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D’Haens G, Baert F, Danese S, Kobayashi T, Loftus EV, Sandborn WJ, Dornic Q, Lindner D, Kisfalvi K, Marins EG, Vermeire S. Efficacy of vedolizumab during intravenous induction therapy in ulcerative colitis and Crohn's disease: post hoc analysis of patient-reported outcomes from the VISIBLE 1 and 2 studies. Eur J Gastroenterol Hepatol 2024; 36:404-415. [PMID: 38417060 PMCID: PMC10904001 DOI: 10.1097/meg.0000000000002728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/11/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND Vedolizumab is an anti-α4β7 integrin antibody used to treat moderate to severe ulcerative colitis (UC) and Crohn's disease (CD). This post hoc analysis of patient-reported outcomes (PROs) from the VISIBLE 1 (NCT02611830) and 2 (NCT02611817) phase 3 studies evaluated onset of treatment effect on patient-reported symptoms during 6-week vedolizumab induction. METHODS Patient-reported stool frequency (SF) and rectal bleeding (RB) (UC Mayo score), and SF and abdominal pain (AP) in CD were collected via electronic diary from VISIBLE patients receiving one or more open-label intravenous (IV) vedolizumab induction doses (weeks 0 and 2). PRO data were analyzed using descriptive statistics. RESULTS Data from 994 patients (UC 383, CD 611) showed mean ratings for all PROs declined consistently week-on-week from baseline through week 6, with early onset of improvement. By week 2, 22% of patients with UC reported RB improvement (≥1-point reduction in RB subscore, 7-day mean), rising to 45% by week 6. By week 6, 18% of patients with UC achieved SF improvement (SF subscore 0; 21% antitumor necrosis factor alpha [anti-TNFα] naive, 13% anti-TNFα experienced). SF improvement in patients with CD (reduction of ≥3 stools, 7-day mean) was achieved by 32% at week 6 (34% anti-TNFα naive, 30% anti-TNFα experienced). Fewer patients with CD reported severe/moderate AP at week 6 (5.1%/28.5%) than baseline (14.6%/61.5%). SF decline appeared greater and faster for anti-TNFα-naive vs. anti-TNFα-experienced patients (UC and CD). CONCLUSION Results indicate early onset of patient-reported UC and CD symptom improvement during vedolizumab IV induction in VISIBLE 1 and 2.
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Affiliation(s)
- Geert D’Haens
- Department of Gastroenterology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Filip Baert
- Department of Gastroenterology, AZ Delta, Roeselare, Belgium
| | - Silvio Danese
- Department of Gastroenterology, IRCCS Ospedale and University Vita-Salute, San Raffaele, Milan, Italy
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Edward V. Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - William J. Sandborn
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | | | | | | | | | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
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Wu T, Hagiwara M, Gnass E, Barman H, Sasson D, Treem W, Ren K, Marins EG, Karki C, Malhi H. Liver disease progression in patients with alpha-1 antitrypsin deficiency and protease inhibitor ZZ genotype with or without lung disease. Aliment Pharmacol Ther 2023; 58:1075-1085. [PMID: 37718576 DOI: 10.1111/apt.17715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/09/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Alpha-1 antitrypsin deficiency (AATD) is caused by mutations in SERPINA1, which encodes alpha-1 antitrypsin, a protease inhibitor (Pi). Individuals with AATD and the homozygous Pi*ZZ genotype have variable risk of progressive liver disease but the influence of comorbid lung disease is poorly understood. AIMS To characterise patients with AATD Pi*ZZ and liver disease (AATD-LD-Pi*ZZ) with or without lung disease and describe liver disease-related clinical events longitudinally. METHODS This was an observational cohort study of patients in the Mayo Clinic Healthcare System (January 2000-September 2021). Patients were identified using diagnosis codes and natural language processing. Fibrosis stage (F0-F4) was assessed using a hierarchical approach at baseline (90 days before or after the index date) and follow-up. Clinical events associated with liver disease progression were assessed. RESULTS AATD-LD-Pi*ZZ patients with lung disease had a longer median time from AATD diagnosis to liver disease diagnosis versus those without lung disease (2.2 vs. 0.2 years, respectively). Compared to those without lung disease, patients with lung disease had a longer time to liver disease-related clinical events (8.5 years and not reached, respectively). AATD-LD-Pi*ZZ patients without lung disease were more likely to undergo liver transplantation compared with those with lung disease. CONCLUSION In patients with AATD and lung disease, there is a delay in the diagnosis of comorbid liver disease. Our findings suggest that liver disease may progress more rapidly in patients without comorbid lung disease.
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Affiliation(s)
- Tiffany Wu
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - May Hagiwara
- Takeda Development Center Americas, Inc., Lexington, Massachusetts, USA
| | | | | | | | - William Treem
- Takeda Development Center Americas, Inc., Lexington, Massachusetts, USA
| | - Kaili Ren
- Takeda Development Center Americas, Inc., Lexington, Massachusetts, USA
| | - Ed G Marins
- Takeda Development Center Americas, Inc., Lexington, Massachusetts, USA
| | - Chitra Karki
- Takeda Development Center Americas, Inc., Lexington, Massachusetts, USA
| | - Harmeet Malhi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Picker N, Hagiwara M, Baumann S, Marins EG, Wilke T, Ren K, Maywald U, Karki C, Strnad P. Liver disease epidemiology and burden in patients with alterations in plasma protein metabolism: German retrospective insurance claims analysis. World J Hepatol 2023; 15:1127-1139. [PMID: 37970617 PMCID: PMC10642430 DOI: 10.4254/wjh.v15.i10.1127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/11/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Alpha-1 antitrypsin deficiency is a rare genetic disease and a leading cause of inherited alterations in plasma protein metabolism (APPM). AIM To understand the prevalence, burden and progression of liver disease in patients with APPM including alpha-1 antitrypsin deficiency. METHODS We conducted a retrospective analysis of anonymized patient-level claims data from a German health insurance provider (AOK PLUS). The APPM cohort comprised patients with APPM (identified using the German Modification of the International Classification of Diseases-10th Revision [ICD-10-GM] code E88.0 between 01/01/2010-30/09/2020) and incident liver disease (ICD-10-GM codes K74, K70.2-3 and K71.7 between 01/01/2012-30/09/2020). The control cohort comprised patients without APPM but with incident liver disease. Outcomes were incidence/prevalence of liver disease in patients with APPM, demographics/baseline characteristics, diagnostic procedures, progression-free survival (PFS), disease progression and mortality. RESULTS Overall, 2680 and 26299 patients were included in the APPM (fibrosis, 96; cirrhosis, 2584) and control (fibrosis, 1444; cirrhosis, 24855) cohorts, respectively. Per 100000 individuals, annual incidence and prevalence of APPM and liver disease was 10-15 and 36-51, respectively. In the APPM cohort, median survival was 4.7 years [95% confidence interval (CI): 3.5-7.0] and 2.5 years (95%CI: 2.3-2.8) in patients with fibrosis and cirrhosis, respectively. A higher proportion of patients in the APPM cohort experienced disease progression (92.0%) compared with the control cohort (67.2%). Median PFS was shorter in the APPM cohort (0.9 years, 95%CI: 0.7-1.1) compared with the control cohort (3.7 years, 95%CI: 3.6-3.8; P < 0.001). Patients with cirrhosis in the control cohort had longer event-free survival for ascites, hepatic encephalopathy, hepatic failure and esophageal/gastric varices than patients with cirrhosis in the APPM cohort (P < 0.001). Patients with fibrosis in the control cohort had longer event-free survival for ascites, cirrhosis, hepatic failure and esophageal/gastric varices than patients with fibrosis in the APPM cohort (P < 0.001). In the APPM cohort, the most common diagnostic procedures within 12 mo after the first diagnosis of liver disease were imaging procedures (66.3%) and laboratory tests (51.0%). CONCLUSION Among patients with liver disease, those with APPM experience substantial burden and earlier liver disease progression than patients without APPM.
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Affiliation(s)
- Nils Picker
- Real-World Evidence, Cytel Inc. Ingress-Health HWM GmbH, Wismar 23966, Germany
| | - May Hagiwara
- R&D, Global Evidence and Outcomes, Takeda Development Center Americas, Inc., Cambridge, MA 02139, United States
| | - Severin Baumann
- Real-World Evidence, Cytel Inc. Ingress-Health HWM GmbH, Wismar 23966, Germany
| | - Ed G Marins
- Global Medical Affairs, Takeda Development Center Americas, Inc., Cambridge, MA 02139, United States
| | - Thomas Wilke
- IPAM Institute, IPAM E.V., Wismar 23966, Germany
| | - Kaili Ren
- Statistics and Quantitative Sciences, Data Science Institute, Takeda Development Center Americas, Inc., Cambridge, MA 02139, United States
| | - Ulf Maywald
- Drug Department, AOK PLUS, Dresden 01058, Germany
| | - Chitra Karki
- R&D, Global Evidence and Outcomes, Takeda Development Center Americas, Inc., Cambridge, MA 02139, United States
| | - Pavel Strnad
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen 52074, Germany.
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Carmona S, Hans L, Njoya M, Simon CO, Marins EG, Michel-Treil V, Cunningham P. A multi-center study comparing the analytical sensitivity and clinical concordance of three HIV-1 viral load assays. J Virol Methods 2021; 300:114373. [PMID: 34826517 DOI: 10.1016/j.jviromet.2021.114373] [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: 09/07/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND HIV-1 viral load assays are essential tools for clinical management of people living with HIV-1. OBJECTIVES AND STUDY DESIGN We evaluated concordance between three assays: the cobas® HIV-1 test for use on the cobas® 6800 and cobas® 8800 systems (cobas HIV-1); the COBAS® TaqMan® HIV-1 Test, v2.0 for use with the High Pure System and the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 test, v2.0. Analytical sensitivity, precision and accuracy of all three methods were assessed using the WHO 2nd International Standard for HIV-1, with concentrations from 5 to 1000 copies/mL. Accuracy and concordance were evaluated using 212 clinical specimens. Overall percent agreement (OPA) was determined using three different thresholds used as medical decision points. RESULTS The limit of detection was below 20 copies/mL for each assay. The hit rate for each assay was 100 % for concentrations ≥ 50 copies/mL. Only the cobas HIV-1 test generated quantifiable data for all replicates at 50 copies/mL. Between 50 and 400 copies/mL, results for all assays were accurate within 0.09 log10 copies/mL, with standard deviation less than 0.14 log10 copies/mL. The mean difference between paired results in clinical specimens ranged from -0.050 to 0.107 log10 copies/mL across all assay comparisons. The OPA between pairs of assays ranged from 94.8 to 98.1% at the 50 copies/mL cutoff, and improved to a range of 97.6-99.0% at the 200 copies/mL cutoff. At the 1000 copies/mL cutoff, OPA between assays was 98.5-99.0%. CONCLUSIONS The cobas HIV-1 assay is highly sensitive, accurate and suitable for use in clinical practice.
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Affiliation(s)
- Sergio Carmona
- HIV & Haematology Molecular Laboratory, Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand - NHLS, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Lucia Hans
- HIV & Haematology Molecular Laboratory, Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand - NHLS, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
| | | | | | - Ed G Marins
- Roche Molecular Systems, Pleasanton, CA, USA
| | | | - Philip Cunningham
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital Sydney Limited, Darlinghurst, New South Wales, Australia
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Hans L, Marins EG, Simon CO, Magubane D, Seiverth B, Carmona S. Classification of HIV-1 virological treatment failure using the Roche cobas plasma separation card on cobas 8800 compared to dried blood spots on Abbott RealTime HIV-1. J Clin Virol 2021; 140:104839. [PMID: 33991979 DOI: 10.1016/j.jcv.2021.104839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/30/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Measurement of HIV-1 viral load (VL) is essential for monitoring antiretroviral treatment (ART) efficacy. In remote settings, dried blood spots (DBS) may be used as the specimen type. However, cellular components in DBS not present in the gold standard specimen type, plasma, may result in low specificity i.e., over-estimation of VL results from DBS compared to plasma. The Abbott RealTime HIV-1 assay system has been reported to have improved specificity using DBS compared to other tests. A new specimen collection matrix, the cobas plasma separation card (PSC, Roche Molecular Systems), enables specimen collection from a finger prick or venous blood, using a multi-layer absorption and filtration design that results in a specimen similar to plasma. OBJECTIVES AND STUDY DESIGN We performed a direct comparison between VL results from PSC tested with the cobas 6800/8800 assay (c8800) and DBS tested with the Abbott RealTime HIV-1 assay. RESULTS Overall concordance between PSC and plasma around the 1000 copies/mL threshold was high (>97%). Compared to VL measured using DBS and the RealTime assay, PSC and c8800 showed improved sensitivity (96.9% vs 90.6%) and specificity (97.4% vs. 87.2%) using plasma as the reference, as there were fewer patients with VL below 1000 copies/mL in plasma in whom VL was over this threshold using PSC compared to DBS. The limit of detection for PSC was lower than for DBS (575 vs. 2314 copies/mL). CONCLUSIONS cobas PSC represents a promising specimen type for use with the cobas 6600/8800 system in settings where plasma cannot be used.
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Affiliation(s)
- Lucia Hans
- University of the Witwatersrand, School of Pathology, Department of Molecular Medicine and Haematology, Johannesburg, South Africa; National Health Laboratory Service, Johannesburg, South Africa.
| | - Ed G Marins
- Roche Molecular Systems, Inc., Pleasanton, United States
| | | | - Dieketseng Magubane
- University of the Witwatersrand, School of Pathology, Department of Molecular Medicine and Haematology, Johannesburg, South Africa; National Health Laboratory Service, Johannesburg, South Africa
| | | | - Sergio Carmona
- University of the Witwatersrand, School of Pathology, Department of Molecular Medicine and Haematology, Johannesburg, South Africa; National Health Laboratory Service, Johannesburg, South Africa
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Maasoumy B, Geretti AM, Frontzek A, Austin H, Aretzweiler G, Garcia-Álvarez M, Leuchter S, Simon CO, Marins EG, Canchola JA, Cornberg M, Delgado R, Wedemeyer H. HBV-RNA Co-amplification May Influence HBV DNA Viral Load Determination. Hepatol Commun 2020; 4:983-997. [PMID: 32626831 PMCID: PMC7327219 DOI: 10.1002/hep4.1520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 03/13/2020] [Accepted: 03/18/2020] [Indexed: 12/30/2022] Open
Abstract
Despite effective hepatitis B virus (HBV)‐DNA suppression, HBV RNA can circulate in patients receiving nucleoside/nucleotide analogues (NAs). Current assays quantify HBV DNA by either real‐time polymerase chain reaction (PCR), which uses DNA polymerase, or transcription‐mediated amplification, which uses reverse‐transcriptase (RT) and RNA polymerase. We assessed the effect of RT capability on HBV‐DNA quantification in samples from three cohorts, including patients with quantified HBV RNA. We compared the HBV‐DNA levels by real‐time PCR (cobas HBV, Roche 6800/8800; Xpert HBV, Cepheid), transcription‐mediated amplification (Aptima HBV, Hologic), and real‐time PCR with added RT capability (cobas HBV+RT). In the first cohort (n = 45) followed over 192 weeks of NA therapy, on‐treatment HBV‐DNA levels were higher with cobas HBV+RT than cobas HBV (mean difference: 0.14 log10 IU/mL). In a second cohort (n = 50) followed over 96 weeks of NA therapy, HBV‐DNA viral load was significantly higher with the cobas HBV+RT and Aptima HBV compared with the cobas HBV test at all time points after initiation of NA therapy (mean difference: 0.65‐1.16 log10 IU/mL). A clinically significant difference was not detected between the assays at baseline. In a third cohort (n = 53), after a median of 2.2 years of NA therapy, we detected HBV RNA (median 5.6 log10 copies/mL) in 23 patients (43.4%). Median HBV‐DNA levels by Aptima HBV were 2.4 versus less than 1 log10 IU/mL in samples with HBV RNA and without HBV RNA, respectively (P = 0.0006). In treated patients with HBV RNA, Aptima HBV measured higher HBV‐DNA levels than Xpert HBV and cobas HBV. Conclusion: Tests including an RT step may overestimate HBV DNA, particularly in samples with low viral loads as a result of NA therapy. This overestimation is likely due to amplification of HBV RNA and may have an impact on clinical decisions.
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Affiliation(s)
- Benjamin Maasoumy
- Department of Gastroenterology, Hepatology and Endocrinology Hannover Medical School Hannover Germany.,Center for Infection Research Hannover-Braunschweig site Braunschweig Germany
| | | | | | - Harrison Austin
- Institute of Infection University of Liverpool Liverpool United Kingdom
| | | | | | | | | | | | | | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology Hannover Medical School Hannover Germany.,Center for Infection Research Hannover-Braunschweig site Braunschweig Germany.,Center for Individualized Infection Medicine Hannover Germany
| | | | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology Hannover Medical School Hannover Germany.,Essen University Hospital University of Duisburg-Essen Essen Germany
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Marins EG, Krey N, Becker A, Melzer S, Hoppler M. Evaluation of the cobas® HCV test for quantifying HCV RNA in dried plasma spots collected using the cobas® Plasma Separation Card. J Virol Methods 2020; 278:113820. [PMID: 31945390 DOI: 10.1016/j.jviromet.2020.113820] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/09/2020] [Accepted: 01/11/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study evaluated the performance of the cobas® hepatitis C virus (HCV) Test for use on the cobas® 6800/8800 Systems for the detection and quantification of HCV RNA collected using the cobas® Plasma Separation Card (PSC) compared with plasma samples. METHODS Whole EDTA-venous blood was collected from 50 HCV-positive donors and 140 μL from each donor was spotted onto a PSC and stored either frozen or at ambient temperature. These were compared with matched EDTA-plasma samples. The limit of detection (LoD) of the assay for PSC samples was determined using serial dilutions of the Roche HCV secondary calibration standard. The stability of the PSC samples across a range of timepoints was also assessed. RESULTS The mean titer difference between ambient and -10 °C storage of PSC samples was 0.04 log10 IU/mL (95% CI: 0.00, 0.07). The mean titer difference between frozen PSC samples and EDTA plasma samples was -1.59 log10 IU/mL (95% CI: -1.66, -1.53) and between ambient PSC samples and EDTA samples was -1.64 log10 IU/mL (95% CI: -1.70, -1.57). Correlation between PSC samples and EDTA plasma was linear in both cases (frozen: slope = 1.039, intercept=-1.839, R2 = 0.89; ambient: slope = 1.012, intercept=-1.712, R2 = 0.88). The LoD of the cobas® HCV Test using the PSC was 866 IU/mL (95% CI: 698, 1153 IU/mL) and 408 IU/mL (95% CI: 336, 544 IU/mL) using an optimized Assay Specific Analysis Package. CONCLUSIONS PSC samples correlate well with plasma viral load and demonstrate a LoD below 1000 IU/mL and good stability at ambient temperature for 28 days. A correction factor would allow quantification of HCV viral RNA load from samples collected using a PSC.
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Affiliation(s)
- Ed G Marins
- Roche Molecular Systems, Inc., 4300 Hacienda Drive, Pleasanton, CA, 94588, USA.
| | - Nicole Krey
- Roche Molecular Systems, Inc., 4300 Hacienda Drive, Pleasanton, CA, 94588, USA
| | - Annegret Becker
- Roche Molecular Systems, Inc., 4300 Hacienda Drive, Pleasanton, CA, 94588, USA
| | - Sina Melzer
- Roche Molecular Systems, Inc., 4300 Hacienda Drive, Pleasanton, CA, 94588, USA
| | - Matthias Hoppler
- Roche Molecular Systems, Inc., 4300 Hacienda Drive, Pleasanton, CA, 94588, USA
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Mücke MM, Maasoumy B, Dietz J, Mücke VT, Simon CO, Canchola JA, Cornberg M, Marins EG, Manns MP, Zeuzem S, Wedemeyer H, Sarrazin C, Vermehren J. Utility of the new cobas HCV test for viral load monitoring during direct-acting antiviral therapy. PLoS One 2019; 14:e0224751. [PMID: 31738773 PMCID: PMC6860929 DOI: 10.1371/journal.pone.0224751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/21/2019] [Indexed: 11/23/2022] Open
Abstract
Background The COBAS AmpliPrep/COBAS TaqMan assay HCV (CAP/CTM) is widely used in clinical routine for HCV testing. Recently, the new cobas HCV test was established for high throughput testing with minimal operator intervention. As different assays may yield different quantitative/qualitative results that possibly impact treatment decisions, the aim of this study was to externally evaluate the cobas HCV test performance in comparison to CAP/CTM in a clinically relevant setting. Methods Serum samples were obtained from 270 patients who received direct acting antiviral therapy with different treatment regimens at two study sites (Hannover and Frankfurt) in 2016. Overall, 1545 samples (baseline, on-treatment and follow-up) were tested in parallel by both assays. Results The mean difference between cobas HCV and CAP/CTM for the quantification of HCV RNA was 0.008 log10 IU/ml HCV RNA (95% limits of agreement: -0.02–0.036) showing excellent agreement of both assays. With respect to clinical cut offs (HCV RNA detectable vs. target not detected and HCV RNA above the lower limit of quantification (LLOQ) vs. <LLOQ), discordant results were obtained in 9.5% and 4.6%, respectively; the greatest differences were observed during early stages of antiviral therapy (week 1, week 2 and week 4), but none were statistically significant. Overall percent agreement for SVR between cobas HCV and CAP/CTM at the 15 IU/ml cutoff was 99.2% (95%CI 92.7%-100%). Conclusion The performance of the new cobas HCV test was comparable to CAP/CTM in a clinical setting representing a large patient population with HCV GT 1 and 3 treated with DAAs.
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Affiliation(s)
- Marcus M. Mücke
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Benjamin Maasoumy
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Julia Dietz
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Victoria T. Mücke
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | | | - Marcus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Ed G. Marins
- Roche Molecular Systems, Pleasanton, CA, United States of America
| | - Michael P. Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Christoph Sarrazin
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
- Department of Gastroenterology, St. Josefs-Hospital, Wiesbaden, Germany
| | - Johannes Vermehren
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
- * E-mail:
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Adams P, Vancutsem E, Nicolaizeau C, Servais JY, Piérard D, François JH, Schneider T, Paxinos EE, Marins EG, Canchola JA, Seguin-Devaux C. Multicenter evaluation of the cobas® HIV-1 quantitative nucleic acid test for use on the cobas® 4800 system for the quantification of HIV-1 plasma viral load. J Clin Virol 2019; 114:43-49. [PMID: 30991164 DOI: 10.1016/j.jcv.2019.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/07/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Measurement of HIV-1 viral load (VL) is necessary to monitor treatment efficacy in patients receiving antiretroviral therapy. We evaluated the performance of the cobas® HIV-1 quantitative nucleic acid test for use on the cobas® 4800 system ("cobas 4800 HIV-1"). METHODS Limit of detection, linearity, accuracy, precision, and specificity of cobas 4800 HIV-1, COBAS® AmpliPrep/COBAS® Taqman® HIV-1 version 2.0 (CAP/CTM HIV-1 v2) and Abbott RealTime HIV-1 were determined in one or two out of three sites. RESULTS The limit of detection of the cobas 4800 HIV-1 for 400 μL and 200 μL input volumes was 14.2 copies/mL (95% CI: 12.5-16.6 copies/mL) and 43.9 copies/mL (37.7-52.7 copies/mL), respectively. Cobas 4800 HIV-1 demonstrated 100% specificity, and results were linear for all analyzed group M HIV-1 subtypes. Precision was high (SD < 0.19 log10) across all measured ranges, reagent lots and input volumes. Correlation between cobas 4800 HIV-1 and CAP/CTM HIV-1 v2 or RealTime HIV-1 was high (R2 ≥ 0.95). Agreement between cobas 4800 HIV-1 and CAP/CTM HIV-1 v2 was 96.5% (95.0%-97.7%) at a threshold of 50 copies/mL, and 97.2% (95.8%-98.3%) at 200 copies/mL. Agreement between cobas 4800 HIV-1 and RealTime HIV-1 was 96.6% (93.4%-98.5%) at 50 copies/mL, and 97.0% (94.0%-98.8%) at 200 copies/mL. The mean difference between cobas 4800 HIV-1 and CAP/CTM HIV-1 v2 or RealTime HIV-1 was -0.10 log10 or 0.01 log10, respectively. CONCLUSIONS The cobas 4800 HIV-1 test is highly sensitive, accurate and correlated well with other assays, including agreement around clinically relevant thresholds, indicating minimal overall VL quantification differences between tested platforms.
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Affiliation(s)
- Phillip Adams
- Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg
| | - Ellen Vancutsem
- AIDS Reference Laboratory, Dept. Microbiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Cyrielle Nicolaizeau
- Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg
| | - Jean-Yves Servais
- Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg
| | - Denis Piérard
- AIDS Reference Laboratory, Dept. Microbiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | | | | | - Ed G Marins
- Roche Molecular Systems, Pleasanton, CA, USA
| | | | - Carole Seguin-Devaux
- Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg.
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10
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Yao JD, Young S, Heilek GM, Marino E, Paxinos EE, Marins EG, Valsamakis A. Diagnosis and monitoring of HCV infection using the cobas ® HCV test for use on the cobas ® 6800/8800 systems. J Clin Virol 2018. [PMID: 29518694 DOI: 10.1016/j.jcv.2018.02.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Accurate, sensitive, and specific tests for detection and monitoring of hepatitis C virus (HCV) RNA concentrations are essential for diagnosis and management of HCV infections. We evaluated the next-generation reverse-transcription real-time PCR test, cobas® HCV test for use with the cobas® 6800/8800 systems ("cobas HCV") by determining its analytical performance characteristics and clinical utility for the diagnosis and therapeutic monitoring of chronic HCV infections. METHODS The limit of detection (LOD), linearity, precision, specificity, matrix equivalence of plasma and serum, and quantitative agreement with the COBAS® AmpliPrep/COBAS® TaqMan® HCV Test version 2.0 ("CAP/CTM HCV v2") were evaluated. Clinical utility for the diagnosis of chronic HCV infection was demonstrated by testing plasma from HCV seropositive individuals and comparing results to a nucleic acid amplification test (NAAT) approved for use in the diagnosis of chronic hepatitis C. Clinical specificity was investigated by testing plasma from HCV antibody negative subjects with non-HCV related liver diseases. Utility for monitoring treatment response was defined by testing plasma collected during treatment of HCV genotypes (GT) 1, 2, and 3 and determining positive predictive value (PPV), negative predictive value (NPV) and the odds ratio (OR) for predicting cure (sustained virologic response 12 weeks after treatment cessation, "SVR12"). RESULTS The cobas HCV test demonstrated an LOD of at least 15 IU/mL and measurable range from 15 to at least 1.0E + 08 IU/mL (1.2-8.0 log10 IU/mL) for GT 1-6, with high accuracy (≤0.16 log10 difference) and precision (standard deviation 0.04-0.14 log10) throughout the linear range. Paired plasma and serum samples showed highly correlated performance (R2 = 0.97). Quantification was 100% specific for HCV in analytical studies. Correlation with CAP/CTM HCV v2 was high in patient samples (mean titer difference: 0.05 log10 with a 95% CI: 0.03-0.06 log10). For the diagnosis of chronic HCV, positive and negative percent agreement between cobas HCV and the comparator NAAT were 98.8-100% on the cobas 6800 and 8800 systems. Clinical specificity of cobas HCV using samples from HCV antibody negative subjects with non-HCV related liver diseases was 99.6% and 100% on cobas 6800 and 8800 systems. In therapeutic monitoring and SVR12 prediction during experimental treatment for chronic HCV GT 1 infections, undetectable HCV RNA by cobas HCV at different on-treatment weeks had a PPV 76.8%-79.4%, NPV 29.9%-100%, and OR 1.64-47.52. During therapy of HCV GT 2 and GT 3, treatment week 4 and 12 results were: PPV, 84.7% and 75.3%; NPV, 47.8% and 50.0%; OR, 5.09 and 3.05. CONCLUSIONS The cobas HCV test is highly sensitive, specific, and accurate HCV RNA test for GT 1-6. It demonstrates excellent correlation with the FDA-approved CAP/CTM HCV v2 test. It is useful clinically for detection of active HCV infection in individuals that have had a positive anti-HCV antibody test result and in monitoring treatment response.
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Affiliation(s)
- Joseph D Yao
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Stephen Young
- University of New Mexico/Tricore Laboratories, Albuquerque, NM, United States
| | | | | | | | - Ed G Marins
- Roche Molecular Systems, Pleasanton CA, United States
| | - Alexandra Valsamakis
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21287, United States.
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11
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Maasoumy B, Bremer B, Lehmann P, Marins EG, Michel-Treil V, Simon CO, Njoya M, Cornberg M, Paxinos E, Manns MP, Vermehren J, Sarrazin C, Sohn JY, Cho Y, Wedemeyer H. Commutability and concordance of four hepatitis B virus DNA assays in an international multicenter study. Therap Adv Gastroenterol 2017; 10:609-618. [PMID: 28835775 PMCID: PMC5557192 DOI: 10.1177/1756283x17722745] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/17/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND HBV DNA is the most important molecular marker in hepatitis B, used to determine treatment indication and monitoring. Most patients require lifelong hepatitis B virus (HBV) management, thus viral load (VL) monitoring may be performed at different laboratories, with different HBV assays, which may result in different VL results. This multicenter study compares the commutability and concordance of results from four different HBV DNA assays: CAP/CTM HBVv2, HPS/CTM HBVv2 and the new cobas 6800/8800 HBV and cobas 4800 HBV assays. METHODS Across all four assays, HBV limit of detection (LoD) and linearity at lower concentrations were assessed using panels traceable to the World Health Organization international standard, and concordance was investigated at the important medical decision cutoffs 2000 and 20,000 IU/ml, using specimens from HBV-positive patients. RESULTS The calculated LoD via a probit curve was 2.7 IU/ml for cobas 6800/8800 HBV, 2.8 IU/ml for cobas 4800 HBV, 9.6 IU/ml for CAP/CTM HBVv2, and 6.2 IU/ml for HPS/CTM HBVv2. The average accuracy was comparable between cobas 6800/8800 HBV, cobas 4800 HBV and CAP/CTM HBVv2 (0.04-0.05 log10 IU/ml), while a slightly lower accuracy was documented for HPS/CTM HBVv2 (-0.16 log10 IU/ml). A total of 211-245 clinical samples were used for a pairwise comparison. Mean paired log differences ranged from -0.17 log10 IU/ml to -0.01 log10 IU/ml. Coefficient of determination was over 98% for all pairs with high overall percent agreement at the 2000 and 20,000 IU/ml cutoffs (from 91.7% to 96.3%). In a subset of samples with VL±0.5 log10 to the 2000 and 20,000 IU/ml thresholds, concordance was still 72% and 82%, respectively. CONCLUSIONS The new cobas 6800/8800 HBV and 4800 HBV assays show high accuracy in samples with low-level viremia and a high concordance with the established HBV tests, CAP/CTM HBVv2 and HPS/CTM HBVv2, at 2000 and 20,000 IU/ml. Thus, all four HBV assays have high commutability and may be used interchangeably in routine clinical practice.
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Affiliation(s)
| | | | | | - Ed G. Marins
- Roche Molecular Systems Inc., Roche Diagnostics, Pleasanton, CA, USA
| | | | | | - Merlin Njoya
- Roche Molecular Systems Inc., Roche Diagnostics, Pleasanton, CA, USA
| | | | - Ellen Paxinos
- Roche Molecular Systems Inc., Roche Diagnostics, Pleasanton, CA, USA
| | | | | | | | - Ji Yeon Sohn
- Department of Laboratory Medicine, National Cancer Center, Goyang, Republic of Korea
| | - Yunjung Cho
- Korea University College of Medicine, Seoul, Republic of Korea
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12
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Stelzl E, Haas B, Bauer B, Zhang S, Fiss EH, Hillman G, Hamilton AT, Mehta R, Heil ML, Marins EG, Santner BI, Kessler HH. First identification of a recombinant form of hepatitis C virus in Austrian patients by full-genome next generation sequencing. PLoS One 2017; 12:e0181273. [PMID: 28742818 PMCID: PMC5526534 DOI: 10.1371/journal.pone.0181273] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 03/29/2017] [Accepted: 06/28/2017] [Indexed: 12/20/2022] Open
Abstract
Hepatitis C virus (HCV) intergenotypic recombinant forms have been reported for various HCV genotypes/subtypes in several countries worldwide. In a recent study, four patients living in Austria had been identified to be possibly infected with a recombinant HCV strain. To clarify results and determine the point of recombination, full-genome next-generation sequencing using the Illumina MiSeq v2 300 cycle kit (Illumina, San Diego, CA, USA) was performed in the present study. Samples of all of the patients contained the recombinant HCV strain 2k/1b. The point of recombination was found to be within the HCV NS2 gene between nucleotide positions 3189-3200 based on H77 numbering. While three of four patients were male and had migration background from Chechnya (n = 2) and Azerbaijan (n = 1), the forth patient was a female born in Austria. Three of the four patients including the female had intravenous drug abuse as a risk factor for HCV transmission. While sequencing techniques are limited to a few specialized laboratories, a genotyping assay that uses both ends of the HCV genome should be employed to identify patients infected with a recombinant HCV strain. The correct identification of recombinant strains also has an impact considering the tailored choice of anti-HCV treatment.
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Affiliation(s)
- Evelyn Stelzl
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Bernhard Haas
- Department of Internal Medicine, General Hospital Graz-West, Graz, Austria
| | - Bernd Bauer
- General Hospital Hörgas-Enzenbach, Gratwein, Austria
| | - Sherry Zhang
- Roche Molecular Diagnostics, Pleasanton, CA, United States of America
| | - Ellen H. Fiss
- Roche Molecular Diagnostics, Pleasanton, CA, United States of America
| | - Grantland Hillman
- Roche Molecular Diagnostics, Pleasanton, CA, United States of America
| | - Aaron T. Hamilton
- Roche Molecular Diagnostics, Pleasanton, CA, United States of America
| | - Rochak Mehta
- Roche Molecular Diagnostics, Pleasanton, CA, United States of America
| | - Marintha L. Heil
- Roche Molecular Diagnostics, Pleasanton, CA, United States of America
| | - Ed G. Marins
- Roche Molecular Diagnostics, Pleasanton, CA, United States of America
| | - Brigitte I. Santner
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Harald H. Kessler
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
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13
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Marins EG, Bodinaidu K, Lin M, Deforest A. Evaluation of the COBAS ® AmpliPrep/COBAS ® TaqMan ® HCV Test v2.0 for HCV viral load monitoring using dried blood spot specimens. J Virol Methods 2017; 247:77-80. [PMID: 28576449 DOI: 10.1016/j.jviromet.2017.05.016] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/24/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Abstract
This study evaluated the use of dried blood spot (DBS) for HCV viral load quantification using the COBAS® AmpliPrep/COBAS® Taqman® HCV Quantitative Test v2.0 (CAP/CTM HCV v2), and compared two different procedures for preparation of DBS samples with a Specimen Pre-Extraction (SPEX) reagent (either heated [SPEX with SH] for 10min at 56°C on a thermomixer, or incubated for 1h at room temperature [SPEX at RT]) against the standard plasma input. Whole blood specimens from 48 patients with chronic HCV infection and Whatman® 903 Protein Saver Cards were used to prepare 35μL DBS. An aliquot of plasma was spun and frozen from each draw. Mean DBS viral load results were compared to the corresponding results from plasma. Correlation between DBS to plasma was linear for both SPEX with SH (R2=0.96) and SPEX at RT (R2=0.97) procedures, with a constant negative offset of approximately 2.0log10IU/mL between whole blood DBS without any adjustments and plasma results. After volume corrections, the mean offset to plasma decreased to -0.39 and -0.36 for the two procedures, respectively. The study demonstrated the use of DBS for HCV viral load correlates well with plasma with a constant offset.
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Affiliation(s)
- Ed G Marins
- Roche Molecular Systems, 4300 Hacienda Dr, Pleasanton, CA, 94588, United States.
| | - Keerthi Bodinaidu
- Roche Molecular Systems, 4300 Hacienda Dr, Pleasanton, CA, 94588, United States
| | - Matthew Lin
- Roche Molecular Systems, 4300 Hacienda Dr, Pleasanton, CA, 94588, United States
| | - Alison Deforest
- Roche Molecular Systems, 4300 Hacienda Dr, Pleasanton, CA, 94588, United States
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14
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Stelzl E, Appel HM, Mehta R, Marins EG, Berg J, Paar C, Zurl H, Santner BI, Kessler HH. Evaluation of the new cobas® HCV genotyping test based on real-time PCRs of three different HCV genome regions. Clin Chem Lab Med 2017; 55:517-521. [PMID: 27740913 DOI: 10.1515/cclm-2016-0620] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/13/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Determination of the hepatitis C virus (HCV) genotype and discrimination between HCV subtypes 1a and 1b is still mandatory prior to anti-HCV treatment initiation. The aim of this study was to evaluate the performance of the recently introduced cobas® HCV GT assay (Roche) and to compare it to two comparator assays. METHODS The cobas® HCV GT assay is based on primer-specific real-time polymerase chain reaction (PCR). For comparison, the TRUGENE® HCV 5'NC Genotyping Kit (Siemens) and the VERSANT® HCV Genotype 2.0 Assay (Siemens) were employed. Accuracy of the new assay was determined using proficiency panels. For clinical evaluation, 183 residual clinical samples obtained from patients with chronic hepatitis C infection were included. RESULTS When accuracy was tested, panel members containing HCV subtypes 1a, 1b, and 3a were identified as expected; however, the new assay failed to identify low titer panel members containing HCV subtype 5a correctly. Of 183 clinical samples, 160 gave concordant results. For seven samples, an indeterminate result was reported with the cobas® HCV GT assay and the remaining 16 samples were found discordant with one of the comparator assays. When time-to-results of the assays were compared, the new assay showed shorter total time and similar hands-on time per sample. CONCLUSIONS The cobas® HCV GT assay showed a good performance and proved to be suitable for use in the routine diagnostic laboratory. Due to the high level of automation, fast and reliable results are obtained with short hands-on time.
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Liu J, Goicochea P, Block T, Brosgart CL, Donaldson EF, Lenz O, Gee Lim S, Marins EG, Mishra P, Peters MG, Miller V. Advancing the regulatory path on hepatitis B virus treatment and curative research: a stakeholders consultation. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30302-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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16
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Liu J, Goicochea P, Block T, Brosgart CL, Donaldson EF, Lenz O, Gee Lim S, Marins EG, Mishra P, Peters MG, Miller V. Advancing the regulatory path on hepatitis B virus treatment and curative research: a stakeholders consultation. J Virus Erad 2017; 3:1-6. [PMID: 28275452 PMCID: PMC5337416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hepatitis B infection remains a significant disease burden around the world, with an estimated two billion individuals infected and 350 million living with chronic hepatitis B. Current antivirals are efficacious, but require lifelong treatment for the majority of infected individuals. The field is galvanised to improve diagnostics and treatment with the goal to develop shorter, finite treatments leading to viral control after treatment discontinuation. Achievement of complete and functional cure is challenged by the complexity of the virus life cycle, the lack of adequate preclinical models, the cccDNA-mediated persistence of HBV in liver cells, the lack of validated biomarkers to predict viral control and cure, and the probable need for combination treatment involving antiviral- and immune-based strategies. Experts from diverse stakeholder groups participating in the HBV Forum (a project of the Forum for Collaborative Research) contributed their expertise and perspective to resolving issues and overcoming barriers in the regulatory path for novel HBV therapeutic strategies; addressing gaps in preclinical models, diagnostics, clinical trial design, biomarkers and endpoints, and public health efforts. Interviewees highlighted the need for open and collaborative ongoing dialogues among stakeholders in a neutral space as a critical process to move the field forwards. The Forum model facilitates dialogue and deliberation of this nature, with dedicated experts from all stakeholder groups participating. The promise of an HBV cure is exciting. Now is the time to work together toward that goal.
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Affiliation(s)
- Jonathan Liu
- Forum for Collaborative Research,
Washington DC,
USA,University of California,
Berkeley School of Public Health,
Division of Infectious Diseases and Vaccinology,
California,
USA
| | | | | | | | | | - Oliver Lenz
- Janssen Research and Development,
Beerse,
Belgium
| | | | | | - Poonam Mishra
- US Food and Drug Administration,
Silver Spring,
MarylandUSA
| | | | - Veronica Miller
- Forum for Collaborative Research,
Washington DC,
USA,Corresponding author: Veronica Miller,
Forum for Collaborative Research,
1608 Rhode Island Ave NW,
Washington, DC20036,
USA
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