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Mourelatos P, Vrettou CS, Diamantopoulos A, Vassiliou AG, Jahaj E, Angelousi A, Pratikaki M, Katsaounou P, Kotanidou A, Vassiliadi DA, Dimopoulou I. A prospective study on endocrine function in patients with long-COVID symptoms. Hormones (Athens) 2024; 23:59-67. [PMID: 37996650 DOI: 10.1007/s42000-023-00511-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/01/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE To investigate hormonal status in patients with long-COVID and explore the interrelationship between hormone levels and long-COVID symptoms. DESIGN Prospective observational study. PARTICIPANTS Patients who visited our long-COVID outpatients' clinic due to long-COVID symptoms from February 2021 to December 2022. MEASUREMENTS Total triiodothyronine, free thyroxine, thyrotropin, thyroglobulin, anti-thyroperoxidase, and antithyroglobulin autoantibodies were measured for thyroid assessment. Other hormones measured were growth hormone, insulin-like growth factor 1 (IGF-1), adrenocorticotropic hormone (ACTH), serum cortisol, dehydroepiandrosterone sulfate (DHEA-S), total testosterone, plasma insulin, and C-peptide. Blood glucose and glycosylated hemoglobin were also measured. To assess adrenal reserve, an ACTH stimulation test was performed. The fatigue assessment scale (FAS) was used to evaluate fatigue severity. RESULTS Eighty-four adult patients were included. Overall, 40.5% of the patients had at least one endocrine disorder. These included prediabetes (21.4%), low DHEA-S (21.4%), subclinical hypothyroidism (3.6%), non-specific thyroid function abnormality (7.1%), thyroid autoimmunity (7.1%), low testosterone in males (6.6%), and low IGF-1 (3.6%). All patients had normal adrenal reserve. Long-COVID-19 symptoms were present in all patients and the most commonly reported symptom was fatigue (89.3%). The FAS score was higher than normal (≥ 22) in 42.8% of patients. There were no associations between patients' symptoms and hormone levels. Diabetic patients reported confusion (p = 0.020) and hair loss (p = 0.040) more often than non-diabetics. CONCLUSIONS The evaluation of endocrine function 3 months after a positive SARS-CoV2 test revealed only subclinical syndromes. The vast majority of patients reported mainly fatigue, among other symptoms, which were unrelated, however, to endocrine function.
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Affiliation(s)
- Panagiotis Mourelatos
- Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - Charikleia S Vrettou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece.
| | - Aristidis Diamantopoulos
- Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - Alice G Vassiliou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Edison Jahaj
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Anna Angelousi
- Unit of Endocrinology, First Department of Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Pratikaki
- Biochemical Department, Evangelismos Hospital, Athens, Greece
| | - Paraskevi Katsaounou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Dimitra A Vassiliadi
- Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - Ioanna Dimopoulou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece
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Athanasiou N, Diamantopoulos A, Keskinidou C, Katsaounou P, Angelousi A, Jahaj E, Mourelatos P, Vrettou CS, Botoula E, Vassiliou AG, Kotanidou A, Tsagarakis S, Dimopoulou I, Vassiliadi DA. Adrenal function in relation to cytokines and outcome in non-critically ill patients with COVID-19. J Endocrinol Invest 2024; 47:721-728. [PMID: 37702927 DOI: 10.1007/s40618-023-02189-y] [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: 06/06/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE We aimed to identify whether hypothalamic-pituitary-adrenal (HPA) axis dysfunction is related to deterioration in a percentage of patients who progress to severe COVID-19. METHODS In this cohort observational study, we evaluated HPA axis activation by measuring cortisol, adrenocorticotropic hormone (ACTH), dehydroepiandrosterone sulfate (DHEA-S) levels, whole blood expression levels of the key glucocorticoid receptor, GCR-α, and the glucocorticoid-induced leucine zipper (GILZ), and cytokines, as markers of the inflammatory phase, in 149 patients with respiratory infection admitted in the ward, without known adrenal disease and/or confounding medications (glucocorticoids). One hundred and four (104) patients were SARS-CoV-2 positive (C +) and controls consisted of 45 SARS-CoV-2-negative patients (NC). RESULTS No differences in cortisol levels were observed between the C + and the NC patients. Cortisol levels correlated with ACTH (r = 0.284, p = 0.001) and IL-6 (r = 0.289, p = 0.04). In C + patients, cortisol levels mainly correlated with IL-6 levels (r = 0.28; p = 0.017). GCR-α expression was significantly higher in C + patients compared to NC. Patients with higher cortisol levels were more likely to progress to respiratory function deterioration or die. Both GCR-α and GILZ expression were significantly higher in C + non-survivors. CONCLUSION Our findings indicate that cortisol serves as an indicator of disease severity. GILZ expression appears to be a more effective marker of mortality prediction in moderate COVID-19 cases. However, routine measurement of GILZ levels is currently unavailable. Elevated levels of cortisol may be indicative of patients with moderate COVID-19 who are at a higher risk of deterioration. This information can aid in identifying individuals who require early medical attention.
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Affiliation(s)
- N Athanasiou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - A Diamantopoulos
- Department of Endocrinology Diabetes and Metabolism, National and European Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - C Keskinidou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - P Katsaounou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - A Angelousi
- First Department of Internal Medicine, Unit of Endocrinology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - E Jahaj
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - P Mourelatos
- Department of Endocrinology Diabetes and Metabolism, National and European Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - C S Vrettou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - E Botoula
- Department of Endocrinology Diabetes and Metabolism, National and European Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - A G Vassiliou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - A Kotanidou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - S Tsagarakis
- Department of Endocrinology Diabetes and Metabolism, National and European Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - I Dimopoulou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - D A Vassiliadi
- Department of Endocrinology Diabetes and Metabolism, National and European Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece.
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Asimakos AT, Vassiliou AG, Keskinidou C, Spetsioti S, Antonoglou A, Vrettou CS, Mourelatos P, Diamantopoulos A, Pratikaki M, Athanasiou N, Jahaj E, Gallos P, Kotanidou A, Dimopoulou I, Orfanos SE, Katsaounou P. Persistent Endothelial Lung Damage and Impaired Diffusion Capacity in Long COVID. J Pers Med 2023; 13:1351. [PMID: 37763119 PMCID: PMC10533128 DOI: 10.3390/jpm13091351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Since the beginning of the pandemic, both COVID-19-associated coagulopathy biomarkers and a plethora of endothelial biomarkers have been proposed and tested as prognostic tools of severity and mortality prediction. As the pandemic is gradually being controlled, attention is now focusing on the long-term sequelae of COVID-19. In the present study, we investigated the role of endothelial activation/dysfunction in long COVID syndrome. This observational study included 68 consecutive long COVID patients and a healthy age and sex-matched control group. In both groups, we measured 13 endothelial biomarkers. Moreover, in the long COVID patients, we evaluated fatigue and dyspnea severity, lung diffusion capacity (DLCO), and the 6-min walk (6MWT) test as measures of functional capacity. Our results showed that markers of endothelial activation/dysfunction were higher in long COVID patients, and that soluble intracellular adhesion molecule 1 (sICAM-1) and soluble vascular adhesion molecule 1 (sVCAM-1) negatively correlated with lung diffusion and functional capacity (sICAM-1 vs. DLCO, r = -0.306, p = 0.018; vs. 6MWT, r = -0.263, p = 0.044; and sVCAM-1 vs. DLCO, r= -0.346, p = 0.008; vs. 6MWT, r = -0.504, p < 0.0001). In conclusion, evaluating endothelial biomarkers alongside clinical tests might yield more specific insights into the pathophysiological mechanisms of long COVID manifestations.
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Affiliation(s)
- Andreas T. Asimakos
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Alice G. Vassiliou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Chrysi Keskinidou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Stavroula Spetsioti
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Archontoula Antonoglou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Charikleia S. Vrettou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Panagiotis Mourelatos
- Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, 106 76 Athens, Greece; (P.M.); (A.D.)
| | - Aristidis Diamantopoulos
- Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, 106 76 Athens, Greece; (P.M.); (A.D.)
| | - Maria Pratikaki
- Biochemical Department, Evangelismos Hospital, 106 76 Athens, Greece;
| | - Nikolaos Athanasiou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Edison Jahaj
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Parisis Gallos
- Computational Biomedicine Laboratory, Department of Digital Systems, University of Piraeus, 185 34 Piraeus, Greece;
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Ioanna Dimopoulou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Stylianos E. Orfanos
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
| | - Paraskevi Katsaounou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.T.A.); (A.G.V.); (C.K.); (S.S.); (A.A.); (C.S.V.); (N.A.); (E.J.); (A.K.); (I.D.); (S.E.O.)
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Lakshminarayan R, Bent C, Taylor J, Bryant T, Ahmad R, Diamantopoulos A, Morgan RA. Developing day-case units: imperative for optimal patient care in interventional radiology. Clin Radiol 2023; 78:295-300. [PMID: 36702708 DOI: 10.1016/j.crad.2022.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/21/2022] [Accepted: 11/15/2022] [Indexed: 01/15/2023]
Abstract
As interventional radiology (IR) treatments have evolved, they have become less invasive, enabling rapid recovery, which expedites ambulation and promotes same-day discharge. As a result of this, a significant proportion of IR elective work can be provided using a day-case service model. Reconfiguration of IR services to increase day-case procedures using a dedicated IR day-case unit (RDU) to facilitate the passage of patients is vital to ensure best medical practice. The aim of this review is to discuss the benefits of day-case IR procedures, the optimal structure of an RDU, and to inform radiologists how to introduce and/or improve day-case IR services in their IR practice.
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Affiliation(s)
- R Lakshminarayan
- Department of Vascular Radiology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - C Bent
- Department of Radiology, University Hospitals Dorset, Dorset, UK
| | - J Taylor
- Interventional Radiology, Frimley Health Foundation Trust, Surrey, UK
| | - T Bryant
- Department of Radiology, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - R Ahmad
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - A Diamantopoulos
- Department of Interventional Radiology, Guys' and St Thomas' NHS Foundation Trust, London, UK; School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - R A Morgan
- Department of Radiology, St George's University Hospitals NHS Foundation Trust and St George's, University of London, London, UK.
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Bryant T, Ahmad R, Diamantopoulos A, Lakshminarayan R, Bent C, Taylor J, Morgan RA. Access to beds for interventional radiology patients: improving patient care. Clin Radiol 2023; 78:288-294. [PMID: 36707396 DOI: 10.1016/j.crad.2022.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 01/15/2023]
Abstract
This review describes the rationale in support of admitting rights for interventional radiologists and presents options for the management of interventional radiology (IR) inpatients. The manuscript also discusses wider aspects of IR involvement in inpatient treatment, such as income and funding for IR services, and the implications for IR as a clinical specialty.
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Affiliation(s)
- T Bryant
- Department of Radiology, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - R Ahmad
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - A Diamantopoulos
- Department of Interventional Radiology, Guys' and St. Thomas' NHS Foundation Trust, London, UK; School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - R Lakshminarayan
- Department of Vascular Radiology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - C Bent
- Department of Radiology, University Hospitals Dorset, Dorset, UK
| | - J Taylor
- Department of Radiology, Frimley Health Foundation Trust, Surrey, UK
| | - R A Morgan
- Department of Radiology, St George's University Hospitals NHS Foundation Trust and St George's, University of London, London, UK.
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Deutschbein T, Reimondo G, Di Dalmazi G, Bancos I, Patrova J, Vassiliadi DA, Nekić AB, Debono M, Lardo P, Ceccato F, Petramala L, Prete A, Chiodini I, Ivović M, Pazaitou-Panayiotou K, Alexandraki KI, Hanzu FA, Loli P, Yener S, Langton K, Spyroglou A, Kocjan T, Zacharieva S, Valdés N, Ambroziak U, Suzuki M, Detomas M, Puglisi S, Tucci L, Delivanis DA, Margaritopoulos D, Dusek T, Maggio R, Scaroni C, Concistrè A, Ronchi CL, Altieri B, Mosconi C, Diamantopoulos A, Iñiguez-Ariza NM, Vicennati V, Pia A, Kroiss M, Kaltsas G, Chrisoulidou A, Marina LV, Morelli V, Arlt W, Letizia C, Boscaro M, Stigliano A, Kastelan D, Tsagarakis S, Athimulam S, Pagotto U, Maeder U, Falhammar H, Newell-Price J, Terzolo M, Fassnacht M. Age-dependent and sex-dependent disparity in mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: an international, retrospective, cohort study. Lancet Diabetes Endocrinol 2022; 10:499-508. [PMID: 35533704 PMCID: PMC9679334 DOI: 10.1016/s2213-8587(22)00100-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The association between cortisol secretion and mortality in patients with adrenal incidentalomas is controversial. We aimed to assess all-cause mortality, prevalence of comorbidities, and occurrence of cardiovascular events in uniformly stratified patients with adrenal incidentalomas and cortisol autonomy (defined as non-suppressible serum cortisol on dexamethasone suppression testing). METHODS We conducted an international, retrospective, cohort study (NAPACA Outcome) at 30 centres in 16 countries. Eligible patients were aged 18 years or older with an adrenal incidentaloma (diameter ≥1 cm) detected between Jan 1, 1996, and Dec 31, 2015, and availability of a 1 mg dexamethasone suppression test result from the time of the initial diagnosis. Patients with clinically apparent hormone excess, active malignancy, or follow-up of less than 36 months were excluded. Patients were stratified according to the 0800-0900 h serum cortisol values after an overnight 1 mg dexamethasone suppression test; less than 50 nmol/L was classed as non-functioning adenoma, 50-138 nmol/L as possible autonomous cortisol secretion, and greater than 138 nmol/L as autonomous cortisol secretion. The primary endpoint was all-cause mortality. Secondary endpoints were the prevalence of cardiometabolic comorbidities, cardiovascular events, and cause-specific mortality. The primary and secondary endpoints were assessed in all study participants. FINDINGS Of 4374 potentially eligible patients, 3656 (2089 [57·1%] with non-functioning adenoma, 1320 [36·1%] with possible autonomous cortisol secretion, and 247 [6·8%] with autonomous cortisol secretion) were included in the study cohort for mortality analysis (2350 [64·3%] women and 1306 [35·7%] men; median age 61 years [IQR 53-68]; median follow-up 7·0 years [IQR 4·7-10·2]). During follow-up, 352 (9·6%) patients died. All-cause mortality (adjusted for age, sex, comorbidities, and previous cardiovascular events) was significantly increased in patients with possible autonomous cortisol secretion (HR 1·52, 95% CI 1·19-1·94) and autonomous cortisol secretion (1·77, 1·20-2·62) compared with patients with non-functioning adenoma. In women younger than 65 years, autonomous cortisol secretion was associated with higher all-cause mortality than non-functioning adenoma (HR 4·39, 95% CI 1·93-9·96), although this was not observed in men. Cardiometabolic comorbidities were significantly less frequent with non-functioning adenoma than with possible autonomous cortisol secretion and autonomous cortisol secretion (hypertension occurred in 1186 [58·6%] of 2024 patients with non-functioning adenoma, 944 [74·0%] of 1275 with possible autonomous cortisol secretion, and 179 [75·2%] of 238 with autonomous cortisol secretion; dyslipidaemia occurred in 724 [36·2%] of 1999 patients, 547 [43·8%] of 1250, and 123 [51·9%] of 237; and any diabetes occurred in 365 [18·2%] of 2002, 288 [23·0%] of 1250, and 62 [26·7%] of 232; all p values <0·001). INTERPRETATION Cortisol autonomy is associated with increased all-cause mortality, particularly in women younger than 65 years. However, until results from randomised interventional trials are available, a conservative therapeutic approach seems to be justified in most patients with adrenal incidentaloma. FUNDING Deutsche Forschungsgemeinschaft, Associazione Italiana per la Ricerca sul Cancro, Università di Torino.
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Affiliation(s)
- Timo Deutschbein
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany; Medicover Oldenburg MVZ, Oldenburg, Germany
| | - Giuseppe Reimondo
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Turin, Italy
| | - Guido Di Dalmazi
- Endocrinology and Prevention and Care of Diabetes Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater University of Bologna, Bologna, Italy
| | - Irina Bancos
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Jekaterina Patrova
- Department of Clinical Science and Education, Södersjukhuset AB, Karolinska Institutet, Stockholm, Sweden
| | - Dimitra Argyro Vassiliadi
- Department of Endocrinology, Diabetes, and Metabolism, National Expertise Centre for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - Anja Barač Nekić
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Miguel Debono
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Pina Lardo
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Filippo Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy
| | - Luigi Petramala
- Second Hypertension Unit, Department of Translational and Precision Medicine, University Sapienza, Rome, Italy
| | - Alessandro Prete
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes, and Metabolism, Birmingham Health Partners, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Iacopo Chiodini
- Istituto Auxologico Italiano, IRCCS, University of Milan, Milan, Italy
| | - Miomira Ivović
- Clinic for Endocrinology, Diabetes, and Metabolic Diseases, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Krystallenia I Alexandraki
- 1st Department of Propaedeutic and Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Paola Loli
- Department of Endocrinology, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Serkan Yener
- Department of Endocrinology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Katharina Langton
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Dresden, Dresden, Germany
| | - Ariadni Spyroglou
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitäts-Spital Zürich, Zürich, Switzerland; University Hospital Munich, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Tomaz Kocjan
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Department of Endocrinology, Diabetes, and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Sabina Zacharieva
- Department of Endocrinology, University Hospital of Endocrinology, Medical University, Sofia, Bulgaria
| | - Nuria Valdés
- Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Hospital Universitario de Cabueñes, Gijón, Spain
| | - Urszula Ambroziak
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Mari Suzuki
- Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health, Bethesda, MD, USA
| | - Mario Detomas
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Soraya Puglisi
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Turin, Italy
| | - Lorenzo Tucci
- Endocrinology and Prevention and Care of Diabetes Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater University of Bologna, Bologna, Italy
| | | | - Dimitris Margaritopoulos
- Department of Endocrinology, Diabetes, and Metabolism, National Expertise Centre for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - Tina Dusek
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Roberta Maggio
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Carla Scaroni
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy
| | - Antonio Concistrè
- Second Hypertension Unit, Department of Translational and Precision Medicine, University Sapienza, Rome, Italy
| | - Cristina Lucia Ronchi
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes, and Metabolism, Birmingham Health Partners, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Barbara Altieri
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Cristina Mosconi
- Endocrinology and Prevention and Care of Diabetes Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Diagnostic and Interventional Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Aristidis Diamantopoulos
- Department of Endocrinology, Diabetes, and Metabolism, National Expertise Centre for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - Nicole Marie Iñiguez-Ariza
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Valentina Vicennati
- Endocrinology and Prevention and Care of Diabetes Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater University of Bologna, Bologna, Italy
| | - Anna Pia
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Turin, Italy
| | - Matthias Kroiss
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany; University Hospital Munich, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Gregory Kaltsas
- 1st Department of Propaedeutic and Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Ljiljana V Marina
- Clinic for Endocrinology, Diabetes, and Metabolic Diseases, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Valentina Morelli
- Istituto Auxologico Italiano, IRCCS, University of Milan, Milan, Italy
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes, and Metabolism, Birmingham Health Partners, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Claudio Letizia
- Second Hypertension Unit, Department of Translational and Precision Medicine, University Sapienza, Rome, Italy
| | - Marco Boscaro
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy
| | - Antonio Stigliano
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Darko Kastelan
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Stylianos Tsagarakis
- Department of Endocrinology, Diabetes, and Metabolism, National Expertise Centre for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - Shobana Athimulam
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Rochester, MN, USA; Division of Endocrinology, Diabetes, Bone and Mineral Disorders, Henry Ford Health System, Detroit, MI, USA
| | - Uberto Pagotto
- Endocrinology and Prevention and Care of Diabetes Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater University of Bologna, Bologna, Italy
| | - Uwe Maeder
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Henrik Falhammar
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - John Newell-Price
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Massimo Terzolo
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Turin, Italy
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany; Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany.
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7
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Prete A, Subramanian A, Bancos I, Chortis V, Tsagarakis S, Lang K, Macech M, Delivanis DA, Pupovac ID, Reimondo G, Marina LV, Deutschbein T, Balomenaki M, O'Reilly MW, Gilligan LC, Jenkinson C, Bednarczuk T, Zhang CD, Dusek T, Diamantopoulos A, Asia M, Kondracka A, Li D, Masjkur JR, Quinkler M, Ueland GÅ, Dennedy MC, Beuschlein F, Tabarin A, Fassnacht M, Ivović M, Terzolo M, Kastelan D, Young WF, Manolopoulos KN, Ambroziak U, Vassiliadi DA, Taylor AE, Sitch AJ, Nirantharakumar K, Arlt W. Cardiometabolic Disease Burden and Steroid Excretion in Benign Adrenal Tumors : A Cross-Sectional Multicenter Study. Ann Intern Med 2022; 175:325-334. [PMID: 34978855 DOI: 10.7326/m21-1737] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Benign adrenal tumors are commonly discovered on cross-sectional imaging. Mild autonomous cortisol secretion (MACS) is regularly diagnosed, but its effect on cardiometabolic disease in affected persons is ill defined. OBJECTIVE To determine cardiometabolic disease burden and steroid excretion in persons with benign adrenal tumors with and without MACS. DESIGN Cross-sectional study. SETTING 14 endocrine secondary and tertiary care centers (recruitment from 2011 to 2016). PARTICIPANTS 1305 prospectively recruited persons with benign adrenal tumors. MEASUREMENTS Cortisol excess was defined by clinical assessment and the 1-mg overnight dexamethasone-suppression test (serum cortisol: <50 nmol/L, nonfunctioning adrenal tumor [NFAT]; 50 to 138 nmol/L, possible MACS [MACS-1]; >138 nmol/L and absence of typical clinical Cushing syndrome [CS] features, definitive MACS [MACS-2]). Net steroid production was assessed by multisteroid profiling of 24-hour urine by tandem mass spectrometry. RESULTS Of the 1305 participants, 49.7% had NFAT (n = 649; 64.1% women), 34.6% had MACS-1 (n = 451; 67.2% women), 10.7% had MACS-2 (n = 140; 73.6% women), and 5.0% had CS (n = 65; 86.2% women). Prevalence and severity of hypertension were higher in MACS-2 and CS than NFAT (adjusted prevalence ratios [aPRs] for hypertension: MACS-2, 1.15 [95% CI, 1.04 to 1.27], and CS, 1.37 [CI, 1.16 to 1.62]; aPRs for use of ≥3 antihypertensives: MACS-2, 1.31 [CI, 1.02 to 1.68], and CS, 2.22 [CI, 1.62 to 3.05]). Type 2 diabetes was more prevalent in CS than NFAT (aPR, 1.62 [CI, 1.08 to 2.42]) and more likely to require insulin therapy for MACS-2 (aPR, 1.89 [CI, 1.01 to 3.52]) and CS (aPR, 3.06 [CI, 1.60 to 5.85]). Urinary multisteroid profiling revealed an increase in glucocorticoid excretion from NFAT over MACS-1 and MACS-2 to CS, whereas androgen excretion decreased. LIMITATIONS Cross-sectional design; possible selection bias. CONCLUSION A cardiometabolic risk condition, MACS predominantly affects women and warrants regular assessment for hypertension and type 2 diabetes. PRIMARY FUNDING SOURCE Diabetes UK, the European Commission, U.K. Medical Research Council, the U.K. Academy of Medical Sciences, the Wellcome Trust, the U.K. National Institute for Health Research, the U.S. National Institutes of Health, the Claire Khan Trust Fund at University Hospitals Birmingham Charities, and the Mayo Clinic Foundation for Medical Education and Research.
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Affiliation(s)
- Alessandro Prete
- The Institute of Metabolism and Systems Research, University of Birmingham, Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, and Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom (A.P., V.C., K.L.)
| | - Anuradhaa Subramanian
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom (A.S.)
| | - Irina Bancos
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom, and Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota (I.B.)
| | - Vasileios Chortis
- The Institute of Metabolism and Systems Research, University of Birmingham, Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, and Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom (A.P., V.C., K.L.)
| | - Stylianos Tsagarakis
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece (S.T., M.B., A.D., D.A.V.)
| | - Katharina Lang
- The Institute of Metabolism and Systems Research, University of Birmingham, Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, and Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom (A.P., V.C., K.L.)
| | - Magdalena Macech
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland (M.M., T.B., A.K., U.A.)
| | - Danae A Delivanis
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota (D.A.D., C.D.Z., D.L., W.F.Y.)
| | - Ivana D Pupovac
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia (I.D.P., T.D., D.K.)
| | - Giuseppe Reimondo
- Division of Internal Medicine, University of Turin, San Luigi Hospital, Turin, Italy (G.R., M.T.)
| | - Ljiljana V Marina
- Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia (L.V.M., M.I.)
| | - Timo Deutschbein
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital Würzburg, University of Würzburg, Würzburg, and Medicover Oldenburg MVZ, Oldenburg, Germany (T.D.)
| | - Maria Balomenaki
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece (S.T., M.B., A.D., D.A.V.)
| | - Michael W O'Reilly
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom, and Department of Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Republic of Ireland (M.W.O.)
| | - Lorna C Gilligan
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom (L.C.G., C.J., K.N.M., A.E.T.)
| | - Carl Jenkinson
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom (L.C.G., C.J., K.N.M., A.E.T.)
| | - Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland (M.M., T.B., A.K., U.A.)
| | - Catherine D Zhang
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota (D.A.D., C.D.Z., D.L., W.F.Y.)
| | - Tina Dusek
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia (I.D.P., T.D., D.K.)
| | - Aristidis Diamantopoulos
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece (S.T., M.B., A.D., D.A.V.)
| | - Miriam Asia
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, and Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom (M.A.)
| | - Agnieszka Kondracka
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland (M.M., T.B., A.K., U.A.)
| | - Dingfeng Li
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota (D.A.D., C.D.Z., D.L., W.F.Y.)
| | - Jimmy R Masjkur
- Department of Medicine III and Institute of Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany (J.R.M.)
| | | | - Grethe Å Ueland
- Department of Endocrinology, Haukeland University Hospital, Bergen, Norway (G.Å.U.)
| | - M Conall Dennedy
- Department of Endocrinology, University Hospital Galway, Newcastle, Galway, Republic of Ireland (M.C.D.)
| | - Felix Beuschlein
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitäts Spital Zürich (USZ) und Universität Zürich (UZH), Zurich, Switzerland, and Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, Munich, Germany (F.B.)
| | - Antoine Tabarin
- Service d'Endocrinologie, Centre Hospitalier Universitaire de Bordeaux, Hôpital du Haut-Lévêque, Pessac, France (A.T.)
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital Würzburg, University of Würzburg, Würzburg, Germany (M.F.)
| | - Miomira Ivović
- Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia (L.V.M., M.I.)
| | - Massimo Terzolo
- Division of Internal Medicine, University of Turin, San Luigi Hospital, Turin, Italy (G.R., M.T.)
| | - Darko Kastelan
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia (I.D.P., T.D., D.K.)
| | - William F Young
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota (D.A.D., C.D.Z., D.L., W.F.Y.)
| | - Konstantinos N Manolopoulos
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom (L.C.G., C.J., K.N.M., A.E.T.)
| | - Urszula Ambroziak
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland (M.M., T.B., A.K., U.A.)
| | - Dimitra A Vassiliadi
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece (S.T., M.B., A.D., D.A.V.)
| | - Angela E Taylor
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom (L.C.G., C.J., K.N.M., A.E.T.)
| | - Alice J Sitch
- Institute of Applied Health Research, University of Birmingham, and NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom (A.J.S.)
| | - Krishnarajah Nirantharakumar
- Institute of Metabolism and Systems Research, University of Birmingham, Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, and Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom (K.N.)
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, and NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom (W.A.)
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8
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Ilias I, Pratikaki M, Diamantopoulos A, Jahaj E, Mourelatos P, Athanasiou N, Tsipilis S, Zacharis A, Vassiliou AG, Vassiliadi DA, Tsagarakis S, Kotanidou A, Dimopoulou I. Testosterone, free, bioavailable and total, in patients with COVID-19. Minerva Endocrinol (Torino) 2021; 47:111-116. [PMID: 34546019 DOI: 10.23736/s2724-6507.21.03610-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Low Testosterone (mainly total testosterone; TTe) has been noted in patients with COVID-19. Calculated free testosterone (FTe) and bioavailable testosterone (BavTe) may reflect more accurately this hormone's levels. In this study, we sought to assess TTe, FTe as well as BavTe in male patients with COVID-19. SUBJECTS/METHODS Sera were collected upon admission from 65 men (10 in the intensive care units [ICU] and 55 in the wards) with polymerase chain reaction - proven COVID-19. A group of age-matched COVID-19-negative men (n=29) hospitalized in general medical wards served as controls. Age, body mass index (BMI) and 28-day mortality were noted. Measurements included TTe, sex-hormone binding globulin, albumin (the latter two for calculating FTe and BavTe) and laboratory markers of inflammation (white blood cell count [WBC], D-Dimers [D-D], lactate dehydrogenease [LDH], ferritin [Fer] and C-reactive protein [CRP]). RESULTS Profoundly low TTe, FTe and BavTe were noted in most patients, and were associated with disease severity/outcome (being the lowest in COVID-19 patients in the ICU and overall being lower in non-survivors; analysis of covariance p<0.05). Pearson's correlations for logTe, logFTe or logBavTe versus WBC, D-D, LDH, Ferr or CRP were negative, ranging from -0.403 to -0.293 (p=0.009 to 0.014). CONCLUSIONS TTe, FTe and BavTe are prone to be low in patients with COVID-19, are negatively associated with disease severity and may be considered to have prognostic value.
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Affiliation(s)
- Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece -
| | - Maria Pratikaki
- Department of Microbiology, Evangelismos Hospital, Athens, Greece
| | | | - Edison Jahaj
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School of National & Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Mourelatos
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Nikolaos Athanasiou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School of National & Kapodistrian University of Athens, Athens, Greece
| | | | - Alexandros Zacharis
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School of National & Kapodistrian University of Athens, Athens, Greece
| | - Alice G Vassiliou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School of National & Kapodistrian University of Athens, Athens, Greece
| | - Dimitra A Vassiliadi
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Stylianos Tsagarakis
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School of National & Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Dimopoulou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos Hospital, Medical School of National & Kapodistrian University of Athens, Athens, Greece
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9
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Vassiliadi DA, Ilias I, Pratikaki M, Jahaj E, Vassiliou AG, Detsika M, Ampelakiotou K, Koulenti M, Manolopoulos KN, Tsipilis S, Gavrielatou E, Diamantopoulos A, Zacharis A, Athanasiou N, Orfanos S, Kotanidou A, Tsagarakis S, Dimopoulou I. Thyroid hormone alterations in critically and non-critically ill patients with SARS-CoV-2 infection. Endocr Connect 2021; 10:646-655. [PMID: 34010152 PMCID: PMC8240704 DOI: 10.1530/ec-21-0029] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/19/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Following the evolution of COVID-19 pandemic, reports pointed on a high prevalence of thyroiditis-related thyrotoxicosis. Interpretation of thyroid tests during illness, however, is hampered by changes occurring in the context of non-thyroidal illness syndrome (NTIS). In order to elucidate these findings, we studied thyroid function in carefully selected cohorts of COVID-19 positive and negative patients. DESIGN Cohort observational study. METHODS We measured TSH, FT4, T3 within 24 h of admission in 196 patients without thyroid disease and/or confounding medications. In this study, 102 patients were SARS-CoV-2 positive; 41 admitted in the ICU, 46 in the ward and 15 outpatients. Controls consisted of 94 SARS-CoV-2 negative patients; 39 in the ICU and 55 in the ward. We designated the thyroid hormone patterns as consistent with NTIS, thyrotoxicosis and hypothyroidism. RESULTS A NTIS pattern was encountered in 60% of ICU and 36% of ward patients, with similar frequencies between SARS-CoV-2 positive and negative patients (46.0% vs 46.8%, P = NS). A thyrotoxicosis pattern was observed in 14.6% SARS-CoV-2 ICU patients vs 7.7% in ICU negative (P = NS) and, overall in 8.8% of SARS-CoV-2 positive vs 7.4% of negative patients. In these patients, thyroglobulin levels were similar to those with normal thyroid function or NTIS. The hypothyroidism pattern was rare. CONCLUSIONS NTIS pattern is common and relates to the severity of disease rather than SARS-CoV-2 infection. A thyrotoxicosis pattern is less frequently observed with similar frequency between patients with and without COVID-19. It is suggested that thyroid hormone monitoring in COVID-19 should not differ from other critically ill patients.
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Affiliation(s)
- Dimitra Argyro Vassiliadi
- Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
- Correspondence should be addressed to D A Vassiliadi:
| | - Ioannis Ilias
- Department of Endocrinology Diabetes and Metabolism, Elena Venizelou Hospital, Elena Venizelou Square, Athens, Greece
| | - Maria Pratikaki
- 1st Department of Critical Care & Pulmonary Services, Medical School National & Kapodistrian, Evangelismos Hospital, University of Athens, Athens, Greece
| | - Edison Jahaj
- 1st Department of Critical Care & Pulmonary Services, Medical School National & Kapodistrian, Evangelismos Hospital, University of Athens, Athens, Greece
| | - Alice G Vassiliou
- 1st Department of Critical Care, GP Livanos & M Simou Laboratories, Medical School National & Kapodistrian, Evangelismos Hospital, University of Athens, Athens, Greece
| | - Maria Detsika
- 1st Department of Critical Care, GP Livanos & M Simou Laboratories, Medical School National & Kapodistrian, Evangelismos Hospital, University of Athens, Athens, Greece
| | - Kleio Ampelakiotou
- Department of Immunology and Histocompatibility Evangelismos Hospital, Athens, Greece
| | - Marina Koulenti
- Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - Konstantinos N Manolopoulos
- Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - Stamatis Tsipilis
- 1st Department of Critical Care & Pulmonary Services, Medical School National & Kapodistrian, Evangelismos Hospital, University of Athens, Athens, Greece
| | - Evdokia Gavrielatou
- 1st Department of Critical Care & Pulmonary Services, Medical School National & Kapodistrian, Evangelismos Hospital, University of Athens, Athens, Greece
| | - Aristidis Diamantopoulos
- Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - Alexandros Zacharis
- 1st Department of Critical Care & Pulmonary Services, Medical School National & Kapodistrian, Evangelismos Hospital, University of Athens, Athens, Greece
| | - Nicolaos Athanasiou
- 1st Department of Critical Care & Pulmonary Services, Medical School National & Kapodistrian, Evangelismos Hospital, University of Athens, Athens, Greece
| | - Stylianos Orfanos
- 2nd Department of Critical Care Medical School National & Kapodistrian University of Athens Attikon University Hospital, Athens-Haidari, Greece
| | - Anastasia Kotanidou
- 1st Department of Critical Care & Pulmonary Services, Medical School National & Kapodistrian, Evangelismos Hospital, University of Athens, Athens, Greece
| | - Stylianos Tsagarakis
- Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - Ioanna Dimopoulou
- 1st Department of Critical Care & Pulmonary Services, Medical School National & Kapodistrian, Evangelismos Hospital, University of Athens, Athens, Greece
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Haugeberg G, Bakland G, Rødevand E, Widding Hansen IJ, Diamantopoulos A, Pripp AH. POS0612 EXPLORING EQUIVALENCE BETWEEN BIOSIMILAR SB4 AND REFERENCE ETANERCEPT BY ASSESSING EFFECTIVENESS IN RHEUMATOID ARTHRITIS PATIENTS TREATED IN ORDINARY CLINICAL PRACTICE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Biosimilar drugs follow a tailored approval pathway that usually includes a Phase III comparative efficacy randomized controlled trial with a high internal but low external validity. Therefore, observational studies with high external validity are important to reassure patients and physicians that there are no clinically meaningful differences in effectiveness between a biosimilar and its reference drug. A EULAR Task Force systematic review and others have noted that recent comparative effectiveness studies often do not disclose applied analytical methods in sufficient detail, with many studies not adjusting for confounders nor accounting for attrition or missing data. 1,2Objectives:To apply the EULAR Points to Consider for Comparative Effectiveness Research (CER) in an analysis of reference etanercept (ETN) and SB4 biosimilar ETN in patients with rheumatoid arthritis (RA) treated in ordinary clinical practice in Norway.Methods:ETN-naÏve patients with RA starting ETN treatment between January 2010 and July 2018 at five centres in Norway were followed for at least 1 year; the 2 cohorts remained on either ETN or SB4 throughout. The primary outcome was DAS28 at Week 52. This CER has been designed to formally assess equivalence for DAS28, based on the accepted equivalence margin of 0.6.3 Conventional regression and propensity score (PS) models have been applied for the primary outcome evaluation of DAS28 at Week 52. Based on clinical knowledge, the confounders adjusted for in the step-wise PS model were age, gender, DAS28, order of biologics, and concomitant conventional synthetic disease-modifying anti-rheumatic drugs. A standardized difference (d) of <0.1 indicates a good match.Results:In the unmatched sample, there were 575 patients treated with reference ETN and 299 treated with SB4. Before PS matching, baseline mean (SD) DAS28 was different between the ETN and SB4 groups, 4.3 (1.2) vs 4.0 (1.3), (d) = 0.25. After PS matching, there were 176 RA patients in each group; baseline mean (SD) DAS28 was 4.1 (1.2) vs 4.1 (1.3), (d) = 0.05. At Week 52, the difference (mean [95% confidence interval (CI)]) between reference ETN and SB4 for primary outcome DAS28 at Week 52 was -0.02 (-0.33 to 0.29) in the unmatched analysis. Since the entire 95% CI is within the pre-defined equivalence margin of 0.6, equivalence at Week 52 has formally been shown. The analysis of the PS matched groups to Week 52 is ongoing and results will be presented in the poster.Conclusion:Our results show the importance of adopting proper analytical techniques when comparing a biosimilar with its reference product. A conventional regression model may not fully account for differences in key clinical measures (in this instance, disease activity) between the two groups at baseline, and therefore the Week 52 results might be biased. The propensity score matched model ensures comparability of the groups at baseline and therefore the validity of the Week 52 results should be more robust.References:[1]Cantini F and Benucci M. Mandatory, cost-driven switching from originator etanercept to its biosimilar SB4: possible fallout on non-medical switching. Ann Rheum Dis 2020; 79: e13.[2]Lauper K KJ, De Wit M, Fautrel B, et al. A Systematic Review to Inform the EULRA Points to Consider When Analysing and Reporting Comparative Effectiveness Research With Observational Data in Rheumatology. Annals of the Rheumatic Diseases 2020; 79:[3]Fransen J and van Riel PL. The Disease Activity Score and the EULAR response criteria. Clin Exp Rheumatol 2005; 23: S93-99.Acknowledgements:The authors wish to acknowledge Janet Addison and Ulrich Freudensprung of Biogen for their intellectual contributions to this abstract and Bjørg Tilde Fevang for providing data from Haukeland University Hospital in Bergen. Editorial support for the preparation of this abstract was provided by Excel Scientific Solutions (Fairfield, CT, USA); funding was provided by Biogen International GmbH.Disclosure of Interests:Glenn Haugeberg Grant/research support from: Biogen, Gunnstein Bakland: None declared, Erik Rødevand: None declared, Inger Johanne Widding Hansen: None declared, Andreas Diamantopoulos: None declared, Are Hugo Pripp: None declared
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Brkic A, Diamantopoulos A, Haugeberg G. OP0238 DRUG COST FOR BIOLOGIC AND TARGETED SYNTHETIC DMARDS FOR RHEUMATOID ARTHRITIS PATIENTS IN NORWAY FROM 2010 TO 2019 - A COUNTRY WITH A NATIONAL TENDER SYSTEM FOR DRUG PRESCRIPTION. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Biologic and Target Synthetic disease-modifying antirheumatic drugs (BTSs) have caused a paradigm shift in the treatment of patients with inflammatory joint disorders, e.g., rheumatoid arthritis (RA), where remission is now attainable [1]. The high cost of BTSs has caused restrictions on use and prescription, contributing to inequality of care worldwide [2]. An annual tender system was introduced in 2008 in Norway to reduce the costs of these drugs [3].Objectives:Explore changes in drug costs for BTSs for RA patients treated at Norwegian rheumatology outpatient clinics between 2010 and 2019.Methods:The project BioRheuma (BIOlogic treatment of patients suffering from inflammatory RHEUMAtic disorders in Norway) aimed to monitor patients treated with BTSs while using a designed computer program. Anonymized data files from the ten participating centers were merged and analyzed (EXCEL and SPSS). For each year in the ten-year period, the annual total cost for BTSs and mean BTS cost for treatment of one patient was calculated for all current BTSs users, for all those who started BTSs, and for patients starting naïve to BTSs. The cost was calculated based on price offers given at the annual tender process for the different years.Results:The number of registered RA patients in the databases increased from 4909 in 2010 to 9335 in 2019. Simultaneously, the number of patients treated with BTSs increased from 1959 (39.9%) in 2010 to 4209 (45.1%) in 2019. The total treatment expenditure of these BTS treated patients was lowest in 2010 with 226 million Norwegian Kroner (NOK), highest in 2014 (350 million NOK) treating 3448 patients, and second-lowest in 2019 (255 million NOK).The number of BTSs used for each year (Figure 1) is shown for all current users, all who started new BTSs treatment, and those starting BTSs naïve to BTSs. The same figure also reports the average cost of treating one RA patient with BTSs in these three groups. For the current users of BTSs, when the number of treated patients during follow-up doubled, the mean cost to treat one patient with BTSs was reduced by approximately 50% (decreasing from 115497 NOK in 2010 to 60701 NOK in 2019). The number of patients starting on BTSs approximately doubled, while keeping a steady small increase for the naïve patients to BTSs (382 in 2010 to 405 in 2019). The average starting treatment cost decreased from 114549 NOK in 2010 to 37384 NOK in 2019, and from 114987 NOK in 2010 to 28249 NOK in 2019, for patients starting on BTSs and for patients naïve to BTSs, respectively.Figure 1.A ten-year overview of treating RA patient with BTSsConclusion:Our data shows that the average annual costs of treating a Norwegian RA patient on a current BTS, with a national tender system, were reduced by approximately 50% over the ten years 2010-19. For patients starting on a BTS, the average annual cost was reduced by approximately 75%. The consequence for the payers is that treatment can be offered at a lower price, and thus costly drugs may become more available for patients. We believe that mechanisms like the Norwegian tender system enforced upon the commercial pharmaceutical market improve competition and increase availability and use of costly drugs.References:[1]Smolen JS, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis 2020;79;685-99.[2]Bergstra SA, et al. Inequity in access to bDMARD care and how it influences disease outcomes across countries worldwide: results from the METEOR-registry. Ann Rheum Dis 2018;77:1413–20.[3]Norwegian Hospital Procurement. (Jan 2021). Available from: https://sykehusinnkjop.no.Acknowledgements:To all members of the BioRheuma projectDisclosure of Interests:None declared
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Katsogridakis E, Lea T, Yap T, Batchelder A, Saha P, Diamantopoulos A, Saratzis N, Davies R, Zayed H, Bown MJ, Saratzis A. Acute kidney injury following endovascular intervention for peripheral artery disease. Br J Surg 2021; 108:152-159. [PMID: 33711140 DOI: 10.1093/bjs/znaa057] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/21/2020] [Accepted: 09/27/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The incidence of, and risk factors for, acute kidney injury (AKI) after endovascular intervention for peripheral artery disease (PAD) remain unknown. The aim of this study was to assess the proportion of patients who develop AKI and explore the risk factors. METHODS Prospectively collected data on patients undergoing femoropopliteal endovascular intervention for symptomatic PAD across three vascular centres were analysed. The proportion of patients developing AKI (according to the Kidney Disease Improving Global Outcomes definition) within 48 h, and the proportion developing the composite Major Adverse Kidney Events (MAKE) endpoints (death, dialysis, drop in estimated glomerular filtration rate at least 25 per cent) at 30 days (MAKE30) and remains 90 days (MAKE90) were calculated. Multivariable regression analysis was used to assess predictors of AKI, and the association between AKI and death. RESULTS Some 2041 patients were included in the analysis. AKI developed in 239 patients (11.7 per cent), with 47 (2.3 per cent) requiring dialysis within 30 days, and 18 (0.9 per cent) requiring ongoing dialysis. The MAKE30 and MAKE90 composite endpoints were reached in 358 (17.5 per cent) and 449 (22.0 per cent) patients respectively. Risk factors for AKI were age, sex, congestive heart failure, chronic limb-threatening ischaemia, emergency procedure, and pre-existing chronic kidney disease. AKI, dementia, congestive heart failure, and major amputation were risk factors for medium-term mortality. CONCLUSION AKI is a common complication after intervention for PAD and is associated with medium-term mortality.
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Affiliation(s)
- E Katsogridakis
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - T Lea
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - T Yap
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - A Batchelder
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - P Saha
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - A Diamantopoulos
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - N Saratzis
- Department of Vascular Surgery, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - R Davies
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - H Zayed
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - M J Bown
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - A Saratzis
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.,Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
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Ilias I, Diamantopoulos A, Botoula E, Athanasiou N, Zacharis A, Tsipilis S, Jahaj E, Vassiliou AG, Vassiliadi DA, Kotanidou A, Tsagarakis S, Dimopoulou I. Covid-19 and Growth Hormone/Insulin-Like Growth Factor 1: Study in Critically and Non-Critically Ill Patients. Front Endocrinol (Lausanne) 2021; 12:644055. [PMID: 34220703 PMCID: PMC8242942 DOI: 10.3389/fendo.2021.644055] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 05/28/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We aimed to measure insulin-like growth factor 1 (IGF1) and growth hormone (GH) in critically and non-critically ill patients with Covid-19 and assess them vis-a-vis clinical and laboratory parameters and prognostic tools. SUBJECTS AND METHODS We included patients who were admitted to the wards or the ICU of the largest Covid-19 referral hospital in Greece; patients with non-Covid-19 pneumonia served as controls. Apart from the routine laboratory work-up for Covid-19 we measured GH and IGF1 (and calculated normalized IGF-1 values as standard deviation scores; SDS), after blood sampling upon admission to the wards or the ICU. RESULTS We studied 209 critically and non-critically ill patients with Covid-19 and 39 control patients. Patients with Covid-19 who were ICU non-survivors were older and presented with a worse hematological/biochemical profile (including white blood cell count, troponin, glucose, aminotransferases and lactate dehydrogenase) compared to ICU survivors or Covid-19 survivors in the wards. Overall, IGF-1 SDS was higher in Covid-19 survivors compared to non-survivors (-0.96 ± 1.89 vs -2.05 ± 2.48, respectively, p=0.030). No significant differences were noted in GH between the groups. Nevertheless, in critically ill patients with Covid-19, the prognostic value of IGF-1 (raw data), IGF-1 (SDS) and GH for survival/non-survival was on a par with that of APACHE II and SOFA (with a marginal difference between GH and SOFA). CONCLUSION In conclusion, our findings suggest that there might be an association between low IGF1 (and possibly GH) and poor outcome in patients with Covid-19.
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Affiliation(s)
- Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
- *Correspondence: Ioannis Ilias,
| | | | - Efthymia Botoula
- Department of Endocrinology, Diabetes and Metabolism, Evagelismos Hospital, Athens, Greece
| | - Nikolaos Athanasiou
- First Department of Critical Care Medicine & Pulmonary Services, Medical School of National & Kapodistrian University of Athens, Evagelismos Hospital, Athens, Greece
| | - Alexandros Zacharis
- First Department of Critical Care Medicine & Pulmonary Services, Medical School of National & Kapodistrian University of Athens, Evagelismos Hospital, Athens, Greece
| | | | - Edison Jahaj
- First Department of Critical Care Medicine & Pulmonary Services, Medical School of National & Kapodistrian University of Athens, Evagelismos Hospital, Athens, Greece
| | - Alice G. Vassiliou
- First Department of Critical Care Medicine & Pulmonary Services, Medical School of National & Kapodistrian University of Athens, Evagelismos Hospital, Athens, Greece
| | - Dimitra A. Vassiliadi
- Department of Endocrinology, Diabetes and Metabolism, Evagelismos Hospital, Athens, Greece
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine & Pulmonary Services, Medical School of National & Kapodistrian University of Athens, Evagelismos Hospital, Athens, Greece
| | - Stylianos Tsagarakis
- Department of Endocrinology, Diabetes and Metabolism, Evagelismos Hospital, Athens, Greece
| | - Ioanna Dimopoulou
- First Department of Critical Care Medicine & Pulmonary Services, Medical School of National & Kapodistrian University of Athens, Evagelismos Hospital, Athens, Greece
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Saratzis A, Lea T, Yap T, Batchelder A, Thomson B, Saha P, Diamantopoulos A, Saratzis N, Davies R, Zayed H. Paclitaxel and Mortality Following Peripheral Angioplasty: An Adjusted and Case Matched Multicentre Analysis. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.07.053] [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: 11/28/2022]
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Rinciog C, Diamantopoulos A, Gentilini A, Bondue B, Dahlqvist C, Froidure A, Wuyts WA, Soulard S. Cost-Effectiveness Analysis of Nintedanib Versus Pirfenidone in Idiopathic Pulmonary Fibrosis in Belgium. Pharmacoecon Open 2020; 4:449-458. [PMID: 31939146 PMCID: PMC7426351 DOI: 10.1007/s41669-019-00191-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Nintedanib (Ofev®) and pirfenidone (Esbriet®) are recommended by international guidelines as treatment options for idiopathic pulmonary fibrosis (IPF). OBJECTIVES To compare the cost-effectiveness of nintedanib with that of pirfenidone for the treatment of IPF from a Belgian healthcare payer perspective. METHODS The economic analysis used a Markov model that calculated outcomes over patient lifetime. Overall survival was assumed to be the same for the two comparators. Data from a network meta-analysis were used for loss of lung function, acute exacerbation events, safety and treatment discontinuation (for any reason). The health-state utility estimates in the model were calculated from EQ-5D scores collected in nintedanib studies. The assumed resource use for background care was also based on patient-level data that were categorised to fit the health states in the model and synthesised with costs and tariffs from Belgian national databases. RESULTS Treatment with nintedanib resulted in an estimated total cost of €102,315, which was less than the total cost of treatment with pirfenidone (€113,313). Given the similarities in the survival and progression outcomes obtained with nintedanib and pirfenidone, the model predicted near equivalence in total QALYs (3.353 QALYs for the nintedanib arm and 3.318 for the pirfenidone arm). Results were largely driven by model assumptions underlying mortality, acute exacerbations and treatment discontinuation. CONCLUSIONS After performing a synthesis of the most recently published evidence for IPF patients and assuming a Belgian healthcare payer perspective, we found nintedanib to be more cost-saving than pirfenidone.
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Affiliation(s)
- C Rinciog
- Symmetron Limited, 8 Devonshire Square, London, UK.
| | | | - A Gentilini
- Symmetron Limited, 8 Devonshire Square, London, UK
| | - B Bondue
- Department of Respiratory Medicine, Erasme University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - C Dahlqvist
- Department of Pneumology, CHU UCL Namur Site Godinne, Yvoir, Belgium
| | - A Froidure
- Department of Pneumology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - W A Wuyts
- Unit for Interstitial Lung Diseases, Department of Respiratory Medicine, University Hospitals Leuven, Louvain, Belgium
| | - S Soulard
- Boehringer Ingelheim, Amsterdam, The Netherlands
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Das JP, Thulasidasan N, Ahmed I, Diamantopoulos A. Transarterial chemoembolization for hepatocellular carcinoma: a bibliometric analysis of the most cited articles. Jpn J Radiol 2020; 38:1190-1196. [PMID: 32767200 DOI: 10.1007/s11604-020-01028-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Bibliometric analysis is a quantitative assessment of the academic literature in a particular field. The aim of our study was to characterize the 100 top-cited articles regarding transarterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC). MATERIALS AND METHODS The 'Web of Science' database was used to identify the leading articles regarding TACE for HCC. We determined the top 100 articles according to citations and performed an analysis on year of publication, authorship, department affiliation, publishing journal, institution and country of origin, subject matter and article type. RESULTS The top-cited articles received between 92 and 2254 citations (median 283.4). The top 100 papers were published in 32 journals between 1983 and 2016. Cancer, Radiology and Hepatology published the most articles (n = 40). Internal medicine was the department affiliation of the first author in 49%. The country providing the most highly cited articles was Japan (n = 24). CONCLUSION We performed an analysis of the 100 top-cited articles dealing with TACE for HCC, presenting a detailed list of the most influential and historically significant papers. Japan was the country that produced the most top-cited articles, highlighting its key contribution to this field of the literature.
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Affiliation(s)
- J P Das
- Department of Interventional Radiology, Guy's and St, Thomas' Hospital, London, UK. .,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA.
| | - N Thulasidasan
- Department of Interventional Radiology, Guy's and St, Thomas' Hospital, London, UK
| | - I Ahmed
- Department of Interventional Radiology, Guy's and St, Thomas' Hospital, London, UK
| | - A Diamantopoulos
- Department of Interventional Radiology, Guy's and St, Thomas' Hospital, London, UK
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Andel PM, Brådland S, Haraldstad V, Bitter H, Diamantopoulos A, Haugeberg G. THU0292 THE PERFORMANCE OF THE SUGGESTED EXPANSION OF THE 1990 ACR CRITERIA WITH THE ORIGINAL ACR 1990 CRITERIA IN GIANT CELL ARTERITIS PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The ACR Giant Cell Arteritis (GCA) criteria from 1990 includes items of clinical findings and biopsy results (1). Since that time better imaging modalities as ultrasound (US), magnetic resonance imaging (MRI) and positron emission tomography (PET) have challenged the former gold standard status of biopsy diagnosing GCA (2). In 2017 suggested expansion of the ACR criteria was proposed including these imaging modalities and a more nuanced set of clinical features (3).Objectives:To test the sensitivity of the suggested expanded GCA criteria against the original ACR 1990 criteria in a retrospective cohort of patients diagnosed with GCA.Methods:We included all patients diagnosed with GCA in our rheumatology clinic between 2006 and 2018 in Agder County in Southern Norway. A predefined protocol was used when reviewing the medical records in GCA patients at the time of diagnosis. Data collected included the separate items for the original and the suggested expansion of the ACR 1990 criteria. We calculated the sensitivity of both criteria sets and recorded the frequency and absolute numbers of the single criteria items as shown in table 1.Table 1.Disease features of switch and swap TA patients at 2ndbDMARD start.Original CriteriaNSuggested expansion CriterianNCriterion 1Age ≥ 50 yrs77Age ≥ 50 yrs7777Criterion 2New onset of or new type of localized pain in the head48New onset of or new type of localized pain in the head4861Visual symptoms14Sight loss2PMR22Constitutional symptoms2Tongue claudication5Jaw claudication16Criterion 3Abnormal temporal artery palpationtenderness, decreased pulse26Abnormal of extracranial arteries tenderness to palpation, decreased pulse2630Bruits over arteries6Criterion 4ESR > 50 mm/h62ESR > 50 mm/h6272CRP > 10 mg/l72Criterion 5Abnormal artery biopsy22/37Abnormal artery biopsy22/3768US61/69MRI6/10F-FDG PET4/4Results:A total of 77 patients (22 men and 55 Women) with a diagnosis of GCA were identified. Mean age was 69.2 years. The table below shows the absolute number of patients fulfilling the separate criteria for the ACR 1990 and the suggested expansion criteria. Patients were usually not exposed to all submodalities of criterion 5. The denominator for item 5 in the table displays the number of assessments performed for biopsy and the separate imaging modalities.The number of patients fulfilling the original ACR 1990 criteria was 51 (66.2%) and for the suggested expansion criteria 75 (97.4%). All patients fulfilled the age criterion. For the original ACR 1990 criteria, 62.3% met criterion 2, 33.8% criterion 3, 80.5% criterion 4 and 28.6% criterion 5, whereas for the suggested expansion criteria the percentages was 79.2%, 39.0%, 93.5% and 88.3% respectively.Conclusion:The proposed expansion of the ACR 1990 criteria had a much higher sensitivity (97.4%) than the original criteria (66.2%) tested in a clinical cohort of GCA patients. The single most important parameter increasing sensitivity was US examination however also new clinical features and C-reactive protein measurement contributed to increase the sensitivity.References:[1]Hunder GG et al. Arthritis Rheum 1990;33:1122-8[2]Dejaco C et al. Ann Rheum Dis 2018;77:636-43[3]Dejaco C et al. Rheumatology 2017;56:505-15.Disclosure of Interests:Peter Michael Andel Grant/research support from: Travel Grant from Vest Agder Legeforening, Norge, Serina Brådland: None declared, Vilde Haraldstad: None declared, Helle Bitter: None declared, Andreas Diamantopoulos: None declared, Glenn Haugeberg: None declared
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Andel PM, Brådland S, Haraldstad V, Bitter H, Diamantopoulos A, Haugeberg G. FRI0199 PRESENCE AND DISTRIBUTION OF VASCULITIS IN TEMPORAL, AXILLARY AND SUBCLAVIAN ARTERIES IN GIANT CELL ARTERITIS ASSESSED BY ULTRASONOGRAPHY AT ONSET OF DIAGNOSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:In the last two decades ultrasound (US) has become a significant and valuable mode of diagnosing giant cell arteritis (GCA) in clinical practice (1). This is also reflected in the suggested expansion of the ACR 1990 criteria where imaging including US is equated with biopsy (2). Favorable sensitivity compared to biopsy has been shown and explained with the widespread uneven distribution of inflammation in cranial and extracranial arteries (3).Objectives:To explore the prevalence and distribution of inflammatory involvement in temporal, axillary and subclavian arteries in patients diagnosed with GCA at an ordinary rheumatology clinic.Methods:In this retrospective study we identified all patients diagnosed with GCA between 2006 and 2019. Since 2006 US has been used at the clinic to diagnose GCA. The vascular US examination was performed by two experienced ultrasonographers (HB, APD). The medical records were reviewed and data were collected using a predefined protocol including data collection for US at the time of diagnosis. Standard US procedure contained an assessment of both temporal arteries (superficial artery, frontal artery and parietal artery) in longitudinal and transversal planes with and without colordoppler mode. A positive US test was defined in presence of hypoechoic vessel wall thickening (halo sign). The axillary and subclavian arteries where assessed in B-mode and intima media thickness (IMT) was measured. A positive test was defined if IMT > 1 mm.Results:A total of 69 GCA patients (20 men and 49 women) with US performed at the time of diagnosis were identified. Among them, 67 (97.1%) patients met the suggested expansion ACR 1990 criteria. The mean age was 69.9 years. Detailed results for vasculitis distribution for the temporal artery with its branches and the axillary and subclavian arteries are shown in the table below. Positive US findings were recorded in 61 patients (88.4%). A total of 45 patients (65.2%) had a positive US test in the temporal artery and 41 patients (59.4%) in the extracranial arteries. Solely extracranial arteritis was observed in 18 patients (29.5%), 22 (36.0%) had exclusively temporal involvement. Involvement of both cranial and extracranial arteries was observed in 21 patients (34.4%). Only nine patients had positive findings at just one site. Five patients had isolated unilateral subclavian affection, and two patients had isolated unilateral frontal artery and superficial artery involvement each.Table.Positive US finding in 69 GCA patientsExtracranial arteriesTemporal arteriesSubclavianAxillarySuperficialParietalFrontalRight side1336192032Left side1327181832total1538222040total4145Conclusion:Our data highlights the importance and value of a complete US of cranial and extracranial arteries diagnosing GCA in daily clinical care. The data demonstrate the widespread nature of arterial affection in GCA and the fact that it is often more than one site that is affected. The spreading pattern was comparable to older studies in the respect of large vessel and multisite involvement.References:[1]Dejaco C. et al. Ann Rheum Dis. 2018;77:636-43.[2]Dejaco C et al. Rheumatology 2017;56:505-15.[3]Schmidt W A. Rheumatology. 2018;57;ii22-ii31.Disclosure of Interests:Peter Michael Andel Grant/research support from: Travel Grant from Vest Agder Legeforening, Norge, Serina Brådland: None declared, Vilde Haraldstad: None declared, Helle Bitter: None declared, Andreas Diamantopoulos: None declared, Glenn Haugeberg: None declared
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Witte KK, Elkind MSV, Reynolds M, Tsintzos SI, Ziegler PD, Quiroz ME, Wolff C, Ricinog C, Sawyer L, Diamantopoulos A. P3157Economic evaluation of insertable cardiac monitors in detecting previously undiagnosed atrial fibrillation and subsequently moderating stoke risk in a high-risk population in the United Kingdom. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K K Witte
- University of Leeds, Leeds, United Kingdom
| | - M S V Elkind
- Columbia University, New York, United States of America
| | - M Reynolds
- Baim Institute for Clinical Research, Health Economics and Outcomes Research, Boston, United States of America
| | - S I Tsintzos
- Medtronic International Trading Sarl, Global Health Economics and Outcomes Research, Tolochenaz, Switzerland
| | - P D Ziegler
- Medtronic Global CRHF HQ, Global Health Economics and Outcomes Research, Mounds View, United States of America
| | - M E Quiroz
- Medtronic Global CRHF HQ, Global Health Economics and Outcomes Research, Mounds View, United States of America
| | - C Wolff
- Medtronic International Trading Sarl, EMEA Health Economics and Outcomes Research, Tolochenaz, Switzerland
| | - C Ricinog
- Symmetron Ltd., Health Economics and Outcomes Research, London, United Kingdom
| | - L Sawyer
- Symmetron Ltd., Health Economics and Outcomes Research, London, United Kingdom
| | - A Diamantopoulos
- Symmetron Ltd., Health Economics and Outcomes Research, London, United Kingdom
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Papazachariou L, Papagregoriou G, Hadjipanagi D, Demosthenous P, Voskarides K, Koutsofti C, Stylianou K, Ioannou P, Xydakis D, Tzanakis I, Papadaki A, Kallivretakis N, Nikolakakis N, Perysinaki G, Gale DP, Diamantopoulos A, Goudas P, Goumenos D, Soloukides A, Boletis I, Melexopoulou C, Georgaki E, Frysira E, Komianou F, Grekas D, Paliouras C, Alivanis P, Vergoulas G, Pierides A, Daphnis E, Deltas C. Frequent COL4 mutations in familial microhematuria accompanied by later-onset Alport nephropathy due to focal segmental glomerulosclerosis. Clin Genet 2017. [PMID: 28632965 DOI: 10.1111/cge.13077] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Familial microscopic hematuria (FMH) is associated with a genetically heterogeneous group of conditions including the collagen-IV nephropathies, the heritable C3/CFHR5 nephropathy and the glomerulopathy with fibronectin deposits. The clinical course varies widely, ranging from isolated benign familial hematuria to end-stage renal disease (ESRD) later in life. We investigated 24 families using next generation sequencing (NGS) for 5 genes: COL4A3, COL4A4, COL4A5, CFHR5 and FN1. In 17 families (71%), we found 15 pathogenic mutations in COL4A3/A4/A5, 9 of them novel. In 5 families patients inherited classical AS with hemizygous X-linked COL4A5 mutations. Even more patients developed later-onset Alport-related nephropathy having inherited heterozygous COL4A3/A4 mutations that cause thin basement membranes. Amongst 62 heterozygous or hemizygous patients, 8 (13%) reached ESRD, while 25% of patients with heterozygous COL4A3/A4 mutations, aged >50-years, reached ESRD. In conclusion, COL4A mutations comprise a frequent cause of FMH. Heterozygous COL4A3/A4 mutations predispose to renal function impairment, supporting that thin basement membrane nephropathy is not always benign. The molecular diagnosis is essential for differentiating the X-linked from the autosomal recessive and dominant inheritance. Finally, NGS technology is established as the gold standard for the diagnosis of FMH and associated collagen-IV glomerulopathies, frequently averting the need for invasive renal biopsies.
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Affiliation(s)
- L Papazachariou
- Molecular Medicine Research Center & Laboratory of Molecular and Medical Genetics, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
| | - G Papagregoriou
- Molecular Medicine Research Center & Laboratory of Molecular and Medical Genetics, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
| | - D Hadjipanagi
- Molecular Medicine Research Center & Laboratory of Molecular and Medical Genetics, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
| | - P Demosthenous
- Molecular Medicine Research Center & Laboratory of Molecular and Medical Genetics, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
| | - K Voskarides
- Molecular Medicine Research Center & Laboratory of Molecular and Medical Genetics, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
| | - C Koutsofti
- Molecular Medicine Research Center & Laboratory of Molecular and Medical Genetics, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
| | - K Stylianou
- Department of Nephrology, University of Crete-Greece, Heraklion, Greece
| | - P Ioannou
- Department of Nephrology, University of Crete-Greece, Heraklion, Greece
| | - D Xydakis
- Department of Nephrology, University of Crete-Greece, Heraklion, Greece
| | - I Tzanakis
- Department of Nephrology, General Hospital of Chania, Crete, Greece
| | - A Papadaki
- Department of Nephrology, General Hospital of Chania, Crete, Greece
| | - N Kallivretakis
- Department of Nephrology, General Hospital of Chania, Crete, Greece
| | - N Nikolakakis
- Division of Nephrology, General Hospital of Rethymno, Crete, Greece
| | - G Perysinaki
- Division of Nephrology, General Hospital of Rethymno, Crete, Greece
| | - D P Gale
- UCL Division of Medicine and Centre for Nephrology, University College London, London, UK
| | | | - P Goudas
- IATOS Dialysis Unit, Patra, Greece
| | - D Goumenos
- Department of Nephrology, Medical School, University of Patras, Patra, Greece
| | - A Soloukides
- Protypo Nefrologiko Athinon Dialysis Center, Athens, Greece
| | - I Boletis
- Department of Nephrology, Laikon Hospital, Athens, Greece
| | - C Melexopoulou
- Department of Nephrology, Laikon Hospital, Athens, Greece
| | - E Georgaki
- Pediatric Nephrology Unit, "IASO" Children's Hospital, Athens, Greece
| | - E Frysira
- Department of Pediatrics, Athens University Medical School, Agia Sophia Children's Hospital, Athens, Greece
| | - F Komianou
- Department of Medical Genetics, Athens University Medical School, Agia Sophia Children's Hospital, Athens, Greece
| | - D Grekas
- University Hospital AXEPA, Thessaloniki, Greece
| | - C Paliouras
- Department of Nephrology, General Hospital of Rhodes, Rhodes, Greece
| | - P Alivanis
- Department of Nephrology, General Hospital of Rhodes, Rhodes, Greece
| | - G Vergoulas
- Organ Transplant Unit, Hippokratio General Hospital, Thessaloniki, Greece
| | - A Pierides
- Molecular Medicine Research Center & Laboratory of Molecular and Medical Genetics, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus.,Department of Nephrology, Hippocrateon Hospital, Nicosia, Cyprus
| | - E Daphnis
- Department of Nephrology, University of Crete-Greece, Heraklion, Greece
| | - C Deltas
- Molecular Medicine Research Center & Laboratory of Molecular and Medical Genetics, Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus
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Rinciog C, Watkins M, Chang S, Maher TM, LeReun C, Esser D, Diamantopoulos A. A Cost-Effectiveness Analysis of Nintedanib in Idiopathic Pulmonary Fibrosis in the UK. Pharmacoeconomics 2017; 35:479-491. [PMID: 28039616 PMCID: PMC5357477 DOI: 10.1007/s40273-016-0480-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND International guidelines recommend nintedanib (OFEV®) as an option for the treatment of idiopathic pulmonary fibrosis (IPF). OBJECTIVE The objective of this study was to assess the cost effectiveness of nintedanib versus pirfenidone, N-acetylcysteine and best supportive care (BSC) for the treatment of IPF from a UK payer's perspective. METHODS A Markov model was designed to capture the changes in the condition of adults with IPF. Efficacy outcomes included mortality, lung function decline and acute exacerbations. Treatment safety (serious adverse events) and tolerability (overall discontinuation) were also considered. The baseline risk of these events was derived from patient-level data from the placebo arms of nintedanib clinical trials (TOMORROW, INPULSIS-1, INPULSIS-2). A network meta-analysis (NMA) was conducted to estimate the relative effectiveness of the comparator treatments. Quality of life and healthcare resource use data from the clinical trials were also incorporated in the economic model. RESULTS Nintedanib showed statistically significant differences against placebo on acute exacerbation events avoided and lung function decline. In the cost-effectiveness analysis, the results were split between two treatments with relative low costs and modest effectiveness (BSC and N-acetylcysteine) and two that showed improved effectiveness (lung function) and higher costs (nintedanib and pirfenidone). All comparators were assumed to have similar projected survival and the difference in quality-adjusted life-years (QALYs) was driven by the acute exacerbations and lung function estimates. In the base-case deterministic pairwise comparison with pirfenidone, nintedanib was found to have fewer acute exacerbations and resulted in less costs and more QALYs gained. CONCLUSIONS Compared with BSC (placebo), nintedanib and pirfenidone were the only treatments to show statistical significance in the efficacy parameters. We found substantial uncertainty in the overall cost-effectiveness results between nintedanib and pirfenidone. N-Acetylcysteine was largely similar to BSC but with a worse survival profile. INPULSIS-1 and INPULSIS-2 ClinicalTrials.gov numbers, NCT01335464 and NCT01335477.
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Affiliation(s)
| | - M Watkins
- Boehringer Ingelheim Limited, Bracknell, UK
| | - S Chang
- Symmetron Limited, Elstree, UK
| | - T M Maher
- NIHR Biomedical Research Unit Royal Brompton Hospital, London, UK
- Fibrosis Research Group, National Heart and Lung Institute, Imperial College London, London, UK
| | - C LeReun
- , Sainte-Anne, Guadeloupe, France
| | - D Esser
- Boehringer Ingelheim GmbH, Ingelheim, Germany
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22
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Patel SD, Biasi L, Paraskevopoulos I, Silickas J, Lea T, Diamantopoulos A, Katsanos K, Zayed H. Comparison of angioplasty and bypass surgery for critical limb ischaemia in patients with infrapopliteal peripheral artery disease. Br J Surg 2016; 103:1815-1822. [PMID: 27650636 DOI: 10.1002/bjs.10292] [Citation(s) in RCA: 34] [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] [Received: 03/12/2016] [Revised: 06/08/2016] [Accepted: 07/07/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND Both infrapopliteal (IP) bypass surgery and percutaneous transluminal angioplasty have been shown to be effective in patients with critical limb ischaemia (CLI). The most appropriate method of revascularization has yet to be established, as no randomized trials have been reported. The aim of this study was to compare the outcomes of patients with similar characteristics treated using either revascularization method. METHODS Consecutive patients undergoing IP bypass and IP angioplasty for CLI (Rutherford 4-6) at a single institution were compared following propensity score matching. The study endpoints were primary, assisted primary and secondary patency, and amputation-free survival at 12 months, calculated by Kaplan-Meier analysis. RESULTS Some 279 limbs in 243 patients were included in the study. The two groups differed significantly with respect to the incidence of diabetes (P = 0·024), estimated glomerular filtration rate (P = 0·006), total lesion length (P < 0·001) and Rutherford classification (P = 0·008). These factors were used to construct the propensity score model, which yielded a matched cohort of 125 legs in each group. Primary patency (54·4 versus 51·4 per cent; P = 0·014), assisted primary patency (77·5 versus 62·7 per cent; P = 0·003), secondary patency (84·4 versus 65·8 per cent; P < 0·001) and amputation-free survival (78·7 versus 74·1 per cent; P = 0·043) were significantly better after bypass than angioplasty. However, limb salvage was similar (90·4 versus 94·2 per cent; P = 0·161), and overall complications (36·0 versus 21·6 per cent; P = 0·041) as well as length of hospital stay (18(4-134) versus 5(0-110); P = 0·001) were worse in the surgical bypass group. CONCLUSION There was no difference in limb salvage rates, but patency and amputation-free survival rates were better 1 year after bypass surgery.
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Affiliation(s)
- S D Patel
- Departments of Vascular and Endovascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - L Biasi
- Departments of Vascular and Endovascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - I Paraskevopoulos
- Departments of Interventional Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Silickas
- Departments of Vascular and Endovascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - T Lea
- Departments of Vascular and Endovascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Diamantopoulos
- Departments of Interventional Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - K Katsanos
- Departments of Interventional Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - H Zayed
- Departments of Vascular and Endovascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
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23
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Berg Ø, Haugeberg G, Diamantopoulos A. AB0771 Osteoporosis as A Prognostic Factor for Surgery Treatment Failure in Hip Fracture Patients Treated with Internal Screw Fixation:. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4444] [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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24
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Diamantopoulos A, Myklebust G, Kvivik I, Omdal R. AB0033 High Mobility Group box 1 Protein Is Not Elevated in Active Phases of Giant Cell Arteritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4447] [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: 11/03/2022]
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25
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Spiliopoulos S, Theodosiadou V, Diamantopoulos A, Katsanos K, Kitrou P, Kagadis G, Siablis D, Karnabatidis D. FEATURED ABSTRACT, 10-year clinical outcomes of infrapopliteal drug-eluting stenting for critical limb ischemia in diabetic patients. J Vasc Interv Radiol 2015. [DOI: 10.1016/j.jvir.2014.12.147] [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: 11/25/2022] Open
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26
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Rinciog C, Myrén KJ, Aldén M, Diamantopoulos A, LeReun C. An Indirect Treatment Comparison of Cabozantinib Verse Vandetanib in Progressive Medullary Thyroid Cancer (MTC). Value Health 2014; 17:A616-A617. [PMID: 27202157 DOI: 10.1016/j.jval.2014.08.2173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | | | | | - C LeReun
- Independent Biostatistician, Carrigaline county, Ireland
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27
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Harland D, Naisbett-Groet B, Chang S, Sungher DK, Sawyer L, Diamantopoulos A. Mabthera® (Rituximab) for the Treatment of Severe Granulomatosis With Polyangiitis (Gpa) and Microscopic Polyangiitis (Mpa) - A Cost-Utility Model for the United Kingdom. Value Health 2014; 17:A382. [PMID: 27200855 DOI: 10.1016/j.jval.2014.08.2626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- D Harland
- Roche Products Limited, Welwyn Garden City, UK
| | | | - S Chang
- Symmetron Limited, Herts, UK
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28
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Sawyer L, Chang S, Diamantopoulos A, Dejonckheere F. Efficacy Of Novel Dmards In Early Active Rheumatoid Arthritis: An Indirect Comparison. Value Health 2014; 17:A374. [PMID: 27200810 DOI: 10.1016/j.jval.2014.08.2580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - S Chang
- Symmetron Limited, Herts, UK
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29
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Diamantopoulos A, Katsanos K. Atherectomy of the femoropopliteal artery: a systematic review and meta-analysis of randomized controlled trials. J Cardiovasc Surg (Torino) 2014; 55:655-665. [PMID: 25008063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A systematic review was performed to provide a qualitative analysis and quantitative data synthesis of randomized controlled trials (RCTs) assessing debulking atherectomy versus balloon angioplasty for treatment of femoropopliteal artery occlusive disease. PubMed (MEDLINE), EMBASE, AMED, Scopus, online content and meeting abstracts were searched in May 2014 for eligible RCTs following the PRISMA selection process. Risk of bias was assessed using the Cochrane Collaboration's tool. Pooled risks were calculated with a random effects model to account for clinical and conceptual heterogeneity. Sensitivity analysis was employed to test the robustness of the results. Six RCTs comprising 287 patients (328 lesions) treated with either debulking atherectomy or balloon angioplasty for femoropopliteal artery disease were analyzed and synthesized. Technical success was similar between the atherectomy and the angioplasty group (93.6% vs. 96.2%, RR: 0.99. 95%CI: 0.95-1.03, P=0.57, I(2)=0%). Need for bail-out stenting and distal arterial embolization were largely similar between atherectomy and balloon angioplasty alone. After a median follow-up of 9 months the 2 groups showed similar primary patency (RR: 0.90, 95%CI: 0.56-1.46, P=0.68, I(2)=69%). Only 2 low-quality studies reported amputation and mortality rates, both of which were found significantly less in the atherectomy arms. Analysis of a limited body of low quality evidence with high risk of bias showed that debulking atherectomy of the femoropopliteal artery does not seem to confer any procedural advantage or improvement of clinical outcomes over balloon angioplasty alone.
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Affiliation(s)
- A Diamantopoulos
- Department of Interventional Radiology Guy's and St. Thomas' NHS Foundation Trust London, UK -
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30
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Sawyer L, Chang S, Diamantopoulos A, Dejonckheere F. AB0432 Efficacy of Biologic Treatments in Early Active Rheumatoid Arthritis: an Indirect Comparison. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2177] [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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31
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Piper J, Serafim AS, Ponte C, Singh S, Dasgupta B, Schmidt W, McNally E, Diamantopoulos A, Hutchings A, Luqmani R. SAT0190 A Diagnostic Protocol for GIANT Cell Arteritis (GCA) Using Ultrasound Assessment. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4144] [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: 11/03/2022]
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32
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Michelsen B, Diamantopoulos A, Kavanaugh A, Haugeberg G. SAT0385 Lack of Correlation between Clinical and Ultrasonographic Evidence of Disease Activity in Psoriatic Arthritis:. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2016] [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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33
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Diamantopoulos A, Myklebust G, Wigaard E, Amundsen L, Soldal D, Haugeberg G. FRI0447 The Incidence Rate of GIANT Cell Arteritis in Southern Norway is Lower than Previous Reported: A Result of Temporal Variations or A Sign of A True Shift in Incidence Rates? Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3850] [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: 11/03/2022]
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34
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Diamantopoulos A, Haugeberg G, Myklebust G. AB0565 Can Color Doppler Ultrasound BE Used to Monitor Treatment Response in Large Vessel GIANT Cell Arteritis? Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3844] [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: 11/03/2022]
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35
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Kitrou P, Parthipun A, Diamantopoulos A, Padayachee S, Karunanithy N, Ahmed I, Zayed H, Katsanos K. Paclitaxel-coated balloons for failing peripheral bypass grafts: the BYPACS study. J Cardiovasc Surg (Torino) 2014; 55:217-224. [PMID: 24670829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Aim of the present study was to report the imaging and clinical outcomes of a prospective single-center study investigating paclitaxel-coated balloons (PCB) for the treatment of failing peripheral bypass grafts (BYPACS study). METHODS In total, 32 patients had their failing peripheral native or synthetic bypass graft treated with PCB angioplasty (Group PCB). Basic inclusion criteria were any significant proximal or distal anastomotic stenosis confirmed by Duplex ultrasound (DUS; PSVR>2.5) associated with significantly reduced in-graft velocities (<45 cm/s) putting the graft at risk of thrombosis. Results were compared with a similar historical control group of 24 patients who had their failing peripheral bypass treated with plain uncoated balloon angioplasty (Group PTA). Primary endpoint was binary lesion restenosis defined as >50% stenosis of the treated lesion on DUS. Secondary endpoints included freedom from target lesion revascularization (TLR) defined as a patent peripheral bypass graft regardless of restenosis but without any repeat intervention (driven by reduced in-graft velocities <45 cm/s), major amputations and graft thrombosis. Multivariable Cox proportional hazards regression analysis was applied to adjust for confounding factors of heterogeneity. Results are reported as Cox-adjusted hazard ratios (HR and 95% CI). RESULTS Baseline variables were equally distributed between the two groups. Median follow-up was 7 months in group PCB and 8 months in group PTA. Rates of binary restenosis were similar between the 2 groups (HR=1.08, 95% CI=0.49-2.40; P=0.84). Freedom from TLR was also similar (HR=0.97, 95% CI=0.36-2.66; P=0.88). One amputation occurred in the PCB group and 2 in the PTA (P=0.58). Four events of bypass thrombosis occurred in each group (P=0.71). CONCLUSION PCB does not significantly inhibit restenosis or improve freedom from repeat angioplasty after treatment of failing peripheral arterial vein or synthetic bypass grafts.
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MESH Headings
- Aged
- Aged, 80 and over
- Amputation, Surgical
- Angiography, Digital Subtraction
- Angioplasty, Balloon/adverse effects
- Angioplasty, Balloon/instrumentation
- Blood Flow Velocity
- Blood Vessel Prosthesis
- Blood Vessel Prosthesis Implantation/adverse effects
- Blood Vessel Prosthesis Implantation/instrumentation
- Cardiovascular Agents/administration & dosage
- Constriction, Pathologic
- Drug Carriers
- Equipment Design
- Female
- Graft Occlusion, Vascular/diagnosis
- Graft Occlusion, Vascular/etiology
- Graft Occlusion, Vascular/physiopathology
- Graft Occlusion, Vascular/therapy
- Humans
- Kaplan-Meier Estimate
- Limb Salvage
- London
- Male
- Middle Aged
- Multivariate Analysis
- Paclitaxel/administration & dosage
- Peripheral Arterial Disease/diagnosis
- Peripheral Arterial Disease/physiopathology
- Peripheral Arterial Disease/surgery
- Peripheral Arterial Disease/therapy
- Proportional Hazards Models
- Prospective Studies
- Prosthesis Failure
- Regional Blood Flow
- Reoperation
- Risk Factors
- Time Factors
- Treatment Failure
- Ultrasonography, Doppler, Duplex
- Vascular Access Devices
- Veins/physiopathology
- Veins/transplantation
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Affiliation(s)
- P Kitrou
- Department of Interventional Radiology Guy's and St. Thomas' Hospitals, NHS Foundation Trust King's Health Partners, London, UK -
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36
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Kitrou P, Spiliopoulos S, Christeas N, Diamantopoulos A, Siablis D, Karnabatidis D. Paclitaxel-coated balloons as a treatment option of arterio-venous fistula stenosis: 1-year final results of a prospective randomized controlled trial. J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2013.12.027] [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: 10/25/2022] Open
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37
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Gibbons C, Diamantopoulos A, Pang H, Huertas C, Dejonckheere F. FRI0414 Tocilizumab in methotrexate-intolerant or contraindicated patients – a cost-utility model for scotland. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.2871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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38
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Sawyer L, Diamantopoulos A, Brunner HI, De Benedetti F, Ruperto N, Dejonckheere F, Keane C. PReS-FINAL-2070: Efficacy of biologic treatments in juvenile idiopathic arthritis with a polyarticular course: an indirect comparison. Pediatr Rheumatol Online J 2013. [PMCID: PMC4043887 DOI: 10.1186/1546-0096-11-s2-p82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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39
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Monreal M, Folkerts K, Diamantopoulos A, Imberti D, Brosa M. Cost-effectiveness impact of rivaroxaban versus new and existing prophylaxis for the prevention of venous thromboembolism after total hip or knee replacement surgery in France, Italy and Spain. Thromb Haemost 2013; 110:987-94. [PMID: 23965805 DOI: 10.1160/th12-12-0919] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 12/13/2012] [Accepted: 08/06/2013] [Indexed: 12/14/2022]
Abstract
Venous thromboembolism (VTE) has a significant impact on healthcare costs but is largely preventable with anticoagulant prophylaxis using low-molecular-weight heparins (LMWHs), such as enoxaparin or dalteparin. Rivaroxaban and dabigatran etexilate are two new oral anticoagulants (NOACs) both compared with enoxaparin in separate trials. A decision analytic model with a healthcare and national payer perspective over a five-year time horizon was used to evaluate the cost-effectiveness of the NOACs for VTE prophylaxis after total hip replacement (THR) or total knee replacement (TKR) in France, Italy and Spain. Efficacy and safety data were obtained from randomised controlled trials of rivaroxaban vs enoxaparin and an indirect statistical comparison for rivaroxaban vs dabigatran. Rivaroxaban demonstrated dominance across all comparisons, indications and countries. In THR, total per-patient costs were reduced by up to €160 in the enoxaparin comparison and €115 in the dabigatran comparison, respectively. In addition, quality-adjusted life-years (QALYs) were increased by up to 0.0011 and 0.0012 in each comparison, respectively. Similarly, total costs were reduced in TKR by up to €137 and €28 in the enoxaparin and dabigatran comparisons, respectively. The total number of QALYs was increased by up to 0.0014 in the enoxaparin comparison and 0.0005 in the dabigatran comparison. The results were driven by costs since the incremental benefits were minimal. Rivaroxaban use could result in substantial healthcare cost savings and improved quality of life. The results are applicable across three European countries with differing healthcare systems so, potentially, could be generalised to a much wider population.
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Affiliation(s)
- M Monreal
- Alex Diamantopoulos, Symmetron Ltd., Kinetic Centre, Theobald Street, Elstree, Herts WD6 4PJ, UK, Tel.: +44 208 387 1595, Fax:+44 208 711 6876, E-mail:
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Evers T, Diamantopoulos A. Real-life treatment persistence with newer oral anticoagulants and potential strokes avoided in patients with atrial fibrillation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Diamantopoulos A, LeReun C, Westhovens R, Dejonckheere F. THU0308 Indirect comparison of ACR response of biologic treatments in active SJIA. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2273] [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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Eppeland S, Diamantopoulos A, Soldal D, Haugeberg G. OP0082 Short term effect of 2-weeks rehabilitation on disease activity and health status in patients with ankylosing spondylitis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1765] [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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Sawyer L, Diamantopoulos A, Brunner H, De Benedetti F, Ruperto N, Dejonckheere F, Keane C. SAT0470 Efficacy of Biologic Treatments in Juvenile Idiopathic Arthritis with a Polyarticular Course: An Indirect Comparison. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2194] [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: 11/03/2022]
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Hallinen T, Soini E, Diamantopoulos A, Dejonckheere F, Vihervaara V, Hautala A, Aalto K. THU0305 Cost-utility of tocilizumab in the treatment of systemic juvenile idiopathic arthritis in finland. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2270] [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] [Indexed: 11/03/2022]
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Spiliopoulos S, Pastromas G, Kitrou P, Karnabatidis D, Katsanos K, Diamantopoulos A, Siablis D. Clopidogrel resistance: a novel risk factor for repeat procedures after peripheral angioplasty or stenting. J Vasc Interv Radiol 2013. [DOI: 10.1016/j.jvir.2013.01.477] [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: 10/27/2022] Open
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Mehta P, Holder S, Fisher B, Vincent T, Nadesalingam K, Maciver H, Shingler W, Bakshi J, Hassan S, D'Cruz D, Chan A, Litwic AE, McCrae F, Seth R, McCrae F, Nandagudi A, Jury E, Isenberg D, Karjigi U, Paul A, Rees F, O'Dowd E, Kinnear W, Johnson S, Lanyon P, Bakshi J, Stevens R, Narayan N, Marguerie C, Robinson H, Ffolkes L, Worsnop F, Ostlere L, Kiely P, Dharmapalaiah C, Hassan N, Nandagudi A, Bharadwaj A, Skibinska M, Gendi N, Davies EJ, Akil M, Kilding R, Ramachandran Nair J, Walsh M, Farrar W, Thompson RN, Borukhson L, McFadyen C, Singh D, Rajagopal V, Chan AML, Wearn Koh L, Christie JD, Croot L, Gayed M, Disney B, Singhal S, Grindulis K, Reynolds TD, Conway K, Williams D, Quin J, Dean G, Churchill D, Walker-Bone KE, Goff I, Reynolds G, Grove M, Patel P, Lazarus MN, Roncaroli F, Gabriel C, Kinderlerer AR, Nikiphorou E, Hall FC, Bruce E, Gray L, Krutikov M, Wig S, Bruce I, D'Agostino MA, Wakefield R, Berner Hammer H, Vittecoq O, Galeazzi M, Balint P, Filippucci E, Moller I, Iagnocco A, Naredo E, Ostergaard M, Gaillez C, Kerselaers W, Van Holder K, Le Bars M, Stone MA, Williams F, Wolber L, Karppinen J, Maatta J, Thompson B, Atchia I, Lorenzi A, Raftery G, Platt P, Platt PN, Pratt A, Turmezei TD, Treece GM, Gee AH, Poole KE, Chandratre PN, Roddy E, Clarson L, Richardson J, Hider S, Mallen C, Lieberman A, Prouse PJ, Mahendran P, Samarawickrama A, Churchill D, Walker-Bone KE, Ottery FD, Yood R, Wolfson M, Ang A, Riches P, Thomson J, Nuki G, Humphreys J, Verstappen SM, Chipping J, Hyrich K, Marshall T, Symmons DP, Roy M, Kirwan JR, Marshall RW, Matcham F, Scott IC, Rayner L, Hotopf M, Kingsley GH, Scott DL, Steer S, Ma MH, Dahanayake C, Scott IC, Kingsley G, Cope A, Scott DL, Dahanayake C, Ma MH, Scott IC, Kingsley GH, Cope A, Scott DL, Wernham A, Ward L, Carruthers D, Deeming A, Buckley C, Raza K, De Pablo P, Nikiphorou E, Carpenter L, Jayakumar K, Solymossy C, Dixey J, Young A, Singh A, Penn H, Ellerby N, Mattey DL, Packham J, Dawes P, Hider SL, Ng N, Humby F, Bombardieri M, Kelly S, Di Cicco M, Dadoun S, Hands R, Rocher V, Kidd B, Pyne D, Pitzalis C, Poore S, Hutchinson D, Low A, Lunt M, Mercer L, Galloway J, Davies R, Watson K, Dixon W, Symmons D, Hyrich K, Mercer L, Lunt M, Low A, Galloway J, Watson KD, Dixon WG, Symmons D, Hyrich KL, Low A, Lunt M, Mercer L, Bruce E, Dixon W, Hyrich K, Symmons D, Malik SP, Kelly C, Hamilton J, Heycock C, Saravanan V, Rynne M, Harris HE, Tweedie F, Skaparis Y, White M, Scott N, Samson K, Mercieca C, Clarke S, Warner AJ, Humphreys J, Lunt M, Marshall T, Symmons D, Verstappen S, Chan E, Kelly C, Woodhead FA, Nisar M, Arthanari S, Dawson J, Sathi N, Ahmad Y, Koduri G, Young A, Kelly C, Chan E, Ahmad Y, Woodhead FA, Nisar M, Arthanari S, Dawson J, Sathi N, Koduri G, Young A, Cumming J, Stannett P, Hull R, Metsios G, Stavropoulos Kalinoglou A, Veldhuijzen van Zanten JJ, Nightingale P, Koutedakis Y, Kitas GD, Nikiphorou E, Dixey J, Williams P, Kiely P, Walsh D, Carpenter L, Young A, Perry E, Kelly C, de-Soyza A, Moullaali T, Eggleton P, Hutchinson D, Veldhuijzen van Zanten JJ, Metsios G, Stavropoulos-Kalinoglou A, Sandoo A, Kitas GD, de Pablo P, Maggs F, Carruthers D, Faizal A, Pugh M, Jobanputra P, Kehoe O, Cartwright A, Askari A, El Haj A, Middleton J, Aynsley S, Hardy J, Veale D, Fearon U, Wilson G, Muthana M, Fossati G, Healy L, Nesbitt A, Becerra E, Leandro MJ, De La Torre I, Cambridge G, Nelson PN, Roden D, Shaw M, Davari Ejtehadi H, Nevill A, Freimanis G, Hooley P, Bowman S, Alavi A, Axford J, Veitch AM, Tugnet N, Rylance PB, Hawtree S, Muthana M, Aynsley S, Mark Wilkinson J, Wilson AG, Woon Kam N, Filter A, Buckley C, Pitzalis C, Bombardieri M, Croft AP, Naylor A, Zimmermann B, Hardie D, Desanti G, Jaurez M, Muller-Ladner U, Filer A, Neumann E, Buckley C, Movahedi M, Lunt M, Ray DW, Dixon WG, Burmester GR, Matucci-Cerinic M, Navarro-Blasco F, Kary S, Unnebrink K, Kupper H, Mukherjee S, Cornell P, Richards S, Rahmeh F, Thompson PW, Westlake SL, Javaid MK, Batra R, Chana J, Round G, Judge A, Taylor P, Patel S, Cooper C, Ravindran V, Bingham CO, Weinblatt ME, Mendelsohn A, Kim L, Mack M, Lu J, Baker D, Westhovens R, Hewitt J, Han C, Keystone EC, Fleischmann R, Smolen J, Emery P, Genovese M, Doyle M, Hsia EC, Hart JC, Lazarus MN, Kinderlerer AR, Harland D, Gibbons C, Pang H, Huertas C, Diamantopoulos A, Dejonckheere F, Clowse M, Wolf D, Stach C, Kosutic G, Williams S, Terpstra I, Mahadevan U, Smolen J, Emery P, Ferraccioli G, Samborski W, Berenbaum F, Davies O, Koetse W, Bennett B, Burkhardt H, Weinblatt ME, Fleischmann R, Davies O, Luijtens K, van der Heijde D, Mariette X, van Vollenhoven RF, Bykerk V, de Longueville M, Arendt C, Luijtens K, Cush J, Khan A, Maclaren Z, Dubash S, Chalam VC, Sheeran T, Price T, Baskar S, Mulherin D, Molloy C, Keay F, Heritage C, Douglas B, Fleischmann R, Weinblatt ME, Schiff MH, Khanna D, Furst DE, Maldonado MA, Li W, Sasso EH, Emerling D, Cavet G, Ford K, Mackenzie-Green B, Collins D, Price E, Williamson L, Golla J, Vagadia V, Morrison E, Tierney A, Wilson H, Hunter J, Ma MH, Scott DL, Reddy V, Moore S, Ehrenstein M, Benson C, Wray M, Cairns A, Wright G, Pendleton A, McHenry M, Taggart A, Bell A, Bosworth A, Cox M, Johnston G, Shah P, O'Brien A, Jones P, Sargeant I, Bukhari M, Nusslein H, Alten R, Galeazzi M, Lorenz HM, Boumpas D, Nurmohamed MT, Bensen W, Burmester GR, Peter HH, Rainer F, Pavelka K, Chartier M, Poncet C, Rauch C, Le Bars M, Lempp H, Hofmann D, Adu A, Congreve C, Dobson J, Rose D, Simpson C, Wykes T, Cope A, Scott DL, Ibrahim F, Schiff M, Alten R, Weinblatt ME, Nash P, Fleischmann R, Durez P, Kaine J, Delaet I, Kelly S, Maldonado M, Patel S, Genovese M, Jones G, Sebba A, Lepley D, Devenport J, Bernasconi C, Smart D, Mpofu C, Gomez-Reino JJ, Verma I, Kaur J, Syngle A, Krishan P, Vohra K, Kaur L, Garg N, Chhabara M, Gibson K, Woodburn J, Telfer S, Buckley F, Finckh A, Huizinga TW, Dejonckheere F, Jansen JP, Genovese M, Sebba A, Rubbert-Roth A, Scali JJ, Alten R, Kremer JM, Pitts L, Vernon E, van Vollenhoven RF, Sharif MI, Das S, Emery P, Maciver H, Shingler W, Helliwell P, Sokoll K, Vital EM. Case Reports * 1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGF Receptor Mutations in Benign Joint Hypermobility. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket197] [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: 11/12/2022] Open
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Katsanos K, Kitrou P, Karnabatidis D, Spiliopoulos S, Diamantopoulos A, Siablis D. Abstract No LB01 Paclitaxel-coated balloon angioplasty versus plain balloon dilatation for the treatment of failing dialysis access: a prospective randomized controlled trial. J Vasc Interv Radiol 2012. [DOI: 10.1016/j.jvir.2012.05.007] [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] [Indexed: 11/26/2022] Open
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Spiliopoulos S, Katsanos K, Diamantopoulos A, Karnabatidis D, Siablis D. Does ultrasound-guided lidocaine injection improve local anaesthesia before femoral artery catheterization? Clin Radiol 2011; 66:449-55. [PMID: 21353211 DOI: 10.1016/j.crad.2011.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 11/29/2010] [Accepted: 01/05/2011] [Indexed: 02/08/2023]
Abstract
AIM To present the results of a prospective, randomized, single-centre study investigating local anaesthesia before percutaneous common femoral artery (CFA) puncture and catheterization with the use of ultrasound-guided injection of lidocaine versus standard infiltration by manual palpation. MATERIALS AND METHODS Patients scheduled to undergo diagnostic or therapeutic transfemoral catheter-based procedures gave informed consent and were randomized in two groups. In the first arm local anaesthesia with lidocaine hydrochloride 1% was performed under ultrasound guidance (group U/S), while in the second arm the standard method of manual artery palpation was applied (group M). In both groups, subsequent CFA catheterization was achieved under ultrasound guidance. The primary study endpoint was peri-procedural pain level evaluated with a visual-analogue scale (VAS score 0-10). RESULTS Between January 2009 and 2010, 200 patients (161 men, mean age 63±12 years) were equally assigned to each group without any significant differences in baseline demographics. Patients in group U/S experienced significantly less pain during CFA catheterization in comparison with group M with a difference of three points in mean VAS score reported (1.6±1.6 versus 4.6±1.9, p<0.0001). In addition, significantly less volume of lidocaine was used in group U/S compared to group M (16±2.7 versus 19±0.8ml, p<0.001).Total vascular access time was similar in both groups (4.4±1.3 versus 4.5±1.3min). Overall complications included two small groin haematomas in each group. CONCLUSION Ultrasound-guided local anaesthesia of the CFA prior to percutaneous transcatheter procedures is safe and achieves superior levels of analgesia with minimal patient pain and discomfort compared to the standard method of manual palpation.
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Affiliation(s)
- S Spiliopoulos
- Department of Diagnostic and Interventional Radiology, Patras University Hospital, School of Medicine, Patras, Greece.
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Karnabatidis D, Katsanos K, Spiliopoulos S, Diamantopoulos A, Siablis D. Abstract No. 81: Primary everolimus-eluting stenting versus balloon angioplasty with bail-out bare metal stenting of long infrapopliteal lesions for critical limb ischemia treatment. J Vasc Interv Radiol 2011. [DOI: 10.1016/j.jvir.2011.01.090] [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: 11/26/2022] Open
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Kagadis G, Tsioupinaki K, Loudos G, Diamantopoulos A, Soultanidis G, Karnabatidis D, Mihailidis D, Nikiforidis G. SU-GG-I-180: Application of Molecular Imaging in the Monitoring of Angiogenesis of a Hindlimb Ischemia Model. Med Phys 2010. [DOI: 10.1118/1.3468216] [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: 11/07/2022] Open
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