hernández-Gutierrez
- Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Antonio Carcas
- Servicio de Farmacología Clínica, Departamento de Farmacología y Terapéutica, Facultad de Medicina, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Eunate Arana-Arri
- Biocruces Bizkaia, Hospital Universitario Cruces, CIBERDEM, CIBERER, Endo-ERN, UPV-EHU, Barakaldo, Spain
| | - Marta Tortajada
- Servicio de Prevención de Riesgos Laborales, Salud Laboral, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Inmaculada Fuentes
- Unidad de Soporte a la Investigación Clínica, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Ana Ascaso
- Servicio de Farmacología Clínica, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - María Teresa García-Morales
- Instituto de Investigación Sanitaria Hospital 12 de octubre (imas12), Facultad de Medicina, Universidad Complutense de Madrid (UCM)
- Spanish Clinical Research Network – SCReN – ISCIII, Madrid, Spain
| | | | - José-Ramón Arribas
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Servicio de Medicina Interna, Departamento de Medicina, Facultad de Medicina, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Natale Imaz-Ayo
- Biocruces Bizkaia, Hospital Universitario Cruces, CIBERDEM, CIBERER, Endo-ERN, UPV-EHU, Barakaldo, Spain
| | - Eugènia Mellado-Pau
- Servicio de Medicina Preventiva y Epidemiologia, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Antonia Agustí
- Servicio de Farmacología Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Carla Pérez-Ingidua
- Servicio de Farmacología Clínica, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Agustín Gómez de la Cámara
- Instituto de Investigación Sanitaria Hospital 12 de octubre (imas12), Facultad de Medicina, Universidad Complutense de Madrid (UCM)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
- Spanish Clinical Research Network – SCReN – ISCIII, Madrid, Spain
| | - Jordi Ochando
- Laboratorio de Referencia en Inmunología, Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | | | - Jesús Frías
- Servicio de Farmacología Clínica, Departamento de Farmacología y Terapéutica, Facultad de Medicina, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - José Alcamí
- Unidad de Inmunopatología del SIDA, Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Corresponding author at: Unidad de Inmunopatología del SIDA Instituto de Salud Carlos III, 28220 Majadahonda, Spain.
| | - Mayte Pérez-Olmeda
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Corresponding author at: Laboratorio de Serología, Instituto de salud Carlos III, 28220 Majadahonda, Spain.
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Iglesias-Lopez C, Agustí A, Vallano A, Obach M. Current landscape of clinical development and approval of advanced therapies. Mol Ther Methods Clin Dev 2021; 23:606-618. [PMID: 34901306 PMCID: PMC8626628 DOI: 10.1016/j.omtm.2021.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/04/2021] [Revised: 08/06/2021] [Accepted: 11/07/2021] [Indexed: 01/26/2023]
Abstract
Advanced therapy medicinal products (ATMPs) are innovative therapies that mainly target orphan diseases and high unmet medical needs. The uncertainty about the product's benefit-risk balance at the time of approval, the limitations of nonclinical development, and the complex quality aspects of those highly individualized advanced therapies are playing a key role in the clinical development, approval, and post-marketing setting for these therapies. This article reviews the current landscape of clinical development of advanced therapies, its challenges, and some of the efforts several stakeholders are conducting to move forward within this field. Progressive iteration of the science, methodologically sound clinical developments, establishing new standards for ATMPs development with the aim to ensure consistency in clinical development, and the reproducibility of knowledge is required, not only to increase the evidence generation for approval but to set principles to achieve translational success in this field.
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Affiliation(s)
- Carolina Iglesias-Lopez
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonia Agustí
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
- Clinical Pharmacology Service, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Antoni Vallano
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
- Medicines Department, Catalan Healthcare Service, Barcelona, Spain
| | - Merce Obach
- Medicines Department, Catalan Healthcare Service, Barcelona, Spain
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Borobia AM, Carcas AJ, Pérez-Olmeda M, Castaño L, Bertran MJ, García-Pérez J, Campins M, Portolés A, González-Pérez M, García Morales MT, Arana-Arri E, Aldea M, Díez-Fuertes F, Fuentes I, Ascaso A, Lora D, Imaz-Ayo N, Barón-Mira LE, Agustí A, Pérez-Ingidua C, Gómez de la Cámara A, Arribas JR, Ochando J, Alcamí J, Belda-Iniesta C, Frías J. Immunogenicity and reactogenicity of BNT162b2 booster in ChAdOx1-S-primed participants (CombiVacS): a multicentre, open-label, randomised, controlled, phase 2 trial. Lancet 2021; 398:121-130. [PMID: 34181880 PMCID: PMC8233007 DOI: 10.1016/s0140-6736(21)01420-3] [Citation(s) in RCA: 259] [Impact Index Per Article: 86.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND To date, no immunological data on COVID-19 heterologous vaccination schedules in humans have been reported. We assessed the immunogenicity and reactogenicity of BNT162b2 (Comirnaty, BioNTech, Mainz, Germany) administered as second dose in participants primed with ChAdOx1-S (Vaxzevria, AstraZeneca, Oxford, UK). METHODS We did a phase 2, open-label, randomised, controlled trial on adults aged 18-60 years, vaccinated with a single dose of ChAdOx1-S 8-12 weeks before screening, and no history of SARS-CoV-2 infection. Participants were randomly assigned (2:1) to receive either BNT162b2 (0·3 mL) via a single intramuscular injection (intervention group) or continue observation (control group). The primary outcome was 14-day immunogenicity, measured by immunoassays for SARS-CoV-2 trimeric spike protein and receptor binding domain (RBD). Antibody functionality was assessed using a pseudovirus neutralisation assay, and cellular immune response using an interferon-γ immunoassay. The safety outcome was 7-day reactogenicity, measured as solicited local and systemic adverse events. The primary analysis included all participants who received at least one dose of BNT162b2 and who had at least one efficacy evaluation after baseline. The safety analysis included all participants who received BNT162b2. This study is registered with EudraCT (2021-001978-37) and ClinicalTrials.gov (NCT04860739), and is ongoing. FINDINGS Between April 24 and 30, 2021, 676 individuals were enrolled and randomly assigned to either the intervention group (n=450) or control group (n=226) at five university hospitals in Spain (mean age 44 years [SD 9]; 382 [57%] women and 294 [43%] men). 663 (98%) participants (n=441 intervention, n=222 control) completed the study up to day 14. In the intervention group, geometric mean titres of RBD antibodies increased from 71·46 BAU/mL (95% CI 59·84-85·33) at baseline to 7756·68 BAU/mL (7371·53-8161·96) at day 14 (p<0·0001). IgG against trimeric spike protein increased from 98·40 BAU/mL (95% CI 85·69-112·99) to 3684·87 BAU/mL (3429·87-3958·83). The interventional:control ratio was 77·69 (95% CI 59·57-101·32) for RBD protein and 36·41 (29·31-45·23) for trimeric spike protein IgG. Reactions were mild (n=1210 [68%]) or moderate (n=530 [30%]), with injection site pain (n=395 [88%]), induration (n=159 [35%]), headache (n=199 [44%]), and myalgia (n=194 [43%]) the most commonly reported adverse events. No serious adverse events were reported. INTERPRETATION BNT162b2 given as a second dose in individuals prime vaccinated with ChAdOx1-S induced a robust immune response, with an acceptable and manageable reactogenicity profile. FUNDING Instituto de Salud Carlos III. TRANSLATIONS For the French and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Alberto M Borobia
- Servicio de Farmacología Clínica, Departamento de Farmacología y Terapéutica, Facultad de Medicina, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Antonio J Carcas
- Servicio de Farmacología Clínica, Departamento de Farmacología y Terapéutica, Facultad de Medicina, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Luis Castaño
- Hospital Universitario de Cruces, Biocruces Bizkaia HRI, UPV/EHU, OSAKIDETZA, CIBERDEM, CIBERER, Endo-ERN, Barakaldo-Bilbao, Spain
| | - María Jesús Bertran
- Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Javier García-Pérez
- Unidad de Inmunopatología del SIDA, Instituto de Salud Carlos III, Madrid, Spain
| | - Magdalena Campins
- Servicio de Medicina Preventiva y Epidemiología, Servicio de Farmacología Clínica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Portolés
- Servicio de Farmacología Clínica, Hospital Clínico San Carlos, IdISSC, Departamento de Farmacología y Toxicología, Universidad Complutense de Madrid, Madrid, Spain
| | - María González-Pérez
- Laboratorio de Referencia en Inmunología, Instituto de Salud Carlos III, Madrid, Spain
| | - María Teresa García Morales
- Instituto de Investigación Sanitaria Hospital 12 de Octubre, CIBER de Epidemiología y Salud Pública, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Eunate Arana-Arri
- Hospital Universitario de Cruces, Biocruces Bizkaia HRI, UPV/EHU, OSAKIDETZA, CIBERDEM, CIBERER, Endo-ERN, Barakaldo-Bilbao, Spain
| | - Marta Aldea
- Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Inmaculada Fuentes
- Unidad de Soporte a la Investigación Clínica, Vall d'Hebron Institut de Recerca, Servicio de Farmacología Clínica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Ascaso
- Servicio de Farmacología Clínica, Hospital Clínico San Carlos, IdISSC, Departamento de Farmacología y Toxicología, Universidad Complutense de Madrid, Madrid, Spain
| | - David Lora
- Instituto de Investigación Sanitaria Hospital 12 de Octubre, CIBER de Epidemiología y Salud Pública, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Natale Imaz-Ayo
- Hospital Universitario de Cruces, Biocruces Bizkaia HRI, UPV/EHU, OSAKIDETZA, CIBERDEM, CIBERER, Endo-ERN, Barakaldo-Bilbao, Spain
| | - Lourdes E Barón-Mira
- Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Antonia Agustí
- Departmento de Farmacología, Terapéutica y Toxicología, Servicio de Farmacología Clínica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carla Pérez-Ingidua
- Servicio de Farmacología Clínica, Hospital Clínico San Carlos, IdISSC, Departamento de Farmacología y Toxicología, Universidad Complutense de Madrid, Madrid, Spain
| | - Agustín Gómez de la Cámara
- Instituto de Investigación Sanitaria Hospital 12 de Octubre, CIBER de Epidemiología y Salud Pública, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - José Ramón Arribas
- Servicio de Medicina Interna, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Jordi Ochando
- Laboratorio de Referencia en Inmunología, Instituto de Salud Carlos III, Madrid, Spain
| | - José Alcamí
- Unidad de Inmunopatología del SIDA, Instituto de Salud Carlos III, Madrid, Spain
| | - Cristóbal Belda-Iniesta
- Centro Nacional de Microbiología, and Evaluation and Promotion of Research, Instituto de Salud Carlos III, Madrid, Spain.
| | - Jesús Frías
- Servicio de Farmacología Clínica, Departamento de Farmacología y Terapéutica, Facultad de Medicina, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain.
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7
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Iglesias-Lopez C, Obach M, Vallano A, Agustí A. Comparison of regulatory pathways for the approval of advanced therapies in the European Union and the United States. Cytotherapy 2021; 23:261-274. [PMID: 33483292 DOI: 10.1016/j.jcyt.2020.11.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 09/18/2020] [Revised: 11/21/2020] [Accepted: 11/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AIMS Regulatory agencies in the European Union (EU) and in the United States of America (USA) have adapted and launched regulatory pathways to accelerate patient access to innovative therapies, such as advanced therapy medicinal products (ATMPs). The aim of this study is to analyze similarities and differences between regulatory pathways followed by the approved ATMPs in both regions. METHODS A retrospective analysis of the ATMPs approved by EU and US regulatory agencies was carried out until May 31, 2020. Data were collected on the features and timing of orphan drug designation (ODD), scientific advice (SA), expedited program designation (EP), marketing authorization application (MAA) and marketing authorization (MA) for both regions. RESULTS In the EU, a total of fifteen ATMPs were approved (eight gene therapies, three somatic cell therapies, three tissue-engineered products and one combined ATMP), whereas in the USA, a total of nine were approved (five gene therapies and four cell therapies); seven of these were authorized in both regions. No statistical differences were found in the mean time between having the ODD or EP granted and the start of the pivotal clinical trial or MAA in the EU and USA, although the USA required less time for MAA assessment than the EU (mean difference, 5.44, P = 0.012). The MAA assessment was shorter for those products with a PRIME or breakthrough designation.. No differences were found in the percentage of ATMPs with expedited MAA assessment between the EU and the USA (33.3% versus 55.5%, respectively, P = 0.285) or in the time required for the MAA expedited review (mean difference 4.41, P = 0.105). Approximately half of the products in both regions required an Advisory Committee during the MAA review, and 60% required an oral explanation in the EU. More than half of the approved ATMPs (67% and 55.55% in the EU and the USA, respectively) were granted an ODD, 70% by submitting preliminary clinical data in the EU. The mean number of SA and protocol assistance per product conducted by the European Medicines Agency was 1.71 and 3.75, respectively, and only 13% included parallel advice with health technology assessment bodies. A total of 53.33% of the products conducted the first SA after the pivotal clinical study had started, reporting more protocol amendments. Finally, of the seven ATMPs authorized in both regions, the type of MA differed for only two ATMPs (28.6%), and four out of eight products non-commercialized in the USA had a non-standard MA in the EU. CONCLUSIONS The current approved ATMPs mainly target orphan diseases. Although EU and US regulatory procedures may differ, the main regulatory milestones reached by the approved ATMPs are similar in both regions, with the exception of the time for MAA evaluation, the number of authorized products in the regions and the type of authorization for some products. More global regulatory convergence might further simplify and expedite current ATMP development in these regions.
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Affiliation(s)
- Carolina Iglesias-Lopez
- Department of Pharmacology, Therapeutics and Toxicology. Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Mercè Obach
- Medicines Department, Catalan Healthcare Service, Barcelona, Spain
| | - Antonio Vallano
- Department of Pharmacology, Therapeutics and Toxicology. Universitat Autònoma de Barcelona, Bellaterra, Spain; Medicines Department, Catalan Healthcare Service, Barcelona, Spain.
| | - Antonia Agustí
- Department of Pharmacology, Therapeutics and Toxicology. Universitat Autònoma de Barcelona, Bellaterra, Spain; Clinical Pharmacology Service, Vall d'Hebron University Hospital, Barcelona, Spain
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8
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Agustí A, Chang CWS, Quijandría F, Johansson G, Wilson CM, Sabín C. Tripartite Genuine Non-Gaussian Entanglement in Three-Mode Spontaneous Parametric Down-Conversion. Phys Rev Lett 2020; 125:020502. [PMID: 32701323 DOI: 10.1103/physrevlett.125.020502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/19/2020] [Indexed: 06/11/2023]
Abstract
We show that the states generated by a three-mode spontaneous parametric down-conversion (SPDC) interaction Hamiltonian possess tripartite entanglement of a different nature to other paradigmatic three-mode entangled states generated by the combination of two-mode SPDC interactions. While two-mode SPDC generates Gaussian states whose entanglement can be characterized by standard criteria based on two-mode quantum correlations, these criteria fail to capture the entanglement generated by three-mode SPDC. We use criteria built from three-mode correlation functions to show that the class of states recently generated in a superconducting-circuit implementation of three-mode SPDC ideally have tripartite entanglement, contrary to recent claims in the literature. These criteria are suitable for triple SPDC but we show that they fail to detect tripartite entanglement in other states which are known to possess it, which illustrates the existence of two fundamentally different notions of tripartite entanglement in three-mode continuous-variable systems.
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Affiliation(s)
- A Agustí
- Instituto de Física Fundamental, CSIC, Serrano, 113-bis, 28006 Madrid, Spain
| | - C W Sandbo Chang
- Institute for Quantum Computing and Electrical and Computer Engineering, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
| | - F Quijandría
- Microtechnology and Nanoscience, MC2, Chalmers University of Technology, SE-412 96 Göteborg, Sweden
| | - G Johansson
- Microtechnology and Nanoscience, MC2, Chalmers University of Technology, SE-412 96 Göteborg, Sweden
| | - C M Wilson
- Institute for Quantum Computing and Electrical and Computer Engineering, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
| | - C Sabín
- Instituto de Física Fundamental, CSIC, Serrano, 113-bis, 28006 Madrid, Spain
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9
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San-José A, Pérez-Bocanegra C, Agustí A, Laorden H, Gost J, Vidal X, Oropeza V, Romero R. Integrated health intervention on polypharmacy and inappropriate prescribing in elderly people with multimorbidity: Results at the end of the intervention and at 6 months after the intervention. Med Clin (Barc) 2020; 156:263-269. [PMID: 32593414 DOI: 10.1016/j.medcli.2020.04.030] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE To analyse the impact of an integrated health intervention focused on polypharmacy and inappropriate prescribing (IP) in elderly people with multimorbidity. MATERIAL AND METHODS Patients were referred for assessment and intervention from primary care or hospital to an interdisciplinary team composed of primary and hospital medical staff and nurses. Pharmacological assessment was centred on polypharmacy and IP using the STOPP/START criteria. Changes in polypharmacy and in IP were analysed at the end of the intervention and at 6 months. RESULTS One hundred consecutive patients (mean (SD) age 81.5(8.0) years, 54(54%) male) were analysed. Mean prescribed medicines at baseline was > 10. There were no significant changes at the end of the intervention and at 6 months. The proportion of patients with two or more STOPP criteria reduced from 37% at the beginning of the intervention to 18% at the end (p< .001), and the proportion of those with START criteria from 13% to 6% (p = .004). These differences persisted at 6 months. The number of STOPP and START criteria before the intervention was associated with a decrease in the STOPP and START criteria at the end of the intervention and at 6 months. A reduction in polypharmacy (p= .041) and in falls (p= .034) was observed at 6 months in those with a decrease in the STOPP criteria at the end of the intervention. CONCLUSIONS An integrated health intervention centred on polypharmacy and IP in elderly people improves inappropriate prescribing that persists beyond the intervention.
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Affiliation(s)
- Antonio San-José
- Geriatric Unit. Internal Medicine Service, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Carmen Pérez-Bocanegra
- Geriatric Unit. Internal Medicine Service, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Antonia Agustí
- Clinical Pharmacology Service, Vall d'Hebron University Hospital , Barcelona, Spain; Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Helena Laorden
- Primary Care Centre Casernes. Catalan Institut of Health, Barcelona, Spain
| | - Jordi Gost
- Primary Care Centre Casernes. Catalan Institut of Health, Barcelona, Spain
| | - Xavier Vidal
- Clinical Pharmacology Service, Vall d'Hebron University Hospital , Barcelona, Spain; Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Vanessa Oropeza
- Geriatric Unit. Internal Medicine Service, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Rosa Romero
- Primary Care Centre Casernes. Catalan Institut of Health, Barcelona, Spain
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10
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Iglesias-Lopez C, Agustí A, Obach M, Vallano A. Corrigendum: Regulatory Framework for Advanced Therapy Medicinal Products in Europe and United States. Front Pharmacol 2020; 11:766. [PMID: 32523535 PMCID: PMC7261870 DOI: 10.3389/fphar.2020.00766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/11/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Carolina Iglesias-Lopez
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonia Agustí
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.,Clinical Pharmacology Service, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mercè Obach
- Medicines Department, Catalan Healthcare Service, Barcelona, Spain
| | - Antonio Vallano
- Medicines Department, Catalan Healthcare Service, Barcelona, Spain.,Pathology and Experimental Therapeutics Department, University of Barcelona, Barcelona, Spain
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11
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Iglesias-Lopez C, Obach M, Vallano A, Agustí A, Montané J. Hurdles of environmental risk assessment procedures for advanced therapy medicinal products: comparison between the European Union and the United States. Crit Rev Toxicol 2019; 49:580-596. [DOI: 10.1080/10408444.2019.1689380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- C. Iglesias-Lopez
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Auntònoma de Barcelona, Barcelona, Spain
| | - M. Obach
- Medicines Department, Catalan Healthcare Service, Barcelona, Spain
| | - A. Vallano
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Auntònoma de Barcelona, Barcelona, Spain
- Medicines Department, Catalan Healthcare Service, Barcelona, Spain
| | - A. Agustí
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Auntònoma de Barcelona, Barcelona, Spain
- Clinical Pharmacology Service, Vall d’Hebron University Hospital, Barcelona, Spain
| | - J. Montané
- Blanquerna School of Health Science, Ramon Llull University, Barcelona, Spain
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12
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Iglesias-López C, Agustí A, Obach M, Vallano A. Regulatory Framework for Advanced Therapy Medicinal Products in Europe and United States. Front Pharmacol 2019; 10:921. [PMID: 31543814 PMCID: PMC6728416 DOI: 10.3389/fphar.2019.00921] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [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: 05/16/2019] [Accepted: 07/22/2019] [Indexed: 12/04/2022] Open
Abstract
Advanced therapy medicinal products (ATMPs) are a fast-growing field of innovative therapies. The European Union (EU) and the United States (US) are fostering their development. For both regions, ATMPs fall under the regulatory framework of biological products, which determines the legal basis for their development. Sub-classifications of advanced therapies are different between regions, while in EU, there are four major groups, i.e., gene therapy, somatic cell therapy, tissue-engineered therapies, and combined advanced therapies; in US, the sub-classification covers two major groups of products, i.e., gene therapy and cellular therapy. The inclusion criteria that define a gene therapy are equivalent in both regions, and the exclusion criteria are directly related to the indications of the product. In the EU, there is a clear differentiation between cell- and tissue-based products regarding their classification as advanced therapies or coverage by other legal frameworks, whereas in US, there is a broader classification about whether or not these products can be categorized as biologic products. Both in EU and in US, in order to classify a cell- or a tissue-based product as an advanced therapy, it must be ensured that the processing of the cells implies a manipulation that alters their biological characteristics, although the term of manipulation in US differentiates between structural and non-structural cells and tissues. The regulatory terminology used to define ATMPs and their sub-classification reveals some differences between EU and US.
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Affiliation(s)
- Carolina Iglesias-López
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonia Agustí
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.,Clinical Pharmacology Service, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mercè Obach
- Medicines Department, Catalan Healthcare Service, Barcelona, Spain
| | - Antonio Vallano
- Medicines Department, Catalan Healthcare Service, Barcelona, Spain.,Pathology and Experimental Therapeutics Department, University of Barcelona, Barcelona, Spain
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13
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Boada M, Guzmán R, Montesinos M, Libreros A, Guirao A, Sánchez-Lorente D, Gimferrer JM, Agustí A, Molins L. UPSTAGING, CENTRALITY AND SURVIVAL IN EARLY STAGE NON-SMALL CELL LUNG CANCER VIDEO-ASSISTED SURGERY. Lung Cancer 2019; 134:254-258. [DOI: 10.1016/j.lungcan.2019.06.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/28/2019] [Accepted: 06/30/2019] [Indexed: 12/11/2022]
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14
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Guirao A, Molins L, Ramón I, Sunyer G, Viñolas N, Marrades R, Sánchez D, Fibla JJ, Boada M, Hernández J, Guzmán R, Libreros A, Gómez-Caro A, Guerrero C, Agustí A. Trained dogs can identify malignant solitary pulmonary nodules in exhaled gas. Lung Cancer 2019; 135:230-233. [PMID: 31235316 DOI: 10.1016/j.lungcan.2019.06.008] [Citation(s) in RCA: 4] [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: 02/23/2019] [Revised: 06/04/2019] [Accepted: 06/07/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To investigate the capacity of a trained dog to identify LC in patients with malignant SPN. METHODS We collected 90 exhaled gas samples from 30 patients with SPN (3 samples/patient). As controls we used 61 healthy volunteers and 18 COPD patients without SNP or LC, in each of whom we collected 5 exhaled gas samples (n = 395). The dog (Blat, a 4-year-old crossbreed between a Labrador Retriever and a Pitbull) and the methodology used were the same as previously reported by our group (see: https://drive.google.com/open?id=1R4mOtOtuZkTeb5iOEEv0K9r2kHKlPhWd). RESULTS Of 30 patients with SPN, Blat recognized 27 of them as positive for LC and 3 as negative for LC. These results fully matched post-surgical pathological results. Sensibility was 0.97, Specificity 0.99, Positive Predictive value 0.97 and negative predictive value 0.99. The AUC of the ROC curve was 0.985. CONCLUSIONS Trained dogs can identify accurately the malignant origin of SPN. It is now time to develop technology that can match canine olfaction and facilitate the implementation of this diagnostic approach in the clinic.
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Affiliation(s)
- A Guirao
- Institut Respiratori, Hospital Clínic, Universitat de Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - L Molins
- Institut Respiratori, Hospital Clínic, Universitat de Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBER Enfermedades Respiratorias (CIBERES), Spain
| | - I Ramón
- ARGUS Detection Dogs, Barcelona, Spain
| | - G Sunyer
- CIBER Enfermedades Respiratorias (CIBERES), Spain
| | - N Viñolas
- Institut Clínic de Malalties Hematològiques i Oncològiques, Hospital Clínic, Universitat de Barcelona, Spain
| | - R Marrades
- Institut Respiratori, Hospital Clínic, Universitat de Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBER Enfermedades Respiratorias (CIBERES), Spain
| | - D Sánchez
- Institut Respiratori, Hospital Clínic, Universitat de Barcelona, Spain
| | - J J Fibla
- Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - M Boada
- Institut Respiratori, Hospital Clínic, Universitat de Barcelona, Spain
| | - J Hernández
- Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - R Guzmán
- Institut Respiratori, Hospital Clínic, Universitat de Barcelona, Spain
| | - A Libreros
- Institut Respiratori, Hospital Clínic, Universitat de Barcelona, Spain
| | - A Gómez-Caro
- Institut Respiratori, Hospital Clínic, Universitat de Barcelona, Spain
| | - C Guerrero
- Institut Respiratori, Hospital Clínic, Universitat de Barcelona, Spain
| | - A Agustí
- Institut Respiratori, Hospital Clínic, Universitat de Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBER Enfermedades Respiratorias (CIBERES), Spain
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15
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Bobolea I, Arismendi E, Valero A, Agustí A. Early Life Origins of Asthma: A Review of Potential Effectors. J Investig Allergol Clin Immunol 2018; 29:168-179. [PMID: 30561365 DOI: 10.18176/jiaci.0361] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There is growing evidence that events occurring early in life, both before and after birth, are significantly associated with the risk of asthma, chronic obstructive pulmonary disease, and diminished lung function later in life. In fact, from conception to death, a series of continuous, dynamic gene-environment interactions determine 2 fundamental biological processes, namely, lung development and lung aging. Over 130 birth cohorts have been initiated in the last 30 years. Data from these cohorts have improved our understanding of the inception, progression, and persistency of asthma. In this review, we summarize the main data for the early life events proven to determine later development and persistence of asthma, such as maternal atopy and smoking, preterm birth/bronchopulmonary dysplasia, infections, nutrition, obesity, smoking, and other environmental exposures in childhood and adolescence. While some of these factors are obviously impossible to prevent or eliminate, others have been proven to have a protective role, and current research is aimed optimizing them. Available prophylactic measures are also reviewed. In the case of environmental pollution, large scale political interventions successfully managed to decrease contamination levels, leading to improved lung function and lower asthma prevalence in the respective geographical areas. Future research should focus on better understanding these complex interactions in order to develop and enhance effective preventive therapeutic measures.
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Affiliation(s)
- I Bobolea
- Respiratory Institute, Hospital Clínic, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut d'Investigacio Biomedica August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Spain
| | - E Arismendi
- Institut d'Investigacio Biomedica August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Spain
| | - A Valero
- Respiratory Institute, Hospital Clínic, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut d'Investigacio Biomedica August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Spain
| | - A Agustí
- Respiratory Institute, Hospital Clínic, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut d'Investigacio Biomedica August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Spain
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16
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Fuentes Camps I, Rodríguez A, Agustí A. Non-commercial vs. commercial clinical trials: a retrospective study of the applications submitted to a research ethics committee. Br J Clin Pharmacol 2018; 84:1384-1388. [PMID: 29446851 PMCID: PMC5980428 DOI: 10.1111/bcp.13555] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 07/26/2017] [Revised: 12/18/2017] [Accepted: 02/07/2018] [Indexed: 11/29/2022] Open
Abstract
There are many difficulties in undertaking independent clinical research without support from the pharmaceutical industry. In this retrospective observational study, some design characteristics, the clinical trial public register and the publication rate of noncommercial clinical trials were compared to those of commercial clinical trials. A total of 809 applications of drug-evaluation clinical trials were submitted from May 2004 to May 2009 to the research ethics committee of a tertiary hospital, and 16.3% of trials were noncommercial. They were mainly phase IV, multicentre national, and unmasked controlled trials, compared to the commercial trials that were mainly phase II or III, multicentre international, and double-blind masked trials. The commercial trials were registered and published more often than noncommercial trials. More funding for noncommercial research is still needed. The results of the research, commercial or noncommercial, should be disseminated in order not to compromise either its scientific or its social value.
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Affiliation(s)
- Inmaculada Fuentes Camps
- Clinical Pharmacology ServiceHospital Universitari Vall d'HebronBarcelonaSpain
- Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
| | - Alexis Rodríguez
- Clinical Pharmacology ServiceHospital Universitari Vall d'HebronBarcelonaSpain
- Vall d'Hebron Research Institute (VHIR)BarcelonaSpain
| | - Antonia Agustí
- Clinical Pharmacology ServiceHospital Universitari Vall d'HebronBarcelonaSpain
- Department of Pharmacology, Therapeutics and ToxicologyUniversitat Autònoma de BarcelonaCerdanyola del Vallès, BarcelonaSpain
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17
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Gómez-Giménez B, Felipo V, Cabrera-Pastor A, Agustí A, Hernández-Rabaza V, Llansola M. Developmental Exposure to Pesticides Alters Motor Activity and Coordination in Rats: Sex Differences and Underlying Mechanisms. Neurotox Res 2017; 33:247-258. [DOI: 10.1007/s12640-017-9823-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 09/13/2017] [Accepted: 09/20/2017] [Indexed: 12/01/2022]
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18
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Rivas-Cobas PC, Ramírez-Duque N, Gómez Hernández M, García J, Agustí A, Vidal X, Formiga F, López-Soto A, Torres OH, San-José A. Características del uso inadecuado de medicamentos en pacientes pluripatológicos de edad avanzada. Gaceta Sanitaria 2017; 31:327-331. [DOI: 10.1016/j.gaceta.2016.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 06/19/2016] [Accepted: 06/20/2016] [Indexed: 11/27/2022]
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19
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Reddel HK, Gerhardsson de Verdier M, Agustí A, Beasley R, Bel EH, Janson C, Make B, Martin RJ, Pavord I, Postma D, Price D, Keen C, Gardev A, Rennard S, Sveréus A, Bansal AT, Brannman L, Karlsson N, Nuevo J, Nyberg F, Young S, Vestbo J. P138 An innovative approach to study design: using electronic medical records to inform the feasibility and design of the novelty study (a novel observational longitudinal study on patients with asthma and/or COPD). Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Antonia Agustí
- Clinical Pharmacology Service, Department of Pharmacology, Therapeutics and Toxicology, Fundació Institut Català de Farmacologia, Hospital Universitari Vall D'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio San José
- Internal Medicine Service, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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21
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Formiga F, Vidal X, Agustí A, Chivite D, Rosón B, Barbé J, López-Soto A, Torres OH, Fernández-Moyano A, García J, Ramírez-Duque N, San José A. Inappropriate prescribing in elderly people with diabetes admitted to hospital. Diabet Med 2016; 33:655-62. [PMID: 26333026 DOI: 10.1111/dme.12894] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 11/29/2022]
Abstract
AIMS To assess inappropriate prescribing in older people with diabetes mellitus during the month prior to a hospitalization, using tools on potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs) and comparing inappropriate prescribing in patients with without diabetes. METHODS In an observational, prospective multicentric study, we assessed inappropriate prescribing in 672 patients aged 75 years and older during hospital admission. The Beers, Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert Doctors to Right Treatment (START) criteria and Assessing Care of Vulnerable Elders (ACOVE-3) medicine quality indicators were used. We analysed demographic and clinical factors associated with inappropriate prescribing. RESULTS Of 672 patients, 249 (mean age 82.4 years, 62.9% female) had a diagnosis of diabetes mellitus. The mean number of prescribing drugs per patient with diabetes was 12.6 (4.5) vs. 9.4 (4.3) in patients without diabetes (P < 0.001). Of those patients with diabetes, 74.2% used 10 or more medications; 54.5% of patients with diabetes had at least one Beers-listed PIM, 68.1% had at least one STOPP-listed PIM, 64.6% had at least one START-listed PPO and 62.8% had at least one ACOVE-3-listed PPO. Except for the Beers criteria, these prevalences were significantly higher in patients with diabetes than in those without. After excluding diabetes-related items from these tools, only STOPP-listed PIMs remained significantly higher among patients with diabetes (P = 0.04). CONCLUSIONS Polypharmacy is common among older patients with diabetes mellitus. Inappropriate prescribing is higher in older patients with diabetes, even when diabetes-related treatment is excluded from the inappropriate prescribing evaluation.
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Affiliation(s)
- F Formiga
- Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
| | - X Vidal
- Clinical Pharmacology Service, Fundació Institut Català de Farmacologia, Hospital Universitari Vall D'Hebron, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Agustí
- Clinical Pharmacology Service, Fundació Institut Català de Farmacologia, Hospital Universitari Vall D'Hebron, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - D Chivite
- Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
| | - B Rosón
- Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - J Barbé
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona
| | - A López-Soto
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital Clínic, Barcelona, Spain
| | - O H Torres
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Fernández-Moyano
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital San Juan De Dios del Aljarafe, Seville, Spain
| | - J García
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicina Service, Hospital General Juan Ramón Jiménez, Huelva, Spain
| | - N Ramírez-Duque
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - A San José
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona
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Pozo-Rodríguez F, Castro-Acosta A, Alvarez CJ, López-Campos JL, Forte A, López-Quilez A, Agustí A, Abraira V. Determinants of between-hospital variations in outcomes for patients admitted with COPD exacerbations: findings from a nationwide clinical audit (AUDIPOC) in Spain. Int J Clin Pract 2015; 69:938-47. [PMID: 25651319 PMCID: PMC5024082 DOI: 10.1111/ijcp.12601] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated significant variability in the processes of care and outcomes of chronic obstructive pulmonary disease (COPD) exacerbations. The AUDIPOC is a Spanish nationwide clinical audit that identified large between-hospital variations in care and clinical outcomes. Here, we test the hypothesis that these variations can be attributed to either patient characteristics, hospital characteristics and/or the so-called hospital-clustering effect, which indicates that patients with similar characteristics may experience different processes of care and outcomes depending on the hospital to which they are admitted. METHODS A clinical audit of 5178 COPD patients consecutively admitted to 129 Spanish public hospitals was performed, with a 90-day follow-up. Multilevel regression analysis was conducted to model the probability of patients experiencing adverse outcomes. For each outcome, an empty model (with no independent variables) was fitted to assess the clustering effect, followed by a model adjusted for the patient- and hospital-level covariables. The hospital-clustering effect was estimated using the intracluster correlation coefficient (ICC); the cluster heterogeneity was estimated with the median odds ratio (MOR), and the coefficients of predictors were estimated with the odds ratio (OR). RESULTS In the empty models, the ICC (MOR) for inpatient mortality and the follow-up mortality and readmission were 0.10 (1.80), 0.08 (1.65) and 0.01 (1.24), respectively. In the adjusted models, the variables that most represented the patients' clinical conditions and interventions were identified as outcome predictors and further reduced the hospital variations. By contrast, the resource factors were primarily unrelated with outcomes. CONCLUSIONS This study demonstrates a noteworthy reduction in the observed crude between-hospital variation in outcomes after accounting for the hospital-cluster effect and the variables representing patient's clinical conditions. This emphasises the predictor importance of the patients' clinical conditions and interventions, and understates the impacts of hospital resources and organisational factors.
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Affiliation(s)
- F Pozo-Rodríguez
- Pulmonary Service and Research Institute, Doce de Octubre University Hospital, Madrid, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - A Castro-Acosta
- Pulmonary Service and Research Institute, Doce de Octubre University Hospital, Madrid, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - C J Alvarez
- Pulmonary Service and Research Institute, Doce de Octubre University Hospital, Madrid, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - J L López-Campos
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, Spain
| | - A Forte
- Department of Economics, Universitat Jaume I, Castellón, Spain
| | - A López-Quilez
- Department of Statistics and Operational Research, University of Valencia, Valencia, Spain
| | - A Agustí
- Thorax Institute, Hospital Clinic, IDIBAPS, Universitat de Barcelona and CIBER Enfermedades Respiratorias, FISIB, Mallorca, Spain
| | - V Abraira
- Unidad de Bioestadística Clínica Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain
- Centre for Biomedical Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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Iavecchia M, Safiya A, Bosch M, Sabaté M, Camps A, Biarnès A, Lalueza P, Pons V, Villar M, Agustí A. Perioperative Management and Outcomes of Patients Treated With Antithrombotics Submitted To Elective Surgery. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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San-José A, Agustí A, Vidal X, Formiga F, Gómez-Hernández M, García J, López-Soto A, Ramírez-Duque N, Torres OH, Barbé J. Inappropriate prescribing to the oldest old patients admitted to hospital: prevalence, most frequently used medicines, and associated factors. BMC Geriatr 2015; 15:42. [PMID: 25887546 PMCID: PMC4403827 DOI: 10.1186/s12877-015-0038-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/24/2015] [Indexed: 12/05/2022] Open
Abstract
Background Scientific evidence on treatments of chronic diseases in patients 85 years old or older is very limited, as is available information on inappropriate prescription (IP) and its associated factors. The study aimed to describe medicine prescription, potentially inappropriate medicines (PIM) and potentially prescribing omissions (PPO) and their associated factors on this population. Methods In the context of an observational, prospective and multicentric study carried out in elderly patients admitted to seven Spanish hospitals for a year, a sub-analysis of those aged 85 years and over was performed. To assess PIMs, the Beers and STOPP criteria were used, and to assess PPOs, the START and the ACOVE-3 criteria were used. To assess factors associated with IP, a multivariate logistic regression analysis was performed. Patients were selected randomly every week on consecutive days from the hospitalization lists. Results A total of 336 patients were included in the sub-analysis with a median (Q1-Q3) age of 88 (86–90) years. The median medicines taken during the month prior to admission was 10 (7–13). Forty-seven point two per cent of patients had at least one Beers-listed PIM, 63.3% at least one STOPP-listed PIM, 53.6% at least one START-listed PPO, and 59.4% at least one ACOVE-3-listed PPO. Use of benzodiazepines in patients who are prone to falls (18.3%) and omission of calcium and vitamin D supplements in patients with osteoporosis (13.3%) were the most common PIM and PPO, respectively. The main factor associated with the Beers-listed and the STOPP-listed PIM was consumption of 10 or more medicines (OR = 5.7, 95% CI 1.8-17.9 and OR = 13.4, 95% CI 4.0-44.0, respectively). The main factors associated with the START-listed PPO was a non-community dwelling origin (OR 2.3, 95% CI 1.0-5.0), and multimorbidity (OR1.8, 95% CI 1.0-3.1). Conclusions Prescribed medicines and PIM and PPO prevalence were high among patients 85 years and over. Benzodiazepine use in those who are prone to falls and omission of calcium and vitamin D in those with osteoporosis were the most frequent PIM and PPO, respectively. Factors associated with PIM and PPO differed with polypharmacy being the most important factor associated with PIM. Electronic supplementary material The online version of this article (doi:10.1186/s12877-015-0038-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Antonio San-José
- Internal Medicine Service, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Àrea General 3ª planta, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain. .,Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain.
| | - Antonia Agustí
- Clinical Pharmacology Service, Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Departament of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Xavier Vidal
- Clinical Pharmacology Service, Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Departament of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Francesc Formiga
- Internal Medicine Service, Hospital Universitari de Bellvitge. Hospitalet de Llobregat, Barcelona, Spain. .,Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain.
| | - Mercedes Gómez-Hernández
- Internal Medicine Service, Hospital San Juan De Dios del Aljarafe, Sevilla, Spain. .,Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain.
| | - Juana García
- Internal Medicine Service, Hospital General Juan Ramón Jiménez, Huelva, Spain. .,Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain.
| | - Alfonso López-Soto
- Internal Medicine Service, Hospital Clínic, Barcelona, Spain. .,Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain.
| | - Nieves Ramírez-Duque
- Internal Medicine Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain. .,Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain.
| | - Olga H Torres
- Internal Medicine Service, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain.
| | - José Barbé
- Internal Medicine Service, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Àrea General 3ª planta, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain. .,Multimorbidity and elderly patients group of the Spanish Society of Internal Medicine, Barcelona, Spain.
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Plaza V, Crespo A, Giner J, Merino JL, Ramos-Barbón D, Mateus EF, Torrego A, Cosio BG, Agustí A, Sibila O. Inflammatory Asthma Phenotype Discrimination Using an Electronic Nose Breath Analyzer. J Investig Allergol Clin Immunol 2015; 25:431-437. [PMID: 26817140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Patients with persistent asthma have different inflammatory phenotypes. The electronic nose is a new technology capable of distinguishing volatile organic compound (VOC) breath-prints in exhaled breath. The aim of the study was to investigate the capacity of electronic nose breath-print analysis to discriminate between different inflammatory asthma phenotypes (eosinophilic, neutrophilic, paucigranulocytic) determined by induced sputum in patients with persistent asthma. METHODS Fifty-two patients with persistent asthma were consecutively included in a cross-sectional proof-of-concept study. Inflammatory asthma phenotypes (eosinophilic, neutrophilic and paucigranulocytic) were recognized by inflammatory cell counts in induced sputum. VOC breath-prints were analyzed using the electronic nose Cyranose 320 and assessed by discriminant analysis on principal component reduction, resulting in cross-validated accuracy values. Receiver operating characteristic (ROC) curves were calculated. RESULTS VOC breath-prints were different in eosinophilic asthmatics compared with both neutrophilic asthmatics (accuracy 73%; P=.008; area under ROC, 0.92) and paucigranulocytic asthmatics (accuracy 74%; P=.004; area under ROC, 0.79). Likewise, neutrophilic and paucigranulocytic breath-prints were also different (accuracy 89%; P=.001; area under ROC, 0.88). CONCLUSION An electronic nose can discriminate inflammatory phenotypes in patients with persistent asthma in a regular clinical setting. ClinicalTrials.gov identifier: NCT02026336.
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Danés I, Agustí A, Vallano A, Alerany C, Martínez J, Bosch JA, Ferrer A, Gratacós L, Pérez A, Olmo M, Marron SMC, Valderrama A, Bonafont X. Outcomes of off-label drug uses in hospitals: a multicentric prospective study. Eur J Clin Pharmacol 2014; 70:1385-93. [PMID: 25196202 PMCID: PMC4198805 DOI: 10.1007/s00228-014-1746-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 08/26/2014] [Indexed: 01/05/2023]
Abstract
PURPOSE The study aims to assess the clinical evidence, outcome and cost of off-label use of medicines in the hospital setting. METHODS A multicentric prospective cohort study of patients treated with off-label medicines was carried out in five tertiary hospitals from May 2011 to May 2012. Information on clinical characteristics of patients, drugs, outcomes and costs was collected. Patients were followed up to 6 months, and information was assessed by reviewing clinical records and interviewing physicians. RESULTS A total of 226 patients were included. The median (interquartile range (IQR)) age of patients was 46 (33-62) years; 59 % were women. Patients had received a median of three previous treatments, and a lack of response (or suboptimal) was the main reason for off-label use (72.1 %). A total of 232 off-label medicines were administered for 102 different indications. The most frequent medicines were rituximab (49; 21.1 %), botulinum toxin (25; 10.7 %) and omalizumab (14; 6.0 %). In 117 (51.8 %) cases, the level of clinical evidence for their use was low. A partial clinical response was observed in 82 patients (36.3 %), complete response in 71 (31.4 %) and stabilization in 11 (4.9 %). A total of 58 (26.5 %) patients had adverse effects, which in 11 (4.9 %) were severe. The median (IQR) cost per patient was 2,943.07 (541.9-5,872.54). CONCLUSIONS There was a high variability of off-label medicines and indications. Although the clinical evidence of off-label medicines was often low, clinical response was observed in many patients with previous multiple treatment failure, but at the expense of some adverse effects and a high cost. Registers of patients would be helpful for clinical decisions, although clinical trials are needed.
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Affiliation(s)
- I Danés
- Clinical Pharmacology Service, Fundació Institut Català de Farmacologia. Hospital Universitari Vall d'Hebron, Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron, 119-129, Barcelona, Spain,
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San-José A, Agustí A, Vidal X, Formiga F, López-Soto A, Fernández-Moyano A, García J, Ramírez-Duque N, Torres OH, Barbé J. Inappropriate prescribing to older patients admitted to hospital: a comparison of different tools of misprescribing and underprescribing. Eur J Intern Med 2014; 25:710-6. [PMID: 25179678 DOI: 10.1016/j.ejim.2014.07.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/25/2014] [Accepted: 07/28/2014] [Indexed: 02/03/2023]
Abstract
PURPOSE This study aims to assess inappropriate prescribing (IP) to elderly patients during the month prior to hospitalization and to compare different IP criteria. METHODS An observational, prospective and multicentric study was carried out in the internal medicine services of seven Spanish hospitals. Patients aged 75years and older were randomly selected after hospital admission for a year. To assess potentially inappropriate medicines (PIMs), the Beers and STOPP criteria were used and to assess potentially prescribing omissions (PPOs), the START criteria and ACOVE-3 medicine quality indicators were used. An analysis to assess factors associated with IP was performed. RESULTS 672 patients [median age (Q1-Q3) 82 (79-86) years, 55.9% female] were included. Median prescribed medicines in the month prior to hospitalization were 10(Q1-Q3 7-13). The prevalence of IP was 87.6%, and 54.3% of patients had PIMs and PPOs concurrently. A higher prevalence rate of PIMs was predicted using the STOPP criteria than with the Beers criteria (p<0.001) and a higher prevalence of PPOs using the ACOVE-3 criteria than using the START criteria (p<0.001) was observed. Polypharmacy (≥ 10 medicines) was the strongest predictor of IP [OR=11.34 95% confidence interval (CI) 4.96-25.94], PIMs [OR=14.16, 95% CI 6.44-31.12], Beers-listed PIMs [OR=8.19, 95% CI 3.01-22.28] and STOPP-listed PIMs [OR=8.21, 95% CI 3.47-19.44]. PIMs was the strongest predictor of PPOs [OR=2.79, 95% CI 1.81-4.28]. CONCLUSIONS A high prevalence of polypharmacy and PIMs and PPOs were reported. More than half the patients had simultaneous PIMs and PPOs. The related factors to PIMs and PPOs were different.
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Affiliation(s)
- Antonio San-José
- Internal Medicine Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain.
| | - Antonia Agustí
- Clinical Pharmacology Service, Hospital Universitari Vall D'Hebron,Spain; Fundació Institut Català de Farmacologia, Spain; Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Spain
| | - Xavier Vidal
- Clinical Pharmacology Service, Hospital Universitari Vall D'Hebron,Spain; Fundació Institut Català de Farmacologia, Spain; Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Spain
| | - Francesc Formiga
- Internal Medicine Service, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain
| | - Alfonso López-Soto
- Internal Medicine Service, Hospital Clínic, Barcelona, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain
| | - Antonio Fernández-Moyano
- Internal Medicine Service, Hospital San Juan De Dios del Aljarafe, Sevilla, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain
| | - Juana García
- Internal Medicine Service, Hospital General Juan Ramón Jiménez, Huelva, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain
| | - Nieves Ramírez-Duque
- Internal Medicine Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain
| | - Olga H Torres
- Universitat Autònoma de Barcelona, Barcelona, Spain; Internal Medicine Service, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain
| | - José Barbé
- Internal Medicine Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain
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San-José A, Agustí A, Vidal X, Barbé J, Torres OH, Ramírez-Duque N, García J, Fernández-Moyano A, López-Soto A, Formiga F. An inter-rater reliability study of the prescribing indicated medications quality indicators of the Assessing Care Of Vulnerable Elders (ACOVE) 3 criteria as a potentially inappropriate prescribing tool. Arch Gerontol Geriatr 2014; 58:460-4. [DOI: 10.1016/j.archger.2013.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 12/17/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
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Aguilera C, Agustí A. Fibrosis sistémica nefrogénica y contrastes de gadolinio. Med Clin (Barc) 2011; 136:643-5. [DOI: 10.1016/j.medcli.2010.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 11/03/2010] [Accepted: 11/04/2010] [Indexed: 11/30/2022]
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Vallano A, Pedrós C, Agustí A, Cereza G, Danés I, Aguilera C, Arnau JM. Educational sessions in pharmacovigilance: What do the doctors think? BMC Res Notes 2010; 3:311. [PMID: 21083899 PMCID: PMC2993731 DOI: 10.1186/1756-0500-3-311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 11/17/2010] [Indexed: 11/13/2022] Open
Abstract
Background The aim of this study was to determine physicians' opinion regarding pharmacovigilance feedback sessions. A survey was conducted in a teaching hospital, and the physicians who attended the sessions were invited to participate by filling out a structured questionnaire. All sessions included a review of adverse drug reactions identified at the hospital and information on pharmacovigilance issues (news on warnings released by regulatory agencies or drug toxicity problems identified by recently published studies in medical journals). The survey questions were related to the interest, satisfaction, and belief in the utility of the sessions. A Likert scale (0-10 points) was used to assess physicians' opinions. Findings A total of 159 physicians attended the sessions and 115 (72.3%) participated in the survey. The mean (SD) age was 38.9 (12.1) years, and 72 (62.6%) were men. The mean (SD) scores of interest, satisfaction with the information provided, and belief in the utility of these sessions were 7.52 (1.61), 7.58 (1.46), and 8.05 (1.38) respectively. Significant differences were observed among physicians according to medical category and speciality in terms of interest, satisfaction, and belief in the utility of those sessions. Conclusions Educational activities for physicians, such as feedback sessions, can be integrated into the pharmacovigilance activities. Doctors who attend the sessions are interested in and satisfied with the information provided and consider the sessions to be useful. Additional studies on the development and effectiveness of educational activities in pharmacovigilance are necessary.
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Affiliation(s)
- Antonio Vallano
- Clinical Pharmacology Service, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital-ICS, Department of Pathology and Experimental Therapeutics, University of Barcelona, Feixa Llarga s/n, 08035 L'Hospitalet de Llobregat, Barcelona, Spain.
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Hernández-Bel P, de la Cuadra-Oyanguren J, Martínez L, López J, Agustí A, Alegre V. Dermatitis alérgica de contacto a quinina por una loción capilar anticaída. Actas Dermo-Sifiliográficas 2010. [DOI: 10.1016/j.ad.2009.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Hernández-Bel P, de la Cuadra-Oyanguren J, Martínez L, López J, Agustí A, Alegre V. [Contact allergic dermatitis to quinine in an anti-hair loss lotion]. Actas Dermosifiliogr 2010; 101:373-375. [PMID: 20487702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
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Hernández-Bel P, de la Cuadra-Oyanguren J, Martínez L, López J, Agustí A, Alegre V. Contact Allergic Dermatitis to Quinine in an Anti-hair Loss Lotion. Actas Dermo-Sifiliográficas (English Edition) 2010. [DOI: 10.1016/s1578-2190(10)70657-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Marin A, Monsó E, Garcia-Nuñez M, Sauleda J, Noguera A, Pons J, Agustí A, Morera J. Variability and effects of bronchial colonisation in patients with moderate COPD. Eur Respir J 2009; 35:295-302. [PMID: 19643939 DOI: 10.1183/09031936.00126808] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sputum and lung function were periodically assessed in stable moderate chronic obstructive pulmonary disease (COPD) outpatients to determine relationships between bronchial colonisation and inflammation. Relationships between potentially pathogenic microorganism (PPM) typology, bronchial inflammation (neutrophilia, tumour necrosis factor-alpha, interleukin (IL)-1beta, IL-6, IL-8, IL-10 and IL-12) and post-bronchodilator decline in forced expiratory volume in 1 s (FEV(1)) were analysed. PPMs periodically showing the same molecular profile using pulse field gel electrophoresis were considered long-term persistent. Bronchial colonisation was observed in 56 out of 79 follow-up examinations (70.9%) and was mainly due to Haemophilus influenzae, Pseudomonas aeruginosa and enterobacteria (n = 47). These PPMs were all related to sputum neutrophilia (p< or =0.05, Chi-squared test), and H. influenzae was related to higher levels of IL-1beta (p = 0.005) and IL-12 (p = 0.01), with a dose-response relationship (Spearman's correlation coefficient of 0.38 for IL-1beta (p = 0.001), and of 0.32 for IL-12 (p = 0.006)). Haemophilus parainfluenzae was not associated with an identifiable inflammatory response. Long-term persistence of the same strain was observed in 12 examinations (21.4%), mainly due to P. aeruginosa or enterobacteria. A neutrophilic bronchial inflammatory response was associated with a statistically significant decline in FEV(1) during follow-up (OR 2.67, 95% CI 1.07-6.62). A load-related relationship to bronchial inflammation in moderate COPD was observed for colonisation by H. influenzae, but not for colonisation by H. parainfluenzae.
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Affiliation(s)
- A Marin
- Servei de Pneumologia, Hospital Germans Trias i Pujol, Carretera de Canyet s/n, 08916 Badalona, Catalonia, Spain.
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Puente-Maestu L, Pérez-Parra J, Godoy R, Moreno N, Tejedor A, González-Aragoneses F, Bravo JL, Alvarez FV, Camaño S, Agustí A. Abnormal mitochondrial function in locomotor and respiratory muscles of COPD patients. Eur Respir J 2009; 33:1045-52. [PMID: 19129279 DOI: 10.1183/09031936.00112408] [Citation(s) in RCA: 126] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Several cellular and molecular alterations have been described in skeletal and respiratory muscles of patients with chronic obstructive pulmonary disease (COPD), but information on potential abnormalities of mitochondrial function is scarce. The aim of the present study was to investigate mitochondrial function in the vastus lateralis (VL) and external intercostalis (EI) of COPD patients. Biopsies from VL and EI were obtained during surgery for lung cancer in 13 patients with mild to moderate COPD (age 68+/-6 yrs, forced expiratory volume in one second (FEV(1)) 66+/-15% predicted) and 19 control subjects (age 67+/-9 yrs, FEV(1) 95+/-18% pred). State 3 and 4 mitochondrial oxygen consumption (V'(O(2),m)), ATP synthesis, citrate synthase, cytochrome oxidase (COX) and complex I-III activities, as well as reactive oxygen species (ROS) production, were determined. In COPD patients, in both muscles, COX activity (VL: COPD 3.0+/-0.8 versus control 2.0+/-0.8; EI: 3.7+/-1.6 versus 2.4+/-0.9 micromol min(-1) mg(-1)) and ROS production (VL: 1,643+/-290 versus 1,285+/-468; EI: 1,033+/-210 versus 848+/-288 arbitrary units) were increased, whereas state 3 V'(O(2),m) was reduced (VL: 2.9+/-0.3 versus 3.6+/-0.4; EI: 3.6+/-0.3 versus 4.1+/-0.4 mmol min(-1) kg(-1)). Skeletal muscle mitochondria of patients with chronic obstructive pulmonary disease show electron transport chain blockade and excessive production of reactive oxygen species. The concurrent involvement of both vastus lateralis and external intercostalis suggests a systemic (rather than a local) mechanism(s) already occurring in relatively early stages (Global Initiative for Chronic Obstructive Lung Disease stage II) of the disease.
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Affiliation(s)
- L Puente-Maestu
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Abstract
Fluticasone propionate reduces the frequency and severity of the episodes of exacerbation of chronic obstructive pulmonary disease (COPD). Streptococcus pneumoniae and Haemophilus influenzae are frequently isolated in these episodes. Both express phosphorylcholine, an epitope that mediates their interaction with airway epithelial cells via the platelet-activating factor receptor (PAFR). The present work studies the effects of fluticasone propionate on the expression of PAFR on human airway epithelial cells, the invasion of these cells by S. pneumoniae and H. influenzae, and the course of pneumococcal infection in vivo. The following were used in the experiments: S. pneumoniae and H. influenzae isolated from patients with COPD, cell cultures of type II pneumocytes and bronchoepithelial cells, and a mouse model of lung infection. Fluticasone propionate was found to reduce PAFR expression on the surface of the two cells types studied. All S. pneumoniae and H. influenzae isolates expressed phosphorylcholine. Treatment of both cells lines with fluticasone propionate reduced invasion of both microorganisms and reduced the bacterial load of mice infected with S. pneumoniae. Fluticasone propionate reduces the invasion of airway epithelial cells by Streptococcus pneumoniae and Haemophilus influenzae through its effect on platelet-activating factor receptor. These results may help explain the beneficial effects of fluticasone propionate on chronic obstructive pulmonary disease exacerbations.
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Affiliation(s)
- M Barbier
- University Institute of Health Sciences Research, University of the Balearic Islands, Palma de Mallorca, Spain
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Piérola J, Barceló A, de la Peña M, Barbé F, Soriano JB, Sánchez Armengol A, Martínez C, Agustí A. beta3-Adrenergic receptor Trp64Arg polymorphism and increased body mass index in sleep apnoea. Eur Respir J 2007; 30:743-7. [PMID: 17626108 DOI: 10.1183/09031936.00152006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Obesity is an important risk factor for obstructive sleep apnoea syndrome (OSAS), insulin resistance and cardiovascular disease. The substitution of tryptophan 64 with arginine (Trp64Arg) polymorphism (Arg variant) of the beta(3)-adrenergic receptor (ADRB3) has been associated with obesity. In this study, the prevalence of the Trp64Arg ADRB3 polymorphism in a large group of patients with OSAS and its association with body mass index (BMI), insulin resistance and hypertension were evaluated. ADRB3 genotype was determined in 387 patients with OSAS and 137 healthy subjects recruited from three Spanish tertiary hospitals. The distributions of the ADRB3 genotypes were similar in OSAS and controls, and, in a multivariate model, the risk of OSAS was not associated with the presence of the Arg variant of the ADRB3 gene. However, BMI was higher in those patients with OSAS who carried this genetic variant than in those with the Trp variant. Furthermore, a linear trend for higher BMI was found in those with the Arg variant (56, 75 and 100% for Trp/Trp, Trp/Arg and Arg/Arg, respectively). Insulin resistance, blood pressures and serum levels of lipids and glucose were not associated with the presence of the Arg variant of the ADRB3 gene. The presence of the arginine 64 allele of the beta(3)-adrenergic receptor gene does not increase the risk of obstructive sleep apnoea syndrome, but is associated with the development of obesity in those patients who suffer obstructive sleep apnoea syndrome.
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Affiliation(s)
- J Piérola
- Serveis de Anàlisis Cliniques i Pneumologia, Hospital Universitari Son Dureta, C/ Andrea Doria 55, 07014, Palma de Mallorca, Spain
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Abstract
Excessive daytime sleepiness (EDS) is not invariably present in patients with obstructive sleep apnoea syndrome (OSAS). The aim of the present study was to investigate polysomnographic determinants of EDS in patients with OSAS. EDS was assessed using the Epworth Sleepiness Scale (ESS) and the multiple sleep latency test (MSLT). Patients showed EDS whenever the ESS score was >10 and the MSLT score <5 min. Absence of EDS was defined as having an ESS score of <10 and an MSLT score of >10 min. In total, 23 male patients with EDS (mean+/-sd ESS and MSLT score 17+/-3 and 4+/-1 min, respectively) and 17 without EDS (ESS and MSLT score 5+/-2 and 16+/-3 min, respectively), were studied. Both groups exhibited a similar apnoea/hypopnoea index (62+/-18 versus 60+/-20 events.h(-1)). Patients with EDS exhibited shorter sleep latency (11+/-16 versus 18+/-18 min) and greater sleep efficiency (90+/-7 versus 82+/-13%) than those without EDS. Patients with EDS showed lower oxygenation (lowest arterial oxygen saturation 69+/-12 versus 79+/-8%; mean arterial oxygen saturation 87+/-6 versus 90+/-5%). Sleep stage distribution and arousal index did not differ between the groups. Patients with obstructive sleep apnoea syndrome and excessive daytime sleepiness are characterised by shorter sleep latency, increased sleep efficiency and worse nocturnal oxygenation than those without excessive daytime sleepiness. Nocturnal hypoxaemia can be a major determinant of excessive daytime sleepiness in patients with obstructive sleep apnoea syndrome.
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Affiliation(s)
- O Mediano
- Respiratory Dept, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida (IRBLLEIDA), Lleida, Spain
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MESH Headings
- Abnormalities, Drug-Induced/etiology
- Abortion, Habitual/drug therapy
- Abortion, Habitual/prevention & control
- Abortion, Spontaneous/chemically induced
- Adult
- Animals
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Anti-Inflammatory Agents, Non-Steroidal/adverse effects
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Anticoagulants/administration & dosage
- Anticoagulants/therapeutic use
- Antiphospholipid Syndrome/drug therapy
- Aspirin/administration & dosage
- Aspirin/adverse effects
- Aspirin/therapeutic use
- Cerebral Hemorrhage/chemically induced
- Cohort Studies
- Confidence Intervals
- Controlled Clinical Trials as Topic
- Drug Therapy, Combination
- Female
- Fetal Diseases/chemically induced
- Hemorrhage/chemically induced
- Heparin/administration & dosage
- Heparin/therapeutic use
- Humans
- Infant, Newborn
- Infant, Premature, Diseases/chemically induced
- Macaca mulatta
- Male
- Meta-Analysis as Topic
- Multicenter Studies as Topic
- Odds Ratio
- Platelet Aggregation Inhibitors/administration & dosage
- Platelet Aggregation Inhibitors/adverse effects
- Platelet Aggregation Inhibitors/therapeutic use
- Pre-Eclampsia/drug therapy
- Pre-Eclampsia/prevention & control
- Pregnancy
- Pregnancy Complications/chemically induced
- Pregnancy Complications/drug therapy
- Pregnancy Complications/prevention & control
- Pregnancy Trimester, Second
- Pregnancy Trimester, Third
- Risk Factors
- Rodentia
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Affiliation(s)
- Cristina Aguilera
- Fundació Institut Català de Farmacologia, Servicio de Farmacología Clínica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
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41
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Abstract
Anaemia of chronic disease (ACD), with chronically low levels of circulating haemoglobin, is an immune driven abnormality that occurs in many inflammatory diseases, and also in chronic heart failure. Although chronic obstructive pulmonary disease (COPD) is "traditionally" associated with polycythaemia, the systemic inflammation that is now recognised as a feature of COPD makes it a possible cause of ACD. If present in COPD, anaemia could worsen dyspnoea and limit exercise tolerance. Preliminary evidence suggests that anaemia in COPD patients may be more prevalent than expected, concerning 10-15% of patients suffering from severe forms of the disease. A database study conducted in 2,524 COPD patients being prescribed long-term oxygen therapy has shown that a low haematocrit is a strong predictor of survival in this population, before body mass index, and is associated with more hospitalisations and a longer cumulative duration of hospitalisation. COPD patients with low haemoglobin levels have a poorer prognosis than COPD patients with normal haemoglobin levels in the event of acute gastrointestinal bleeding or after elective aneurysm repair. Raising haemoglobinaemia through transfusion decreases minute ventilation and work of breathing in COPD patients. These preliminary evidences point to the need to study the prevalence of anaemia, and its physiological and clinical impact in chronic obstructive pulmonary disease. When this body of knowledge is available, the question of the putative benefits of raising haemoglobinaemia in chronic obstructive pulmonary disease will have to be addressed.
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Affiliation(s)
- T Similowski
- Service de Pneumologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and UPRES EA2397 Université Paris VI Pierre et Marie Curie, Paris, France.
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Vallano A, Cereza G, Pedròs C, Agustí A, Danés I, Aguilera C, Arnau JM. Obstacles and solutions for spontaneous reporting of adverse drug reactions in the hospital. Br J Clin Pharmacol 2006; 60:653-8. [PMID: 16305591 PMCID: PMC1884880 DOI: 10.1111/j.1365-2125.2005.02504.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIM To describe the opinions of hospital physicians concerning problems regarding the spontaneous reporting of adverse drug reactions (ADRs) and ways to solve them. METHODS A qualitative study was carried out. Fifteen focus groups were conducted among physicians working in a tertiary teaching hospital. A total of 208 physicians from different medical specialities participated. The focus group discussions were recorded by three different observers and the transcripts of each session were analysed for issues and themes emerging from the text. RESULTS Four types of obstacles to spontaneous reporting were considered particularly important: (i) problems with the ADR(S) diagnosis; (ii) problems with the usual workload and lack of time; (iii) problems related to the organization and activities of the pharmacovigilance system; (iv) and problems related to potential conflicts. The potential solutions suggested for improving spontaneous reporting were to define the kind of ADR(S) which should be reported, to facilitate an easy contact and quick access to the hospital pharmacovigilance system, to facilitate information and support for reporting and feedback of pharmacovigilance activities. CONCLUSIONS The perception of the different obstacles by the hospital physicians is an important factor in determining the causes of the underreporting of ADRs and addressing these obstacles could lead to an improvement in spontaneous reporting. A closer relationship between the doctors and the pharmacovigilance centre is suggested as a means of solving these problems. More information is needed to improve the spontaneous reporting of ADR(S) in specialized healthcare.
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Affiliation(s)
- A Vallano
- Fundació Institut Català de Farmacologia, WHO Collaborating Centre for Research and Training in Pharmacoepidemiology, Barcelona, Spain.
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45
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Affiliation(s)
- B G Cosío
- Servicio de Neumología, Hospital Universitario Son Dureta, Palma de Mallorca, Islas Baleares, España
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46
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Cosío BG, Agustí A. Empleo de esteroides inhalados en el tratamiento de la EPOC. Rev Clin Esp 2005; 205:24-6. [PMID: 15718014 DOI: 10.1016/s0014-2565(05)72473-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- B G Cosío
- Servicio de Neumología, Hospital Universitario Son Dureta, Palma de Mallorca
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Agustí A, Pozo F, Roca J, Rodríguez de Castro F, Salvatierra A. [Read me, please!]. Arch Bronconeumol 2005; 41:50-2. [PMID: 15676136 DOI: 10.1016/s1579-2129(06)60394-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- A Agustí
- Comité Técnico del Centro Respira de Investigación (CRI), SEPAR, Spain.
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48
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Diogène E, Agustí A. Réplica. Med Clin (Barc) 2004. [DOI: 10.1157/13064424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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49
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Diogène E, Agustí A. Cartas al editor. Med Clin (Barc) 2004; 123:237-8; author reply 239. [PMID: 15282083 DOI: 10.1016/s0025-7753(04)74473-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
BACKGROUND Weight loss, mostly due to skeletal muscle atrophy, is a frequent and clinically relevant problem in patients with chronic obstructive pulmonary disease (COPD). The molecular mechanisms underlying this phenomenon are unclear. This study sought to investigate whether activation of the nuclear transcription factor NF-kappaB and upregulation of the inducible form of nitric oxide synthase (iNOS) occur in the skeletal muscle of patients with COPD and low body weight as potential molecular mechanisms leading to cachexia METHODS NF-kappaB DNA binding activity was determined by electromobility shift assay and the immunoreactivity of its inhibitory subunit IkappaB-kappa and that of iNOS by Western blot analysis in biopsy specimens of the quadriceps femoris muscle of seven COPD patients with normal body mass index (BMI, 27.5 (1) kg/m(2)) and seven patients with low BMI (18.5 (1) kg/m(2)). RESULTS Compared with patients with normal body weight, those with low BMI showed a 30% increase in NF-kappaB DNA binding activity, a lower expression of IkappaB-alpha (3.37 (0.47) IOD v 5.96 (0.75) IOD, p<0.05; mean difference 2.59; 95% CI -4.53 to -0.65) and higher iNOS expression (1.51 (0.29) IOD v 0.78 (0.11) IOD, p<0.05; mean difference 0.74; 95% CI 0.04 to 1.42). CONCLUSIONS NF-kappaB activation and iNOS induction occur in skeletal muscle of COPD patients with low body weight. These changes might contribute to the molecular pathogenesis of cachexia in COPD.
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Affiliation(s)
- A Agustí
- Servei de Pneumologia, Hospital Universitari Son Dureta & Institut Universitari d'Investigacions en Ciencies de la Salut (IUNICS), Palma de Mallorca, Spain.
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