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Ademola A, Bala F, Menon BK, Thornton J, Casetta I, Nannoni S, Goyal M, Herlihy D, Fainardi E, Power S, Saia V, Hegarty A, Pracucci G, Demchuk A, Mangiafico S, Boyle K, Michel P, Hildebrand KA, Sajobi TT, Hill MD, Toni D, Murphy S, Kim BJ, Almekhlafi MA. Workflow and Outcome of Thrombectomy in Late Time Window. A Pooled Multicenter Analysis. Can J Neurol Sci 2024:1-18. [PMID: 38639107 DOI: 10.1017/cjn.2024.60] [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: 04/20/2024]
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Bala F, Almekhlafi M, Singh N, Alhabli I, Ademola A, Coutts SB, Deschaintre Y, Khosravani H, Appireddy R, Moreau F, Phillips S, Gubitz G, Tkach A, Catanese L, Dowlatshahi D, Medvedev G, Mandzia J, Pikula A, Shankar J, Williams H, Field TS, Manosalva A, Siddiqui M, Zafar A, Imoukhoude O, Hunter G, Benali F, Horn M, Hill MD, Shamy M, Sajobi TT, Buck BH, Swartz RH, Menon BK, Poppe AY. Safety and efficacy of tenecteplase versus alteplase in stroke patients with carotid tandem lesions: Results from the AcT trial. Int J Stroke 2024; 19:322-330. [PMID: 37731173 PMCID: PMC10903116 DOI: 10.1177/17474930231205208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Carotid tandem lesions ((TL) ⩾70% stenosis or occlusion) account for 15-20% of acute stroke with large vessel occlusion. AIMS We investigated the safety and efficacy of intravenous tenecteplase (0.25 mg/kg) versus intravenous alteplase (0.9 mg/kg) in patients with carotid TL. METHODS This is a substudy of the alteplase compared with the tenecteplase trial. Patients with ⩾70% stenosis of the extracranial internal carotid artery (ICA) and concomitant occlusion of the intracranial ICA, M1 or M2 segments of the middle cerebral artery on baseline computed tomography angiography (CTA) were included. Primary outcome was 90-day-modified Rankin Scale (mRS) 0-1. Secondary outcomes were mRS 0-2, mortality, and symptomatic ICH (sICH). Angiographic outcomes were successful recanalization (revised Arterial Occlusive Lesion (rAOL) 2b-3) on first and successful reperfusion (eTICI 2b-3) on final angiographic acquisitions. Multivariable mixed-effects logistic regression was performed. RESULTS Among 1577 alteplase versus tenecteplase randomized controlled trial (AcT) patients, 128 (18.8%) had carotid TL. Of these, 93 (72.7%) underwent intravenous thrombolysis plus endovascular thrombectomy (IVT + EVT), while 35 (27.3%) were treated with IVT alone. In the IVT + EVT group, tenecteplase was associated with higher odds of 90-day-mRS 0-1 (46.0% vs. 32.6%, adjusted OR (aOR) 3.21; 95% CI = 1.06-9.71) compared with alteplase. No statistically significant differences in rates of mRS 0-2 (aOR 1.53; 95% CI = 0.51-4.55), initial rAOL 2b-3 (16.3% vs. 28.6%), final eTICI 2b-3 (83.7% vs. 85.7%), and mortality (18.0% vs. 16.3%) were found. SICH only occurred in one patient. There were no differences in outcomes between thrombolytic agents in the IVT-only group. CONCLUSION In patients with carotid TL treated with EVT, intravenous tenecteplase may be associated with similar or better clinical outcomes, similar angiographic reperfusion rates, and safety outcomes as compared with alteplase.
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Affiliation(s)
- Fouzi Bala
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Mohammed Almekhlafi
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Nishita Singh
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ibrahim Alhabli
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Ayoola Ademola
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Yan Deschaintre
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Houman Khosravani
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Ramana Appireddy
- Division of Neurology, Department of Medicine, Queen’s University, Kingston, ON, Canada
| | | | | | - Gord Gubitz
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | | | - Luciana Catanese
- Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Dar Dowlatshahi
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - George Medvedev
- The University of British Columbia, Vancouver, BC, Canada
- Fraser Health Authority, New Westminster, BC, Canada
| | - Jennifer Mandzia
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Aleksandra Pikula
- Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Jay Shankar
- University of Manitoba, Winnipeg, MB, Canada
| | | | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, The University of British Columbia, Vancouver, BC, Canada
| | | | | | - Atif Zafar
- St. Michael’s Hospital, Toronto, ON, Canada
| | | | - Gary Hunter
- University of Saskatchewan, Saskatoon, SK, Canada
| | - Faysal Benali
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - MacKenzie Horn
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Michel Shamy
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tolulope T Sajobi
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Brian H Buck
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Richard H Swartz
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Bijoy K Menon
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Alexandre Y Poppe
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
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Sajobi TT, Arimoro OI, Ademola A, Singh N, Bala F, Almekhlafi MA, Deschaintre Y, Coutts SB, Thirunavukkarasu S, Khosravani H, Appireddy R, Moreau F, Gubitz GJ, Tkach A, Catanese L, Dowlatshahi D, Medvedev G, Mandzia J, Pikula A, Shankar JS, Williams H, Field TS, Manosalva A, Siddiqui M, Zafar A, Imoukhuede O, Hunter G, Demchuk AM, Mishra SM, Gioia LC, Jalini S, Cayer C, Phillips SJ, Elamin E, Shoamanesh A, Subramaniam S, Kate MP, Jacquin G, Camden MC, Benali F, Alhabli I, Horn M, Stotts G, Hill MD, Gladstone DJ, Poppe AY, Sehgal A, Zhang Q, Lethebe B, Doram C, Shamy M, Kenney C, Buck BH, Swartz RH, Menon BK. Quality of Life After Intravenous Thrombolysis for Acute Ischemic Stroke: Results From the AcT Randomized Controlled Trial. Stroke 2024; 55:524-531. [PMID: 38275116 DOI: 10.1161/strokeaha.123.044690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/30/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Recent evidence from thrombolysis trials indicates the noninferiority of intravenous tenecteplase to intravenous alteplase with respect to good functional outcomes in patients with acute stroke. We examined whether the health-related quality of life (HRQOL) of patients with acute stroke differs by the type of thrombolysis treatment received. In addition, we examined the association between the modified Rankin Scale score 0 to 1 and HRQOL and patient-reported return to prebaseline stroke functioning at 90 days. METHODS Data were from all patients included in the AcT trial (Alteplase Compared to Tenecteplase), a pragmatic, registry-linked randomized trial comparing tenecteplase with alteplase. HRQOL at 90-day post-randomization was assessed using the 5-item EuroQOL questionnaire (EQ5D), which consists of 5 items and a visual analog scale (VAS). EQ5D index values were estimated from the EQ5D items using the time tradeoff approach based on Canadian norms. Tobit regression and quantile regression models were used to evaluate the adjusted effect of tenecteplase versus alteplase treatment on the EQ5D index values and VAS score, respectively. The association between return to prebaseline stroke functioning and the modified Rankin Scale score 0 to 1 and HRQOL was quantified using correlation coefficient (r) with 95% CI. RESULTS Of 1577 included in the intention-to-treat analysis patients, 1503 (95.3%) had complete data on the EQ5D. Of this, 769 (51.2%) were administered tenecteplase and 717 (47.7%) were female. The mean EQ5D VAS score and EQ5D index values were not significantly higher for those who received intravenous tenecteplase compared with those who received intravenous alteplase (P=0.10). Older age (P<0.01), more severe stroke assessed using the National Institutes of Health Stroke Scale (P<0.01), and longer stroke onset-to-needle time (P=0.004) were associated with lower EQ5D index and VAS scores. There was a strong association (r, 0.85 [95% CI, 0.81-0.89]) between patient-reported return to prebaseline functioning and modified Rankin Scale score 0 to 1 Similarly, there was a moderate association between return to prebaseline functioning and EQ5D index (r, 0.45 [95% CI, 0.40-0.49]) and EQ5D VAS scores (r, 0.42 [95% CI, 0.37-0.46]). CONCLUSIONS Although there is no differential effect of thrombolysis type on patient-reported global HRQOL and EQ 5D-5L index values in patients with acute stroke, sex- and age-related differences in HRQOL were noted in this study. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03889249.
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Affiliation(s)
- Tolulope T Sajobi
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Olayinka I Arimoro
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
| | - Ayoola Ademola
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Nishita Singh
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (N.S., J.S.S.)
- University of Manitoba, Winnipeg, Canada (N.S., J.S.S.)
| | - Fouzi Bala
- Department of Diagnostic and Interventional Neuroradiology, Tours University Hospital, France (F. Bala)
| | - Mohammed A Almekhlafi
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.)
| | - Yan Deschaintre
- Département of Neurosciences, Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
- Centre Hospitalier de l'Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
| | - Shelagh B Coutts
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.)
| | - Sibi Thirunavukkarasu
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (S.T., S.M.M., M.P.K., B.H.B.)
| | - Houman Khosravani
- Division of Neurology, Department of Medicine, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (H.K., D.J.G., R.H.S.)
| | - Ramana Appireddy
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada (R.A., S.J.)
| | | | - Gordon J Gubitz
- Queen Elizabeth Health Sciences Centre, Halifax, NS, Canada (G.J.G., S.J.P., A. Shoamanesh)
| | | | - Luciana Catanese
- Hamilton Health Sciences Centre, McMaster University, Hamilton, ON, Canada (L.C.)
| | - Dar Dowlatshahi
- Department of Medicine, Ottawa Heart Research Institute, University of Ottawa, ON, Canada (D.D., M. Shamy)
| | - George Medvedev
- Department of Medicine, University of British Columbia & Fraser Health Authority, New Westminster, BC, Canada (G.M., G.S.)
- University of British Columbia, Fraser Health Authority, New Westminster, BC, Canada (G.M., G.S.)
| | - Jennifer Mandzia
- London Health Sciences Centre and Western University, ON, Canada (J.M.)
| | | | - Jai Shiva Shankar
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (N.S., J.S.S.)
- University of Manitoba, Winnipeg, Canada (N.S., J.S.S.)
| | | | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, The University of British Columbia, Vancouver, Canada (T.S.F.)
| | | | | | - Atif Zafar
- St. Michael's Hospital, Toronto, ON, Canada (A.Z.)
| | | | - Gary Hunter
- University of Saskatchewan, Saskatoon, Canada (G.H.)
| | - Andrew M Demchuk
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Sachin M Mishra
- Hotchkiss Brain Institute, Calgary, AB, Canada (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.)
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (S.T., S.M.M., M.P.K., B.H.B.)
| | - Laura C Gioia
- Département of Neurosciences, Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
- Centre Hospitalier de l'Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
| | - Shirin Jalini
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada (R.A., S.J.)
| | - Caroline Cayer
- Centre de recherche du CHUS, Centre intégré Universitaire de Santé et des Services Sociaux de l'Estrie, Sherbrooke, QC, Canada (C.C.)
| | - Stephen J Phillips
- Queen Elizabeth Health Sciences Centre, Halifax, NS, Canada (G.J.G., S.J.P., A. Shoamanesh)
| | | | - Ashkan Shoamanesh
- Queen Elizabeth Health Sciences Centre, Halifax, NS, Canada (G.J.G., S.J.P., A. Shoamanesh)
| | - Suresh Subramaniam
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Mahesh P Kate
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (S.T., S.M.M., M.P.K., B.H.B.)
| | - Gregory Jacquin
- Département of Neurosciences, Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
- Centre Hospitalier de l'Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
| | - Marie-Christine Camden
- Enfant-Jésus Hospital, Centre Hospitalier Universitaire de Québec, Laval University, Canada (M.-C.C.)
| | - Faysal Benali
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Ibrahim Alhabli
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - MacKenzie Horn
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Grant Stotts
- Department of Medicine, University of British Columbia & Fraser Health Authority, New Westminster, BC, Canada (G.M., G.S.)
- University of British Columbia, Fraser Health Authority, New Westminster, BC, Canada (G.M., G.S.)
| | - Michael D Hill
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.)
| | - David J Gladstone
- Division of Neurology, Department of Medicine, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (H.K., D.J.G., R.H.S.)
| | - Alexandre Y Poppe
- Département of Neurosciences, Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
- Centre Hospitalier de l'Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
| | - Arshia Sehgal
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Qiao Zhang
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Brendan Lethebe
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
| | - Craig Doram
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Michel Shamy
- Department of Medicine, Ottawa Heart Research Institute, University of Ottawa, ON, Canada (D.D., M. Shamy)
| | - Carol Kenney
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Brian H Buck
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (S.T., S.M.M., M.P.K., B.H.B.)
| | - Richard H Swartz
- Division of Neurology, Department of Medicine, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (H.K., D.J.G., R.H.S.)
| | - Bijoy K Menon
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.)
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Kim DJ, Singh N, Catanese L, Yu AYX, Demchuk AM, Lloret-Villas MI, Deschaintre Y, Coutts SB, Khosravani H, Appireddy R, Moreau F, Gubitz G, Tkach A, Dowlatshahi D, Medvedev G, Mandzia J, Pikula A, Shankar J, Williams H, Manosalva H, Siddiqui M, Zafar A, Imoukhuede O, Hunter G, Phillips S, Hill MD, Poppe AY, Ademola A, Shamy M, Bala F, Sajobi TT, Swartz RH, Almekhlafi MA, Menon BK, Field TS. Sex-Based Analysis of Workflow and Outcomes in Acute Ischemic Stroke Patients Treated With Alteplase Versus Tenecteplase. Stroke 2024; 55:288-295. [PMID: 38174568 DOI: 10.1161/strokeaha.123.045320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Understanding sex differences in stroke care is important in reducing potential disparities. Our objective was to explore sex differences in workflow efficiency, treatment efficacy, and safety in the AcT trial (Alteplase Compared to Tenecteplase). METHODS AcT was a multicenter, registry-linked randomized noninferiority trial comparing tenecteplase (0.25 mg/kg) with alteplase (0.9 mg/kg) in acute ischemic stroke within 4.5 hours of onset. In this post hoc analysis, baseline characteristics, workflow times, successful reperfusion (extended Thrombolysis in Cerebral Infarction score ≥2b), symptomatic intracerebral hemorrhage, 90-day functional independence (modified Rankin Scale score, 0-1), and 90-day mortality were compared by sex. Mixed-effects regression analysis was used adjusting for age, stroke severity, and occlusion site for outcomes. RESULTS Of 1577 patients treated with intravenous thrombolysis (2019-2022), 755 (47.9%) were women. Women were older (median, 77 [68-86] years in women versus 70 [59-79] years in men) and had a higher proportion of severe strokes (National Institutes of Health Stroke Scale score >15; 32.4% versus 24.9%) and large vessel occlusions (28.7% versus 21.5%) compared with men. All workflow times were comparable between sexes. Women were less likely to achieve functional independence (31.7% versus 39.8%; unadjusted relative risk, 0.80 [95% CI, 0.70-0.91]) and had higher mortality (17.7% versus 13.3%; unadjusted relative risk, 1.33 [95% CI, 1.06-1.69]). Adjusted analysis showed no difference in outcomes between sexes. CONCLUSIONS Differences in prognostic factors of age, stroke severity, and occlusion site largely accounted for higher functional dependence and mortality in women. No sex disparities were apparent in workflow quality indicators. Given the integration of the AcT trial into clinical practice, these results provide reassurance that no major sex biases are apparent in acute stroke management throughout participating Canadian centers. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03889249.
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Affiliation(s)
- Diana J Kim
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Nishita Singh
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada (N.S., J.S.)
| | - Luciana Catanese
- Hamilton Health Sciences Centre, McMaster University, Hamilton, ON, Canada (L.C.)
| | - Amy Y X Yu
- Division of Neurology, Sunnybrook Health Sciences Centre (A.Y.X.Y., H.K., R.H.S.), University of Toronto, ON, Canada
| | - Andrew M Demchuk
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | | | - Yan Deschaintre
- Department of Neurosciences, Université de Montréal, QC, Canada (Y.D.)
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Houman Khosravani
- Division of Neurology, Sunnybrook Health Sciences Centre (A.Y.X.Y., H.K., R.H.S.), University of Toronto, ON, Canada
| | - Ramana Appireddy
- Division of Neurology, Queen's University, Kingston, ON, Canada (R.A.)
| | | | - Gord Gubitz
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (G.G., S.P.)
| | | | - Dar Dowlatshahi
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada (D.D., M. Shamy)
| | - George Medvedev
- Royal Columbian Hospital, New Westminster, BC, Canada (G.M.)
| | - Jennifer Mandzia
- London Health Sciences Centre, Western University, London, ON, Canada (J.M.)
| | | | - Jai Shankar
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada (N.S., J.S.)
| | | | | | | | - Atif Zafar
- St Michael's Hospital, Toronto, ON, Canada (A.Z.)
| | | | - Gary Hunter
- University of Saskatchewan, Saskatoon, Canada (G.H.)
| | - Stephen Phillips
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (G.G., S.P.)
| | - Michael D Hill
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | | | - Ayoola Ademola
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Michel Shamy
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada (D.D., M. Shamy)
| | - Fouzi Bala
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Tolulope T Sajobi
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Richard H Swartz
- Division of Neurology, Sunnybrook Health Sciences Centre (A.Y.X.Y., H.K., R.H.S.), University of Toronto, ON, Canada
| | - Mohammed A Almekhlafi
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Bijoy K Menon
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, The University of British Columbia, Vancouver, Canada (T.S.F.)
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Sawatzky R, Sajobi TT, Russell L, Awosoga OA, Ademola A, Böhnke JR, Lawal O, Brobbey A, Lix LM, Anota A, Sebille V, Sprangers MAG, Verdam MGE. Response shift results of quantitative research using patient-reported outcome measures: a descriptive systematic review. Qual Life Res 2024; 33:293-315. [PMID: 37702809 PMCID: PMC10850024 DOI: 10.1007/s11136-023-03495-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE The objective of this systematic review was to describe the prevalence and magnitude of response shift effects, for different response shift methods, populations, study designs, and patient-reported outcome measures (PROM)s. METHODS A literature search was performed in MEDLINE, PSYCINFO, CINAHL, EMBASE, Social Science Citation Index, and Dissertations & Theses Global to identify longitudinal quantitative studies that examined response shift using PROMs, published before 2021. The magnitude of each response shift effect (effect sizes, R-squared or percentage of respondents with response shift) was ascertained based on reported statistical information or as stated in the manuscript. Prevalence and magnitudes of response shift effects were summarized at two levels of analysis (study and effect levels), for recalibration and reprioritization/reconceptualization separately, and for different response shift methods, and population, study design, and PROM characteristics. Analyses were conducted twice: (a) including all studies and samples, and (b) including only unrelated studies and independent samples. RESULTS Of the 150 included studies, 130 (86.7%) detected response shift effects. Of the 4868 effects investigated, 793 (16.3%) revealed response shift. Effect sizes could be determined for 105 (70.0%) of the studies for a total of 1130 effects, of which 537 (47.5%) resulted in detection of response shift. Whereas effect sizes varied widely, most median recalibration effect sizes (Cohen's d) were between 0.20 and 0.30 and median reprioritization/reconceptualization effect sizes rarely exceeded 0.15, across the characteristics. Similar results were obtained from unrelated studies. CONCLUSION The results draw attention to the need to focus on understanding variability in response shift results: Who experience response shifts, to what extent, and under which circumstances?
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Affiliation(s)
- Richard Sawatzky
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, BC, V2Y 1Y1, Canada.
- Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, Canada.
- University of Gothenburg Centre for Person‑Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Tolulope T Sajobi
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Lara Russell
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, BC, V2Y 1Y1, Canada
- Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, Canada
| | | | - Ayoola Ademola
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Jan R Böhnke
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Oluwaseyi Lawal
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Anita Brobbey
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Amelie Anota
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, Besançon, France
| | - Véronique Sebille
- INSERM, MethodS in Patient-Centered Outcomes and HEalth ResEarch, SPHERE, Nantes Université, Université de Tours, CHU Nantes, 44000, Nantes, France
| | - Mirjam A G Sprangers
- Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Mathilde G E Verdam
- Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health, Amsterdam, The Netherlands
- Department of Methodology and Statistics, Institute of Psychology, Leiden University, Leiden, The Netherlands
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6
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Ademola A, Thabane L, Adekanye J, Okikiolu A, Babatunde S, Almekhlafi MA, Menon BK, Hill MD, Hildebrand KA, Sajobi TT. The credibility of subgroup analyses reported in stroke trials is low: A systematic review. Int J Stroke 2023; 18:1161-1168. [PMID: 36988330 PMCID: PMC10676048 DOI: 10.1177/17474930231168517] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Subgroup analyses are widely used to evaluate the heterogeneity of treatment effects in randomized clinical trials. However, there is a limited investigation of the quality of prespecified and reported subgroup analyses in stroke trials. This study evaluated the credibility of subgroup analyses in stroke trials. METHODS AND ANALYSIS We searched Medline/PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the Web of Science from inception to 24 March 2021. Three reviewers screened, extracted, and analyzed the data from the publications. Primary publications of stroke trials that reported at least one subgroup effect and had published corresponding study protocols were included. The Instrument for Assessing the Credibility of Effect Modification Analyses (ICEMAN) was used to examine the quality of the subgroup effects reported, with each subgroup effect assigned a credibility rating ranging from very low to high. Subgroup effects with two or more "definitely no" responses received a low credibility rating. The risk of bias was assessed using the Cochrane Risk-of-Bias tool for randomized trials version 2. RESULTS Seventy-four articles met the inclusion criteria and reported a combined total of 647 subgroup effects. The median sample size was 1264 (interquartile range (IQR): 380-3876), and the median number of subgroups prespecified in the protocol was 6 (IQR: 2-10). Sixty-one (82%) studies used the univariate test of interaction. Of the total 647 subgroup effects reported in these studies, 319 (49%) were reported in acute stroke trials, while 423 (65%) had low credibility. CONCLUSION The quality of subgroup analysis reporting in stroke trials remains poor. More effort is needed to train trialists on the best methods for designing and performing subgroup analyses, and how to report the results. TRIAL REGISTRATION NUMBER We prospectively registered the review with International Prospective Register for Systematic Reviews (registration number: CRD42020223133).
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Affiliation(s)
- Ayoola Ademola
- Department of Community Health Sciences and O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Joel Adekanye
- Department of Community Health Sciences and O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Ayooluwanimi Okikiolu
- Department Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Samuel Babatunde
- Office of Institutional Analysis, University of Calgary, Calgary, AB, Canada
| | - Mohammed A Almekhlafi
- Department Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Bijoy K Menon
- Department of Community Health Sciences and O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Michael D Hill
- Department of Community Health Sciences and O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | | | - Tolulope T Sajobi
- Department of Community Health Sciences and O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
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Singh N, Almekhlafi MA, Bala F, Ademola A, Coutts SB, Deschaintre Y, Khosravani H, Buck B, Appireddy R, Moreau F, Gubitz G, Tkach A, Catanese L, Dowlatshahi D, Medvedev G, Mandzia J, Pikula A, Shankar JJ, Ghrooda E, Poppe AY, Williams H, Field TS, Manosalva A, Siddiqui MM, Zafar A, Imoukhoude O, Hunter G, Shamy M, Demchuk AM, Claggett BL, Hill MD, Sajobi TT, Swartz RH, Menon BK. Effect of Time to Thrombolysis on Clinical Outcomes in Patients With Acute Ischemic Stroke Treated With Tenecteplase Compared to Alteplase: Analysis From the AcT Randomized Controlled Trial. Stroke 2023; 54:2766-2775. [PMID: 37800372 DOI: 10.1161/strokeaha.123.044267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/23/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The AcT (Alteplase Compared to Tenecteplase) randomized controlled trial showed that tenecteplase is noninferior to alteplase in treating patients with acute ischemic stroke within 4.5 hours of symptom onset. The effect of time to treatment on clinical outcomes with alteplase is well known; however, the nature of this relationship is yet to be described with tenecteplase. We assessed whether the association of time to thrombolysis treatment with clinical outcomes in patients with acute ischemic stroke differs by whether they receive intravenous tenecteplase versus alteplase. METHODS Patients included were from AcT, a pragmatic, registry-linked, phase 3 randomized controlled trial comparing intravenous tenecteplase to alteplase in patients with acute ischemic stroke. Eligible patients were >18 years old, with disabling neurological deficits, presenting within 4.5 hours of symptom onset, and eligible for thrombolysis. Primary outcome was modified Rankin Scale score 0 to 1 at 90 days. Safety outcomes included 24-hour symptomatic intracerebral hemorrhage and 90-day mortality rates. Mixed-effects logistic regression was used to assess the following: (a) the association of stroke symptom onset to needle time; (b) door (hospital arrival) to needle time with outcomes; and (c) if these associations were modified by type of thrombolytic administered (tenecteplase versus alteplase), after adjusting for age, sex, baseline stroke severity, and site of intracranial occlusion. RESULTS Of the 1538 patients included in this analysis, 1146 (74.5%; 591 tenecteplase and 555 alteplase) presented within 3 hours versus 392 (25.5%; 196: TNK and 196 alteplase) who presented within 3 to 4.5 hours of symptom onset. Baseline patient characteristics in the 0 to 3 hours versus 3- to 4.5-hour time window were similar, except patients in the 3- to 4.5-hour window had lower median baseline National Institutes of Health Stroke Severity Scale (10 versus 7, respectively) and lower proportion of patients with large vessel occlusion on baseline CT angiography (26.9% versus 18.7%, respectively). Type of thrombolytic agent (tenecteplase versus alteplase) did not modify the association between continuous onset to needle time (Pinteraction=0.161) or door-to-needle time (Pinteraction=0.972) and primary clinical outcome. Irrespective of the thrombolytic agent used, each 30-minute reduction in onset to needle time was associated with a 1.8% increase while every 10 minutes reduction in door-to-needle time was associated with a 0.2% increase in the probability of achieving 90-day modified Rankin Scale score 0 to 1, respectively. CONCLUSIONS The effect of time to tenecteplase administration on clinical outcomes is like that of alteplase, with faster administration resulting in better clinical outcomes. REGISTRATION URL: https://classic. CLINICALTRIALS gov; Unique identifier: NCT03889249.
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Affiliation(s)
- Nishita Singh
- Department of Neurosciences, Radiology and Community Health Sciences, University of Calgary, Canada (N.S., M.A.A., A.A., S.B.C., A.M.D., M.D.H., T.T.S., B.K.M.)
- Department of Internal Medicine (Neurology Division), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada (N.S., E.G.)
| | - Mohammed A Almekhlafi
- Department of Neurosciences, Radiology and Community Health Sciences, University of Calgary, Canada (N.S., M.A.A., A.A., S.B.C., A.M.D., M.D.H., T.T.S., B.K.M.)
- Department of Community Health Sciences, University of Calgary, Canada (M.A.A., A.A., S.B.C., M.D.H., T.T.S., B.K.M.)
- Department of Radiology, University of Calgary, Canada (M.A.A., F.B., S.B.C., M.D.H., B.K.M.)
| | - Fouzi Bala
- Department of Radiology, University of Calgary, Canada (M.A.A., F.B., S.B.C., M.D.H., B.K.M.)
- Diagnostic and Interventional Neuroradiology, Tours University Hospital, France (F.B.)
| | - Ayoola Ademola
- Department of Neurosciences, Radiology and Community Health Sciences, University of Calgary, Canada (N.S., M.A.A., A.A., S.B.C., A.M.D., M.D.H., T.T.S., B.K.M.)
- Department of Community Health Sciences, University of Calgary, Canada (M.A.A., A.A., S.B.C., M.D.H., T.T.S., B.K.M.)
| | - Shelagh B Coutts
- Department of Neurosciences, Radiology and Community Health Sciences, University of Calgary, Canada (N.S., M.A.A., A.A., S.B.C., A.M.D., M.D.H., T.T.S., B.K.M.)
- Department of Community Health Sciences, University of Calgary, Canada (M.A.A., A.A., S.B.C., M.D.H., T.T.S., B.K.M.)
- Department of Radiology, University of Calgary, Canada (M.A.A., F.B., S.B.C., M.D.H., B.K.M.)
| | - Yan Deschaintre
- Department of Clinical Neurosciences, Université de Montréal, Canada (Y.D., A.Y.P.)
| | - Houman Khosravani
- Department of Medicine, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, Canada (H.K., R.H.S.)
| | - Brian Buck
- Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Canada (B.B.)
| | - Ramana Appireddy
- Department of Medicine, Division of Neurology, Queen's University, Kingston, ON, Canada (R.A.)
| | - Francois Moreau
- Department of Internal Medicine, Université de Sherbrooke, QC, Canada (F.M.)
| | - Gord Gubitz
- Queen Elizabeth Health Sciences Centre, Halifax, NS, Canada (G.G.)
| | - Aleksander Tkach
- Department of Neurosciences, Kelowna General Hospital, Canada (A.T.)
| | - Luciana Catanese
- Department of Medicine, McMaster University, Hamilton, Canada (L.C.)
| | - Dar Dowlatshahi
- Department of Medicine, and Ottawa Hospital Research Institute, University of Ottawa, Canada (D.D., M.S.)
| | - George Medvedev
- Department of Neurosciences, University of British Columbia, Vancouver, Canada (G.M., T.S.F.)
| | - Jennifer Mandzia
- London Health Sciences Centre and Western University, ON, Canada (J.M.)
| | - Aleksandra Pikula
- London Health Sciences Centre and Western University, ON, Canada (J.M.)
| | - Jai Jai Shankar
- Department of Radiology, Health Sciences Center, University of Manitoba, Winnipeg, Canada (J.J.S.)
| | - Esseeddeegg Ghrooda
- Department of Internal Medicine (Neurology Division), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada (N.S., E.G.)
| | - Alexandre Y Poppe
- Department of Clinical Neurosciences, Université de Montréal, Canada (Y.D., A.Y.P.)
| | - Heather Williams
- Department of Medicine, Queen Elizabeth Health Sciences Centre, Charlottetown, Canada (H.W.)
| | - Thalia S Field
- Department of Neurosciences, University of British Columbia, Vancouver, Canada (G.M., T.S.F.)
| | - Alejandro Manosalva
- Department of Medicine, Medicine Hat Regional Hospital, Calgary, Canada (A.M.)
| | | | - Atif Zafar
- St Michael's Hospital, Toronto, ON, Canada (A.Z.)
| | - Oje Imoukhoude
- Department of Medicine, Red Deer Regional Hospital, Calgary, Canada (O.I.)
| | - Gary Hunter
- Department of Medicine, University of Saskatoon, Canada (G.H.)
| | - Michel Shamy
- Department of Medicine, and Ottawa Hospital Research Institute, University of Ottawa, Canada (D.D., M.S.)
| | - Andrew M Demchuk
- Department of Neurosciences, Radiology and Community Health Sciences, University of Calgary, Canada (N.S., M.A.A., A.A., S.B.C., A.M.D., M.D.H., T.T.S., B.K.M.)
| | - Brian L Claggett
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA (B.L.C.)
| | - Michael D Hill
- Department of Neurosciences, Radiology and Community Health Sciences, University of Calgary, Canada (N.S., M.A.A., A.A., S.B.C., A.M.D., M.D.H., T.T.S., B.K.M.)
- Department of Community Health Sciences, University of Calgary, Canada (M.A.A., A.A., S.B.C., M.D.H., T.T.S., B.K.M.)
- Department of Radiology, University of Calgary, Canada (M.A.A., F.B., S.B.C., M.D.H., B.K.M.)
| | - Tolulope T Sajobi
- Department of Neurosciences, Radiology and Community Health Sciences, University of Calgary, Canada (N.S., M.A.A., A.A., S.B.C., A.M.D., M.D.H., T.T.S., B.K.M.)
- Department of Community Health Sciences, University of Calgary, Canada (M.A.A., A.A., S.B.C., M.D.H., T.T.S., B.K.M.)
| | - Richard H Swartz
- Department of Medicine, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, Canada (H.K., R.H.S.)
| | - Bijoy K Menon
- Department of Neurosciences, Radiology and Community Health Sciences, University of Calgary, Canada (N.S., M.A.A., A.A., S.B.C., A.M.D., M.D.H., T.T.S., B.K.M.)
- Department of Community Health Sciences, University of Calgary, Canada (M.A.A., A.A., S.B.C., M.D.H., T.T.S., B.K.M.)
- Department of Radiology, University of Calgary, Canada (M.A.A., F.B., S.B.C., M.D.H., B.K.M.)
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Bala F, Singh N, Buck B, Ademola A, Coutts SB, Deschaintre Y, Khosravani H, Appireddy R, Moreau F, Phillips S, Gubitz G, Tkach A, Catanese L, Dowlatshahi D, Medvedev G, Mandzia J, Pikula A, Shankar JJ, Williams H, Field TS, Manosalva Alzate A, Siddiqui M, Zafar A, Imoukhoude O, Hunter G, Alhabli I, Benali F, Horn M, Hill MD, Shamy M, Sajobi TT, Swartz RH, Menon BK, Almekhlafi M. Safety and Efficacy of Tenecteplase Compared With Alteplase in Patients With Large Vessel Occlusion Stroke: A Prespecified Secondary Analysis of the ACT Randomized Clinical Trial. JAMA Neurol 2023; 80:824-832. [PMID: 37428494 PMCID: PMC10334294 DOI: 10.1001/jamaneurol.2023.2094] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/28/2023] [Indexed: 07/11/2023]
Abstract
Importance It is unknown whether intravenous thrombolysis using tenecteplase is noninferior or preferable compared with alteplase for patients with acute ischemic stroke. Objective To examine the safety and efficacy of tenecteplase compared to alteplase among patients with large vessel occlusion (LVO) stroke. Design, Setting, and Participants This was a prespecified analysis of the Intravenous Tenecteplase Compared With Alteplase for Acute Ischaemic Stroke in Canada (ACT) randomized clinical trial that enrolled patients from 22 primary and comprehensive stroke centers across Canada between December 10, 2019, and January 25, 2022. Patients 18 years and older with a disabling ischemic stroke within 4.5 hours of symptom onset were randomly assigned (1:1) to either intravenous tenecteplase or alteplase and were monitored for up to 120 days. Patients with baseline intracranial internal carotid artery (ICA), M1-middle cerebral artery (MCA), M2-MCA, and basilar occlusions were included in this analysis. A total of 1600 patients were enrolled, and 23 withdrew consent. Exposures Intravenous tenecteplase (0.25 mg/kg) vs intravenous alteplase (0.9 mg/kg). Main Outcomes and Measures The primary outcome was the proportion of modified Rankin scale (mRS) score 0-1 at 90 days. Secondary outcomes were an mRS score from 0 to 2, mortality, and symptomatic intracerebral hemorrhage. Angiographic outcomes were successful reperfusion (extended Thrombolysis in Cerebral Infarction scale score 2b-3) on first and final angiographic acquisitions. Multivariable analyses (adjusting for age, sex, National Institute of Health Stroke Scale score, onset-to-needle time, and occlusion location) were carried out. Results Among 1577 patients, 520 (33.0%) had LVO (median [IQR] age, 74 [64-83] years; 283 [54.4%] women): 135 (26.0%) with ICA occlusion, 237 (45.6%) with M1-MCA, 117 (22.5%) with M2-MCA, and 31 (6.0%) with basilar occlusions. The primary outcome (mRS score 0-1) was achieved in 86 participants (32.7%) in the tenecteplase group vs 76 (29.6%) in the alteplase group. Rates of mRS 0-2 (129 [49.0%] vs 131 [51.0%]), symptomatic intracerebral hemorrhage (16 [6.1%] vs 11 [4.3%]), and mortality (19.9% vs 18.1%) were similar in the tenecteplase and alteplase groups, respectively. No difference was noted in successful reperfusion rates in the first (19 [9.2%] vs 21 [10.5%]) and final angiogram (174 [84.5%] vs 177 [88.9%]) among 405 patients who underwent thrombectomy. Conclusions and Relevance The findings in this study indicate that intravenous tenecteplase conferred similar reperfusion, safety, and functional outcomes compared to alteplase among patients with LVO.
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Affiliation(s)
- Fouzi Bala
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Nishita Singh
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Internal Medicine, Neurology Division, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brian Buck
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ayoola Ademola
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Shelagh B. Coutts
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Yan Deschaintre
- Department of Neurosciences, Université de Montréal, Montréal, Québec, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Houman Khosravani
- Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, Ontario, Canada
| | - Ramana Appireddy
- Division of Neurology, Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | | | - Stephen Phillips
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Gord Gubitz
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | - Luciana Catanese
- Hamilton Health Sciences Centre and McMaster University, Hamilton, Ontario, Canada
| | - Dar Dowlatshahi
- Department of Medicine, University of Ottawa, and the Ottawa Heart Research Institute, Ottawa, Ontario, Canada
| | - George Medvedev
- University of British Columbia and the Fraser Health Authority, New Westminster, British Columbia, Canada
| | - Jennifer Mandzia
- London Health Sciences Centre and Western University, London, Ontario, Canada
| | - Aleksandra Pikula
- Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Jai Jai Shankar
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heather Williams
- Queen Elizabeth Hospital, Charlottetown, Prince Edward Island, Canada
| | - Thalia S. Field
- Vancouver Stroke Program and the Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Atif Zafar
- St Michael’s Hospital, Toronto, Ontario, Canada
| | | | - Gary Hunter
- Division of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ibrahim Alhabli
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Faysal Benali
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - MacKenzie Horn
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael D. Hill
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Michel Shamy
- Department of Medicine, University of Ottawa, and the Ottawa Heart Research Institute, Ottawa, Ontario, Canada
| | - Tolulope T. Sajobi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Richard H. Swartz
- Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, Ontario, Canada
| | - Bijoy K. Menon
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Mohammed Almekhlafi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
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Bala F, Kim BJ, Najm M, Thornton J, Fainardi E, Michel P, Alpay K, Herlihy D, Goyal M, Casetta I, Nannoni S, Ylikotila P, Power S, Saia V, Hegarty A, Pracucci G, Rautio R, Ademola A, Demchuk A, Mangiafico S, Boyle K, Hill MD, Toni D, Murphy S, Menon BK, Almekhlafi MA. Outcomes with Endovascular Treatment of Patients with M2 Segment MCA Occlusion in the Late Time Window. AJNR Am J Neuroradiol 2023; 44:447-452. [PMID: 36958801 PMCID: PMC10084904 DOI: 10.3174/ajnr.a7833] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/23/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND AND PURPOSE Randomized trials in the late window have demonstrated the efficacy and safety of endovascular thrombectomy in large-vessel occlusions. Patients with M2-segment MCA occlusions were excluded from these trials. We compared outcomes with endovascular thrombectomy in patients with M2-versus-M1 occlusions presenting 6-24 hours after symptom onset. MATERIALS AND METHODS Analyses were on pooled data from studies enrolling patients with stroke treated with endovascular thrombectomy 6-24 hours after symptom onset. We compared 90-day functional independence (mRS ≤ 2), mortality, symptomatic intracranial hemorrhage, and successful reperfusion (expanded TICI = 2b-3) between patients with M2 and M1 occlusions. The benefit of successful reperfusion was then assessed among patients with M2 occlusion. RESULTS Of 461 patients, 367 (79.6%) had M1 occlusions and 94 (20.4%) had M2 occlusions. Patients with M2 occlusions were older and had lower median baseline NIHSS scores. Patients with M2 occlusion were more likely to achieve 90-day functional independence than those with M1 occlusion (adjusted OR = 2.13; 95% CI, 1.25-3.65). There were no significant differences in the proportion of successful reperfusion (82.9% versus 81.1%) or mortality (11.2% versus 17.2%). Symptomatic intracranial hemorrhage risk was lower in patients with M2-versus-M1 occlusions (4.3% versus 12.2%, P = .03). Successful reperfusion was independently associated with functional independence among patients with M2 occlusions (adjusted OR = 2.84; 95% CI, 1.11-7.29). CONCLUSIONS In the late time window, patients with M2 occlusions treated with endovascular thrombectomy achieved better clinical outcomes, similar reperfusion, and lower symptomatic intracranial hemorrhage rates compared with patients with M1 occlusion. These results support the safety and benefit of endovascular thrombectomy in patients with M2 occlusions in the late window.
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Affiliation(s)
- F Bala
- From the Calgary Stroke Program (F.B., M.N., M.G., A.D., M.D.H., B.K.M., M.A.A.), Departments of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Alberta, Canada
- Diagnostic and Interventional Neuroradiology Department (F.B.), University Hospital of Tours, Tours, France
| | - B J Kim
- Department of Neurology and Cerebrovascular Center (B.J.K.), Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - M Najm
- From the Calgary Stroke Program (F.B., M.N., M.G., A.D., M.D.H., B.K.M., M.A.A.), Departments of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Alberta, Canada
| | - J Thornton
- Neuroradiology Department (J.T., D.H., S.P.)
- Royal College of Surgeons in Ireland (J.T., A.H.), Dublin, Ireland
| | - E Fainardi
- Neuroradiology Unit (E.F.), Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - P Michel
- Stroke Center (P.M., S.N.), Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - K Alpay
- Department of Radiology (K.A., R.R.), Turku University Hospital, Turku, Finland
| | - D Herlihy
- Neuroradiology Department (J.T., D.H., S.P.)
| | - M Goyal
- From the Calgary Stroke Program (F.B., M.N., M.G., A.D., M.D.H., B.K.M., M.A.A.), Departments of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Alberta, Canada
| | - I Casetta
- Clinica Neurologica (I.C.), University of Ferrara, Ferrara, Italy
| | - S Nannoni
- Stroke Center (P.M., S.N.), Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - P Ylikotila
- Neurocenter (P.Y.), Turku University Hospital, University of Turku, Turku, Finland
| | - S Power
- Neuroradiology Department (J.T., D.H., S.P.)
| | - V Saia
- Stroke Unit (V.S.), Santa Corona Hospital, Pietra Ligure, Italy
| | - A Hegarty
- Royal College of Surgeons in Ireland (J.T., A.H.), Dublin, Ireland
| | - G Pracucci
- Stroke Unit (G.P.), Careggi University Hospital, Florence, Italy
| | - R Rautio
- Department of Radiology (K.A., R.R.), Turku University Hospital, Turku, Finland
| | - A Ademola
- Department of Community Health Sciences (A.A., M.D.H., B.K.M., M.A.A.), University of Calgary, Calgary, Alberta, Canada
| | - A Demchuk
- From the Calgary Stroke Program (F.B., M.N., M.G., A.D., M.D.H., B.K.M., M.A.A.), Departments of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Alberta, Canada
| | - S Mangiafico
- Interventional Neuroradiology Unit (S. Mangiafico), Institute for Hospitalization and Healthcare Neuromed, Pozzilli, Italy
| | - K Boyle
- Department of Geriatric and Stroke Medicine (K.B.), Beaumont Hospital, Dublin, Ireland
| | - M D Hill
- From the Calgary Stroke Program (F.B., M.N., M.G., A.D., M.D.H., B.K.M., M.A.A.), Departments of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences (A.A., M.D.H., B.K.M., M.A.A.), University of Calgary, Calgary, Alberta, Canada
| | - D Toni
- Emergency Department (D.T.), Stroke Unit, Sapienza University Hospital, Rome, Italy
| | - S Murphy
- Department of Geriatric and Stroke Medicine (S. Murphy), The Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine (S. Murphy), Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Medicine (S. Murphy), University College Dublin, Dublin, Ireland
| | - B K Menon
- From the Calgary Stroke Program (F.B., M.N., M.G., A.D., M.D.H., B.K.M., M.A.A.), Departments of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences (A.A., M.D.H., B.K.M., M.A.A.), University of Calgary, Calgary, Alberta, Canada
| | - M A Almekhlafi
- From the Calgary Stroke Program (F.B., M.N., M.G., A.D., M.D.H., B.K.M., M.A.A.), Departments of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences (A.A., M.D.H., B.K.M., M.A.A.), University of Calgary, Calgary, Alberta, Canada
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OLUWATUYI K, Asinobi A, Ademola A, Biliaminu S, Jegede T, Alonge O, Salau Q, Fasoranti I, Asowata O, Ekogiawe F, Adetona G. WCN23-1232 EARLY DETECTION AND OUTCOME OF ACUTE KIDNEY INJURY USING SERUM CYSTATIN C IN CHILDREN WITH SEVERE MALARIA AT FEDERAL MEDICAL CENTRE, OWO. Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.089] [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: 03/22/2023] Open
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Ademola A, Thabane L, Adekanye J, Babatunde S, Almekhlafi M, Menon B, Hill MD, Hildebrand K, Sajobi T. Abstract WMP48: The Credibility Of Subgroup Analyses Reporting In Stroke Trials Is Poor: A Methodological Review. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wmp48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background:
Subgroup analyses are widely used to evaluate heterogeneity of treatment effects in randomized clinical trials. However, there is a limited investigation of the quality of prespecified and reported subgroup analyses in stroke trials. This study evaluated the credibility of subgroup analyses in stroke trials.
Methods and Analysis:
We searched Medline/PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the Web of Science from inception to March 24
th
, 2021. Three reviewers screened, extracted, and analyzed the data from the publications. Primary publications of stroke trials that reported at least one subgroup effect and had published corresponding study protocols were included. The Instrument for Assessing the Credibility of Effect Modification Analyses (ICEMAN) was used to examine the quality of the subgroup effects reported. The risk of bias was assessed using the Cochrane Risk-of-Bias tool for randomized trials version 2.
Results:
Seventy-four articles met the inclusion criteria and altogether reported 647 subgroup effects. The median sample size was 1264 (interquartile range (IQR): 380 - 3876) while the median number of subgroups prespecified in the protocol was 6 (IQR:2 - 10), and 61 studies (82.4%) used the univariate test of interaction. One hundred and thirty-nine subgroup effects (43.6%) in acute stroke treatment and 131 subgroup effects (35.03%) in studies published in 2015 or later had moderate credibility. Overall, 458 subgroup effects (70.8%) had low credibility, while 189 subgroup effects (29.2%) had moderate credibility.
Conclusion:
Subgroup analysis reporting quality in stroke trials remains poor. Trialists and medical journal publishers must ensure that reporting guidelines, such as ICEMAN, are adopted to improve the credibility of reported subgroup analyses in stroke trials.
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Sajobi T, Ademola A, Arimoro OI, Singh N, Bala F, Almekhlafi M, Deschaintre Y, Appireddy R, Gubitz GJ, Tkach A, Catanese L, Medvedev G, Shankar JJ, Manosalva Alzate HA, Imoukhuede O, Kenney CC, Sehgal A, Zhang Q, Doram C, Zafar A, Moreau F, Williams H, Buck BH, Hill MD, Swartz RH, Menon BK. Abstract WMP11: Health-related Quality Of Life After Thrombolysis In Acute Stroke: Results From The Act Trial. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wmp11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background and aims:
Recent evidence from thrombolysis trials indicate the non-inferiority of the Tenecteplase (TNK) to the Alteplase (TPA) with respect to functional outcomes in acute stroke patients. This study examines the predictors of patient-reported health-related quality of life (HRQOL) in acute stroke patients who received thrombolysis therapy.
Methods:
Data were used from all acute stroke patients included in AcT, a pragmatic, registry-linked randomized trial comparing TNK with TPA. HRQOL at 90-day post-randomization was assessed using the EuroQol-5D-5L (EQ-5D) visual analogue scale (VAS). Based on the Canadian norms, health state utilities were estimated from the EQ-5D items using the EQ-5D time trade-off approach. Tobit regression model and linear mixed-effects regression were used to evaluate the adjusted effect of type of treatment on health utility scores and VAS score, respectively.
Results:
Of the 1262 patients included in this analysis, 647(51.3%) were administered the TNK, 584(46.3%) were female, and 380(30.1%) were greater than or equal to 80 years old. There was no significant adjusted effect of the type of thrombolysis on health utility scores (adjusted beta coefficient [95%CI] = 0.029 [-0.001, 0.062]), but patients who received TNK reported higher adjusted VAS scores than those that received TPA [adjusted beta coefficient [95%CI] = 2.1 [-0.29, 4.49]). Older age (p < 0.01), female sex (p = 0.01), higher NIHSS score (p < 0.01) were associated with lower health utilities and VAS scores.
Conclusion:
There is no differential effect of the type of thrombolysis on patient-reported global HRQOL and health state utilities of acute stroke patients. Disparities in HRQOL were mainly explained by sex, age, and disease severity.
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Menon BK, Buck BH, Singh N, Deschaintre Y, Almekhlafi MA, Coutts SB, Thirunavukkarasu S, Khosravani H, Appireddy R, Moreau F, Gubitz G, Tkach A, Catanese L, Dowlatshahi D, Medvedev G, Mandzia J, Pikula A, Shankar J, Williams H, Field TS, Manosalva A, Siddiqui M, Zafar A, Imoukhuede O, Hunter G, Demchuk AM, Mishra S, Gioia LC, Jalini S, Cayer C, Phillips S, Elamin E, Shoamanesh A, Subramaniam S, Kate M, Jacquin G, Camden MC, Benali F, Alhabli I, Bala F, Horn M, Stotts G, Hill MD, Gladstone DJ, Poppe A, Sehgal A, Zhang Q, Lethebe BC, Doram C, Ademola A, Shamy M, Kenney C, Sajobi TT, Swartz RH. Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT): a pragmatic, multicentre, open-label, registry-linked, randomised, controlled, non-inferiority trial. Lancet 2022; 400:161-169. [PMID: 35779553 DOI: 10.1016/s0140-6736(22)01054-6] [Citation(s) in RCA: 114] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Intravenous thrombolysis with alteplase bolus followed by infusion is a global standard of care for patients with acute ischaemic stroke. We aimed to determine whether tenecteplase given as a single bolus might increase reperfusion compared with this standard of care. METHODS In this multicentre, open-label, parallel-group, registry-linked, randomised, controlled trial (AcT), patients were enrolled from 22 primary and comprehensive stroke centres across Canada. Patients were eligible for inclusion if they were aged 18 years or older, with a diagnosis of ischaemic stroke causing disabling neurological deficit, presenting within 4·5 h of symptom onset, and eligible for thrombolysis per Canadian guidelines. Eligible patients were randomly assigned (1:1), using a previously validated minimal sufficient balance algorithm to balance allocation by site and a secure real-time web-based server, to either intravenous tenecteplase (0·25 mg/kg to a maximum of 25 mg) or alteplase (0·9 mg/kg to a maximum of 90mg; 0·09 mg/kg as a bolus and then a 60 min infusion of the remaining 0·81 mg/kg). The primary outcome was the proportion of patients who had a modified Rankin Scale (mRS) score of 0-1 at 90-120 days after treatment, assessed via blinded review in the intention-to-treat (ITT) population (ie, all patients randomly assigned to treatment who did not withdraw consent). Non-inferiority was met if the lower 95% CI of the difference in the proportion of patients who met the primary outcome between the tenecteplase and alteplase groups was more than -5%. Safety was assessed in all patients who received any of either thrombolytic agent and who were reported as treated. The trial is registered with ClinicalTrials.gov, NCT03889249, and is closed to accrual. FINDINGS Between Dec 10, 2019, and Jan 25, 2022, 1600 patients were enrolled and randomly assigned to tenecteplase (n=816) or alteplase (n=784), of whom 1577 were included in the ITT population (n=806 tenecteplase; n=771 alteplase). The median age was 74 years (IQR 63-83), 755 (47·9%) of 1577 patients were female and 822 (52·1%) were male. As of data cutoff (Jan 21, 2022), 296 (36·9%) of 802 patients in the tenecteplase group and 266 (34·8%) of 765 in the alteplase group had an mRS score of 0-1 at 90-120 days (unadjusted risk difference 2·1% [95% CI - 2·6 to 6·9], meeting the prespecified non-inferiority threshold). In safety analyses, 27 (3·4%) of 800 patients in the tenecteplase group and 24 (3·2%) of 763 in the alteplase group had 24 h symptomatic intracerebral haemorrhage and 122 (15·3%) of 796 and 117 (15·4%) of 763 died within 90 days of starting treatment INTERPRETATION: Intravenous tenecteplase (0·25 mg/kg) is a reasonable alternative to alteplase for all patients presenting with acute ischaemic stroke who meet standard criteria for thrombolysis. FUNDING Canadian Institutes of Health Research, Alberta Strategy for Patient Oriented Research Support Unit.
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Affiliation(s)
- Bijoy K Menon
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Cumming School of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, Canada.
| | - Brian H Buck
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Nishita Singh
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Yan Deschaintre
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Mohammed A Almekhlafi
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Cumming School of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, Canada
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Cumming School of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, Canada
| | - Sibi Thirunavukkarasu
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Houman Khosravani
- Department of Medicine (Division of Neurology), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Ramana Appireddy
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Gord Gubitz
- Queen Elizabeth Health Sciences Centre, Halifax, NS, Canada
| | | | - Luciana Catanese
- Hamilton Health Sciences Centre and McMaster University, Hamilton, ON, Canada
| | - Dar Dowlatshahi
- Department of Medicine, University of Ottawa and the Ottawa Heart Research Institute, Ottawa, ON, Canada
| | - George Medvedev
- University of British Columbia and the Fraser Health Authority, New Westminster, BC, Canada
| | - Jennifer Mandzia
- London Health Sciences Centre and Western University, London, ON, Canada
| | - Aleksandra Pikula
- Toronto Western Hospital and the University of Toronto, Toronto, ON, Canada
| | - Jai Shankar
- University of Manitoba, Winnipeg, MB, Canada
| | | | - Thalia S Field
- Vancouver Stroke Program and the Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Atif Zafar
- St Michael's Hospital, Toronto, ON, Canada
| | | | - Gary Hunter
- University of Saskatchewan, Saskatoon, SK, Canada
| | - Andrew M Demchuk
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Cumming School of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, Canada
| | - Sachin Mishra
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Laura C Gioia
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Shirin Jalini
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Caroline Cayer
- Centre de recherche du CHUS, Centre intégré Universitaire de Santé et des Services Sociaux de l'Estrie, Sherbrooke, QC, Canada
| | | | | | - Ashkan Shoamanesh
- Hamilton Health Sciences Centre and McMaster University, Hamilton, ON, Canada
| | - Suresh Subramaniam
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Mahesh Kate
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Gregory Jacquin
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Marie-Christine Camden
- Enfant-Jésus Hospital, Centre Hospitalier Universitaire de Québec, Laval University, Québec City, QC, Canada
| | - Faysal Benali
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Ibrahim Alhabli
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Fouzi Bala
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - MacKenzie Horn
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Grant Stotts
- Department of Medicine, University of Ottawa and the Ottawa Heart Research Institute, Ottawa, ON, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Cumming School of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, Canada
| | - David J Gladstone
- Department of Medicine (Division of Neurology), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Alexandre Poppe
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Arshia Sehgal
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Qiao Zhang
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Brendan Cord Lethebe
- Cumming School of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Craig Doram
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Ayoola Ademola
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Cumming School of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Michel Shamy
- Department of Medicine, University of Ottawa and the Ottawa Heart Research Institute, Ottawa, ON, Canada
| | - Carol Kenney
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Tolulope T Sajobi
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Cumming School of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Richard H Swartz
- Department of Medicine (Division of Neurology), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Ajayi O, Charles-Davies M, Anetor J, Ademola A. T025 The influence of follicular and luteal phases of the menstrual cycle on the indicators of obesity, endocrine disruptors, reproductive and thyroid hormones in African black women with breast cancer. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.262] [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: 11/29/2022]
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15
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Ademola A, Hildebrand K, Almekhlafi M, Menon BK, Demchuk AM, Goyal M, Hill MD, Thabane L, Sajobi T. Abstract TP186: Heterogeneity Of Endovascular Treatment Effect: A Comparison Of Subgroup Identification Methods In Acute Stroke Trials. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Trials’ data are increasingly re-analyzed to identify treatment effect heterogeneity: that is, subgroups of patients who have either enhanced or adverse effects in a trial. This study investigates the robustness of subgroup identification methods in an acute stroke trial.
Methods and Analysis:
The Model-based recursive partitioning (MOB), Stochastic Subgroup Identification based on Differential Effects Search (Stochastic SIDEScreen), and Virtual Twin (VT) methods would be used to detect heterogeneity in Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times (ESCAPE) trial.
Results:
In the ESCAPE trial, patients in the intervention group had a higher rate of functional independence (90-day mRS 0-2) than those in the control group (OR=2.6; p<0.001, and 95% CI=1.7–3.8). The three methods identified patients with differential treatment effects. The MOB identified 2-terminal subgroups, with the NIHSS > 11 group showing a significant treatment effect (OR=3.67; p<0.001 and 95% CI=2.11–6.40), while the subgroup of with a maximum NIHSS score of 11 did not (OR=1.63; p=0.463 and 95% CI=0.44–6.05). The stochastic SIDEScreen identified 4-terminal subgroups, but the group of patients with NIHSS greater than 9 and older than 54 years had a significant treatment effect (OR=4.92; p<0.001, and 95% CI= 2.66–9.10). Other three subgroups, like patients with a maximum NIHSS score of 9 and older than 54 years (OR=2.17, p=0.34, and 95% CI=0.44–10.65), did not have a significant treatment effect. VT identified 6-terminal subgroups; the subgroup consisting of patients older than 56 years and NIHSS > 11 had significant treat effect (OR=5.11; p<0.001 and 95% CI=2.68–9.73). As other renaming 4 subgroups, the subgroup consisting of younger patients and with a maximum NIHSS score of 11 did not show a treatment effect (OR=1.60, p=0.64, and 95% CI=0.39–6.30).
Conclusion:
Data-driven subgroup identification methods provide insight into the heterogeneity of treatment effects in acute stroke trials. Information about the identified subgroups might inform the development of clinical practice guidelines for acute stroke management.
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Affiliation(s)
| | | | | | | | | | - Mayank Goyal
- SEAMAN FAMILY MR RESEARCH CENTRE, Calgary, Canada
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16
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Bala F, Casetta I, Nannoni S, Herlihy D, Goyal M, Fainardi E, Michel P, Thornton JM, Power S, Saia V, Pracucci GIOVANNI, Demchuk AM, Mangiafico S, Boyle K, Hill M, Toni D, Ademola A, Kim B, Menon BK, Almekhlafi M. Abstract TP155: Sex Differences In Outcome And Workflow Of Endovascular Treatment In Late Window Stroke Patients. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Sex-related differences exist in many aspects of stroke and were mainly investigated in the early time window with conflicting results. However, data regarding sex disparities in late presenters are scarce. Therefore, we sought to investigate differences in outcomes between women and men treated with endovascular treatment (EVT) in the late time window.
Methods:
Analyses were based on the Selection Of Late-window Stroke for Thrombectomy by Imaging Collateral Extent Consortium, which was an individual-patient level analysis of seven trials and registries. Baseline characteristics, functional independence (modified Rankin Scale ≤ 2), mortality, and symptomatic intracranial hemorrhage (sICH) were compared between women and men. Effect of sex on the association between age, successful reperfusion (Thrombolysis in cerebral infarction 2b-3) and outcomes was assessed using multivariable logistic regression with interaction terms.
Results:
Among 608 patients treated with EVT, 50.5% were women. Women were older than men by median 4 years and had a lower prevalence of tandem occlusions (14.0% vs. 22.9%). In the subset of patients with available perfusion volumes (n= 195), women had smaller penumbra (median IQR:97 mL [60- 130] vs. 109 mL [73-189]; p= 0.008), and mismatch volumes, (79 mL [49-101] vs. 91 mL [57-158] ; p= 0.02). Pre and intrahospital times were similar between sexes. Outcomes did not differ between women and men, and there was no sex-by-age interaction on functional independence. However, men had higher likelihood of mortality (p
interaction
= 0.004) and sICH (p
interaction
= 0.016) with advancing age. Sex did not influence the relation between successful reperfusion and outcomes.
Conclusions:
In this multicenter analysis of late presenters treated with EVT, sex was not associated with clinical outcomes. However, sex influenced the association between age and safety outcomes with men experiencing worse outcomes with advancing age.
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Affiliation(s)
| | - Ilaria Casetta
- Clinica Neurologica, Univ of Ferrara, Italy, Ferrara, Italy
| | | | | | - Mayank Goyal
- SEAMAN FAMILY MR RESEARCH CENTRE, Calgary, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | - Beom Kim
- SNU BUNDANG HOSPITAL, Seongnam-si Gyeonggi-do
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17
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Ademola A, Menon BK, GOYAL MAYANK, Thornton JM, Casetta I, Nannoni S, Herlihy D, Fainardi E, Power S, Saia V, Hegarty A, Pracucci GIOVANNI, Demchuk AM, Mangiafico S, Boyle K, Michel P, Bala F, Hildebrand KA, Sajobi T, Hill MD, Toni D, Murphy S, Kim BJ, Almekhlafi MA. Abstract 88: Workflow Delays And Outcome Of Endovascular Thrombectomy In The Late Stroke Window:results From A Pooled Multicenter Analysis. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Efficient healthcare workflow leads to faster reperfusion and better functional outcomes of stroke in the early-time window. We investigated the impact of care delays on the outcomes of stroke patients treated with endovascular thrombectomy (EVT) in the late window.
Methods:
Pooled data from seven randomized clinical trials and registries that only included patients who underwent EVT in the late time window (onset/last known well (LKW) time to imaging time of 6 hours or more) were combined for this analysis. The time intervals from stroke onset to successful reperfusion were analyzed. Logistic regression was used to estimate the likelihood of a functionally independent outcome at 90 days (modified Rankin scale 0-2) for each time interval while adjusting for relevant patients’ characteristics. Negative binomial regression was used to evaluate the relationship between each time interval and the predictors.
Results:
584 patients were included in this analysis. The median age was 70 years (IQR: 21), 293 [50.17%] were females, 298 (53.31%) had wake-up strokes, and the median ASPECTS was 8 (IQR: 2). All patients had CT, and CTA imaging, and 360 (61.64%) underwent perfusion imaging. Successful reperfusion was achieved in 469 (80.45%) patients, and 249 (44.54%) had independent outcomes at 90 days. For every 30 minutes delay, the estimated probability of functional independence decreased by 19% for the emergency department (ED) arrival to imaging time interval, by 25% from groin puncture to end of EVT, and by 12% from ED arrival to end of EVT. Older age and higher NIHSS were associated with longer time from imaging to groin puncture. However, only age was associated with a longer estimated times from stroke onset/LKW to arrival in ED and from stroke onset/LKW to the end of EVT.
Conclusion:
Faster in-hospital care is associated with improved functional independence among late-window patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Beom J Kim
- SNU BUNDANG HOSPITAL, Seongnam-si Gyeonggi-do
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18
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Bala F, Casetta I, Nannoni S, Herlihy D, Goyal M, Fainardi E, Michel P, Thornton J, Power S, Saia V, Hegarty A, Pracucci G, Demchuk A, Mangiafico S, Boyle K, Hill MD, Toni D, Murphy S, Ademola A, Kim BJ, Menon BK, Almekhlafi MA. Sex-Related Differences in Outcomes After Endovascular Treatment of Patients With Late-Window Stroke. Stroke 2022; 53:311-318. [PMID: 34983244 DOI: 10.1161/strokeaha.121.037127] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Sex-related differences exist in many aspects of acute stroke and were mainly investigated in the early time window with conflicting results. However, data regarding sex disparities in late presenters are scarce. Therefore, we sought to investigate differences in outcomes between women and men treated with endovascular treatment in the late time window. METHODS Analyses were based on the SOLSTICE Consortium (Selection of Late-Window Stroke for Thrombectomy by Imaging Collateral Extent), which was an individual-patient level analysis of seven trials and registries. Baseline characteristics, 90-day functional independence (modified Rankin Scale score ≤2), mortality, and symptomatic intracranial hemorrhage were compared between women and men. Effect of sex on the association of age and successful reperfusion (final Thrombolysis in Cerebral Infarction 2b-3) with outcomes was assessed using multivariable logistic regression adjusted for age, National Institutes of Health Stroke Scale score, Alberta Stroke Program Early CT Score, time from onset to puncture, occlusion location, intravenous thrombolysis, and successful reperfusion, with interaction terms. RESULTS Among 608 patients treated with endovascular treatment, 50.5% were women. Women were older than men (median age of 72 versus 68 years, P=0.02) and had a lower prevalence of tandem occlusions (14.0% versus 22.9%, P=0.005). Workflow times were similar between sexes. Adjusted outcomes did not differ between women and men. Functional independence at 90 days was achieved by 127 out of 292 women (43.5%) and 135 out of 291 men (46.4%). Mortality at 90 days (54 [18.5%] versus 48 [16.5%]) and symptomatic intracranial hemorrhage (37 [13.3%] versus 33 [11.6%]) were similar between women and men. There was no sex-by-age interaction on functional outcomes. However, men had higher likelihood of mortality (Pinteraction=0.003) and symptomatic intracranial hemorrhage (Pinteraction=0.017) with advancing age. Sex did not influence the relation between successful reperfusion and outcomes. CONCLUSIONS In this multicenter analysis of late patients treated with endovascular treatment, sex was not associated with functional outcome. However, sex influenced the association between age and safety outcomes, with men experiencing worse outcomes with advancing age.
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Affiliation(s)
- Fouzi Bala
- Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, University of Calgary, Alberta, Canada. (F.B., M.G., A.D., M.D.H., B.K.M., M.A.A.)
| | - Ilaria Casetta
- Clinica Neurologica, University of Ferrara, Italy (I.C.)
| | - Stefania Nannoni
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland (S.N., P.M.)
| | - Darragh Herlihy
- Neuroradiology Department, Beaumont Hospital, Dublin, Ireland. (D.H., J.T., S.P., A.H.)
| | - Mayank Goyal
- Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, University of Calgary, Alberta, Canada. (F.B., M.G., A.D., M.D.H., B.K.M., M.A.A.)
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy (E.F.)
| | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland (S.N., P.M.)
| | - John Thornton
- Neuroradiology Department, Beaumont Hospital, Dublin, Ireland. (D.H., J.T., S.P., A.H.).,Royal College of Surgeons in Ireland, Dublin, Ireland (J.T.)
| | - Sarah Power
- Neuroradiology Department, Beaumont Hospital, Dublin, Ireland. (D.H., J.T., S.P., A.H.)
| | - Valentina Saia
- Stroke Unit, Santa Corona Hospital, Pietra Ligure (SV), Italy (V.S.)
| | - Aidan Hegarty
- Neuroradiology Department, Beaumont Hospital, Dublin, Ireland. (D.H., J.T., S.P., A.H.)
| | | | - Andrew Demchuk
- Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, University of Calgary, Alberta, Canada. (F.B., M.G., A.D., M.D.H., B.K.M., M.A.A.)
| | | | - Karl Boyle
- Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland. (K.B.)
| | - Michael D Hill
- Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, University of Calgary, Alberta, Canada. (F.B., M.G., A.D., M.D.H., B.K.M., M.A.A.).,Department of Community Health Sciences, University of Calgary, Alberta, Canada. (M.D.H., A.A., B.K.M., M.A.A.)
| | - Danilo Toni
- Emergency Department, Stroke Unit, Sapienza University Hospital, Rome, Italy (D.T.)
| | - Sean Murphy
- Department of Geriatric and Stroke Medicine, The Mater Misericordiae University Hospital; School of Medicine, Royal College of Surgeons in Ireland; School of Medicine, University College Dublin, Ireland (S.M.)
| | - Ayoola Ademola
- Department of Community Health Sciences, University of Calgary, Alberta, Canada. (M.D.H., A.A., B.K.M., M.A.A.)
| | - Beom Joon Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea (B.J.K.)
| | - Bijoy K Menon
- Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, University of Calgary, Alberta, Canada. (F.B., M.G., A.D., M.D.H., B.K.M., M.A.A.).,Department of Community Health Sciences, University of Calgary, Alberta, Canada. (M.D.H., A.A., B.K.M., M.A.A.)
| | - Mohammed A Almekhlafi
- Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, University of Calgary, Alberta, Canada. (F.B., M.G., A.D., M.D.H., B.K.M., M.A.A.).,Department of Community Health Sciences, University of Calgary, Alberta, Canada. (M.D.H., A.A., B.K.M., M.A.A.)
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19
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Mazzei DR, Ademola A, Abbott JH, Sajobi T, Hildebrand K, Marshall DA. Are education, exercise and diet interventions a cost-effective treatment to manage hip and knee osteoarthritis? A systematic review. Osteoarthritis Cartilage 2021; 29:456-470. [PMID: 33197558 DOI: 10.1016/j.joca.2020.10.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/08/2020] [Accepted: 10/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify research gaps and inform implementation we systematically reviewed the literature evaluating cost-effectiveness of recommended treatments (education, exercise and diet) for the management of hip and/or knee OA. METHODS We searched Medline, Embase, Cochrane Central Register of Controlled Trials, National Health Services Economic Evaluation Database, and EconLit from inception to November 2019 for trial-based economic evaluations investigating hip and/or knee OA core treatments. Two investigators screened relevant publications, extracted data and synthesized results. Risk of bias was assessed using the Consensus on Health Economic Criteria list. RESULTS Two cost-minimization, five cost-effectiveness and 16 cost-utility analyses evaluated core treatments in six health systems. Exercise therapy with and without education or diet was cost-effective or cost-saving compared to education or physician-delivered usual care at conventional willingness to pay (WTP) thresholds in 15 out of 16 publications. Exercise interventions were cost-effective compared to physiotherapist-delivered usual care in three studies at conventional WTP thresholds. Education interventions were not cost-effective compared to usual care or placebo at conventional WTP thresholds in three out of four publications. CONCLUSIONS Structured core treatment programs were clinically effective and cost-effective, compared to physician-delivered usual care, in five health care systems. Providing education about core treatments was not consistently cost-effective. Implementing structured core treatment programs into funded clinical pathways would likely be an efficient use of health system resources and enhance physician-delivered usual primary care.
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Affiliation(s)
- D R Mazzei
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - A Ademola
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - J H Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand.
| | - T Sajobi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - K Hildebrand
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - D A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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20
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Eddy PhD S, Mariani L, Alakwaa F, McCown P, Ju W, Harder J, Reich H, Eichinger F, Godfrey B, Boima V, Ademola A, Hodgin J, Ojo A, Kretzler M. POS-372 A PRECISION MEDICINE APPROACH IDENTIFIES NONINVASIVE BIOMARKERS ASSOCIATED WITH INTRARENAL PATHWAY ACTIVATION IN PATIENTS WITH PROTEINURIC RENAL DISEASES. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.390] [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: 10/21/2022] Open
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21
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Hildebrand KA, Ademola A, Hart DA. Nonsurgical treatments for post-traumatic elbow contractures: approaches for the prevention of their development and progression. Ann Joint 2021. [DOI: 10.21037/aoj-20-62] [Citation(s) in RCA: 1] [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: 11/06/2022]
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22
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Mazzei DR, Ademola A, Abbott JH, Sajobi T, Hildebrand K, Marshall DA. Systematic review of economic evaluations investigating education, exercise, and dietary weight management to manage hip and knee osteoarthritis: protocol. Syst Rev 2020; 9:229. [PMID: 33023665 PMCID: PMC7542349 DOI: 10.1186/s13643-020-01492-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/22/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND International guidelines recommend education, exercise, and dietary weight management as core treatments to manage osteoarthritis (OA) regardless of disease severity or co-morbidity. Evidence supports the clinical effectiveness of OA management programs, but the cost-effectiveness of core treatments remains unclear. We will systematically review, synthesize, and assess the literature in economic evaluations of core treatments (education, exercise, and dietary weight management) for the management of hip and/or knee OA. METHODS We will search the following elecftronic databases (from inception onwards): MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), National Health Services Economic Evaluation Database, and EconLit. Economic evaluations alongside randomized or nonrandomized clinical trials investigating OA education, exercise, and dietary weight management interventions will be included. Title, abstract, and full text of relevant publications will be screened independently by two reviewers. A content matter expert will resolve any conflicts between two reviewers. Key information from relevant papers will be extracted and tabulated to provide an overview of the published literature. Methodological quality will be evaluated using the Consensus on Health Economic Criteria list. A narrative synthesis without meta-analysis will be conducted. Subgroup analysis will attempt to find trends between research methods, intervention characteristics, and results. DISCUSSION The findings of this review will evaluate the breadth and quality of economic evaluations conducted alongside clinical trials for core treatments in OA management. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020155964.
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Affiliation(s)
- Darren R Mazzei
- McCaig Institute for Bone and Joint Health and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Ayoola Ademola
- McCaig Institute for Bone and Joint Health and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - J Haxby Abbott
- Department of Surgical Sciences, University of Otago, 201 Great King Street, Dunedin, Otago, 9016, New Zealand
| | - Tolulpe Sajobi
- McCaig Institute for Bone and Joint Health and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Kevin Hildebrand
- McCaig Institute for Bone and Joint Health and Department of Surgery, University of Calgary, 1403 29 St NW, Calgary, Alberta, T2N 2T9, Canada
| | - Deborah A Marshall
- McCaig Institute for Bone and Joint Health and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
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23
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Liu CS, Ademola A, Zhang M, Garven A, Kopka M, Salo PT, Hart DA, Befus AD, Hildebrand KA. Human serum mast cell tryptase levels in elbow fractures or dislocations and its association with injury severity. J Orthop Res 2020; 38:2015-2019. [PMID: 32112583 DOI: 10.1002/jor.24642] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/07/2020] [Accepted: 02/19/2020] [Indexed: 02/04/2023]
Abstract
Mast cells contain an abundance of tryptase, and preclinical models have shown elevated serum mast cell tryptase (SMCT) in the setting of posttraumatic joint contractures. Therefore, SMCT emerged as a potential biomarker to help recognize patients with more severe injuries and a higher likelihood of developing contractures. The objective of this study is to assess SMCT levels in participants with varying severity of elbow fractures and/or dislocations. A prospective cohort including 13 participants with more severe injuries that required an operation and 28 participants with less severe injuries managed nonoperatively were evaluated. A control group of eight individuals without elbow injuries was also evaluated. The SMCT levels were measured using an enzyme-linked immunosorbent assay kit specific for human mast cell tryptase. A one-way analysis of variance and Tukey's Honest Significance test was used to assess for statistical significance among and between the three groups. The average time from injury to the collection of the blood samples was 4 ± 2 days. Highly significant differences were identified between the operative, nonoperative, and control groups (P = .0005). In the operative group, SMCT levels were significantly higher than the nonoperative group (P = .0005) and the control group (P = .009), suggesting a correlation between SMCT levels and injury severity. There was no statistically significant difference in SMCT levels between the nonoperative and control groups. The SMCT levels were elevated in participants with acute elbow injuries requiring operative intervention, suggesting that SMCT levels were higher in injuries regarded as more severe.
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Affiliation(s)
- Crystal S Liu
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Ayoola Ademola
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mei Zhang
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexandra Garven
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Michaela Kopka
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,Banff Sport Medicine, Banff, Alberta, Canada
| | - Paul T Salo
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David A Hart
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Bone and Joint Health Strategic Clinic Network, Edmonton, Alberta, Canada
| | - A Dean Befus
- Department of Medicine, Alberta Respiratory Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin A Hildebrand
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Ademola A, Asinobi A. SUN-197 PAEDIATRIC DIALYSIS AT A TERTIARY HOSPITAL IN SOUTH WEST NIGERIA- A FOUR-YEAR REVIEW. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.731] [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: 10/24/2022] Open
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Asinobi A, Ademola A, Lawal T, Nwankwo A. SAT-003 HAEMOGLOBINURIA- ASSOCIATED SEVERE CHILDHOOD ACUTE KIDNEY INJURY IN IBADAN NIGERIA. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.007] [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] Open
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Ademola A, Hildebrand KA, Schneider PS, Mohtadi NGH, White NJ, Bosse MJ, Garven A, Walker REA, Sajobi TT. PrEvention of posttraumatic contractuRes with Ketotifen 2 (PERK 2) - protocol for a multicenter randomized clinical trial. BMC Musculoskelet Disord 2020; 21:123. [PMID: 32093652 PMCID: PMC7041204 DOI: 10.1186/s12891-020-3139-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Injuries and resulting stiffness around joints, especially the elbow, have huge psychological effects by reducing quality of life through interference with normal daily activities such as feeding, dressing, grooming, and reaching for objects. Over the last several years and through numerous research results, the myofibroblast-mast cell-neuropeptide axis of fibrosis had been implicated in post-traumatic joint contractures. Pre-clinical models and a pilot randomized clinical trial (RCT) demonstrated the feasibility and safety of using Ketotifen Fumarate (KF), a mast cell stabilizer to prevent elbow joint contractures. This study aims to evaluate the efficacy of KF in reducing joint contracture severity in adult participants with operately treated elbow fractures and/or dislocations. Methods/design A Phase III randomized, controlled, double-blinded multicentre trial with 3 parallel groups (KF 2 mg or 5 mg or lactose placebo twice daily orally for 6 weeks). The study population consist of adults who are at least 18 years old and within 7 days of injury. The types of injuries are distal humerus (AO/OTA type 13) and/or proximal ulna and/or proximal radius fractures (AO/OTA type 2 U1 and/or 2R1) and/or elbow dislocations (open fractures with or without nerve injury may be included). A stratified randomization scheme by hospital site will be used to assign eligible participants to the groups in a 1:1:1 ratio. The primary outcome is change in elbow flexion-extension range of motion (ROM) arc from baseline to 12 weeks post-randomization. The secondary outcomes are changes in ROM from baseline to 6, 24 & 52 weeks, PROMs at 2, 6, 12, 24 & 52 weeks and impact of KF on safety including serious adverse events and fracture healing. Descriptive analysis for all outcomes will be reported and ANCOVA be used to evaluate the efficacy KF over lactose placebo with respect to the improvement in ROM. Discussion The results of this study will provide evidence for the use of KF in reducing post-traumatic joint contractures and improving quality of life after joint injuries. Trial registration This study was prospectively registered (July 10, 2018) with ClinicalTrials.gov reference: NCT03582176.
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Affiliation(s)
- Ayoola Ademola
- McCaig Institute of Bone and Joint, University of Calgary, Calgary, Canada. .,Department of Community Health Sciences, University of Calgary, Calgary, Canada.
| | - Kevin A Hildebrand
- McCaig Institute of Bone and Joint, University of Calgary, Calgary, Canada.,Department of Surgery, University of Calgary, Calgary, Canada
| | - Prism S Schneider
- McCaig Institute of Bone and Joint, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Surgery, University of Calgary, Calgary, Canada
| | - Nicholas G H Mohtadi
- McCaig Institute of Bone and Joint, University of Calgary, Calgary, Canada.,Department of Surgery, University of Calgary, Calgary, Canada
| | - Neil J White
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Michael J Bosse
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, USA
| | | | - Richard E A Walker
- McCaig Institute of Bone and Joint, University of Calgary, Calgary, Canada.,Department of Radiology, University of Calgary, Calgary, Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
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LAWAL T, Ademola A, Asinobi A, Takure A, Lawal T, Olulana O, Ogundoyin O, Olapade-Olaopa E. MON-310 POSTERIOR URETHRAL VALVE AT A PAEDIATRIC NEPHROLOGY UNIT IN SOUTH WESTERN NIGERIA. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.1121] [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: 12/01/2022] Open
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28
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Alao M, Asinobi O A, Ademola A, Agunloye A, Udeme E. SAT-255 POPULATION PREVALENCE OF CHILDHOOD CHRONIC KIDNEY DISEASE IN NIGERIA USING SERUM CREATININE AND CYSTATIN-C. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.291] [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: 10/26/2022] Open
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29
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Orji MG, Chidebe R, Igbokwe C, Banwo-Fatai K, Adesoye B, Gimba S, Agbi R, Nwosu T, Ikeagwu N, Onyekachi C, Ademola A, Amadi-Obi U, Ezenwaanne J, Ikechukwu I, Yahaya O, Ononogbu F, Okenwa V, Nwodilae G, Biose A, Nwabueze O, Dada R, Gimba R, Adamu E, Joseph F, Onwere C, Alimi I, Oriaku I, Emezue P, Dantsoho S, Nwagboso E, Abdulazeez J, Okoro N, Orjiakor T. From Diagnosis to Survivorship: Using Cancer Support Group as an Advocacy and Support Platform for Cancer Care in Nigeria. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.98500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and context: Cancer diagnosis comes with a lot of challenges. It is a huge burden to the patient, family, and community; subjecting them to financial crisis, emotional distress, dearth of self-esteem, and physiologic deformations. From a patient's perspective, treatment of cancer is complex and complicated with the weak healthcare system, attitude of healthcare workers, lack of insurance, lack of trust to orthodox medicine and stigmatization. Cancer patients are constantly seeking solace, people to listen to them and people who understand their state of mind and can be a source of inspiration. Studies have shown that peer cancer support group results in psychological benefit and improve relationships. The 2016 World Cancer Congress patient's pavilion inspired us to start up a cancer support group for cancer patients, survivors and caregivers known as Abuja Breast Cancer Support Group (ABC-SG). The cancer support was primarily founded for only breast cancer patient, survivor, caregivers and for peer support; as at today the group has transited from being patient group to also being an advocacy group with a number of activities and programs aimed at propelling all cancer patients from diagnosis to survivorship. Aim: To disseminate impact of establishing a breast cancer support group in Abuja and how it has helped cancer patients/survivors inspire each other while engaging policymakers to make cancer control a national health priority in Nigeria. Strategy/Tactics: The study reviewed the 1-year activities of the ABC-SG and surveyed the impact of the peer support to the 36 members of the group. Program/Policy process: As part of Project PINK BLUE SPARC MBC activities, ABC-SG was supported in different activities and programs targeted at peer support and policy change advocacy. Outcomes: The cancer support group have become a point of networking and inspiration for several patients and survivors; hence, more cancer patients are beginning to come out from their closest to identify with the support and make their diagnosis public. What was learned: There is an improvement in psychological states of patients and their physiologic understanding of their diagnosis by meeting together, networking, and interaction through social media. Our qualitative finding also showed that cancer patients needs platforms to speak out, to advocate and to change the course of cancer care if provided with all the necessary training and support.
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Affiliation(s)
- M.-G. Orji
- Abuja Breast Cancer Support Group, Patient's Advocacy, Abuja, Nigeria
| | - R.C.W. Chidebe
- Project PINK BLUE - Health and Psychological Trust Centre, Research and Administration, Abuja, Nigeria
| | - C. Igbokwe
- Abuja Breast Cancer Support Group, Patient's Advocacy, Abuja, Nigeria
| | - K. Banwo-Fatai
- Project PINK BLUE - Health and Psychological Trust Centre, Programmes, Abuja, Nigeria
| | - B.S. Adesoye
- Abuja Breast Cancer Support Group, Patient's Support, Abuja, Nigeria
| | - S. Gimba
- Abuja Breast Cancer Support Group, Patient's Advocacy, Abuja, Nigeria
| | - R. Agbi
- Abuja Breast Cancer Support Group, Research and Programmes, Abuja, Nigeria
| | - T.O. Nwosu
- Abuja Breast Cancer Support Group, Patient's Security, Abuja, Nigeria
| | - N.C. Ikeagwu
- Abuja Breast Cancer Support Group, Caregivers Support Group, Abuja, Nigeria
| | - C. Onyekachi
- Abuja Breast Cancer Support Group, Caregivers Support Group, Abuja, Nigeria
| | - A. Ademola
- Abuja Breast Cancer Support Group, Caregivers Support Group, Abuja, Nigeria
| | - U. Amadi-Obi
- Abuja Breast Cancer Support Group, Research and Programmes, Abuja, Nigeria
| | - J.N. Ezenwaanne
- Abuja Breast Cancer Support Group, Caregivers Support Group, Abuja, Nigeria
| | - I. Ikechukwu
- Abuja Breast Cancer Support Group, Patient's Advocacy, Abuja, Nigeria
| | - O. Yahaya
- Abuja Breast Cancer Support Group, Patient's Support, Abuja, Nigeria
| | - F. Ononogbu
- Abuja Breast Cancer Support Group, Patient's Support, Abuja, Nigeria
| | - V. Okenwa
- Abuja Breast Cancer Support Group, Patient's Security, Abuja, Nigeria
| | - G. Nwodilae
- Abuja Breast Cancer Support Group, Caregivers Support Group, Abuja, Nigeria
| | - A. Biose
- Abuja Breast Cancer Support Group, Patient's Support, Abuja, Nigeria
| | - O. Nwabueze
- Abuja Breast Cancer Support Group, Caregivers Support Group, Abuja, Nigeria
| | - R. Dada
- Abuja Breast Cancer Support Group, Patient's Advocacy, Abuja, Nigeria
| | - R. Gimba
- Abuja Breast Cancer Support Group, Patient's Support, Abuja, Nigeria
| | - E. Adamu
- Abuja Breast Cancer Support Group, Nutrition and Cancer Care, Abuja, Nigeria
| | - F. Joseph
- Abuja Breast Cancer Support Group, Caregivers Support Group, Abuja, Nigeria
| | - C. Onwere
- Abuja Breast Cancer Support Group, Caregivers Support Group, Abuja, Nigeria
| | - I.M. Alimi
- Abuja Breast Cancer Support Group, Caregivers Support Group, Abuja, Nigeria
| | - I. Oriaku
- Abuja Breast Cancer Support Group, Patient's Support, Abuja, Nigeria
| | - P. Emezue
- Project PINK BLUE - Health and Psychological Trust Centre, Patients' Care and Research, Abuja, Nigeria
| | - S.A. Dantsoho
- Project PINK BLUE - Health and Psychological Trust Centre, Programmes, Abuja, Nigeria
| | - E.J. Nwagboso
- Project PINK BLUE - Health and Psychological Trust Centre, Programmes, Abuja, Nigeria
| | - J. Abdulazeez
- Project PINK BLUE - Health and Psychological Trust Centre, Abuja, Nigeria
| | - N. Okoro
- Project PINK BLUE - Health and Psychological Trust Centre, Monitoring and Evaluation, Abuja, Nigeria
| | - T.C. Orjiakor
- University of Nigeria, Department of Psychology, Nsukka, Nigeria
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30
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Olopade OI, Pitt JJ, Riester M, Odetunde A, Yoshimatsu T, Labrot E, Ademola A, Sanni A, Okedere B, Mahan S, Nwosu I, Leary R, Ajani M, Johnson RS, Sveen E, Zheng Y, Wang S, Fitzgerald DJ, Grundstad J, Tuteja J, Clayton W, Khramtsova G, Oludara M, Omodele F, Benson O, Adeoye A, Morhason-Bello O, Ogundiran T, Babalola C, Popoola A, Morrissey M, Chen L, Huo D, Falusi A, Winckler W, Obafunwa J, Papoutsakis D, Ojengbede O, White KP, Ibrahim N, Oluwasola O, Barretina J. Abstract PD8-05: Comparative analysis of the genomic landscape of breast cancers from women of African and European ancestry. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-pd8-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objectives: Paucity of data on populations of African Ancestry in clinical trials continues to limit our ability to design and implement innovative solutions to narrow the breast cancer survival gap amongst Africans, African Americans, and European Americans. We have developed a cross-continent research infrastructure to examine the spectrum of genomic alterations in breast tumors from West Africa and subsequently, to compare them to tumors from African American women and women of European Ancestry in The Cancer Genome Atlas (TCGA) database.
Methods: Consecutive women with breast cancer presenting for treatment at the University College Hospital, Ibadan and at Lagos State University Teaching Hospital, Lagos, Nigeria gave informed consent and were recruited to the West African Breast Cancer Study (WABCS) between 2013-2016. Tumor-normal pairs were subjected to exome and/or high-depth (90x) genome sequencing. High confidence somatic mutations (substitutions, insertions/deletions and structural variants) were obtained by using multiple variant callers. Furthermore, 1,089 exomic and 80 genomic breast tumor-normal pairs from TCGA were harmonized with WABCS samples, resulting in a cohort of 147 West Africans (147 exome; 40 genome), 154 African Americans (154 exome; 31 genome), and 776 Caucasians (776 exome; 43 genome).
Results: Across the exomes, genes commonly altered in breast cancer in TCGA are also altered in women of African ancestry, but the mutational spectrum is quite different, demonstrating overrepresentation of tumors with aggressive phenotypes. Overall, TP53 (65%), ERBB2 (27%), and GATA3 (17%) showed statistically significant higher alteration frequencies in West Africans and African Americans. In contrast, PIK3CA (24%) was less frequently mutated. Of note, GATA3 mutation was statistically significantly more frequent in Nigerians (39%) and African Americans (16.7%) compared to Caucasians (10.5%), in ER-positive cancers. Analysis on Structural Variants (SV), on the other hand, has shown that the genome-wide SV counts among three populations are comparable in ER-negative cancers, while Nigerians have significantly more SV counts compared to African Americans (P=0.0013) or European Americans (P=2.9x10-5) in ER-positive cancers. Similarly, genome-wide substitution patterns in ER+ and ER- cancers varied widely by race/ethnicity. In ER- cases, West Africans carried the highest proportion of canonical APOBEC-associated substitutions, particularly C>T transitions. Conversely, European Americans with ER+ disease showed a higher proportion of C>T than both West Africans (Welch t-test P = 0.044) and African Americans (Welch t-test P = 0.011). Mutation signature analyses highlighted multiple APOBEC signatures, with notable contribution differences across ancestry and ER status. A signature likely corresponding to DNA damage repair correlated with the proportion of genetic ancestry, being most prevalent in European Americans and least common in Nigerians, particularly in ER-negative cancers, with African Americans showing a degree of this signature's contribution in between the two populations (linear model adjusted for age, P=1.0x10-10).
Conclusions: Overall, our data suggests mutation spectra differences in across race/ethnicity and geography. Identification of molecular characteristics such as higher rates of HER2 enriched tumors and higher rates of GATA3 mutations in ER positive tumors are beginning to reveal the genomic basis of race-associated phenotypes and outcomes in breast cancer. Population differences in frequency and spectrum of mutations should now inform the design of innovative clinical trials that improve health equity and accelerate Precision Oncology care in diverse populations.
Citation Format: Olopade OI, Pitt JJ, Riester M, Odetunde A, Yoshimatsu T, Labrot E, Ademola A, Sanni A, Okedere B, Mahan S, Nwosu I, Leary R, Ajani M, Johnson RS, Sveen E, Zheng Y, Wang S, Fitzgerald DJ, Grundstad J, Tuteja J, Clayton W, Khramtsova G, Oludara M, Omodele F, Benson O, Adeoye A, Morhason-Bello O, Ogundiran T, Babalola C, Popoola A, Morrissey M, Chen L, Huo D, Falusi A, Winckler W, Obafunwa J, Papoutsakis D, Ojengbede O, White KP, Ibrahim N, Oluwasola O, Barretina J. Comparative analysis of the genomic landscape of breast cancers from women of African and European ancestry [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr PD8-05.
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Affiliation(s)
- OI Olopade
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - JJ Pitt
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - M Riester
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - A Odetunde
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - T Yoshimatsu
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - E Labrot
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - A Ademola
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - A Sanni
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - B Okedere
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - S Mahan
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - I Nwosu
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - R Leary
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - M Ajani
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - RS Johnson
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - E Sveen
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Y Zheng
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - S Wang
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - DJ Fitzgerald
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - J Grundstad
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - J Tuteja
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - W Clayton
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - G Khramtsova
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - M Oludara
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - F Omodele
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - O Benson
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - A Adeoye
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - O Morhason-Bello
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - T Ogundiran
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - C Babalola
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - A Popoola
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - M Morrissey
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - L Chen
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - D Huo
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - A Falusi
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - W Winckler
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - J Obafunwa
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - D Papoutsakis
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - O Ojengbede
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - KP White
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - N Ibrahim
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - O Oluwasola
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - J Barretina
- Center for Global Health, The University of Chicago, Chicago, IL; Institute for Genomics and Systems Biology, The University of Chicago, Chicago, IL; Novartis Institutes for BioMedical Research, Cambridge, MA; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Oncology Unit, Lagos State University, Ikeja, Lagos, Nigeria; The University of Chicago, Chicago, IL, Nigeria; Centre for Population & Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
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Olayiwola OA, Ogundiran TO, Hardeman A, Yoshimatsu TF, Clayton W, Adeoye A, Ademola A, Ajani MA, Khramtsova G, Grushko TA, Huo D, Zheng Y, Parker J, Perou C, Olopade OI. Abstract P6-04-05: Genotype-phenotype classification of triple negative breast cancers (TNBC) in women of African descent using the PAM50 NanoString platform and genomic data. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-04-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: TNBC has the highest mortality rate amongst all other breast cancer types due to its complex tumor heterogeneity and lack of well-defined molecular targets. It is known that women of African descent are two to three times more likely to develop TNBC compared to women of European ancestry, yet wide-scale genomic studies of African and African American breast tumors are limited. To elucidate genotypes and molecular subtypes associated with the most aggressive forms of breast cancer, we used the PAM50 NanoString platform to reclassify Nigerian (NG), African American (AA) and Caucasian (CA) tumors previously annotated by Immunohistochemistry (IHC), and correlated our findings to their germline genotype data obtained using high-throughput technologies.
Methods: RNAs were isolated from formalin-fixed, paraffin embedded (FFPE) tumor tissues using the High Pure Paraffin Kit (Roche) following manufacturer's protocol, and assayed on NanoString nCounter Analysis System using a custom Nano110 (PAM50 + claudin-low & VEGF signatures) probe set. Intrinsic subtyping and gene-expression data were evaluated using R statistical software. All study samples were previously annotated and subtyped by the ER/PR/HER2 IHC classifier. Genotypes were obtained from next generation sequencing or Illumina Human2.5M BeadChip platform using germline DNA from more than 2000 breast cancer cases and 2000 controls were studied.
Results: To date, Intrinsic molecular subtyping by Nano110 has been completed on 69 NG, 81 AA and 74 CA tumors. Concordance between IHC and PAM50 was 59%, which is adequate and comparable to previous studies. Basal-like subtype was overrepresented and accounted for nearly 30% of NG and AA cases, compared to 17% in CA cases. HER2-enriched subtype was overrepresented only in NG cases (9%). The proportion with Luminal A tumors were 44% NG, 56% AA and 68% CA, respectively.
Conclusions: PAM50 NanoString assay is reliable and high-throughput for molecular subtyping breast cancer using RNA extracted from FFPE tumors. Ongoing work will correlate PAM50 intrinsic subtypes to genotype data.
Citation Format: Olayiwola OA, Ogundiran TO, Hardeman A, Yoshimatsu TF, Clayton W, Adeoye A, Ademola A, Ajani MA, Khramtsova G, Grushko TA, Huo D, Zheng Y, Parker J, Perou C, Olopade OI. Genotype-phenotype classification of triple negative breast cancers (TNBC) in women of African descent using the PAM50 NanoString platform and genomic data. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-04-05.
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Affiliation(s)
- OA Olayiwola
- University College Hospital, Ibadan, Nigeria; Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL; The University of Chicago, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - TO Ogundiran
- University College Hospital, Ibadan, Nigeria; Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL; The University of Chicago, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - A Hardeman
- University College Hospital, Ibadan, Nigeria; Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL; The University of Chicago, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - TF Yoshimatsu
- University College Hospital, Ibadan, Nigeria; Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL; The University of Chicago, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - W Clayton
- University College Hospital, Ibadan, Nigeria; Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL; The University of Chicago, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - A Adeoye
- University College Hospital, Ibadan, Nigeria; Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL; The University of Chicago, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - A Ademola
- University College Hospital, Ibadan, Nigeria; Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL; The University of Chicago, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - MA Ajani
- University College Hospital, Ibadan, Nigeria; Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL; The University of Chicago, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - G Khramtsova
- University College Hospital, Ibadan, Nigeria; Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL; The University of Chicago, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - TA Grushko
- University College Hospital, Ibadan, Nigeria; Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL; The University of Chicago, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - D Huo
- University College Hospital, Ibadan, Nigeria; Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL; The University of Chicago, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Y Zheng
- University College Hospital, Ibadan, Nigeria; Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL; The University of Chicago, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - J Parker
- University College Hospital, Ibadan, Nigeria; Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL; The University of Chicago, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - C Perou
- University College Hospital, Ibadan, Nigeria; Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL; The University of Chicago, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - OI Olopade
- University College Hospital, Ibadan, Nigeria; Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL; The University of Chicago, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
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Olopade OI, Odetunde A, Riester M, Yoshimatsu T, Labrot E, Ademola A, Sanni A, Okedere B, Mahan S, Nwosu I, Leary R, Ajani M, Johnson RS, Sveen E, Zheng Y, Clayton W, Khramtsova G, Oludara M, Omodele F, Benson O, Adeoye A, Morhason-Bello O, Ogundiran T, Babalola C, Popoola A, Morrissey M, Huo D, Falusi A, Winckler W, Obafunwa J, Papoutsakis D, Ojengbede O, Ibrahim N, Oluwasola O, Barretina J. Abstract P6-03-17: Genomic landscape of breast cancers from women of African ancestry across the diaspora. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-03-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objectives: Of all ethnic/racial groups, age-standardized mortality rate from breast cancer is highest for African American women in the US for reasons that remain understudied. The paucity of genomic studies of breast tumors across the African Diaspora further restricts our understanding of the biology of breast cancer in underserved populations. To gain a better understanding of the genomic landscape of breast cancer in women of African Ancestry, we have developed a cross continent translational research infrastructure to examine the spectrum of genetic alterations in breast tumors from West Africa compared to the spectrum of alterations observed in tumors from African-American and other women who are predominantly white in The Cancer Genome Atlas (TCGA) dataset.
Methods: Peripheral blood and breast cancer biopsy tissues were collected from 214 patients enrolled in the West Africa Breast Cancer Study (WABCS) at the University of Ibadan/University College Hospital (UI/UCH) and at Lagos State University Teaching Hospital (LASUTH). Blood DNA as well as breast cancer tissue DNA and RNA were extracted at the Novartis Institutes for Biomedical Research (NIBR), UI/UCH, and LASUTH using a modified protocol of PAXgene Tissue DNA and RNA extraction method. Whole-exome (WES) and transcriptome (RNA-seq) sequencing were performed on the Illumina HiSeq2000 platform at NIBR. Single Nucleotide Variants (SNVs) and insertions/deletions (indels) were called using MuTect and Pindel, while Copy Number Alterations (CNAs) were called using an in-house implementation of the ABSOLUTE method. Observed mutations were compared against those reported in the TCGA dataset. ER, PR and HER2 status were determined by immunohistochemistry (IHC) at UI/UCH, LASUTH and UChicago.
Results: WES data for 95 tumors have been analyzed thus far. Genes commonly mutated in breast cancer in TCGA are also mutated in WABCS but the mutational spectrum is vastly different. TP53 (64%), MYC (31%), and GATA3 (26%), showed significantly higher alteration frequencies in WABCS and African Americans. In contrast, PIK3CA (20%), CDH1 (2%), and MAP3K1 (2%) were less frequently mutated in women of African ancestry. In addition to the high proportion with TP53 mutations, the proportion with HER2 positive subtype of 42.1% and triple-negative subtype of 37.9% suggest that tumors with the most aggressive features are overrepresented in breast cancer patients in West Africa.
Conclusions: In the first study of its kind, high throughput genomic analysis of the largest cohort of women of African ancestry has uncovered alterations in cancer genes, some of which may be amenable to treatment with targeted therapies. Furthermore, we provide evidence that population differences in frequency and spectrum of mutations should drive the design and deployment of precision medicine initiatives. Only then can we develop innovative interventions to reduce the unacceptably high rates of mortality from breast cancer in underserved and under resourced populations.
Citation Format: Olopade OI, Odetunde A, Riester M, Yoshimatsu T, Labrot E, Ademola A, Sanni A, Okedere B, Mahan S, Nwosu I, Leary R, Ajani M, Johnson RS, Sveen E, Zheng Y, Clayton W, Khramtsova G, Oludara M, Omodele F, Benson O, Adeoye A, Morhason-Bello O, Ogundiran T, Babalola C, Popoola A, Morrissey M, Huo D, Falusi A, Winckler W, Obafunwa J, Papoutsakis D, Ojengbede O, Ibrahim N, Oluwasola O, Barretina J. Genomic landscape of breast cancers from women of African ancestry across the diaspora. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-03-17.
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Affiliation(s)
- OI Olopade
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - A Odetunde
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - M Riester
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - T Yoshimatsu
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - E Labrot
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - A Ademola
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - A Sanni
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - B Okedere
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - S Mahan
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - I Nwosu
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - R Leary
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - M Ajani
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - RS Johnson
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - E Sveen
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - Y Zheng
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - W Clayton
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - G Khramtsova
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - M Oludara
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - F Omodele
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - O Benson
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - A Adeoye
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - O Morhason-Bello
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - T Ogundiran
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - C Babalola
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - A Popoola
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - M Morrissey
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - D Huo
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - A Falusi
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - W Winckler
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - J Obafunwa
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - D Papoutsakis
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - O Ojengbede
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - N Ibrahim
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - O Oluwasola
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
| | - J Barretina
- The University of Chicago, Chicago, IL; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria; Novartis Institutes for BioMedical Research, Cambridge, MA; University of Ibadan, Ibadan, Oyo, Nigeria; Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; Lagos State University, Ikeja, Lagos, Nigeria
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Sighoko D, Hou N, Ogundiran T, Adebamowo C, Ademola A, Ojengbede O, Anetor I, Akinleye S, Ndom P, Gakwaya A, Huo D, Olopade OI. Abstract P3-06-13: Transient increase in breast cancer risk after a full term pregnancy among African women. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p3-06-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
African women affected by breast cancer (BC) have high parity with five children or more, are relatively young at first full term pregnancy (FFTP), are diagnosed at a young age and are often premenopausal at diagnosis. While several studies have assessed the role of reproductive factors for BC risk among African women, none of them have assessed whether there is dual effect of age at full term pregnancy (FTP). In this communications, using a large dataset from an on-going hospital-based case-control study, we examine the role of age at full term pregnancy on breast cancer risk among African women.
Methods
The study includes sites in Nigeria (University College Hospital, Ibadan), Cameroon (Yaoundé General Hospital) and Uganda (Breast Clinic of Mulago Hospital of Kampala). It was initiated in 1998 in Nigeria and extended to Cameroon and Uganda in 2011. Cases were consecutive females diagnosed with invasive BC. Controls were recruited from the community or within the hospital and have never being diagnosed with any cancer. Cases and controls were aged 18 years or more and gave informed consent. Full term pregnancy was defined as a pregnancy that lasted at least 7 months and included both live birth and stillbirth. Logistic regression models were used to assess the effects of age at first and second FTP, and their interaction with current age on BC risk. Age at menarche, parity, body mass index and hormone contraception use were included in the models.
Results
The study includes 1668 cases and 2399 controls recruited between 1998 and May 2013. Mean duration of live birth was 9 months (SD±0.52) and 8.8 months (SD±0.66) for a stillbirth. Overall, the mean age at FFTP was 23 years (SD±4.91) for both cases and controls. Compared to nulliparous women, parous women who had FFTP at 20 years have increased risk (OR = 1.59, CI 95%, 1.16-2.21) to develop BC in the year following the pregnancy. Up to 5 years following the FFTP, this OR is 1.38 (CI 95%, 1.06-1.80) while it is 0.77 (CI 95%, 0.62-0.95) 25 years later. This observation was also true for parous women who have had their FFTP at 25, 30, or 35 years. Moreover, a similar pattern was observed when comparing uniparous women to women with 2 or more children.
Conclusion
Our results show a transient increase in risk of BC after a full term pregnancy which declined and became protective over time. This observation is consistent with the effect of pregnancy on BC that has been described in other populations and may partially explain the current profile of breast cancer among African women.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-06-13.
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Affiliation(s)
- D Sighoko
- The University of Chicago, Chicago, IL; The University of Ibadan, Ibadan, Nigeria; University of Maryland, Baltimore, MD; Institute of Human Virology, Abuja, Nigeria; Healthy Life for All Foundation, Ibadan, Nigeria; Yaoundé General Hospital, Yaounde, Cameroon; Mulago Hospital, Kampala, Uganda
| | - N Hou
- The University of Chicago, Chicago, IL; The University of Ibadan, Ibadan, Nigeria; University of Maryland, Baltimore, MD; Institute of Human Virology, Abuja, Nigeria; Healthy Life for All Foundation, Ibadan, Nigeria; Yaoundé General Hospital, Yaounde, Cameroon; Mulago Hospital, Kampala, Uganda
| | - T Ogundiran
- The University of Chicago, Chicago, IL; The University of Ibadan, Ibadan, Nigeria; University of Maryland, Baltimore, MD; Institute of Human Virology, Abuja, Nigeria; Healthy Life for All Foundation, Ibadan, Nigeria; Yaoundé General Hospital, Yaounde, Cameroon; Mulago Hospital, Kampala, Uganda
| | - C Adebamowo
- The University of Chicago, Chicago, IL; The University of Ibadan, Ibadan, Nigeria; University of Maryland, Baltimore, MD; Institute of Human Virology, Abuja, Nigeria; Healthy Life for All Foundation, Ibadan, Nigeria; Yaoundé General Hospital, Yaounde, Cameroon; Mulago Hospital, Kampala, Uganda
| | - A Ademola
- The University of Chicago, Chicago, IL; The University of Ibadan, Ibadan, Nigeria; University of Maryland, Baltimore, MD; Institute of Human Virology, Abuja, Nigeria; Healthy Life for All Foundation, Ibadan, Nigeria; Yaoundé General Hospital, Yaounde, Cameroon; Mulago Hospital, Kampala, Uganda
| | - O Ojengbede
- The University of Chicago, Chicago, IL; The University of Ibadan, Ibadan, Nigeria; University of Maryland, Baltimore, MD; Institute of Human Virology, Abuja, Nigeria; Healthy Life for All Foundation, Ibadan, Nigeria; Yaoundé General Hospital, Yaounde, Cameroon; Mulago Hospital, Kampala, Uganda
| | - I Anetor
- The University of Chicago, Chicago, IL; The University of Ibadan, Ibadan, Nigeria; University of Maryland, Baltimore, MD; Institute of Human Virology, Abuja, Nigeria; Healthy Life for All Foundation, Ibadan, Nigeria; Yaoundé General Hospital, Yaounde, Cameroon; Mulago Hospital, Kampala, Uganda
| | - S Akinleye
- The University of Chicago, Chicago, IL; The University of Ibadan, Ibadan, Nigeria; University of Maryland, Baltimore, MD; Institute of Human Virology, Abuja, Nigeria; Healthy Life for All Foundation, Ibadan, Nigeria; Yaoundé General Hospital, Yaounde, Cameroon; Mulago Hospital, Kampala, Uganda
| | - P Ndom
- The University of Chicago, Chicago, IL; The University of Ibadan, Ibadan, Nigeria; University of Maryland, Baltimore, MD; Institute of Human Virology, Abuja, Nigeria; Healthy Life for All Foundation, Ibadan, Nigeria; Yaoundé General Hospital, Yaounde, Cameroon; Mulago Hospital, Kampala, Uganda
| | - A Gakwaya
- The University of Chicago, Chicago, IL; The University of Ibadan, Ibadan, Nigeria; University of Maryland, Baltimore, MD; Institute of Human Virology, Abuja, Nigeria; Healthy Life for All Foundation, Ibadan, Nigeria; Yaoundé General Hospital, Yaounde, Cameroon; Mulago Hospital, Kampala, Uganda
| | - D Huo
- The University of Chicago, Chicago, IL; The University of Ibadan, Ibadan, Nigeria; University of Maryland, Baltimore, MD; Institute of Human Virology, Abuja, Nigeria; Healthy Life for All Foundation, Ibadan, Nigeria; Yaoundé General Hospital, Yaounde, Cameroon; Mulago Hospital, Kampala, Uganda
| | - OI Olopade
- The University of Chicago, Chicago, IL; The University of Ibadan, Ibadan, Nigeria; University of Maryland, Baltimore, MD; Institute of Human Virology, Abuja, Nigeria; Healthy Life for All Foundation, Ibadan, Nigeria; Yaoundé General Hospital, Yaounde, Cameroon; Mulago Hospital, Kampala, Uganda
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Arogba SS, Ademola A, Elum M. The effect of solvent treatment on the chemical composition and organoleptic acceptability of traditional condiments from Nigeria. Plant Foods Hum Nutr 1995; 48:31-8. [PMID: 8719736 DOI: 10.1007/bf01089197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Three Nigerian condiments from locust bean, melon, and soya bean were prepared by the traditional technique of uncontrolled fermentation and then partly defatted by hexane and di-ethyl ether extraction respectively. Proximate analysis and consumer preference tests were conducted. Results showed that while crude protein, ash and fibre contents remained virtually unchanged, the carbohydrate contents of the treated condiments (derived by difference) increased remarkably. The increase was associated with the significant reduction of about 50% (p = 0.05) in lipid contents of the three condiments. The observed solvent effect correlated positively with panelists' preference rating for the treated locust bean and melon condiments. Except with the soya bean condiment, higher mean scores were observed after the solvent treatment for the four sensory attributes assessed. However, condiment-type and treatment notwithstanding, colour and odour appear to critically determine the level of acceptability of condiments.
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Affiliation(s)
- S S Arogba
- Department of Food Technology, Federal Polytechnic, Idah, Kogi State, Nigeria
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