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Yang Y, Wheatley M, Meakem V, Galarneau E, Gutierrez B, Zhong GY. Editing VvDXS1 for the creation of muscat flavour in Vitis vinifera cv. Scarlet Royal. Plant Biotechnol J 2024. [PMID: 38243882 DOI: 10.1111/pbi.14290] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/01/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024]
Abstract
Muscat flavour represents a group of unique aromatic attributes in some grape varieties. Biochemically, grape berries with muscat flavour produce high levels of monoterpenes. Monoterpene biosynthesis is mainly through the DOXP/MEP pathway, and VvDXS1 encodes the first enzyme in this plastidial pathway of terpene biosynthesis in grapevine. A single-point mutation resulting in the substitution of a lysine with an asparagine at position 284 in the VvDXS1 protein has previously been identified as the major cause for producing muscat flavour in grapes. In this study, the same substitution in the VvDXS1 protein was successfully created through prime editing in the table grape Vitis vinifera cv. 'Scarlet Royal'. The targeted point mutation was detected in most of the transgenic vines, with varying editing efficiencies. No unintended mutations were detected in the edited alleles, either by PCR Sanger sequencing or by amplicon sequencing. More than a dozen edited vines were identified with an editing efficiency of more than 50%, indicating that these vines were likely derived from single cells in which one allele was edited. These vines had much higher levels of monoterpenes in their leaves than the control, similar to what was found in leaf samples between field-grown muscat and non-muscat grapes.
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Affiliation(s)
- Yingzhen Yang
- USDA-Agricultural Research Service, Grape Genetics Research Unit, Geneva, New York, USA
| | - Matthew Wheatley
- USDA-Agricultural Research Service, Grape Genetics Research Unit, Geneva, New York, USA
| | - Victoria Meakem
- USDA-Agricultural Research Service, Plant Genetic Resources Unit, Geneva, New York, USA
| | - Erin Galarneau
- USDA-Agricultural Research Service, Plant Genetic Resources Unit, Geneva, New York, USA
| | - Benjamin Gutierrez
- USDA-Agricultural Research Service, Plant Genetic Resources Unit, Geneva, New York, USA
| | - Gan-Yuan Zhong
- USDA-Agricultural Research Service, Grape Genetics Research Unit, Geneva, New York, USA
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2
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Xi X, Gutierrez B, Zha Q, Yin X, Sun P, Jiang A. Optimization of In Vitro Embryo Rescue and Development of a Kompetitive Allele-Specific PCR (KASP) Marker Related to Stenospermocarpic Seedlessness in Grape ( Vitis vinifera L.). Int J Mol Sci 2023; 24:17350. [PMID: 38139179 PMCID: PMC10744101 DOI: 10.3390/ijms242417350] [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: 10/18/2023] [Revised: 12/02/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Seedlessness is one of the highest valued agronomic traits in grapes. Embryo rescue in combination with marker-assisted selection have been widely applied in seedless grape breeding due to the advantages of increasing the ratio of seedless progenies and shortening the breeding cycle. However, the large number of deformed seedlings produced during embryo rescue and the lack of fast, efficient, and low-cost markers severely inhibit the process of seedless grape breeding. In this study, a total of eighty-three grape cultivars (51 seedless and 32 seeded) with diverse genetic backgrounds and two populations derived from embryo rescue, including 113 F1 hybrid individuals (60 seedless and 53 seeded), were utilized. We screened suitable media for converting malformed seedlings into normal seedlings, analyzed the association between the SNP in VviAGL11 and seeded/seedless phenotype, and developed a KASP marker related to stenospermocarpic seedlessness. Our results indicated that the transformation rate of 37.8% was obtained with MS medium supplemented with 2.0 mg·L-1 of 6-BA and 0.5 mg·L-1 of IBA. The presence of an A nucleotide allele at position chr18:26889437 was further confirmed to be fully associated with the stenospermocarpic seedlessness phenotype. The developed KASP marker, based on the verified SNP locus in VviAGL11, successfully distinguished the seedless and seeded genotypes with high precision and throughput. The results will contribute to enhancing the efficiency of embryo rescue and facilitate parent selection and early selection of seedless offspring with molecular markers, thereby accelerating the breeding process in seedless table grapes.
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Affiliation(s)
- Xiaojun Xi
- Forestry and Pomology Research Institute, Shanghai Academy of Agricultural Sciences, Shanghai 201403, China; (X.X.); (Q.Z.); (X.Y.); (P.S.)
- Shanghai Key Lab of Protected Horticultural Technology, Shanghai Academy of Agricultural Sciences, Shanghai 201403, China
| | - Benjamin Gutierrez
- Plant Genetic Resources Unit, US Department of Agriculture-Agricultural Research Service, Geneva, NY 14456, USA;
| | - Qian Zha
- Forestry and Pomology Research Institute, Shanghai Academy of Agricultural Sciences, Shanghai 201403, China; (X.X.); (Q.Z.); (X.Y.); (P.S.)
- Shanghai Key Lab of Protected Horticultural Technology, Shanghai Academy of Agricultural Sciences, Shanghai 201403, China
| | - Xiangjing Yin
- Forestry and Pomology Research Institute, Shanghai Academy of Agricultural Sciences, Shanghai 201403, China; (X.X.); (Q.Z.); (X.Y.); (P.S.)
- Shanghai Key Lab of Protected Horticultural Technology, Shanghai Academy of Agricultural Sciences, Shanghai 201403, China
| | - Pengpeng Sun
- Forestry and Pomology Research Institute, Shanghai Academy of Agricultural Sciences, Shanghai 201403, China; (X.X.); (Q.Z.); (X.Y.); (P.S.)
- Shanghai Key Lab of Protected Horticultural Technology, Shanghai Academy of Agricultural Sciences, Shanghai 201403, China
| | - Aili Jiang
- Forestry and Pomology Research Institute, Shanghai Academy of Agricultural Sciences, Shanghai 201403, China; (X.X.); (Q.Z.); (X.Y.); (P.S.)
- Shanghai Key Lab of Protected Horticultural Technology, Shanghai Academy of Agricultural Sciences, Shanghai 201403, China
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Mansfeld BN, Yocca A, Ou S, Harkess A, Burchard E, Gutierrez B, van Nocker S, Gottschalk C. A haplotype resolved chromosome-scale assembly of North American wild apple Malus fusca and comparative genomics of the fire blight Mfu10 locus. Plant J 2023; 116:989-1002. [PMID: 37639371 DOI: 10.1111/tpj.16433] [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] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/08/2023] [Accepted: 08/12/2023] [Indexed: 08/31/2023]
Abstract
SUMMARYThe Pacific crabapple (Malus fusca) is a wild relative of the commercial apple (Malus × domestica). With a range extending from Alaska to Northern California, M. fusca is extremely hardy and disease resistant. The species represents an untapped genetic resource for the development of new apple cultivars with enhanced stress resistance. However, gene discovery and utilization of M. fusca have been hampered by the lack of genomic resources. Here, we present a high‐quality, haplotype‐resolved, chromosome‐scale genome assembly and annotation for M. fusca. The genome was assembled using high‐fidelity long‐reads and scaffolded using genetic maps and high‐throughput chromatin conformation capture sequencing, resulting in one of the most contiguous apple genomes to date. We annotated the genome using public transcriptomic data from the same species taken from diverse plant structures and developmental stages. Using this assembly, we explored haplotypic structural variation within the genome of M. fusca, identifying thousands of large variants. We further showed high sequence co‐linearity with other domesticated and wild Malus species. Finally, we resolve a known quantitative trait locus associated with resistance to fire blight (Erwinia amylovora). Insights gained from the assembly of a reference‐quality genome of this hardy wild apple relative will be invaluable as a tool to facilitate DNA‐informed introgression breeding.
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Affiliation(s)
- Ben N Mansfeld
- Department of Biology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Alan Yocca
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama, USA
| | - Shujun Ou
- Department of Molecular Genetics, The Ohio State University, Columbus, Ohio, USA
| | - Alex Harkess
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama, USA
| | - Erik Burchard
- USDA ARS, Appalachian Fruit Research Station, Kearneysville, West Virginia, USA
| | | | - Steve van Nocker
- Department of Horticulture, Michigan State University, East Lansing, Michigan, USA
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4
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Bessou A, Colin X, De Nascimento J, Sopwith W, Ferrante S, Gorsh B, Gutierrez B, Sansbury L, Willson J, Sapra S, Paka P, Wang F. Assessing the treatment pattern, health care resource utilisation, and economic burden of multiple myeloma in France using the Système National des Données de Santé (SNDS) database: a retrospective cohort study. Eur J Health Econ 2023; 24:321-333. [PMID: 35610398 PMCID: PMC10060291 DOI: 10.1007/s10198-022-01463-9] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 04/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Real-world data on health care resource utilisation (HCRU) and costs for French patients with multiple myeloma (MM) are limited due to the quickly evolving MM treatment landscape. This retrospective, national-level study quantified the MM economic burden in France. METHODS The study included patients with newly diagnosed MM from the Système National des Données de Santé coverage claims database between 2013 and 2018 who received active treatment within 30 days of diagnosis. HCRU included hospitalisations, drugs, consultations, procedures, tests, devices, transport, and sick leave. Costs were annualized to 2019 prices. Drug treatments, reported by line of therapy (LOT), were algorithmically defined using drug regimen, duration of therapy, and gaps between treatments. Analyses were stratified by stem cell transplantation status and LOT. RESULTS Among 6413 eligible patients, 6229 (97.1%) received ≥ 1 identifiable LOT; most received 1 (39.8%) or 2 LOT (27.5%) during follow-up. Average annual hospitalisation was 6.3 episodes/patient/year (median duration: 11.6 days). The average annual cost/patient was €58.3 K. Key cost drivers were treatment (€28.2 K; 39.5% of total HCRU within one year of MM diagnosis) and hospitalisations (€22.2 K; 48.6% of total HCRU costs in first year). Monthly treatment-related costs increased from LOT1 (€2.447 K) and LOT5 + (€7.026 K); only 9% of patients received LOT5 + . At LOT4 + , 37 distinct regimens were identified. Hospitalisation costs were higher in patients with stem cell transplantation than total population, particularly in the first year. CONCLUSIONS This study showed a high economic burden of MM in France (€72.37 K/patient/year in the first year) and the diversity of regimens used in late-line treatments.
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Affiliation(s)
| | | | | | | | - Shannon Ferrante
- Value Evidence and Outcomes, GlaxoSmithKline, Upper Providence, Collegeville, PA, USA
| | - Boris Gorsh
- Value Evidence and Outcomes, GlaxoSmithKline, Upper Providence, Collegeville, PA, USA
| | - Benjamin Gutierrez
- Value Evidence and Outcomes, GlaxoSmithKline, Upper Providence, Collegeville, PA, USA
| | - Leah Sansbury
- Value Evidence and Outcomes, GlaxoSmithKline, Research Triangle Park, Durham, NC, USA
| | - Jenny Willson
- Value Evidence and Outcomes, GlaxoSmithKline, London, UK
| | - Sandhya Sapra
- Value Evidence and Outcomes, GlaxoSmithKline, Upper Providence, Collegeville, PA, USA
| | - Prani Paka
- Global Medical Affairs, GlaxoSmithKline, Upper Providence, Collegeville, PA, USA
| | - Feng Wang
- Value Evidence and Outcomes, GlaxoSmithKline, Upper Providence, Collegeville, PA, USA.
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5
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Fernandez-Cadena JC, Carvajal M, Muñoz E, Prado-Vivar B, Marquez S, Proaño S, Bayas R, Guadalupe JJ, Becerra-Wong M, Gutierrez B, Morey-Leon G, Trueba G, Grunauer M, Barragán V, Rojas-Silva P, Andrade-Molina D, Cárdenas P. First case of within-host co-infection of different SARS-CoV-2 variants in Ecuador. New Microbes New Infect 2022; 48:101001. [PMID: 35818397 PMCID: PMC9259011 DOI: 10.1016/j.nmni.2022.101001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/24/2022] [Indexed: 11/28/2022] Open
Abstract
Background COVID-19 infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause mild symptoms to severe illness and death. Co-infections of SARS-CoV-2 with other respiratory viruses have been described. However, two SARS-CoV-2 lineage co-infection have been rarely reported. Methodology A genotyping analysis and two different types of whole genome sequencing were performed (Illumina MiniSeq and ONT MinION). When examining the phylogenetic analysis in NextClade and Pangolin webservers, and considering the genotyping findings, conflicting results were obtained. Results The raw data of the sequencing was analyzed, and nucleotide variants were identified between different reads of the virus genome. B.1 and P.1 lineages were identified within the same sample. Conclusions We concluded that this is a co-infection case with two SARS-CoV-2 lineages, the first one reported in Ecuador.
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Affiliation(s)
| | - M Carvajal
- Universidad San Francisco de Quito, COCIBA, Instituto de Microbiología, Ecuador
| | - E Muñoz
- Universidad San Francisco de Quito, COCIBA, Instituto de Microbiología, Ecuador
| | - B Prado-Vivar
- Universidad San Francisco de Quito, COCIBA, Instituto de Microbiología, Ecuador
| | - S Marquez
- Universidad San Francisco de Quito, COCIBA, Instituto de Microbiología, Ecuador
| | - S Proaño
- Universidad San Francisco de Quito, COCIBA, Instituto de Microbiología, Ecuador
| | - R Bayas
- Universidad San Francisco de Quito, COCIBA, Instituto de Microbiología, Ecuador
| | - J J Guadalupe
- Universidad San Francisco de Quito, COCIBA, Laboratorio de Biotecnología Vegetal, Ecuador
| | - M Becerra-Wong
- Universidad San Francisco de Quito, COCIBA, Instituto de Microbiología, Ecuador
| | - B Gutierrez
- Universidad San Francisco de Quito, COCIBA, Laboratorio de Biotecnología Vegetal, Ecuador.,Departament of Zoology, University of Oxford, UK
| | | | - G Trueba
- Universidad San Francisco de Quito, COCIBA, Instituto de Microbiología, Ecuador
| | - M Grunauer
- Universidad San Francisco de Quito, COCSA, Escuela de Medicina, Ecuador.,Unidad de Cuidados Intensivos, Hospital de los Valles, Quito, Ecuador
| | - V Barragán
- Universidad San Francisco de Quito, COCIBA, Instituto de Microbiología, Ecuador
| | - P Rojas-Silva
- Universidad San Francisco de Quito, COCIBA, Instituto de Microbiología, Ecuador
| | | | - P Cárdenas
- Universidad San Francisco de Quito, COCIBA, Instituto de Microbiología, Ecuador
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6
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Diallo K, Rivière M, Gutierrez B, Andry F, Bertolotti A, Zemali N, Saint-Pastou Terrier C, Manaquin R, Koumar Y, Poubeau P. Cerebellar syndrome associated with legionellosis: A case report and literature review. Rev Med Interne 2022; 43:440-443. [DOI: 10.1016/j.revmed.2022.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 11/25/2022]
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7
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Thapa R, Singh J, Gutierrez B, Arro J, Khan A. Genome-wide association mapping identifies novel loci underlying fire blight resistance in apple. Plant Genome 2021; 14:e20087. [PMID: 33650322 DOI: 10.1002/tpg2.20087] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/17/2020] [Indexed: 05/12/2023]
Abstract
Fire blight, caused by epiphytotic gram-negative bacteria Erwinia amylovora, is the most destructive bacterial disease of apple (Malus spp.). Genetic mechanisms of fire blight resistance have mainly been studied using traditional biparental quantitative trait loci (QTL) mapping approaches. Here, we use large-scale historic shoot and blossom fire blight data collected over multiple years and genotyping-by-sequencing (GBS) markers to identify significant marker-trait associations in a diverse set of 566 apple [Malus domestica (Suckow) Borkh.] accessions. There was large variation in fire blight resistance and susceptibility in these accessions. We identified 23 and 38 QTL significantly (p < .001) associated with shoot and blossom blight resistance, respectively. The QTL are distributed across all 17 chromosomes of apple. Four shoot blight and 19 blossom blight QTL identified in this study colocalized with previously identified QTL associated with resistance to fire blight or apple scab. Using transcriptomics data of two apple cultivars with contrasting fire blight responses, we also identified candidate genes for fire blight resistance that are differentially expressed between resistant and susceptible cultivars and located within QTL intervals for fire blight resistance. However, further experiments are needed to confirm and validate these marker-trait associations and develop diagnostic markers before use in marker-assisted breeding to develop apple cultivars with decreased fire blight susceptibility.
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Affiliation(s)
- Ranjita Thapa
- Plant Pathology and Plant-Microbe Biology Section, Cornell University, Geneva, NY, 14456, USA
| | - Jugpreet Singh
- Plant Pathology and Plant-Microbe Biology Section, Cornell University, Geneva, NY, 14456, USA
| | - Benjamin Gutierrez
- USDA-ARS Plant Genetic Resources Unit, New York State Agricultural Experiment Station, 630 West North Street, Geneva, NY, 14456, USA
| | - Jie Arro
- USDA-ARS Plant Genetic Resources Unit, New York State Agricultural Experiment Station, 630 West North Street, Geneva, NY, 14456, USA
| | - Awais Khan
- Plant Pathology and Plant-Microbe Biology Section, Cornell University, Geneva, NY, 14456, USA
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8
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Nieto Callejo M, Gallardo I, Gutierrez B, Cabero M, Ruiz L, Alvarez Y, Simon I, Calvo H, Munoz J, Margolles A, San Roman J, Cachofeiro V, Hernandez M. Oleanolic acid protection against experimental autoimmune myocarditis modulates the microbiota and the intestinal barrier integrity. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Autoimmune myocarditis is a cause of dilated cardiomyopathy and heart failure. Recent studies have indicated that leaky gut may allow environmental factors to enter the body and trigger the initiation/development of autoimmune disease. Moreover, there is a growing literature supporting that, beside myocardial fibrosis, a leaky intestinal barrier and gut dysbiosis are pathogenic factors linked to heart failure. The natural triterpene oleanolic acid (OA) has been shown to beneficially influence the severity of the experimental autoimmune myocarditis (EAM), a preclinical model of human myocarditis, via anti-oxidant and immunomodulatory mechanisms. Herein, we investigate gastrointestinal (GI) disturbances and the gut microbiota composition associated with EAM as potential therapeutic target of OA.
Methods and results
BALB/c mice were α-myosin-inmunized to induce EAM and treated with OA (25 mg/kg/day, i.p). On day 21, heart fibrosis and parameters related to gut damage such as oxidative stress (O2- ions, lipid peroxidation), gut permeability (D-lactate; I-FABP), inflammation and mucins were determined in serum and/or colon. Fecal microbial profiles were identified by 16S rRNA gene sequencing analysis. Firstly, histological analysis of hearts showed presence of fibrosis (Sirius Red stain) in EAM mice, whereas these effects were not detectable in myocardium from healthy or OA-treated EAM mice. In addition, OA preserved the mucin-containing goblet cells along the colon (Alcian Blue/PAS stain). Consistently, serum levels of the epithelial gut damage markers, including D-lactate and iFABP were significantly reduced in OA treated-EAM mice. The beneficial OA effects also included a decrease in the pro-inflammatory mediators sPLA2-IIA and IL-1β and a protection from the oxidative stress response (DHE stain and TBARS) in serum and colonic tissue of EAM-mice. Furthermore, gut microbiota composition showed a lower bacterial diversity and different relative abundance of certain bacterial taxa in EAM-mice compared to control mice. The families of Muribaculaceae, Lachnospiraceae, and Ruminococcaceae were significantly affected in EAM mice, and only Muribaculaceae recovered levels similar to the healthy-control group, after treatment with OA.
Conclusion
Our data show that in addition to the heart, the intestinal barrier and gut microbiota are altered in myocarditis, and that OA treatment could ameliorate this profile. Our data contribute to the idea that gut dysbiosis and GI dysfunction influences myocarditis pathogenesis, and provides new findings regarding the beneficial activity of OA in EAM, suggesting that it may be an interesting candidate to be explored for the treatment of human patients.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): MINECO, ISCIII, CIBERCV-ISCIII
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Affiliation(s)
- M.L Nieto Callejo
- Instituto de Biologia y Genetica Molecular, CSIC-UVA, Valladolid, Spain
| | - I Gallardo
- Instituto de Biologia y Genetica Molecular, CSIC-UVA, Valladolid, Spain
| | - B Gutierrez
- Instituto de Biologia y Genetica Molecular, CSIC-UVA, Valladolid, Spain
| | - M.I Cabero
- Instituto de Biologia y Genetica Molecular, CSIC-UVA, Valladolid, Spain
| | - L Ruiz
- Instituto de Productos Lácteos, CSIC, Asturias, Spain
| | - Y Alvarez
- Instituto de Biologia y Genetica Molecular, CSIC-UVA, Valladolid, Spain
| | - I Simon
- Instituto de Biologia y Genetica Molecular, CSIC-UVA, Valladolid, Spain
| | - H Calvo
- Instituto de Biologia y Genetica Molecular, CSIC-UVA, Valladolid, Spain
| | - J.C Munoz
- University Hospital del Rio Hortega, Cardiologia, Valladolid, Spain
| | - A Margolles
- Instituto de Productos Lácteos, CSIC, Asturias, Spain
| | - J.A San Roman
- University Hospital of Vallodolid, ICICOR, Valladolid, Spain
| | - V Cachofeiro
- Complutense University of Madrid, Department of Physiology, Madrid, Spain
| | - M Hernandez
- Complutense University of Madrid, Department of Physiology, Madrid, Spain
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Cypierre A, Gutierrez B, Pestourie N, Pinet P, Durox H, Ducroix-Roubertou S, Genet C, Brisset J, Barraud O, Faucher J. Bactériémies à Klebsiella pneumoniae productrice de carbapénémase NDM au cours d’une épidémie : données épidémiologiques, traitements et évolutions. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.064] [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: 10/23/2022]
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10
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Suvannasankha A, Prawitz T, Kapetanakis V, Sarri G, Hughes R, Wang F, Hogea C, Allen Ferrante S, Gutierrez B, Gorsh B, Willson J, Popat R. 901P Matching-adjusted indirect comparisons (MAIC) of safety between single-agent belantamab mafodotin versus selinexor plus dexamethasone in relapsed/refractory multiple myeloma (RRMM). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.019] [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: 10/23/2022] Open
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11
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Handwerker DA, Ianni G, Gutierrez B, Roopchansingh V, Gonzalez-Castillo J, Chen G, Bandettini PA, Ungerleider LG, Pitcher D. Theta-burst TMS to the posterior superior temporal sulcus decreases resting-state fMRI connectivity across the face processing network. Netw Neurosci 2020; 4:746-760. [PMID: 32885124 PMCID: PMC7462428 DOI: 10.1162/netn_a_00145] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 05/08/2020] [Indexed: 01/15/2023] Open
Abstract
Humans process faces by using a network of face-selective regions distributed across the brain. Neuropsychological patient studies demonstrate that focal damage to nodes in this network can impair face recognition, but such patients are rare. We approximated the effects of damage to the face network in neurologically normal human participants by using theta burst transcranial magnetic stimulation (TBS). Multi-echo functional magnetic resonance imaging (fMRI) resting-state data were collected pre- and post-TBS delivery over the face-selective right superior temporal sulcus (rpSTS), or a control site in the right motor cortex. Results showed that TBS delivered over the rpSTS reduced resting-state connectivity across the extended face processing network. This connectivity reduction was observed not only between the rpSTS and other face-selective areas, but also between nonstimulated face-selective areas across the ventral, medial, and lateral brain surfaces (e.g., between the right amygdala and bilateral fusiform face areas and occipital face areas). TBS delivered over the motor cortex did not produce significant changes in resting-state connectivity across the face processing network. These results demonstrate that, even without task-induced fMRI signal changes, disrupting a single node in a brain network can decrease the functional connectivity between nodes in that network that have not been directly stimulated. Human behavior is dependent on brain networks that perform different cognitive functions. We combined theta burst transcranial magnetic stimulation (TBS) with resting-state fMRI to study the face processing network. Disruption of the face-selective right posterior superior temporal sulcus (rpSTS) reduced fMRI connectivity across the face network. This impairment in connectivity was observed not only between the rpSTS and other face-selective areas, but also between nonstimulated face-selective areas on the ventral and medial brain surfaces (e.g., between the right amygdala and bilateral fusiform face areas and occipital face areas). Thus, combined TBS/fMRI can be used to approximate and measure the effects of focal brain damage on brain networks, and suggests such an approach may be useful for mapping intrinsic network organization.
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Affiliation(s)
- Daniel A Handwerker
- Section on Functional Imaging Methods, Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, MD, USA
| | - Geena Ianni
- Section on Neurocircuitry, Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, MD, USA
| | - Benjamin Gutierrez
- Section on Functional Imaging Methods, Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, MD, USA
| | - Vinai Roopchansingh
- Functional MRI Facility, National Institute of Mental Health, Bethesda, MD, USA
| | - Javier Gonzalez-Castillo
- Section on Functional Imaging Methods, Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, MD, USA
| | - Gang Chen
- Scientific and Statistical Computing Core, National Institute of Mental Health, Bethesda, MD, USA
| | - Peter A Bandettini
- Section on Functional Imaging Methods, Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, MD, USA
| | - Leslie G Ungerleider
- Section on Neurocircuitry, Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, MD, USA
| | - David Pitcher
- Department of Psychology, University of York, Heslington, York, UK
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Gutierrez B, Joffee E, Luxton-Gourgey K, Landau S, Gupta K. Evaluation of a Prototype Talking Directory Display System (TDDS) in an Inter-modal Transit Facility. Journal of Visual Impairment & Blindness 2020. [DOI: 10.1177/0145482x9709100611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- B. Gutierrez
- American Foundation for the Blind, 11 Penn Plaza, Suite 300, New York, NY 10001
| | - E. Joffee
- Information Center, American Foundation for the Blind, 11 Penn Plaza, Suite 300, New York, NY 10001
| | - K. Luxton-Gourgey
- Computer Center for Visually Impaired People, Baruch College, City University of New York, Box H0648, 17 Lexington Avenue, New York, NY 10010
| | - S. Landau
- Stein Partnership, 20 West 20th Street, New York, NY 10011
| | - K.M. Gupta
- Tactual graphics, Baruch College, City University of New York, 17 Lexington Avenue, New York, NY 10010
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13
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Eliason L, Opalinska J, Martin ML, Correll J, Gutierrez B, Popat R. DREAMM-1 Patient perspectives from the first-in-human study of single-agent belantamab mafodotin for relapsed and refractory multiple myeloma (RRMM). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e20531] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20531 Background: Patient-reported outcomes in RRMM remain poor, particularly for those refractory to immunomodulatory agents, proteasome inhibitors, and anti-CD38 antibodies, and there is an increased risk of cumulative toxicities in these patients. Single-agent belantamab mafodotin (GSK2857916), a first-in-class, B-cell maturation antigen–binding immunoconjugate, has demonstrated deep and durable responses with a manageable safety profile in heavily pretreated patients with RRMM (DREAMM-1, NCT02064387). Here, we present patient-reported clinical benefit/tolerability of belantamab mafodotin evaluated by trial-embedded end-of-treatment (EOT) and follow-up interviews. Methods: DREAMM-1 study design and results have been reported ( Blood Cancer J 2019). Patients in the Part 2 expansion phase were administered single-agent belantamab mafodotin 3.4 mg/kg IV once every 3 weeks for 16 cycles and invited to participate in interviews at EOT and 6-month follow-up. Patients discussed symptoms, treatment-related adverse events (AEs), treatment burden, and overall treatment satisfaction, rated 0–10 (0 = not severe to 10 = most severe/0 = not at all satisfied to 10 = extremely satisfied). Results: A total of 17/35 patients (9 female [53%]) were interviewed; 4/17 patients completed both interviews. Most patients (94%; 16/17) achieved a partial response or better. At EOT, patients reported an improvement from the worst point in symptoms of bone pain (mean change in score from 6.4 to 4.0) and fatigue (8.0 to 5.5). The most commonly reported treatment-related AE was blurred vision (76%; 13/17). Among those reporting this AE, 62% (8/13) reported resolution or steady improvement in vision after EOT; with a reduction in severity rating from 7.3 at worst to 5.3 at EOT for this event. Most patients (93%; 13/14) never considered stopping treatment owing to AEs, including ocular events. Overall treatment satisfaction was high (mean score 7.9; median 9.0). Conclusions: Despite small sample sizes, trial-embedded interviews provide valuable insight into patient experience with belantamab mafodotin. Patients treated with single-agent belantamab mafodotin reported high treatment satisfaction and improvements in symptoms. Visual symptoms were frequent but manageable, and improved or resolved after treatment. Funding: GlaxoSmithKline (117159). Drug linker technology licensed from Seattle Genetics; monoclonal antibody produced using POTELLIGENT Technology licensed from BioWa. Clinical trial information: NCT02064387.
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Affiliation(s)
| | | | | | | | | | - Rakesh Popat
- NIHR/University College London Hospital Clinical Research Facility, NHS Foundation Trust, London, United Kingdom
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Yang Y, Cuenca J, Wang N, Liang Z, Sun H, Gutierrez B, Xi X, Arro J, Wang Y, Fan P, Londo J, Cousins P, Li S, Fei Z, Zhong GY. A key 'foxy' aroma gene is regulated by homology-induced promoter indels in the iconic juice grape 'Concord'. Hortic Res 2020; 7:67. [PMID: 32337050 PMCID: PMC7166211 DOI: 10.1038/s41438-020-0304-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/19/2020] [Accepted: 03/30/2020] [Indexed: 05/25/2023]
Abstract
'Concord', the most well-known juice grape with a parentage of the North American grape species Vitis labrusca L., possesses a special 'foxy' aroma predominantly resulted from the accumulation of methyl anthranilate (MA) in berries. This aroma, however, is often perceived as an undesirable attribute by wine consumers and rarely noticeable in the common table and wine grape species V. vinifera. Here we discovered homology-induced promoter indels as a major genetic mechanism for species-specific regulation of a key 'foxy' aroma gene, anthraniloyl-CoA:methanol acyltransferase (AMAT), that is responsible for MA biosynthesis. We found the absence of a 426-bp and/or a 42-bp sequence in AMAT promoters highly associated with high levels of AMAT expression and MA accumulation in 'Concord' and other V. labrusca-derived grapes. These promoter variants, all with direct and inverted repeats, were further confirmed in more than 1,300 Vitis germplasm. Moreover, functional impact of these indels was validated in transgenic Arabidopsis. Superimposed on the promoter regulation, large structural changes including exonic insertion of a retrotransposon were present at the AMAT locus in some V. vinifera grapes. Elucidation of the AMAT genetic regulation advances our understanding of the 'foxy' aroma trait and makes it genetically trackable and amenable in grapevine breeding.
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Affiliation(s)
- Yingzhen Yang
- US Department of Agriculture-Agricultural Research Service, Grape Genetics Research Unit, Geneva, NY USA
| | - José Cuenca
- US Department of Agriculture-Agricultural Research Service, Grape Genetics Research Unit, Geneva, NY USA
- Present Address: Centro de Citricultura y Producción Vegetal. Instituto Valenciano de Investigaciones Agrarias, Moncada, Valencia, Spain
| | - Nian Wang
- US Department of Agriculture-Agricultural Research Service, Grape Genetics Research Unit, Geneva, NY USA
- Present Address: College of Horticulture and Forestry, Huazhong Agricultural University, Wuhan, Hubei China
| | - Zhenchang Liang
- Beijing Key Laboratory of Grape Sciences and Enology, Laboratory of Plant Resources, Institute of Botany, Chinese Academy of Sciences, Beijing, China
| | - Honghe Sun
- Boyce Thompson Institute for Plant Research, Cornell University, Ithaca, NY USA
| | - Benjamin Gutierrez
- US Department of Agriculture-Agricultural Research Service, Plant Genetic Resources Unit, Geneva, NY USA
| | - Xiaojun Xi
- US Department of Agriculture-Agricultural Research Service, Plant Genetic Resources Unit, Geneva, NY USA
- Forestry and Pomology Research Institute, Shanghai Academy of Agricultural Sciences, Shanghai, China
| | - Jie Arro
- US Department of Agriculture-Agricultural Research Service, Plant Genetic Resources Unit, Geneva, NY USA
| | - Yi Wang
- Beijing Key Laboratory of Grape Sciences and Enology, Laboratory of Plant Resources, Institute of Botany, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Peige Fan
- Beijing Key Laboratory of Grape Sciences and Enology, Laboratory of Plant Resources, Institute of Botany, Chinese Academy of Sciences, Beijing, China
| | - Jason Londo
- US Department of Agriculture-Agricultural Research Service, Grape Genetics Research Unit, Geneva, NY USA
| | | | - Shaohua Li
- Beijing Key Laboratory of Grape Sciences and Enology, Laboratory of Plant Resources, Institute of Botany, Chinese Academy of Sciences, Beijing, China
| | - Zhangjun Fei
- Boyce Thompson Institute for Plant Research, Cornell University, Ithaca, NY USA
- US Department of Agriculture–Agricultural Research Service, Robert W. Holley Center for Agriculture and Health, Ithaca, NY USA
| | - Gan-Yuan Zhong
- US Department of Agriculture-Agricultural Research Service, Grape Genetics Research Unit, Geneva, NY USA
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15
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Bezanahary H, Gutierrez B, Dumonteil S, Coste Mazeau P, Eyraud JL, Preux PM, Fauchais AL, Ly K, Aubard Y. Risk factors of pregnancy morbidity in migrant women from Subsaharan Africa. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.173] [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: 11/13/2022] Open
Abstract
Abstract
Reduction of maternal mortality remains a major public health issue worldwide. In France, the latest national confidential enquiry regarding maternal mortality (2010-2012) stated a ratio of 10 /100 000 livebirths whereas the goal was 5/100 000. The risk of death among pregnant women from Subsaharan Africa (SSA) was 3 times higher.
We performed a monocentric observational retrospective study from 01/01/2009 to 01/09/2016 in order to better understand the factors of maternal morbidity among SSA pregnant women. Demographic characteristics as well as pregnancy outcomes were collected. Antenatal clinics attendance was scored (+1 if positive, +1 if done following the recommended schedule). A total 1 489 (7%) out of 20 755 pregnancies were registred among SSA women. Mean age was 29 years (14-48), mean gestity/parity were respectively 3.5 and 1.8. About 38% of pregnancies occured in overweight or obese women. Obstetrical complications were seen in 542 (36%) pregnancies: gestational diabetes (n = 206, 36,4%), hypertensive disorders (n = 122, 8,2%), 19 had both. Pre-eclampsia represented 4%, sepsis 5%, premature rupture of membrane 5% and post partum haemorrhage 3%. Livebirths was high (97%) with a mean gestational age of 37(22-41), a mean birth weight of 3150g (500-5000). The unique maternal death in this cohort was due to amniotic fluid embolism. Complication risk factors were age (30 versus 28 years; p < 0.0001), BMI (26 versus 25 kg/m2; p < 0.0001), past history of chronic hypertension and pregestational diabetes (p < 0,001). Furthermore, the score of antenatal care attendance was low in those who presented pregnancy morbidities (p = 0.0006) (adjusted with age, BMI> 25 and chronic hypertension).
Higher risk of maternal morbidity among SSA women is not only explained by individual risk factors but also by a lack of compliance to the recommended antenatal care even if they live in France. Further investigations including sociological studies are therefore needed.
Key messages
Maternal mortality and morbidity are higher among migrant women from Subsaharan Africa. Our study highlights a non compliance to the recommended antenatal care surveillance among risk factors.
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Affiliation(s)
- H Bezanahary
- Internal Medicine, CHU Dupuytren 2, Limoges, France
| | - B Gutierrez
- Internal Medicine, CHU Dupuytren 2, Limoges, France
| | - S Dumonteil
- Internal Medicine, CHU Dupuytren 2, Limoges, France
| | | | - J L Eyraud
- Obstetric Department, CHU, Limoges, France
| | - P M Preux
- UMR 1094 NET, INSERM, Limoges, France
| | - A L Fauchais
- Internal Medicine, CHU Dupuytren 2, Limoges, France
| | - K Ly
- Internal Medicine, CHU Dupuytren 2, Limoges, France
| | - Y Aubard
- Obstetric Department, CHU, Limoges, France
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16
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Gallardo I, Gutierrez B, Hernandez M, Cabero I, Alvarez Y, Simon I, Munoz JC, San Roman JA, Cachofeiro V, Nieto Callejo ML. P6284The antioxidant MitoQ protects against intestinal disturbances in the experimental autoimmune model of myocarditis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0882] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose
Myocarditis and dilated cardiomyopathy represent the acute and chronic phases of an inflammatory disease of the myocardium, for which no standardized treatment is currently available in clinical practice. Myocardial fibrosis an oxidative stress are pathogenic factors associated with these processes. However, new research has found that gut health can be linked to some cardiac conditions. Thus, in this study we investigated whether intestinal disturbances are present in myocarditis, using a murine experimental autoimmune model (EAM) that mimics human myocarditis, as well as the potential beneficial effect of treatment with the mitochondrial antioxidant, MitoQ.
Methods and results
EAM was induced in BALB/c mice with a myocardiogenic peptide and mice were treated with MitoQ (50 mg/kg/day, i.p). On day 21 (acute phase), we assessed signs of heart injury (e.g. hypertrophy, fibrosis, oxidative stress) and parameters related to gut damage such as accumulation of reactive oxigen species (superoxide anion: O2·−), inflammation (IL-1β, IL-33, TNFα), microbial translocation (sCD14; intestinal fatty acid binding protein, I-FABP) and mucins in serum and/or intestine. MitoQ teatment significantly reduced the high heart weight/body weight ratio (HW/BW) of EAM mice, a characteristic hallmark of cardiac hyperthropy. Histological analysis of hearts showed presence of fibrosis (Sirius Red stain) and high O2·− levels (DHE stain) in EAM mice whereas these effects were not detectable in cardiac tissue from healthy or MitoQ-treated EAM mice. In addition, the enhanced O2·− ions (DHE stain) and mucin loss (Alcian Blu/PAS stain) found in colon, ileum, jejunum and duodenum sections from EAM mice were attenuated by MitoQ treatment. The systemic markers associated to intestinal barrier disruption, sCD14 and I-FABP, were found strongly increased in serum from EAM mice, and MitoQ prevents this rise. The beneficial MitoQ effects were also associated with a decrease in the pro-inflammatory cytokines TNFα, IL-33 and IL-1β, both in serum and colonic tissue of treated-EAM mice, as well as a reduction of the myeloperoxidase activity in colon, compared with untreated EAM mice.
Conclusion
Our data show that in addition to the heart, the intestinal tissue is also damaged in the preclinical model of experimental autoimmune myocarditis, and that MitoQ treatment could reverse this profile. Since there are systemic markers released from the intestine, therapeutic strategies targeting to prevent the intestinal oxidative stress and its associated gut barrier dysfunction, could contribute to the amelioration of the disease.
Acknowledgement/Funding
SAF2016-81063; CIBERCV
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Affiliation(s)
- I Gallardo
- Institute of Biology & Molecular Genetic, CSIC-UVA, Valladolid, Spain
| | - B Gutierrez
- Institute of Biology & Molecular Genetic, CSIC-UVA, Valladolid, Spain
| | - M Hernandez
- Institute of Biology & Molecular Genetic, CSIC-UVA, Valladolid, Spain
| | - I Cabero
- Institute of Biology & Molecular Genetic, CSIC-UVA, Valladolid, Spain
| | - Y Alvarez
- Institute of Biology & Molecular Genetic, CSIC-UVA, Valladolid, Spain
| | - I Simon
- Institute of Biology & Molecular Genetic, CSIC-UVA, Valladolid, Spain
| | - J C Munoz
- University Hospital del Rio Hortega, Cardiologia, Valladolid, Spain
| | - J A San Roman
- University Hospital of Vallodolid, ICICOR, Valladolid, Spain
| | - V Cachofeiro
- Complutense University of Madrid, Department of Physiology, Madrid, Spain
| | - M L Nieto Callejo
- Institute of Biology & Molecular Genetic, CSIC-UVA, Valladolid, Spain
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17
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Gutierrez B, Gayet S, Bertolino J, Jean E, Le Goff L, Voisin H, Sampo M, Meunier B, Harle JR, Ebbo M, Schleinitz N, Menard A, Bernit E. [Ocular syphilis, a re-emergent pathology: Series of 12 patients in one Hospital, 2017]. Rev Med Interne 2019; 41:160-167. [PMID: 31301942 DOI: 10.1016/j.revmed.2019.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 06/09/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Syphilis is a sexually transmitted disease. All organs might be affected, but ocular syphilis only occurs in 0.6 percent of patients. We collected all cases of ocular syphilis requiring hospitalization at the University Hospital Center (UHC) in Marseille in 2017. PATIENTS AND METHODS This was a retrospective monocentric study. The diagnosis of ocular syphilis was based on the combination of ocular inflammation with a positive syphilitic serology. For each patient, sex, age, HIV status, ocular and extraocular symptoms, initial visual acuity, syphilis serology, cerebrospinal fluid (CSF) analysis if done, treatment and clinical response were collected. RESULTS Ten men and two women, aged 28 to 86 years, were hospitalized. Two patients were HIV-positive. Ophtalmological lesions were heterogeneous the posterior structures were most affected. Anterior uveitis was isolated in one patient. Five patients had extraocular signs with cutaneous and/or mucosal involvement. No patient had neurological symptoms. Diagnosis of neurosyphilis through CSF analysis was definite for one patient, probable for 5 patients and ruled out for 2 patients. Six patients received treatment with penicillin G and six with ceftriaxone. Visual acuity improved in all cases. DISCUSSION Ophtalmic cases of syphilis have become more frequent over the past few years in France. The diagnosis should be suspected in cases of eye inflammation even in the absence of favourable clinical presentation or anamnesis. Search for HIV co-infection should be systematic. Our study shows that ceftriaxone remains an effective alternative to penicillin G.
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Affiliation(s)
- B Gutierrez
- Service de medecine interne, CHU limoges, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France.
| | - S Gayet
- Service de gériatrie, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France
| | - J Bertolino
- Service de service de médecine interne, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France
| | - E Jean
- Service de service de médecine interne, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France
| | - L Le Goff
- 8, allée Turcat-Mery, 13008 Marseille, France
| | - H Voisin
- Service d'ophtalmologie, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France
| | - M Sampo
- Service d'ophtalmologie, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France
| | - B Meunier
- Service de service de médecine interne, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France
| | - J-R Harle
- Service de service de médecine interne, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France
| | - M Ebbo
- Service de service de médecine interne, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France
| | - N Schleinitz
- Service de service de médecine interne, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France
| | - A Menard
- Service de maladies infectieuses et tropicales de l'IHU méditerranée infection, 19-21, boulevard Jean-Moulin, 13005 Marseille, France
| | - E Bernit
- Service de service de médecine interne, AP-HM, 278, rue Saint-Pierre, 13005 Marseille, France
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18
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Gutierrez B, Grados A, Palat S, Ribeiro E, Ruivard M, Le Gouellec N, Haroche J, Papo T, Harlé J, Ly K, Schleinitz N, Ebbo M. Évènements thrombotiques artériels et veineux au cours de la maladie associée aux IgG4 : étude rétrospective à partir des données de la cohorte nationale française. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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19
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Bertolino J, Ecosse Q, Coso D, Meunier B, Gutierrez B, Schleinitz N, Harlé J, Daniel L, Gaubert J, Bernit E. Amylose AL et maladie kystique pulmonaire : une association rare. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.148] [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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20
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Perez-Gonzalez J, Arámbula-Cosío F, Guzmán M, Camargo L, Gutierrez B, Mateus D, Navab N, Medina-Bañuelos V. Spatial Compounding of 3-D Fetal Brain Ultrasound Using Probabilistic Maps. Ultrasound Med Biol 2018; 44:278-291. [PMID: 29107355 DOI: 10.1016/j.ultrasmedbio.2017.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/12/2017] [Accepted: 09/01/2017] [Indexed: 06/07/2023]
Abstract
A new method to address the problem of shadowing in fetal brain ultrasound volumes is presented. The proposed approach is based on the spatial composition of multiple 3-D fetal head projections using the weighted Euclidean norm as an operator. A support vector machine, which is trained with optimal textural features, was used to assign weighting according to the posterior probabilities of brain tissue and shadows. Both phantom and real fetal head ultrasound volumes were compounded using previously reported operators and compared with the proposed composition method to validate it. The quantitative evaluations revealed increases in signal-to-noise ratio ≤35% and in contrast-to-noise ratio ≤135% using real data. Qualitative comparisons made by obstetricians indicated that this novel method adequately recovers brain tissue and improves the visibility of the main cerebral structures. This may prove useful both for fetal monitoring and in the diagnosis of brain defects. Overall this new approach outperforms spatial composition methods previously reported.
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Affiliation(s)
- Jorge Perez-Gonzalez
- Neuroimaging Laboratory, Electrical Engineering Department, Universidad Autónoma Metropolitana, Iztapalapa, Mexico
| | - Fernando Arámbula-Cosío
- Biomedical Imaging Laboratory, Centro de Ciencias Aplicadas y Desarrollo Tecnológico, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Mario Guzmán
- Department of Fetal Medicine, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Lisbeth Camargo
- Department of Fetal Medicine, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Benjamin Gutierrez
- Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany; Chair for Computer Aided Medical Procedures, Technische Universität München, Munich, Germany
| | - Diana Mateus
- Chair for Computer Aided Medical Procedures, Technische Universität München, Munich, Germany
| | - Nassir Navab
- Chair for Computer Aided Medical Procedures, Technische Universität München, Munich, Germany
| | - Verónica Medina-Bañuelos
- Neuroimaging Laboratory, Electrical Engineering Department, Universidad Autónoma Metropolitana, Iztapalapa, Mexico.
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21
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Meunier B, Bertolino J, Gutierrez B, Doddoli S, Seguier J, Ebbo M, Durand J, Swiader L, Harlé J, Bernit E, Schleinit N. Agranulocytose néonatale : une complication rare des neutropénies auto-immunes. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.219] [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: 11/16/2022]
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22
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Bertolino J, Bregeon F, Meunier B, Gutierrez B, Ecosse Q, Richaud L, Doddoli S, Jean E, Schleinitz N, Bernit E. Atteinte des muscles expiratoires chez l’adulte drépanocytaire, à propos d’un cas. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.222] [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: 10/18/2022]
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23
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Richaud L, Bertolino J, Gutierrez B, Meunier B, Ecosse Q, Doddoli S, Jean E, Doche E, Brunel H, Schleinitz N, Bernit E. Récupération clinico-radiologique d’un syndrome d’embolie graisseuse cérébrale chez un patient drépanocytaire. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.223] [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]
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24
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Norelli JL, Wisniewski M, Fazio G, Burchard E, Gutierrez B, Levin E, Droby S. Genotyping-by-sequencing markers facilitate the identification of quantitative trait loci controlling resistance to Penicillium expansum in Malus sieversii. PLoS One 2017; 12:e0172949. [PMID: 28257442 PMCID: PMC5336245 DOI: 10.1371/journal.pone.0172949] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/13/2017] [Indexed: 11/30/2022] Open
Abstract
Blue mold caused by Penicillium expansum is the most important postharvest disease of apple worldwide and results in significant financial losses. There are no defined sources of resistance to blue mold in domesticated apple. However, resistance has been described in wild Malus sieversii accessions, including plant introduction (PI)613981. The objective of the present study was to identify the genetic loci controlling resistance to blue mold in this accession. We describe the first quantitative trait loci (QTL) reported in the Rosaceae tribe Maleae conditioning resistance to P. expansum on genetic linkage group 3 (qM-Pe3.1) and linkage group 10 (qM-Pe10.1). These loci were identified in a M.× domestica 'Royal Gala' X M. sieversii PI613981 family (GMAL4593) based on blue mold lesion diameter seven days post-inoculation in mature, wounded apple fruit inoculated with P. expansum. Phenotypic analyses were conducted in 169 progeny over a four year period. PI613981 was the source of the resistance allele for qM-Pe3.1, a QTL with a major effect on blue mold resistance, accounting for 27.5% of the experimental variability. The QTL mapped from 67.3 to 74 cM on linkage group 3 of the GMAL4593 genetic linkage map. qM-Pe10.1 mapped from 73.6 to 81.8 cM on linkage group 10. It had less of an effect on resistance, accounting for 14% of the experimental variation. 'Royal Gala' was the primary contributor to the resistance effect of this QTL. However, resistance-associated alleles in both parents appeared to contribute to the least square mean blue mold lesion diameter in an additive manner at qM-Pe10.1. A GMAL4593 genetic linkage map composed of simple sequence repeats and 'Golden Delicious' single nucleotide polymorphism markers was able to detect qM-Pe10.1, but failed to detect qM-Pe3.1. The subsequent addition of genotyping-by-sequencing markers to the linkage map provided better coverage of the PI613981 genome on linkage group 3 and facilitated discovery of qM-Pe3.1. A DNA test for qM-Pe3.1 has been developed and is currently being evaluated for its ability to predict blue mold resistance in progeny segregating for qM-Pe3.1. Due to the long juvenility of apple, the availability of a DNA test to screen for the presence of qM-Pe3.1 at the seedling stage will greatly improve efficiency of breeding apple for blue mold resistance.
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Affiliation(s)
- John L. Norelli
- Appalachian Fruit Research Station, Agricultural Research Service, United States Department of Agriculture, Kearneysville, West Virginia, United States of America
| | - Michael Wisniewski
- Appalachian Fruit Research Station, Agricultural Research Service, United States Department of Agriculture, Kearneysville, West Virginia, United States of America
| | - Gennaro Fazio
- Plant Genetic Resources Research, Agricultural Research Service, United States Department of Agriculture, Geneva, New York, United States of America
| | - Erik Burchard
- Appalachian Fruit Research Station, Agricultural Research Service, United States Department of Agriculture, Kearneysville, West Virginia, United States of America
| | - Benjamin Gutierrez
- Plant Genetic Resources Research, Agricultural Research Service, United States Department of Agriculture, Geneva, New York, United States of America
| | - Elena Levin
- Department of Postharvest Science, Agricultural Research Organization, the Volcani Center, Bet Dagan, Israel
| | - Samir Droby
- Department of Postharvest Science, Agricultural Research Organization, the Volcani Center, Bet Dagan, Israel
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Wilson M, Gutierrez B, Offord SJ, Blanchette CM, Eramo A, Earnshaw S, Kamat SA. Inpatient resource use and costs associated with switching from oral antipsychotics to aripiprazole once-monthly for the treatment of schizophrenia. Drugs Context 2016; 5:212273. [PMID: 27114739 PMCID: PMC4831639 DOI: 10.7573/dic.212273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Indexed: 01/03/2023] Open
Abstract
Background: Schizophrenia is associated with high direct healthcare costs due to progression of disease and frequent occurrence of relapses. Aripiprazole once-monthly (AOM) has been shown to reduce total psychiatric hospitalizations among patients who switched from oral standard of care (SOC) therapy to AOM in a multicenter, open-label, mirror-image study of patients with schizophrenia. Because of the increasing need to improve patient outcomes while containing costs, it is important to understand the impact of AOM treatment initiation on medical costs associated with psychiatric hospitalizations and antipsychotic pharmacy costs. Methods: In the current study, an economic model was developed using data from the AOM mirror-image study to evaluate the psychiatric hospitalization-related medical costs and antipsychotic pharmacy costs during a 6-month period before (retrospective period) and after (prospective period) the AOM treatment initiation. The economic model evaluated cost-saving potential of AOM among all patients (n=433) as well as a subset of patients with ≥1 prior hospitalization (n=165) who switched from oral SOC to AOM. Unit cost data were obtained from publicly available sources. Results: Both hospitalizations and hospital days were reduced following a switch from oral SOC to AOM. As a result, psychiatric hospitalization-related costs were lower during the prospective period when compared with the retrospective period. Furthermore, the increase in antipsychotic pharmacy costs due to switching from oral SOC to AOM was offset by a reduction in psychiatric hospitalization-related medical costs. Per-patient costs were reduced by $1,046 (USD) in the overall population and by $20,353 in a subset of patients who had at least 1 psychiatric hospitalization during the retrospective period. Results were most sensitive to changes in hospitalization costs. Conclusions: AOM is associated with reducing the risk of relapse among patients with schizophrenia. The increase in antipsychotic pharmacy costs due to switching from oral SOC to AOM was offset by a reduction in costs associated with psychiatric hospitalizations, thereby presenting a cost-saving opportunity for health plans.
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Cypierre A, Gondran G, Liozon E, Lapébie F, Parreau S, Bezanahary H, Palat S, Engalenc X, Gutierrez B, Ly K, Fauchais A. Vaccination anti-pneumococcique en médecine interne : à propos de 108 cas. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gutierrez B, Badano A, Samuelson F. Erratum: “Analytic variance estimates of Swank and Fano factors” [Med. Phys.
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, 072102 (5pp.) (2014)]. Med Phys 2015; 42:6769. [DOI: 10.1118/1.4932369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
| | - Aldo Badano
- US Food and Drug Administration, Silver Spring, Maryland 20993
| | - Frank Samuelson
- US Food and Drug Administration, Silver Spring, Maryland 20993
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Blanchette CM, Liang C, Lubeck DP, Newsome B, Rossetti S, Gu X, Gutierrez B, Lin ND. Progression of autosomal dominant kidney disease: measurement of the stage transitions of chronic kidney disease. Drugs Context 2015; 4:212275. [PMID: 25922609 PMCID: PMC4407687 DOI: 10.7573/dic.212275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/11/2015] [Accepted: 01/05/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is a progressive genetic disorder characterized by the development of numerous kidney cysts that result in kidney failure. Little is known regarding the key patient characteristics and utilization of healthcare resources for ADPKD patients along the continuum of disease progression. This observational study was designed to describe the characteristics of ADPKD patients and compare them with those of patients with other chronic kidney diseases. METHODS This retrospective cohort study involved patients with a claim for ADPKD or PKD unspecified from 1/1/2000-2/28/2013 and ≥6 months of previous continuous enrollment (baseline) within a large database of administrative claims in the USA. A random sample of chronic kidney disease (CKD) patients served as comparators. For a subset of ADPKD patients who had only a diagnosis code of unspecified PKD, abstraction of medical records was undertaken to estimate the proportion of patients who had medical chart-confirmed ADPKD. In patients with linked electronic laboratory data, the estimated glomerular filtration rate was calculated via serum creatinine values to determine CKD stage at baseline and during follow-up. Proportions of patients transitioning to another stage and the mean age at transition were calculated. RESULTS ADPKD patients were, in general, younger and had fewer physician visits, but had more specific comorbidities at observation start compared with CKD patients. ADPKD patients had a longer time in the milder stages and longer duration before recorded transition to a more severe stage compared with CKD patients. Patients with ADPKD at risk of rapid progression had a shorter time-to-end-stage renal disease than patients with CKD and ADPKD patients not at risk, but stage duration was similar between ADPKD patients at risk and those not at risk. CONCLUSIONS These results suggest that distribution of patients by age at transition to next stage may be useful for identification of ADPKD patients at risk of rapid progression. The results also suggest that medical claims with diagnosis codes for "unspecified PKD", in absence of a diagnosis code for autosomal recessive polycystic kidney disease, may be a good proxy for ADPKD.
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Affiliation(s)
- Christopher M Blanchette
- University of North Carolina, Charlotte, NC, USA
- Otsuka America Pharmaceutical, Inc., Princeton, NJ, USA
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Blanchette CM, Craver C, Belk KW, Lubeck DP, Rossetti S, Gutierrez B. Hospital-based inpatient resource utilization associated with autosomal dominant polycystic kidney disease in the US. J Med Econ 2015; 18:303-11. [PMID: 25372357 DOI: 10.3111/13696998.2014.985381] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Polycystic kidney disease (PKD) is a clinically and genetically heterogeneous class of genetic disorders characterized by development of renal cysts leading to renal failure and end stage renal disease (ESRD). Autosomal dominant polycystic kidney disease (ADPKD) accounts for the majority of PKD cases and is the predominant monogenic cause of ESRD. Limited information on patient characteristics and healthcare resource utilization is available in this population. This study assessed hospital-based inpatient utilization of patients with ADPKD in the US to help further understand the disease, which may lead to treatments that delay progression and reduce healthcare resource utilization. METHODS A cross-sectional analysis was conducted using MedAssets Health System Data to investigate inpatient resource utilization for a total of 1876 patients hospitalized with ADPKD or chronic kidney disease (CKD). Patient characteristics and inpatient resource utilization were compared between hospitalized patients with ADPKD and CKD, including demographic and clinical characteristics, overall health, rates of complications and surgical interventions, and average length of hospital and intensive care unit stay. RESULTS Compared with patients with CKD, patients with ADPKD were more likely to have commercial insurance as their primary payer (36.1 vs 17.8%) and were significantly younger (mean age 57.9 vs 69.5 years) and generally healthier (Charlson Comorbidity Score of 2.0 vs 3.3). Patients with ADPKD also had a substantially shorter average length of hospital stay (6.3 vs 10.3 days). However, patients with ADPKD experienced more kidney-related complications and a higher surgical procedure rate (mainly for transplant and complete nephrectomy). CONCLUSIONS Although patients with ADPKD were generally healthier than patients with CKD, specific kidney function complications were more frequent. Patients with ADPKD had a higher rate of major kidney procedures, which may contribute to the high burden of ADPKD-related hospital-based inpatient resource utilization.
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Kamat SA, Offord S, Docherty J, Lin J, Eramo A, Baker RA, Gutierrez B, Karson C. Reduction in inpatient resource utilization and costs associated with long-acting injectable antipsychotics across different age groups of Medicaid-insured schizophrenia patients. Drugs Context 2015; 4:212267. [PMID: 25834621 PMCID: PMC4376094 DOI: 10.7573/dic.212267] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/05/2015] [Accepted: 02/06/2015] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Evaluate utilization of inpatient healthcare resources and associated costs after 12 months of treatment using long-acting injectable (LAI) antipsychotic medications among a large sample of Medicaid-insured patients categorized by different age groups. METHOD Adult patients with schizophrenia were identified from the Thomson Reuters MarketScan Research database (1/1/2006-12/31/2010) before initiation of treatment using LAI antipsychotic agents. Utilization of inpatient healthcare resources and associated direct medical costs were compared for 12-month baseline and 12-month follow-up periods. RESULTS Among 3,094 Medicaid-insured patients with schizophrenia initiating treatment with LAIs, the mean number of all-cause hospitalizations and hospitalization days were reduced by 24% and 31% (p<0.0001) compared with baseline, respectively, with similar significant reductions among all age groups (18-30, 31-40, 41-50, and 51-60 years). During 12-month follow-up with LAIs, mean reductions in all-cause costs were $4,369 (18-30 years, p<0.0001), $3,681 (31-40 years, p<0.0001), $2,051 (41-50 years, p=0.1332), and $4,492 (51-60 years, p=0.0107). Subanalyses separating first-generation and second-generation medication groups resulted in mean reduction in all-cause costs of $3,561 and $3,645, respectively. CONCLUSIONS Results from this large cohort study provide naturalistic real-world evidence of the utility of LAIs in patients with schizophrenia and suggest that these agents may help to reduce the risk of relapse across all age groups (especially among younger patients). Given that relapse prevention is the ultimate goal of antipsychotic treatment, results from this large Medicaid patient population establish the value of LAIs for the management of schizophrenia.
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Affiliation(s)
| | - Steve Offord
- Otsuka America Pharmaceutical, Inc., Princeton, NJ, USA
| | - John Docherty
- Otsuka America Pharmaceutical, Inc., Princeton, NJ, USA
| | - Jay Lin
- Novosys Health, Flemington, NJ, USA
| | | | - Ross A Baker
- Otsuka Pharmaceutical Development and Commercialization, Inc., Princeton, NJ, USA
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Blanchette CM, Nunes AP, Lin ND, Mortimer KM, Noone J, Tangirala K, Johnston S, Gutierrez B. Adherence to risk evaluation and mitigation strategies (REMS) requirements for monthly testing of liver function. Drugs Context 2015; 4:dic-4-212272. [PMID: 25709706 PMCID: PMC4335780 DOI: 10.7573/dic.212272] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 12/29/2014] [Accepted: 12/08/2014] [Indexed: 12/13/2022] Open
Abstract
Background: Risk evaluation and mitigation strategies (REMS), as mandated by the US Food and Drug Administration (FDA) for medications with the potential for harm, are increasingly incorporating rigid protocols for patient evaluation, but little is known about compliance with these programs. Despite the inherent limitations, data on administrative claims may provide an opportunity to investigate adherence to these programs. Methods: We assessed adherence to liver function test (LFT) requirements included in the REMS program for bosentan through use of administrative claims. Patients observed in the Optum Research Database who were initiators of bosentan from November 20, 2001 to March 31, 2013 were included. Adherence to LFTs was calculated using pharmacy claims for bosentan dispensation and medical claims for laboratory services, and was assessed at the time of drug initiation and within specified time intervals throughout follow-up. Results: Of 742 patients, 523 (70.5%) had ≥1 qualifying LFT. Among patients with ≥12 dispensations, claims for LFTs at individual dispensations were 53.2–64.0%. Median proportion of dispensations with ≥1 LFT was 0.8 among patients with ≥6 (interquartile range, 0.7–1.0) or ≥12 (0.7–0.9) dispensations. Adherence was 90–100% for 33.3% of all initiators, whereas 29.3% of initiators were non-adherent (defined as <50% of on-therapy LFTs). Conclusions: Analyses of administrative claims suggest that the REMS program for bosentan may not have adequately guaranteed adherence to the program’s monthly monitoring of LFTs. Such investigations of existing REMS programs may provide insight on how to accomplish more successful evaluation of REMS.
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Affiliation(s)
| | | | | | | | - Joshua Noone
- University of North Carolina, Charlotte, NC, USA
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Brunelli SM, Blanchette CM, Claxton AJ, Roy D, Rossetti S, Gutierrez B. End-stage renal disease in autosomal dominant polycystic kidney disease: a comparison of dialysis-related utilization and costs with other chronic kidney diseases. Clinicoecon Outcomes Res 2015; 7:65-72. [PMID: 25609987 PMCID: PMC4293218 DOI: 10.2147/ceor.s76269] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is the leading inheritable cause of end-stage renal disease (ESRD) and one of the leading causes of ESRD overall. ADPKD patients differ from the overall dialysis population; however, there is little published data regarding health care costs for ADPKD patients on dialysis. METHODS This retrospective observational cohort study was designed to quantify health care utilization and costs for ADPKD patients with ESRD who received initial services at a single large dialysis organization between January 1, 2007 and December 31, 2009. Parallel results and baseline patient characteristics for control patients with ESRD etiologies other than ADPKD were performed for reference. Dialysis-related utilization and health care costs for patients with ADPKD in ESRD overall and during time horizons that correspond to Medicare-eligibility benchmarks were analyzed. Baseline patient characteristics were described for all patients and included demographics, comorbid illnesses, and clinical characteristics. Dialysis-related utilization, hospitalization rates, and health care costs were considered longitudinally. RESULTS Total health care costs for ADPKD patients were high at US$51,048 per patient-year based on the overall analysis. Total health care costs were lower for ADPKD patients than for control patients on dialysis. Patients with ADPKD were generally younger, had a lower Charlson Comorbidity Index, and had lower rates of comorbid conditions, which may have contributed to the lower overall costs seen for patients with ADPKD. CONCLUSION Health care resource utilization and costs for patients with ADPKD in ESRD requiring dialysis were high, and therapeutic interventions that can prevent or delay the progression to ESRD may increase dialysis-free life for patients with ADPKD.
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Affiliation(s)
| | - Christopher M Blanchette
- University of North Carolina, Charlotte, NC, USA ; Otsuka America Pharmaceutical, Inc., Princeton, NJ, USA
| | | | - Debosree Roy
- University of North Carolina, Charlotte, NC, USA
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Davis KL, Gutierrez B, Zyczynski T, Kaye JA. Real-World Treatment Patterns in Men with Castration- Resistant Prostate Cancer Receiving Docetaxel. J Health Econ Outcomes Res 2015; 2:119-130. [PMID: 37663582 PMCID: PMC10471399 DOI: 10.36469/9894] [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] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Background: Docetaxel has been a standard of care for castration-resistant prostate cancer (CRPC) in the United States since 2004, yet little has been reported on its patterns of use in routine practice. To help understand these patterns, a retrospective study was conducted and is reported here. Methods: Medical records from 394 patients treated in the United States were reviewed. Data were collected by 48 physicians from oncology (patient N=344) and 8 physicians from urology (patient N=50) practices. Inclusion criteria were: CRPC diagnosed between 2004 and 2010; received docetaxel; discontinued docetaxel due to rising prostate-specific antigen (PSA), progression of bone lesions, or progression of nodal or visceral metastases. Data were collected from physicians using an internet-based case report form. We evaluated patient demographics, characteristics of the docetaxel regimen, and other treatments used until docetaxel discontinuation. Results: Patients had a mean [±SD] age of 66.5 [8.9] years, the majority (63%) were white, and geographic dispersion was similar to the US population. The majority of patients initiated docetaxel between 2008 and 2010. After CRPC diagnosis, 8% of patients had initiated another cancer-directed therapy before starting docetaxel. Most (78.9%) patients initiated docetaxel with prednisone, while 18.5% initiated docetaxel alone and 2.6% initiated with other medications. Half of patients initiated docetaxel within 1 month after CRPC diagnosis, while 25% started ≥6 months later. Other non-chemotherapy treatments used with docetaxel were hormonal therapy (22.8%), radiotherapy (17.3%), and surgery (4.1%). Most patients (75%) received ≥4 docetaxel cycles, half received ≥6 cycles, 25% received ≥8 cycles and 10% received ≥10 cycles. Increased tumor mass, with/without new bone lesions or rising PSA, was the most common reason for docetaxel discontinuation (74% of patients). Conclusions: Concordant with guidelines, docetaxel and prednisone was the preferred first-line chemotherapy regimen in CRPC patients reviewed for this study. However, one quarter of patients did not initiate docetaxel until ≥6 months after CRPC diagnosis and total exposure varied considerably, with only 10% receiving ≥10 cycles. Future studies are needed to describe specific reasons explaining timing of docetaxel initiation and duration of exposure in some CRPC patients.
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Affiliation(s)
- Keith L Davis
- RTI Health Solutions, Research Triangle Park, NC, USA
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Broder MS, Gutierrez B, Cherepanov D, Linhares Y. Burden of skeletal-related events in prostate cancer: unmet need in pain improvement. Support Care Cancer 2014; 23:237-47. [PMID: 25270847 DOI: 10.1007/s00520-014-2437-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 09/09/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Up to 75% of patients with prostate cancer experience metastatic bone disease, which leads to an increased risk for skeletal-related events (SREs) including pathological bone fracture, spinal cord compression, and hypercalcemia of malignancy. Our objective was to systematically review the literature on the impact of SREs on quality of life (QOL), morbidity, and survival with a primary focus on the impact of SREs on pain in prostate cancer patients. METHODS We searched PubMed, limiting to peer-reviewed English-language human studies published in 2000-2010. The search was based on the US Food and Drug Administration and European Medicines Agency definition of an SRE, which includes pathologic fracture, spinal cord compression (SCC), hypercalcemia of malignancy, and radiotherapy or surgery to bone resulting from severe bone pain. RESULTS A total of 209 articles were screened, of which 173 were excluded, and 36 were included in this review. Patients with SREs had more pain and worse survival compared with no SREs. Pathologic bone fractures worsened QOL and were associated with shorter survival. Radiation therapy of SCC alleviated pain and improved morbidity. SCC was associated with decreases in patient survival. Radiation therapy and surgery to bone improved pain. CONCLUSIONS Specific SREs are associated with worse outcomes, including increased pain, poorer QOL, morbidity, and survival. Treatment of SREs is associated with improved pain, although there remains a need for more effective treatment of SREs in prostate cancer patients.
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Affiliation(s)
- M S Broder
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Dr., Suite 404, Beverly Hills, CA, 90212, USA
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Citrome L, Kamat SA, Sapin C, Baker RA, Eramo A, Ortendahl J, Gutierrez B, Hansen K, Bentley TGK. Cost-effectiveness of aripiprazole once-monthly compared with paliperidone palmitate once-monthly injectable for the treatment of schizophrenia in the United States. J Med Econ 2014; 17:567-76. [PMID: 24758296 DOI: 10.3111/13696998.2014.917089] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To develop a decision-analytic model to estimate the cost-effectiveness of initiating maintenance treatment with aripiprazole once-monthly (AOM) vs paliperidone long-acting injectable (PLAI) once-monthly among patients with schizophrenia in the US. METHODS A decision-analytic model was developed to evaluate a hypothetical cohort of patients initiating maintenance treatment with AOM or PLAI. Rates of relapse, adverse events (AEs), and direct medical costs were estimated for 1 year. Patients either remained on initial treatment or discontinued treatment due to lack of efficacy, AEs, or other reasons, including non-adherence. Data from placebo-controlled pivotal trials and product prescribing information (PI) were used to estimate treatment efficacy and AEs. Analyses were performed assuming dosing of clinical trials, real-world practice, PIs, and highest therapeutic dose available, because of variation in practice settings. The main outcome of interest was incremental cost per schizophrenia hospitalization averted with AOM vs PLAI. RESULTS Based on placebo-controlled pivotal trials' dosing, AOM improved clinical outcomes by reducing schizophrenia relapses vs PLAI (0.181 vs 0.277 per person per year [pppy]) at an additional cost of US$1276 pppy, resulting in an incremental cost-effectiveness ratio (ICER) of US$13,280/relapse averted. When PI dosing was assumed, this ICER increased to US$19,968/relapse averted. When real-world dosing and highest available dosing were assumed, AOM was associated with fewer relapses and lower overall treatment costs vs PLAI. CONCLUSIONS AOM consistently provided favorable clinical benefits. Under various dosing scenarios, AOM results indicated fewer relapses at lower overall costs or a reasonable cost-effectiveness threshold (i.e., less than the cost of a hospitalization relapse) vs PLAI. Given the heterogeneous nature of schizophrenia and variability in treatment response, health plans may consider open access for treatments like AOM. Since model inputs were based on data from separate placebo-controlled trials, generalization of results to the real-world setting is limited.
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Affiliation(s)
- Leslie Citrome
- Department of Psychiatry & Behavioral Sciences, New York Medical College , Valhalla, NY , USA
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Blanchette CM, Iorga ŞR, Altan A, Seare JG, Fan Y, Rossetti S, Gutierrez B. Healthcare Resource Utilization and Costs Associated with Autosomal Dominant Polycystic Kidney Disease. J Health Econ Outcomes Res 2014; 2:63-74. [PMID: 37664083 PMCID: PMC10471403 DOI: 10.36469/9889] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Background: Autosomal dominant polycystic kidney disease (ADPKD), a hereditary nephropathy, eventually leads to end-stage renal disease (ESRD), typically by mid-life. Objectives: The objective of this study was to assess real-world healthcare resource utilization and cost among commercially insured (COM) and Medicare Advantage (MAPD) ADPKD patients in addition to the cost profile by chronic kidney disease (CKD) stage. Methods: Patients diagnosed with ADPKD (two or more claims) with ≥30 days of continuous medical and pharmacy benefits and no evidence of autosomal recessive polycystic kidney disease were selected (Optum Research Database and Impact National Benchmarking Database: 1/1/06-8/31/12). Plan and patient paid healthcare costs and resource utilization per patient per month (PPPM) were described in total and by insurance type. CKD stage was established based on serum creatinine laboratory values or dialysis-related codes. Adjusted, CKD stage-specific costs were predicted for 4 years using regression models. Results: Of the 36,253,096 patients in the databases (1/1/06-8/31/12), 5,051 had evidence of ADPKD. Following exclusion criteria, 4,356 COM and 468 MAPD ADPKD patients remained. Total healthcare resource utilization and costs were high, and costs increased substantially from CKD stage 1-5. PPPM healthcare costs were 37% for ADPKD management and 52% for dialysis services. Predicted 4-year healthcare costs by CKD stage were $40,164 (stage 1), $33,397 (stage 2), $42,686 (stage 3), $148,402 (stage 4), and $207,548 (stage 5). Conclusions: Healthcare resource utilization and costs associated with ADPKD were substantial, irrespective of payer type, and primarily driven by CKD stage. Of the total healthcare costs, 88% were ADPKD- and dialysis-related. Most impactful was the spike in predicted cost when patients progressed from CKD stage 3 to stage 4 (by 348%) after multivariate adjustment. These stage 4-associated costs are primarily due to ultimate progression into stage 5 and ESRD within the 4-year time frame.
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Affiliation(s)
- Christopher M Blanchette
- Otsuka America Pharmaceutical, Inc., Princeton, NJ, USA; University of North Carolina, Charlotte, NC, USA
| | | | | | | | - Ying Fan
- OptumInsight, Eden Prairie, MN, USA
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Abstract
PURPOSE Variance estimates for detector energy resolution metrics can be used as stopping criteria in Monte Carlo simulations for the purpose of ensuring a small uncertainty of those metrics and for the design of variance reduction techniques. METHODS The authors derive an estimate for the variance of two energy resolution metrics, the Swank factor and the Fano factor, in terms of statistical moments that can be accumulated without significant computational overhead. The authors examine the accuracy of these two estimators and demonstrate how the estimates of the coefficient of variation of the Swank and Fano factors behave with data from a Monte Carlo simulation of an indirect x-ray imaging detector. RESULTS The authors' analyses suggest that the accuracy of their variance estimators is appropriate for estimating the actual variances of the Swank and Fano factors for a variety of distributions of detector outputs. CONCLUSIONS The variance estimators derived in this work provide a computationally convenient way to estimate the error or coefficient of variation of the Swank and Fano factors during Monte Carlo simulations of radiation imaging systems.
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Affiliation(s)
| | - Aldo Badano
- US Food and Drug Administration, Silver Spring, Maryland 20993
| | - Frank Samuelson
- US Food and Drug Administration, Silver Spring, Maryland 20993
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Ulcickas Yood M, Zyczynski TM, Wells K, Casso D, Gutierrez B, Woodcroft KJ, Cheng S. Incidence of skeletal-related events (SREs) among prostate cancer patients. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e16035] [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
e16035 Background: Skeletal related events (SREs) occur in men with prostate cancer and may result from both bone metastases and exposure to androgen deprivation therapy (ADT). The objective of this study was to quantify the incidence of SREs in patients with prostate cancer treated with ADT or orchiectomy in clinical practice. Methods: Prostate cancer patients served by Henry Ford Health System (HFHS) were identified via the HFHS tumor registry. Eligible patients were newly diagnosed with prostate cancer between 2004 and 2010 and treated with ADT or orchiectomy. Comprehensive population-based data were compiled using tumor registry with linkages to pharmacy, laboratory results, and healthcare encounter databases. SREs included spinal cord compression, surgery to bone, pathologic fracture and radiation to bone. Disease progression and metastases were identified by medical record review. Results: We identified 702 patients with prostate cancer and receipt of ADT or orchiectomy; 57.6% were >70 years of age and 43.7% were African American. 56.3% of patients were initially diagnosed at AJCC stage II, 9.8% at stage III, 22.1% at stage IV, and 11.8% had missing or unknown stage. A total of 93 patients (13.2%) had one or more SREs: radiation to bone (8.5%) and spinal cord compression (3.1%) were the most common SREs. We then limited the cohort to patients initially diagnosed with or progressing to AJCC stage IV prostate cancer (N=207). Among this group, 47.8% were >70 years of age. The mean time from stage IV diagnosis to end of follow-up was 35.6 months. In this subgroup, 16.4% of patients were initially diagnosed at AJCC stage II, 8.2% at stage III, 69.6% at stage IV, and 5.8% had missing or unknown stage. 57 patients (27.5%) had one or more SREs. Conclusions: Some clinical trials have found 36-41% of high-risk metastatic prostate cancer patients developed SREs during 3 years of follow-up. In this population-based cohort of patients with prostate cancer receiving ADT or orchiectomy and treated in real-world clinical practice, we found the incidence of SREs to be lower than what has been reported in clinical trials. Additional analyses exploring the incidence of SREs in patients diagnosed with metastatic castrate resistant prostate cancer will be presented.
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Affiliation(s)
| | | | - Karen Wells
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI
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Abstract
e15165 Background: Docetaxel has been a standard of care for castration-resistant prostate cancer (CRPC) in the US since 2004 (TAX 327), yet little has been reported on its patterns of use in routine practice. To help understand these patterns, a retrospective study was conducted and is reported here. Methods: Medical records from 394 patients treated in the US were reviewed: 48 from oncology (N=344) and 8 from urology (N=50) practices. Inclusion criteria were: CRPC diagnosed between 2004 and 2010; received docetaxel; discontinued docetaxel due to rising PSA, progression of bone lesions, or progression of nodal or visceral metastases. Data were collected from physicians using an internet-based case report form. We evaluated patient demographics, characteristics of the docetaxel regimen and other treatments used until docetaxel discontinuation. Results: Patients had a mean [±SD] age of 66.5 [8.9] years, the majority (63%) were white, and geographic dispersion was similar to the US population. The majority of patients initiated docetaxel between 2008 and 2010. After CRPC diagnosis, 8% of patients initiated another cancer-directed therapy before starting docetaxel. Most (78.9%) patients initiated docetaxel with prednisone, while 18.5% initiated docetaxel alone and 2.6% initiated with other drugs. Half of patients initiated docetaxel within 1 month after CRPC diagnosis, while 25% started ≥6 months later. Other non-chemotherapy treatments used with docetaxel were hormonal therapy (22.8%), radiotherapy (17.3%), and surgery (4.1%). Most patients (75%) received ≥4 docetaxel cycles, half received ≥6 cycles, 25% received ≥8 cycles and 10% received ≥10 cycles. Increased tumor mass, with/without new bone lesions or rising PSA, was the most common reason for docetaxel discontinuation (74% of patients). Conclusions: Concordant with guidelines, docetaxel and prednisone was the preferred first-line chemotherapy regimen in CRPC patients. However, one quarter of patients did not initiate docetaxel until ≥6 months after CRPC diagnosis and total exposure varied considerably, with only 10% receiving ≥10 cycles. Future studies are needed to describe specific reasons for docetaxel delay and sub-maximal exposure in some CRPC patients.
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Silver HS, Blanchette CM, Kamble S, Petersen H, Letter MA, Meddis D, Gutierrez B. Relationship between short-acting β2-adrenergic agonist use and healthcare costs. Am J Manag Care 2011; 17:19-27. [PMID: 21348565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To assess whether increased short-acting β(2)-adrenergic agonist (SABA) claims are associated with asthma exacerbations and increased healthcare costs. STUDY DESIGN Cross-sectional study. METHODS Patients (N = 93,604) were health plan members aged 6-56 years with at least 2 years of enrollment between July 1, 2003, and June 30, 2007, an asthma diagnosis, and at least 1 asthma medication claim per study year. Two years of administrative claims were collected. SABA use was categorized as 0 (none), (1/2) to 2 (low), 2(1/2) to 6 (moderate), 6(1/2) to 12 (high), and more than 12 (excessive) canister equivalents per year. Multivariate analyses were adjusted for age, sex, geographic region, comorbidities, specialist consultation, controller medication use, and asthma severity. RESULTS Half of high and excessive SABA users had few or no controller claims. Compared with SABA nonusers, high and excessive SABA users had significantly higher odds (odds ratio [95% confidence interval]) of asthma-related emergency department/urgent care visits (6.47 [5.25, 7.98] and 7.68 [6.04, 9.76], respectively), hospitalizations (5.37 [6.04, 9.76]; 6.90 [4.90, 9.73]), and oral corticosteroid use (2.89 [2.72, 3.08]; 3.71 [3.41, 4.03]). Excessive SABA users had 3.0 times ($1791) and high SABA users had 2.2 times ($1326) higher asthma-related healthcare costs than low SABA users ($595). Total costs also increased with higher SABA use, but with smaller incremental differences between excessive and high SABA users and low SABA users. CONCLUSIONS Increased SABA use is associated with higher total and asthma-related healthcare costs. Opportunity exists to lessen overreliance on SABAs.
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Affiliation(s)
- Harris S Silver
- Division of Clinical and Outcomes Research, Lovelace Respiratory Research Institute, Kannapolis, NC 28081, USA
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Silver HS, Blanchette CM, Kamble S, Petersen H, Letter M, Meddis D, Gutierrez B. Quarterly assessment of short-acting beta(2)-adrenergic agonist use as a predictor of subsequent health care use for asthmatic patients in the United States. J Asthma 2010; 47:660-6. [PMID: 20615167 DOI: 10.3109/02770901003702824] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE An annual time frame for risk assessment may not account for the variable course of asthma. The purpose of this study was to determine whether excessive short-acting beta(2)-adrenergic agonist (SABA) dispensed quarterly was associated with asthma exacerbations in the subsequent quarter. PATIENTS AND METHODS This retrospective cohort analysis included 93,604 health plan members aged 6-56 years with >or=2 years of continuous enrollment (2003-2007), an asthma diagnosis, and asthma prescription claims. The amount of SABA dispensed in claims (metered-dose inhaler and nebulized) was converted to canister equivalents (CEs) in the first observation quarter and categorized as 0, 0.5-3, and >or=3 (excessive SABA use). Asthma exacerbation risk (hospitalization, emergency department [ED] visit, or oral corticosteroid [OCS] claim in the subsequent quarter) was assessed using logistic regression. Covariates used in the regression models were age, sex, geographic region, comorbidities, specialist consultation, asthma controller medication use, and asthma severity. RESULTS The cohort included 33,951 patients aged 6-17 years (36%) and 59,653 aged 18-56 years (64%); 64% had 0 SABA CE, and 5% had >3 SABA CEs. Compared with 0 CE, excessive SABA use (>3 CEs) was associated with an increased likelihood of hospitalization (adjusted odds ratio [OR]: 3.15, 95% confidence interval [CI]: 1.89-5.27) and an ED/urgent care (UC) visit (adjusted OR: 3.14, 95% CI: 2.32-4.28). CONCLUSION The risk of an asthma exacerbation was associated with excessive SABA use in the previous quarter. Assessment of excessive SABA dispensed during a calendar quarter can be used to identify patients at increased exacerbation risk in the subsequent quarter.
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Affiliation(s)
- Harris S Silver
- Division of Clinical and Outcomes Research, Lovelace Respiratory Research Institute, Albuquerque, New Mexico, USA
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O'Connor RD, Bleecker ER, Long A, Tashkin D, Peters S, Klingman D, Gutierrez B. Subacute lack of asthma control and acute asthma exacerbation history as predictors of subsequent acute asthma exacerbations: evidence from managed care data. J Asthma 2010; 47:422-8. [PMID: 20528597 DOI: 10.3109/02770901003605332] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Monitoring indicators of subacute lack of asthma control (SALAC) may help to reduce asthma morbidity. OBJECTIVE To determine whether SALAC, independent of current asthma exacerbations, is associated with subsequent acute asthma exacerbations. METHODS Administrative claims data from PharMetrics/IMS Health were used to identify patients 12 years or older continuously enrolled in a participating U.S. health plan from 2001 to 2004 with >or=1 asthma claim (International Classification of Diseases, Ninth Revision, Clinical Modification code 493.x), no chronic obstructive pulmonary disease or cystic fibrosis claims, and >or=1 prescription for an asthma medication during 2001-2004. SALAC was defined as more than 4 asthma-related physician visits (or >or=2/quarter) or more than 5 short-acting beta((2))-adrenergic agonist prescriptions during 2001. Effect of asthma control category (Exacerbation Only [EO], SALAC Only [SO], Both Exacerbation and SALAC [Both], Neither Exacerbation nor SALAC [Neither]) in 2001 on acute asthma exacerbations (hospitalization, emergency department visit, or short-term oral corticosteroid use) during 2002-2004 was assessed using logistic regression, adjusting for gender, age, health plan type, and region. RESULTS Of 11,779 patients, 8% were assigned to the EO group, 26% to SO, 12% to Both, and 54% to Neither in 2001. The incidence of exacerbations in 2002-2004 was higher for Both (61.8%) versus EO (55.0%) and for SO (37.3%) versus Neither (31.9%). The risk of exacerbation in 2002-2004 was increased significantly (p < .0001) for Both (3.394; 95% confidence interval [CI] = 3.009, 3.827), EO (2.503; 95% CI = 2.176, 2.879), and SO (1.277; 95% CI = 1.166, 1.399) versus Neither. CONCLUSION In this study, the risk of subsequent exacerbation was greatest in patients with both SALAC and acute asthma exacerbations, followed by those with exacerbations only and those with SALAC only. SO identified an additional 26% of asthma patients at increased risk for subsequent exacerbation. The results from this study demonstrate that SALAC indicators and a history of acute asthma exacerbations are independent predictors of future acute asthma exacerbations and highlight the important role of subacute asthma worsening in predicting and preventing future asthma exacerbations.
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Affiliation(s)
- Richard D O'Connor
- Department of Quality Management, Sharp Rees-Stealy Medical Group, San Diego, California, CA 92101, USA.
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Blanchette CM, Culler SD, Ershoff D, Gutierrez B. Association between previous health care use and initiation of inhaled corticosteroid and long-acting beta2-adrenergic agonist combination therapy among US patients with asthma. Clin Ther 2010; 31:2574-83. [PMID: 20110003 DOI: 10.1016/j.clinthera.2009.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Combination inhaled corticosteroid and long-acting beta(2)-adrenergic agonist (ICS/LABA) therapy is recommended for patients whose asthma is not adequately controlled by other maintenance therapies and for those with moderate to severe asthma. OBJECTIVES This study examined the appropriateness of initiation of ICS/LABA combination therapy based on health care use criteria and the proportions of US patients filling prescriptions for either of 2 available therapies. METHODS This retrospective cohort study analyzed data from commercially insured asthma patients aged 12 to 64 years who initiated combination therapy with fluticasone propionate/salmeterol (FSC) or budesonide/ formoterol fumarate dihydrate (BFC) from July 1, 2007, to June 30, 2008. Continuously enrolled patients who had not received ICS/LABA therapy during a 12-month preindex period were assigned to the BFC or FSC cohort based on their initial ICS/LABA prescription (index date). Appropriate initiation of ICS/LABA combination therapy was determined based on the risks for asthma exacerbation, high impairment, and previous controller medication use. Specifically, initiation of ICS/LABA therapy was considered appropriate if patients had claims during the preindex period for an ICS or leukotriene receptor antagonist, an asthma-related emergency department visit or hospitalization, >or=2 courses of oral corticosteroid, or >or=6 canisters of a rescue short-acting beta(2)-adrenergic agonist (SABA). Factors associated with appropriate initiation of ICS/LABA therapy were assessed by multivariate logistic regression. RESULTS Of 16,205 patients initiated on ICS/LABA therapy, 39.2% met >or=1 criterion for appropriate use-788 of 1417 patients (55.6%) in the BFC group and 5572 of 14,788 patients (37.7%) in the FSC group (P < 0.001). Significantly greater proportions of BFC than FSC users met the individual criteria for previous controller medication use (45.7% vs 26.1%, respectively) and high SABA use (9.7% vs 6.1%). BFC users had a significantly higher likelihood of meeting >or=1 appropriateness criterion compared with FSC users (odds ratio = 1.79; 95% CI, 1.60-2.00; P < 0.001). Also significantly associated with appropriate use were receipt of the initial ICS/LABA prescription from a pulmonologist or allergist rather than from a physician in family medicine/general practice (P < 0.001), residence in the West relative to the Northeast (P < 0.005), and presence of specific comorbidities (allergic rhinitis, sinusitis, gastroesophageal reflux disease, and acute respiratory infection; all, P < 0.001). CONCLUSIONS Just under 40% of patients met the criteria for appropriate initiation of ICS/LABA therapy, with significantly greater proportions of BFC than FSC users meeting the overall and individual criteria for appropriate use. Patients with appropriate initiation of ICS/LABA therapy were significantly more likely to be treated by pulmonologists and allergists than by family medicine/general practitioners.
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Affiliation(s)
- Christopher M Blanchette
- Division of Clinical and Outcomes Research, Lovelace Respiratory Research Institute, Kannapolis, North Carolina 287081, USA.
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Broder MS, Gutierrez B, Chang E, Meddis D, Schatz M. Ratio of controller to total asthma medications: determinants of the measure. Am J Manag Care 2010; 16:170-178. [PMID: 20225912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To investigate differences in demographics, physician specialty, and medication use between patients who achieve high versus low ratios of controller to total asthma medications. STUDY DESIGN Cohort analysis. METHODS We used a Health Insurance Portability and Accountability Act-compliant claims database to identify patients aged 5 to 56 years with persistent asthma during a premeasurement year and a measurement year. Based on values in the measurement year, the ratio of controller to total asthma medications ratio was defined using the following formula: (Units of Controllers) / (Units of Controllers + Relievers). Descriptive analysis and multivariate logistic regression models were used to examine patients with high and low ratios. RESULTS The final study group comprised 38,538 patients with persistent asthma; 28,496 (73.9%) had high ratios. Specialty of usual-care physician differed (P <.001), with more high-ratio patients than low-ratio patients having an allergist or pulmonologist. Patients who received combination inhaled corticosteroid-long-acting beta-agonist therapy (odds ratio [OR], 2.4) or leukotriene receptor antagonist therapy (OR, 3.5) were more likely to be in the high-ratio group compared with those dispensed a single inhaled corticosteroid. High-group and low-group assignment could be calculated by partial-year data: assignment based on 1 quarter of data was concordant with assignment based on full-year ratio in 91% of cases (Pearson product moment correlation coefficient, 0.864; kappa statistic, 0.761), and assignment based on 2 quarters of data was concordant with full-year results in 94% of cases (Pearson product moment correlation coefficient, 0.928; kappa statistic, 0.843). CONCLUSIONS A high ratio of controller to total asthma medications is associated with greater controller adherence and with more controller fills. The ratio can be calculated using 1 or 2 quarters of pharmacy claims data, at a time when intervention may reduce asthma-related exacerbations. Interventions that may improve the ratio include changing from single inhaled corticosteroid therapy and from asthma specialist care.
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Affiliation(s)
- Michael S Broder
- Partnership for Health Analytic Research, Beverly Hills, CA, USA
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Stephenson JJ, Quimbo RA, Gutierrez B. Subacute lack of asthma control as a predictor of subsequent acute asthma exacerbation in a managed care population. Am J Manag Care 2010; 16:108-114. [PMID: 20148615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate whether an assessment of subacute lack of asthma control (SALAC) predicts subsequent acute asthma exacerbation (AAE). STUDY DESIGN This retrospective administrative claims study used medical and pharmacy claims from the HealthCore Integrated Research Database to identify patients aged 6 to 64 years with asthma and having 3 years' continuous enrollment from January 1, 2003, through December 31, 2005. METHODS Study inclusion criteria were at least 2 outpatient visits or at least 1 hospitalization or emergency department (ED) visit with an asthma diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification code 493.xx) in at least 1 of 3 years (2003-2005). SALAC was defined as more than 4 asthma outpatient visits or more than 5 short-acting beta2-agonist (SABA) prescriptions per year, and AAE was defined as at least 1 hospitalization or ED visit with a primary asthma diagnosis or an oral corticosteroid burst prescription. Generalized estimating equations modeled the risk of subsequent-year AAE as a function of 2 sets of variables to determine the independent effect of prior-year SALAC and its components on subsequent-year AAE. The first set included age, sex, geographic region, prior year AAE, and prior-year SALAC. The second set included age, sex, geographic region, prior-year AAE, high prior-year SABA use, and frequent prior-year asthma outpatient visits. RESULTS Of 35,806 patients with asthma, 46.6% were male, and 35.8% were younger than 18 years. The mean annual prevalence of SALAC was 12.1%. Controlling for all other variables, the generalized estimating equation results indicate that prior-year SALAC is associated with a 60% increased risk of subsequent-year AAE (P <.001). Increased prior-year asthma outpatient visits and SABA use are associated with 34% and 85%, respectively, greater risks of subsequent-year AAE (P <.001 for both). CONCLUSION SALAC and its components can aid in predicting patients at risk for AAE.
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Leidy NK, Gutierrez B, Lampl K, Uryniak T, O'Brien CD. Can patients with asthma feel inhaler therapy working right away? Two clinical trials testing the effect of timing of assessment on patient perception. J Asthma 2010; 46:1006-12. [PMID: 19995138 DOI: 10.3109/02770900903301260] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Feeling a maintenance therapy work right away may provide positive reinforcement and may offer one way to improve adherence in patients with asthma. Precise measurement is required to accurately compare the presence of this effect across clinical trial treatment groups. METHODS Two randomized, controlled studies tested whether timing of assessment (daily vs weekly, study 1; and predose vs postdose, study 2) influenced patients' reports of whether they can feel a medication working right away (perception), and their satisfaction with this perception (satisfaction). These 2-week US-based multicenter double-blind, parallel-group studies included patients > or = 18 years of age with mild to moderate persistent asthma. In each, patients were randomized to one of two drugs with different onset profiles: budesonide/formoterol pressurized metered-dose inhaler (pMDI) 80/4.5 microg x 2 inhalations (160/9 microg) twice daily or budesonide pMDI 80 microg x 2 inhalations (160 microg) twice daily. Patients were further randomized to complete previously validated perception and satisfaction questions in a cross-over fashion, either daily and weekly (N = 123) or predose and postdose (N = 134). Patient surveys also assessed perceptions of the onset of effect of medication and their value of these perceptions. RESULTS No significant differences were observed in patients' reports of perception, either daily versus weekly or predose versus postdose. A statistically significant difference in satisfaction was found in study 1 only, favoring weekly recall (p < 0.05), with sensitivity analysis showing no difference by treatment group (p = 0.162). Across both studies, most patients (87%) who perceived their inhaler working right away (136 of 157 patients) identified positive airway sensations. Most patients reported that feeling their medication work right away is reassuring and would help them manage their asthma. CONCLUSION Assessment timing has no effect on patient response to the perception of feeling a medication working right away. Differences found in satisfaction levels reported with weekly versus daily recall were consistent across treatment groups, indicating that no bias was introduced in favor of either treatment group. Patients characterized the perception of feeling a maintenance therapy working right away as easier breathing and reported this perception as beneficial to patient self-care.
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Affiliation(s)
- Nancy Kline Leidy
- Center for Health Outcomes Research, United BioSource Corporation, Bethesda, Maryland 20814, USA.
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Chan RCF, Gutierrez B, Ichim TE, Lin F. Enhancement of DNA cancer vaccine efficacy by combination with anti-angiogenesis in regression of established subcutaneous B16 melanoma. Oncol Rep 2009; 22:1197-203. [PMID: 19787240 DOI: 10.3892/or_00000555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Immunotherapy of cancer offers great promise, however translation into human studies has yielded relatively poor results to date. The concept of combining cancer vaccination with angiogenesis inhibition is appealing, due to favorable safety profile of both approaches, as well as possible biological synergies. Here we studied the anti-tumor effects of combining plasmid DNA (pDNA) vaccination and anti-angiogenesis in B16F10 murine model. By using electroporation-mediated gene/pDNA delivery, the anti-tumor efficacy of vaccination with pDNAs encoding gp100, TRP2 and Ii-PADRE was facilitated by administration of soluble form of EphB4 fused with human serum albumin (sEphB4-HSA), or by co-delivery of pDNAs encoding Angiostatin and/or Endostatin. In an optimized administration protocol, melanoma vaccination together with intratumoral delivery of pDNAs encoding Angiostatin and Endostatin resulted in 57% tumor-free survival over 90 days after challenge. These data support the general concept that suppression of angiogenesis may allow for enhanced efficacy of anti-tumor immunity, suggesting the synergetic effects of therapeutic pDNA vaccination and angiogenesis inhibition in cancer therapy.
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Affiliation(s)
- Ray Chun-Fai Chan
- Department of Research and Development, Inovio Biomedical Corporation, San Diego, CA 92121-1318, USA
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Abstract
OBJECTIVE Study aims were to develop and assess the measurement properties of a four-part treatment satisfaction measure for patients with asthma. The Asthma Treatment Satisfaction Measure (ATSM) incorporates specific attributes representing patient expectations, treatment preferences, self-reported treatment outcomes, and overall treatment satisfaction. This paper describes patients' ability to detect change in their satisfaction with asthma therapies using the ATSM. METHODS Adult patients with chronic asthma requiring a change in their asthma controller medications were recruited from sites in the US and Canada. Interviews were conducted with 22 patients to elicit areas important to patients in asthma treatment for measurement of satisfaction, providing the basis for the four-part questionnaire that was then tested for clarity. An additional 105 patients participated in the validation study and completed the first two parts of the ATSM (expectations and importance of treatment) at their initial visit (baseline) prior to a change in treatment. Parts 3 and 4 (treatment outcomes and treatment satisfaction) were completed after 4 weeks on the new treatment. A daily diary was completed by patients at home between visits. During clinical visits, patients also completed the Asthma Specific Quality of Life Questionnaire Standardized version assessing HRQL (AQLQ(S)), the Asthma Control Questionnaire 6-item version (ACQ-6), a 9-item asthma symptom checklist, items assessing symptom severity, and a single item overall rating of satisfaction (numerical analog scale between 0 and 10). Derived total satisfaction scores were compared to scores produced by the single global treatment satisfaction item using score variation and distribution plots. RESULTS Qualitative results identified 11 key attributes of asthma treatment. Internal consistency for the expectations, outcomes, and satisfaction parts of the measures (11 items each) were 0.73, 0.82 and 0.95, respectively. ATSM scores were able to discriminate between control and lack of control measured by ACQ-6 scores (F = 30.09; p < 0.001); between improvement, no change, or worsening of symptoms using the 4-week diary (F = 7.05; p < 0.001); between mild, moderate and severe levels of self-reported severity of asthma (F = 2.07; p < 0.001); and levels of self-reported health status (F = 5.96; p < 0.001). Compared to the single overall satisfaction item, the ATSM satisfaction score demonstrated a broader and more normal distribution. Irrespective of the variety of treatment regimens being changed from and changed to in the normal care setting, 4 of the 11 attributes still detected statistically significant differences in (p < 0.05) levels of patient satisfaction related to their new asthma treatment regimen. CONCLUSION By augmenting a satisfaction rating with the constructs that help define satisfaction with treatment (expectation, importance and actual treatment experience), the ATSM scores demonstrated greater ability to detect changes in treatment and provide a potentially useful measurement system for pharmacologic evaluation. This study was conducted using a normal care setting to identify patients undergoing a change in treatment. Therefore, the main limitations were the inability to control for efficacy of treatment, and a relatively small sample. Several individual ATSM satisfaction scores were able to detect significant levels of patient satisfaction related to their treatment, while the global satisfaction scores were unable to detect any significant differences.
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Affiliation(s)
- Mona L Martin
- Health Research Associates, Inc., 6505 216th St. SW, Suite 105, Mountlake Terrace, WA 98043, USA.
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Ye X, Gutierrez B, Zarotsky V, Nelson M, Blanchette CM. Appropriate use of inhaled corticosteroid and long-acting beta(2)-adrenergic agonist combination therapy among asthma patients in a US commercially insured population. Curr Med Res Opin 2009; 25:2251-8. [PMID: 19622006 DOI: 10.1185/03007990903155915] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine health care utilization measures indicating which asthma patients are appropriate for inhaled corticosteroid and long-acting beta(2)-adrenergic agonist (ICS/LABA) therapy and determine whether two ICS/LABA therapies were initiated in accordance with guidelines. RESEARCH DESIGN AND METHODS A retrospective cohort study of commercially insured asthma patients aged > or =12 years that initiated fluticasone propionate/salmeterol (FSC) or budesonide/formoterol fumarate dihydrate (BFC) combination therapy in 2007 was conducted. Use was considered appropriate if patients met any of the following during a 1-year period before ICS/LABA initiation: ICS or leukotriene receptor antagonist (LTRA) use; an asthma-related emergency department (ED) visit or hospitalization; > or =2 oral corticosteroids (OCS) courses; or > or =6 short-acting beta(2)-adrenergic agonist (SABA) canisters. Multivariate logistic regression was used to assess factors associated with appropriate ICS/LABA use. Certain limitations inherent to the use of claims data for research apply to this study. RESULTS Of 24,231 patients who initiated ICS/LABA therapy, 993 received BFC and 23,238 received FSC. Among all patients, 37.6% met > or =1 criteria for appropriate use. However, compared with FSC users, BFC users had a significantly higher likelihood of meeting > or =1 of these criteria (odds ratio, 2.01; 95% CI, 1.76-2.30; p < 0.001), and a higher proportion of BFC than FSC patients met 4 of the 5 appropriate use criteria. In total, 58.4% of BFC patients versus 36.7% of FSC patients met > or =1 criteria for appropriate use. Other factors associated with appropriate use included age, region, Charlson comorbidity score, number of medications, and prescriber specialty. CONCLUSION Fewer than half of all patients fulfilled the specified criteria for being appropriate for ICS/LABA therapy. However, a significantly higher proportion of BFC than FSC users met the criteria for appropriate use of ICS/LABA therapy. These results may suggest a need for improved physician awareness of consensus guidelines for the initiation of ICS/LABA therapy.
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Affiliation(s)
- Xin Ye
- i3 Innovus, Eden Prairie, MN, USA
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