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Patel V, Levick B, Boult S, Gibbons DC, Drysdale M, Lloyd EJ, Singh M, Birch HJ. Characteristics and outcomes of COVID-19 patients presumed to be treated with sotrovimab in NHS hospitals in England. BMC Infect Dis 2024; 24:428. [PMID: 38649824 PMCID: PMC11036565 DOI: 10.1186/s12879-024-09311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The impact of the constantly evolving severe acute respiratory syndrome coronavirus 2 on the effectiveness of early coronavirus disease 2019 (COVID-19) treatments is unclear. Here, we report characteristics and acute clinical outcomes of patients with COVID-19 treated with a monoclonal antibody (mAb; presumed to be sotrovimab) across six distinct periods covering the emergence and predominance of Omicron subvariants (BA.1, BA.2, and BA.5) in England. METHODS Retrospective cohort study using data from the Hospital Episode Statistics database from January 1-July 31, 2022. Included patients received a mAb delivered by a National Health Service (NHS) hospital as a day-case, for which the primary diagnosis was COVID-19. Patients were presumed to have received sotrovimab based on NHS data showing that 99.98% of COVID-19-mAb-treated individuals received sotrovimab during the study period. COVID-19-attributable hospitalizations were reported overall and across six distinct periods of Omicron subvariant prevalence. Subgroup analyses were conducted in patients with severe renal disease and active cancer. RESULTS Among a total of 10,096 patients, 1.0% (n = 96) had a COVID-19-attributable hospitalization, 4.6% (n = 465) had a hospital visit due to any cause, and 0.3% (n = 27) died due to any cause during the acute period. COVID-19-attributable hospitalization rates were consistent among subgroups, and no significant differences were observed across periods of Omicron subvariant predominance. CONCLUSIONS Levels of COVID-19-attributable hospitalizations and deaths were low in mAb-treated patients and among subgroups. Similar hospitalization rates were observed whilst Omicron BA.1, BA.2, and BA.5 were predominant, despite reported reductions in in vitro neutralization activity of sotrovimab against BA.2 and BA.5.
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Affiliation(s)
- Vishal Patel
- GSK House, 980 Great West Road, TW8 9GS, Brentford, Middlesex, UK
| | | | | | - Daniel C Gibbons
- GSK House, 980 Great West Road, TW8 9GS, Brentford, Middlesex, UK
| | - Myriam Drysdale
- GSK House, 980 Great West Road, TW8 9GS, Brentford, Middlesex, UK.
| | - Emily J Lloyd
- GSK House, 980 Great West Road, TW8 9GS, Brentford, Middlesex, UK
| | - Moushmi Singh
- GSK House, 980 Great West Road, TW8 9GS, Brentford, Middlesex, UK
| | - Helen J Birch
- GSK House, 980 Great West Road, TW8 9GS, Brentford, Middlesex, UK
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Drysdale M, Galimov ER, Yarwood MJ, Patel V, Levick B, Gibbons DC, Watkins JD, Young S, Pierce BF, Lloyd EJ, Kerr W, Birch HJ, Kamalati T, Brett SJ. Comparative effectiveness of sotrovimab versus no treatment in non-hospitalised high-risk COVID-19 patients in north west London: a retrospective cohort study. BMJ Open Respir Res 2024; 11:e002238. [PMID: 38575338 PMCID: PMC11002339 DOI: 10.1136/bmjresp-2023-002238] [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: 12/06/2023] [Accepted: 03/14/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND We assessed the effectiveness of sotrovimab vs no early COVID-19 treatment in highest-risk COVID-19 patients during Omicron predominance. METHODS Retrospective cohort study using the Discover dataset in North West London. Included patients were non-hospitalised, aged ≥12 years and met ≥1 National Health Service highest-risk criterion for sotrovimab treatment. We used Cox proportional hazards models to compare HRs of 28-day COVID-19-related hospitalisation/death between highest-risk sotrovimab-treated and untreated patients. Age, renal disease and Omicron subvariant subgroup analyses were performed. RESULTS We included 599 sotrovimab-treated patients and 5191 untreated patients. Compared with untreated patients, the risk of COVID-19 hospitalisation/death (HR 0.50, 95% CI 0.24, 1.06; p=0.07) and the risk of COVID-19 hospitalisation (HR 0.43, 95% CI 0.18, 1.00; p=0.051) were both lower in the sotrovimab-treated group; however, statistical significance was not reached. In the ≥65 years and renal disease subgroups, sotrovimab was associated with a significantly reduced risk of COVID-19 hospitalisation, by 89% (HR 0.11, 95% CI 0.02, 0.82; p=0.03) and 82% (HR 0.18, 95% CI 0.05, 0.62; p=0.007), respectively. CONCLUSIONS Risk of COVID-19 hospitalisation in sotrovimab-treated patients aged ≥65 years and with renal disease was significantly lower compared with untreated patients. Overall, risk of hospitalisation was also lower for sotrovimab-treated patients, but statistical significance was not reached.
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Affiliation(s)
| | | | | | | | - Bethany Levick
- Evidence & Access, OPEN Health Communications LLP, London, UK
| | | | | | | | | | | | - William Kerr
- Global Medical Affairs, GSK, Brentford, Middlesex, UK
| | | | | | - Stephen J Brett
- Department of Surgery and Cancer, Imperial College London, London, UK
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Seesaghur A, Egger P, Warden J, Abbasi A, Levick B, Riaz M, McMahon P, Thompson M, Cheeseman S. Assessment of bone-targeting agents use in patients with bone metastasis from breast, lung or prostate cancer using structured and unstructured electronic health records from a regional UK-based hospital. BMJ Open 2023; 13:e069214. [PMID: 37156580 PMCID: PMC10410833 DOI: 10.1136/bmjopen-2022-069214] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/13/2023] [Indexed: 05/10/2023] Open
Abstract
UNLABELLED ObjectiveTo assess use of bone-targeting agents (BTA) in patients with confirmed bone metastases (BM) from breast cancer (BC), non-small cell lung cancer (NSCLC) or prostate cancer (PC). DESIGN Retrospective cohort study. SETTING Regional hospital-based oncology database of approximately 2 million patients in England. PARTICIPANTS Patients aged ≥18 years with a diagnosis of BC, NSCLC or PC as well as BM between 1 January 2007 and 31 December 2018, with follow-up to 30 June 2020 or death; BM diagnosis ascertained from recorded medical codes and unstructured data using natural language processing (NLP). MAIN OUTCOMES MEASURES Initiation or non-initiation of BTA following BM diagnosis, time from BM diagnosis to BTA initiation, time from first to last BTA, time from last BTA to death. RESULTS This study included 559 BC, 894 NSCLC and 1013 PC with BM; median age (Q1-Q3) was 65 (52-76), 69 (62-77) and 75 (62-77) years, respectively. NLP identified BM diagnosis from unstructured data for 92% patients with BC, 92% patients with NSCLC and 95% patients with PC. Among patients with BC, NSCLC and PC with BM, 47%, 87% and 88% did not receive a BTA, and 53%, 13% and 12% received at least one BTA, starting a median 65 (27-167), 60 (28-162) and 610 (295-980) days after BM, respectively. Median (Q1-Q3) duration of BTA treatment was 481 (188-816), 89 (49-195) and 115 (53-193) days for patients with BC, NSCLC and PC. For those with a death record, median time from last BTA to death was 54 (26-109) for BC, 38 (17-98) for NSCLC and 112 (44-218) days for PC. CONCLUSION In this study identifying BM diagnosis from both structured and unstructured data, a high proportion of patients did not receive a BTA. Unstructured data provide new insights on the real-world use of BTA.
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Affiliation(s)
- Anouchka Seesaghur
- Centre for Observational Research, Amgen Ltd Uxbridge, Uxbridge, Middlesex, UK
| | - Peter Egger
- Real World Studies, IQVIA Europe, London, UK
| | | | - Ali Abbasi
- Centre for Observational Research, Amgen Ltd Uxbridge, Uxbridge, Middlesex, UK
| | | | - Majid Riaz
- Real World Studies, IQVIA Europe, London, UK
| | | | | | - Sue Cheeseman
- REAL Oncology, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Cheeseman S, Levick B, Sopwith W, Fenton H, Nam EJ, Kim D, Lim S, Martin E, Frenel JS, Bocquet F, Kubelac P, Achimas-Cadariu P, Vlad C, Chevrier M, Rouzier R, Carton M, Savva-Bordalo J, Magalhães M, Borges M, Wolf A, Becker S, Niklas N, Guergova-Kuras M, Hall G. Ovarian Real-World International Consortium (ORWIC): A multicentre, real-world analysis of epithelial ovarian cancer treatment and outcomes. Front Oncol 2023; 13:1114435. [PMID: 36776297 PMCID: PMC9911857 DOI: 10.3389/fonc.2023.1114435] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Introduction Much drug development and published analysis for epithelial ovarian cancer (EOC) focuses on early-line treatment. Full sequences of treatment from diagnosis to death and the impact of later lines of therapy are rarely studied. We describe the establishment of an international network of cancer centers configured to compare real-world treatment pathways in UK, Portugal, Germany, South Korea, France and Romania (the Ovarian Real-World International Consortium; ORWIC). Methods 3344 patients diagnosed with EOC (2012-2018) were analysed using a common data model and hub and spoke programming approach applied to existing electronic medical records. Consistent definition of line of therapy between sites and an efficient approach to analysis within the limitations of local information governance was achieved. Results Median age of participants was 53-67 years old and 5-29% were ECOG >1. Between 62% and 84% of patients were diagnosed with late-stage disease (FIGO III-IV). Sites treating younger and fitter patients had higher rates of debulking surgery for those diagnosed at late stage than sites with older, more frail patients. At least 21% of patients treated with systemic anti-cancer therapy (SACT) had recurrent disease following second-line therapy (2L); up to 11 lines of SACT treatment were recorded for some patients. Platinum-based SACT was consistently used across sites at 1L, but choices at 2L varied, with hormone therapies commonly used in the UK and Portugal. The use (and type) of maintenance therapy following 1L also varied. Beyond 2L, there was little consensus between sites on treatment choice: trial compounds and unspecified combinations of other agents were common. Discussion Specific treatment sequences are reported up to 4L and the establishment of this network facilitates future analysis of comparative outcomes per line of treatment with the aim of optimizing available options for patients with recurrent EOC. In particular, this real-world network can be used to assess the growing use of PARP inhibitors. The real-world optimization of advanced line treatment will be especially important for patients not usually eligible for involvement with clinical trials. The resources to enable this analysis to be implemented elsewhere are supplied and the network will seek to grow in coverage of further sites.
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Affiliation(s)
- Sue Cheeseman
- Leeds Cancer Center, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Bethany Levick
- Leeds Cancer Center, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom,Oncology Evidence Network, IQVIA, London, United Kingdom
| | - Will Sopwith
- Leeds Cancer Center, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom,Oncology Evidence Network, IQVIA, London, United Kingdom
| | - Hayley Fenton
- Leeds Cancer Center, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom,Oncology Evidence Network, IQVIA, London, United Kingdom
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Institute of Women’s Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - DongKyu Kim
- Department of Family Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea,Real-World Evidence Team, ALYND, Yonsei University Health System, Seoul, Republic of Korea
| | - Subin Lim
- Real-World Evidence Team, ALYND, Yonsei University Health System, Seoul, Republic of Korea
| | - Elodie Martin
- Department of Biostatistics, Clinical Trial Sponsor Unit, Institut de Cancérologie de l’Ouest, Nantes-Angers, France
| | - Jean-Sébastien Frenel
- Oncology Department, Institut de Cancérologie de l’Ouest, Center for Research in Cancerology and Immunology, INSERM UMR 1232, Nantes University and Angers University, Nantes-Angers, France
| | - François Bocquet
- Data Factory and Analytics Department, Institut de Cancérologie de l’Ouest, Law and Social Change Laboratory, Faculty of Law and Political Sciences, CNRS UMR 6297, Nantes University, Nantes-Angers, France
| | - Paul Kubelac
- The Oncology Institute “Prof. Dr. Ion Chiricuta”, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Patriciu Achimas-Cadariu
- The Oncology Institute “Prof. Dr. Ion Chiricuta”, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Catalin Vlad
- The Oncology Institute “Prof. Dr. Ion Chiricuta”, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Marion Chevrier
- Department of Biostatistics, Institut Curie, Paris Sciences et Lettres (PSL) University, Paris, France
| | - Roman Rouzier
- Department of Breast and Gynecological Surgery, Institut Curie, Paris, France
| | - Matthieu Carton
- Department of Biostatistics, Institut Curie, Paris Sciences et Lettres (PSL) University, Paris, France
| | - Joana Savva-Bordalo
- Department of Medical Oncology, Portuguese Oncology Institute of Porto (IPO-Porto) Porto, Porto, Portugal
| | - Marta Magalhães
- Cancer Epidemiology Group-Research Center, IPO Porto, Comprehensive Cancer Center (Porto.CCC), RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Marina Borges
- Management, Outcomes Research and Economics in Healthcare Group-Research Center, IPO Porto, Comprehensive Cancer Center (Porto.CCC), RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Andrea Wolf
- Internal Medicine, Universitätsklinikum Frankfurt am Main, Frankfurt, Germany
| | - Sven Becker
- Internal Medicine, Universitätsklinikum Frankfurt am Main, Frankfurt, Germany
| | - Nicolas Niklas
- Internal Medicine, Universitätsklinikum Frankfurt am Main, Frankfurt, Germany,Oncology Evidence Network, IQVIA Commercial GmbH and Co. OHG, Frankfurt am Main, Frankfurt, Germany
| | | | - Geoff Hall
- Leeds Cancer Center, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom,*Correspondence: Geoff Hall,
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Snee M, Cheeseman S, Levick B, Hall G, Rohde G, Stratmann J, Wolf A, van Gils C, Griner R, Mahmood A, Niklas N, Divan H, Krishna A. 44P Real-world (RW) treatment patterns, patient characteristics and outcomes in advanced non-small cell lung cancer (aNSCLC) with PD1/L1 as first-line (1L) therapy in the UK and Germany. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Levick B, Cheeseman S, Nam EJ, Doh H, Lim S, Kim D, Bocquet F, Martin E, Kubelac P, Achimaș-Cadariu P, Calisto R, Magalhães M, Becker S, Wolf A, Niklas N, Guergova-Kuras M, Hall G. OEN: Multi-center, international, real-world evidence studies performed using health records without data pooling—The use of a common data model and shared analytical methods. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e13554] [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
e13554 Background: The value of real-world evidence derived from the care of patients managed outside the context of clinical trials is well recognised. However, the ability to link data from multiple centres, especially those from different countries, is complicated by complex legal and information governance differences. The Oncology Evidence Network is a collaboration of large hospital centres, with strong clinical informatics capabilities in six countries in Europe and Asia working with the support of an industrial partner to provide high quality, real world data reflecting routine clinical care. We have developed an efficient workflow based on a study-specific common data model (CDM) clinically validated at each site and analysed with a single analysis script, which embeds a set of data quality rules. Local implementation allows each centre to generate analytical outputs aligned across the different sites without the need for any patient level data to leave the participating site. This approach has been designed and tested in Epithelial Ovarian Cancer (EOC) patients. Methods: A CDM was agreed using expert advisors from each centre. Clinical alignment was achieved through iterative assessment of clinical vignettes, to ensure common definitions of clinical assessment, prognosis, and treatment algorithms in EOC patients. A data guide detailing variable level derivations and validation rules, general data coding principles, and conversions/codes from international coding systems was developed. The analysis scripts were implemented as a bespoke package (OpenOvary) in R. The package includes functions to validate the data against the CDM, and generate a standard output including tables, numerical summaries and Kaplan-Meier analysis of progression and overall survival. Results: 2,925 patient records from 6 centres across 6 countries were included in the study with 27 key data items curated by each centre. Treatment data is available detailing relevant surgical procedures and their outcomes, and regimens of SACT throughout patients’ care from diagnosis to death. Data completeness was generally high for key data items, with missing data ranging from 0-16% for FIGO stage at diagnosis and 0-14% for tumour morphology. The CDM and R script will be made publicly available for other centres to adopt and facilitate analysis of their local data. Conclusions: This collaboration has brought together a substantial body of data describing the care and outcomes for EOC patients. A CDM and flexible shared analysis approach enabled unified analysis and reporting whilst avoiding the transfer of patient level data and its pooling into a common database. The process of clinical and data alignment has generated a replicable model for rapid extension to other study centres to join the EOC study, or application to other disease areas.
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Affiliation(s)
- Bethany Levick
- Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Sue Cheeseman
- Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Eun Ji Nam
- Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Haewon Doh
- ALYND, Yonsei University Health System, Seoul, South Korea
| | - Subin Lim
- ALYND, Yonsei University Health System, Seoul, South Korea
| | - DongKyu Kim
- ALYND, Yonsei University Health System, Seoul, South Korea
| | | | | | - Paul Kubelac
- "Prof. Dr. Ion Chiricuţă" Institute of Oncology, Cluj-Napoca, Romania
| | | | - Rita Calisto
- Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Marta Magalhães
- Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | | | - Andrea Wolf
- Universitätsklinikum Frankfurt am Main, Frankfurt, Germany
| | - Nicolas Niklas
- IQVIA Commercial GmbH & Co. OHG, Frankfurt Am Main, Germany
| | | | - Geoff Hall
- Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
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Hall G, Cheeseman S, Levick B, Nam EJ, Lim S, Classe JM, Martin E, Kubelac P, Achimaș-Cadariu P, Savva-Bordalo J, Borges M, Becker S, Shaid S, Niklas N, Guergova-Kuras M. An international, multicenter, real-world analysis of epithelial ovarian cancer treatment and outcomes. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5531] [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
5531 Background: Few major studies have examined and compared the management and outcomes of patients from diagnosis to death between countries. We have established an international collaboration across Europe and South Korea to compare treatment and outcomes in Epithelial Ovarian Cancer (EOC). Methods: Patients diagnosed with EOC between January 2012 and December 2018 (age ≥18), were included for analysis. Data from medical records from five European and a single South Korean treatment centre were extracted, standardised to a common data model and analysed at each centre using a common script developed in R. Time to each progression/recurrence event (defined as time to next treatment) and overall survival have been estimated using Kaplan Meier methodology and outcomes stratified by categories of interest. Changes in the use of anti-cancer therapies over time and the incidence of BRCA mutations and incidence/timing of second breast cancers have also been examined. Results: A total cohort of 2925 patients was identified with a median age at each centre of 53 to 67 years. Advanced disease (FIGO stage III - IV) (range 57% to 84%) and high-grade serous morphology (38% to 70%) were most common at each centre. The timing of surgery (primary, interval debulking or delayed) and the proportion of patients undergoing surgery varied with stage. Patients with stage I disease where most likely to undergo surgery (range 73% to 100%) and stage IV the least (range 39% to 84%). Median overall survival for high grade serous cancers ranged from 1.9 to 4.9 years, and for the whole cohort from 2.1 to 5.5 years. Median time to next treatment at first relapse for the whole cohort ranged from 14 to 22 months. Second breast cancers were noted in 6 to 17% of patients and the majority of these occurred before the diagnosis of EOC at a median time of 96 to 118 months prior to diagnosis of EOC. Additional data on treatment pathways, BRCA status and outcomes by line of therapy for each centre will be presented. Conclusions: Preliminary analysis of results across this network suggests a variation in patient populations between sites and substantial differences in both treatments and outcomes. The establishment of a common data model and the use of a common analytic script between sites across six different countries allows for detailed exploration of the factors influencing differences in patient management and treatment outcomes in ovarian cancer patients.
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Affiliation(s)
- Geoff Hall
- Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Sue Cheeseman
- Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Bethany Levick
- Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Eun Ji Nam
- Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Subin Lim
- ALYND, Yonsei University Health System, Seoul, South Korea
| | | | | | - Paul Kubelac
- "Prof. Dr. Ion Chiricuţă" Institute of Oncology, Cluj-Napoca, Romania
| | | | | | - Marina Borges
- Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | | | | | - Nicolas Niklas
- IQVIA Commercial GmbH & Co. OHG, Frankfurt Am Main, Germany
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Douglas F, Morris E, Finan P, Taylor J, Birch R, Levick B. The Impact of Comorbidity On Post-Operative Outcomes Following Major Resection For Colorectal Cancer Within The English NHS. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2019.09.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Levick B, Laudisoit A, Tepage F, Ensoy-Musoro C, Mandro M, Bonareri Osoro C, Suykerbuyk P, Kashama JM, Komba M, Tagoto A, Falay D, Begon M, Colebunders R. High prevalence of epilepsy in onchocerciasis endemic regions in the Democratic Republic of the Congo. PLoS Negl Trop Dis 2017; 11:e0005732. [PMID: 28708828 PMCID: PMC5529017 DOI: 10.1371/journal.pntd.0005732] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/26/2017] [Accepted: 06/20/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An increased prevalence of epilepsy has been reported in many onchocerciasis endemic areas. The objective of this study was to determine the prevalence of epilepsy in onchocerciasis endemic areas in the Democratic Republic of the Congo (DRC) and investigate whether a higher annual intake of Ivermectin was associated with a lower prevalence of epilepsy. METHODOLOGY/PRINCIPLE FINDINGS Between July 2014 and February 2016, house-to-house epilepsy prevalence surveys were carried out in areas with a high level of onchocerciasis endemicity: 3 localities in the Bas-Uele, 24 in the Tshopo and 21 in the Ituri province. Ivermectin uptake was recorded for every household member. This database allowed a matched case-control pair subset to be created that enabled putative risk factors for epilepsy to be tested using univariate logistic regression models. Risk factors relating to onchocerciasis were tested using a multivariate random effects model. To identify presence of clusters of epilepsy cases, the Kulldorff's scan statistic was used. Of 12, 408 people examined in the different health areas 407 (3.3%) were found to have a history of epilepsy. A high prevalence of epilepsy was observed in health areas in the 3 provinces: 6.8-8.5% in Bas-Uele, 0.8-7.4% in Tshopo and 3.6-6.2% in Ituri. Median age of epilepsy onset was 9 years, and the modal age 12 years. The case control analysis demonstrated that before the appearance of epilepsy, compared to the same life period in controls, persons with epilepsy were around two times less likely (OR: 0.52; 95%CI: (0.28, 0.98)) to have taken Ivermectin than controls. After the appearance of epilepsy, there was no difference of Ivermectin intake between cases and controls. Only in Ituri, a significant cluster (p-value = 0.0001) was identified located around the Draju sample site area. CONCLUSIONS The prevalence of epilepsy in health areas in onchocerciasis endemic regions in the DRC was 2-10 times higher than in non-onchocerciasis endemic regions in Africa. Our data suggests that Ivermectin protects against epilepsy in an onchocerciasis endemic region. However, a prospective population based intervention study is needed to confirm this.
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Affiliation(s)
- Bethany Levick
- Institute of Integrative Biology, School of Biological Sciences, University of Liverpool, Liverpool, United-Kingdom
| | - Anne Laudisoit
- Institute of Integrative Biology, School of Biological Sciences, University of Liverpool, Liverpool, United-Kingdom
- CIFOR, Jalan Cifor, Situ Gede, Sindang Barang, Bogor Bar, Jawa Barat, Indonesia
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Floribert Tepage
- National Onchocerciasis Control Program (PNLO), Ministry of Health, Buta, Democratic Republic of the Congo
| | - Chellafe Ensoy-Musoro
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, University of Hasselt, Hasselt, Belgium
| | - Michel Mandro
- Ituri Provincial Health Division, Ministry of Health, Bunia, Democratic Republic of the Congo
| | - Caroline Bonareri Osoro
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, University of Hasselt, Hasselt, Belgium
- Nanyuki Teaching and Referral Hospital, Nanyuki, Kenya
| | | | - Jean Marie Kashama
- Neuropsychopathologic Centre of Mont Amba (CNPP), University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Michel Komba
- Biodiversity Monitoring Centre, Faculty of Sciences, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Alliance Tagoto
- National HIV program, Ministry of Health, Kisangani, Democratic Republic of the Congo
| | - Dadi Falay
- Department of Pediatrics, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Michael Begon
- Institute of Integrative Biology, School of Biological Sciences, University of Liverpool, Liverpool, United-Kingdom
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Levick B, South A, Hastings IM. A Two-Locus Model of the Evolution of Insecticide Resistance to Inform and Optimise Public Health Insecticide Deployment Strategies. PLoS Comput Biol 2017; 13:e1005327. [PMID: 28095406 PMCID: PMC5283767 DOI: 10.1371/journal.pcbi.1005327] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 07/27/2016] [Revised: 01/31/2017] [Accepted: 12/20/2016] [Indexed: 12/01/2022] Open
Abstract
We develop a flexible, two-locus model for the spread of insecticide resistance applicable to mosquito species that transmit human diseases such as malaria. The model allows differential exposure of males and females, allows them to encounter high or low concentrations of insecticide, and allows selection pressures and dominance values to differ depending on the concentration of insecticide encountered. We demonstrate its application by investigating the relative merits of sequential use of insecticides versus their deployment as a mixture to minimise the spread of resistance. We recover previously published results as subsets of this model and conduct a sensitivity analysis over an extensive parameter space to identify what circumstances favour mixtures over sequences. Both strategies lasted more than 500 mosquito generations (or about 40 years) in 24% of runs, while in those runs where resistance had spread to high levels by 500 generations, 56% favoured sequential use and 44% favoured mixtures. Mixtures are favoured when insecticide effectiveness (their ability to kill homozygous susceptible mosquitoes) is high and exposure (the proportion of mosquitoes that encounter the insecticide) is low. If insecticides do not reliably kill homozygous sensitive genotypes, it is likely that sequential deployment will be a more robust strategy. Resistance to an insecticide always spreads slower if that insecticide is used in a mixture although this may be insufficient to outperform sequential use: for example, a mixture may last 5 years while the two insecticides deployed individually may last 3 and 4 years giving an overall ‘lifespan’ of 7 years for sequential use. We emphasise that this paper is primarily about designing and implementing a flexible modelling strategy to investigate the spread of insecticide resistance in vector populations and demonstrate how our model can identify vector control strategies most likely to minimise the spread of insecticide resistance. Malaria results in hundreds of thousands of deaths annually. The two most effective malaria control interventions have been insecticide treated bed nets and indoor residual spraying of insecticides but their successes are now threatened by insecticide resistance in mosquitoes. Insecticide deployment strategies can be designed to try to minimise the spread of insecticide resistance. We develop a highly flexible model of the evolution of insecticide resistance which we use to assess the relative performance of two insecticide deployment strategies: two insecticides used in sequence (where one is replaced by the other once a resistance threshold is reached) or as a mixture (where they are applied together). The relative performance of the strategies depended on the input parameter values that are likely to depend on the insecticide properties and local malaria transmission patterns. In the parameter space we explored, mixtures were favoured when insecticide effectiveness (ability to kill wildtype susceptible mosquitoes) was high and exposure (the proportion of mosquitoes that encounter the insecticide) was low. If insecticides do not reliably kill susceptible mosquitoes, it is likely that sequential deployment will be better. This flexible model is designed to enable detailed exploration of deployment issues and their influence on the strategies most likely to minimise the evolution of insecticide resistance.
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Affiliation(s)
- Bethany Levick
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Andy South
- Independent consultant, Norwich, United Kingdom
| | - Ian M. Hastings
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
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Colebunders R, Tepage F, Rood E, Mandro M, Abatih EN, Musinya G, Mambandu G, Kabeya J, Komba M, Levick B, Mokili JL, Laudisoit A. Prevalence of River Epilepsy in the Orientale Province in the Democratic Republic of the Congo. PLoS Negl Trop Dis 2016; 10:e0004478. [PMID: 27139245 PMCID: PMC4854481 DOI: 10.1371/journal.pntd.0004478] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 10/01/2015] [Accepted: 01/30/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An increased prevalence of epilepsy has been reported in many onchocerciasis endemic areas. OBJECTIVE To determine the prevalence and distribution of epilepsy in an onchocerciasis endemic region in the Democratic Republic of the Congo (DRC). DESIGN/METHODS An epilepsy prevalence study was carried out in 2014, in two localities of the Bas-Uélé district, an onchocerciasis endemic region in the Orientale Province of the DRC. Risk factors for epilepsy were identified using a random effects logistic regression model and the distribution of epilepsy cases was investigated using the Moran's I statistic of spatial auto-correlation. RESULTS Among the 12,776 individuals of Dingila, 373 (2.9%) individuals with epilepsy were identified. In a house-to-house survey in Titule, 68 (2.3%) of the 2,908 people who participated in the survey were found to present episodes of epilepsy. Epilepsy showed a marked spatial pattern with clustering of cases occurring within and between adjacent households. Individual risk of epilepsy was found to be associated with living close to the nearest fast flowing river where blackflies (Diptera: Simuliidae)-the vector of Onchocerca volvulus-oviposit and breed. CONCLUSIONS The prevalence of epilepsy in villages in the Bas-Uélé district in the DRC was higher than in non-onchocerciasis endemic regions in Africa. Living close to a blackflies infested river was found to be a risk factor for epilepsy.
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Affiliation(s)
- Robert Colebunders
- Global Health Institute, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Floribert Tepage
- National Onchocerciasis Control Program, Kisangani, Democratic Republic of the Congo
| | - Ente Rood
- Royal Tropical Institute, Amsterdam, The Netherlands
| | - Michel Mandro
- Provincial Health Division Ituri, Bunia, Democratic Republic of the Congo
| | - Emmanuel Nji Abatih
- Department of Biomedical Science, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Germain Mambandu
- Provincial Ministry of Public Health, Kisangani, Democratic Republic of the Congo
| | - José Kabeya
- Provincial Ministry of Public Health, Kisangani, Democratic Republic of the Congo
| | - Michel Komba
- Biodiversity Monitoring Centre (CSB), Faculty of Sciences, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Bethany Levick
- Institute of Integrative Biology, School of Biological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - John L Mokili
- Biology Department, San Diego State University, San Diego, California, United States of America
| | - Anne Laudisoit
- Global Health Institute, University of Antwerp, Antwerp, Belgium
- Institute of Integrative Biology, School of Biological Sciences, University of Liverpool, Liverpool, United Kingdom
- Evolutionary Biology group, University of Antwerp, Antwerp, Belgium
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Levick B, Laudisoit A, Wilschut L, Addink E, Ageyev V, Yeszhanov A, Sapozhnikov V, Belayev A, Davydova T, Eagle S, Begon M. The Perfect Burrow, but for What? Identifying Local Habitat Conditions Promoting the Presence of the Host and Vector Species in the Kazakh Plague System. PLoS One 2015; 10:e0136962. [PMID: 26325073 PMCID: PMC4556633 DOI: 10.1371/journal.pone.0136962] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 12/29/2014] [Accepted: 08/10/2015] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The wildlife plague system in the Pre-Balkhash desert of Kazakhstan has been a subject of study for many years. Much progress has been made in generating a method of predicting outbreaks of the disease (infection by the gram negative bacterium Yersinia pestis) but existing methods are not yet accurate enough to inform public health planning. The present study aimed to identify characteristics of individual mammalian host (Rhombomys opimus) burrows related to and potentially predictive of the presence of R.opimus and the dominant flea vectors (Xenopsylla spp.). METHODS Over four seasons, burrow characteristics, their current occupancy status, and flea and tick burden of the occupants were recorded in the field. A second data set was generated of long term occupancy trends by recording the occupancy status of specific burrows over multiple occasions. Generalised linear mixed models were constructed to identify potential burrow properties predictive of either occupancy or flea burden. RESULTS At the burrow level, it was identified that a burrow being occupied by Rhombomys, and remaining occupied, were both related to the characteristics of the sediment in which the burrow was constructed. The flea burden of Rhombomys in a burrow was found to be related to the tick burden. Further larger scale properties were also identified as being related to both Rhombomys and flea presence, including latitudinal position and the season. CONCLUSIONS Therefore, in advancing our current predictions of plague in Kazakhstan, we must consider the landscape at this local level to increase our accuracy in predicting the dynamics of gerbil and flea populations. Furthermore this demonstrates that in other zoonotic systems, it may be useful to consider the distribution and location of suitable habitat for both host and vector species at this fine scale to accurately predict future epizootics.
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Affiliation(s)
- Bethany Levick
- Ecology, Evolution and Genomics of Infectious Disease Research Group, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Anne Laudisoit
- Ecology, Evolution and Genomics of Infectious Disease Research Group, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Liesbeth Wilschut
- Department of Physical Geography, Utrecht University, Utrecht, The Netherlands
| | - Elisabeth Addink
- Department of Physical Geography, Utrecht University, Utrecht, The Netherlands
| | - Vladimir Ageyev
- M.Akimbayev’s Kazakh Science Centre for Quarantine and Zoonotic Diseases, Almaty, Kazakhstan
| | - Aidyn Yeszhanov
- M.Akimbayev’s Kazakh Science Centre for Quarantine and Zoonotic Diseases, Almaty, Kazakhstan
| | - Valerij Sapozhnikov
- M.Akimbayev’s Kazakh Science Centre for Quarantine and Zoonotic Diseases, Almaty, Kazakhstan
| | - Alexander Belayev
- M.Akimbayev’s Kazakh Science Centre for Quarantine and Zoonotic Diseases, Almaty, Kazakhstan
- Taldykorgan anti-plague station, Taldykorgan, Kazakhstan
| | - Tania Davydova
- Taldykorgan anti-plague station, Taldykorgan, Kazakhstan
| | - Sally Eagle
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Mike Begon
- Ecology, Evolution and Genomics of Infectious Disease Research Group, Institute of Integrative Biology, University of Liverpool, Liverpool, United Kingdom
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