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Aguiar R, Bourmpaki E, Bunce C, Coker B, Delaney F, de Jongh L, Oliveira G, Weir A, Higgins F, Spiridou A, Hasan S, Smith J, Mulla A, Glampson B, Mercuri L, Montero R, Hernandez-Fuentes M, Roufosse CA, Simmonds N, Clatworthy M, McLean A, Ploeg R, Davies J, Várnai KA, Woods K, Lord G, Pruthi R, Breen C, Chowdhury P. Incidence, Risk Factors, and Effect on Allograft Survival of Glomerulonephritis Post-transplantation in a United Kingdom Population: Cohort Study. Front Nephrol 2022; 2:923813. [PMID: 37675026 PMCID: PMC10479671 DOI: 10.3389/fneph.2022.923813] [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] [Received: 04/19/2022] [Accepted: 06/17/2022] [Indexed: 09/08/2023]
Abstract
Background Post-transplant glomerulonephritis (PTGN) has been associated with inferior long-term allograft survival, and its incidence varies widely in the literature. Methods This is a cohort study of 7,623 patients transplanted between 2005 and 2016 at four major transplant UK centres. The diagnosis of glomerulonephritis (GN) in the allograft was extracted from histology reports aided by the use of text-mining software. The incidence of the four most common GN post-transplantation was calculated, and the risk factors for disease and allograft outcomes were analyzed. Results In total, 214 patients (2.8%) presented with PTGN. IgA nephropathy (IgAN), focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN), and membranoproliferative/mesangiocapillary GN (MPGN/MCGN) were the four most common forms of post-transplant GN. Living donation, HLA DR match, mixed race, and other ethnic minority groups were associated with an increased risk of developing a PTGN. Patients with PTGN showed a similar allograft survival to those without in the first 8 years of post-transplantation, but the results suggest that they do less well after that timepoint. IgAN was associated with the best allograft survival and FSGS with the worst allograft survival. Conclusions PTGN has an important impact on long-term allograft survival. Significant challenges can be encountered when attempting to analyze large-scale data involving unstructured or complex data points, and the use of computational analysis can assist.
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Affiliation(s)
- Rute Aguiar
- Department of Transplantation and Renal Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Elli Bourmpaki
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Catey Bunce
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Bola Coker
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Guy’s & St Thomas’ National Health Service (NHS) Foundation Trust and King’s College London, London, United Kingdom
| | - Florence Delaney
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Guy’s & St Thomas’ National Health Service (NHS) Foundation Trust and King’s College London, London, United Kingdom
| | - Leonardo de Jongh
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Guy’s & St Thomas’ National Health Service (NHS) Foundation Trust and King’s College London, London, United Kingdom
| | - Giovani Oliveira
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Guy’s & St Thomas’ National Health Service (NHS) Foundation Trust and King’s College London, London, United Kingdom
| | - Alistair Weir
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Guy’s & St Thomas’ National Health Service (NHS) Foundation Trust and King’s College London, London, United Kingdom
| | - Finola Higgins
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Guy’s & St Thomas’ National Health Service (NHS) Foundation Trust and King’s College London, London, United Kingdom
| | - Anastasia Spiridou
- Data Research, Innovation and Virtual Environments Unit (DRIVE), Great Ormond Street Hospital for Children National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Syed Hasan
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Guy’s & St Thomas’ National Health Service (NHS) Foundation Trust and King’s College London, London, United Kingdom
| | - Jonathan Smith
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Guy’s & St Thomas’ National Health Service (NHS) Foundation Trust and King’s College London, London, United Kingdom
| | - Abdulrahim Mulla
- National Institute for Health and Care Research (NIHR) Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare National Health Service (NHS) Trust, Hammersmith Hospital, London, United Kingdom
| | - Ben Glampson
- Research Informatics Team, Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Luca Mercuri
- National Institute for Health and Care Research (NIHR) Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare National Health Service (NHS) Trust, Hammersmith Hospital, London, United Kingdom
| | - Rosa Montero
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Guy’s & St Thomas’ National Health Service (NHS) Foundation Trust and King’s College London, London, United Kingdom
| | | | - Candice A. Roufosse
- Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
| | - Naomi Simmonds
- Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
| | - Menna Clatworthy
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Adam McLean
- Renal Section, Department of Medicine, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
| | - Rutger Ploeg
- Nuffield Department of Surgical Sciences, Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Jim Davies
- National Institute for Health and Care Research (NIHR) Oxford Biomedical Research Centre, Big Data Institute, University of Oxford, Oxford, Oxfordshire, United Kingdom
- Department of Computer Science, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Kinga Anna Várnai
- National Institute for Health and Care Research (NIHR) Oxford Biomedical Research Centre, Big Data Institute, University of Oxford, Oxford, Oxfordshire, United Kingdom
- Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, Oxfordshire, United Kingdom
| | - Kerrie Woods
- National Institute for Health and Care Research (NIHR) Oxford Biomedical Research Centre, Big Data Institute, University of Oxford, Oxford, Oxfordshire, United Kingdom
- Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, Oxfordshire, United Kingdom
| | - Graham Lord
- Faculty of Biology Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Rishi Pruthi
- Department of Transplantation and Renal Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Cormac Breen
- Department of Transplantation and Renal Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Paramit Chowdhury
- Department of Transplantation and Renal Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
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2
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Mahil S, Yates M, Langan S, Yiu Z, Tsakok T, Dand N, Mason K, McAteer H, Meynell F, Coker B, Vincent A, Urmston D, Vesty A, Kelly J, Lancelot C, Moorhead L, Bachelez H, Bruce I, Capon F, Contreras C, Cope A, De La Cruz C, Di Meglio P, Gisondi P, Hyrich K, Jullien D, Lambert J, Marzo‐Ortega H, McInnes I, Naldi L, Norton S, Puig L, Sengupta R, Spuls P, Torres T, Warren R, Waweru H, Weinman J, Griffiths C, Barker J, Brown M, Galloway J, Smith C. Risk-mitigating behaviours in people with inflammatory skin and joint disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey. Br J Dermatol 2021; 185:80-90. [PMID: 33368145 PMCID: PMC9214088 DOI: 10.1111/bjd.19755] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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] [Accepted: 12/19/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse coronavirus disease 2019 (COVID-19) outcomes compared with patients receiving no systemic treatments. OBJECTIVES We used international patient survey data to explore the hypothesis that greater risk-mitigating behaviour in those receiving targeted therapies may account, at least in part, for this observation. METHODS Online surveys were completed by individuals with psoriasis (globally) or rheumatic and musculoskeletal diseases (RMDs) (UK only) between 4 May and 7 September 2020. We used multiple logistic regression to assess the association between treatment type and risk-mitigating behaviour, adjusting for clinical and demographic characteristics. We characterized international variation in a mixed-effects model. RESULTS Of 3720 participants (2869 psoriasis, 851 RMDs) from 74 countries, 2262 (60·8%) reported the most stringent risk-mitigating behaviour (classified here under the umbrella term 'shielding'). A greater proportion of those receiving targeted therapies (biologics and Janus Kinase inhibitors) reported shielding compared with those receiving no systemic therapy [adjusted odds ratio (OR) 1·63, 95% confidence interval (CI) 1·35-1·97]. The association between targeted therapy and shielding was preserved when standard systemic therapy was used as the reference group (OR 1·39, 95% CI 1·23-1·56). Shielding was associated with established risk factors for severe COVID-19 [male sex (OR 1·14, 95% CI 1·05-1·24), obesity (OR 1·37, 95% CI 1·23-1·54), comorbidity burden (OR 1·43, 95% CI 1·15-1·78)], a primary indication of RMDs (OR 1·37, 95% CI 1·27-1·48) and a positive anxiety or depression screen (OR 1·57, 95% CI 1·36-1·80). Modest differences in the proportion shielding were observed across nations. CONCLUSIONS Greater risk-mitigating behaviour among people with IMIDs receiving targeted therapies may contribute to the reported lower risk of adverse COVID-19 outcomes. The behaviour variation across treatment groups, IMIDs and nations reinforces the need for clear evidence-based patient communication on risk-mitigation strategies and may help inform updated public health guidelines as the pandemic continues.
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3
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Mahil SK, Yates M, Yiu ZZN, Langan SM, Tsakok T, Dand N, Mason KJ, McAteer H, Meynell F, Coker B, Vincent A, Urmston D, Vesty A, Kelly J, Lancelot C, Moorhead L, Bachelez H, Capon F, Contreras CR, De La Cruz C, Di Meglio P, Gisondi P, Jullien D, Lambert J, Naldi L, Norton S, Puig L, Spuls P, Torres T, Warren RB, Waweru H, Weinman J, Brown MA, Galloway JB, Griffiths CM, Barker JN, Smith CH. Describing the burden of the COVID-19 pandemic in people with psoriasis: findings from a global cross-sectional study. J Eur Acad Dermatol Venereol 2021; 35:e636-e640. [PMID: 34145643 PMCID: PMC8447018 DOI: 10.1111/jdv.17450] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S K Mahil
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.,NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - M Yates
- NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.,Centre for Rheumatic Diseases, King's College London, London, UK
| | - Z Z N Yiu
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - S M Langan
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.,Faculty of Epidemiology, and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - T Tsakok
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.,NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - N Dand
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Health Data Research UK, London, UK
| | - K J Mason
- Centre for Rheumatic Diseases, King's College London, London, UK.,School of Medicine, Keele University, Keele, UK
| | - H McAteer
- The Psoriasis Association, Northampton, UK
| | - F Meynell
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.,NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - B Coker
- NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - A Vincent
- NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - D Urmston
- The Psoriasis Association, Northampton, UK
| | - A Vesty
- The Psoriasis Association, Northampton, UK
| | - J Kelly
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - C Lancelot
- International Federation of Psoriasis Associations (IFPA), Bromma, Sweden
| | - L Moorhead
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - H Bachelez
- Department of Dermatology, AP-HP Hôpital Saint-Louis, Paris, France.,INSERM U1163, Imagine Institute for Human Genetic Diseases, Université de Paris, Paris, France
| | - F Capon
- NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.,Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - C R Contreras
- Catedra de Dermatologia, Hospital de Clinicas, Facultad de Ciencias Medicas, Universidad Nacional de Asuncion, San Lorenzo, Paraguay
| | | | - P Di Meglio
- NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.,St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - P Gisondi
- Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - D Jullien
- Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon, University of Lyon, Lyon, France.,Groupe de Recherche sur le Psoriasis (GrPso) de la Société Française de Dermatologie, Paris, France
| | - J Lambert
- Department of Dermatology, Ghent University, Ghent, Belgium
| | - L Naldi
- Centro Studi GISED, Bergamo, Italy
| | - S Norton
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - L Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P Spuls
- Department of Dermatology, Amsterdam Public Health/Infection and Immunology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - T Torres
- Department of Dermatology, Centro Hospitalar do Porto, Porto, Portugal
| | - R B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - H Waweru
- International Federation of Psoriasis Associations (IFPA), Bromma, Sweden
| | - J Weinman
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - M A Brown
- NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.,Centre for Rheumatic Diseases, King's College London, London, UK
| | - J B Galloway
- Centre for Rheumatic Diseases, King's College London, London, UK.,Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - C M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - J N Barker
- NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.,St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - C H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.,NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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4
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Chalkidou A, Macmillan T, Grzeda MT, Peacock J, Summers J, Eddy S, Coker B, Patrick H, Powell H, Berry L, Webster G, Ostler P, Dickinson PD, Hatton MQ, Henry A, Keevil S, Hawkins MA, Slevin N, van As N. Stereotactic ablative body radiotherapy in patients with oligometastatic cancers: a prospective, registry-based, single-arm, observational, evaluation study. Lancet Oncol 2021; 22:98-106. [PMID: 33387498 DOI: 10.1016/s1470-2045(20)30537-4] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Stereotactic ablative body radiotherapy (SABR) is increasingly being used to treat oligometastatic cancers, but high-level evidence to provide a basis for policy making is scarce. Additional evidence from a real-world setting is required. We present the results of a national study of patients with extracranial oligometastases undergoing SABR, representing the largest dataset, to our knowledge, on outcomes in this population so far. METHODS In 2015, National Health Service (NHS) England launched a Commissioning through Evaluation scheme that funded a prospective, registry-based, single-arm, observational, evaluation study of patients with solid cancer and extracranial oligometastases treated with SABR. Prescribed doses ranged from 24-60 Gy administered in three to eight fractions. The study was done at 17 NHS radiotherapy centres in England. Patients were eligible for the scheme if aged 18 years or older with confirmed primary carcinoma (excluding haematological malignancies), one to three extracranial metastatic lesions, a disease-free interval from primary tumour development to metastases of longer than 6 months (with the exception of synchronous colorectal liver metastases), a WHO performance status of 2 or lower, and a life expectancy of at least 6 months. The primary outcome was overall survival at 1 year and 2 years from the start of SABR treatment. The study is now completed. FINDINGS Between June 15, 2015, and Jan 30, 2019, 1422 patients were recruited from 17 hospitals in England. The median age of the patients was 69 years (IQR 62-76), and the most common primary tumour was prostate cancer (406 [28·6%] patients). Median follow-up was 13 months (IQR 6-23). Overall survival was 92·3% (95% CI 90·5-93·9) at 1 year and 79·2% (76·0-82·1) at 2 years. The most common grade 3 adverse event was fatigue (28 [2·0%] of 1422 patients) and the most common serious (grade 4) event was increased liver enzymes (nine [0·6%]). Notreatment-related deaths were reported. INTERPRETATION In patients with extracranial oligometastatic cancer, use of SABR was associated with high overall survival and low toxicity. 'The study findings complement existing evidence from a randomised, phase 2 trial, and represent high-level, real-world evidence supporting the use of SABR in this patient cohort, with a phase 3 randomised, controlled trial to confirm these findings underway. Based on the selection criteria in this study, SABR was commissioned by NHS England in March, 2020, as a treatment option for patients with oligometastatic disease. FUNDING NHS England Commissioning through Evaluation scheme.
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Affiliation(s)
- Anastasia Chalkidou
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Thomas Macmillan
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Mariusz T Grzeda
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Janet Peacock
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Jennifer Summers
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Saskia Eddy
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Bola Coker
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Hannah Patrick
- National Institute for Health and Care Excellence, Manchester, UK
| | - Helen Powell
- National Institute for Health and Care Excellence, Manchester, UK
| | - Lee Berry
- National Institute for Health and Care Excellence, Manchester, UK
| | - Gareth Webster
- Department of Medical Physics, Worcestershire Acute Hospitals National Health Service (NHS) Trust, Worcester, UK
| | | | - Peter D Dickinson
- Clinical Oncology Department, St James's University Hospital and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Matthew Q Hatton
- Clinical Oncology Department, Weston Park Hospital, Sheffield, UK
| | - Ann Henry
- Clinical Oncology Department, St James's University Hospital and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Stephen Keevil
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Maria A Hawkins
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Nick Slevin
- The Christie NHS Foundation Trust, Manchester, UK
| | - Nicholas van As
- The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, UK
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5
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Mahil SK, Dand N, Mason KJ, Yiu ZZN, Tsakok T, Meynell F, Coker B, McAteer H, Moorhead L, Mackenzie T, Rossi MT, Rivera R, Mahe E, Carugno A, Magnano M, Rech G, Balogh EA, Feldman SR, De La Cruz C, Choon SE, Naldi L, Lambert J, Spuls P, Jullien D, Bachelez H, McMahon DE, Freeman EE, Gisondi P, Puig L, Warren RB, Di Meglio P, Langan SM, Capon F, Griffiths CEM, Barker JN, Smith CH. Factors associated with adverse COVID-19 outcomes in patients with psoriasis-insights from a global registry-based study. J Allergy Clin Immunol 2021; 147:60-71. [PMID: 33075408 PMCID: PMC7566694 DOI: 10.1016/j.jaci.2020.10.007] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/01/2020] [Accepted: 10/08/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The multimorbid burden and use of systemic immunosuppressants in people with psoriasis may confer greater risk of adverse outcomes of coronavirus disease 2019 (COVID-19), but the data are limited. OBJECTIVE Our aim was to characterize the course of COVID-19 in patients with psoriasis and identify factors associated with hospitalization. METHODS Clinicians reported patients with psoriasis with confirmed/suspected COVID-19 via an international registry, Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection. Multiple logistic regression was used to assess the association between clinical and/or demographic characteristics and hospitalization. A separate patient-facing registry characterized risk-mitigating behaviors. RESULTS Of 374 clinician-reported patients from 25 countries, 71% were receiving a biologic, 18% were receiving a nonbiologic, and 10% were not receiving any systemic treatment for psoriasis. In all, 348 patients (93%) were fully recovered from COVID-19, 77 (21%) were hospitalized, and 9 (2%) died. Increased hospitalization risk was associated with older age (multivariable-adjusted odds ratio [OR] = 1.59 per 10 years; 95% CI = 1.19-2.13), male sex (OR = 2.51; 95% CI = 1.23-5.12), nonwhite ethnicity (OR = 3.15; 95% CI = 1.24-8.03), and comorbid chronic lung disease (OR = 3.87; 95% CI = 1.52-9.83). Hospitalization was more frequent in patients using nonbiologic systemic therapy than in those using biologics (OR = 2.84; 95% CI = 1.31-6.18). No significant differences were found between classes of biologics. Independent patient-reported data (n = 1626 across 48 countries) suggested lower levels of social isolation in individuals receiving nonbiologic systemic therapy than in those receiving biologics (OR = 0.68; 95% CI = 0.50-0.94). CONCLUSION In this international case series of patients with moderate-to-severe psoriasis, biologic use was associated with lower risk of COVID-19-related hospitalization than with use of nonbiologic systemic therapies; however, further investigation is warranted on account of potential selection bias and unmeasured confounding. Established risk factors (being older, being male, being of nonwhite ethnicity, and having comorbidities) were associated with higher hospitalization rates.
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Affiliation(s)
- Satveer K Mahil
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Nick Dand
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Health Data Research UK, London, United Kingdom
| | - Kayleigh J Mason
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Zenas Z N Yiu
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Teresa Tsakok
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Freya Meynell
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Bola Coker
- National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Helen McAteer
- The Psoriasis Association, Northampton, United Kingdom
| | - Lucy Moorhead
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Teena Mackenzie
- Dermatology Department, Churchill Hospital, Oxford, United Kingdom
| | | | - Raquel Rivera
- Dermatology Department, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Emmanuel Mahe
- Department of Dermatology, Hôpital Victor Dupouy, Argenteuil, France; Groupe de recherche sur le psoriasis (GrPso) de la Société Française de Dermatologie, Paris, France
| | - Andrea Carugno
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Giulia Rech
- Dermatology Unit, Santa Chiara Hospital, Trento, Italy
| | - Esther A Balogh
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Siew Eng Choon
- Jeffrey Cheah School Of Medicine and Health Sciences, Monash University, Subang Jaya, Selangor
| | | | - Jo Lambert
- Department of Dermatology, Ghent University, Ghent, Belgium
| | - Phyllis Spuls
- Department of Dermatology, Amsterdam Public Health/Infection and Immunology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Denis Jullien
- Groupe de recherche sur le psoriasis (GrPso) de la Société Française de Dermatologie, Paris, France; Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Hervé Bachelez
- Department of Dermatology, AP-HP Hôpital Saint-Louis, Paris, France; INSERM U1163, Imagine Institute for Human Genetic Diseases, Université de Paris, Paris, France
| | | | - Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Paolo Gisondi
- Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Richard B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Paola Di Meglio
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Sinéad M Langan
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom; Faculty of Epidemiology, and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Francesca Capon
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Jonathan N Barker
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Catherine H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom.
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6
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Jin H, Chalkidou A, Hawkins M, Summers J, Eddy S, Peacock JL, Coker B, Kartha MR, Good J, Pennington M. Cost-Effectiveness Analysis of Stereotactic Ablative Body Radiation Therapy Compared With Surgery and Radiofrequency Ablation in Two Patient Cohorts: Metastatic Liver Cancer and Hepatocellular Carcinoma. Clin Oncol (R Coll Radiol) 2020; 33:e143-e154. [PMID: 32951952 DOI: 10.1016/j.clon.2020.08.010] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/10/2020] [Accepted: 08/26/2020] [Indexed: 02/07/2023]
Abstract
AIMS To compare the cost-effectiveness of stereotactic ablative body radiation therapy (SABR) with radiofrequency ablation and surgery in adult patients with metastatic liver cancer and hepatocellular carcinoma (HCC). MATERIALS AND METHODS Two patient cohorts were assessed: liver oligometastases and HCC. For each patient cohort, a decision analytic model was constructed to assess the cost-effectiveness of interventions over a 5-year horizon. A Markov process was embedded in the decision model to simulate the possible prognosis of cancer. Data on transition probabilities, survival, side-effects, quality of life and costs were obtained from published sources and the SABR Commissioning through Evaluation (CtE) scheme. The primary outcome was the incremental cost-effectiveness ratio with respect to quality-adjusted life-years. The robustness of the results was examined in a sensitivity analysis. Analyses were conducted from a National Health Service and Personal Social Services perspective. RESULTS In the base case analysis, which assumed that all three interventions were associated with the same cancer progression rates and mortality rates, SABR was the most cost-effective intervention for both patient cohorts. This conclusion was sensitive to the cancer progression rate, mortality rate and cost of interventions. Assuming a willingness-to-pay threshold of £20 000 per quality-adjusted life-year, the probability that SABR is cost-effective was 57% and 50% in liver oligometastases and HCC, respectively. CONCLUSIONS Our results indicate a potential for SABR to be cost-effective for patients with liver oligometastases and HCC. This finding supports further investigation in clinical trials directly comparing SABR with surgery and radiofrequency ablation.
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Affiliation(s)
- H Jin
- King's Health Economics (KHE), Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK.
| | - A Chalkidou
- King's Technology Evaluation Centre (KiTEC), London, UK
| | - M Hawkins
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - J Summers
- School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - S Eddy
- School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - J L Peacock
- School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - B Coker
- School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - M R Kartha
- King's Health Economics (KHE), Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK; King's Technology Evaluation Centre (KiTEC), London, UK
| | - J Good
- Queen Elizabeth Hospital, Birmingham, UK
| | - M Pennington
- King's Health Economics (KHE), Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
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7
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Pennington M, Summers J, Coker B, Eddy S, Kartha MR, Edwards K, Freeman R, Goodden J, Powell H, Verity C, Peacock JL. Selective dorsal rhizotomy; evidence on cost-effectiveness from England. PLoS One 2020; 15:e0236783. [PMID: 32776949 PMCID: PMC7416930 DOI: 10.1371/journal.pone.0236783] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 07/15/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives Selective dorsal rhizotomy (SDR) has gained interest as an intervention to reduce spasticity and pain, and improve quality of life and mobility in children with cerebral palsy mainly affecting the legs (diplegia). We evaluated the cost-effectiveness of SDR in England. Methods Cost-effectiveness was quantified with respect to Gross Motor Function Measure (GMFM-66) and the pain dimension of the Cerebral Palsy Quality of Life questionnaire for Children (CPQOL-Child). Data on outcomes following SDR over two years were drawn from a national evaluation in England which included 137 children, mean age 6.6 years at surgery. The incremental impact of SDR on GMFM-66 was determined through comparison with data from a historic Canadian cohort not undergoing SDR. Another single centre provided data on hospital care over ten years for 15 children undergoing SDR at a mean age of 7.0 years, and a comparable cohort managed without SDR. The incremental impact of SDR on pain was determined using a before and after comparison using data from the national evaluation. Missing data were imputed using multiple imputation. Incremental costs of SDR were determined as the difference in costs over 5 years for the patients undergoing SDR and those managed without SDR. Uncertainty was quantified using bootstrapping and reported as the cost-effectiveness acceptability curve. Results In the base case, the incremental cost-effectiveness ratios (ICERs) for SDR are £1,382 and £903 with respect to a unit improvement in GMFM-66 and the pain dimension of CPQOL-Child, respectively. Inclusion of data to 10 years indicates SDR is cheaper than management without SDR. Incremental costs and ICERs for SDR rose in sensitivity analysis applying an alternative regression model to cost data. Conclusions Data on outcomes from a large observational study of SDR and long-term cost data on children who did and did not receive SDR indicates SDR is cost-effective.
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Affiliation(s)
- Mark Pennington
- Kings Health Economics, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, United Kingdom
- King’s Technology Evaluation Centre, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- * E-mail:
| | - Jennifer Summers
- King’s Technology Evaluation Centre, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Bola Coker
- King’s Technology Evaluation Centre, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Saskia Eddy
- King’s Technology Evaluation Centre, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Muralikrishnan R. Kartha
- Kings Health Economics, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, United Kingdom
- King’s Technology Evaluation Centre, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | - Karen Edwards
- The Robert Jones & Agnes Hunt Hospital, Oswestry, United Kingdom
| | - Robert Freeman
- The Robert Jones & Agnes Hunt Hospital, Oswestry, United Kingdom
| | - John Goodden
- Department of Neurosurgery, Leeds General Infirmary, Leeds, United Kingdom
| | - Helen Powell
- National Institute for Health and Care Excellence, Manchester, United Kingdom
| | | | - Janet L. Peacock
- King’s Technology Evaluation Centre, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
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Mahil SK, Yiu ZZN, Mason KJ, Dand N, Coker B, Wall D, Fletcher G, Bosma A, Capon F, Iversen L, Langan SM, Di Meglio P, Musters AH, Prieto-Merino D, Tsakok T, Warren RB, Flohr C, Spuls PI, Griffiths CEM, Barker J, Irvine AD, Smith CH. Global reporting of cases of COVID-19 in psoriasis and atopic dermatitis: an opportunity to inform care during a pandemic. Br J Dermatol 2020; 183:404-406. [PMID: 32348554 PMCID: PMC7267275 DOI: 10.1111/bjd.19161] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- S K Mahil
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Z Z N Yiu
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - K J Mason
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - N Dand
- St John's Institute of Dermatology within the, School of Basic & Medical Biosciences, King's College London, London, UK
| | - B Coker
- NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - D Wall
- Hair Restoration Blackrock, Dublin, Ireland.,National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, Dublin, Ireland
| | - G Fletcher
- National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, Dublin, Ireland
| | - A Bosma
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - F Capon
- St John's Institute of Dermatology within the, School of Basic & Medical Biosciences, King's College London, London, UK
| | - L Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus C, Denmark
| | - S M Langan
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.,Faculty of Epidemiology, and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - P Di Meglio
- St John's Institute of Dermatology within the, School of Basic & Medical Biosciences, King's College London, London, UK
| | - A H Musters
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - D Prieto-Merino
- Faculty of Epidemiology, and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - T Tsakok
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - R B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - C Flohr
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - P I Spuls
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - C E M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - J Barker
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - A D Irvine
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - C H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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9
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Ozuguz U, Oruc S, Ulu MS, Demirbas H, Acay A, Coker B, Beyazıt B, Yaman M, Koken T. Does vitamin D have any role in the improvement of diabetic peripheral neuropathy in type 1 diabetic patients? J Endocrinol Invest 2016; 39:1411-1417. [PMID: 27436228 DOI: 10.1007/s40618-016-0509-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/04/2016] [Indexed: 01/10/2023]
Abstract
AIM The aim of this study was to evaluate the relationship between diabetic peripheral neuropathy (DPN) and vitamin D, nerve growth factor (NGF) and oxidative stress markers in patients with type 1 diabetes. METHODS Ninety-six patients with type 1 diabetes were included in the study. All patients were evaluated for DPN with Michigan Neuropathy Screening Instrument. Fasting blood glucose, HbA1c, lipid parameters, 25 (OH) D3, NGF, total oxidant status, total antioxidant status and oxidative stress index were measured. RESULTS Twenty-six patients (27 %) had DPN (group 1) and 70 patients did not have neuropathy (group 2). When the groups were evaluated with respect to general demographic characteristics, no differences were detected. Mean age, duration of diabetes and retinopathy were found significantly higher in patients who had neuropathy. Glomerular filtration rate levels were significantly lower in the neuropathy group. Between the groups, 25 (OH) vitamin D levels were significantly lower in the neuropathy group, while there were no differences in NGF levels or in oxidative stress markers. Michigan neuropathy examination score was positively correlated with age, and diabetes duration was negatively correlated with 25 (OH) vitamin D levels. In addition, 25 (OH) vitamin D was positively correlated with NGF. In the logistic regression analysis to determine the independent variables that will affect the development of neuropathy, duration of diabetes was detected as the only factor (p = 0.039, OR = 1.071). CONCLUSION It seems that the most important risk factor for the development of neuropathy in type 1 diabetic patients is disease duration.
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Affiliation(s)
- U Ozuguz
- Department of Internal Medicine, Endocrinology and Metabolism, Faculty of Medicine, Afyon Kocatepe University, 03200, Afyonkarahisar, Turkey.
| | - S Oruc
- Department of Neurology, Faculty of Medicine, Afyon Kocatepe University, 03200, Afyonkarahisar, Turkey
| | - M S Ulu
- Department of Internal Medicine, Faculty of Medicine, Afyon Kocatepe University, 03200, Afyonkarahisar, Turkey
| | - H Demirbas
- Department of Neurology, Faculty of Medicine, Afyon Kocatepe University, 03200, Afyonkarahisar, Turkey
| | - A Acay
- Department of Internal Medicine, Faculty of Medicine, Afyon Kocatepe University, 03200, Afyonkarahisar, Turkey
| | - B Coker
- Department of Internal Medicine, Faculty of Medicine, Afyon Kocatepe University, 03200, Afyonkarahisar, Turkey
| | - B Beyazıt
- Department of Neurology, Faculty of Medicine, Afyon Kocatepe University, 03200, Afyonkarahisar, Turkey
| | - M Yaman
- Department of Neurology, Faculty of Medicine, Afyon Kocatepe University, 03200, Afyonkarahisar, Turkey
| | - T Koken
- Department of Biochemistry, Faculty of Medicine, Afyon Kocatepe University, 03200, Afyonkarahisar, Turkey
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10
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Reid F, Peacock J, Coker B, McMillan V, Lewis C, Keevil S, Sherwood R, Vivian G, Logan R, Summers J. A Multicenter Prospective Study to Investigate the Diagnostic Accuracy of the SeHCAT Test in Measuring Bile Acid Malabsorption: Research Protocol. JMIR Res Protoc 2016; 5:e13. [PMID: 26832436 PMCID: PMC4754532 DOI: 10.2196/resprot.4467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 03/25/2015] [Revised: 07/10/2015] [Accepted: 07/13/2015] [Indexed: 11/29/2022] Open
Abstract
Background Bile acid malabsorption (BAM) is one possible explanation for chronic diarrhea. BAM may be idiopathic, or result from ileal resection or inflammation including Crohn’s disease, or may be secondary to other conditions, including cholecystectomy, peptic ulcer surgery, and chronic pancreatitis. No “gold standard” exists for clinical diagnosis of BAM, but response to treatment with a bile acid sequestrant (BAS) is often accepted as confirmation. The SeHCAT (tauroselcholic [selenium-75] acid) test uses a radiolabeled synthetic bile acid and provides a diagnostic test for BAM, but its performance against “trial of treatment” is unknown. Fibroblast growth factor 19 (FGF-19) and 7-alpha-hydroxy-4-cholesten-3-one (C4) also offer potential new biomarkers of BAM. Objective This protocol describes a multicenter prospective study to evaluate the diagnostic accuracy of SeHCAT and 2 biomarkers in predicting BAM as assessed by trial of treatment. Methods Participating gastroenterology centers should have a minimum workload of 30 SeHCAT patients per annum. Patients should not be pregnant, on medication that could confound follow-up, or have any severe comorbidity. All eligible patients attending a gastrointestinal appointment will be invited to participate. On attending the SeHCAT test, blood and fecal samples will be collected for analysis of FGF-19 by enzyme-linked immunosorbent assay and for C4 and fractionated bile acids by liquid chromatography–mass spectrometry. A capsule containing radiolabeled SeHCAT will be administered orally and a scan performed to measure SeHCAT activity. Patients will return on day 7 to undergo a second scan to measure percentage SeHCAT retention. The test result will be concealed from clinicians and patients. BAS will be dispensed to all patients, with a follow-up gastroenterologist appointment at 2 weeks for clinical assessment of treatment response and adherence. Patients responding positively will continue treatment for a further 2 weeks and all patients will have a final follow-up at 8 weeks. The diagnostic accuracy of the SeHCAT test and biomarkers will be analyzed at different thresholds using sensitivity, specificity, positive and negative predictive value, likelihood ratios, and area under the curve in a sample of 600 patients. Multivariable logistic regression models will be used to assess the association between presence of BAM and continuous SeHCAT retention levels after adjustment for confounders. Results Funding is being sought to conduct this research. Conclusions The SeHCAT test for diagnosis of BAM has been in common use in the United Kingdom for more than 30 years and an evidence-based assessment of its accuracy is overdue. The proposed study has some challenges. Some forms of BAS treatment are unpleasant due to the texture and taste of the resin powder, which may negatively affect recruitment and treatment adherence. Trial of treatment is not as “golden” a standard as would be ideal, and itself warrants further study.
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Affiliation(s)
- Fiona Reid
- Division of Health and Social Care Research, King's College London, London, United Kingdom.
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11
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12
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Khan MS, Challacombe B, Elhage O, Rimington P, Coker B, Murphy D, Grieve A, Dasgupta P. A dual-centre, cohort comparison of open, laparoscopic and robotic-assisted radical cystectomy. Int J Clin Pract 2012; 66:656-62. [PMID: 22507234 DOI: 10.1111/j.1742-1241.2011.02888.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The role of minimally invasive radical cystectomy as opposed to open surgery for bladder cancer is not yet established. We present comparative outcomes of open, laparoscopic and robotic-assisted radical cystectomy MATERIAL AND METHODS Prospective cohort comparison of 158 patients from 2003-2008 undergoing open radical cystectomy (ORC) (n = 52), laparoscopic radical cystectomy (LRC) (n =58) or robotic-assisted radical cystectomy (RARC) (n = 48) performed by a team of three surgeons at two hospitals. Peri-operative data, complication rates, length of hospital stay, oncological outcome (including lymph node status) and survival were recorded. Statistical analyses were adjusted to account for potential confounding factors such as ASA grade, gender, age, diversion type and final histology. RESULTS RARC took longer than LRC and ORC. Patients were about 30 times more likely to have a transfusion if they had ORC than if they had RARC (p < 0.0001) and about eight times more likely to have a transfusion if they had LRC compared with RARC (p < 0.006). Patients were four times more likely to have a transfusion if they had ORC as compared with LRC (p < 0.007). Patients were four times more likely to have complications if they had ORC than RARC (p = 0.006) and about three times more likely to have complications with LRC than with RARC (p = 0.02). Hospital stay was mean 19 days after ORC, 16 days after LRC and 10 days after RARC. CONCLUSIONS Despite study limitations, RARC had the lowest transfusion and complication rates and the shortest length of stay, although taking the longest to perform.
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Affiliation(s)
- M S Khan
- Urology Centre, Guy's & Thomas' NHS Foundation Trust, London, UK
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13
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O'Brien T, Ray E, Singh R, Coker B, Beard R. Prevention of bladder tumours after nephroureterectomy for primary upper urinary tract urothelial carcinoma: a prospective, multicentre, randomised clinical trial of a single postoperative intravesical dose of mitomycin C (the ODMIT-C Trial). Eur Urol 2011; 60:703-10. [PMID: 21684068 DOI: 10.1016/j.eururo.2011.05.064] [Citation(s) in RCA: 212] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 05/31/2011] [Indexed: 01/13/2023]
Abstract
BACKGROUND Standard treatment for upper urinary tract urothelial carcinoma (UUTUC) is nephroureterectomy. Subsequently, around 40% of patients will develop a bladder tumour potentially because of implantation from the primary tumour. OBJECTIVE To prevent bladder tumour after nephroureterectomy with a single postoperative dose of intravesical mitomycin C (MMC). DESIGN, SETTING, AND PARTICIPANTS A prospective, randomised, nonblinded trial (ODMIT-C: One Dose Mitomycin C) was undertaken in 46 British centres between July 2000 and December 2006. The study recruited 284 patients with no previous or concurrent history of bladder cancer undergoing nephroureterectomy for suspected UUTUC. INTERVENTION A single postoperative intravesical dose of MMC (40 mg in 40 ml saline) or standard management on removal of the urinary catheter. MEASUREMENTS Bladder tumour formation was judged by visual appearance at cystoscopy at 3, 6, and 12 mo following nephroureterectomy. RESULTS AND LIMITATIONS One hundred forty-four patients were randomised to receive MMC and 140 patients to receive standard care. In the MMC arm, 105 of 144 patients (73%) and 115 of 140 patients (82%) in the standard care arm received their allocated treatment. Thirteen of 105 patients who received MMC and 20 of 115 patients allocated to standard treatment did not complete follow-up. By modified intention-to-treat analysis, 21 of 120 patients (17%) in the MMC arm developed a bladder recurrence in the first year compared to 32 of 119 patients (27%) in the standard treatment arm (p=0.055). By treatment as per protocol analysis, 17 of 105 patients (16%) in the MMC arm and 31 of 115 patients (27%) in the standard treatment arm developed a recurrence (p=0.03). No serious adverse events were reported. A limitation is that histologic proof of recurrence was not required in this trial. CONCLUSIONS A single postoperative dose of intravesical MMC appears to reduce the risk of a bladder tumour within the first year following nephroureterectomy for UUTUC. The absolute reduction in risk is 11%, the relative reduction in risk is 40%, and the number needed to treat to prevent one bladder tumour is nine.
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Affiliation(s)
- Tim O'Brien
- Urology Centre, Guys Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK.
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14
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Willis S, Pardos-Martinez M, Coker B, Thomas K, Anderson P, Rottenberg G, Jenkins E, O’Brien T. THE SUCCESSFUL, SUSTAINABLE ELIMINATION OF A WAITING LIST FOR UROLOGY OUTPATIENTS. BJU Int 2010; 107:526-30. [DOI: 10.1111/j.1464-410x.2010.09952.x] [Citation(s) in RCA: 7] [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] [Indexed: 11/26/2022]
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Coker B, Sawicka E. Factitious surgical emphysema. Case Reports 2009; 2009:bcr07.2008.0409. [DOI: 10.1136/bcr.07.2008.0409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Coull N, Rottenberg G, Rankin S, Pardos-Martinez M, Coker B, Jenkins E, O'Brien T. Assessing the feasibility of a one-stop approach to diagnosis for urological patients. Ann R Coll Surg Engl 2009; 91:305-9. [PMID: 19344549 DOI: 10.1308/003588409x391802] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Conventional publicly funded out-patient services in many specialties are characterised by delays, fragmented diagnostic processes, and overloaded clinics. This is bad for patients as it is clinically dangerous; bad for managers who spend hours managing the failure; bad for doctors who respond by overloading clinics; and bad for purchasers who have to fund the multiple out-patient visits needed. Sound clinical and financial reasons exist for introducing more efficient diagnostic processes. PATIENTS AND METHODS A total of 330 consecutive patients referred to the urology department of Guy's and St Thomas' NHS Foundation Trust were invited to attend one of nine one-stop clinics staffed by consultant urologists with specialist registrars, nurses, and clerical staff. Pre-clinic blood and urine tests were ordered based on the referral letter. Clinics had facilities to perform cystoscopy, ultrasound, and urinary flow studies. Correspondence was generated in real time, and a copy given to the patient. RESULTS Overall, 257 patients attended the clinics. Twenty-three patients cancelled appointments and 50 patients did not attend. Pre-clinic tests were requested in 133 patients and were completed by 86% of the patients who attended. Of patients, 42% were diagnosed and discharged; 28% were listed for surgery, extracorporeal shock wave lithotripsy (ESWL), or referred to another specialty. About 30% of patients needed further out-patient review; in approximately two-thirds to complete a diagnosis and one-third to review the results of therapy initiated. An estimated 350 appointments and 550 patient visits to hospital were saved. CONCLUSIONS A one-stop method of consultation is efficient across a range of urological presenting complaints, and dramatically reduces the need for follow-up consultations. It has potential to: (i) reduce delays to being seen in out-patients; (ii) lead to more cost-effective care; and (iii) increase safety and patient satisfaction. It should become the standard of care in urology, and is probably applicable in many other disciplines.
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Affiliation(s)
- Nadine Coull
- Department of Urology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK.
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17
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O'Brien TS, Singh R, Ray E, Coker B, Beard R. ODMIT C: A PROSPECTIVE RANDOMISED MULTICENTRE TRIAL OF A SINGLE POST-OPERATIVE DOSE OF INTRAVESICAL MITOMYCIN C TO PREVENT BLADDER CANCER FORMATION FOLLOWING NEPHROURETERECTOMY FOR UPPER TRACT TCC (UTTCC). J Urol 2009. [DOI: 10.1016/s0022-5347(09)60392-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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