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Wyatt NJ, Watson H, Anderson CA, Kennedy NA, Raine T, Ahmad T, Allerton D, Bardgett M, Clark E, Clewes D, Cotobal Martin C, Doona M, Doyle JA, Frith K, Hancock HC, Hart AL, Hildreth V, Irving PM, Iqbal S, Kennedy C, King A, Lawrence S, Lees CW, Lees R, Letchford L, Liddle T, Lindsay JO, Maier RH, Mansfield JC, Marchesi JR, McGregor N, McIntyre RE, Ostermayer J, Osunnuyi T, Powell N, Prescott NJ, Satsangi J, Sharma S, Shrestha T, Speight A, Strickland M, Wason JM, Whelan K, Wood R, Young GR, Zhang X, Parkes M, Stewart CJ, Jostins-Dean L, Lamb CA. Defining predictors of responsiveness to advanced therapies in Crohn's disease and ulcerative colitis: protocol for the IBD-RESPONSE and nested CD-metaRESPONSE prospective, multicentre, observational cohort study in precision medicine. BMJ Open 2024; 14:e073639. [PMID: 38631839 PMCID: PMC11029295 DOI: 10.1136/bmjopen-2023-073639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 02/20/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Characterised by chronic inflammation of the gastrointestinal tract, inflammatory bowel disease (IBD) symptoms including diarrhoea, abdominal pain and fatigue can significantly impact patient's quality of life. Therapeutic developments in the last 20 years have revolutionised treatment. However, clinical trials and real-world data show primary non-response rates up to 40%. A significant challenge is an inability to predict which treatment will benefit individual patients.Current understanding of IBD pathogenesis implicates complex interactions between host genetics and the gut microbiome. Most cohorts studying the gut microbiota to date have been underpowered, examined single treatments and produced heterogeneous results. Lack of cross-treatment comparisons and well-powered independent replication cohorts hampers the ability to infer real-world utility of predictive signatures.IBD-RESPONSE will use multi-omic data to create a predictive tool for treatment response. Future patient benefit may include development of biomarker-based treatment stratification or manipulation of intestinal microbial targets. IBD-RESPONSE and downstream studies have the potential to improve quality of life, reduce patient risk and reduce expenditure on ineffective treatments. METHODS AND ANALYSIS This prospective, multicentre, observational study will identify and validate a predictive model for response to advanced IBD therapies, incorporating gut microbiome, metabolome, single-cell transcriptome, human genome, dietary and clinical data. 1325 participants commencing advanced therapies will be recruited from ~40 UK sites. Data will be collected at baseline, week 14 and week 54. The primary outcome is week 14 clinical response. Secondary outcomes include clinical remission, loss of response in week 14 responders, corticosteroid-free response/remission, time to treatment escalation and change in patient-reported outcome measures. ETHICS AND DISSEMINATION Ethical approval was obtained from the Wales Research Ethics Committee 5 (ref: 21/WA/0228). Recruitment is ongoing. Following study completion, results will be submitted for publication in peer-reviewed journals and presented at scientific meetings. Publications will be summarised at www.ibd-response.co.uk. TRIAL REGISTRATION NUMBER ISRCTN96296121.
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Affiliation(s)
- Nicola J Wyatt
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Hannah Watson
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Carl A Anderson
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Nicholas A Kennedy
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Tim Raine
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tariq Ahmad
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Dean Allerton
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Michelle Bardgett
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Clark
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Clewes
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | | | - Mary Doona
- Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jennifer A Doyle
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine Frith
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Helen C Hancock
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Ailsa L Hart
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Victoria Hildreth
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Peter M Irving
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Sameena Iqbal
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Ciara Kennedy
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew King
- Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sarah Lawrence
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Charlie W Lees
- Institute of Genetics & Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Edinburgh IBD Unit, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Robert Lees
- Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Laura Letchford
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Trevor Liddle
- Research Informatics Team, Clinical Research, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - James O Lindsay
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
- Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Rebecca H Maier
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - John C Mansfield
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Julian R Marchesi
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, St Mary's Hospital, Imperial College London, London, UK
| | - Naomi McGregor
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | | | | | | | - Nick Powell
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, St Mary's Hospital, Imperial College London, London, UK
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Natalie J Prescott
- Department of Medical and Molecular Genetics, Guy's Hospital, King's College London, London, UK
| | - Jack Satsangi
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Shriya Sharma
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Tara Shrestha
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Ally Speight
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - James Ms Wason
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, UK
| | - Ruth Wood
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Gregory R Young
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Xinyue Zhang
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Miles Parkes
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Christopher J Stewart
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Christopher A Lamb
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Szilagyi PG, Duru OK, Casillas A, Ong MK, Vangala S, Tseng CH, Albertin C, Humiston SG, Clark E, Ross MK, Evans SA, Sloyan M, Fox CR, Lerner C. Text vs Patient Portal Messaging to Improve Influenza Vaccination Coverage: A Health System-Wide Randomized Clinical Trial. JAMA Intern Med 2024:2816427. [PMID: 38497955 PMCID: PMC10949147 DOI: 10.1001/jamainternmed.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/26/2023] [Indexed: 03/19/2024]
Abstract
Importance Increasing influenza vaccination rates is a public health priority. One method recommended by the US Centers for Disease Control and Prevention and others is for health systems to send reminders nudging patients to be vaccinated. Objective To evaluate and compare the effect of electronic health record (EHR)-based patient portal reminders vs text message reminders on influenza vaccination rates across a health system. Design, Setting, and Participants This 3-arm randomized clinical trial was conducted from September 7, 2022, to April 30, 2023, among primary care patients within the University of California, Los Angeles (UCLA) health system. Interventions Arm 1 received standard of care. The health system sent monthly reminder messages to patients due for an influenza vaccine by portal (arm 2) or text (arm 3). Arm 2 had a 2 × 2 nested design, with fixed vs responsive monthly reminders and preappointment vs no preappointment reminders. Arm 3 had 1 × 2 design, with preappointment vs no preappointment reminders. Preappointment reminders for eligible patients were sent 24 and 48 hours before scheduled primary care visits. Fixed reminders (in October, November, and December) involved identical messages via portal or text. Responsive portal reminders involved a September message asking patients about their plans for vaccination, with a follow-up reminder if the response was affirmative but the patient was not yet vaccinated. Main Outcomes and Measures The primary outcome was influenza vaccination by April 30, 2023, obtained from the UCLA EHR, including vaccination from pharmacies and other sources. Results A total of 262 085 patients (mean [SD] age, 45.1 [20.7] years; 237 404 [90.6%] adults; 24 681 [9.4%] children; 149 349 [57.0%] women) in 79 primary care practices were included (87 257 in arm 1, 87 478 in arm 2, and 87 350 in arm 3). At the entire primary care population level, none of the interventions improved influenza vaccination rates. All groups had rates of approximately 47%. There was no statistical or clinically significant improvement following portal vs text, preappointment reminders vs no preappointment reminders (portal and text reminders combined), or responsive vs fixed monthly portal reminders. Conclusions and Relevance At the population level, neither portal nor text reminders for influenza vaccination were effective. Given that vaccine hesitancy may be a major reason for the lack of impact of portal or text reminders, more intensive interventions by health systems are needed to raise influenza vaccination coverage levels. Trial Registration ClinicalTrials.gov Identifier: NCT05525494.
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Affiliation(s)
- Peter G. Szilagyi
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California, Los Angeles
| | - O. Kenrik Duru
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Alejandra Casillas
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Michael K. Ong
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- VA Greater Los Angeles Healthcare System, Los Angeles, California
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California at Los Angeles
| | - Chi-Hong Tseng
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California at Los Angeles
| | - Christina Albertin
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California, Los Angeles
| | | | - Emma Clark
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California, Los Angeles
| | - Mindy K. Ross
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California, Los Angeles
| | - Sharon A. Evans
- Department of Information Services and Solutions, UCLA Health System, Los Angeles, California
| | - Michael Sloyan
- Department of Information Services and Solutions, UCLA Health System, Los Angeles, California
| | - Craig R. Fox
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Anderson School of Management, University of California, Los Angeles
- Department of Psychology, University of California, Los Angeles
| | - Carlos Lerner
- Department of Pediatrics, UCLA Mattel Children’s Hospital, University of California, Los Angeles
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3
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Wilke SK, Al-Rubkhi A, Koyama C, Ishikawa T, Oda H, Topper B, Tsekrekas EM, Möncke D, Alderman OLG, Menon V, Rafferty J, Clark E, Kastengren AL, Benmore CJ, Ilavsky J, Neuefeind J, Kohara S, SanSoucie M, Phillips B, Weber R. Microgravity effects on nonequilibrium melt processing of neodymium titanate: thermophysical properties, atomic structure, glass formation and crystallization. NPJ Microgravity 2024; 10:26. [PMID: 38448495 PMCID: PMC10918169 DOI: 10.1038/s41526-024-00371-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/19/2024] [Indexed: 03/08/2024] Open
Abstract
The relationships between materials processing and structure can vary between terrestrial and reduced gravity environments. As one case study, we compare the nonequilibrium melt processing of a rare-earth titanate, nominally 83TiO2-17Nd2O3, and the structure of its glassy and crystalline products. Density and thermal expansion for the liquid, supercooled liquid, and glass are measured over 300-1850 °C using the Electrostatic Levitation Furnace (ELF) in microgravity, and two replicate density measurements were reproducible to within 0.4%. Cooling rates in ELF are 40-110 °C s-1 lower than those in a terrestrial aerodynamic levitator due to the absence of forced convection. X-ray/neutron total scattering and Raman spectroscopy indicate that glasses processed on Earth and in microgravity exhibit similar atomic structures, with only subtle differences that are consistent with compositional variations of ~2 mol. % Nd2O3. The glass atomic network contains a mixture of corner- and edge-sharing Ti-O polyhedra, and the fraction of edge-sharing arrangements decreases with increasing Nd2O3 content. X-ray tomography and electron microscopy of crystalline products reveal substantial differences in microstructure, grain size, and crystalline phases, which arise from differences in the melt processes.
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Affiliation(s)
- Stephen K Wilke
- Materials Development, Inc., Evanston, IL, 60202, USA.
- X-ray Science Division, Advanced Photon Source, Argonne National Laboratory, Lemont, IL, 60439, USA.
| | | | | | | | - Hirohisa Oda
- Japan Aerospace Exploration Agency, Tsukuba, Japan
| | - Brian Topper
- Center for High Technology Materials, University of New Mexico, Albuquerque, NM, 87106, USA
| | - Elizabeth M Tsekrekas
- Inamori School of Engineering at the New York State College of Ceramics, Alfred University, Alfred, NY, 14802, USA
| | - Doris Möncke
- Inamori School of Engineering at the New York State College of Ceramics, Alfred University, Alfred, NY, 14802, USA
| | - Oliver L G Alderman
- ISIS Neutron & Muon Source, Rutherford Appleton Laboratory, Chilton, Didcot, Oxon, OX11 0QX, UK
| | | | | | - Emma Clark
- Materials Development, Inc., Evanston, IL, 60202, USA
| | - Alan L Kastengren
- X-ray Science Division, Advanced Photon Source, Argonne National Laboratory, Lemont, IL, 60439, USA
| | - Chris J Benmore
- X-ray Science Division, Advanced Photon Source, Argonne National Laboratory, Lemont, IL, 60439, USA
| | - Jan Ilavsky
- X-ray Science Division, Advanced Photon Source, Argonne National Laboratory, Lemont, IL, 60439, USA
| | - Jörg Neuefeind
- Neutron Science Division, Spallation Neutron Source, Oak Ridge National Laboratory, Oak Ridge, TN, 37831, USA
| | - Shinji Kohara
- National Institute for Materials Science, Tsukuba, Japan
| | | | | | - Richard Weber
- Materials Development, Inc., Evanston, IL, 60202, USA
- X-ray Science Division, Advanced Photon Source, Argonne National Laboratory, Lemont, IL, 60439, USA
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4
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Carrie S, Fouweather T, Homer T, O'Hara J, Rousseau N, Rooshenas L, Bray A, Stocken DD, Ternent L, Rennie K, Clark E, Waugh N, Steel AJ, Dooley J, Drinnan M, Hamilton D, Lloyd K, Oluboyede Y, Wilson C, Gardiner Q, Kara N, Khwaja S, Leong SC, Maini S, Morrison J, Nix P, Wilson JA, Teare MD. Effectiveness of septoplasty compared to medical management in adults with obstruction associated with a deviated nasal septum: the NAIROS RCT. Health Technol Assess 2024; 28:1-213. [PMID: 38477237 PMCID: PMC11017631 DOI: 10.3310/mvfr4028] [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] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Background The indications for septoplasty are practice-based, rather than evidence-based. In addition, internationally accepted guidelines for the management of nasal obstruction associated with nasal septal deviation are lacking. Objective The objective was to determine the clinical effectiveness and cost-effectiveness of septoplasty, with or without turbinate reduction, compared with medical management, in the management of nasal obstruction associated with a deviated nasal septum. Design This was a multicentre randomised controlled trial comparing septoplasty, with or without turbinate reduction, with defined medical management; it incorporated a mixed-methods process evaluation and an economic evaluation. Setting The trial was set in 17 NHS secondary care hospitals in the UK. Participants A total of 378 eligible participants aged > 18 years were recruited. Interventions Participants were randomised on a 1: 1 basis and stratified by baseline severity and gender to either (1) septoplasty, with or without turbinate surgery (n = 188) or (2) medical management with intranasal steroid spray and saline spray (n = 190). Main outcome measures The primary outcome was the Sino-nasal Outcome Test-22 items score at 6 months (patient-reported outcome). The secondary outcomes were as follows: patient-reported outcomes - Nasal Obstruction Symptom Evaluation score at 6 and 12 months, Sino-nasal Outcome Test-22 items subscales at 12 months, Double Ordinal Airway Subjective Scale at 6 and 12 months, the Short Form questionnaire-36 items and costs; objective measurements - peak nasal inspiratory flow and rhinospirometry. The number of adverse events experienced was also recorded. A within-trial economic evaluation from an NHS and Personal Social Services perspective estimated the incremental cost per (1) improvement (of ≥ 9 points) in Sino-nasal Outcome Test-22 items score, (2) adverse event avoided and (3) quality-adjusted life-year gained at 12 months. An economic model estimated the incremental cost per quality-adjusted life-year gained at 24 and 36 months. A mixed-methods process evaluation was undertaken to understand/address recruitment issues and examine the acceptability of trial processes and treatment arms. Results At the 6-month time point, 307 participants provided primary outcome data (septoplasty, n = 152; medical management, n = 155). An intention-to-treat analysis revealed a greater and more sustained improvement in the primary outcome measure in the surgical arm. The 6-month mean Sino-nasal Outcome Test-22 items scores were -20.0 points lower (better) for participants randomised to septoplasty than for those randomised to medical management [the score for the septoplasty arm was 19.9 and the score for the medical management arm was 39.5 (95% confidence interval -23.6 to -16.4; p < 0.0001)]. This was confirmed by sensitivity analyses and through the analysis of secondary outcomes. Outcomes were statistically significantly related to baseline severity, but not to gender or turbinate reduction. In the surgical and medical management arms, 132 and 95 adverse events occurred, respectively; 14 serious adverse events occurred in the surgical arm and nine in the medical management arm. On average, septoplasty was more costly and more effective in improving Sino-nasal Outcome Test-22 items scores and quality-adjusted life-years than medical management, but incurred a larger number of adverse events. Septoplasty had a 15% probability of being considered cost-effective at 12 months at a £20,000 willingness-to-pay threshold for an additional quality-adjusted life-year. This probability increased to 99% and 100% at 24 and 36 months, respectively. Limitations COVID-19 had an impact on participant-facing data collection from March 2020. Conclusions Septoplasty, with or without turbinate reduction, is more effective than medical management with a nasal steroid and saline spray. Baseline severity predicts the degree of improvement in symptoms. Septoplasty has a low probability of cost-effectiveness at 12 months, but may be considered cost-effective at 24 months. Future work should focus on developing a septoplasty patient decision aid. Trial registration This trial is registered as ISRCTN16168569 and EudraCT 2017-000893-12. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/226/07) and is published in full in Health Technology Assessment; Vol. 28, No. 10. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Sean Carrie
- Ear, Nose and Throat Department, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tony Fouweather
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tara Homer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James O'Hara
- Ear, Nose and Throat Department, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Leila Rooshenas
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Alison Bray
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine Rennie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Clark
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nichola Waugh
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Alison J Steel
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Jemima Dooley
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Michael Drinnan
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Hamilton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kelly Lloyd
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Yemi Oluboyede
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Caroline Wilson
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Quentin Gardiner
- Ear, Nose and Throat Department, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Naveed Kara
- Ear, Nose and Throat Department, Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Sadie Khwaja
- Ear, Nose and Throat Department, Manchester Royal Infirmary, Manchester University Foundation NHS Trust, Manchester, UK
| | - Samuel Chee Leong
- Ear, Nose and Throat Department, Aintree Hospital, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sangeeta Maini
- Ear, Nose and Throat Department, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | | | - Paul Nix
- Ear, Nose and Throat Department, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Janet A Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - M Dawn Teare
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Kawar L, Clark E, Kubba H. External peri-stomal skin granulations in paediatric tracheostomy: Incidence, outcomes and a proposed treatment algorithm. Int J Pediatr Otorhinolaryngol 2024; 176:111821. [PMID: 38147731 DOI: 10.1016/j.ijporl.2023.111821] [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: 07/30/2023] [Revised: 11/15/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND External peri-stomal skin granulations after tracheostomy in children are common and may interfere with routine tube changes. This study is the first attempt to describe the incidence and outcomes, along with a proposed treatment algorithm. METHODS A retrospective review of all inpatient children with a tracheostomy between January 2020 and May 2022 at the Royal Hospital for Children (RHC) in Glasgow. The presence of external peri-stomal granulation, date of onset and resolution, recurrence and treatment modalities were noted. All tracheostomy tubes used during the study period were made of silicone. RESULTS A total of 50 episodes of peri-stomal granulation were identified in 27 children (52 %). Median age at the end of the study period was 4.3 years, with younger children experiencing more frequent granulation. 3 episodes interfered with tracheostomy tube changes. Time to resolution of the granulation was significantly longer with topical steroid/antimicrobial ointment monotherapy, but recurrence was less common when this was used a first treatment modality. CONCLUSION Non-invasive measures such as topical anti-microbials should be used in the first instance when managing external stoma-site granulations. More invasive measures, such as silver nitrate cautery and surgical excision, should be considered if the granulation tissue is not improving or when it poses a risk to safe tube changes.
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Affiliation(s)
- Luai Kawar
- University College Hospital, 235 Euston Road, London NW1 2BU, England, UK.
| | - Emma Clark
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UK.
| | - Haytham Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UK.
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6
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Betrán AP, Torloni MR, Althabe F, Altieri E, Arulkumaran S, Ashraf F, Bailey P, Bonet M, Bucagu M, Clark E, Changizi N, Churchill R, Dominico S, Downe S, Draycott T, Faye A, Feeley C, Geelhoed D, Gherissi A, Gholbzouri K, Grupta G, Hailegebriel TD, Hanson C, Hartmann K, Hassan L, Hofmeyr GJ, Jayathilaka AC, Kabore C, Kidula N, Kingdon C, Kuzmenko O, Lumbiganon P, Mola GDL, Moran A, de Muncio B, Nolens B, Opiyo N, Pattinson RC, Romero M, van Roosmalen J, Siaulys MM, Camelo JS, Smith J, Sobel HL, Sobhy S, Sosa C, Souza JP, ten Hoope-Bender P, Thangaratinam S, Varallo J, Wright A, Yates A, Oladapo OO. A research agenda to improve incidence and outcomes of assisted vaginal birth. Bull World Health Organ 2023; 101:723-729. [PMID: 37961052 PMCID: PMC10630731 DOI: 10.2471/blt.23.290140] [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] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/15/2023] [Accepted: 09/13/2023] [Indexed: 11/15/2023] Open
Abstract
Access to emergency obstetric care, including assisted vaginal birth and caesarean birth, is crucial for improving maternal and childbirth outcomes. However, although the proportion of births by caesarean section has increased during the last few decades, the use of assisted vaginal birth has declined. This is particularly the case in low- and middle-income countries, despite an assisted vaginal birth often being less risky than caesarean birth. We therefore conducted a three-step process to identify a research agenda necessary to increase the use of, or reintroduce, assisted vaginal birth: after conducting an evidence synthesis, which informed a consultation with technical experts who proposed an initial research agenda, we sought and incorporated the views of women's representatives of this agenda. This process has allowed us to identify a comprehensive research agenda, with topics categorized as: (i) the need to understand women's perceptions of assisted vaginal birth, and provide appropriate and reliable information; (ii) the importance of training health-care providers in clinical skills but also in respectful care, effective communication, shared decision-making and informed consent; and (iii) the barriers to and facilitators of implementation and sustainability. From women's feedback, we learned of the urgent need to recognize labour, childbirth and postpartum experiences as inherently physiological and dignified human processes, in which interventions should only be implemented if necessary. The promotion and/or reintroduction of assisted vaginal birth in low-resource settings requires governments, policy-makers and hospital administrators to support skilled health-care providers who can, in turn, respectfully support women in labour and childbirth.
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Affiliation(s)
- Ana Pilar Betrán
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
| | - Maria Regina Torloni
- EBH Postgraduate Programme, Department of Medicine, Sao Paulo Federal University-UNIFESP, Sao Paulo, Brazil
| | | | - Elena Altieri
- Behavioural Insights Unit, Department of Communications, World Health Organization, Geneva, Switzerland
| | - Sabaratnam Arulkumaran
- St George's University of London, London, United Kingdom of Great Britain and Northern Ireland
| | - Fatema Ashraf
- Department of Obstetrics & Gynaecology, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh
| | - Patricia Bailey
- Reproductive, Maternal, Newborn and Child Health, FHI360, Durham, North Carolina, United States of America
| | - Mercedes Bonet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
| | - Maurice Bucagu
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Emma Clark
- Maternal Child Health and Nutrition, USAID Bureau for Global Health, Arlington, United States
| | - Nasrin Changizi
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Robyn Churchill
- Maternal Child Health and Nutrition, USAID Bureau for Global Health, Arlington, United States
| | | | - Soo Downe
- Department of Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Tim Draycott
- The Chilterns, Southmead Hospital, Bristol, United Kingdom
| | - Arfang Faye
- Reproductive, Maternal, Newborn, Child and Adolescent Health Unit, Ministry of Health, Gambia
| | - Claire Feeley
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | | | - Atf Gherissi
- High School for Health Science and Techniques, University of Tunis El Manar, Tunis, Tunisia
| | | | - Gagan Grupta
- United Nations Children's Fund, New York, United States
| | | | - Claudia Hanson
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Katharina Hartmann
- Mother Hood e.V. - Federal Parents' Initiative for the Protection of Mother and Child during Pregnancy, Bonn, Germany
| | - Lubna Hassan
- Women's Health Intervention and Development Initiative, Islamabad, Pakistan
| | - George Justus Hofmeyr
- Department of Obstetrics and Gyneacology, University of Botswana, Gaborone, Botswana
| | | | - Charles Kabore
- Institut de Recherche en Sciences de la Sante, Ouagadougou, Burkina Faso
| | - Nancy Kidula
- WHO Regional Office for Africa, Brazzaville, Congo
| | - Carol Kingdon
- Research in Childbirth and Health Unit, University of Central Lancashire, Preston, United Kingdom
| | - Oleg Kuzmenko
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- EBH Postgraduate Programme, Department of Medicine, Sao Paulo Federal University-UNIFESP, Sao Paulo, Brazil
| | - Pisake Lumbiganon
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Buenos Aires, Argentina
| | - Glen DL Mola
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Behavioural Insights Unit, Department of Communications, World Health Organization, Geneva, Switzerland
| | - Allisyn Moran
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Bremen de Muncio
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- St George's University of London, London, United Kingdom of Great Britain and Northern Ireland
| | - Barbara Nolens
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Department of Obstetrics & Gynaecology, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh
| | - Newton Opiyo
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
| | - Robert C Pattinson
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Reproductive, Maternal, Newborn and Child Health, FHI360, Durham, North Carolina, United States of America
| | - Mariana Romero
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Jos van Roosmalen
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Maternal Child Health and Nutrition, USAID Bureau for Global Health, Arlington, United States
| | - Monica M Siaulys
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jose Simon Camelo
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Thamini Uhai (Value Life), United Republic of Tanzania
| | - Jeffrey Smith
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Department of Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Howard L Sobel
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- The Chilterns, Southmead Hospital, Bristol, United Kingdom
| | - Soha Sobhy
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Reproductive, Maternal, Newborn, Child and Adolescent Health Unit, Ministry of Health, Gambia
| | - Claudio Sosa
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Joao Paulo Souza
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Tete, Mozambique
| | - Petra ten Hoope-Bender
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- High School for Health Science and Techniques, University of Tunis El Manar, Tunis, Tunisia
| | - Shakila Thangaratinam
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - John Varallo
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- United Nations Children's Fund, New York, United States
| | - Alison Wright
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Ann Yates
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Mother Hood e.V. - Federal Parents' Initiative for the Protection of Mother and Child during Pregnancy, Bonn, Germany
| | - Olufemi O Oladapo
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
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7
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Carrie S, O'Hara J, Fouweather T, Homer T, Rousseau N, Rooshenas L, Bray A, Stocken DD, Ternent L, Rennie K, Clark E, Waugh N, Steel AJ, Dooley J, Drinnan M, Hamilton D, Lloyd K, Oluboyede Y, Wilson C, Gardiner Q, Kara N, Khwaja S, Leong SC, Maini S, Morrison J, Nix P, Wilson JA, Teare MD. Clinical effectiveness of septoplasty versus medical management for nasal airways obstruction: multicentre, open label, randomised controlled trial. BMJ 2023; 383:e075445. [PMID: 37852641 PMCID: PMC10583133 DOI: 10.1136/bmj-2023-075445] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To assess the clinical effectiveness of septoplasty. DESIGN Multicentre, randomised controlled trial. SETTING 17 otolaryngology clinics in the UK's National Health Service. PARTICIPANTS 378 adults (≥18 years, 67% men) newly referred with symptoms of nasal obstruction associated with septal deviation and at least moderate symptoms of nasal obstruction (score >30 on the Nasal Obstruction and Symptom Evaluation (NOSE) scale). INTERVENTIONS Participants were randomised 1:1 to receive either septoplasty (n=188) or defined medical management (n=190, nasal steroid and saline spray for six months), stratified by baseline symptom severity and sex. MAIN OUTCOME MEASURES The primary outcome measure was patient reported score on the Sino-Nasal Outcome Test-22 (SNOT-22) at six months, with 9 points defined as the minimal clinically important difference. Secondary outcomes included quality of life and objective nasal airflow measures. RESULTS Mean SNOT-22 scores at six months were 19.9 (95% confidence interval 17.0 to 22.7) in the septoplasty arm (n=152, intention-to-treat population) and 39.5 (36.1 to 42.9) in the medical management arm (n=155); an estimated 20.0 points lower (better) for participants randomised to receive septoplasty (95% confidence interval 16.4 to 23.6, P<0.001, adjusted for baseline continuous SNOT-22 score and the stratification variables sex and baseline NOSE severity categories). Greater improvement in SNOT-22 scores was predicted by higher baseline symptom severity scores. Quality of life outcomes and nasal airflow measures (including peak nasal inspiratory flow and absolute inhalational nasal partitioning ratio) improved more in participants in the septoplasty group. Readmission to hospital with bleeding after septoplasty occurred in seven participants (4% of 174 who had septoplasty), and a further 20 participants (12%) required antibiotics for infections. CONCLUSIONS Septoplasty is a more effective intervention than a defined medical management regimen with a nasal steroid and saline spray in adults with nasal obstruction associated with a deviated nasal septum. TRIAL REGISTRATION ISRCTN Registry ISRCTN16168569.
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Affiliation(s)
- Sean Carrie
- Department of Ear, Nose and Throat, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN, UK
| | - James O'Hara
- Department of Ear, Nose and Throat, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tony Fouweather
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tara Homer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Leila Rooshenas
- Bristol Medical School, Population Health Science Institute, University of Bristol, Bristol, UK
| | - Alison Bray
- Northern Medical Physics and Clinical Engineering, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine Rennie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Clark
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nichola Waugh
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Alison J Steel
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Jemima Dooley
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Michael Drinnan
- Northern Medical Physics and Clinical Engineering, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - David Hamilton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kelly Lloyd
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Yemi Oluboyede
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Caroline Wilson
- Northern Ireland Clinical Trials, Belfast, Northern Ireland, UK
| | | | - Naveed Kara
- Department of Ear, Nose and Throat, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Sadie Khwaja
- Department of Ear, Nose and Throat, Manchester University Foundation NHS Trust, Manchester, UK
| | - Samuel C Leong
- Department of Ear, Nose and Throat, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sangeeta Maini
- Department of Ear, Nose and Throat, NHS Grampian, Aberdeen, UK
| | - Jillian Morrison
- General Practice and primary Care, University of Glasgow, Glasgow, UK
| | - Paul Nix
- Department of Ear, Nose and Throat, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Janet A Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - M Dawn Teare
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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8
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Clark E, Solomon J, Cunningham SD, Bard K, Storey AS. Leadership Link: Evaluation of an Online Leadership Curriculum for Certified Midwives and Certified Nurse-Midwives. J Midwifery Womens Health 2023; 68:627-636. [PMID: 37202902 DOI: 10.1111/jmwh.13508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/28/2023] [Accepted: 04/01/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Midwifery leadership is vital for improving maternal health outcomes, yet limited leadership training opportunities exist. This study evaluated acceptability and preliminary outcomes of Leadership Link, a scalable online learning program that aims to increase midwives' leadership competencies. METHODS The program evaluation study enrolled early-career midwives (<10 years since certification) into an online leadership curriculum using the LinkedIn Learning platform. The curriculum consisted of 10 courses (approximately 11 hours) of self-paced, non-health care-specific leadership content supplemented with brief midwifery-specific introductions from midwifery leaders. A preprogram, postprogram, and follow-up study design was used to evaluate changes in 16 self-assessed leadership abilities, self-perception as a leader, and resilience. Data were also collected on the application of leadership skills acquired through, and career advancements attributed to, program participation. RESULTS A total of 186 individuals activated LinkedIn Learning accounts. Almost half (41.9%) completed the full curriculum. Satisfaction was high, with 83.3% of postprogram survey respondents reporting the program was "probably" or "definitely" worth the time invested. Seventy-six participants (40.9%) provided matched pre- and immediate postprogram survey data on at least some of the 16 self-assessed leadership abilities. All 16 abilities showed statistically significant increases in pre- to postprogram mean scores, ranging from 6.4% to 32.5%. Both self-perception as a leader and resilience scores significantly increased from baseline. More than 87% of postprogram and follow-up survey respondents reported having applied new or improved leadership abilities to at least a small degree. Fifty-eight percent of follow-up survey respondents reported at least one midwifery career advancement, of whom 43.6% attributed the advancement, at least in part, to Leadership Link. DISCUSSION The findings suggest that the online Leadership Link curriculum is acceptable and may be effective in improving midwives' leadership capacity, potentially enhancing career opportunities and engagement in system change.
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Affiliation(s)
- Emma Clark
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Julie Solomon
- J. Solomon Consulting, LLC, Mountain View, California
| | - Shayna D Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Kristin Bard
- J. Solomon Consulting, LLC, Mountain View, California
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9
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Yu G, Rice S, Heer R, Lewis R, Vadiveloo T, Mariappan P, Penegar S, Clark E, Tandogdu Z, Hall E, Vale L. Photodynamic Diagnosis-guided Transurethral Resection of Bladder Tumour in Participants with a First Suspected Diagnosis of Intermediate- or High-risk Non-muscle-invasive Bladder Cancer: Cost-effectiveness Analysis Alongside a Randomised Controlled Trial. EUR UROL SUPPL 2023; 53:67-77. [PMID: 37441343 PMCID: PMC10334235 DOI: 10.1016/j.euros.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 07/15/2023] Open
Abstract
Background Recurrence of non-muscle-invasive bladder cancer (NMIBC) is common after transurethral resection of bladder tumour (TURBT). Photodynamic diagnosis (PDD) may reduce recurrence. PDD uses a photosensitiser in the bladder that causes the tumour to fluoresce to guide resection. PDD provides better diagnostic accuracy and allows more complete tumour resection. Objective To estimate the economic efficiency of PDD-guided TURBT (PDD-TURBT) in comparison to white light-guided TURNT (WL-TURBT) in individuals with a suspected first diagnosis of NMIBC at intermediate or high risk of recurrence on the basis of routine visual assessment before being scheduled for TURBT. Design setting and participants This is a health economic evaluation alongside a pragmatic, open-label, parallel-group randomised trial from a societal perspective. A total of 493 participants (aged ≥16 yr) were randomly allocated to PDD-TURBT (n = 244) or WL-TURBT (n = 249) in 22 UK National Health Service hospitals. Outcome measurements and statistical analysis Cost effectiveness ratios were based on the use of health care resources associated with PDD-TURBT and WL-TURBT and quality-adjusted life years (QALYs) gained within the trial. Uncertainties in key parameters were assessed using sensitivity analyses. Results and limitations On the basis of the use of resources driven by the trial protocol, the incremental cost effectiveness of PDD-TURBT in comparison to WL-TURBT was not cost saving. At 3 yr, the total cost was £12 881 for PDD-TURBT and £12 005 for WL-TURBT. QALYs at three years were 2.087 for PDD-TURBT and 2.094 for WL-TURBT. The probability that PDD-TURBT is cost effective was never >30% above the range of societal cost-effectiveness thresholds. Conclusions There was no evidence of a difference in either costs or QALYs over 3-yr follow-up between PDD-TURBT and WL-TURBT in individuals with suspected intermediate- or high-risk NMIBC. PDD-TURBT is not supported for the management of primary intermediate- or high-risk NMIBC. Patient summary We assessed overall costs for two approaches for removal of bladder tumours in noninvasive cancer and measured quality-adjusted life years gained for each. We found that use of a photosensitiser in the bladder was not more cost effective than use of white light only during tumour removal.
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Affiliation(s)
- Ge Yu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Rice
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rakesh Heer
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | | | - Thenmalar Vadiveloo
- Centre for Healthcare Randomized Trials, University of Aberdeen, Aberdeen, UK
| | - Paramananthan Mariappan
- Edinburgh Bladder Cancer Surgery, Department of Urology, Western General Hospital, Edinburgh, UK
| | | | - Emma Clark
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Zafer Tandogdu
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Emma Hall
- The Institute of Cancer Research, London, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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10
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Gravestock P, Clark E, Morton M, Sharma S, Fisher H, Walker J, Wood R, Hancock H, Waugh N, Cooper A, Maier R, Marshall J, Chandler R, Bahl A, Crabb S, Jain S, Pedley I, Jones R, Staffurth J, Heer R. Using the AR-V7 biomarker to determine treatment in metastatic castrate resistant prostate cancer, a feasibility randomised control trial, conclusions from the VARIANT trial. NIHR Open Res 2023; 2:49. [PMID: 37035713 PMCID: PMC7614403 DOI: 10.3310/nihropenres.13284.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 04/05/2023]
Abstract
Background Prostate cancer is the most commonly diagnosed malignancy in the UK. Castrate resistant prostate cancer (CRPC) can be difficult to manage with response to next generation hormonal treatment variable. AR-V7 is a protein biomarker that can be used to predict response to treatment and potentially better inform management in these patients. Our aim was to establish the feasibility of conducting a definitive randomised controlled trial comparing the clinical utility of AR-V7 biomarker assay in personalising treatments for patients with metastatic CRPC within the United Kingdom (UK) National Health Service (NHS). Due to a number of issues the trial was not completed successfully, we aim to discuss and share lessons learned herein. Methods We conducted a randomised, open, feasibility trial, which aimed to recruit 70 adult men with metastatic CRPC within three secondary care NHS trusts in the UK to be run over an 18-month period. Participants were randomised to personalised treatment based on AR-V7 status (intervention) or standard care (control). The primary outcome was feasibility, which included: recruitment rate, retention and compliance. Additionally, a baseline prevalence of AR-V7 expression was to be estimated. Results Fourteen participants were screened and 12 randomised with six into each arm over a nine-month period. Reliability issues with the AR-V7 assay meant prevalence was not estimated. Due to limited recruitment the study did not complete to target. Conclusions Whilst the trial did not complete to target, we have ascertained that men with advanced cancer are willing to take part in trials utilising biomarker guided treatment. A number of issues were identified that serve as important learning points in future clinical trials.
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Affiliation(s)
- Paul Gravestock
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE3 3HD, UK
| | - Emma Clark
- Translational and Clinical Research Institute, NU Cancer, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK
| | - Miranda Morton
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE2 4AE, UK
| | - Shirya Sharma
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE2 4AE, UK
| | - Holly Fisher
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK
| | - Jenn Walker
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE2 4AE, UK
| | - Ruth Wood
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE2 4AE, UK
| | - Helen Hancock
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE2 4AE, UK
| | - Nichola Waugh
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE2 4AE, UK
| | | | - Rebecca Maier
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE2 4AE, UK
| | - John Marshall
- Trial Management Group, VARIANT Trial, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK
| | - Robert Chandler
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE3 3HD, UK
| | - Amit Bahl
- University Hospitals Bristol NHS Foundation Trust, Bristol, BS1 3NU, UK
| | - Simon Crabb
- University of Southampton, Southampton, Hampshire, SO17 1BJ, UK
| | - Suneil Jain
- Queens University Belfast, Belfast, BT7 1NN, UK
| | - Ian Pedley
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE3 3HD, UK
| | - Rob Jones
- Institute of Cancer Services, University of Glasgow, Glasgow, G12 0YN, UK
| | - John Staffurth
- Velindre University NHS Trust, Cardiff, CF15 7QZ, UK
- Division of Cancer and Genetics, Cardiff University, Cardiff, CF14 4XN, UK
| | - Rakesh Heer
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE3 3HD, UK
- Translational and Clinical Research Institute, NU Cancer, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK
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11
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Johnson AN, Clockston RLM, Fremling L, Clark E, Lundeberg P, Mueller M, Graham DJ. Changes in Adults' Eating Behaviors During the Initial Months of the COVID-19 Pandemic: A Narrative Review. J Acad Nutr Diet 2023; 123:144-194.e30. [PMID: 36075551 PMCID: PMC9444582 DOI: 10.1016/j.jand.2022.08.132] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 08/20/2022] [Accepted: 08/31/2022] [Indexed: 11/18/2022]
Abstract
Factors such as regulations and health concerns shifted daily habits, including eating behaviors, during the early months of the coronavirus disease 2019 (COVID-19) pandemic. This comprehensive narrative review synthesizes research on eating behavior changes during the early months of the pandemic (February to June 2020), including changes in amount, rate, and timing of food consumption, types and healthfulness of foods consumed, the occurrence of other specified eating behaviors (eg, restrained eating or binging), and reasons for eating (eg, stress or cravings), among adults. A literature search using three EBSCOhost databases and Google Scholar was conducted to identify relevant articles made available in 2020. A total of 71 articles representing 250,715 individuals from more than 30 countries were reviewed. Findings show eating behaviors changed little during the early COVID-19 pandemic for most participants. Among those whose eating behaviors changed, increases in both intake and frequency of eating meals and snacks were more common than decreases. Findings on timing of eating and healthfulness of food consumed showed mixed results. However, when changes occurred in the type of food consumed, increases were more common for snacks, homemade pastries, white bread/pasta, legumes, and fruits/vegetables; decreases were more common for meats, seafood/fish, frozen foods, fast food, dark breads/grains, and dark leafy green vegetables. During the pandemic, binging, uncontrolled eating, and overeating increased, meal skipping decreased, and restrictive eating had mixed findings. Changes in factors such as emotions and mood (eg, depression), cravings, and environmental factors (eg, food insecurity) were related to changes in eating behaviors. Findings can inform clinical practitioners in efforts to mitigate disruptions to normal, healthy eating patterns among adults both in and outside of global health catastrophes.
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Affiliation(s)
- Ashlie N Johnson
- Department of Psychology, Linfield University, McMinnville, Oregon.
| | | | - Lindsey Fremling
- Department of Psychology, Colorado State University, Fort Collins, Colorado
| | - Emma Clark
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado
| | - Pamela Lundeberg
- Department of Psychology, Colorado State University, Fort Collins, Colorado
| | - Megan Mueller
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, Colorado
| | - Dan J Graham
- Department of Psychology, Colorado State University, Fort Collins, Colorado
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Clark E, Brown T, Yu ML. The Association Between Children’s Interoceptive Awareness and Their Daily Participation: An Exploratory Study. Journal of Occupational Therapy, Schools, & Early Intervention 2022. [DOI: 10.1080/19411243.2022.2158987] [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] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Emma Clark
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Australia
- Occupational Science and Therapy Program, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Ted Brown
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Australia
| | - Mong-Lin Yu
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Australia
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Dickinson MJ, Carlo-Stella C, Morschhauser F, Bachy E, Corradini P, Iacoboni G, Khan C, Wróbel T, Offner F, Trněný M, Wu SJ, Cartron G, Hertzberg M, Sureda A, Perez-Callejo D, Lundberg L, Relf J, Dixon M, Clark E, Humphrey K, Hutchings M. Glofitamab for Relapsed or Refractory Diffuse Large B-Cell Lymphoma. N Engl J Med 2022; 387:2220-2231. [PMID: 36507690 DOI: 10.1056/nejmoa2206913] [Citation(s) in RCA: 135] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The prognosis for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) is poor. Glofitamab is a bispecific antibody that recruits T cells to tumor cells. METHODS In the phase 2 part of a phase 1-2 study, we enrolled patients with relapsed or refractory DLBCL who had received at least two lines of therapy previously. Patients received pretreatment with obinutuzumab to mitigate cytokine release syndrome, followed by fixed-duration glofitamab monotherapy (12 cycles total). The primary end point was complete response according to assessment by an independent review committee. Key secondary end points included duration of response, survival, and safety. RESULTS Of the 155 patients who were enrolled, 154 received at least one dose of any study treatment (obinutuzumab or glofitamab). At a median follow-up of 12.6 months, 39% (95% confidence interval [CI], 32 to 48) of the patients had a complete response according to independent review. Results were consistent among the 52 patients who had previously received chimeric antigen receptor T-cell therapy (35% of whom had a complete response). The median time to a complete response was 42 days (95% CI, 42 to 44). The majority (78%) of complete responses were ongoing at 12 months. The 12-month progression-free survival was 37% (95% CI, 28 to 46). Discontinuation of glofitamab due to adverse events occurred in 9% of the patients. The most common adverse event was cytokine release syndrome (in 63% of the patients). Adverse events of grade 3 or higher occurred in 62% of the patients, with grade 3 or higher cytokine release syndrome in 4% and grade 3 or higher neurologic events in 3%. CONCLUSIONS Glofitamab therapy was effective for DLBCL. More than half the patients had an adverse event of grade 3 or 4. (Funded by F. Hoffmann-La Roche; ClinicalTrials.gov number, NCT03075696.).
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MESH Headings
- Humans
- Cytokine Release Syndrome/chemically induced
- Cytokine Release Syndrome/prevention & control
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/immunology
- Neoplasm Recurrence, Local/drug therapy
- Antibodies, Bispecific/adverse effects
- Antibodies, Bispecific/immunology
- Antibodies, Bispecific/therapeutic use
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Affiliation(s)
- Michael J Dickinson
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Carmelo Carlo-Stella
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Franck Morschhauser
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Emmanuel Bachy
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Paolo Corradini
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Gloria Iacoboni
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Cyrus Khan
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Tomasz Wróbel
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Fritz Offner
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Marek Trněný
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Shang-Ju Wu
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Guillaume Cartron
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Mark Hertzberg
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Anna Sureda
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - David Perez-Callejo
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Linda Lundberg
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - James Relf
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Mark Dixon
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Emma Clark
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Kathryn Humphrey
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Martin Hutchings
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
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14
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Heer R, Lewis R, Duncan A, Penegar S, Vadiveloo T, Clark E, Yu G, Mariappan P, Cresswell J, McGrath J, N'Dow J, Nabi G, Mostafid H, Kelly J, Ramsay C, Lazarowicz H, Allan A, Breckons M, Campbell K, Campbell L, Feber A, McDonald A, Norrie J, Orozco-Leal G, Rice S, Tandogdu Z, Taylor E, Wilson L, Vale L, MacLennan G, Hall E. Photodynamic versus white-light-guided resection of first-diagnosis non-muscle-invasive bladder cancer: PHOTO RCT. Health Technol Assess 2022; 26:1-144. [PMID: 36300825 PMCID: PMC9639219 DOI: 10.3310/plpu1526] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Around 7500 people are diagnosed with non-muscle-invasive bladder cancer in the UK annually. Recurrence following transurethral resection of bladder tumour is common, and the intensive monitoring schedule required after initial treatment has associated costs for patients and the NHS. In photodynamic diagnosis, before transurethral resection of bladder tumour, a photosensitiser that is preferentially absorbed by tumour cells is instilled intravesically. Transurethral resection of bladder tumour is then conducted under blue light, causing the photosensitiser to fluoresce. Photodynamic diagnosis-guided transurethral resection of bladder tumour offers better diagnostic accuracy than standard white-light-guided transurethral resection of bladder tumour, potentially reducing the chance of subsequent recurrence. OBJECTIVE The objective was to assess the clinical effectiveness and cost-effectiveness of photodynamic diagnosis-guided transurethral resection of bladder tumour. DESIGN This was a multicentre, pragmatic, open-label, parallel-group, non-masked, superiority randomised controlled trial. Allocation was by remote web-based service, using a 1 : 1 ratio and a minimisation algorithm balanced by centre and sex. SETTING The setting was 22 NHS hospitals. PARTICIPANTS Patients aged ≥ 16 years with a suspected first diagnosis of high-risk non-muscle-invasive bladder cancer, no contraindications to photodynamic diagnosis and written informed consent were eligible. INTERVENTIONS Photodynamic diagnosis-guided transurethral resection of bladder tumour and standard white-light cystoscopy transurethral resection of bladder tumour. MAIN OUTCOME MEASURES The primary clinical outcome measure was the time to recurrence from the date of randomisation to the date of pathologically proven first recurrence (or intercurrent bladder cancer death). The primary health economic outcome was the incremental cost per quality-adjusted life-year gained at 3 years. RESULTS We enrolled 538 participants from 22 UK hospitals between 11 November 2014 and 6 February 2018. Of these, 269 were allocated to photodynamic diagnosis and 269 were allocated to white light. A total of 112 participants were excluded from the analysis because of ineligibility (n = 5), lack of non-muscle-invasive bladder cancer diagnosis following transurethral resection of bladder tumour (n = 89) or early cystectomy (n = 18). In total, 209 photodynamic diagnosis and 217 white-light participants were included in the clinical end-point analysis population. All randomised participants were included in the cost-effectiveness analysis. Over a median follow-up period of 21 months for the photodynamic diagnosis group and 22 months for the white-light group, there were 86 recurrences (3-year recurrence-free survival rate 57.8%, 95% confidence interval 50.7% to 64.2%) in the photodynamic diagnosis group and 84 recurrences (3-year recurrence-free survival rate 61.6%, 95% confidence interval 54.7% to 67.8%) in the white-light group (hazard ratio 0.94, 95% confidence interval 0.69 to 1.28; p = 0.70). Adverse event frequency was low and similar in both groups [12 (5.7%) in the photodynamic diagnosis group vs. 12 (5.5%) in the white-light group]. At 3 years, the total cost was £12,881 for photodynamic diagnosis-guided transurethral resection of bladder tumour and £12,005 for white light. There was no evidence of differences in the use of health services or total cost at 3 years. At 3 years, the quality-adjusted life-years gain was 2.094 in the photodynamic diagnosis transurethral resection of bladder tumour group and 2.087 in the white light group. The probability that photodynamic diagnosis-guided transurethral resection of bladder tumour was cost-effective was never > 30% over the range of society's cost-effectiveness thresholds. LIMITATIONS Fewer patients than anticipated were correctly diagnosed with intermediate- to high-risk non-muscle-invasive bladder cancer before transurethral resection of bladder tumour and the ratio of intermediate- to high-risk non-muscle-invasive bladder cancer was higher than expected, reducing the number of observed recurrences and the statistical power. CONCLUSIONS Photodynamic diagnosis-guided transurethral resection of bladder tumour did not reduce recurrences, nor was it likely to be cost-effective compared with white light at 3 years. Photodynamic diagnosis-guided transurethral resection of bladder tumour is not supported in the management of primary intermediate- to high-risk non-muscle-invasive bladder cancer. FUTURE WORK Further work should include the modelling of appropriate surveillance schedules and exploring predictive and prognostic biomarkers. TRIAL REGISTRATION This trial is registered as ISRCTN84013636. FUNDING This project was funded by the National Institute for Health and Care Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 40. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rakesh Heer
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca Lewis
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Anne Duncan
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Steven Penegar
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Thenmalar Vadiveloo
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Emma Clark
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Ge Yu
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | | | - Joanne Cresswell
- Department of Urology, South Tees Hospitals NHS Trust, Middlesbrough, UK
| | - John McGrath
- Department of Urology, Royal Devon and Exeter Hospital NHS Trust, Exeter, UK
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Ghulam Nabi
- School of Medicine, University of Dundee, Dundee, UK
| | - Hugh Mostafid
- Department of Urology, Basingstoke and North Hampshire NHS Foundation Trust, Basingstoke, UK
| | - John Kelly
- University College London Cancer Institute, University College London Hospitals NHS Foundation Trust, London, UK
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Henry Lazarowicz
- Department of Urology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Angela Allan
- Department of Urology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Matthew Breckons
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Campbell
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Louise Campbell
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Andy Feber
- University College London Cancer Institute, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alison McDonald
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Giovany Orozco-Leal
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Rice
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Zafer Tandogdu
- University College London Cancer Institute, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Laura Wilson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
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15
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Heer R, Lewis R, Vadiveloo T, Yu G, Mariappan P, Cresswell J, McGrath J, Nabi G, Mostafid H, Lazarowicz H, Kelly J, Duncan A, Penegar S, Breckons M, Wilson L, Clark E, Feber A, Orozco-Leal G, Tandogdu Z, Taylor E, N'Dow J, Norrie J, Ramsay C, Rice S, Vale L, MacLennan G, Hall E. A Randomized Trial of PHOTOdynamic Surgery in Non-Muscle-Invasive Bladder Cancer. NEJM Evid 2022; 1:EVIDoa2200092. [PMID: 38319866 DOI: 10.1056/evidoa2200092] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
PDD or WL Resection of Tumors in NMIBCIn this open-label trial, patients with intermediate- or high-risk non-muscle-invasive bladder cancer at diagnosis were randomly assigned to photodynamic diagnosis or white light-guided transurethral resection of bladder tumor. Three-year recurrence-free rates were 57.8% and 61.6% in the PDD and WL groups, respectively, with no difference in quality-adjusted life years between the treatment groups at 3 years.
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Affiliation(s)
- Rakesh Heer
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Thenmalar Vadiveloo
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, United Kingdom
| | - Ge Yu
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paramananthan Mariappan
- Edinburgh Bladder Cancer Surgery, Department of Urology, Western General Hospital, Edinburgh
| | | | - John McGrath
- Royal Devon and Exeter Hospital NHS Trust, Exeter, United Kingdom
| | - Ghulam Nabi
- University of Dundee, Dundee, United Kingdom
| | - Hugh Mostafid
- Basingstoke and North Hampshire NHS Foundation Trust, Basingstoke, United Kingdom
| | - Henry Lazarowicz
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - John Kelly
- University College London Hospitals NHS Foundation Trust, London
| | - Anne Duncan
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, United Kingdom
| | | | - Matt Breckons
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Laura Wilson
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Emma Clark
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andy Feber
- University College London Hospitals NHS Foundation Trust, London
| | | | - Zafer Tandogdu
- University College London Hospitals NHS Foundation Trust, London
| | | | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - John Norrie
- Edinburgh Clinical Trials Unit, Edinburgh University, Edinburgh
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Stephen Rice
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Luke Vale
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, United Kingdom
| | - Emma Hall
- The Institute of Cancer Research, London
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16
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Campos M, Phelan J, Spadar A, Collins E, Gonçalves A, Pelloquin B, Vaselli NM, Meiwald A, Clark E, Stica C, Orsborne J, Sylla M, Edi C, Camara D, Mohammed AR, Afrane YA, Kristan M, Walker T, Gomez LF, Messenger LA, Clark TG, Campino S. High-throughput barcoding method for the genetic surveillance of insecticide resistance and species identification in Anopheles gambiae complex malaria vectors. Sci Rep 2022; 12:13893. [PMID: 35974073 PMCID: PMC9381500 DOI: 10.1038/s41598-022-17822-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/01/2022] [Indexed: 12/30/2022] Open
Abstract
Surveillance of malaria vector species and the monitoring of insecticide resistance are essential to inform malaria control strategies and support the reduction of infections and disease. Genetic barcoding of mosquitoes is a useful tool to assist the high-throughput surveillance of insecticide resistance, discriminate between sibling species and to detect the presence of Plasmodium infections. In this study, we combined multiplex PCR, custom designed dual indexing, and Illumina next generation sequencing for high throughput single nucleotide polymorphism (SNP)-profiling of four species from the Anopheles (An.) gambiae complex (An. gambiae sensu stricto, An. coluzzii, An. arabiensis and An. melas). By amplifying and sequencing only 14 genetic fragments (500 bp each), we were able to simultaneously detect Plasmodium infection; insecticide resistance-conferring SNPs in ace1, gste2, vgsc and rdl genes; the partial sequences of nuclear ribosomal internal transcribed spacers (ITS1 and ITS2) and intergenic spacers (IGS), Short INterspersed Elements (SINE), as well as mitochondrial genes (cox1 and nd4) for species identification and genetic diversity. Using this amplicon sequencing approach with the four selected An. gambiae complex species, we identified a total of 15 non-synonymous mutations in the insecticide target genes, including previously described mutations associated with resistance and two new mutations (F1525L in vgsc and D148E in gste2). Overall, we present a reliable and cost-effective high-throughput panel for surveillance of An. gambiae complex mosquitoes in malaria endemic regions.
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Affiliation(s)
- Monica Campos
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jody Phelan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Anton Spadar
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Emma Collins
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Adéritow Gonçalves
- Laboratório de Entomologia Médica, Instituto Nacional de Saúde Pública, Praia, 719, Cabo Verde
| | - Bethanie Pelloquin
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- School of Tropical Medicine and Global Health, University of Nagasaki, Nagasaki, Japan
| | - Natasha Marcella Vaselli
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Anne Meiwald
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Emma Clark
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Caleb Stica
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - James Orsborne
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Moussa Sylla
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland
| | - Constant Edi
- Centre Suisse de Recherches Scientifiques en Cote d'Ivoire, Abidjan, Côte d'Ivoire
| | - Denka Camara
- Programme National de Lutte Contre le Paludisme, Ministère de la Santé, BP. 595, Conakry, Guinea
| | - Abdul Rahim Mohammed
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Yaw Asare Afrane
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Mojca Kristan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Thomas Walker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Louisa A Messenger
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Taane G Clark
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Susana Campino
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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Moura IB, Grada A, Spittal W, Clark E, Ewin D, Altringham J, Fumero E, Wilcox MH, Buckley AM. Profiling the Effects of Systemic Antibiotics for Acne, Including the Narrow-Spectrum Antibiotic Sarecycline, on the Human Gut Microbiota. Front Microbiol 2022; 13:901911. [PMID: 35711781 PMCID: PMC9194605 DOI: 10.3389/fmicb.2022.901911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Treatment for moderate-to-severe acne vulgaris relies on prolonged use of oral tetracycline-class antibiotics; however, these broad-spectrum antibiotics are often associated with off-target effects and negative gastrointestinal sequelae. Sarecycline is a narrow-spectrum antibiotic treatment option. Here, we investigated the effect of prolonged sarecycline exposure, compared with broad-spectrum tetracyclines (doxycycline and minocycline) upon the colonic microbiota. Three in vitro models of the human colon were instilled with either minocycline, doxycycline or sarecycline, and we measured microbiota abundance and diversity changes during and after antibiotic exposure. Significant reductions in microbial diversity were observed following minocycline and doxycycline exposure, which failed to recover post antibiotic withdrawal. Specifically, minocycline caused a ~10% decline in Lactobacillaceae and Bifidobacteriaceae abundances, while doxycycline caused a ~7% decline in Lactobacillaceae and Bacteroidaceae abundances. Both minocycline and doxycycline were associated with a large expansion (>10%) of Enterobacteriaceae. Sarecycline caused a slight decline in bacterial diversity at the start of treatment, but abundances of most families remained stable during treatment. Ruminococcaceae and Desulfovibrionaceae decreased 9% and 4%, respectively, and a transient increased in Enterobacteriaceae abundance was observed during sarecycline administration. All populations recovered to pre-antibiotic levels after sarecycline exposure. Overall, sarecycline had minimal and transient impact on the gut microbiota composition and diversity, when compared to minocycline and doxycycline.
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Affiliation(s)
- Ines B Moura
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | | | - William Spittal
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Emma Clark
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Duncan Ewin
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - James Altringham
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | | | - Mark H Wilcox
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom.,Department of Microbiology, Leeds Teaching Hospital NHS Trust, Old Medical School, Leeds General Infirmary, Leeds, United Kingdom
| | - Anthony M Buckley
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom.,Microbiome and Nutritional Science Group, School of Food Science, Faculty of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
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18
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Dickinson M, Carlo-Stella C, Morschhauser F, Bachy E, Corradini P, Iacoboni G, Khan C, Wrobel T, Offner F, Trneny M, Wu SJ, Cartron G, Hertzberg M, Sureda Balari A, Perez-Callejo D, Lundberg L, Relf J, Clark E, Humphrey K, Hutchings M. Glofitamab in patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) and ≥ 2 prior therapies: Pivotal phase II expansion results. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7500] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7500 Background: Glofitamab is a T-cell engaging bispecific antibody (Ab) with a novel 2:1 configuration that confers bivalency for CD20 (B cells) and monovalency for CD3 (T cells). In a Phase I/II study (NCT03075696), escalating glofitamab doses were highly active and well tolerated in pts with R/R B-cell lymphomas, with obinutuzumab pretreatment (Gpt) and Cycle (C) 1 step-up dosing providing effective CRS mitigation. For the first time, we present pivotal Phase II expansion results in pts with R/R DLBCL and ≥2 prior therapies. Methods: All pts had DLBCL (DLBCL NOS, HGBCL, PMBCL, or trFL) and had received ≥2 prior regimens including ≥1 anti-(a) CD20 Ab and ≥1 anthracycline. IV Gpt (1000mg) was given 7 days before the first glofitamab dose. IV glofitamab was then given as step-up doses on Day (D) 1 (2.5mg) and D8 (10mg) of C1 and at the target dose (30mg) on D1 of C2–12 (21-day cycles). The primary endpoint was CR rate (best response during initial treatment) assessed by Independent Review Committee (IRC) using Lugano 2014 criteria. CRS was assessed using ASTCT criteria. Results: As of Sep 14, 2021, 107 pts had received ≥1 dose of study treatment (median age: 66 yrs [21–90]; Ann Arbor stage III–IV disease: 74%; IPI score ≥3: 54%; DLBCL NOS: 74%). Median prior therapies was 3 (2–7); 59% had ≥3 prior therapies and 35% had received prior CAR T-cells (CAR-Ts). Most pts were refractory to a prior aCD20 Ab-containing regimen (85%) and to their most recent regimen (85%). Many were refractory to their initial therapy (59%) and to prior CAR-Ts (32%). After a median follow-up of 9 months (0.1–16), ORR and CR rates by IRC were 50.0% and 35.2%, respectively. CR rates were consistent in pts with and without prior CAR-Ts (32% vs 37%). Median time to CR was 42 days (95% CI: 41–48). The majority of CRs (33/38; 87%) were ongoing at data cut. An estimated 84% of complete responders and 61% of responders remained in response at 9 months. At data cut, the projected 12-month OS rate was 48%, and 92% of complete responders were alive. These results are consistent with earlier Phase I data in 100 pts treated with target glofitamab doses ≥10mg (CR rate: 34%; estimated 20-month CR rate in complete responders: 72%). CRS occurred in 68% of pts, was primarily associated with the initial doses, and was mostly Gr 1 (51%) or Gr 2 (12%); Gr 3 (3%) and Gr 4 (2%) events were uncommon. All but 2 CRS events were resolved at data cut. Glofitamab-related neurologic AEs potentially consistent with ICANS occurred in 3 pts (all Gr 1–2). No glofitamab-related Gr 5 (fatal) AEs occurred. Glofitamab-related AEs leading to discontinuation were uncommon (3 pts, 3%). Conclusions: Fixed-duration glofitamab induces durable complete remissions and has favorable safety in pts with R/R DLBCL and ≥2 prior therapies, including those with prior exposure to CAR-Ts. Glofitamab is a promising new therapy for pts with heavily pretreated and/or highly refractory DLBCL. Clinical trial information: NCT03075696.
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Affiliation(s)
- Michael Dickinson
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and The University of Melbourne, Melbourne, Australia
| | | | | | | | - Paolo Corradini
- Università degli Studi di Milano and Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCSS) Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Cyrus Khan
- Allegheny Health Network, Pittsburgh, PA
| | | | | | - Marek Trneny
- Charles University Hospital, Prague, Czech Republic
| | - Shang-Ju Wu
- National Taiwan University Hospital, Taipei, Taiwan
| | | | - Mark Hertzberg
- Prince of Wales Hospital and University of New South Wales, Sydney, NSW, Australia
| | - Anna Sureda Balari
- Institut Català d'Oncologia – Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
| | | | | | - James Relf
- Roche Products Ltd, Welwyn Garden City, United Kingdom
| | - Emma Clark
- Roche Products Ltd, Welwyn Garden City, United Kingdom
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19
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Poole K, Chappell D, Brown J, Clark E, Fleming J, Shepstone L, Turmezei T, Wagner A, Willoughby K, Kaptoge S. OP0243 OSTEOPOROSIS CASE-FINDING IN PEOPLE UNDERGOING ROUTINE DIAGNOSTIC CT SCANS ALMOST TRIPLED THE RATE OF OSTEOPOROSIS TREATMENT AT 12 MONTHS. A RANDOMISED, MULTI-CENTRE FEASIBILITY STUDY USING WAITING ROOM FRAX, OPPORTUNISTIC CT BONE DENSITY AND VERTEBRAL FRACTURE ASSESSMENT VERSUS USUAL CARE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundUp to 40% of all diagnostic computed tomography (CT) scans include views of the spine or hips. Among older people, osteoporosis or vertebral fractures have been found in 30% of such CT scans. Our ‘PHOENIX’ intervention repurposes CT scans taken for other reasons to identify fractures and measure bone density as an ‘added extra’. Early detection and treatment of osteoporosis in CT-attending patients could improve health outcomes.ObjectivesTo determine the feasibility and efficacy of PHOENIX versus usual care in a multi-centre, randomised, pragmatic study conducted in Eastern England involving our Cambridge Specialist Hospital ‘hub’ and four regional General Hospital ‘spokes’.MethodsWomen ≥65 and men ≥75 years attending for routine diagnostic CT scans were invited to participate via a novel consent form incorporating FRAX Fracture Risk Assessment questions. After calculating their FRAX 10-year risk score, higher risk patients were block randomised (1:1:1) to Group 1) PHOENIX intervention, 2) Active Control, where the GP was sent the patients’ FRAX answers only, or 3) Usual Care where data were only analysed after 13 months had elapsed. The CT scans of high FRAX risk patients in Group 1 were retrieved by the Cambridge team using NHS Connecting for Health (Burnbank, UK). The team performed vertebral fracture assessment and measured bone density using QCT Pro (Mindways, USA). They added patient-specific treatment and investigation management advice from ‘drop down’ menus before results were reviewed by a physician, authorised and sent to general practitioners (GPs). Baseline CT scans from groups 2 and 3 were assessed in the same way after 13 months to ensure no patient with osteoporosis/fractures was neglected long term. Assuming 25% attrition, the study was powered to find a superior osteoporosis treatment rate in Group 1 (estimated 20%) versus 16% (Active Control) and 5% (Usual Care). Co-primary feasibility endpoints were the ability to a) randomise 375 patients within 10 months and b) retain 75% of survivors able to complete a 1-year bone health outcome questionnaire. Secondary outcomes included osteoporosis/vertebral fracture identification rates and osteoporosis treatment rates. Stakeholder acceptability and economic aspects will be reported separately.ResultsFrom 1828 invites, 595 participants consented to participate of whom 213 were excluded due to ‘low’ FRAX score. Mortality at 12 months was 20%. Both feasibility objectives were achieved: 1) 382 people were randomised within 10 months; 2) 84.4% of survivors at 1 year (95%CI: 80.5, 88.3) were successfully followed-up. Groups were well matched at baseline. The average age of 375 patients (334 female, 41 male) was 75.2 years (74.6, 75.9). Osteoporosis of the hip/spine was present in 41% of 362 analysable CT scans. From the 264 spines that were suitable for VFA, 20% (n=53) were found to have vertebral fractures, with 8.3% having multiple vertebral fractures (n=22). Osteoporosis treatment was reported in 8.5% of Usual Care group (2.9, 14.2) and 24.2% (15.4, 33.0) of PHOENIX group participants, while in the Active Control group (FRAX only) it was 18.8% (10.9, 26.6 p=0.021). In the PHOENIX group, a recommendation to treat was sent to 50 patients’ GPs at baseline. Only 18 of the 50 patients (36%) were found to be taking osteoporosis treatment 12 months after this advice was sent.ConclusionOsteoporosis treatment rates were almost tripled by screening patients attending for routine diagnostic CT scans with waiting room FRAX, CT-bone densitometry and vertebral fracture analysis.AcknowledgementsThis project is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0816-20027) and by the Cambridge NIHR Biomedical Research Centre (BRC-1215-20014). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Funding is in place to 31.03.2022. Three individuals, Mr Jeremy Dearling, Mrs Tessa Plume and Dr Ann Frost joined our trial group as PPI representatives; they were specifically involved in patient documentation design (particularly the PHOENIX pack, informed consent form which facilitated consent without having a researcher present) and contributed to suggestions for increasing patient recruitment and follow up.Disclosure of InterestsNone declared
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Bennett SE, Gooberman-Hill R, Clark E, Paskins Z, Walsh N, Drew S. POS1514-HPR UNDERSTANDING AND CHARACTERISING PATIENT PATHWAYS TO TREATMENT FOR VERTEBRAL FRACTURES: A QUALITATIVE STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundOsteoporosis involves thinning of the bones, making them more prone to break. The most common osteoporotic fracture is a vertebral fracture (OVF). People with OVFs are at high risk of further fractures. To reduce this risk, guidelines recommend prescription of bone protection therapies to people who have experienced a fracture. However, many patients do not receive diagnosis. Understanding patient pathways to treatment for OVFs will provide information to improve practice and aid in effective identification and management.ObjectivesTo understand and characterise patient pathways to treatment for OVFs.MethodsTwenty-three semi-structured qualitative interviews were conducted with patients aged ≥50 years with diagnosis of OVF. Patients were recruited through two hospitals in England and were purposively sampled to capture variation in pathways to diagnosis, sex, age, comorbidities and other relevant characteristics. Interviews were audio-recorded, transcribed and analysed thematically, with themes transposed onto key stages of the patient pathway.ResultsSeveral factors influenced patient pathways to treatment:Patient appraisal and self-management: Characteristics and attitudes towards back pain impacted treatment-seeking behaviour. Patients who appraised their pain as ‘different’, severe or disruptive, or associated with an injury such as a fall, were more likely to seek help. Limited availability of information about OVFs and risk factors meant most patients did not associate symptoms with a potential OVF. Factors contributing to delayed consultation included the normalisation of back pain and prioritisation of comorbid conditions. Several misappraised their symptoms as a “pulled muscle” or other minor injury. Many adopted strategies to manage pain, including use of painkillers, lying flat or resting. For some, a lack of improvement in symptoms over time, combined with worsening pain, created a ‘tipping point’ in seeking care. There was a moral dimension for some patients who did not want to “bother” healthcare professionals.Healthcare professional appraisal: Differential diagnosis was a barrier to treatment and healthcare professionals interpreted OVF pain as broken ribs, muscular pain, kidney pain or sciatica. GPs tended to instigate watchful waiting, in which patients were asked to re-consult if pain did not improve. Feeling disbelieved caused some patients to become disillusioned and reluctant to re-consult and a small number of patients presented at Accident and Emergency. Those already having treatment for musculoskeletal conditions with access to specialist care, were more likely to receive timely diagnosis.Communication of diagnosis: Patients discussed multiple methods of communication, including written communication and clinical conversations. Several expressed confusion around the use of unfamiliar medical terminology, the implications of OVFs, how many OVFs they had experienced and how they had been identified.Treatment initiation: Bone protection therapies were not consistently prescribed after diagnosis. Patients who were familiar with these therapies were unsure whether treatment should be initiated in primary or secondary care. Patients described how they felt a need to be proactive by arranging appointments and asking for treatment.ConclusionThe study provides novel findings about patient pathways to treatment and will be used to identify targeted solutions to improve management of OVFs. This work addresses stages of the Model of Pathways to Treatment[1] and provides detailed understanding of patients’ experiences of these stages. Further work with healthcare professionals in primary care is underway to identify additional system-level factors that may impact patients’ journeys to treatment.References[1]Scott, S.E., et al., The model of pathways to treatment: conceptualization and integration with existing theory. Br J Health Psychol, 2013. 18(1): p. 45-65.AcknowledgementsThis study is funded by the National Institute for Health Research (NIHR) Research for Patient Benefit (RfPB) programme NIHR201523. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.Disclosure of InterestsNone declared
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21
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Buckley A, Moura I, Clark E, Altringham J, Spittal W, Bentley K, Wilcox M. Profiling the effects of acne therapeutics, including the novel antibiotic sarecycline, on the human microbiota. Access Microbiol 2022. [DOI: 10.1099/acmi.ac2021.po0014] [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: 11/18/2022] Open
Abstract
Many factors shape the human intestinal microbiota, some of which can confer a deleterious effect on the microbiota, e.g. antibiotic therapy. Disruption to the microbiota has been implicated in the progression of C. difficile infection (CDI), multiplication of multi-drug resistant organisms and many extra-intestinal diseases. Thus, determining the off-target effects of antibiotics is essential to determine a patient’s risk of these diseases, particularly for new therapies. Here we characterise the effect of sarecycline, a novel tetracycline antibiotic for the treatment of moderate to severe acne vulgaris; and compared its effect to the gut microbiota with other acne treatments. Using four independent in vitro gut models, we exposed the human microbiota to either sarecycline, minocycline, doxycycline, or clindamycin, and monitored the changes to the bacterial populations, and whether these changes were sufficient to induce CDI.
Sarecycline or doxycycline exposure caused a temporary reduction in the bacterial diversity upon initial exposure. Sarecycline exposure was characterised by a transient increase in Enterococcus spp. and Enterobacteriaceae, and a decrease in Bifidobacterium spp. Doxycycline exposure caused longer-term changes to the Lactobacillaceae and Ruminococcaceae populations. Minocycline exposure resulted in a dramatic reduction to the bacterial diversity, with extensive expansions to the Enterococcus spp. and Enterobacteriaceae populations, whilst the Lactobacillaceae and Ruminococcaceae populations contracted. Whilst clindamycin did induce simulated CDI, neither sarecycline, minocycline, nor doxycycline created a niche conducive for CDI.
These data show that long-term sarecycline use has a lower potential for disruption of the colonic microbiota, compared with the current treatments for acne vulgaris.
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22
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Poole KES, Chappell DDG, Clark E, Fleming J, Shepstone L, Turmezei TD, Wagner AP, Willoughby K, Kaptoge SK. PHOENIX (Picking up Hidden Osteoporosis Effectively during Normal CT Imaging without additional X-rays): protocol for a randomised, multicentre feasibility study. BMJ Open 2022; 12:e050343. [PMID: 35613783 PMCID: PMC9125739 DOI: 10.1136/bmjopen-2021-050343] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Two million out of the UK's 5 million routine diagnostic CT scans performed each year incorporate the thoracolumbar spine or pelvic region. Up to one-third reveal undiagnosed osteoporosis or vertebral fractures. We developed an intervention, Picking up Hidden Osteoporosis Effectively during Normal CT Imaging without additional X-rays ('PHOENIX'), to facilitate early detection and management of osteoporosis in people attending hospitals for CT scans. METHODS AND ANALYSIS A multicentre, randomised, pragmatic feasibility study. From the general CT-attending population, women aged ≥65 years and men aged ≥75 years attending for CT scans are invited to participate, via a novel consent form incorporating Fracture Risk Assessment (FRAX) questions. Those at increased 10-year risk (within the amber or red zones of the UK FRAX graphical outputs for further action) are block randomised (1:1:1) to (1) PHOENIX intervention, (2) active control or (3) usual care. The PHOENIX intervention comprises (i) retrieving the CT scans using the NHS Image Exchange Portal, (ii) Mindways QCT Pro software analysis of CT hip and spine none density with CT vertebral fracture assessment, (iii) sending the participants' general practitioner (GP) a clinical report including diagnosis, necessary investigations and recommended treatment. Baseline CT scans from groups 2 and 3 are assessed with the PHOENIX intervention only at study end. Assuming 25% attrition, the study is powered to find a predicted superior osteoporosis treatment rate with PHOENIX (20%) vs 16% among patients whose GPs were sent the FRAX questionnaire only (active control) and 5% in the usual care group. Five hospitals are participating to determine feasibility. The co-primary feasibility outcome measures are (a) ability to randomise 375 patients within 10 months and (b) retention of 75% of survivors, completing their 1-year bone health outcome questionnaire. Secondary 1-year outcomes include osteoporosis/vertebral fracture identification rates and osteoporosis treatment rates. Stakeholder acceptability and economic aspects are evaluated. ETHICS AND DISSEMINATION Approved by committee (National Research Ethics Service) East of England (EE) as REF/19/EE/0176. Dissemination will be through the Royal Osteoporosis Society (to patients and public) as well as to clinician peers via national and international bone/rheumatology scientific and clinical meetings. TRIAL REGISTRATION NUMBER ISRCTN14722819.
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Affiliation(s)
- Kenneth E S Poole
- Department of Medicine, University of Cambridge, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
- Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Daniel D G Chappell
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
- Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emma Clark
- Clinical Science at North Bristol, University of Bristol, Bristol, UK
| | - Jane Fleming
- Cambridge Public Health, University of Cambridge, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Thomas D Turmezei
- Department of Medicine, University of Cambridge, Cambridge, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
- Radiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Adam P Wagner
- Norwich Medical School, University of East Anglia, Norwich, UK
- NIHR Collaboration for Leadership in Applied Health Research & Care (CLAHRC) East of England, Cambridge, UK
| | - Karen Willoughby
- Department of Medicine, University of Cambridge, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Stephen K Kaptoge
- Cambridge Public Health, University of Cambridge, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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23
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Lambertini M, Fielding S, Loibl S, Janni W, Clark E, Franzoi MA, Fumagalli D, Caballero C, Arecco L, Salomoni S, Ponde NF, Poggio F, Kim HJ, Villarreal-Garza C, Pagani O, Paluch-Shimon S, Ballestrero A, Del Mastro L, Piccart M, Bines J, Partridge AH, de Azambuja E. Impact of age on clinical outcomes and efficacy of adjuvant dual anti-HER2 targeted therapy. J Natl Cancer Inst 2022; 114:1117-1126. [PMID: 35512402 PMCID: PMC9360461 DOI: 10.1093/jnci/djac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/21/2022] [Accepted: 04/27/2022] [Indexed: 11/22/2022] Open
Abstract
Background Young age at breast cancer (BC) diagnosis has historically been a rationale for overtreatment. Limited data with short follow-up exist on the prognostic value of age at diagnosis in HER2-positive BC and the benefit of anti-HER2 therapy in young patients. Methods APHINITY (NCT01358877) is an international, placebo-controlled, double-blind randomized phase III trial in HER2-positive early BC patients investigating the addition of pertuzumab to adjuvant chemotherapy plus trastuzumab. The prognostic and predictive value of age on invasive disease-free survival (IDFS) as continuous and dichotomous variable (aged 40 years or younger and older than 40 years) was assessed. A subpopulation treatment effect pattern plot analysis was conducted to illustrate possible treatment-effect heterogeneity based on age as a continuous factor. Results Of 4804 included patients, 768 (16.0%) were aged 40 years or younger at enrollment. Median follow-up was 74 (interquartile range = 62-75) months. Young age was not prognostic either as dichotomous (hazard ratio [HR] = 1.06, 95% confidence interval [CI] = 0.84 to 1.33) or continuous (HR = 1.00, 95% CI = 1.00 to 1.01) variable. Lack of prognostic effect of age was observed irrespective of hormone receptor status and treatment arm. No statistically significant interaction was observed between age and pertuzumab effect (Pinteraction = 0.61). Adding pertuzumab improved IDFS for patients in the young (HR = 0.86, 95% CI = 0.56 to 1.32) and older (HR = 0.75, 95% CI = 0.62 to 0.92) cohorts. Similar results were observed irrespective of hormone receptor status. Subpopulation treatment effect pattern plot analysis confirmed the benefit of pertuzumab in 6-year IDFS across age subpopulations. Conclusions In patients with HER2-positive early BC treated with modern anticancer therapies, young age did not demonstrate either prognostic or predictive value, irrespective of hormone receptor status.
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Affiliation(s)
- Matteo Lambertini
- Correspondence to: Matteo Lambertini, MD, PhD, Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Policlinico San Martino Hospital, University of Genova, Largo Rosanna Benzi 10, 16132 Genova, Italy (e-mail: )
| | | | | | - Wolfgang Janni
- Department of Obstetrics and Gynecology, Universitaetsklinikum, Ulm, Germany
| | - Emma Clark
- Roche Products Ltd, Welwyn Garden City, UK
| | | | | | | | - Luca Arecco
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Sharon Salomoni
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | | | - Francesca Poggio
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Hee Jeong Kim
- Division of Breast, Department of Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Olivia Pagani
- Geneva University Hospitals, Lugano University and Swiss Group for Clinical Cancer Research (SAKK), Geneva, Switzerland
| | - Shani Paluch-Shimon
- Sharett Institute of Oncology, Hadassah University Hospital & Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Alberto Ballestrero
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Department of Specialist Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Martine Piccart
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jose Bines
- National Cancer Institute (INCA), Rio de Janeiro, Brazil
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Gelber RD, Wang XV, Cole BF, Cameron D, Cardoso F, Tjan-Heijnen V, Krop I, Loi S, Salgado R, Kiermaier A, Frank E, Fumagalli D, Caballero C, de Azambuja E, Procter M, Clark E, Restuccia E, Heeson S, Bines J, Loibl S, Piccart-Gebhart M. Six-year absolute invasive disease-free survival benefit of adding adjuvant pertuzumab to trastuzumab and chemotherapy for patients with early HER2-positive breast cancer: A Subpopulation Treatment Effect Pattern Plot (STEPP) analysis of the APHINITY (BIG 4-11) trial. Eur J Cancer 2022; 166:219-228. [DOI: 10.1016/j.ejca.2022.01.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 11/17/2022]
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Franzoi MA, Procter M, Twelves C, Ponde N, Eiger D, Emond O, Clark E, Parlier D, Guillaume S, Reaby L, de Azambuja E, Bines J. Timelines to initiate a phase III trial across the globe: a sub-analysis of the APHINITY trial. Ecancermedicalscience 2022; 16:1379. [PMID: 35702414 PMCID: PMC9116999 DOI: 10.3332/ecancer.2022.1379] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Geographic location and national income may influence access to innovation in healthcare. We aimed to study if geographical location and national income influenced the timelines to activate the global phase III APHINITY trial, evaluating adjuvant pertuzumab in patients with HER2-positive early breast cancer. Methods Time from regulatory authority (RA) submission to approval (RAA), time to Ethics Committee/Institutional Review Board (EC/IRB) approval, time from study approval by EC/IRB to first randomised patient and from first to last randomised patient were collected. Analyses were conducted grouping countries by geographical region or economic income classification. Results Forty-one countries (of 42) had data available regarding all relevant timelines. No statistical difference was observed between the time to RAA and geographical region (p = 0.47), although there was a trend to longer time to RAA in upper middle-income economies (p = 0.07). Except for time from first to last patient randomised, there was wide variation in timelines overall and within geographical regions and economic income groups. Conclusions Geographical location and income classification did not appear to be the major drivers influencing time for clinical trial activation. Wide variability in activation timelines within geographical regions and income groups exists and is worthy of further investigation.
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Affiliation(s)
- Maria Alice Franzoi
- Clinical Trials Support Unit, Jules Bordet Institute, Brussels, Belgium
- https://orcid.org/0000-0002-2470-6054
| | | | - Chris Twelves
- University of Leeds and Leeds Teaching Hospitals Trust, Leeds, UK
| | - Noam Ponde
- AC Camargo Cancer Center, São Paulo, Brazil
| | | | | | - Emma Clark
- Roche Products Ltd, Welwyn Garden City, UK
| | - Damien Parlier
- Clinical Trials Support Unit, Jules Bordet Institute, Brussels, Belgium
| | | | - Linda Reaby
- Patient Representative, Newcastle, Australia
| | | | - Jose Bines
- Instituto Nacional de Câncer, INCA, Rio de Janeiro, Brazil
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Lambertini M, Fielding S, Loibl S, Janni W, Clark E, Franzoi MA, Fumagalli D, Caballero C, Arecco L, Salomoni S, Ponde NF, Poggio F, Kim HJ, Villarreal-Garza C, Pagani O, Paluch-Shimon S, Ballestrero A, Mastro LD, Piccart M, Bines J, Partridge AH, de Azambuja E. Abstract P2-13-42: Effect of young age at diagnosis on clinical outcomes and efficacy of anti-HER2 targeted therapy in patients with HER2-positive early breast cancer: Results from the APHINITY trial. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p2-13-42] [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: 11/16/2022]
Abstract
Abstract
Background: The poor prognostic value of young age at diagnosis appears to vary according to breast cancer (BC) subtype, although this has been studied mainly in hormone receptor-positive (HR+) disease, with limited data in HER2-positive BC and short follow-up. Limited evidence exists on the benefit of anti-HER2 therapy in young women with BC. Considering that age has historically been a rationale for overtreatment, further research efforts to better investigate the prognostic and predictive value of age are needed. This exploratory analysis conducted within the APHINITY trial aimed to investigate the prognostic and predictive value of young age in patients with HER2-positive early BC treated with modern chemotherapy and concurrent anti-HER2 targeted treatment. Methods: APHINITY (NCT01358877) is an international, placebo-controlled, double-blind randomized phase III trial in patients with HER2-positive early BC investigating the benefit of adding pertuzumab to adjuvant chemotherapy plus trastuzumab. For the purpose of the present analysis, 40 years of age at enrolment was used as the cut-off to distinguish between young (≤40 years) and older (>40 years) cohorts. Invasive disease-free survival (IDFS) was the primary endpoint. IDFS irrespective of treatment arm and the benefit of adding pertuzumab were evaluated in all patients by comparing the young and older cohorts and then according to centrally-assessed hormone receptor status. Univariate and multivariable Cox proportional hazard models were used to assess the prognostic and predictive value of age on IDFS as a continuous and dichotomous variable (≤40 years and >40 years). A STEPP analysis was also conducted to illustrate possible treatment-effect heterogeneity based on age as a continuous factor. Results: Out of 4,804 patients in the ITT population, 768 (16.0%) were ≤40 years at enrollment. Patients in the young cohort were less overweight/obese (29.3% vs. 50.4%), underwent mastectomy more frequently (63.2% vs. 52.6%), had higher rates of node positive (66.4% vs. 61.8%) and HR+ (71.7% vs. 64.9%) BC as compared to those in the older cohort (all p<0.05). Among patients with HR+ BC that received adjuvant endocrine therapy in the young cohort (n=498), 132 (26.5%) underwent ovarian function suppression while 324 (65.1%) received tamoxifen alone. Overall median follow-up was 74 months (IQR 62-75 months). 6-year IDFS was 88% and 89% in the young and older cohorts, respectively. In univariate and multivariable analyses, young age was not prognostic as dichotomous (unadjusted HR 1.06; 95% CI 0.84-1.33; adjusted HR 1.07; 95% CI 0.84-1.35) nor as continuous (unadjusted HR 1.00; 95% CI 1.00-1.01) variables. The lack of prognostic effect of age was observed irrespective of hormone receptor status and treatment arm. No significant interaction was observed between age and treatment effect (Pinteraction=0.605). The addition of pertuzumab improved IDFS for both patients in the young (6-year IDFS 89% vs. 87%; adjusted HR 0.86; 95% CI 0.56-1.32) and older (6-year IDFS 91% vs. 88%; adjusted HR 0.75; 95% CI 0.62-0.92) cohorts. By analyzing the potential predictive value of age according to hormone receptor status, similar results were observed. The STEPP analysis confirmed the benefit of pertuzumab in 6-year IDFS across age subpopulations. Conclusions: In patients with HER2-positive early BC treated with modern anticancer therapies, young age did not demonstrate prognostic or predictive value in long-term follow-up, irrespective of hormone receptor status and anti-HER2 treatment modalities. These results may help to improve the care of young women with BC, highlighting that, in the current era of precision medicine, age alone is not a reason to expect a different disease outcome or treatment benefit.
Citation Format: Matteo Lambertini, Shona Fielding, Sibylle Loibl, Wolfgang Janni, Emma Clark, Maria Alice Franzoi, Debora Fumagalli, Carmela Caballero, Luca Arecco, Sharon Salomoni, Noam F Ponde, Francesca Poggio, Hee Jeong Kim, Cynthia Villarreal-Garza, Olivia Pagani, Shani Paluch-Shimon, Alberto Ballestrero, Lucia Del Mastro, Martine Piccart, Jose Bines, Ann H. Partridge, Evandro de Azambuja. Effect of young age at diagnosis on clinical outcomes and efficacy of anti-HER2 targeted therapy in patients with HER2-positive early breast cancer: Results from the APHINITY trial [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-13-42.
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Affiliation(s)
- Matteo Lambertini
- University of Genova - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Sibylle Loibl
- German Breast Group (GBG), Neu-Isenburg, and Geothe University, Frankfurt, Germany
| | | | - Emma Clark
- Roche Products Ltd, Welwyn Garden City, United Kingdom
| | | | | | | | - Luca Arecco
- University of Genova - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Sharon Salomoni
- University of Genova - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | | | - Hee Jeong Kim
- Department of Surgical Oncology, Asan Medical Center, Seoul, Korea, Democratic People's Republic of
| | | | - Olivia Pagani
- Geneva University Hospitals, European School of Oncology, Geneva, Switzerland
| | - Shani Paluch-Shimon
- Breast Oncology Unit, Hadassah University Hospital & Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Alberto Ballestrero
- University of Genova - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lucia Del Mastro
- University of Genova - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Martine Piccart
- Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Jose Bines
- National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Ann H. Partridge
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Boston, MA
| | - Evandro de Azambuja
- Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
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Khan H, Connolly T, Loh MY, Clark E. Duodenal volvulus: a rare cause of small bowel obstruction. Ann R Coll Surg Engl 2021; 104:e102-e104. [PMID: 34846192 DOI: 10.1308/rcsann.2021.0242] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Small bowel volvulus is a rare but life-threatening emergency. Volvulus of the duodenum is even rarer without the presence of predisposing factors. The clinical presentation is vague, including abdominal pain, nausea and vomiting, prompt diagnosis of volvulus therefore relies heavily on radiographs. The treatment options lie between conservative or surgical management, where the decision is influenced by the patient and their presentation. This case is of a 100-year-old female with an extensive surgical and medical background presenting with signs of small bowel obstruction. With the help of imaging, a rare case of duodenal volvulus was diagnosed but managed conservatively due to the patient's background, age and personal wishes.
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Affiliation(s)
- H Khan
- Stockport NHS Foundation Trust, UK
| | | | - M-Y Loh
- Stockport NHS Foundation Trust, UK
| | - E Clark
- Stockport NHS Foundation Trust, UK
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Vijay A, Clark E, Beane JD, Starr JE, Grignol VP. Clinical Outcomes of Retroperitoneal Sarcoma Resection Requiring Vascular Reconstruction. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Siqueira IF, Clark E, Neil-Sztramko SE, Belita E, Dobbins M. Informing policy on school and daycare operations during COVID-19 with a living rapid evidence review. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.593] [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: 11/12/2022] Open
Abstract
Abstract
Background
To support evidence-informed decision making (EIDM) for safe re-opening and operation of schools and daycares, the National Collaborating Centre for Methods and Tools (NCCMT) has maintained since May 2020 a living rapid review answering the following question: “What is the role of schools and daycares in COVID-19 transmission”. Traditional rapid review methodology was modified for the COVID-19 context. This presentation will describe the global reach and usefulness of this living rapid review.
Methods
Following completion of each update of the living rapid review, findings were disseminated broadly with the aim of informing policy and public health practice. Key dissemination strategies include e-mails to key contacts and a subscriber list; highlight in a monthly newsletter; media outreach; and social media. The review's reach was analyzed using Google Analytics, citation tracking, and qualitative feedback.
Results
Between May 2020 and April 2021, the living review has been updated 14 times. The posted review has been viewed over 5000 times across 46 countries. The review has been cited and indexed in over 40 sources, including key governmental and non-governmental reports and guidelines. The NCCMT has received positive qualitative feedback on the review's value in informing the public health response related to schools and daycares in various jurisdictions across Canada. Key stakeholders have expanded the review's reach organically as they use the evidence in practice and share the review with their networks.
Lessons
Using a living rapid review to continuously provide high-quality synthesized evidence amidst the evolving COVID-19 research literature demonstrates a responsive approach to decision makers' requests for evidence. An emerging challenge is reaching the proper stakeholders responsible for EIDM, particularly during public health emergencies with many competing high-priority questions and decisions to be made.
Key messages
As the evidence landscape changes due to a surge in literature, evidence-informed decision making can be supported by rapid but rigorous syntheses that evaluate quality and emerging recommendations. A long-standing, trusting relationship with decision makers is key to optimizing living rapid review methodology to meet the evidence needs of decision makers despite the changing literature.
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Affiliation(s)
- IF Siqueira
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
| | - E Clark
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
| | - SE Neil-Sztramko
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
| | - E Belita
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
| | - M Dobbins
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
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Moura I, Spittal W, Clark E, Ewin D, Altringham J, Fumero E, Grada A, Wilcox M, Buckley A. 224 Profiling the effects of acne therapeutics, including the novel narrow-spectrum antibiotic sarecycline, on the human microbiota. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.229] [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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Buckley AM, Moura IB, Altringham J, Ewin D, Clark E, Bentley K, Wilkinson V, Spittal W, Davis G, Wilcox MH. The use of first-generation cephalosporin antibiotics, cefalexin and cefradine, is not associated with induction of simulated Clostridioides difficile infection. J Antimicrob Chemother 2021; 77:148-154. [PMID: 34561709 PMCID: PMC8730689 DOI: 10.1093/jac/dkab349] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/23/2021] [Indexed: 02/04/2023] Open
Abstract
Objectives The use of broad-spectrum cephalosporins is associated with induction of Clostridioides difficile infection (CDI). Recent knowledge on the importance of the healthy microbiota in preventing pathogen colonization/outgrowth highlights the caution needed when prescribing broad-spectrum antibiotics. The use of historical narrow-spectrum antibiotics, such as first-generation cephalosporins, is gaining increased attention once more as they have a reduced impact on the microbiota whilst treating infections. Here, the effects of two first-generation cephalosporins, compared with a third-generation cephalosporin, on the human microbiota were investigated and their propensity to induce simulated CDI. Methods Three in vitro chemostat models, which simulate the physiochemical conditions of the human colon, were seeded with a human faecal slurry and instilled with either narrow-spectrum cephalosporins, cefalexin and cefradine, or a broad-spectrum cephalosporin, ceftriaxone, at concentrations reflective of colonic levels. Results Instillation of cefalexin was associated with reduced recoveries of Bifidobacterium and Enterobacteriaceae; however, Clostridium spp. recoveries remained unaffected. Cefradine exposure was associated with decreased recoveries of Bifidobacterium spp., Bacteroides spp. and Enterobacteriaceae. These changes were not associated with induction of CDI, as we observed a lack of C. difficile spore germination/proliferation, thus no toxin was detected. This is in contrast to a model exposed to ceftriaxone, where CDI was observed. Conclusions These model data suggest that the minimal impact of first-generation cephalosporins, namely cefalexin and cefradine, on the intestinal microbiota results in a low propensity to induce CDI.
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Affiliation(s)
- Anthony M Buckley
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, LS1 9JT, UK
| | - Ines B Moura
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, LS1 9JT, UK
| | - James Altringham
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, LS1 9JT, UK
| | - Duncan Ewin
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, LS1 9JT, UK
| | - Emma Clark
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, LS1 9JT, UK
| | - Karen Bentley
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, LS1 9JT, UK
| | - Vikki Wilkinson
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, LS1 9JT, UK
| | - William Spittal
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, LS1 9JT, UK
| | - Georgina Davis
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, LS1 9JT, UK
| | - Mark H Wilcox
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, LS1 9JT, UK.,Microbiology, Leeds Teaching Hospitals NHS Trust, Old Medical School, Leeds General Infirmary, Leeds, LS1 3EX, UK
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Carlo-Stella C, Khan C, Hutchings M, Offner FC, Morschhauser F, Bachy E, Crump M, Sureda A, lacoboni G, Haioun C, Perez-Callejo D, Lundberg L, Relf J, Clark E, Carlile D, Piccione E, Belousov A, Humphrey K, Dickinson MJ. ABCL-360: Glofitamab Step-Up Dosing (SUD): Updated Efficacy Data Show High Complete Response Rates in Heavily Pretreated Relapsed/Refractory (R/R) Non-Hodgkin Lymphoma (NHL) Patients (Pts). Clinical Lymphoma Myeloma and Leukemia 2021. [DOI: 10.1016/s2152-2650(21)01893-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Paskins Z, Bullock L, Crawford-Manning F, Cottrell E, Fleming J, Leyland S, Edwards JJ, Clark E, Thomas S, Chapman SR, Ryan S, Lefroy JE, Gidlow CJ, Iglesias C, Protheroe J, Horne R, O'Neill TW, Mallen C, Jinks C. Improving uptake of Fracture Prevention drug treatments: a protocol for Development of a consultation intervention (iFraP-D). BMJ Open 2021; 11:e048811. [PMID: 34408051 PMCID: PMC8375717 DOI: 10.1136/bmjopen-2021-048811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Prevention of fragility fractures, a source of significant economic and personal burden, is hindered by poor uptake of fracture prevention medicines. Enhancing communication of scientific evidence and elicitation of patient medication-related beliefs has the potential to increase patient commitment to treatment. The Improving uptake of Fracture Prevention drug treatments (iFraP) programme aims to develop and evaluate a theoretically informed, complex intervention consisting of a computerised web-based decision support tool, training package and information resources, to facilitate informed decision-making about fracture prevention treatment, with a long-term aim of improving informed treatment adherence. This protocol focuses on the iFraP Development (iFraP-D) work. METHODS AND ANALYSIS The approach to iFraP-D is informed by the Medical Research Council complex intervention development and evaluation framework and the three-step implementation of change model. The context for the study is UK fracture liaison services (FLS), which enact secondary fracture prevention. An evidence synthesis of clinical guidelines and Delphi exercise will be conducted to identify content for the intervention. Focus groups with patients, FLS clinicians and general practitioners and a usual care survey will facilitate understanding of current practice, and investigate barriers and facilitators to change. Design of the iFraP intervention will be informed by decision aid development standards and theories of implementation, behaviour change, acceptability and medicines adherence. The principles of co-design will underpin all elements of the study through a dedicated iFraP community of practice including key stakeholders and patient advisory groups. In-practice testing of the prototype intervention will inform revisions ready for further testing in a subsequent pilot and feasibility randomised trial. ETHICS AND DISSEMINATION Ethical approval was obtained from North West-Greater Manchester West Research Ethics Committee (19/NW/0559). Dissemination and knowledge mobilisation will be facilitated through national bodies and networks, publications and presentations. TRIAL REGISTRATION NUMBER researchregistry5041.
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Affiliation(s)
- Zoe Paskins
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | | | - Fay Crawford-Manning
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | | | - Jane Fleming
- Cambridge Public Health, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Cambridge, UK
| | | | | | - Emma Clark
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Simon Thomas
- School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, UK
| | | | - Sarah Ryan
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
- School of Medicine & School of Nursing and Midwifery, Keele University, Stoke-on-Trent, UK
| | - J E Lefroy
- School of Medicine, Keele University, Keele, UK
| | | | - C Iglesias
- Department of Health Sciences, University of York, York, UK
- Danish Centre for Healthcare Improvements, Aalborg Universitet, Aalborg, Denmark
| | | | - Robert Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Clare Jinks
- School of Medicine, Keele University, Keele, UK
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Buckley AM, Moura IB, Arai N, Spittal W, Clark E, Nishida Y, Harris HC, Bentley K, Davis G, Wang D, Mitra S, Higashiyama T, Wilcox MH. Trehalose-Induced Remodelling of the Human Microbiota Affects Clostridioides difficile Infection Outcome in an In Vitro Colonic Model: A Pilot Study. Front Cell Infect Microbiol 2021; 11:670935. [PMID: 34277467 PMCID: PMC8284250 DOI: 10.3389/fcimb.2021.670935] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Received: 02/26/2021] [Accepted: 06/02/2021] [Indexed: 12/19/2022] Open
Abstract
Within the human intestinal tract, dietary, microbial- and host-derived compounds are used as signals by many pathogenic organisms, including Clostridioides difficile. Trehalose has been reported to enhance virulence of certain C. difficile ribotypes; however, such variants are widespread and not correlated with clinical outcomes for patients suffering from C. difficile infection (CDI). Here, we make preliminary observations on how trehalose supplementation affects the microbiota in an in vitro model and show that trehalose-induced changes can reduce the outgrowth of C. difficile, preventing simulated CDI. Three clinically reflective human gut models simulated the effects of sugar (trehalose or glucose) or saline ingestion on the microbiota. Models were instilled with sugar or saline and further exposed to C. difficile spores. The recovery of the microbiota following antibiotic treatment and CDI induction was monitored in each model. The human microbiota remodelled to utilise the bioavailable trehalose. Clindamycin induction caused simulated CDI in models supplemented with either glucose or saline; however, trehalose supplementation did not result in CDI, although limited spore germination did occur. The absence of CDI in trehalose model was associated with enhanced abundances of Finegoldia, Faecalibacterium and Oscillospira, and reduced abundances of Klebsiella and Clostridium spp., compared with the other models. Functional analysis of the microbiota in the trehalose model revealed differences in the metabolic pathways, such as amino acid metabolism, which could be attributed to prevention of CDI. Our data show that trehalose supplementation remodelled the microbiota, which prevented simulated CDI, potentially due to enhanced recovery of nutritionally competitive microbiota against C. difficile.
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Affiliation(s)
- Anthony M. Buckley
- Healthcare Associated Infection Research Group, Molecular Gastroenterology, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Ines B. Moura
- Healthcare Associated Infection Research Group, Molecular Gastroenterology, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Norie Arai
- R&D Division, Hayashibara Co. Ltd./NAGASE Group, Okayama, Japan
| | - William Spittal
- Healthcare Associated Infection Research Group, Molecular Gastroenterology, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Emma Clark
- Healthcare Associated Infection Research Group, Molecular Gastroenterology, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | | | - Hannah C. Harris
- Healthcare Associated Infection Research Group, Molecular Gastroenterology, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Karen Bentley
- Healthcare Associated Infection Research Group, Molecular Gastroenterology, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Georgina Davis
- Healthcare Associated Infection Research Group, Molecular Gastroenterology, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Dapeng Wang
- LeedsOmics, University of Leeds, Leeds, United Kingdom
| | - Suparna Mitra
- Healthcare Associated Infection Research Group, Molecular Gastroenterology, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | | | - Mark H. Wilcox
- Healthcare Associated Infection Research Group, Molecular Gastroenterology, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
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Boekhoud IM, Sidorov I, Nooij S, Harmanus C, Bos-Sanders IMJG, Viprey V, Spittal W, Clark E, Davies K, Freeman J, Kuijper EJ, Smits WK. Haem is crucial for medium-dependent metronidazole resistance in clinical isolates of Clostridioides difficile. J Antimicrob Chemother 2021; 76:1731-1740. [PMID: 33876817 PMCID: PMC8212768 DOI: 10.1093/jac/dkab097] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/02/2021] [Indexed: 01/05/2023] Open
Abstract
Background Until recently, metronidazole was the first-line treatment for Clostridioides difficile infection and it is still commonly used. Though resistance has been reported due to the plasmid pCD-METRO, this does not explain all cases. Objectives To identify factors that contribute to plasmid-independent metronidazole resistance of C. difficile. Methods Here, we investigate resistance to metronidazole in a collection of clinical isolates of C. difficile using a combination of antimicrobial susceptibility testing on different solid agar media and WGS of selected isolates. Results We find that nearly all isolates demonstrate a haem-dependent increase in the MIC of metronidazole, which in some cases leads to isolates qualifying as resistant (MIC >2 mg/L). Moreover, we find an SNP in the haem-responsive gene hsmA, which defines a metronidazole-resistant lineage of PCR ribotype 010/MLST ST15 isolates that also includes pCD-METRO-containing strains. Conclusions Our data demonstrate that haem is crucial for medium-dependent metronidazole resistance in C. difficile.
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Affiliation(s)
- Ilse M Boekhoud
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Igor Sidorov
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sam Nooij
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands.,Center for Microbiome Analyses and Therapeutics, Leiden University Medical Center, Leiden, The Netherlands
| | - Céline Harmanus
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Virginie Viprey
- Healthcare Associated Infection Research Group, School of Medicine, University of Leeds, Leeds, UK
| | - William Spittal
- Healthcare Associated Infection Research Group, School of Medicine, University of Leeds, Leeds, UK
| | - Emma Clark
- Healthcare Associated Infection Research Group, School of Medicine, University of Leeds, Leeds, UK
| | - Kerrie Davies
- Healthcare Associated Infection Research Group, School of Medicine, University of Leeds, Leeds, UK.,European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Study Group for Clostridioides difficile (ESGCD), Basel, Switzerland
| | - Jane Freeman
- Healthcare Associated Infection Research Group, School of Medicine, University of Leeds, Leeds, UK.,European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Study Group for Clostridioides difficile (ESGCD), Basel, Switzerland
| | - Ed J Kuijper
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands.,European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Study Group for Clostridioides difficile (ESGCD), Basel, Switzerland.,National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Wiep Klaas Smits
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands.,Center for Microbiome Analyses and Therapeutics, Leiden University Medical Center, Leiden, The Netherlands.,European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Study Group for Clostridioides difficile (ESGCD), Basel, Switzerland
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Carlo‐Stella C, Hutchings M, Offner FC, Morschhauser F, Bachy E, Crump M, Sureda A, Iacoboni G, Haioun C, Perez‐Callejo D, Lundberg L, Relf J, Clark E, Carlile D, Piccione E, Belousov A, Humphrey K, Dickinson MJ. GLOFITAMAB STEP‐UP DOSING: UPDATED EFFICACY DATA SHOW HIGH COMPLETE RESPONSE RATES IN HEAVILY PRETREATED RELAPSED/REFRACTORY (R/R) NON‐HODGKIN LYMPHOMA (NHL) PATIENTS. Hematol Oncol 2021. [DOI: 10.1002/hon.15_2879] [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: 11/08/2022]
Affiliation(s)
- C Carlo‐Stella
- Humanitas University and Humanitas Research Hospital Department of Biomedical Sciences Milan Italy
| | - M Hutchings
- Rigshospitalet Department of Hematology and Phase 1 Unit Copenhagen Denmark
| | - F. C Offner
- Universitair Ziekenhuis Gent Department of Hematology Gent Belgium
| | - F Morschhauser
- Hôpital Claude Huriez and Centre Hospitalier Régional Universitaire de Lille Department of Hematology Lille France
| | - E Bachy
- Hospices Civils de Lyon and Université Claude Bernard Department of Hematology Pierre‐Bénite France
| | - M Crump
- Princess Margaret Hospital Department of Medical Oncology Toronto Canada
| | - A Sureda
- Institut Català d'Oncologia Hospitalet IDIBELL, Universitat de Barcelona Department of Clinical Haematology Barcelona Spain
| | - G Iacoboni
- Vall d’Hebron University Hospital Department of Hematology Barcelona Spain
| | - C Haioun
- Hopital Henri Mondor, AP‐HP Lymphoid Malignancies Unit Créteil France
| | - D Perez‐Callejo
- N F. Hoffmann‐La Roche Ltd Clinical Science ‐ Product Development Hematology Basel Switzerland
| | - L Lundberg
- N F. Hoffmann‐La Roche Ltd Clinical Science ‐ Product Development Hematology Basel Switzerland
| | - J Relf
- Roche Products Ltd Clinical Safety ‐ Product Development Safety Welwyn Garden City UK
| | - E Clark
- Roche Products Ltd Product Development Biostatistics Welwyn Garden City UK
| | - D Carlile
- Roche Products Ltd Clinical Pharmacology, Pharma Research and Early Development Welwyn Garden City UK
| | - E Piccione
- Genentech, Inc Oncology Biomarker Development South San Francisco USA
| | - A Belousov
- F. Hoffmann‐La Roche Ltd Product Development Biostatistics Basel Switzerland
| | - K Humphrey
- Roche Products Ltd Clinical Science ‐ Product Development Hematology Welwyn Garden City UK
| | - M. J Dickinson
- The Peter MacCallum Cancer Centre Royal Melbourne Hospital and The University of Melbourne Clinical Haematology Melbourne Australia
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Carlo-Stella C, Hutchings M, Offner FC, Morschhauser F, Bachy E, Crump M, Sureda Balari A, Iacoboni G, Haioun C, Perez-Callejo D, Lundberg L, Relf J, Clark E, Carlile D, Piccione E, Belousov A, Humphrey K, Dickinson MJ. Glofitamab step-up dosing (SUD): Complete response rates in updated efficacy data in heavily pretreated relapsed/refractory (R/R) non-Hodgkin lymphoma (NHL) patients (pts). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7519 Background: Glofitamab (RG6026), a T-cell-engaging, bispecific, full-length antibody, allows bivalent binding to CD20 (B-cells), and monovalent binding to CD3 (T-cells). In NP30179 (NCT03075696), an ongoing multicenter, Phase I dose-escalation and expansion study, 0.6–25mg glofitamab fixed-dosing with obinutuzumab pretreatment (Gpt), showed high, durable complete responses and manageable safety in heavily pretreated R/R NHL (Dickinson, et al. EHA 2020). Glofitamab SUD, in addition to Gpt, allowed dose escalation up to 30mg to maximize efficacy, while mitigating cytokine release syndrome (CRS) (Hutchings, et al. JCO 2021). We present updated efficacy data from glofitamab monotherapy SUD cohorts. Methods: Gpt (1000mg) was given to pts 7 days pre-glofitamab initial dose. Intravenous SUD of glofitamab was given on Day (D) 1 and 8 of Cycle (C) 1 and then at the target dose from C2D1 (2.5/10/16mg or 2.5/10/30mg); treatment continued for up to 12 cycles, every 21 days. Response rates were based on the Lugano criteria (Cheson, et al. JCO 2014). Results: Fifty-two pts received glofitamab SUD; 17 and 35 pts received 2.5/10/16mg and 2.5/10/30mg, respectively. Twenty-eight pts (53.8%) had aggressive NHL (aNHL) and 24 pts had indolent NHL (iNHL). Pts had a median age of 68 (44–85) years and received a median of 3 (1–12) prior lines of therapy. Forty (76.9%) and 38 (73.1%) pts were refractory to their most recent and any prior CD20 therapy, respectively. After a median follow-up of 6.3 months, an updated efficacy analysis was conducted on December 1, 2020. For pts with aNHL (N = 28), the best overall response (OR) and complete metabolic response (CMR) rates were 64.3% and 57.1%, respectively; a trend of improved response was observed with increased target dose, with a CMR rate of 71.4% at 2.5/10/30mg (N = 14). Notably, 4/5 pts (80%) with mantle cell lymphoma (2.5/10/16mg, n = 2; 2.5/10/30mg, n = 2) had CMR. For aNHL, 13/16 CMRs are ongoing, with 8 CMRs lasting > 3 months. For pts with iNHL (N = 24), OR and CMR rates were 79.2% and 70.8%, respectively; 14/17 CMRs are ongoing, with 10 CMRs lasting > 3 months. As of August 3, 2020, common adverse events (52 pts) were CRS (63.5%), neutropenia (38.5%), and pyrexia (32.7%). CRS was mostly confined to C1: 24/50 pts had CRS after 2.5mg; 20/49 pts after 10mg; 2/16 and 8/32 pts had CRS after 16 and 30mg (C2D1), respectively. Grade [Gr] 1 and 2 CRS was reported in 18 (34.6%) and 12 (23%) pts, respectively; 3 pts had Gr 3 CRS; none had Gr 4/5 events (ASTCT 2019). Updated data, including biomarker data on baseline CD20 expression and CD8 levels in the tumor, will be presented. Conclusions: Updated data for glofitamab monotherapy SUD show higher preliminary response rates than previously reported in pts with R/R NHL who have failed multiple lines of therapy. CRS was mostly manageable, of low grade, and confined to the first cycle of treatment. Clinical trial information: NCT03075696.
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Affiliation(s)
| | | | | | - Franck Morschhauser
- Hôpital Claude Huriez and Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Emmanuel Bachy
- Hospices Civils de Lyon and Université Claude Bernard, Pierre-Bénite, France
| | - Michael Crump
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Anna Sureda Balari
- Institut Català d'Oncologia Hospitalet, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | | | - James Relf
- Roche Products Ltd, Welwyn Garden City, United Kingdom
| | - Emma Clark
- Roche Products Ltd, Welwyn Garden City, United Kingdom
| | - David Carlile
- Roche Products Ltd, Welwyn Garden City, United Kingdom
| | | | | | | | - Michael J. Dickinson
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and The University of Melbourne, Melbourne, Australia
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Piccart M, Procter M, Fumagalli D, de Azambuja E, Clark E, Ewer MS, Restuccia E, Jerusalem G, Dent S, Reaby L, Bonnefoi H, Krop I, Liu TW, Pieńkowski T, Toi M, Wilcken N, Andersson M, Im YH, Tseng LM, Lueck HJ, Colleoni M, Monturus E, Sicoe M, Guillaume S, Bines J, Gelber RD, Viale G, Thomssen C. Adjuvant Pertuzumab and Trastuzumab in Early HER2-Positive Breast Cancer in the APHINITY Trial: 6 Years' Follow-Up. J Clin Oncol 2021; 39:1448-1457. [DOI: 10.1200/jco.20.01204] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE APHINITY, at 45 months median follow-up, showed that pertuzumab added to adjuvant trastuzumab and chemotherapy significantly improved invasive disease–free survival (IDFS) (hazard ratio 0.81 [95% CI, 0.66 to 1.00], P = .045) for patients with early human epidermal growth factor receptor 2 (HER2)–positive breast cancer (BC), specifically those with node-positive or hormone receptor (HR)–negative disease. We now report the preplanned second interim overall survival (OS) and descriptive updated IDFS analysis with 74 months median follow-up. METHODS After surgery and central HER2-positive confirmation, 4,805 patients with node-positive or high-risk node-negative BC were randomly assigned (1:1) to either 1-year pertuzumab or placebo added to standard adjuvant chemotherapy and 1-year trastuzumab. RESULTS This interim OS analysis comparing pertuzumab versus placebo did not reach the P = .0012 level required for statistical significance ( P = .17, hazard ratio 0.85). Six-year OS were 95% versus 94% with 125 deaths (5.2%) versus 147 (6.1%), respectively. IDFS analysis based on 508 events (intent-to-treat population) showed a hazard ratio of 0.76 (95% CI, 0.64 to 0.91) and 6-year IDFS of 91% and 88% for pertuzumab and placebo groups, respectively. The node-positive cohort continues to derive clear IDFS benefit from pertuzumab (hazard ratio 0.72 [95% CI, 0.59 to 0.87]), 6-year IDFS being 88% and 83%, respectively. Benefit was not seen in the node-negative cohort. In a subset analysis, IDFS benefit from pertuzumab showed a hazard ratio of 0.73 (95% CI, 0.59 to 0.92) for HR-positive disease and a hazard ratio of 0.83 (95% CI, 0.63 to 1.10) for HR-negative disease. Primary cardiac events remain < 1% in both the treatment groups. No new safety signals were seen. CONCLUSION This analysis confirms the IDFS benefit from adding pertuzumab to standard adjuvant therapy for patients with node-positive HER2-positive early BC. Longer follow-up is needed to fully assess OS benefit.
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Affiliation(s)
- Martine Piccart
- Institut Jules Bordet and L'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marion Procter
- Frontier Science Scotland Ltd, Kincraig, Kingussie, United Kingdom
| | | | - Evandro de Azambuja
- Institut Jules Bordet and L'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Emma Clark
- Roche Products Limited, Welwyn Garden City, United Kingdom
| | | | | | | | - Susan Dent
- Duke Cancer Institute, Duke University, Durham, NC
| | - Linda Reaby
- Inaugural Chair—Consumer Advisory Panel, Breast Cancer Trials Group, Newcastle, Australia
- Consumer Advisor to Breast Researchers, Garvan Institute of Research, Sydney, Australia
| | - Hervé Bonnefoi
- Institute Bergonié, UNICANCER, University of Bordeaux, Bordeaux, France
| | - Ian Krop
- Dana-Farber Cancer Institute, Boston, MA
| | - Tsang-Wu Liu
- National Health Research Institutes, Taipei, Taiwan
| | - Tadeusz Pieńkowski
- Oncological Department, Postgraduate Medical Education Center, Warsaw, Poland
| | - Masakazu Toi
- Breast Cancer Unit, Kyoto University Hospital, Kyoto, Japan
| | - Nicholas Wilcken
- Director of Medical Oncology, Westmead Hospital, Sydney
- Associate Professor of Medicine, University of Sydney, Sydney, Australia
| | - Michael Andersson
- Department of Oncology, Rigshospitalet, University Hospital, Copenhagen, Denmark
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Hyuck Im
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ling Ming Tseng
- Comprehensive Breast Health Center, Experimental Surgery, Department of Surgery, Taipei-Veterans General Hospital, Taipei, Taiwan
| | | | - Marco Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | | | | | - Sébastien Guillaume
- Institut Jules Bordet and L'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - José Bines
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Richard D. Gelber
- Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, Frontier Science Foundation, Boston, MA
| | - Giuseppe Viale
- University of Milan, IEO, European Institute of Oncology, IRCCS, Milan, Italy
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Harris HC, Buckley AM, Spittal W, Ewin D, Clark E, Altringham J, Bentley K, Moura IB, Wilcox MH, Woodford N, Davies K, Chilton CH. The effect of intestinal microbiota dysbiosis on growth and detection of carbapenemase-producing Enterobacterales within an in vitro gut model. J Hosp Infect 2021; 113:1-9. [PMID: 33932556 DOI: 10.1016/j.jhin.2021.04.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/18/2021] [Accepted: 04/14/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Carbapenemase-producing Enterobacterales (CPE) can colonize the gut and are of major clinical concern. Identification of CPE colonization is problematic; there is no gold-standard detection method, and the effects of antibiotic exposure and microbiota dysbiosis on detection are unknown. AIM Based on a national survey we selected four CPE screening assays in common use. We used a clinically reflective in vitro model of human gut microbiota to investigate the performance of each test to detect three different CPE strains under different, clinically relevant antibiotic exposures. METHODS Twelve gut models were seeded with a pooled faecal slurry and exposed to CPE either before, after, concomitant with, or in the absence of piperacillin-tazobactam (358 mg/L, 3 × daily, seven days). Total Enterobacterales and CPE populations were enumerated daily. Regular screening for CPE was performed using Cepheid Xpert® Carba-R molecular test, and with Brilliance™ CRE, Colorex™ mSuperCARBA and CHROMID® CARBA SMART agars. FINDINGS Detection of CPE when the microbiota are intact is problematic. Antibiotic exposure disrupts microbiota populations and allows CPE proliferation, increasing detection. The performances of assays varied, particularly with respect to different CPE strains. The Cepheid assay performed better than the three agar methods for detecting a low level of CPE within an intact microbiota, although performance of all screening methods was comparable when CPE populations increased in a disrupted microbiota. CONCLUSION CPE strains differed in their dynamics of colonization in an in vitro gut model and in their subsequent response to antibiotic exposure. This affected detection by molecular and screening methods, which has implications for the sensitivity of CPE screening in healthcare settings.
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Affiliation(s)
- H C Harris
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - A M Buckley
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - W Spittal
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - D Ewin
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - E Clark
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - J Altringham
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - K Bentley
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - I B Moura
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - M H Wilcox
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK; Department of Microbiology, Leeds Teaching Hospitals NHS Trust, The General Infirmary, Leeds, UK
| | - N Woodford
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI), Reference Unit, Microbiology Services - Colindale, Public Health England, UK
| | - K Davies
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK; Department of Microbiology, Leeds Teaching Hospitals NHS Trust, The General Infirmary, Leeds, UK
| | - C H Chilton
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
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Magner K, Ilin J, Clark E, King J, Davis A, Hiremath S. POS-039 N-Acetylcysteine and Contrast-induced Acute Kidney Injury: A Systematic Review and Meta-analysis exploring the Heterogeneity, Publication Bias and Small Study effects. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Clark E, Tullo D, Bertone A. Perceptual reasoning skills mediate the relationship between attention and math proficiency in individuals with a neurodevelopmental condition. Res Dev Disabil 2021; 111:103880. [PMID: 33556699 DOI: 10.1016/j.ridd.2021.103880] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/19/2020] [Accepted: 01/23/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND An important component of academic success in typically developing students is the development of math skills, which is associated with attention and perceptual reasoning (PR) skills. For children with a neurodevelopmental condition (NDC), the relationship is confounded by diagnostic-specific cognitive characteristics. Specifically, enhanced PR is specific to individuals with Autism Spectrum Disorder (ASD). AIMS The purpose of this study was to test: (i) a mediation model where PR skills would mediate the relationship between attention and math proficiency for students with an NCD, and (ii) whether this mediation model is moderated by a diagnostic profile. METHODS AND PROCEDURES One hundred and thirty-seven students with an NDC participated in a school-based study examining the effectiveness of using a standardized measure of attention in predicting math capabilities. OUTCOMES AND RESULTS PR mediated the relationship between attention and math proficiency for students diagnosed with an NDC. However, the model was not moderated by diagnostic profile. CONCLUSIONS AND IMPLICATIONS The results of this study provide a better understanding of the roles of higher-level cognitive ability specific to students with NDCs. Additionally, the superior PR skills demonstrated by the ASD sample further supports the research suggesting this population possesses cognitive strengths in this domain.
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Affiliation(s)
- E Clark
- Perceptual Neuroscience Lab for Autism and Development, Department of Educational and Counselling Psychology, McGill University, Canada.
| | - D Tullo
- Perceptual Neuroscience Lab for Autism and Development, Department of Educational and Counselling Psychology, McGill University, Canada
| | - A Bertone
- Perceptual Neuroscience Lab for Autism and Development, Department of Educational and Counselling Psychology, McGill University, Canada
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Clark E, Davis S, Gooberman-Hill R, Hunt L, Khera T, Zoe P, Tim P, Jon T. Vfrac – a simple clinical tool that identifies older women with back pain at high risk of osteoporotic vertebral fractures. Bone Rep 2021. [DOI: 10.1016/j.bonr.2021.100958] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Akbari A, Kunkel E, Bota S, Harel Z, Le Gal G, Cox C, Hundemer G, Canney M, Clark E, Massicotte-Azarinouch D, Eddeen A, Knoll G, Sood M. POS-468 PROTEINURIA AND VENOUS THROMBOEMBOLISM IN PREGNANCY: A POPULATION-BASED COHORT STUDY. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Clark E, Maguire H, Cannon P, Leung EY. The effects of physical activity, fast-mimicking diet and psychological interventions on cancer survival: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med 2021; 57:102654. [PMID: 33359756 PMCID: PMC8047871 DOI: 10.1016/j.ctim.2020.102654] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Health professionals are often asked if non-pharmacological interventions prolong life. This review aims to evaluate the effects of physical activity, fast-mimicking diet (FMD) and psychological interventions on survival in all cancers. METHODS A systematic review and meta-analysis of randomized controlled trials (RCTs). Only RCTs of physical activity, FMD and psychological interventions (including counselling, cognitive and other psychotherapies) in cancer patients that reported survival outcomes were included. DATA SOURCES CENTRAL, MEDLINE, Embase, CINAHL, APA PsycINFO, Web of Science, ICTRP and ClinicalTrials.gov from inception to January 2020 were searched without language restrictions. The protocol was prospectively registered at PROSPERO (CRD42019160944). RESULTS Thirty-one RCTs (9 on physical activity and 22 on psychological interventions) were included in the final analysis after evaluation of 60,207 records from our initial search. No eligible RCT on FMD was reported. RCTs on group psychological interventions (41.9 %) and in patients with breast cancer (38.7 %) were the most common. Most evaluated short-term interventions and in primary or adjuvant settings. Only one of 9 (11 %) RCTs on physical activity and 8 of 22 (36 %) RCTs on psychological interventions were associated with improved overall survival. Only group psychological interventions in breast cancer had adequate number of RCTs to allow a meta-analysis to be performed. It demonstrated a trend towards improved overall survival (HR -0.20, 95 %CI -0.49 to 0.10), particularly in RCTs that evaluated long-term (>6 months) therapies (HR -0.29, 95 %CI -0.59 to 0.01). CONCLUSION Longer term interventions starting early in the patients' care journey in primary and adjuvant settings have shown the most promise for improving survival. Better designed RCTs including survival outcomes are particularly needed in non-breast cancers.
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Affiliation(s)
- Emma Clark
- Institute of Infection, Immunity and Inflammation, Sir Graeme Davies Building, 120 University Place, University of Glasgow, Glasgow G12 8TA, United Kingdom
| | - Hannah Maguire
- Institute of Infection, Immunity and Inflammation, Sir Graeme Davies Building, 120 University Place, University of Glasgow, Glasgow G12 8TA, United Kingdom
| | - Paul Cannon
- University of Glasgow Library, University of Glasgow, Hillhead St, Glasgow G12 8QE, United Kingdom
| | - Elaine Yl Leung
- Institute of Infection, Immunity and Inflammation, Sir Graeme Davies Building, 120 University Place, University of Glasgow, Glasgow G12 8TA, United Kingdom; Institute of Cancer and Genomic Sciences, 6 Mindelsohn Way, Birmingham B15 2SY, United Kingdom.
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Gelber RD, Wang XV, Cole BF, Cameron D, Cardoso F, Tjan-Heijnen V, Krop I, Loi S, Salgado R, Kiermaier A, Frank E, Fumagalli D, Caballero C, de Azambuja E, Procter M, Clark E, Restuccia E, Heeson S, Bines J, Loibl S, Piccart-Gebhardt M. Abstract PS10-01: 6-year absolute invasive disease-free survival (IDFS) benefit of adding adjuvant pertuzumab to trastuzumab and chemotherapy for patients with early HER2-positive breast cancer: A STEPP analysis of the APHINITY (BIG 4-11) trial. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps10-01] [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: 11/16/2022]
Abstract
Abstract
Background: The primary analysis of the randomized, double-blind, placebo-controlled APHINITY trial, published in 2017, including 4804 patients (pts) with HER2-positive, early breast cancer with 45.4 months' median follow-up, demonstrated that adjuvant pertuzumab (P) added to trastuzumab and chemotherapy, statistically significantly improved invasive disease-free survival (IDFS) compared with placebo (Pla) added to trastuzumab and chemotherapy overall and for pts with node-positive (N+) disease. In 2019, updated descriptive analyses of IDFS with 74.1 months' median follow-up, demonstrated sustained benefit of adding P both overall (HR, 0.76; 95% CI, 0.64-0.91), and for N+ disease (HR, 0.72; 95% CI, 0.59-0.87), while confidence intervals remained wide for the node-negative (N-) cohort (HR, 1.02; 95% CI, 0.69-1.53). There is great interest to explore how these significant overall results translate into absolute treatment benefits for different patient subpopulations.
Methods: Subpopulation Treatment Effect Pattern Plot (STEPP) is an exploratory, graphical method that plots estimates of treatment effect for overlapping patient subpopulations defined by a covariate of interest. Four continuous covariates of interest are considered for defining subpopulations in this report: i) a clinical composite risk score (see below), ii) TILs percentage, iii) HER2 FISH copy number, and iv) a clinical-biological composite risk score combining the previous three factors. Pts with lowest values for the covariate comprise the extreme left STEPP subpopulation, and pts with highest values comprise the extreme right subpopulation. The clinical composite risk score for IDFS based on the overall cohort was calculated using a Cox regression model including the following prespecified clinical characteristics: number of positive nodes, tumor size, age, and centrally-reviewed hormone receptor status. Composite risk scores were scaled between 0 and 100 with higher scores reflecting higher risk of an IDFS event. An example of low clinical risk factors would be T1N0 and aged 40-64; while high risk would be T3N2 or higher and ages <40 or ≥65. At 74.1 months' median follow-up, the composite risk of an IDFS event did not depend on hormone receptor status. Differences in Kaplan-Meier estimates of 6-year IDFS percents (P minus Pla) were used as estimates of treatment effect for each subpopulation. The overall analyses (N=4804) used 9 overlapping subpopulations with ~1000 pts in each, the N- analyses (N=1799) used 5 subpopulations with ~500 pts in each, and the N+ analyses (N=3005) used 7 subpopulations with ~750 pts in each. Intermediate (middle) subpopulations were the 5th, 3rd, and 4th, respectively.
Results: Table of 6-year IDFS percents (%) from Aphinity STEPPs, Overall and for N- and N+ cohorts. For each analysis, results are shown for the two subpopulations at either extreme of the STEPP (i.e. lowest and highest risk or values) as well as the intermediate STEPP subpopulation.
Conclusions: Based on the two extreme and one intermediate subpopulations of the STEPP analyses shown in the table, the intermediate clinical composite risk subpopulation and the highest TILs percentages had the largest absolute improvements in 6-year IDFS percents for P compared with Pla.
Table of 6-year IDFS percents (%) from Aphinity STEPPs, Overall and for N- and N+ cohorts.6-year IDFS %Overall (N=4804)Node-Negative (N=1799)Node-Positive (N=3005)PPlaΔ±SEPPlaΔ±SEPPlaΔ±SEOverall Average Results90.687.82.8±0.995.094.90.1±1.187.983.44.5±1.2Clinical composite riskLowest risk (0 - 21)95.396.2-0.9±1.396.196.5-0.4±1.5---Intermediate (39 - 63)92.687.35.3±1.995.091.04.0±3.093.686.76.9±2.3Highest risk (81 - 100)80.575.84.7±2.8---79.475.44.0±3.2TILs percentageLowest values (0-9)90.487.82.6±2.094.795.2-0.5±2.087.282.64.6±2.7Intermediate (13-21)89.487.71.7±2.194.294.10.1±2.285.484.80.6±2.7Highest values (≥31)95.689.36.3±1.798.194.93.2±1.792.384.97.4±2.4HER2 copy numberLowest values (1-8)87.186.40.7±2.292.794.8-2.1±2.284.182.12.0±2.8Intermediate (9.5-11)91.889.02.8±1.994.996.1-1.3±1.990.783.37.4±2.5Highest values (13-32)90.588.91.6±2.096.095.10.9±2.087.785.32.4±2.6Clinical-biological composite riskLowest risk (0-21)96.796.40.3±1.298.295.72.5±1.6---Intermediate (40-60)93.489.53.9±1.991.792.7-1.0±2.594.288.85.4±2.2Highest risk (79-100)80.175.94.2±2.7---79.575.24.3±3.2
Citation Format: Richard D. Gelber, Xin Victoria Wang, Bernard F. Cole, David Cameron, Fatima Cardoso, Vivianne Tjan-Heijnen, Ian Krop, Sherene Loi, Roberto Salgado, Astrid Kiermaier, Elizabeth Frank, Debora Fumagalli, Carmela Caballero, Evandro de Azambuja, Marion Procter, Emma Clark, Eleonora Restuccia, Sarah Heeson, Jose Bines, Sibylle Loibl, Martine Piccart-Gebhardt. 6-year absolute invasive disease-free survival (IDFS) benefit of adding adjuvant pertuzumab to trastuzumab and chemotherapy for patients with early HER2-positive breast cancer: A STEPP analysis of the APHINITY (BIG 4-11) trial [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS10-01.
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Affiliation(s)
- Richard D. Gelber
- 1Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, Frontier Science Foundation, Boston, MA
| | - Xin Victoria Wang
- 2Dana-Farber Cancer Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Bernard F. Cole
- 3Department of Mathematics and Statistics, University of Vermont, Burlington, VT
| | - David Cameron
- 4Breast International Group (BIG), Brussels, Belgium; and Edinburgh University Cancer Research Centre, IGMM, Western General Hospital, Edinburgh, United Kingdom
| | - Fatima Cardoso
- 5Breast Unit, Champalimaud Clinical Center/Champalimau Foundation, Lisbon, Portugal
| | - Vivianne Tjan-Heijnen
- 6Dept. Medical Oncology, Maastricht University Medical Centre GROW, Maastricht, Netherlands
| | - Ian Krop
- 7Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Sherene Loi
- 8Peter Macallum Cancer Centre, Melbourne, Australia
| | | | - Astrid Kiermaier
- 9Roche Pharma Research and Early Development (pRED), Roche Innovation Center Basel, Basel, Switzerland
| | | | | | | | - Evandro de Azambuja
- 12Institut Jules Bordet and L’Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - Marion Procter
- 13Frontier Science Scotland Ltd., Kincraig, Kingussie, United Kingdom
| | - Emma Clark
- 14Roche Products Limited, Welwyn Garden City, United Kingdom
| | | | - Sarah Heeson
- 14Roche Products Limited, Welwyn Garden City, United Kingdom
| | - Jose Bines
- 16Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Sibylle Loibl
- 17German Breast Group; Neu-Isenburg, Germany; and Centre for Haematology and Oncology Bethanien, Frankfurt, Germany
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Franzoi MA, Procter M, Emond O, Parlier D, Pondé N, Eiger D, Guillaume S, Reaby L, Twelves C, Clark E, de Azambuja E, Bines J. Abstract PS7-21: Timelines to initiate an adjuvant phase III trial across the globe: A sub-analysis of the APHINITY trial. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps7-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:Previous analysis of an adjuvant breast cancer trial (NCT00490139) suggested that geographical location and income affected the time required to set up a clinical trial, being significantly longer in South American and upper-middle income economies, potentially affecting access of innovative therapies in these locations. Understanding that this can be a dynamic process, we performed a similar analysis for the recent global phase III APHINITY trial (NCT01358877), which investigated the addition of pertuzumab to chemotherapy and trastuzumab as adjuvant therapy for patients with HER2-positive primary breast cancer.
Methods:Time to regulatory authority (RA) submission to approval, time to ethics committee/institutional review board (EC/IRB) approval, time from study approval by EC/IRB to first randomized patient, and time from first to last randomized patient were collected prospectively. Analyses were conducted by grouping countries either by geographical region or economic income classification as per 2019 World Bank criteria. Descriptive statistics of medians and ranges were calculated for the different timelines evaluated. Differences between geographical regions and economic income classification groups were calculated using one-way analysis of variance (ANOVA) following data normalization on square roots of the time to local RA. Geographical regions represented by only one participating country were not included in the ANOVA calculations.
Results:APHINITY randomized 4805 patients between November 2011 and August 2013. Of the 42 participating countries, 41 had data available regarding all relevant timelines. Of those, 21 (51.2%) were located in Europe, 9 (21.9%) in the East Asia-Pacific region, 8 (19.5%) in Latin America and Caribbean, 2 (4.8%) in North America, and 1 (2.4%) in Sub-Saharan Africa. Twenty-seven (65.8%) of the participating countries had high, 11 (26.8%) upper-middle, and 3 (7.3%) had lower-middle income economies.
Except for time from first patient to last patient randomized, there was wide variation in timelines within geographical region and across economic income classification. For example, the median time from EC/IRB approval to first recruited patient across all geographical regions was 118 days, but the range was wide (13– 463 days). There was, however, no statistical difference between the time to RA according to geographical region (p=0.47) although there was a trend to longer time to RA in upper-middle income economies compared to the others (p=0.07).
Conclusion
Our results did not demonstrate a significantly longer time for trial activation in Latin American & Caribbean countries and upper-middle income economies compared to other groups in the APHINITY trial. When compared to a previous report, this may reflect collective work from collaborative research groups, pharmaceutical industry sponsors and regulatory authorities across the globe and is to be welcomed. Variability in timelines within geographical regions and income classifications may exist and should be further investigated.
Table 1: Timelines in the activation process of APHINITY across geographical region and economic income classification.Time to RA (days)*Time to EC/IRB (days)Time from EC/IRB approval to first patient (days)Time from first patient to last patient randomized (months)Europe and Central Asia56 (4-135)67 (22-164)109 (13-257)17.6 (13.2-21.7)North America31 (30-32)73 (19-126)126 (86-165)17.6 (13.8-21.5)East Asia and Pacific53 (15-372)67 (31-421)108 (56-147)18 (8.7-19.9)Latin America and Caribbean51 (15-276)43 (19-273)232 (98-463)14.6 (6.5-17.5)Middle East and North Africa-141 (141-141)92 (92-92)13.9 (13.9-13.9)Sub-Saharan Africa103 (103-103)14 (14-14)185 (185-185)18.2 (18.2-18.2)Overall53 (4-372)56 (14-421)118 (13-463)17 (6.5-21.7)High income45 (4-276)60 (19-273)98 (13-257)18.2 (11.9-21.7)Upper middle income92 (15-372)54 (14-421)185 (73-463)14.2 (6.5-18.2)Lower middle income55 (32-111)33 (32-78)201 (147-209)15.1 (13.5-17.4)Overall53 (4-372)56 (14-421)118 (13-463)17 (6.5-21.7)Data are medians (range)*The protocol was not submitted to a country regulatory authority for Israel. The corresponding timelines for Israel cannot be calculated.EC/IRB = ethics committee/institutional review board; RA = regulatory approval
Citation Format: Maria Alice Franzoi, Marion Procter, Orianne Emond, Damien Parlier, Noam Pondé, Daniel Eiger, Sebastien Guillaume, Linda Reaby, Christopher Twelves, Emma Clark, Evandro de Azambuja, Jose Bines. Timelines to initiate an adjuvant phase III trial across the globe: A sub-analysis of the APHINITY trial [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-21.
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Affiliation(s)
| | | | | | | | - Noam Pondé
- 4AC Camargo Cancer Center, São Paulo, Brazil
| | | | | | - Linda Reaby
- 5Patient Representative, Newcastle, Australia
| | | | - Emma Clark
- 7F. Hoffmann-La Roche, Basel, Switzerland
| | | | - Jose Bines
- 8Instituto Nacional do Cancer - INCA, Rio de Janeiro, Brazil
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Morschhauser F, Feugier P, Flinn IW, Gasiorowski R, Greil R, Illés Á, Johnson NA, Larouche JF, Lugtenburg PJ, Patti C, Salles GA, Trněný M, de Vos S, Mir F, Samineni D, Kim SY, Jiang Y, Punnoose E, Sinha A, Clark E, Spielewoy N, Humphrey K, Bazeos A, Zelenetz AD. A phase 2 study of venetoclax plus R-CHOP as first-line treatment for patients with diffuse large B-cell lymphoma. Blood 2021; 137:600-609. [PMID: 33538797 PMCID: PMC7869186 DOI: 10.1182/blood.2020006578] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [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: 04/22/2020] [Accepted: 08/24/2020] [Indexed: 12/29/2022] Open
Abstract
The phase 2 CAVALLI (NCT02055820) study assessed efficacy and safety of venetoclax, a selective B-cell lymphoma-2 (Bcl-2) inhibitor, with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in first-line (1L) diffuse large B-cell lymphoma (DLBCL), including patients demonstrating Bcl-2 protein overexpression by immunohistochemistry (Bcl-2 IHC+). Eligible patients were ≥18 years of age and had previously untreated DLBCL, Eastern Cooperative Oncology Group performance status ≤2, and International Prognostic Index 2 to 5. Venetoclax 800 mg (days 4-10, cycle 1; days 1-10, cycles 2-8) was administered with rituximab (8 cycles) and cyclophosphamide, doxorubicin, vincristine, and prednisone (6-8 cycles) in 21-day cycles. Primary end points were safety, tolerability, and research_plete response (CR) at end of treatment (EOT). Secondary end points were progression-free survival (PFS) and overall survival. Comparative analyses used covariate-adjusted R-CHOP controls from the GOYA/BO21005 study, an appropriate contemporary benchmark for safety and efficacy. Safety and efficacy analyses included 206 patients. CR rate at EOT was 69% in the overall population and was maintained across Bcl-2 IHC+ subgroups. With a median follow-up of 32.2 months, trends were observed for improved investigator-assessed PFS for venetoclax plus R-CHOP in the overall population (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.43-0.87) and Bcl-2 IHC+ subgroups (HR, 0.55; 95% CI, 0.34-0.89) vs R-CHOP. Despite a higher incidence of grade 3/4 hematologic adverse events (86%), related mortality was not increased (2%). Chemotherapy dose intensity was similar in CAVALLI vs GOYA. The addition of venetoclax to R-CHOP in 1L DLBCL demonstrates increased, but manageable, myelosuppression and the potential of improved efficacy, particularly in high-risk Bcl-2 IHC+ patient subgroups.
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Affiliation(s)
- Franck Morschhauser
- Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Groupe de Recherche sur les Formes Injectables et les Technologies Associées (ULR 7365-GRITA), Lille, France
| | - Pierre Feugier
- CHU de Nancy, Université de Lorraine, Vandoeuvre lès Nancy, France
| | - Ian W Flinn
- Sarah Cannon Research Institute-Tennessee Oncology, Nashville, TN
| | | | - Richard Greil
- Paracelcus Medical University Salzburg, Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Árpád Illés
- Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | | | - Pieternella J Lugtenburg
- HOVON Lunenburg Lymphoma Phase I-II Consortium, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Caterina Patti
- Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Gilles A Salles
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, University of Lyon, Pierre-Bénite, France
| | - Marek Trněný
- First Department of Medicine, Charles University General Hospital, Prague, Czech Republic
| | - Sven de Vos
- David Geffen School of Medicine, University of California (UCLA), Los Angeles, CA
| | - Farheen Mir
- Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | | | | | | | | | - Arijit Sinha
- Roche Products Limited, Welwyn Garden City, United Kingdom
| | - Emma Clark
- Roche Products Limited, Welwyn Garden City, United Kingdom
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Patton DE, Pearce CJ, Cartwright M, Smith F, Cadogan CA, Ryan C, Clark E, Francis JJ, Hughes CM. A non-randomised pilot study of the Solutions for Medication Adherence Problems (S-MAP) intervention in community pharmacies to support older adults adhere to multiple medications. Pilot Feasibility Stud 2021; 7:18. [PMID: 33413650 PMCID: PMC7788279 DOI: 10.1186/s40814-020-00762-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Older patients prescribed multiple medications commonly experience difficulties with adherence. High-quality evidence on interventions targeting older patients is lacking. Theory is rarely used to tailor adherence solutions. This study aimed to pilot test a novel intervention, developed using the Theoretical Domains Framework, which guides community pharmacists in identifying adherence barriers and delivering tailored solutions (behaviour change techniques). Key study procedures (e.g. recruitment, data collection) for a future randomised controlled trial (cRCT) were also assessed. METHODS Using purposive sampling, this non-randomised pilot study aimed to recruit 12 community pharmacies (six in Northern Ireland; six in London, England). Pharmacists were trained to deliver the intervention to non-adherent older patients (maximum 10 per pharmacy; target n = 60-120) aged ≥ 65 years (reduced to 50 years due to recruitment challenges) and prescribed ≥ 4 regular medicines. The intervention, guided by an iPad web-application, was delivered over 3-4 face-to-face or telephone sessions, tailored to specific barriers to adherence. We assessed the feasibility of collecting adherence data (primary outcome: self-report and dispensing records), health-related quality of life (HRQOL) and unplanned hospitalisations (secondary outcomes) at baseline and 6-months. The final decision on progressing to a cRCT, using pre-defined 'stop-amend-go' criteria, is presented. RESULTS Fifteen pharmacists from 12 pharmacies were recruited and trained. One pharmacy subsequently dropped out. Sixty patients were recruited (meeting the 'Amend' progression criteria), with 56 receiving the intervention. Adherence barriers were identified for 55 patients (98%) and a wide range of behaviour change solutions delivered (median: 5 per patient). Self-report and dispensing adherence data were available for 37 (61.7%) and 44 (73.3%) patients, respectively. HRQOL data were available for 35 (58.3%) patients. GP-reported and self-reported hospitalisations data were available for 47 (78.3%) and 23 (38.3%) patients, respectively. All progression concepts were met (nine 'Go' and three 'Amend' criteria). CONCLUSION This study demonstrates the feasibility of key study procedures (e.g. pharmacy recruitment) and delivery of a tailored adherence intervention in community pharmacies. However, modifications are required to enhance issues identified with patient recruitment, retention and missing data. A future definitive cRCT will explore the effectiveness of the intervention. TRIAL REGISTRATION ISRCTN, ISRCTN73831533 , Registered 12 January 2018.
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Affiliation(s)
- D. E. Patton
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - C. J. Pearce
- School of Health Sciences, City University of London, London, UK
| | - M. Cartwright
- School of Health Sciences, City University of London, London, UK
| | - F. Smith
- School of Pharmacy, University College London, London, UK
| | - C. A. Cadogan
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - C. Ryan
- School of Pharmacy & Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - E. Clark
- School of Health Sciences, City University of London, London, UK
| | - J. J. Francis
- School of Health Sciences, City University of London, London, UK
| | - C. M. Hughes
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
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Buckley AM, Altringham J, Clark E, Bently K, Spittal W, Ewin D, Wilkinson V, Davis G, Moura IB, Wilcox MH. Eravacycline, a novel tetracycline derivative, does not induce Clostridioides difficile infection in an in vitro human gut model. J Antimicrob Chemother 2021; 76:171-178. [PMID: 32929459 DOI: 10.1093/jac/dkaa386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/18/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES The approval of new antibiotics is essential to combat infections caused by antimicrobial-resistant pathogens; however, such agents should be tested to determine their effect on the resident microbiota and propensity to select for opportunistic pathogens, such as Clostridioides difficile. Eravacycline is a new antibiotic for the treatment of complicated intra-abdominal infections. Here, we determined the effects of eravacycline compared with moxifloxacin on the microbiota and if these were conducive to induction of C. difficile infection (CDI). METHODS We seeded in vitro chemostat models, which simulate the physiological conditions of the human colon, with a human faecal slurry and instilled gut-reflective concentrations of either eravacycline or moxifloxacin. RESULTS Eravacycline instillation was associated with decreased Bifidobacterium, Lactobacillus and Clostridium species, which recovered 1 week after exposure. However, Bacteroides spp. levels decreased to below the limit of detection and did not recover prior to the end of the experiment. Post-eravacycline, a bloom of aerobic bacterial species occurred, including Enterobacteriaceae, compared with pre-antibiotic, which remained high for the duration of the experiment. These changes in microbiota were not associated with induction of CDI, as we observed a lack of C. difficile spore germination and thus no toxin was detected. Moxifloxacin exposure sufficiently disrupted the microbiota to induce simulated CDI, where C. difficile spore germination, outgrowth and toxin production were seen. CONCLUSIONS These model data suggest that, despite the initial impact of eravacycline on the intestinal microbiota, similar to clinical trial data, this novel tetracycline has a low propensity to induce CDI.
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Affiliation(s)
- Anthony M Buckley
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS1 9JT, UK
| | - James Altringham
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS1 9JT, UK
| | - Emma Clark
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS1 9JT, UK
| | - Karen Bently
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS1 9JT, UK
| | - William Spittal
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS1 9JT, UK
| | - Duncan Ewin
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS1 9JT, UK
| | - Vikki Wilkinson
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS1 9JT, UK
| | - Georgina Davis
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS1 9JT, UK
| | - Ines B Moura
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS1 9JT, UK
| | - Mark H Wilcox
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS1 9JT, UK
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Meiwald A, Clark E, Kristan M, Edi C, Jeffries CL, Pelloquin B, Irish SR, Walker T, Messenger LA. Reduced long-lasting insecticidal net efficacy and pyrethroid insecticide resistance are associated with over-expression of CYP6P4, CYP6P3 and CYP6Z1 in populations of Anopheles coluzzii from South-East Côte d'Ivoire. J Infect Dis 2020; 225:1424-1434. [PMID: 33175129 PMCID: PMC9016462 DOI: 10.1093/infdis/jiaa699] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/02/2020] [Indexed: 12/14/2022] Open
Abstract
Background Resistance to major public health insecticides in Côte d’Ivoire has intensified and now threatens the long-term effectiveness of malaria vector control interventions. Methods This study evaluated the bioefficacy of conventional and next-generation long-lasting insecticidal nets (LLINs), determined resistance profiles, and characterized molecular and metabolic mechanisms in wild Anopheles coluzzii from Southeast Côte d’Ivoire in 2019. Results Phenotypic resistance was intense: >25% of mosquitoes survived exposure to 10 times the doses of pyrethroids required to kill susceptible populations. Similarly, the 24-hour mortality rate with deltamethrin-only LLINs was very low and not significantly different from that with an untreated net. Sublethal pyrethroid exposure did not induce significant delayed vector mortality effects 72 hours later. In contrast, LLINs containing the synergist piperonyl butoxide, or new insecticides clothianidin and chlorfenapyr, were highly toxic to A. coluzzii. Pyrethroid-susceptible A. coluzzii were significantly more likely to be infected with malaria, compared with those that survived insecticidal exposure. Pyrethroid resistance was associated with significant overexpression of CYP6P4, CYP6P3, and CYP6Z1. Conclusions Study findings raise concerns regarding the operational failure of standard LLINs and support the urgent deployment of vector control interventions incorporating piperonyl butoxide, chlorfenapyr, or clothianidin in areas of high resistance intensity in Côte d’Ivoire.
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Affiliation(s)
- Anne Meiwald
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Emma Clark
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mojca Kristan
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Constant Edi
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan 01, BP 1303, Abidjan, Côte d'Ivoire
| | - Claire L Jeffries
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bethanie Pelloquin
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Seth R Irish
- U.S. President's Malaria Initiative and Entomology Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Thomas Walker
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Louisa A Messenger
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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