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Zimmer Z, Zajacova A, Fraser K, Powers D, Grol-Prokopczyk H. A global comparative study of wealth-pain gradients: Investigating individual- and country-level associations. Dialogues Health 2023; 2:100122. [PMID: 38099153 PMCID: PMC10718570 DOI: 10.1016/j.dialog.2023.100122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/27/2023] [Accepted: 03/05/2023] [Indexed: 12/17/2023]
Abstract
Pain is a significant yet underappreciated dimension of population health. Its associations with individual- and country-level wealth are not well characterized using global data. We estimate both individual- and country-level wealth inequalities in pain in 51 countries by combining data from the World Health Organization's World Health Survey with country-level contextual data. Our research concentrates on three questions: 1) Are inequalities in pain by individual-level wealth observed in countries worldwide? 2) Does country-level wealth also relate to pain prevalence? 3) Can variations in pain reporting also be explained by country-level contextual factors, such as income inequality? Analytical steps include logistic regressions conducted for separate countries, and multilevel models with random wealth slopes and resultant predicted probabilities using a dataset that pools information across countries. Findings show individual-level wealth negatively predicts pain almost universally, but the association strength differs across countries. Country-level contextual factors do not explain away these associations. Pain is generally less prevalent in wealthier countries, but the exact nature of the association between country-level wealth and pain depends on the moderating influence of country-level income inequality, measured by the Gini index. The lower the income inequality, the more likely it is that poor countries experience the highest and rich countries the lowest prevalence of pain. In contrast, the higher the income inequality, the more nonlinear the association between country-level wealth and pain reporting such that the highest prevalence is seen in highly nonegalitarian middle-income countries. Our findings help to characterize the global distribution of pain and pain inequalities, and to identify national-level factors that shape pain inequalities.
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Affiliation(s)
- Zachary Zimmer
- Department of Family Studies and Gerontology, Global Aging and Community Initiative, 166 Bedford Highway, McCain Centre 201C, Halifax, Nova Scotia B2M2J6, Canada
| | - Anna Zajacova
- Department of Sociology, Social Science Centre Room 5306, University of Western Ontario, London, Ontario N6A5C2, Canada
| | - Kathryn Fraser
- Global Aging and Community Initiative, 166 Bedford Highway, McCain Centre 201C, Halifax, Nova Scotia B2M2J6, Canada
| | - Daniel Powers
- Department of Sociology, RLP 2.622J, University of Texas at Austin, Austin, TX 78712-1086, USA
| | - Hanna Grol-Prokopczyk
- Department of Sociology, 430 Park Hall, University at Buffalo, Buffalo, NY 14260-4140, USA
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Madison AM, Powers D, Maslowsky J, Goyal V. Association Between Publicly Funded Contraceptive Services and the Abortion Rate in Texas, 2010-2015. Obstet Gynecol 2023; 141:361-370. [PMID: 36649327 PMCID: PMC9858333 DOI: 10.1097/aog.0000000000005057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/20/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate how the availability of contraceptive services was associated with a change in the abortion rate before and after Texas' legislative changes to the family planning budget in 2011 and abortion access in 2013. METHODS In this cross-sectional study, we obtained 2010 and 2015 data on contraceptive provision (number of publicly funded clinics and number of contraceptive clients served per 1,000 reproductive-aged women) from the Guttmacher Institute and county-level abortion data from the Texas Department of State Health Services. We categorized counties as having an abortion rate that increased or declined less than the national rate between 2010 and 2015 ( low-decline counties ) compared with those having an abortion rate that declined equal to or greater than the national rate between 2010 and 2015 ( high-decline counties ). We evaluated differences in contraceptive provision between high-decline and low-decline counties and evaluated county characteristics (racial and ethnic composition, unemployment, poverty, uninsured, education, distance to an abortion clinic, deliveries covered by Medicaid, and Catholic hospital marketplace dominance) as potential confounders. RESULTS Of 157 counties that had at least one contraceptive clinic in either 2010 or 2015, 49 were low-decline counties and 108 were high-decline counties. Although the total number of publicly funded family planning clinics increased by 10.8%, there was a 4.7% decrease in the total number of contraceptive clients served statewide. Compared with low-decline counties, high-decline counties had a higher median number of contraceptive clients served per 1,000 women aged 18-44 years (31.9 vs 60.7, P <.05) in 2015. Between 2010 and 2015, the abortion rate decreased 19.7% for each 1.0% increase in contraceptive clients served. CONCLUSION Texas counties with higher abortion-rate declines had more publicly funded contraceptive clinics and served more contraceptive clients than counties with lower declines, which may indicate the importance of greater access to publicly funded contraceptive services.
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Affiliation(s)
- Anita M Madison
- Department of Obstetrics and Gynecology, Louisiana State University Health Science Center, Baton Rouge, Louisiana; the Population Research Center, University of Texas at Austin, Austin, Texas; and the School of Public Health, University of Illinois Chicago, Chicago, Illinois
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De Main A, Powers D, Xie B. LONGITUDINAL ASSOCIATIONS OF SOCIAL CONNECTEDNESS, SOCIAL CONTRIBUTION, SOCIAL ENGAGEMENT, AND LATE-LIFE DRUG USE. Innov Aging 2022. [PMCID: PMC9766017 DOI: 10.1093/geroni/igac059.2018] [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: 12/24/2022] Open
Abstract
Substance misuse among older adults is a growing and complex problem with implications for society, aging adults, and their families. It is understudied in research and clinical practice. Limited and mixed evidence exists that suggests relationships between changes in older adults’ social environment and their drug use over time. This study addressed this gap by examining potential associations between social environment and drug use among community-dwelling older adults. Data were drawn from 3-waves of the national longitudinal survey of Midlife Development in the United States (MIDUS) (N= 2,020; age range=55-94 years; Mean=63.10, SD=5.66 at Wave 1). We estimated multilevel logistic growth models to assess the relationships between social environment indicators (social connectedness, social contribution, social engagement) and drug use, controlling for age, marital status, race/ethnicity, education level, household income, employment status, and number of chronic conditions. Our findings showed significant odds of drug use over the 20-year period of study, which were increased among older adults with multiple chronic conditions with a 59.5% risk of drug-related problems. Social contribution (feelings of being valued by society) negatively predicted older adults’ drug use whereas social connectedness and social engagement were not significant predictors over time. The models also indicated a moderating effect of social contribution on drug use, showing low changes in drug use over time with low social contribution. Our findings illuminate the differential roles of social environment indicators in drug use. Future research, policy, and practice may particularly focus on the role of social contribution in late-life drug use.
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Affiliation(s)
- Atami De Main
- Weill Cornell University, New York City, New York, United States
| | - Daniel Powers
- The University of Texas at Austin, Austin, Texas, United States
| | - Bo Xie
- The University of Texas at Austin, Austin, Texas, United States
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Madison A, Powers D, Maslowsky J, Goyal V. Social Oral Abstracts. Contraception 2022. [DOI: 10.1016/j.contraception.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Maslowsky J, Stritzel H, Al-Hamoodah L, Hendrick CE, Powers D, Barrientos-Gutierrez T, Santelli J. Health Behaviors and Prenatal Health Conditions in Repeat Vs First-time Teenage Mothers in the United States: 2015-2018. J Pediatr Adolesc Gynecol 2021; 34:47-53. [PMID: 32781232 PMCID: PMC7855354 DOI: 10.1016/j.jpag.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/30/2020] [Accepted: 08/02/2020] [Indexed: 01/22/2023]
Abstract
STUDY OBJECTIVE Repeat teenage mothers, those who give birth to a second or higher-order infant before age 20 years, are at elevated risk for adverse perinatal outcomes compared with first-time teenage mothers. The objective of the current study was to compare the prevalence of negative pregnancy-related behaviors and gestational health conditions in the national United States population of first-time and repeat teenage mothers. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective, population-based cohort study using annual US birth data files from 2015 to 2018, N = 799,756 (673,394 [84.2%] first, 126,362 [15.8%] repeat) births to women ages 15-19 years. INTERVENTIONS None. MAIN OUTCOME MEASURES Pregnancy-related behaviors (including adequacy of prenatal care and weight gain, sexually transmitted infection, smoking, and breastfeeding) and gestational health conditions (gestational hypertension and gestational diabetes). RESULTS Repeat (vs first-time) mothers had higher prevalence of negative pregnancy-related behaviors: inadequate prenatal care, smoking, inadequate weight gain, and sexually transmitted infection during pregnancy; they were also less likely to breastfeed. Conversely, repeat teenage mothers experienced lower prevalence of gestational hypertension and gestational diabetes. CONCLUSION Repeat teenage mothers experienced lower prevalence of physical health complications during pregnancy but engaged in more negative pregnancy-related health behaviors. Negative health behavior in pregnancy can lead directly to poor perinatal outcomes for infants. To prevent adverse outcomes from repeat teenage childbearing, we must ensure access to quality, timely, prenatal and postpartum care so teenage mothers can receive support for healthy pregnancy-related behaviors as well as linkage to highly effective contraception to prevent unintended repeat births.
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Holahan C, Holahan C, Lim S, Chen Y, Powers D. Sociodemographic Disadvantage, Living With a Smoker, and Health Risk Behaviors in Middle-Aged and Older Women. Innov Aging 2020. [PMCID: PMC7741150 DOI: 10.1093/geroni/igaa057.1083] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Sociodemographic disadvantage places individuals at risk for an unhealthy lifestyle (Kushi et al., 2012; Shanker et al., 2010), as well as for exposure to second-hand household smoke (Gan et al., 2015; Zhang et al., 2012). However, the role of living with a smoker in the association between sociodemographic status and health behavior is unstudied. This study investigated the role of living with a smoker in partially explaining the link between sociodemographic disadvantage and physical inactivity and poor dietary behaviors. The study used limited access data from the Women’s Health Initiative Observational Study obtained from NHLBI. Participants were 83,597 women ranging in age from 49 to 81; 6038 participants lived with a smoker. Cross-sectional logistic regression analyses examined paths in the models; bias-corrected bootstrapped confidence intervals tested indirect effects in probit analyses. Analyses controlled for age, ethnicity, marital status, and participants’ current smoking status. Results demonstrated a significant association (p < .001) between sociodemographic disadvantage (composite of low education and low income) and living with a smoker (OR = 1.74). The unstandardized indirect effects (CIs are in brackets) from sociodemographic disadvantage through living with a smoker to no exercise, no walking, high percent dietary fat, and low servings of fruits and vegetables through living with a smoker were statistically significant (.023 [.019, .028], .026 [.023, .033], .041 [.037, .047], and .032 [.027, .036], respectively). These findings illustrate the need to address multiple non-smoking health risk behaviors in household smoking interventions for disadvantaged families. This project was supported by the NIH/NCI (R03CA215947).
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Affiliation(s)
- Carole Holahan
- University of Texas at Austin, Austin, Texas, United States
| | | | - Sangdon Lim
- The University of Texas at Austin, Austin, Texas, United States
| | - Yen Chen
- The University of Texas at Austin, Austin, Texas, United States
| | - Daniel Powers
- The University of Texas at Austin, Austin, Texas, United States
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Abstract
BACKGROUND Age-period-cohort (APC) models are often used to decompose health trends into period- and cohort-based sources, but their use in epidemiology and population sciences remains contentious. Central to the contention are researchers' failures to 1) clearly state their analytic assumptions and/or 2) thoroughly evaluate model results. These failures often produce varying conclusions across APC studies and generate confusion about APC methods. Consequently, scholarly exchanges about APC methods usually result in strong disagreements that rarely offer practical advice to users or readers of APC methods. METHODS We use research guidelines to help practitioners of APC methods articulate their analytic assumptions and validate their results. To demonstrate the usefulness of the guidelines, we apply them to a 2015 American Journal of Epidemiology study about trends in black-white differences in U.S. heart disease mortality. RESULTS The application of the guidelines highlights two important findings. On the one hand, some APC methods produce inconsistent results that are highly sensitive to researcher manipulation. On the other hand, other APC methods estimate results that are robust to researcher manipulation and consistent across APC models. CONCLUSIONS The exercise shows the simplicity and effectiveness of the guidelines in resolving disagreements over APC results. The cautious use of APC models can generate results that are consistent across methods and robust to researcher manipulation. If followed, the guidelines can likely reduce the chance of publishing variable and conflicting results across APC studies.
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Affiliation(s)
- Ryan Masters
- University of Colorado Boulder, Boulder, CO, United States of America
| | - Daniel Powers
- University of Texas at Austin, Austin, Texas, United States of America
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Pal SK, Escudier BJ, Atkins MB, Hutson TE, Porta C, Verzoni E, Needle MN, Powers D, McDermott DF, Rini BI. Final Overall Survival Results from a Phase 3 Study to Compare Tivozanib to Sorafenib as Third- or Fourth-line Therapy in Subjects with Metastatic Renal Cell Carcinoma. Eur Urol 2020; 78:783-785. [PMID: 32938569 DOI: 10.1016/j.eururo.2020.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 05/19/2020] [Accepted: 08/11/2020] [Indexed: 11/27/2022]
Abstract
Tivozanib is a potent and selective inhibitor of the VEGF receptor. In an open-label, randomized phase 3 trial, we compared tivozanib to sorafenib in patients with metastatic renal cell carcinoma (mRCC) who had received two or three prior therapies. We have previously reported that the study met its primary endpoint, demonstrating an improvement in progression-free survival with tivozanib versus sorafenib (5.6 mo vs 3.9 mo; hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.56-0.94; p=0.016). The current report reflects the final assessment of overall survival, showing no difference between treatment with tivozanib and sorafenib (HR 0.97, 95% CI 0.75-1.24). Given its activity and distinct tolerability profile, tivozanib represents a treatment option for patients with previously treated mRCC. PATIENT SUMMARY: We show that tivozanib, a targeted therapy, can delay tumor growth relative to an already approved targeted therapy (sorafenib) in patients with kidney cancer who have received two or three prior treatments. No difference in survival was observed.
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Affiliation(s)
- Sumanta K Pal
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Bernard J Escudier
- Department of Oncology Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - Michael B Atkins
- Department of Medical Oncology, Georgetown Lombardi University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Thomas E Hutson
- Urologic Oncology, Baylor Sammons Cancer Center-Texas Oncology, Dallas, TX, USA
| | - Camillo Porta
- Department of Internal Medicine, University of Pavia Chief, Division of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Elena Verzoni
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | | | - David F McDermott
- Department of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Brian I Rini
- Hematology and Oncology, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.
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Maslowsky J, Powers D, Hendrick CE, Al-Hamoodah L. County-Level Clustering and Characteristics of Repeat Versus First Teen Births in the United States, 2015-2017. J Adolesc Health 2019; 65:674-680. [PMID: 31474434 PMCID: PMC6814573 DOI: 10.1016/j.jadohealth.2019.05.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/15/2019] [Revised: 05/01/2019] [Accepted: 05/30/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Approximately 16% of U.S. births to women aged 15-19 years are repeat (second or higher order) births. Repeat teen mothers are at elevated risk for poor perinatal outcomes. Geographic clustering and correlates of repeat teen birth are unknown. METHODS Data from birth certificates on N = 629,939 teen births in N = 3,108 U.S. counties in 2015-2017 were merged with data on county-level demographic, socioeconomic, and health provider characteristics. We identified contiguous clusters of counties with significantly elevated rates of first teen births only, repeat teen births, both, or neither between 2015 and 2017 and compared demographic, socioeconomic, and medical provider characteristics of counties between 2010 and 2016 in each cluster type. RESULTS A total of 193 counties (6.21%) had high rates of repeat births only; 504 (16.22%) had high rates of first teen birth only; 991 (31.89%) had high rates of both repeat and first teen births; and 1,420 (45.69%) had neither. Counties with high repeat (vs. first only) birth rates had higher rates of poverty and unemployment, higher levels of income inequality, lower high school graduation rates, a higher share of racial and ethnic minority residents, fewer publicly funded family planning clinics per capita, and more women receiving contraceptive services at publicly funded clinics. CONCLUSIONS First and repeat teen births cluster in differentially resourced geographic areas. Counties with high repeat teen birth rates have lower socioeconomic conditions than counties with high rates of first teen births only. These counties are more reliant on publicly funded family planning clinics but have fewer of them per capita.
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Affiliation(s)
- Julie Maslowsky
- Department of Kinesiology and Health Education, College of Education, University of Texas at Austin, Austin, Texas.
| | - Daniel Powers
- Department of Sociology, College of Liberal Arts, University of Texas at Austin, Austin, Texas
| | - C Emily Hendrick
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Leila Al-Hamoodah
- Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, Austin, Texas
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Cantu P, Kim Y, Sheehan C, Powers D, Margerison CE, Cubbin C. Downward Neighborhood Poverty Mobility during Childhood Is Associated with Child Asthma: Evidence from the Geographic Research on Wellbeing (GROW) Survey. J Urban Health 2019; 96:558-569. [PMID: 31049846 PMCID: PMC6890910 DOI: 10.1007/s11524-019-00356-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Causal evidence regarding neighborhood effects on health remains tenuous. Given that children have little agency in deciding where they live and spend proportionally more of their lives in neighborhoods than adults, their exposure to neighborhood conditions could make their health particularly sensitive to neighborhood effects. In this paper, we examine the relationship between exposure to poor neighborhoods from birth to ages 4-10 and childhood asthma. We used data from the 2003-2007 California Maternal Infant and Health Assessment (MIHA) and the 2012-2013 Geographic Research on Wellbeing (GROW) survey (N = 2619 mother/child dyads) to fit relative risks of asthma for children who experience different types of neighborhood poverty mobility using Poisson regression controlling for individual-level demographic and socioeconomic characteristics, and neighborhood satisfaction. Our results demonstrate that [1] living in a poor neighborhood at baseline and follow-up and [2] moving into a poor neighborhood were each associated with higher risk of asthma, compared with children not living in a poor neighborhood at either time. Exposure to impoverished neighborhoods and downward neighborhood poverty mobility matters for children's health, particularly for asthma. Public health practitioners and policymakers need to address downward neighborhood economic mobility, in addition to downward family economic mobility, in order to improve children's health.
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Affiliation(s)
- P Cantu
- Population Research Center, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA.,Department of Sociology, The University of Texas at Austin, Austin, TX, USA
| | - Y Kim
- School of Kinesiology and Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - C Sheehan
- School of Social and Family Dynamics, Arizona State University, Tempe, AZ, USA
| | - D Powers
- Population Research Center, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA.,Department of Sociology, The University of Texas at Austin, Austin, TX, USA
| | - C E Margerison
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Catherine Cubbin
- Population Research Center, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA. .,Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA.
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Renn B, Powers D, Arao R, Vredevoogd M, Unützer J. IMPROVING ACCESS TO EVIDENCE-BASED DEPRESSION CARE FOR OLDER RURAL ADULTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Holahan C, Holahan C, Powers D. THE RELATION OF LIVING WITH A SMOKER TO OBESITY IN MIDDLE-AGED AND OLDER WOMEN. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Holahan
- Department of Kinesiology and Health Education, University of Texas at Austin
| | - C Holahan
- Department of Psychology, University of Texas at Austin
| | - D Powers
- Department of Sociology and Population Research Center, University of Texas at Austin
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Hotchkiss A, Refino CJ, Leonard CK, O'Connor JV, Crowley C, McCabe J, Tate K, Nakamura G, Powers D, Levinson A, Mohler M, Spellman MW. The Influence of Carbohydrate Structure on the Clearance of Recombinant Tissue-Type Plasminogen Activator. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1647041] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryModification of the carbohydrate structures of recombinant tissue-type plasminogen activator (rt-PA) can increase or decrease its rate of clearance in rabbits. When rt-PA was treated with sodium periodate to oxidize carbohydrate residues, the rate of clearance was decreased from 9.6 ± 1.9 ml min−1 kg−1 to 3.5 ± 0.6 ml min−1 kg−1 (mean ± SD, n = 5). A similar change in the clearance of rt-PA was introduced by the use of endo-β-N-acetyl- glucosaminidase H (Endo-H), which selectively removes high mannose asparagine-linked oligosaccharides; the clearance of Endo-H-treated rt-PA was 5.0 ± 0.5 ml min−1 kg−1. A mutant of rt-PA was produced with an amino acid substitution at position 117 (Asn replaced with Gin) to remove a potential glycosylation site that normally contains a high mannose structure. The clearance of this material was also decreased, similar to the periodate and Endo-H-treated rt-PA. Conversely, when rt-PA was produced in the CHO 15B cell line, which can produce only high mannose oligosaccharide structures on glycoproteins, the clearance was increased by a factor of 1.8. These results demonstrate that the removal of rt-PA from the blood depends significantly upon the nature of its oligosaccharide structures.
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Affiliation(s)
- A Hotchkiss
- The Department of Pharmacological Sciences, Genentech, Inc., South San Francisco, CA, USA
| | - C J Refino
- The Department of Pharmacological Sciences, Genentech, Inc., South San Francisco, CA, USA
| | - C K Leonard
- The Department of Medicinal and Analytical Chemistry, Genentech, Inc., South San Francisco, CA, USA
| | - J V O'Connor
- The Department of Medicinal and Analytical Chemistry, Genentech, Inc., South San Francisco, CA, USA
| | - C Crowley
- The Department of Cell Genetics, Genentech, Inc., South San Francisco, CA, USA
| | - J McCabe
- The Department of Pharmacological Sciences, Genentech, Inc., South San Francisco, CA, USA
| | - K Tate
- The Department of Molecular Biology, Genentech, Inc., South San Francisco, CA, USA
| | - G Nakamura
- The Department of Medicinal and Analytical Chemistry, Genentech, Inc., South San Francisco, CA, USA
| | - D Powers
- The Department of Molecular Biology, Genentech, Inc., South San Francisco, CA, USA
| | - A Levinson
- The Department of Molecular Biology, Genentech, Inc., South San Francisco, CA, USA
| | - M Mohler
- The Department of Pharmacological Sciences, Genentech, Inc., South San Francisco, CA, USA
| | - M W Spellman
- The Department of Molecular Biology, Genentech, Inc., South San Francisco, CA, USA
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Sheehan C, Powers D, Margerison-Zilko C, McDevitt T, Cubbin C. Historical neighborhood poverty trajectories and child sleep. Sleep Health 2018; 4:127-134. [PMID: 29555124 PMCID: PMC5863576 DOI: 10.1016/j.sleh.2017.12.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 09/06/2017] [Revised: 12/07/2017] [Accepted: 12/12/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To determine whether historical neighborhood poverty measures are associated with mothers' reports of their children's sleep duration and to compare results from historical neighborhood poverty measures to contemporaneous measures of neighborhood poverty. DESIGN The Geographic Research on Wellbeing (GROW) study is a follow-up survey of mothers who gave birth between 2003 and 2007. GROW mothers assessed their own and their children's health and health behaviors 5-10 years later (2012-2013). SETTING Urban Californian counties. PARTICIPANTS GROW respondents. MEASUREMENTS We categorized children's sleep as adequate or inadequate using clinical age-specific guidelines and based on mothers' reports of their child's sleep duration. We conducted a latent class analysis to identify historical poverty classes for all California census tracts using data from 1970 to 2005-2009, and we categorized current neighborhood poverty based on data from 2005 to 2009 only. We then assigned children to different neighborhood exposure classes based on their neighborhood of residence at birth and follow-up. RESULTS Logistic models indicated that net of controls for demographics, child behavior and health characteristics, mother characteristics, and household socioeconomic status, children who grew up in historically low (OR: 0.64, 95% confidence interval=0.45-0.92) or historically moderate poverty classes (OR: 0.68, 95% confidence interval=0.48-0.98) had lower odds of inadequate sleep duration compared with children who grew up in historically high poverty. We show that the historical specification of neighborhood poverty remained significant despite controls, whereas contemporaneous measures of neighborhood poverty did not. CONCLUSIONS Our findings indicate strong associations between historical neighborhood poverty and child sleep duration.
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Affiliation(s)
- Connor Sheehan
- Leonard Davis School of Gerontology, University of Southern California.
| | - Daniel Powers
- Department of Sociology and Population Research Center, University of Texas at Austin
| | | | - Teresa McDevitt
- School of Psychological Sciences, University of Northern Colorado
| | - Catherine Cubbin
- School of Social Work and Population Research Center, University of Texas at Austin
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Powers D, Timlin CL, Dias NW, Santili FV, Mercadante VRG. 153 Progesterone Concentration, Follicle Diameter and Corpus Luteum Volume in Beef Cows Supplemented with Ca Salts of Soybean Oil. J Anim Sci 2018. [DOI: 10.1093/jas/sky027.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Powers
- Virginia Tech - Animal and Poultry Sciences, Blacksburg, VA
| | - C L Timlin
- Virginia Tech - Animal and Poultry Sciences, Blacksburg, VA
| | - N W Dias
- Virginia Tech - Animal and Poultry Sciences, Blacksburg, VA
| | - F V Santili
- Virginia Tech - Animal and Poultry Sciences, Blacksburg, VA
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Wang X, Zhang ZY, Powers D, Wang J, Lu S, Arora S, Hughes L, Christensen J, Kansra V. Bioequivalence of Intravenous and Oral Rolapitant: Results From a Randomized, Open-Label Pivotal Study. J Clin Pharmacol 2017; 57:1600-1606. [PMID: 28906561 DOI: 10.1002/jcph.966] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 03/27/2017] [Accepted: 05/17/2017] [Indexed: 11/09/2022]
Abstract
Rolapitant, a selective and long-acting neurokinin-1 receptor antagonist, is approved in an oral formulation for the prevention of delayed chemotherapy-induced nausea and vomiting in adults. The objective of this pivotal study was to assess the bioequivalence of a single intravenous infusion of rolapitant versus a single oral dose of rolapitant. In this randomized, open-label phase 1 study, healthy volunteers were administered rolapitant as a 180-mg oral dose or a 30-minute 166.5-mg intravenous infusion. Blood samples for pharmacokinetic analysis were collected predose and at points up to 912 hours postdose. Criteria for bioequivalence of the intravenous dose versus the oral dose were met if the 90% confidence intervals (CIs) for the ratios of the geometric least-squares means (GLSMs) for the area under the plasma concentration-time curve (AUC) from time 0 to the time of the last quantifiable concentration (AUC0-t ) and AUC from time 0 extrapolated to infinity (AUC0-∞ ) for rolapitant were within 0.80-1.25. Mean rolapitant systemic exposure and half-lives were similar in the oral (n = 62) and intravenous (n = 61) rolapitant groups. The 90%CIs of the ratio of GLSMs were within the 0.80-1.25 range for AUC0-t (0.94-1.09) and AUC0-∞ (0.93-1.10). The incidence of treatment-emergent adverse events, all mild or moderate in severity, was similar in the intravenous and oral groups. A 166.5-mg intravenous infusion of rolapitant met the bioequivalence criteria based on AUC to a 180-mg oral dose and was well tolerated.
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Wang X, Zhang ZY, Arora S, Hughes L, Wang J, Powers D, Christensen J, Lu S, Kansra V. Effects of Rolapitant Administered Intravenously or Orally on the Pharmacokinetics of Digoxin (P-glycoprotein Substrate) and Sulfasalazine (Breast Cancer Resistance Protein Substrate) in Healthy Volunteers. J Clin Pharmacol 2017; 58:202-211. [PMID: 28906558 DOI: 10.1002/jcph.1005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/26/2017] [Indexed: 12/19/2022]
Abstract
Rolapitant is a selective and long-acting neurokinin-1 receptor antagonist approved in an oral formulation in combination with other antiemetic agents for the prevention of delayed chemotherapy-induced nausea and vomiting in adults. Four open-label phase 1 studies evaluated the safety and drug-drug interactions of a single dose of rolapitant given intravenously (166.5 mg) or orally (180 mg) with oral digoxin (0.5 mg) or sulfasalazine (500 mg), probe substrates for the P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP), respectively. Administration of intravenous rolapitant with the substrates did not result in clinically significant effects on digoxin and sulfasalazine pharmacokinetics. In contrast, peak concentration and area under the curve for last quantifiable plasma concentrations increased by 71% (geometric mean ratio [GMR], 1.71; 90% confidence interval [CI], 1.49-1.95) and 30% (GMR, 1.30; 90%CI, 1.19-1.42), respectively, when rolapitant was coadministered orally with digoxin compared with digoxin alone; they increased by 140% (GMR, 2.40; 90%CI, 2.02-2.86) and 127% (GMR, 2.27; 90%CI, 1.94-2.65), respectively, when rolapitant was given orally with sulfasalazine compared with sulfasalazine alone. Adverse events were mild to moderate in severity in the absence or presence of rolapitant. There were no abnormal clinical laboratory or electrocardiogram findings. Thus, whether administered orally or intravenously, rolapitant was safe and well tolerated. Patients taking oral rolapitant with P-gp and BCRP substrates with a narrow therapeutic index should be monitored for potential adverse events; although increased plasma concentrations of these substrates may raise the risk of toxicity, they are not contraindicated.
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Barbour S, Smit T, Wang X, Powers D, Arora S, Kansra V, Aapro M, Herrstedt J. Integrated safety analysis of rolapitant with coadministered drugs from phase II/III trials: an assessment of CYP2D6 or BCRP inhibition by rolapitant. Ann Oncol 2017; 28:1268-1273. [PMID: 28327932 PMCID: PMC5452074 DOI: 10.1093/annonc/mdx073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Rolapitant, a long-acting neurokinin (NK)1 receptor antagonist (RA), has demonstrated efficacy in prevention of chemotherapy-induced nausea and vomiting in patients administered moderately or highly emetogenic chemotherapy. Unlike other NK1 RAs, rolapitant does not inhibit or induce cytochrome P450 (CYP) 3A4, but it does inhibit CYP2D6 and breast cancer resistance protein (BCRP). To analyze potential drug-drug interactions between rolapitant and concomitant medications, this integrated safety analysis of four double-blind, randomized phase II or III studies of rolapitant examined adverse events (AEs) by use versus non-use of drug substrates of CYP2D6 or BCRP. PATIENTS AND METHODS Patients were randomized to receive either 180 mg oral rolapitant or placebo ∼1-2 h before chemotherapy in combination with a 5-hydroxytryptamine type 3 RA and dexamethasone. Data for treatment-emergent AEs (TEAEs) and treatment-emergent serious AEs (TESAEs) during cycle 1 were pooled across the four studies and summarized in the overall population and by concomitant use/non-use of CYP2D6 or BCRP substrate drugs. RESULTS In the integrated safety population, 828 of 1294 patients (64%) in the rolapitant group and 840 of 1301 patients (65%) in the control group experienced at least one TEAE. Frequencies of common TEAEs were similar in the rolapitant and control populations. Overall, 53% of patients received CYP2D6 substrate drugs, none of which had a narrow therapeutic index (like thioridazine or pimozide), and 63% received BCRP substrate drugs. When grouped by concomitant use versus non-use of CYP2D6 or BCRP substrate drugs, TEAEs and TESAEs occurred with similar frequency in the rolapitant and control populations. CONCLUSIONS The results of this study support the safety of rolapitant as part of an antiemetic triple-drug regimen in patients receiving emetogenic chemotherapy, including those administered concomitant medications that are substrates of CYP2D6 or BCRP, such as ondansetron, docetaxel, or irinotecan.
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Affiliation(s)
- S. Barbour
- Department of Pharmacy, Duke University Hospital, Durham, USA
| | - T. Smit
- The Medical Oncology Center of Rosebank, Johannesburg, South Africa
| | | | | | | | | | - M. Aapro
- IMO Clinique de Genolier, Genolier, Switzerland
| | - J. Herrstedt
- Department of Oncology, Odense University Hospital, Odense, Denmark
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Wang X, Zhang ZY, Powers D, Wang J, Lu S, Kansra V. Rolapitant Absolute Bioavailability and PET Imaging Studies in Healthy Adult Volunteers. Clin Pharmacol Ther 2017; 102:332-339. [DOI: 10.1002/cpt.637] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/20/2016] [Accepted: 01/21/2017] [Indexed: 11/09/2022]
Affiliation(s)
- X Wang
- Tesaro Inc; Waltham Massachusetts USA
| | - ZY Zhang
- Tesaro Inc; Waltham Massachusetts USA
| | - D Powers
- Tesaro Inc; Waltham Massachusetts USA
| | - J Wang
- Tesaro Inc; Waltham Massachusetts USA
| | - S Lu
- Tesaro Inc; Waltham Massachusetts USA
| | - V Kansra
- Tesaro Inc; Waltham Massachusetts USA
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Schwartzberg L, Navari R, Arora S, Powers D, Jordan K, Rapoport B. Abstract P5-11-15: Rolapitant for the prevention of chemotherapy-induced nausea and vomiting in breast cancer patients receiving multiple cycles of emetogenic chemotherapy. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-11-15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Patients (pts) with breast cancer often receive highly emetogenic chemotherapy, such as anthracycline plus cyclophosphamide (AC). Additionally, young age and female gender are risk factors for chemotherapy-induced nausea and vomiting (CINV) in response to emetogenic chemotherapy. We assessed the ability of the long-acting neurokinin-1 receptor antagonist (RA), rolapitant, in the prevention of CINV over multiple cycles in pts with breast cancer
Methods: This is a post hoc analysis of the prevention of CINV in a subset of pts with breast cancer from 3 similarly-designed, randomized, placebo-controlled phase 3 trials in which pts received a single oral dose of 180 mg rolapitant or placebo before chemotherapy. All pts received an oral 5-HT3 RA + dexamethasone (active control). The regimens were cisplatin-based (n=36), AC-based (n=681) or other (n=166; carboplatin, cyclophosphamide, etc). Pts who completed cycle 1 could continue the same antiemetic treatment in multiple cycles. Endpoints for cycle 1 of chemotherapy included complete response (CR; no emesis and no use of rescue medication) and no emesis, and no nausea (maximum visual analogue scale [VAS] <5 mm), in the overall (0–120 h), acute (≤24 h), and delayed (>24–120 h) phases. On days 6-8 of each subsequent chemotherapy cycle, pts self-reported the incidence of emesis or nausea interfering with normal daily life.
Results: In cycle 1, CR in both the overall (62.9% rolapitant, 55.1% control; p=0.018) and delayed (66.7% rolapitant, 59.7% control; p=0.032) phases were higher with rolapitant vs control . Rolapitant also improved no emesis rates in the overall (74.4% rolapitant, 62.6% control; p<0.001) and delayed (77.2% rolapitant, 68.5% control; p=0.004) phases. Although less pts were available for follow up over multiple cycles, a numerically greater proportion of rolapitant-treated pts than control pts reported no emesis (cycles 2-6) and no interfering nausea (cycles 2-5) (table). The incidence of treatment-emergent adverse events (TEAEs) was similar for rolapitant (85.2%) and control (83.2%) during cycles 1-6. The most common TEAEs occurred at comparable rates in the rolapitant and control arms: fatigue (28.5% and 29.4%, respectively), alopecia (28.5% and 31.2%, respectively), and constipation (20.0% and 20.9%, respectively).
Conclusions: Rolapitant added to 5-HT3 RA and dexamethasone therapy improved CINV control and was safe and well-tolerated in pts with breast cancer receiving multiple cycles of emetogenic chemotherapy, mostly AC and carboplatin, historically a high-risk population for CINV.
Pt-Reported Response in Multiple Cycles, % (n/N)* No Emesis No Interfering Nausea CycleRolapitant 180 mgActive Controlp-value *Rolapitant 180 mgActive Controlp-value *288.3 (323/366)80.0 (308/385)0.00271.6 (262/366)68.3 (263/385)0.329390.5 (297/328)80.5 (293/364)<0.00173.8 (242/328)65.9 (240/364)0.025487.5 (266/304)82.4 (277/336)0.07579.3 (241/304)72.0 (242/336)0.033594.9 (111/117)88.2 (127/144)0.05987.2 (102/117)80.6 (116/144)0.152695.3 (102/107)88.9 (120/135)0.07184.1 (90/107)83.0 (112/135)0.811* Unstratified Cochran-Mantel-Haenszel test for between rolapitant and control difference in response rate.
Citation Format: Schwartzberg L, Navari R, Arora S, Powers D, Jordan K, Rapoport B. Rolapitant for the prevention of chemotherapy-induced nausea and vomiting in breast cancer patients receiving multiple cycles of emetogenic chemotherapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-15.
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Affiliation(s)
- L Schwartzberg
- The West Clinic, Memphis, TN; Indiana University School of Medicine - South Bend, South Bend, IN; TESARO, Inc., Waltham, MA; Martin-Luther-University Halle-Wittenberg, Halle, Germany; The Medical Oncology Centre of Rosebank, Johannesburg, South Africa
| | - R Navari
- The West Clinic, Memphis, TN; Indiana University School of Medicine - South Bend, South Bend, IN; TESARO, Inc., Waltham, MA; Martin-Luther-University Halle-Wittenberg, Halle, Germany; The Medical Oncology Centre of Rosebank, Johannesburg, South Africa
| | - S Arora
- The West Clinic, Memphis, TN; Indiana University School of Medicine - South Bend, South Bend, IN; TESARO, Inc., Waltham, MA; Martin-Luther-University Halle-Wittenberg, Halle, Germany; The Medical Oncology Centre of Rosebank, Johannesburg, South Africa
| | - D Powers
- The West Clinic, Memphis, TN; Indiana University School of Medicine - South Bend, South Bend, IN; TESARO, Inc., Waltham, MA; Martin-Luther-University Halle-Wittenberg, Halle, Germany; The Medical Oncology Centre of Rosebank, Johannesburg, South Africa
| | - K Jordan
- The West Clinic, Memphis, TN; Indiana University School of Medicine - South Bend, South Bend, IN; TESARO, Inc., Waltham, MA; Martin-Luther-University Halle-Wittenberg, Halle, Germany; The Medical Oncology Centre of Rosebank, Johannesburg, South Africa
| | - B Rapoport
- The West Clinic, Memphis, TN; Indiana University School of Medicine - South Bend, South Bend, IN; TESARO, Inc., Waltham, MA; Martin-Luther-University Halle-Wittenberg, Halle, Germany; The Medical Oncology Centre of Rosebank, Johannesburg, South Africa
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Rapoport BL, Schwartzberg LS, Arora S, Powers D, Jordan K, Navari RM. Rolapitant for control of chemotherapy-induced nausea and vomiting (CINV) in patients with gynecologic cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.26_suppl.223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
223 Background: Rolapitant, a long-acting neurokinin-1 receptor antagonist, protected against CINV in patients receiving highly or moderately emetogenic chemotherapy (HEC or MEC). Methods: In 3 double-blind phase 3 studies, patients were randomized to receive oral rolapitant 180 mg or placebo before administration of HEC or MEC. All patients received a 5-hydroxytryptamine type 3 receptor antagonist and dexamethasone. In a post hoc analysis of 3 pooled studies (2 HEC and 1 MEC), we assessed the efficacy and safety of rolapitant in patients with gynecologic (ovarian, uterine, or cervical) cancer. Endpoints included complete response (CR; no emesis and no use of rescue medication), no emesis, no nausea (maximum visual analogue scale [VAS] < 5 mm), and complete protection (CP; no emesis, no use of rescue medication, and no significant nausea [maximum VAS < 25 mm]) in the overall (0–120 h), acute (≤ 24 h), and delayed (> 24–120 h) phases. Results: Of 201 patients with gynecologic cancer (60% ovarian, 28% uterine, and 12% cervical cancer), 55% received cisplatin-based HEC and 44% received MEC (99% of whom received carboplatin-based therapy). In the overall and delayed phases, improved rates of CR, no emesis, no nausea, and CP were observed with rolapitant compared with control (Table). The overall incidence of treatment-emergent adverse events was similar in the rolapitant and control groups (45% vs 54%). Conclusions: Rolapitant protected against overall and delayed CINV in patients with gynecologic cancer receiving HEC or MEC. Clinical trial information: NCT01500226, NCT01499849, NCT01500213. [Table: see text]
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Affiliation(s)
| | | | | | | | - Karin Jordan
- Martin Luther University Halle-Wittenberg, Halle, Germany
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Navari RM, Jordan K, Rapoport BL, Schnadig ID, Chasen M, Arora S, Powers D, Schwartzberg LS. Efficacy of rolapitant for prevention of chemotherapy-induced nausea and vomiting (CINV) in patients with gastrointestinal and colorectal cancers. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.26_suppl.222] [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
222 Background: Rolapitant (VARUBI) is a selective, long-acting neurokinin-1 receptor antagonist (RA) for the prevention of CINV. Rolapitant effectively prevented CINV in phase 3 trials of patients (pts) receiving highly or moderately emetogenic chemotherapy (HEC, MEC). While MEC and HEC regimens are commonly used to treat pts with gastrointestinal and colorectal cancers (GI/CRC), very few studies have evaluated the effectiveness of a neurokinin-1 RA regimen in these pts. We assessed the incidence of CINV and efficacy of rolapitant in a subset of pts with GI/CRC. Methods: This is a post hoc analysis of 3 similarly-designed, randomized, placebo-controlled trials. Pts with cancer of the esophagus, stomach, colon/rectum, or anus received a single oral dose of 180 mg oral rolapitant or placebo prior to HEC or MEC. All pts received a 5-hydroxytryptamine type 3 (5-HT3) RA and dexamethasone (active control). The HEC studies included cisplatin, and the MEC study carboplatin, oxaliplatin, irinotecan, epirubicin, and doxorubicin. Endpoints included complete response (CR; no emesis and no use of rescue medication), no emesis, no nausea (maximum visual analogue scale [VAS] < 5 mm), no significant nausea (maximum VAS < 25mm) and complete protection (CP; no emesis, no use of rescue medication, and no significant nausea) in the overall (0-120 h), acute (≤ 24 h), and delayed (> 24-120 h) phases. Results: Out of 188 GI/CRC pts, 101 pts received rolapitant and 87 received active control. Pts treated with rolapitant had significantly higher rates of CR, no nausea, no emesis, and CP in the overall phase (P < 0.05). Rolapitant was well-tolerated and overall incidence of treatment-emergent adverse events comparable in both groups. Conclusions: Addition of rolapitant to 5-HT3RA and dexamethasone therapy significantly improved CR, no nausea, no emesis, and CP in pts with GI/CRC receiving emetogenic chemotherapy. Clinical trial information: NCT01500226, NCT01499849, NCT01500213. [Table: see text]
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Affiliation(s)
| | - Karin Jordan
- Martin Luther University Halle-Wittenberg, Halle, Germany
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Navari RM, Nagy CK, Arora S, Powers D, Clark-Snow RA. Rolapitant for the prevention of nausea in patients receiving moderately or highly emetogenic chemotherapy. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.26_suppl.224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
224 Background: Nausea control remains an unmet need for patients receiving moderately or highly emetogenic chemotherapy (MEC, HEC). The objective of this analysis was to determine the effect of the neurokinin-1 (NK-1) receptor antagonist rolapitant (VARUBI) on the prevention of nausea in patients receiving either MEC or HEC. Methods: Post hoc analyses of nausea from three randomized, double-blind, active-controlled, phase 3 clinical trials were performed for carboplatin-based MEC (n = 401), non-carboplatin-based MEC (n = 228), total MEC (n = 629), anthracycline/cyclophosphamide (AC)-based chemotherapy (n = 703), and cisplatin-based HEC (n = 1070). Patients were randomized 1:1 to oral rolapitant 180 mg or placebo ~1–2 h before chemotherapy. All patients received active control: granisetron 2 mg oral or 10 mcg/kg IV and oral dexamethasone 20 mg. Granisetron was continued on days 2 and 3 for patients receiving MEC or AC-based therapy and dexamethasone 8 mg twice daily on days 2–4 for patients receiving HEC. Patients self-assessed nausea on days 1–6 using a 100-mm visual analog scale (VAS). Percentage of patients with no nausea (NN; maximum VAS < 5 mm) or no significant nausea (NSN; maximum VAS < 25 mm) was determined for overall, delayed, and acute phases of CINV in cycle 1. Results: Rates of NN in the carboplatin-based MEC and total MEC subgroups were significantly higher (P < 0.05) with rolapitant than active control in the delayed and overall phases. In the cisplatin-based HEC subgroup, rates of NN and NSN were significantly higher (P < 0.05) with rolapitant than active control in the delayed, acute, and overall phases. Conclusions: Rolapitant prevents nausea during all CINV phases in patients receiving cisplatin-based HEC, and during the delayed and overall phases in patients receiving carboplatin-based MEC. Clinical trial information: NCT01500226, NCT01499849, NCT01500213.
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Affiliation(s)
- Rudolph M. Navari
- Indiana University School of Medicine South Bend, Cancer Control Program, World Health Organization, South Bend, IN
| | - Cindy K Nagy
- Indiana University School of Medicine South Bend, South Bend, IN
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Navari R, Jordan K, Rapoport B, Schnadig I, Chasen M, Arora S, Powers D, Schwartzberg L. Efficacy of rolapitant for prevention of chemotherapy-induced nausea and vomiting (CINV) in patients with gastrointestinal and colorectal cancers. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Schwartzberg L, Jordan K, Rapoport B, Schnadig I, Chasen M, Arora S, Barbour S, Powers D, Navari R. Safety of rolapitant for prevention of chemotherapy-induced nausea and vomiting (CINV) in patients receiving breast cancer resistant protein (BCRP) substrate chemotherapy agents. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.10] [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: 11/13/2022] Open
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Aapro M, Arora S, Powers D. Efficacy and safety of rolapitant in the prevention of chemotherapy-induced nausea and vomiting (CINV) in elderly patients. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lyman G, King D, Evuarhehe O, Powers D, Harrow B. Systematic review of the efficacy and safety of neurokinin-1 receptor antagonists for chemotherapy-induced nausea and vomiting: identification of the relevant clinical trials. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.11] [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: 11/13/2022] Open
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Rapoport BL, Schwartzberg LS, Arora S, Powers D, Jordan K, Navari RM. Rolapitant for control of chemotherapy-induced nausea and vomiting (CINV) in patients with gynecologic cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Karin Jordan
- Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Schwartzberg LS, Navari RM, Arora S, Powers D, Jordan K, Rapoport BL. Rolapitant for prevention of chemotherapy-induced nausea and vomiting (CINV) in patients with breast cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Karin Jordan
- Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Powers D, Schnadig ID, Modiano MR, Arora S, Schwartzberg LS. Efficacy and safety of rolapitant for prevention of chemotherapy-induced nausea and vomiting (CINV) in patients (pts) receiving anthracycline-cyclophosphamide (AC)-based chemotherapy. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.29_suppl.208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
208 Background: Rolapitant, a novel NK-1 receptor antagonist, demonstrated efficacy in the prevention of CINV in pts receiving moderately- or highly emetogenic chemotherapy (MEC; HEC). In this post-hoc analysis, we evaluated safety and efficacy outcomes in pts receiving AC-based therapy, now considered HEC. Methods: This double-blind, active-controlled study randomized pts to oral rolapitant 180 mg plus granisetron 2 mg and dexamethasone 20 mg or granisetron/dexamethasone alone (active control). Complete response (CR = no emesis and no use of rescue medication), no emesis, no significant nausea, and time to emesis or rescue medication during overall, acute, and delayed phases and treatment-emergent adverse events (AEs) are presented. Results: 703 pts received AC-based therapy, of which 97% had breast cancer. CR was significantly higher for rolapitant vs. active control for delayed and overall phases in pts receiving AC-based therapy (Table). Time to first emesis or use of rescue medication was significantly longer with rolapitant vs. active control (between-group comparison, p = 0.032); median was not reached in either treatment arm. A significantly greater proportion of pts on rolapitant (73.0%) vs. active control (60.2%) had no emesis during the overall phase (p < 0.001). Rates of no significant nausea were similar for rolapitant (63.7%) and active control (62.4%) in the overall phase (p = 0.728). Treatment-related AEs (TRAEs) during Cycle 1 occurred in 8.7% and 8.8% of pts on rolapitant vs. active control. Most frequent TRAEs were constipation (2.9% vs. 2.7%), fatigue (2.3% vs. 2.2%), and headache (2.3% vs. 3.3%). Conclusions: Rolapitant was superior to active control in preventing CINV during delayed and overall phases after AC-based chemotherapy. The safety profiles of the rolapitant and control arms were similar. These results are consistent with those of the overall pt population in this study. Clinical trial information: NCT01500226. [Table: see text]
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Affiliation(s)
| | | | - Manuel R. Modiano
- ACRC/Arizona Clinical Research Center and Arizona Oncology, Tucson, AZ
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Rapoport BL, Schwartzberg LS, Chasen MR, Powers D, Arora S, Navari RM, Schnadig ID. Efficacy and safety of rolapitant for prevention of chemotherapy-induced nausea and vomiting (CINV) over multiple cycles of highly or moderately emetogenic chemotherapy (HEC, MEC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.29_suppl.210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
210 Background: The long-acting neurokinin-1 receptor antagonist (NK-1 RA) rolapitant has demonstrated efficacy for CINV prevention in patients receiving HEC and MEC during Cycle 1. The efficacy and safety of rolapitant was examined during subsequent cycles 2–6 in a pooled analysis. Methods: In 4 double-blind, active-controlled studies, patients were randomized to oral rolapitant 180 mg or placebo 1–2 hours before chemotherapy. All patients received active control: 5HT3 receptor antagonist + oral dexamethasone. Patients completing Cycle 1 could receive the same anti-emetic treatment in subsequent cycles. On Days 6-8 of subsequent cycles, patients self-reported the incidence of emesis, or of nausea interfering with normal daily life following Day 1 of chemotherapy. Results: A greater proportion of patients on rolapitant than on active control reported no emesis or interfering nausea separately for each subsequent cycle. Results of individual studies and pooled analysis are shown in the Table. During cycles 2-6, the incidence of treatment-related adverse events (AEs) was similar for rolapitant (5.5%) and control (6.8%). The most common treatment-related AEs were similar in both arms: constipation (rolapitant: 1.2%; control: 0.8%) and fatigue (rolapitant: 1.3%; control: 1.8%). Conclusions: Rolapitant was superior to active control in reducing CINV when administered over multiple cycles of moderately or highly emetogenic chemotherapy, with no increase in toxicity. Clinical trial information: NCT00394966 - NCT01500213 - NCT01500226 - NCT01499849. [Table: see text]
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Powers D, Hesketh PJ, Schwartzberg LS, Modiano MR, Arora S, Schnadig ID. Efficacy and safety of rolapitant for prevention of chemotherapy-induced nausea and vomiting (CINV) in non–anthracycline/cyclophosphamide (AC)-based moderately emetogenic therapy (MEC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.29_suppl.209] [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
209 Background: Rolapitant, a novel NK-1 receptor antagonist, showed efficacy in CINV prevention in patients (pts) receiving MEC (anthracycline/cyclophosphamide (AC) and other regimens) in a global phase 3 trial. Recent anti-emetic guidelines consider AC based regimens to be highly emetogenic. In this post hoc analysis, the efficacy and safety of rolapitant was assessed in Cycle 1 in pts receiving non-AC MEC, and in the subset of pts receiving carboplatin-based MEC. Methods: In a double-blind, active-controlled study, pts were randomized to oral rolapitant 180 mg or placebo 1–2 hours before MEC. All pts received granisetron 2 mg oral on days 1-3 and oral dexamethasone 20 mg on day 1. Complete response (CR = no emesis + no use of rescue medication), no emesis, and no nausea were assessed in overall (0-120 h), acute (0-24 h), and delayed ( > 24-120 h) phases. Results: CR was significantly (P < 0.01) higher with rolapitant than active control in overall and delayed phases in the carboplatin subset and in all 3 phases in the non-AC population (Table). No emesis rates were significantly (p < 0.05) higher with rolapitant in the carboplatin subset in the overall phase. No nausea rates were significantly (P < 0.05) higher with rolapitant in the overall and delayed phases in carboplatin-based MEC. Incidences of treatment-related AEs in Cycle 1 with rolapitant vs. active control were 11.3% vs. 6.7% in the carboplatin-based subset. Most common AEs with rolapitant and active control were constipation, fatigue, and headache. Conclusions: Rolapitant was superior to active control in preventing CINV in pts receiving non-AC MEC, including in the subgroup receiving carboplatin. Rolapitant was well tolerated with low incidence of AEs. Clinical trial information: NCT01500226. [Table: see text]
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Affiliation(s)
| | | | | | - Manuel R. Modiano
- ACRC/Arizona Clinical Research Center and Arizona Oncology, Tucson, AZ
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Girault N, Bosland L, Dickinson S, Funke F, Güntay S, Herranz L, Powers D. LWR severe accident simulation: Iodine behaviour in FPT2 experiment and advances on containment iodine chemistry. Nuclear Engineering and Design 2012. [DOI: 10.1016/j.nucengdes.2011.11.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Powers D. Distribution of Civilian and Military Maxillofacial Surgical Procedures performed in an Air Force Theatre Hospital: Implications for Training and Readiness. J ROY ARMY MED CORPS 2010; 156:117-21. [DOI: 10.1136/jramc-156-02-13] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
We consider how marital status and marital transitions, important features of the social environment, influence weight change over time, and how these effects vary by age, race, and gender. Growth curve analysis of a four-wave national survey suggests that marital transitions are more important than marital status in predicting change in body weight, and that marital dissolution is more important than marital formation in affecting weight. Widowhood effects on weight loss are a particular concern for population health trends, especially among African Americans.
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Affiliation(s)
- Debra Umberson
- University of Texas at Austin, Department of Sociology, Austin, TX 78712, USA.
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Casotti G, Waldron T, Misquith G, Powers D, Slusher L. Expression and localization of an aquaporin-1 homologue in the avian kidney and lower intestinal tract. Comp Biochem Physiol A Mol Integr Physiol 2007; 147:355-62. [PMID: 17320442 DOI: 10.1016/j.cbpa.2007.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Revised: 01/05/2007] [Accepted: 01/05/2007] [Indexed: 10/23/2022]
Abstract
In birds, the kidneys and lower intestine function in osmoregulation. A 271-amino acid homologue to aquaporin-1 (AQP-1) was isolated from the kidneys, cecae, proximal and distal rectum, and coprodeum of the lower intestine in the house sparrow (Passer domesticus). This protein has six transmembrane domains connected by two cytoplasmic loops and three extracellular loops. It exhibits 94%, 88%, and 78% homology to AQP-1 sequences of chicken, human and toad, respectively. Many of the highly conserved amino acids that are characteristic of AQP-1 are found in the sparrow sequence. RT-PCR was performed and the presence of AQP-1 mRNA was detected in the kidney and all four regions of the lower intestine. Immunoblots of total protein identified a 28-kDa non-glycosylated AQP-1 band and a 56-kDa glycosylated AQP-1 band in the kidney and all four regions of the lower intestine. Immunohistochemistry demonstrated the presence of the AQP-1 protein within both the renal cortex and medulla. In the lower intestine, the protein was present in the proximal rectum, distal rectum, and in the coprodeum. As AQP-1 functions to allow water movement across mammalian cell membranes, its presence in water-permeable cells in a bird suggests it may have a similar function.
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Affiliation(s)
- G Casotti
- Department of Biology, West Chester University of Pennsylvania, West Chester, PA 19383, USA.
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Yang X, Parker D, Whitehead L, Ryder NS, Weidmann B, Stabile-Harris M, Kizer D, McKinnon M, Smellie A, Powers D. A collaborative hit-to-lead investigation leveraging medicinal chemistry expertise with high throughput library design, synthesis and purification capabilities. Comb Chem High Throughput Screen 2006; 9:123-30. [PMID: 16475970 DOI: 10.2174/138620706775541891] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
High throughput screening (HTS) campaigns, where laboratory automation is used to expose biological targets to large numbers of materials from corporate compound collections, have become commonplace within the lead generation phase of pharmaceutical discovery. Advances in genomics and related fields have afforded a wealth of targets such that screening facilities at larger organizations routinely execute over 100 hit-finding campaigns per year. Often, 10(5) or 10(6) molecules will be tested within a campaign/cycle to locate a large number of actives requiring follow-up investigation. Due to resource constraints at every organization, traditional chemistry methods for validating hits and developing structure activity relationships (SAR) become untenable when challenged with hundreds of hits in multiple chemical families per target. To compound the issue, comparison and prioritization of hits versus multiple screens, or physical chemical property criteria, is made more complex by the informatics issues associated with handling large data sets. This article describes a collaborative research project designed to simultaneously leverage the medicinal chemistry and drug development expertise of the Novartis Institutes for Biomedical Research Inc. (NIBRI) and ArQule Inc.'s high throughput library design, synthesis and purification capabilities. The work processes developed by the team to efficiently design, prepare, purify, assess and prioritize multiple chemical classes that were identified during high throughput screening, cheminformatics and molecular modeling activities will be detailed.
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Affiliation(s)
- X Yang
- Infectious Diseases, Novartis Institutes for Biomedical Research Inc., 100 Technology Square, Cambridge, MA 02139, USA
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Wang S, Cowan C, Chipperfield H, Witmyer J, Powers D. Maternal Vs. Embryo Genes: Which One Is More Important For Embryo Culture? Fertil Steril 2005. [DOI: 10.1016/j.fertnstert.2005.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wang S, Chipperfield H, Cowan C, Melton D, Powers D. Comparison of global gene expression profiles between embryos cultured in vitro and obtained in vivo using DNA microarrays. Fertil Steril 2004. [DOI: 10.1016/j.fertnstert.2004.07.722] [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: 11/24/2022]
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Abstract
This article describes women who called a research line to quit smoking and identifies correlates of confidence in quitting among the callers. Approximately 4,000 women called the study line to participate after a single press release, indicating intensive interest in quitting. Overall, the randomized sample of women was aged 26 to 65 years, reported smoking just over one pack per day, was mostly White, predominantly employed, and had quit an average of two times the past year before joining the study. Standard background variables, such as age, income, body weight and smoking history variables did not predict baseline self-efficacy or confidence in quitting. However, level of stress, cognitive restraint, and weight gain concerns did predict self-efficacy. These data indicate strong interest in quitting among women and highlight the role of affect and weight concerns in quitting confidence.
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Affiliation(s)
- D J Bowen
- Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
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Abstract
OBJECTIVE We examined recent trends in success rates for assisted reproduction and determined the influence of changes in patient selection and treatment characteristics on these trends. METHODS We collected baseline information and abstracted treatment-related details and outcomes on 1244 couples accepted for in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT) at three clinics in greater Boston from 1994-1998. RESULTS Delivery rates per initiated cycle improved significantly from 14.9% for IVF and 20.6% for GIFT in 1994-1995 to 22.5% for IVF and 28.0% for GIFT in 1997-1998 (P < or = .001). After adjusting for female age, the two treatment-related variables that appeared most likely to explain this trend were decreased use of GnRH agonists in short course (flare) regimens and increased use of highly purified forms of urinary gonadotropins. CONCLUSION There were significant improvements in the success rates for IVF and GIFT from 1994-1998 that correlated with changes in ovulation induction regimens.
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Affiliation(s)
- D W Cramer
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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Abstract
A case report is presented on the experience of a mother diagnosed with insufficient glandular tissue at 3 months postpartum with her first child who then went on to breastfeed her second child (fifth pregnancy) without supplementation of any kind. The mother had difficulty becoming pregnant and maintaining a pregnancy. She was diagnosed with a luteal phase defect and was thus treated with natural progesterone during her fifth pregnancy. The authors speculate that this treatment may have stimulated the development of her mammary alveolar cells, allowing lactation to progress normally.
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Affiliation(s)
- V Bodley
- Deaconess Family Birth Center, MT, USA
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Koertge TE, Brooks CN, Sarbin AG, Powers D, Gunsolley JC. A longitudinal comparison of tooth whitening resulting from dentifrice use. J Clin Dent 1999; 9:67-71. [PMID: 10518865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The effect of twice-daily brushing with one of three different dentifrices (Arm & Hammer Dental Care, Arm & Hammer Dental Care Extra Whitening, Crest) on stain removal and tooth whitening was examined in 115 volunteers over a period of 12 weeks. The facial surfaces of 12 anterior teeth were assessed for stain using a published, modified version of a standard stain index. Whiteness was measured on teeth 8 and 9 using a single Vita Lumin-Vaccum Shade Guide for consistency. At baseline, the mean facial stain scores were significantly higher (p < 0.05-0.01) for both Arm & Hammer dentifrices than for Crest. In addition, the tooth shades, as indicated by the stain guide, specifically the b* values representing yellowness, were quantified using a Minolta spectrophotometer. Arm & Hammer Dental Care Extra Whitening formula was found to be significantly better than Crest at removing naturally occurring extrinsic stain. The difference between Arm & Hammer Dental Care Extra Whitening and Crest became significant (p < 0.01) after two weeks of use, and remained intact during the balance of the study, achieving p values of 0.0002 for at least one of the three assessed parameters (total stain, proximal, and facial) at weeks 4 and 12. The study also found that Arm & Hammer Dental Care produced a significant increase in tooth whiteness by week 12, whereas Crest showed no such increase at any time during the study. These results suggest that the two Arm & Hammer Baking Soda products are more effective in reducing stain and increasing whiteness than the standard silica-based dentifrice. Their effectiveness is not related to abrasivity since they are less abrasive to tooth enamel than the silica-based product tested.
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Affiliation(s)
- T E Koertge
- Department of Periodontics, Virginia Commonwealth University School of Dentistry, Richmond, USA.
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Bowen D, McTiernan A, Burke W, Powers D, Pruski J, Durfy S, Gralow J, Malone K. Participation in breast cancer risk counseling among women with a family history. Cancer Epidemiol Biomarkers Prev 1999; 8:581-5. [PMID: 10428194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
Recent scientific breakthroughs in the genetics of breast cancer may have had effects on women's perceptions of risk and subsequent worry about breast cancer. Here, we present the rates of interest in counseling among women identified from diverse sources, their levels of cancer worry and perceived risk, and predictors of their agreement to participate in breast cancer risk counseling. Women were identified through breast cancer cases and through media offers. They completed a telephone survey and were ultimately either entered or not entered into a counseling trial. Overall, almost half (46%) of cases who were approached responded to the contact letter asking for information about potentially interested relatives. A total of 588 women responded to the brief media solicitations over a 15-week period. Participants recruited from media contacts reported slightly but significantly higher levels of worry about getting cancer, compared to case-recruited participants. Cancer worry negatively and significantly predicted entry into the counseling project. The results presented here may have implications for recruiting women in the general population with a family history of breast cancer for counseling about their risk for the disease.
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Affiliation(s)
- D Bowen
- Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA.
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Schilling M, Povinelli L, Krause P, Gravenstein M, Ambrozaitis A, Jones HH, Drinka P, Shult P, Powers D, Gravenstein S. Efficacy of zanamivir for chemoprophylaxis of nursing home influenza outbreaks. Vaccine 1998; 16:1771-4. [PMID: 9778755 DOI: 10.1016/s0264-410x(98)00141-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Despite vaccination, influenza remains a common of morbidity in nursing homes. Chemoprophylaxis of residents with currently available antivirals is not always effective and new agents effective against both influenza A and B are needed. In a randomized, unblinded pilot study, we compared 14 day chemoprophylaxis with zanamivir, an antiviral which inhibits influenza neuraminidase, to standard of care during sequential influenza A and influenza B outbreaks in a 735 bed nursing home. Influenza A outbreaks were declared on 6/14 epidemic units. Sixty-five volunteers on four epidemic units were randomized to zanamivir and on two epidemic units, 23 volunteers were randomized to rimantadine. During the 14 days of prophylaxis, only four new febrile respiratory illnesses were detected. One volunteer receiving rimantadine prophylaxis developed laboratory-confirmed influenza. Influenza B outbreaks were declared on 3/14 epidemic units. Thirty-five volunteers on two epidemic units were randomized to zanamivir and 18 volunteers on one epidemic unit were randomized to no drug. During the 14 days of prophylaxis, only one new febrile respiratory illness was detected. One volunteer randomized to receive no drug developed laboratory-confirmed influenza. Zanamivir appears comparably effective to standard of care in preventing influenza-like illness and laboratory-confirmed influenza in nursing homes, but requires further testing.
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Affiliation(s)
- M Schilling
- Eastern Virginia Medical School, Norfolk, VA, USA
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