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Woehrle H, Schoebel C, Ficker JH, Graml A, Schnepf J, Fietze I, Young P, Arzt M. Positive airway pressure telehealth models and long-term therapy termination: a healthcare database analysis. ERJ Open Res 2024; 10:00424-2023. [PMID: 38410706 PMCID: PMC10895437 DOI: 10.1183/23120541.00424-2023] [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: 06/28/2023] [Accepted: 11/21/2023] [Indexed: 02/28/2024] Open
Abstract
Background Telemonitoring-guided interventions can improve short-term positive airway pressure (PAP) therapy adherence, but long-term effects are unknown. This study investigated long-term PAP therapy termination in patients with sleep apnoea managed with standard care, telemonitoring-guided proactive care or telemonitoring-guided proactive care + patient engagement tool. Methods German healthcare provider data were analysed retrospectively. Individuals aged 18-100 years who started PAP from 2014 to 2019 and had device type/interface data were included. Time-to-termination periods were analysed using Kaplan-Meier plots and Cox proportional hazards regression, adjusted for age, sex, insurance type, and device and mask type. Results The per-protocol population (valid telemonitoring data) included 104 612 individuals (71% male; 95% aged >40 years). Mean follow-up was 3.3±2.0 years. The overall therapy termination rate was significantly lower in the telemonitoring-guided proactive care group versus standard care (20% versus 27%; p<0.001), and even lower in the telemonitoring-guided care + patient engagement tool group (11%; p<0.001 versus other treatment groups). Adjusted risk of therapy termination was lower versus standard care (hazard ratio 0.76, 95% confidence interval 0.74-0.78; and 0.41 (0.38-0.44) for telemonitoring-guided proactive care alone + patient engagement). Age <50 or >59 years and use of a nasal pillows or full-face mask were significant predictors of therapy termination; male sex, use of telemonitoring-guided proactive care (± patient engagement) and private insurance were significantly associated with lower therapy termination rates. Conclusions Use of telemonitoring-guided proactive care and a patient engagement tool was associated with lower rates of PAP therapy termination.
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Affiliation(s)
- Holger Woehrle
- Sleep and Ventilation Center Blaubeuren, Lung Center Ulm, Ulm, Germany
| | | | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuernberg and Paracelsus Medical University, Nuernberg, Germany
| | - Andrea Graml
- ResMed Science Center, ResMed Germany, Martinsried, Germany
| | - Jürgen Schnepf
- ResMed Science Center, ResMed Germany, Martinsried, Germany
| | - Ingo Fietze
- Centre for Sleep Medicine, CCM-CC11, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Young
- Department for Neurology, Medical Park, Bad Feilnbach, Germany
| | - Michael Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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Falk M, Schatz S, Reich FPM, Schmidt S, Galster M, Tiemann M, Ficker JH, Brueckl WM. Fluctuation of Acquired Resistance Mutations and Re-Challenge with EGFR TKI in Metastatic NSCLC: A Case Report. Curr Oncol 2023; 30:8865-8871. [PMID: 37887540 PMCID: PMC10605132 DOI: 10.3390/curroncol30100640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Osimertinib has become the preferred first-line therapy for epidermal growth factor receptor (EGFR) mutation-positive metastatic non-small cell lung cancer (NSCLC) in recent years. Originally, it was approved for second-line treatment after epidermal growth factor receptor EGFR tyrosine kinase inhibitors (TKIs) of the first and second generations had failed and EGFR T790M had emerged as a mode of resistance. Osimertinib itself provokes a wide array of on- and off-target molecular alterations that can limit therapeutic success. Liquid biopsy ctDNA (circulating tumor DNA) analysis by hybrid capture (HC) next-generation sequencing (NGS) can help to identify alterations in a minimally invasive way and allows for the detection of common as well as rare resistance alterations. We describe a young female patient who was initially diagnosed with metastatic EGFR L858R-positive NSCLC. She received EGFR TKI therapy at different timepoints during the course of the disease and developed sequential EGFR resistance alterations (EGFR T790M and C797S). In the course of her disease, resistance alteration became undetectable, and the tumor was successfully rechallenged with the original first-generation EGFR TKI as well as osimertinib and altogether showed prolonged response despite a prognostically negative TP53 alteration. To date, the patient has been alive for more than seven years, though initially diagnosed with a heavy metastatic burden.
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Affiliation(s)
- Markus Falk
- Institute for Hematopathology Hamburg, Fangdieckstraße 75A, 22547 Hamburg, Germany; (M.F.); (S.S.); (S.S.); (M.T.)
| | - Stefanie Schatz
- Institute for Hematopathology Hamburg, Fangdieckstraße 75A, 22547 Hamburg, Germany; (M.F.); (S.S.); (S.S.); (M.T.)
| | - Fabian P. M. Reich
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, General Hospital Nuremberg, Ernst-Nathan-Str. 1, 90419 Nuremberg, Germany; (F.P.M.R.); (J.H.F.)
| | - Stefanie Schmidt
- Institute for Hematopathology Hamburg, Fangdieckstraße 75A, 22547 Hamburg, Germany; (M.F.); (S.S.); (S.S.); (M.T.)
| | - Marco Galster
- Department of Radiology, Paracelsus Medical University, General Hospital Nuremberg, Ernst-Nathan-Str. 1, 90419 Nuremberg, Germany;
| | - Markus Tiemann
- Institute for Hematopathology Hamburg, Fangdieckstraße 75A, 22547 Hamburg, Germany; (M.F.); (S.S.); (S.S.); (M.T.)
| | - Joachim H. Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, General Hospital Nuremberg, Ernst-Nathan-Str. 1, 90419 Nuremberg, Germany; (F.P.M.R.); (J.H.F.)
| | - Wolfgang M. Brueckl
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, General Hospital Nuremberg, Ernst-Nathan-Str. 1, 90419 Nuremberg, Germany; (F.P.M.R.); (J.H.F.)
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Falk M, Willing E, Schmidt S, Schatz S, Galster M, Tiemann M, Ficker JH, Brueckl WM. Response of an HER2-Mutated NSCLC Patient to Trastuzumab Deruxtecan and Monitoring of Plasma ctDNA Levels by Liquid Biopsy. Curr Oncol 2023; 30:1692-1698. [PMID: 36826091 PMCID: PMC9954890 DOI: 10.3390/curroncol30020130] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/11/2023] [Indexed: 01/31/2023] Open
Abstract
HER2-targeted therapy is currently the subject of several studies in lung cancer and other solid tumors using either tyrosine kinase inhibitors (TKI) or targeted-antibody-drug conjugates. We describe a 61-year-old female patient with HER2 mutated adenocarcinoma of the lungs who received chemo-immunotherapy, followed by trastuzumab deruxtecan (T-DXd) and third-line Ramucirumab/Docetaxel at disease progression. Plasma ctDNA monitoring was obtained at 12 timepoints during therapy and revealed HER2 mutation allele frequencies that corresponded to the clinical course of disease. HER2-targeted T-DXd therapy resulted in a profound clinical response and may be an option for NSCLC patients carrying an activated HER2 mutation. Longitudinal liquid biopsy quantification of the underlying driver alteration can serve as a powerful diagnostic tool to monitor course of therapy.
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Affiliation(s)
- Markus Falk
- Institute for Histopathology Hamburg, Fangdieckstraße 75A, 22547 Hamburg, Germany
| | - Eva Willing
- Institute for Histopathology Hamburg, Fangdieckstraße 75A, 22547 Hamburg, Germany
| | - Stefanie Schmidt
- Institute for Histopathology Hamburg, Fangdieckstraße 75A, 22547 Hamburg, Germany
| | - Stefanie Schatz
- Institute for Histopathology Hamburg, Fangdieckstraße 75A, 22547 Hamburg, Germany
| | - Marco Galster
- Department of Radiology, Paracelsus Medical University, General Hospital Nurnberg, Ernst-Nathan-Str.1, 90419 Nuremberg, Germany
| | - Markus Tiemann
- Institute for Histopathology Hamburg, Fangdieckstraße 75A, 22547 Hamburg, Germany
| | - Joachim H. Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, General Hospital Nurnberg, Ernst-Nathan-Str.1, 90419 Nuremberg, Germany
| | - Wolfgang M. Brueckl
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, General Hospital Nurnberg, Ernst-Nathan-Str.1, 90419 Nuremberg, Germany
- Correspondence:
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Alter P, Kahnert K, Trudzinski FC, Bals R, Watz H, Speicher T, Söhler S, Andreas S, Welte T, Rabe KF, Wouters EFM, Sassmann-Schweda A, Wirtz H, Ficker JH, Vogelmeier CF, Jörres RA. Disease Progression and Age as Factors Underlying Multimorbidity in Patients with COPD: Results from COSYCONET. Int J Chron Obstruct Pulmon Dis 2022; 17:1703-1713. [PMID: 35936574 PMCID: PMC9346297 DOI: 10.2147/copd.s364812] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/21/2022] [Indexed: 02/02/2023] Open
Affiliation(s)
- Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Germany, Member of the German Center for Lung Research (DZL), Marburg, Germany
- Correspondence: Peter Alter, Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Baldingerstrasse 1, Marburg, Germany, Email
| | - Kathrin Kahnert
- Department of Internal Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Franziska C Trudzinski
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Tim Speicher
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Germany, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Sandra Söhler
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Germany, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Stefan Andreas
- LungClinic Immenhausen and Department of Cardiology and Pneumology, University Medical Center Göttingen, Germany, Member of the German Center for Lung Research (DZL), Göttingen, Germany
| | - Tobias Welte
- Clinic for Pneumology, Hannover Medical School, Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf and Department of Medicine, Christian-Albrechts University, Kiel, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands and Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | | | - Hubert Wirtz
- Department of Internal Medicine I, Pneumology, University of Leipzig, Leipzig, Germany
| | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Klinikum Nuremberg, Nürnberg, Germany
- Paracelsus Medical University Nuremberg, Nürnberg, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Germany, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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Höhl R, Bertram R, Kinzig M, Haarmeyer GS, Baumgärtel M, Geise A, Muschner D, Prosch D, Reger M, Naumann HT, Ficker JH, Kubitz J, Steinmann J, Sörgel F. Isavuconazole Therapeutic Drug Monitoring in critically ill ICU patients - a monocentric retrospective analysis. Mycoses 2022; 65:747-752. [PMID: 35535740 DOI: 10.1111/myc.13469] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The broad-spectrum triazole isavuconazole is used for the treatment of invasive aspergillosis and mucormycosis. Data regarding human plasma concentrations in clinical routine of the drug are rare. OBJECTIVES Plasma concentrations of isavuconazole were determined in critically ill ICU patients while considering different patients' characteristics. METHODS Retrospective analysis of isavuconazole plasma concentrations were obtained as part of routine therapeutic drug monitoring (TDM) of ICU patients with invasive aspergillosis or other fungal infections treated with isavuconazole. Plasma levels 0-4h after last dosing were defined as peak levels (Cmax ), those 20-28h after last dosing as trough levels (Cmin ). RESULTS Overall, 223 isavuconazole levels of 41 patients were analysed, divided into 141 peak levels and 82 trough levels. The overall median Cmax was 2.36 μg/mL (mean 2.43 μg/mL, range 0.41 - 7.79 μg/mL) and the overall median Cmin was 1.74 μg/mL (mean 1.77 μg/mL, range 0.24 - 4.96 μg/mL). In total, 31.7% of the Cmin values of the total cohort were below the plasma target concentrations of 1 μg/mL, defined as EUCAST antifungal clinical breakpoint for Aspergillus fumigatus. Both peak and trough plasma levels of isavuconazole were significantly lower among patients with a body-mass-index (BMI) ≥ 25. In addition, a significant correlation was observed between isavuconazole trough levels and sepsis-related organ failure assessment (SOFA) score. CONCLUSIONS This study shows that isavuconazole plasma concentrations vary in critical ill ICU patients. Significantly lower isavuconazole levels were associated with elevated BMI and higher SOFA score indicating a need of isavuconazole TDM in this specific patient population.
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Affiliation(s)
- Rainer Höhl
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Ralph Bertram
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Martina Kinzig
- Institute for Biomedical and Pharmaceutical Research, 90562 Nuremberg-Heroldsberg, Germany
| | - Golo-Sung Haarmeyer
- Department for Respiratory Medicine, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Matthias Baumgärtel
- Department for Respiratory Medicine, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Arnim Geise
- Department for Respiratory Medicine, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Dorothea Muschner
- Department for Respiratory Medicine, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Doris Prosch
- Department of Anesthesiology, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Mira Reger
- Institute for Biomedical and Pharmaceutical Research, 90562 Nuremberg-Heroldsberg, Germany
| | - Hans-Theodor Naumann
- Department for Respiratory Medicine, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Joachim H Ficker
- Department for Respiratory Medicine, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Jens Kubitz
- Department of Anesthesiology, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Joerg Steinmann
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Fritz Sörgel
- Institute for Biomedical and Pharmaceutical Research, 90562 Nuremberg-Heroldsberg, Germany
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6
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Köbler P, Krauss-Köstler EK, Stein B, Ficker JH, Wilhelm M, Dechêne A, Waller C. Specialized Biopsychosocial Care in Inpatient Somatic Medicine Units-A Pilot Study. Front Public Health 2022; 10:844874. [PMID: 35493384 PMCID: PMC9039260 DOI: 10.3389/fpubh.2022.844874] [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: 12/28/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Specialized biopsychosocial care concepts are necessary to overcome the dualism between physical and psychosocial treatment in acute care hospitals. For patients with complex and chronic comorbid physical and mental health problems, neither standardized psychiatric/psychosomatic nor somatic care units alone are appropriate to their needs. The “Nuremberg Integrated Psychosomatic Acute Unit” (NIPA) has been developed to integrate treatment of both, psychosocial and physical impairments, in an acute somatic care setting. Method NIPA has been established in inpatient internal medical wards for respiratory medicine, oncology and gastroenterology. One to two patients per ward are regularly enrolled in the NIPA treatment while remaining in the same inpatient bed after completion of the somatic care. In a naturalistic study design, we evaluated treatment effects by assessment of symptom load at admission and at discharge using the Patient Health Questionnaire (PHQ) and the Generalized Anxiety Disorder Scale-7 (GAD-7). Furthermore, we assessed the severity of morbidity using diagnosis data during treatment. At discharge, we measured satisfaction with treatment through the Patient Satisfaction Questionnaire (ZUF-8). Results Data from 41 NIPA patients were analyzed (18–87 years, 76% female). Seventy-eight percent suffered from at least moderate depression and 49% from anxiety disorders. Other diagnoses were somatoform pain disorder, somatoform autonomic dysfunction, eating disorder and posttraumatic stress disorder. Hypertension, chronic lung diseases and musculoskeletal disorders as well as chronic oncological and cardiac diseases were the most common somatic comorbidities. Treatment resulted in a significant reduction of depressive mood (admission: M = 10.9, SD = 6.1, discharge: M = 7.6, SD = 5.3, d = 0.58, p = 0.001), anxiety (admission: M = 10.6, SD = 4.9, discharge: M = 7.3, SD = 4.1, d = 0.65, p< 0.001) and stress (admission: M = 6.0, SD = 3.6, discharge: M = 4.1, SD = 2.5, d = 0.70, p< 0.001). Somatic symptom burden was reduced by NIPA treatment (admission: M = 10.9, SD = 5.8, discharge: M = 9.6, SD = 5.5, d = 0.30), albeit not statistically significant (p = 0.073) ZUF-8 revealed that 89% reported large or full satisfaction and 11% partial dissatisfaction with treatment. Discussion NIPA acute care is bridging the gap for patients in need of psychosocial treatment with complex somatic comorbidity. Further long-term evaluation will show whether psychosocial NIPA care is able to reduce the course of physical illness and hospital costs by preventing hospitalization and short-term inpatient re-admissions.
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Affiliation(s)
- Paul Köbler
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Eva K Krauss-Köstler
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Barbara Stein
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Joachim H Ficker
- Department of Internal Medicine 3, Respiratory Medicine, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Martin Wilhelm
- Department of Internal Medicine 5, Oncology/Hematology, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Alexander Dechêne
- Department of Internal Medicine 6, Gastroenterology, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Christiane Waller
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
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Han MK, Antila M, Ficker JH, Gordeev I, Guerreros A, Bernus AL, Roquilly A, Sifuentes-Osornio J, Tabak F, Teijeiro R, Bandelli L, Bonagura DS, Shu X, Felser JM, Knorr B, Cao W, Langmuir P, Lehmann T, Levine M, Savic S. Ruxolitinib in addition to standard of care for the treatment of patients admitted to hospital with COVID-19 (RUXCOVID): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Rheumatol 2022; 4:e351-e361. [PMID: 35368384 PMCID: PMC8963773 DOI: 10.1016/s2665-9913(22)00044-3] [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] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background COVID-19 is associated with acute respiratory distress and cytokine release syndrome. The Janus kinase (JAK)1/JAK2 inhibitor ruxolitinib reduces inflammatory cytokine concentrations in disorders characterised by cytokine dysregulation, including graft-versus-host disease, myelofibrosis, and secondary hemophagocytic lymphohistiocytosis. We assessed whether treatment with the JAK1/JAK2 inhibitor ruxolitinib would be beneficial in patients with COVID-19 admitted to hospital. Methods RUXCOVID was an international, randomised, double-blind, phase 3 trial of ruxolitinib plus standard of care versus placebo plus standard of care in patients with COVID-19. Patients who were hospitalised but not on mechanical ventilation or in the intensive care unit [ICU] were randomly assigned (2:1) to oral ruxolitinib 5 mg twice per day or placebo for 14 days (14 additional days were allowed if no improvement). The primary endpoint was a composite of death, respiratory failure (invasive ventilation), or ICU care by day 29, analysed by logistic regression including region, treatment, baseline clinical status, age, and sex as covariates. This trial is registered with ClinicalTrials.gov, NCT04362137. Findings Between May 4 and Sept 19, 2020, 432 patients were randomly assigned to ruxolitinib (n=287) or placebo (n=145) plus standard of care; the mean age was 56·5 years (SD 13·3), 197 (46%) were female, and 235 (54%) were male. The primary objective was not met: the composite endpoint occurred in 34 (12%) of 284 ruxolitinib-treated patients versus 17 (12%) of 144 placebo-treated patients (odds ratio 0·91, 95% CI 0·48-1·73; p=0·77). By day 29, nine (3%) of 286 ruxolitinib-treated patients had died compared with three (2%) of 145 placebo-treated patients; 22 (8%) of 286 ruxolitinib-treated patients had received invasive ventilation compared with ten (7%) of 145 placebo-treated patients; and 30 (11%) of 284 ruxolitinib-treated patients had received ICU care compared with 17 (12%) of 144 placebo-treated patients. In an exploratory analysis, median time to recovery was 1 day faster with ruxolitinib versus placebo (8 days vs 9 days; hazard ratio 1·10, 95% CI 0·89-1·36). Adverse events included headache (23 [8%] of 281 on ruxolitinib vs 11 [8%] of 143 on placebo) and diarrhoea (21 [7%] vs 12 [8%]). Interpretation Ruxolitinib 5 mg twice per day showed no benefit in the overall study population. A larger sample is required to determine the clinical importance of trends for increased efficacy in patient subgroups. Funding Novartis and Incyte.
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Affiliation(s)
- MeiLan K Han
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Martti Antila
- Department of Medicine, Clínica de Alergia Martti Antila, Sorocaba, Brazil
| | - Joachim H Ficker
- Department of Respiratory Medicine, Paracelsus Medical University, Nuernberg General Hospital, Nuremberg, Germany
| | - Ivan Gordeev
- Department of Healthcare, City Clinical Hospital n.a. O M Filatov, Moscow, Russia
| | | | - Amparo Lopez Bernus
- Department of Internal Medicine, University Hospital of Salamanca, University of Salamanca, CIETUS, IBSAL, Salamanca, Spain
| | - Antoine Roquilly
- Université de Nantes, CHU Nantes, EA3826 Thérapeutiques Anti-Infectieuses, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, France
| | - José Sifuentes-Osornio
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fehmi Tabak
- Department of Infectious Disease and Clinical Microbiology, Medical School of Cerrahpasa, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ricardo Teijeiro
- Department of Medicine, Hospital General de Agudos Dr Ignacio Pirovano, CABA, Argentina
| | | | - Diane S Bonagura
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Xu Shu
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - James M Felser
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Barbara Knorr
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Weihua Cao
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | | | - Michael Levine
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Sinisa Savic
- Department of Immunology and Allergy, Leeds Teaching Hospitals NHS Trust and National Institute for Health Research-Leeds Biomedical Research Centre, Leeds, UK
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8
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Brueckl NF, Wirtz RM, Reich FPM, Veltrup E, Zeitler G, Meyer C, Wuerflein D, Ficker JH, Eidt S, Brueckl WM. Predictive value of mRNA expression and dynamic changes from immune related biomarkers in liquid biopsies before and after start of pembrolizumab in stage IV non-small cell lung cancer (NSCLC). Transl Lung Cancer Res 2022; 10:4106-4119. [PMID: 35004242 PMCID: PMC8674604 DOI: 10.21037/tlcr-21-587] [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: 07/23/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022]
Abstract
Background The aim of this study was to determine whether mRNA expressions and dynamic changes of immune-related genes before and after starting first-line treatment with the PD-1 inhibitor pembrolizumab in patients with NSCLC were of predictive value. Methods CD3, CD8, PD-1, PD-L1 and CTLA-4 mRNA expression levels were measured from peripheral blood before and after three weeks of treatment with the PD-1 inhibitor. Univariate and multivariate analyses were performed retrospectively. Response, progression-free survival (PFS) and overall survival (OS) were determined. Results In univariate analysis an increase of CD3 and CD8 mRNA expression after the first cycle of pembrolizumab were each associated with improved PFS and OS. In contrast, patients with no change or with a decrease in CD3 and CD8 mRNA expression showed significantly worse outcome. CD8 mRNA increase remained an independent predictive factor for PFS and OS in the multivariate analysis with p values of 0.011 and 0.006, respectively. Conclusions An increase of CD8 mRNA expression predicts favorable outcome after first line monotherapy with pembrolizumab, while no change or decrease might serve as an indicator of poor outcome and might give cause for early treatment escalation for instance by addition of chemotherapy or additional ICI treatment, e.g., against CTLA-4.
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Affiliation(s)
- Natalie F Brueckl
- Department of Pathology, St.-Elisabeth Hospital Cologne, Teaching Hospital of the University of Cologne, Cologne, Germany
| | - Ralph M Wirtz
- Department of Pathology, St.-Elisabeth Hospital Cologne, Teaching Hospital of the University of Cologne, Cologne, Germany.,STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | - Fabian P M Reich
- Paracelsus Medical University Nuremberg, Nuremberg, Germany.,Department of Respiratory Medicine, Allergology and Sleep Medicine/Nuernberg Lung Cancer Center, Nuernberg General Hospital, Nuremberg, Germany
| | - Elke Veltrup
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | - Gloria Zeitler
- Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Christian Meyer
- Paracelsus Medical University Nuremberg, Nuremberg, Germany.,Department of Pathology, Nuremberg General Hospital, Nuremberg, Germany
| | - Dieter Wuerflein
- Paracelsus Medical University Nuremberg, Nuremberg, Germany.,Department of Respiratory Medicine, Allergology and Sleep Medicine/Nuernberg Lung Cancer Center, Nuernberg General Hospital, Nuremberg, Germany
| | - Joachim H Ficker
- Paracelsus Medical University Nuremberg, Nuremberg, Germany.,Department of Respiratory Medicine, Allergology and Sleep Medicine/Nuernberg Lung Cancer Center, Nuernberg General Hospital, Nuremberg, Germany
| | - Sebastian Eidt
- Department of Pathology, St.-Elisabeth Hospital Cologne, Teaching Hospital of the University of Cologne, Cologne, Germany
| | - Wolfgang M Brueckl
- Paracelsus Medical University Nuremberg, Nuremberg, Germany.,Department of Respiratory Medicine, Allergology and Sleep Medicine/Nuernberg Lung Cancer Center, Nuernberg General Hospital, Nuremberg, Germany
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9
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Kahnert K, Jörres RA, Lucke T, Trudzinski FC, Mertsch P, Bickert C, Ficker JH, Behr J, Bals R, Watz H, Welte T, Vogelmeier CF, Alter P. Lower Prevalence of Osteoporosis in Patients with COPD Taking Anti-Inflammatory Compounds for the Treatment of Diabetes: Results from COSYCONET. Int J Chron Obstruct Pulmon Dis 2021; 16:3189-3199. [PMID: 34853511 PMCID: PMC8627854 DOI: 10.2147/copd.s335029] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/18/2021] [Indexed: 12/15/2022] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) often have osteoporosis and diabetes as comorbid conditions. Anti-diabetic medication, including metformin, has protective effects on osteoporosis in experimental studies. We therefore studied whether patients with COPD receiving anti-diabetic medication had a lower osteoporosis prevalence in a large COPD cohort, COSYCONET. Methods Assessment of osteoporosis was based on patients’ reports of physician-based diagnoses and the presence of disease-specific medication. The predictive value of physical characteristics, lung function, comorbidities, cardiovascular medication, and the use of anti-inflammatory diabetes medication, including metformin, sulfonylureas, glinides or DPP4I, was evaluated using logistic regression analysis. ClinicalTrials.gov: NCT01245933. Results In total, 2222 patients were eligible for analysis (863 [39%] female, mean age 65 y), 515 of whom had higher symptoms and exacerbations (Global Initiative for Chronic Obstructive Lung Disease group D). Osteoporosis was present in 15.8% of the overall cohort, and in 24.1% of GOLD D patients. Regression analyses identified the following as associated with osteoporosis (p < 0.05): female sex, higher age, lower body-mass index, asthma, higher air trapping, oral steroids, and cardiovascular medication. Although oral anti-diabetic medication was overall not associated with a lower prevalence of osteoporosis (p = 0.131), anti-inflammatory anti-diabetic medication (p = 0.009) and metformin-containing therapy (p = 0.039) were. This was driven by GOLD D patients. Conclusion In a large COPD cohort, anti-inflammatory diabetes therapy, including metformin, was associated with a lower prevalence of osteoporosis, especially in patients with higher symptoms and exacerbations. These findings suggest a protective effect of common anti-diabetic medication on osteoporosis, possibly as a result of attenuated systemic inflammation.
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Affiliation(s)
- Kathrin Kahnert
- Department of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Tanja Lucke
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Franziska C Trudzinski
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Pontus Mertsch
- Department of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Christiane Bickert
- Department of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Joachim H Ficker
- Department of Respiratory Medicine, Nürnberg General Hospital, Paracelsus Medical University, Nürnberg, Germany
| | - Jürgen Behr
- Department of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Tobias Welte
- Clinic for Pneumology, Hannover Medical School, Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg (UMR), Germany, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg (UMR), Germany, Member of the German Center for Lung Research (DZL), Marburg, Germany
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10
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Brueckl WM, Reck M, Rittmeyer A, Kollmeier J, Wesseler C, Wiest GH, Christopoulos P, Stenzinger A, Tufman A, Hoffknecht P, Ulm B, Reich F, Ficker JH, Laack E. Efficacy of docetaxel plus ramucirumab as palliative second-line therapy following first-line chemotherapy plus immune-checkpoint-inhibitor combination treatment in patients with non-small cell lung cancer (NSCLC) UICC stage IV. Transl Lung Cancer Res 2021; 10:3093-3105. [PMID: 34430350 PMCID: PMC8350088 DOI: 10.21037/tlcr-21-197] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/25/2021] [Indexed: 12/26/2022]
Abstract
Background Chemotherapy plus immune-checkpoint inhibitor (CTx+ICI) therapy has become the preferred 1st line treatment in patients with metastatic NSCLC without oncogenic driven mutations. However, the optimal subsequent 2nd line treatment is not defined and several alternatives exist. The purpose of this analysis was to evaluate the efficacy of 2nd line docetaxel plus ramucirumab (D+R) initiated after failure of 1st line CTx+ICI. Methods Retrospective data were collected during routine care from German thoracic oncology centers. Only patients who had received at least one course of 2nd line D+R were included. ORR, PFS, OS and numbers of courses of D+R were investigated with PFS after initiation of D+R being the primary endpoint. Results Seventy-seven patients met the inclusion criteria. 2nd line treatment with D+R achieved an ORR and DCR of 32.5% and 62.4%, respectively. Median PFS for 2nd line therapy was 3.9 months with a DOR of 6.4 months. Median OS of 15.5 and 7.5 months were observed from the start of 1st line therapy and 2nd line treatment, respectively. No unexpected toxicities occurred. Presence of KRAS mutations was associated with significantly worse median PFS to D+R (2.8 vs. 4.5 months in wild-type cases; P=0.021) and was an independent predictor of inferior PFS in multivariate analysis. Conclusions D+R is an effective and safe 2nd line treatment after failure of 1st line CTx+ICI irrespective of NSCLC histology. However, patients with a KRAS mutation did not benefit from D+R in terms of PFS and will require further investigations.
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Affiliation(s)
- Wolfgang M Brueckl
- Department of Respiratory Medicine, Allergology and Sleep Medicine/Nuernberg Lung Cancer Center, Nuernberg General Hospital, Nuremberg, Germany.,Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Martin Reck
- Department of Thoracic Oncology, Airway Research Center North, German Center for Lung Research, Lung Clinic, Grosshansdorf, Germany
| | - Achim Rittmeyer
- Lungenfachklinik Immenhausen, Ambulanz für pneumologische Onkologie, Kassel, Germany
| | - Jens Kollmeier
- Helios Klinikum Emil von Behring, Lungenklinik Heckeshorn, Berlin, Germany
| | - Claas Wesseler
- Asklepios Tumorzentrum Hamburg, Klinikum Harburg, Hamburg, Germany
| | - Gunther H Wiest
- Asklepios Tumorzentrum Hamburg, Klinikum Harburg, Hamburg, Germany
| | | | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Site Heidelberg, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Amanda Tufman
- Medizinische Klinik V, Pneumologie, Klinikum der Universität München, Member of the German Center for Lung Research, CPC-M, Munich, Germany
| | - Petra Hoffknecht
- Lungenzentrum Osnabrueck, Klinik für Thoraxonkologie, Franziskus-Hospital Harderberg, Georgsmarienhütte, Germany
| | - Bernhard Ulm
- Unabhängige statistische Beratung Bernhard Ulm, Munich, Germany
| | - Fabian Reich
- Department of Respiratory Medicine, Allergology and Sleep Medicine/Nuernberg Lung Cancer Center, Nuernberg General Hospital, Nuremberg, Germany.,Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine/Nuernberg Lung Cancer Center, Nuernberg General Hospital, Nuremberg, Germany.,Paracelsus Medical University Nuremberg, Nuremberg, Germany
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11
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Eberhardt R, Slebos DJ, Herth FJF, Darwiche K, Wagner M, Ficker JH, Petermann C, Hübner RH, Stanzel F, Shargill NS, Valipour A. Endobronchial Valve (Zephyr) Treatment in Homogeneous Emphysema: One-Year Results from the IMPACT Randomized Clinical Trial. Respiration 2021; 100:1174-1185. [PMID: 34350884 DOI: 10.1159/000517034] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/22/2021] [Indexed: 11/19/2022] Open
Abstract
RATIONALE The long-term safety and effectiveness of bronchoscopic lung volume reduction with Zephyr endobronchial valves in subjects with severe homogeneous emphysema with little to no collateral ventilation beyond 3 months have yet to be established. METHODS Ninety-three subjects were randomized to either bronchoscopic lung volume reduction with Zephyr valves or standard of care (SoC) (1:1). Zephyr valve subjects were assessed at 3, 6, and 12 months. SoC subjects were assessed at 3 and 6 months; they were then offered crossover to Zephyr valve treatment. RESULTS The mean group difference (Zephyr valve - SoC) for change in FEV1 from baseline to 6 months was 16.3 ± 22.1% (mean ± SD; p < 0.001). Secondary outcomes showed the mean between-group difference for the six-minute walk distance of +28.3 ± 55.3 m (p = 0.016); St. George's Respiratory Questionnaire, -7.51 ± 9.56 points (p < 0.001); modified Medical Research Council, -0.42 ± 0.81 points (p = 0.019); BODE index, -0.85 ± 1.39 points (p = 0.006); and residual volume of -430 ± 830 mL (p = 0.011) in favor of the Zephyr valve group. At 6 months, there were significantly more responders based on the minimal clinically important difference for these same measures in the Zephyr valve versus the SoC group. The clinical benefits were persistent at 12 months. The percentage of subjects with respiratory serious adverse events was higher in the Zephyr valve group compared to SoC during the first 30 days post-procedure but not statistically different for the Zephyr valve and SoC groups from 31 days to 6 months, and stable in the Zephyr valve group out to 12 months. There were 2 deaths in the SoC group in the 31-day to 6-month period and none in the Zephyr valve group out to 12 months. CONCLUSIONS Bronchoscopic lung volume reduction with Zephyr valves in subjects with severe homogeneous emphysema and little to no collateral ventilation provides clinically meaningful change from baseline in lung function, quality of life, exercise capacity, dyspnea, and the BODE index at 6 months, with benefits maintained out to 12 months.
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Affiliation(s)
- Ralf Eberhardt
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg (TLRCH, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg (TLRCH, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Kaid Darwiche
- Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Clinic Essen, Essen, Germany
| | - Manfred Wagner
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
| | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
| | | | | | | | | | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Otto-Wagner-Spital, Wien, Austria.,Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Wien, Austria
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12
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Strassberger C, Zou D, Penzel T, Fietze I, Hedner J, Ficker JH, Randerath W, Sanner B, Sommermeyer D, Grote L. Beyond the AHI-pulse wave analysis during sleep for recognition of cardiovascular risk in sleep apnea patients. J Sleep Res 2021; 30:e13364. [PMID: 34032334 DOI: 10.1111/jsr.13364] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022]
Abstract
Recent evidence supports the use of pulse wave analysis during sleep for assessing functional aspects of the cardiovascular system. The current study compared the influence of pulse wave and sleep study-derived parameters on cardiovascular risk assessment. In a multi-centric study design, 358 sleep apnea patients (age 55 ± 13 years, 64% male, body mass index 30 ± 6 kg m-2 , apnea-hypopnea index 13 [5-26] events per hr) underwent a standard overnight sleep recording. A novel cardiac risk index was computed based on pulse wave signals derived from pulse oximetry, reflecting vascular stiffness, cardiac variability, vascular autonomic tone and nocturnal hypoxia. Cardiovascular risk was determined using the ESC/ESH cardiovascular risk matrix, and categorized to high/low added cardiovascular risk. Comparisons between cardiac risk index and sleep parameters were performed for cardiovascular risk prediction. Apnea-hypopnea index, oxygen desaturation index and cardiac risk index were associated with high cardiovascular risk after adjustment for confounders (p = .002, .001, < .001, respectively). In a nested reference model consisting of age, gender and body mass index, adding cardiac risk index but not apnea-hypopnea index or oxygen desaturation index significantly increased the area under the receiver operating characteristic curve (p = .012, .22 and .16, respectively). In a direct comparison of oxygen desaturation index and cardiac risk index, only the novel risk index had an independent effect on cardiovascular risk prediction (pCRI < .001, pODI = .71). These results emphasize the association between nocturnal pulse wave and overall cardiovascular risk determined by an established risk matrix. Thus, pulse wave analysis during sleep provides a powerful approach for cardiovascular risk assessment in addition to conventional sleep study parameters.
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Affiliation(s)
- Christian Strassberger
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Ding Zou
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Thomas Penzel
- Center of Sleep Medicine, CC12, University Hospital Charité, Berlin, Germany
| | - Ingo Fietze
- Center of Sleep Medicine, CC12, University Hospital Charité, Berlin, Germany
| | - Jan Hedner
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Sleep Disorders Centre, Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nurenberg, Germany
| | | | - Bernd Sanner
- Department of Pulmonary Medicine, Agaplesion Bethesda Krankenhaus Wuppertal, Wuppertal, Germany
| | - Dirk Sommermeyer
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Ludger Grote
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Sleep Disorders Centre, Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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13
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Brückl WM, Reck M, Griesinger F, Schäfer H, Kortsik C, Gaska T, Rawluk J, Krüger S, Kokowski K, Budweiser S, Ficker JH, Hoffmann C, Schüler A, Laack E. Afatinib as first-line treatment in patients with EGFR-mutated non-small cell lung cancer in routine clinical practice. Ther Adv Med Oncol 2021; 13:17588359211012361. [PMID: 33995597 PMCID: PMC8111535 DOI: 10.1177/17588359211012361] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/01/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Lung cancer is a leading cause of cancer-related death in Germany and worldwide. Non-small cell lung cancer (NSCLC) comprises ~80% of lung cancer diagnoses; in White patients, around 10% of NSCLC cases are epidermal growth factor receptor mutation-positive (EGFRm+). Head-to-head clinical trials have demonstrated superior efficacy with second-/third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) versus first-generation EGFR TKIs in EGFRm+ NSCLC. Data from routine clinical practice are necessary to confirm that clinical trial findings are transferable to real-world populations. Methods: In NCT02047903, a prospective non-interventional study in Germany, patients with EGFRm+ NSCLC received first-line afatinib until disease progression or intolerable adverse events. Key objectives were progression-free survival (PFS) rate at 12 months, objective response rate (ORR) and overall survival (OS). Safety/tolerability was also assessed. Results: Of 152 patients, 106 (69.7%) were female, 20 (13.1%) patients had an uncommon EGFR mutation and 51 patients (33.6%) had brain metastases. A starting dose of <40 mg was received by 39 (25.7%) patients. Overall, the 12-month PFS rate was 50.2% while the median PFS was 12.2 months. The ORR was 74.6% and the median OS was 30.4 months. In patients with brain metastases and uncommon mutations, the median PFS was 10.5 and 10.7 months, and the ORR was 77.3% and 83.3%, respectively. Treatment effectiveness was similar in patients with a starting dose of <40 mg (median PFS: 16.4 months; ORR, 81.3%) and a starting dose of 40 mg (median PFS: 10.8 months; ORR, 72.1%). Adverse drug reactions were manageable and consistent with the known afatinib safety profile. Conclusion: The results support clinical trial data for afatinib in routine clinical practice, including in patients generally excluded from clinical trials. Outcomes were positive in patients with uncommon EGFR mutations and in those with brain metastases. Treatment benefit was also seen in patients receiving a <40 mg afatinib starting dose, supporting patient-tailored dosing.
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Affiliation(s)
- Wolfgang M Brückl
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, General Hospital Nuremberg, Ernst-Nathan-Str.1, Nuremberg, 90419, Germany
| | - Martin Reck
- LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, Pius Hospital, University Department Internal Medicine-Oncology, University Medicine, Oldenburg, Germany
| | - Harald Schäfer
- Department of Pneumonology, SHG-Clinic Voelklingen, Germany
| | | | - Tobias Gaska
- Department of Hematology and Oncology, St. Josef Clinic, Paderborn, Germany
| | - Justyna Rawluk
- Faculty of Medicine, University of Freiburg, Germany; Department of Hematology and Oncology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Stefan Krüger
- Department for Pneumology, Cardiology and Intensive Care Medicine, Florence-Nightingale-Hospital, Düsseldorf, Germany
| | - Konrad Kokowski
- Department of Pneumonology, Bogenhausen Hospital, Munich, Germany
| | - Stephan Budweiser
- Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Clinical Centre, Rosenheim, Germany
| | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
| | - Christopher Hoffmann
- Human Pharma Country Medical Affairs, Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - Andrea Schüler
- Human Pharma Country Medical Affairs, Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
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14
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Swol J, Würflein D, Böhm J, Ficker JH. Two most common diagnoses among myriads of cystic lung diseases. Hippokratia 2021; 25:83-86. [PMID: 35937517 PMCID: PMC9347339] [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: 06/15/2023]
Abstract
BACKGROUND Diffuse cystic lung diseases are a group of heterogeneous pathophysiological processes and include neoplastic, inflammatory, and infectious etiologies. This manuscript focuses on manifestations of pulmonary Langerhans cell histiocytosis (PLCH) and lymphangioleiomyomatosis (LAM). Description of the cases: Three female patients with LAM and one with PLCH are described. Stress dyspnea was a key symptom. There were similar cyst patterns in more than one lung lobe with a slow, progressive course. Histopathology confirmed the LAM diagnosis resulting from the nodular proliferate and the cyst wall that strongly expressed Human Melanoma Black-45 (HMB-45). A typical constellation for PLCH was demonstrated in high-resolution computed tomography (HRCT). It was found to be disseminated and relatively thick-walled cysts, mainly in the upper and middle parts. An individualized therapy was applied. Three patients with mild symptoms were followed up, including HRCT evaluations. Sirolimus was administered to one patient with a severe manifestation of LAM. CONCLUSION LAM and PLCH are rare. High-resolution computed tomography is an essential diagnostic tool. Lung emphysema as misdiagnosis should be avoided. The characteristics of pulmonary cysts, the cyst's wall regularity, and identification of associated pulmonary lesions, should be evaluated. A promising new therapy concept are mTOR inhibitors are, especially in LAM. The most important recommendation in PLCH is the cessation of cigarette smoking. HIPPOKRATIA 2021, 25 (2):83-86.
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Affiliation(s)
- J Swol
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - D Würflein
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - J Böhm
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - J H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuremberg, Nuremberg, Germany
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15
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Behr J, Prasse A, Kreuter M, Johow J, Rabe KF, Bonella F, Bonnet R, Grohe C, Held M, Wilkens H, Hammerl P, Koschel D, Blaas S, Wirtz H, Ficker JH, Neumeister W, Schönfeld N, Claussen M, Kneidinger N, Frankenberger M, Hummler S, Kahn N, Tello S, Freise J, Welte T, Neuser P, Günther A. Pirfenidone in patients with progressive fibrotic interstitial lung diseases other than idiopathic pulmonary fibrosis (RELIEF): a double-blind, randomised, placebo-controlled, phase 2b trial. Lancet Respir Med 2021; 9:476-486. [PMID: 33798455 DOI: 10.1016/s2213-2600(20)30554-3] [Citation(s) in RCA: 203] [Impact Index Per Article: 67.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pirfenidone has been shown to slow disease progression in patients with idiopathic pulmonary fibrosis (IPF). However, there are few treatment options for progressive fibrotic interstitial lung diseases (ILDs)) other than IPF. In view of the pathomechanistic and clinical similarities between IPF and other progressive fibrotic ILDs, we aimed to assess the efficacy and safety of pirfenidone in patients with four non-IPF progressive fibrotic ILDs. METHODS We did a multicentre, double-blind, randomised, placebo-controlled, parallel phase 2b trial (RELIEF) in 17 centres with expertise in ILD in Germany. Eligible participants were patients aged 18-80 years with progressive fibrotic ILD due to four diagnoses: collagen or vascular diseases (ie, connective tissue disease-associated ILDs), fibrotic non-specific interstitial pneumonia, chronic hypersensitivity pneumonitis, or asbestos-induced lung fibrosis. Other eligibility criteria included a forced vital capacity (FVC) of 40-90% predicted, a diffusing capacity of the lung for carbon monoxide of 10-90% predicted, and an annual decline of FVC of at least 5% predicted despite conventional therapy, based on at least three measurements within 6-24 months before enrolment. Patients who had received any previous antifibrotic therapy were excluded. We randomly assigned patients (1:1) to either oral pirfenidone (267 mg three times per day in week 1, 534 mg three times per day in week 2, and 801 mg three times per day thereafter) or matched placebo, added to their ongoing medication. Randomisation was done centrally using permuted block randomisation with varying block sizes stratified by the four diagnostic groups. Patients, investigators, statisticians, monitors, and the study coordinator were masked to treatment assignment until database closure. The placebo-controlled study period was 48 weeks (including up-titration). The primary endpoint was absolute change in percentage of predicted FVC (FVC % predicted) from baseline to week 48 in the intention-to-treat population, with imputation of missing data by the smallest sum of squared differences and attribution of deceased patients to the lowest rank in a rank ANCOVA model. Additionally, we did linear mixed-model repeated measures slope analyses of FVC % predicted longitudinal data over the course of the study as a prespecified sensitivity analysis and post-hoc sensitivity analyses of the primary endpoint in the intention-to-treat population using imputation methods of last observation carried forward [LOCF] and a regression-based multiple imputation procedure. Safety was assessed in all patients who received at least one dose of study medication. This trial is registered with EudraCT 2014-000861-32; DRKS00009822 and is no longer recruiting. FINDINGS Between April 5, 2016, and Oct 4, 2018, we randomly assigned 127 patients to treatment: 64 to pirfenidone, 63 to placebo. After 127 patients had been randomised, the study was prematurely terminated on the basis of an interim analysis for futility triggered by slow recruitment. After 48 weeks and in the overall population of 127 patients, rank ANCOVA with diagnostic group included as a factor showed a significantly lower decline in FVC % predicted in the pirfenidone group compared with placebo (p=0·043); the result was similar when the model was stratified by diagnostic group (p=0·042). A significant treatment effect was also observed when applying the LOCF and multiple imputation methods to analyses of the primary endpoint. The median difference (Hodges-Lehmann estimate) between pirfenidone and placebo groups for the primary endpoint was 1·69 FVC % predicted (95% CI -0·65 to 4·03). In the linear mixed-model repeated measures slope analysis of FVC % predicted, the estimated difference between treatment and placebo groups from baseline to week 48 was 3·53 FVC % predicted (95% CI 0·21 to 6·86) with imputation of deaths as prespecified, or 2·79 FVC % predicted (95% CI 0·03 to 5·54) without imputation. One death (non-respiratory) occurred in the pirfenidone group (2%) and five deaths (three of which were respiratory) occurred in the placebo group (8%). The most frequent serious adverse events in both groups were infections and infestations (five [8%] in the pirfenidone group, ten [16%] in the placebo group); general disorders including disease worsening (two [3%] in the pirfenidone group, seven [11%] in the placebo group); and cardiac disorders (one ([2%] in the pirfenidone group, 5 [8%] in the placebo group). Adverse events (grade 3-4) of nausea (two patients on pirfenidone, two on placebo), dyspnoea (one patient on pirfenidone, one on placebo), and diarrhoea (one patient on pirfenidone) were also observed. INTERPRETATION In view of the premature study termination, results should be interpreted with care. Nevertheless, our data suggest that in patients with fibrotic ILDs other than IPF who deteriorate despite conventional therapy, adding pirfenidone to existing treatment might attenuate disease progression as measured by decline in FVC. FUNDING German Center for Lung Research, Roche Pharma.
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Affiliation(s)
- Jürgen Behr
- Department of Internal Medicine V, University Hospital, Ludwig Maximilian University (LMU) Munich, Member of the German Center for Lung Research (DZL), Munich, Germany; Asklepios Lung Center Gauting, DZL, Munich, Germany.
| | - Antje Prasse
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover Medical School, Hannover, Germany
| | - Michael Kreuter
- Center for Interstitial And Rare Lung Diseases, Department of Pneumology, Thoraxklinik Heidelberg University Hospital, Heidelberg, Germany
| | - Johannes Johow
- Coordinating Center for Clinical Trials, Philipps University Marburg, Marburg, Member of the German Center for Lung Research, Germany
| | - Klaus F Rabe
- Lung Clinic Grosshansdorf, Grosshansdorf, Germany
| | - Francesco Bonella
- Department of Pulmonary Medicine, Ruhrlandklinik, University Essen, Essen, Germany
| | - Reiner Bonnet
- Zentralklinik Bad Berka, Department of Pulmonary Medicine, Bad Berka, Germany
| | | | - Matthias Held
- Department of Pulmonary Medicine, KWM Missio Clinic, Würzburg, Würzburg, Germany
| | - Heinrike Wilkens
- Department of Pulmonary Medicine, Saarland University Medical Center, Homburg, Germany
| | | | - Dirk Koschel
- Lung Clinic Coswig, University Carl Gustav Carus Dresden, Dresden, Germany
| | - Stefan Blaas
- Donaustauf Hospital, Center for Pneumology, Donaustauf, Germany
| | - Hubert Wirtz
- Department of Pulmonary Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Joachim H Ficker
- Paracelsus Medical University Nuernberg, Nuernberg General Hospital, Nuernberg, Germany
| | - Wolfgang Neumeister
- Department of Pulmonary Medicine, Catholic Clinic Koblenz Montabaur, Koblenz, Germany
| | - Nicolas Schönfeld
- Helios Klinikum Emil von Behring, Lungenklinik Heckeshorn, Berlin, Germany
| | | | - Nikolaus Kneidinger
- Department of Internal Medicine V, University Hospital, Ludwig Maximilian University (LMU) Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Marion Frankenberger
- Comprehensive Pneumology Center, Helmholtz Center Munich, Ludwig Maximilian University Munich, Munich, Germany; Asklepios Clinic Gauting, Munich, Germany
| | - Simone Hummler
- Center for Interstitial And Rare Lung Diseases, Department of Pneumology, Thoraxklinik Heidelberg University Hospital, Heidelberg, Germany
| | - Nicolas Kahn
- Center for Interstitial And Rare Lung Diseases, Department of Pneumology, Thoraxklinik Heidelberg University Hospital, Heidelberg, Germany
| | - Silke Tello
- Center for Interstitial and Rare Lung Diseases, Justus-Liebig University Giessen, Giessen, Germany
| | - Julia Freise
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover Medical School, Hannover, Germany
| | - Petra Neuser
- Coordinating Center for Clinical Trials, Philipps University Marburg, Marburg, Member of the German Center for Lung Research, Germany
| | - Andreas Günther
- Center for Interstitial and Rare Lung Diseases, Justus-Liebig University Giessen, Giessen, Germany; Member of the German Center for Lung Research and Cardiopulmonary Institute, and Agaplesion Lung Clinic Waldhof-Elgershausen, Greifenstein, Germany
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Barco S, Schmidtmann I, Ageno W, Bauersachs RM, Becattini C, Bernardi E, Beyer-Westendorf J, Bonacchini L, Brachmann J, Christ M, Czihal M, Duerschmied D, Empen K, Espinola-Klein C, Ficker JH, Fonseca C, Genth-Zotz S, Jiménez D, Harjola VP, Held M, Iogna Prat L, Lange TJ, Manolis A, Meyer A, Mustonen P, Rauch-Kroehnert U, Ruiz-Artacho P, Schellong S, Schwaiblmair M, Stahrenberg R, Westerweel PE, Wild PS, Konstantinides SV, Lankeit M. Early discharge and home treatment of patients with low-risk pulmonary embolism with the oral factor Xa inhibitor rivaroxaban: an international multicentre single-arm clinical trial. Eur Heart J 2021; 41:509-518. [PMID: 31120118 DOI: 10.1093/eurheartj/ehz367] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 04/27/2019] [Accepted: 05/13/2019] [Indexed: 12/30/2022] Open
Abstract
AIMS To investigate the efficacy and safety of early transition from hospital to ambulatory treatment in low-risk acute PE, using the oral factor Xa inhibitor rivaroxaban. METHODS AND RESULTS We conducted a prospective multicentre single-arm investigator initiated and academically sponsored management trial in patients with acute low-risk PE (EudraCT Identifier 2013-001657-28). Eligibility criteria included absence of (i) haemodynamic instability, (ii) right ventricular dysfunction or intracardiac thrombi, and (iii) serious comorbidities. Up to two nights of hospital stay were permitted. Rivaroxaban was given at the approved dose for PE for ≥3 months. The primary outcome was symptomatic recurrent venous thromboembolism (VTE) or PE-related death within 3 months of enrolment. An interim analysis was planned after the first 525 patients, with prespecified early termination of the study if the null hypothesis could be rejected at the level of α = 0.004 (<6 primary outcome events). From May 2014 through June 2018, consecutive patients were enrolled in seven countries. Of the 525 patients included in the interim analysis, three (0.6%; one-sided upper 99.6% confidence interval 2.1%) suffered symptomatic non-fatal VTE recurrence, a number sufficiently low to fulfil the condition for early termination of the trial. Major bleeding occurred in 6 (1.2%) of the 519 patients comprising the safety population. There were two cancer-related deaths (0.4%). CONCLUSION Early discharge and home treatment with rivaroxaban is effective and safe in carefully selected patients with acute low-risk PE. The results of the present trial support the selection of appropriate patients for ambulatory treatment of PE.
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Affiliation(s)
- Stefano Barco
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, Building 403, 55131 Mainz, Germany
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Obere Zahlbacher Strasse 69, 55131 Mainz, Germany
| | - Walter Ageno
- Department of Medicine and Surgery, Research Center on Thromboembolic Diseases and Antithrombotic Therapies, University of Insubria, Viale Luigi Borri 57, 21100 Varese, Italy
| | - Rupert M Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt, Grafenstrasse 9, 64283 Darmstadt, Germany
| | - Cecilia Becattini
- Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Via G. Dottori 1, 06129 Perugia, Italy
| | - Enrico Bernardi
- Department of Emergency Medicine, ULSS n.7, Via Brigata Bisagno 4, 31015 Conegliano (Treviso), Italy
| | - Jan Beyer-Westendorf
- Thrombosis Research Unit, Division of Hematology, Department of Medicine I, University Hospital "Carl Gustav Carus", Fetscherstrasse 74, 01307 Dresden, Germany.,Kings Thrombosis Service, Department of Hematology, Kings College London, Denmark Hill, Brixton, SE5 9RS, London, UK
| | - Luca Bonacchini
- S.C. Medicina d'Urgenza e Pronto Soccorso, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162 Milano, Italy
| | - Johannes Brachmann
- II Medical Department, Coburg Hospital, Ketschendorfer Strasse 33, 96450 Coburg, Germany
| | - Michael Christ
- Emergency Care (Notfallzentrum), Luzerner Kantonsspital, 6000 Luzern, Switzerland
| | - Michael Czihal
- Division of Vascular Medicine, Hospital of the Ludwig-Maximilians-University, Georgenstrasse 5, 80799 Munich, Germany
| | - Daniel Duerschmied
- Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Klaus Empen
- Department of Internal Medicine, University Medical Center, Fleischmannstrasse 6, 17489 Greifswald, Germany
| | - Christine Espinola-Klein
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, Building 403, 55131 Mainz, Germany.,Center for Cardiology, Cardiology 1, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Joachim H Ficker
- Department of Respiratory Medicine, Nuremberg General Hospital/Paracelsus Medical University, Prof.-Ernst-Nathan-Strasse 1, 90419 Nuremberg, Germany
| | - Cândida Fonseca
- Department of Internal Medicine, Hospital S. Francisco Xavier/CHLO, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisbon, Portugal
| | - Sabine Genth-Zotz
- Department of Internal Medicine I, Katholisches Klinikum Mainz, An der Goldrube 11, 55131 Mainz, Germany
| | - David Jiménez
- Respiratory Department, Ramón y Cajal Hospital, Universidad de Alcala, IRYCIS, Ctra. Colmenar Viejo, km. 9, 100, 28034 Madrid, Spain
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Tukholmankatu 8A, 00290 Helsinki, Finland
| | - Matthias Held
- Department of Internal Medicine, Medical Mission Hospital, Academic Teaching Hospital of the Julius-Maximilian University of Wuerzburg, Josef-Schneider-Strasse 2, 97080 Wuerzburg, Germany
| | - Lorenzo Iogna Prat
- Department of Emergency Medicine, Santa Maria della Misericordia Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Tobias J Lange
- Department of Internal Medicine II, Division of Pneumology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Athanasios Manolis
- Department of Cardiology, General Hospital 'Asklepeion Voulas', Leof. Vasileos Pavlou 1, 166 73 Athens, Greece
| | - Andreas Meyer
- Kliniken Maria Hilf, Klinik für Pneumologie, Krankenhaus St. Franziskus, Viersener Str. 450, 41063 Mönchengladbach, Germany
| | - Pirjo Mustonen
- Department of Medicine, Keski-Suomi Central Hospital and University of Jyväskylä, Keskussairaalantie 19, 40620 Jyväskylä, Finland
| | - Ursula Rauch-Kroehnert
- Department of Cardiology, University Heart Center Berlin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Pedro Ruiz-Artacho
- Emergency Department, Clinico San Carlos Hospital, IdISSC, alle del Prof Martín Lagos, s/n, 28040 Madrid, Spain.,Internal Medicine Department, University Clinic of Navarra, Calle Marquesado de Sta. Marta 1, 28027 Madrid, Spain
| | - Sebastian Schellong
- Vascular Center, Municipal Hospital of Dresden-Friedrichstadt, Friedrichstraße 41, 01067 Dresden, Germany
| | - Martin Schwaiblmair
- Department of Cardiology, Respiratory Medicine and Intensive Care, Klinikum Augsburg, Ludwig-Maximilians-University Munich, Stenglinstrasse 2, 86156 Munich, Germany
| | - Raoul Stahrenberg
- Helios Albert-Schweitzer-Klinik, Albert-Schweitzer-Weg 1, 37154 Northeim, Germany
| | - Peter E Westerweel
- Department of Internal Medicine, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands
| | - Philipp S Wild
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, Building 403, 55131 Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany.,Center for Cardiology, Preventive Cardiology and Preventive Medicine, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, Building 403, 55131 Mainz, Germany.,Department of Cardiology, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Mareike Lankeit
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, Building 403, 55131 Mainz, Germany.,Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité - University Medicine Berlin, Augustenburgerplatz 1, 13353 Berlin, Germany.,Clinic of Cardiology and Pneumology, Heart Center, University Medical Center Goettingen, Robert-Koch-Strasse 40, 37075 Goettingen, Germany
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Brueckl WM, Ficker JH, Zeitler G. Clinically relevant prognostic and predictive markers for immune-checkpoint-inhibitor (ICI) therapy in non-small cell lung cancer (NSCLC). BMC Cancer 2020; 20:1185. [PMID: 33272262 PMCID: PMC7713034 DOI: 10.1186/s12885-020-07690-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [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: 08/10/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) either alone or in combination with chemotherapy have expanded our choice of agents for the palliative treatment of non-small cell lung cancer (NSCLC) patients. Unfortunately, not all patients will experience favorable response to treatment with ICI and may even suffer from severe side effects. Therefore, prognostic and predictive markers, beyond programmed death ligand 1 (PD-L1) expression status, are of utmost importance for decision making in the palliative treatment. This review focuses on clinical, laboratory and genetic markers, most of them easily to obtain in the daily clinical practice. RESULTS Recently, a number of prognostic and predictive factors in association to palliative ICI therapy have been described in NSCLC. Besides biometric parameters and clinical characteristics of the tumor, there are useful markers from routine blood sampling as well as innovative soluble genetic markers which can be determined before and during ICI treatment. Additionally, the level of evidence is noted. CONCLUSIONS These factors can be helpful to predict patients' outcome and tumor response to ICI. They should be implemented prospectively in ICI based clinical trials to develop reliable algorithms for palliative NSCLC treatment.
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Affiliation(s)
- Wolfgang M Brueckl
- Department of Respiratory Medicine, Allergology and Sleep Medicine / Nuremberg Lung Cancer Center, Paracelsus Medical University, General Hospital Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany.
- Paracelsus Medical Private University Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany.
| | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine / Nuremberg Lung Cancer Center, Paracelsus Medical University, General Hospital Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
- Paracelsus Medical Private University Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
| | - Gloria Zeitler
- Paracelsus Medical Private University Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
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Swol J, Boehm J, Jakoubova R, Ficker JH. Gluteal abscess caused by Mycobacterium tuberculosis. Tech Coloproctol 2020; 24:1315-1316. [PMID: 33068189 DOI: 10.1007/s10151-020-02357-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 10/06/2020] [Indexed: 11/26/2022]
Affiliation(s)
- J Swol
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuremberg, General Hospital Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany.
| | - J Boehm
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuremberg, General Hospital Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
| | - R Jakoubova
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuremberg, General Hospital Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
| | - J H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuremberg, General Hospital Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
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Barco S, Schmidtmann I, Ageno W, Anušić T, Bauersachs RM, Becattini C, Bernardi E, Beyer-Westendorf J, Bonacchini L, Brachmann J, Christ M, Czihal M, Duerschmied D, Empen K, Espinola-Klein C, Ficker JH, Fonseca C, Genth-Zotz S, Jiménez D, Harjola VP, Held M, Iogna Prat L, Lange TJ, Lankeit M, Manolis A, Meyer A, Münzel T, Mustonen P, Rauch-Kroehnert U, Ruiz-Artacho P, Schellong S, Schwaiblmair M, Stahrenberg R, Valerio L, Westerweel PE, Wild PS, Konstantinides SV. Survival and quality of life after early discharge in low-risk pulmonary embolism. Eur Respir J 2020; 57:13993003.02368-2020. [DOI: 10.1183/13993003.02368-2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/21/2020] [Indexed: 11/05/2022]
Abstract
IntroductionEarly discharge of patients with acute low-risk pulmonary embolism requires validation by prospective trials with clinical and quality-of-life outcomes.MethodsThe multinational Home Treatment of Patients with Low-Risk Pulmonary Embolism with the Oral Factor Xa Inhibitor Rivaroxaban (HoT-PE) single-arm management trial investigated early discharge followed by ambulatory treatment with rivaroxaban. The study was stopped for efficacy after the positive results of the predefined interim analysis at 50% of the planned population. The present analysis includes the entire trial population (576 patients). In addition to 3-month recurrence (primary outcome) and 1-year overall mortality, we analysed self-reported disease-specific (Pulmonary Embolism Quality of Life (PEmb-QoL) questionnaire) and generic (five-level five-dimension EuroQoL (EQ-5D-5L) scale) quality of life as well as treatment satisfaction (Anti-Clot Treatment Scale (ACTS)) after pulmonary embolism.ResultsThe primary efficacy outcome occurred in three (0.5%, one-sided upper 95% CI 1.3%) patients. The 1-year mortality was 2.4%. The mean±sd PEmb-QoL decreased from 28.9±20.6% at 3 weeks to 19.9±15.4% at 3 months, a mean change (improvement) of −9.1% (p<0.0001). Improvement was consistent across all PEmb-QoL dimensions. The EQ-5D-5L was 0.89±0.12 at 3 weeks after enrolment and improved to 0.91±0.12 at 3 months (p<0.0001). Female sex and cardiopulmonary disease were associated with poorer disease-specific and generic quality of life; older age was associated with faster worsening of generic quality of life. The ACTS burden score improved from 40.5±6.6 points at 3 weeks to 42.5±5.9 points at 3 months (p<0.0001).ConclusionsOur results further support early discharge and ambulatory oral anticoagulation for selected patients with low-risk pulmonary embolism. Targeted strategies may be necessary to further improve quality of life in specific patient subgroups.
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Brueckl WM, Reck M, Rittmeyer A, Kollmeier J, Wesseler C, Wiest GH, Christopoulos P, Tufman A, Hoffknecht P, Ulm B, Reich F, Ficker JH, Laack E. Efficacy of Docetaxel Plus Ramucirumab as Palliative Third-Line Therapy Following Second-Line Immune-Checkpoint-Inhibitor Treatment in Patients With Non-Small-Cell Lung Cancer Stage IV. Clin Med Insights Oncol 2020; 14:1179554920951358. [PMID: 32884390 PMCID: PMC7440727 DOI: 10.1177/1179554920951358] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/23/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Antiangiogenic agents have been shown to stimulate the immune system and cause synergistic effects with chemotherapy. Effects might be even stronger after immune-checkpoint-inhibitor (ICI) therapy. The purpose of this analysis was to evaluate the efficacy of ramucirumab plus docetaxel (R + D) as third-line treatment after failure of a first-line platinum-based chemotherapy and a second-line ICI treatment in patients with non-small-cell lung cancer (NSCLC) stage IV. METHODS Retrospective data were collected from 9 German thoracic oncology centers. Only patients who had received at least 1 cycle of third-line R + D were included. The numbers of cycles, objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were investigated. RESULTS Sixty-seven patients met the criteria for inclusion. Third-line treatment with R + D achieved an ORR of 36% and a disease control rate (DCR) of 69%. Median PFS for third-line therapy was 6.8 months with a duration of response (DOR) of 10.2 months. A median OS of 29 months was observed from the start of first-line therapy with a median OS of 11.0 months from the start of third-line treatment. No unexpected toxicities occurred. CONCLUSION R + D is a highly effective and safe third-line treatment after failure of second-line programmed cell death protein 1/programmed cell death-ligand 1 (PD1/PD-L1)-derived ICI therapy irrespective of NSCLC histology. As there may be synergistic effects of second- and third-line treatments, this sequence is a very suitable option for patients not treated with first-line ICI. In addition, R + D should continue to be investigated as a second-line treatment option after failure of chemotherapy plus ICI in the palliative first-line treatment.
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Affiliation(s)
- Wolfgang M Brueckl
- Nuremberg Lung Cancer Center, Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Martin Reck
- LungenClinic Grosshansdorf, Großhansdorf, Germany
| | - Achim Rittmeyer
- Ambulanz für pneumologische Onkologie, Lungenfachklinik Immenhausen, Kassel, Germany
| | - Jens Kollmeier
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Claas Wesseler
- Asklepios Tumorzentrum Hamburg, Asklepios Klinikum Harburg, Hamburg, Germany
| | - Gunther H Wiest
- Asklepios Tumorzentrum Hamburg, Asklepios Klinikum Harburg, Hamburg, Germany
| | | | - Amanda Tufman
- Medizinische Klinik und Poliklinik V (Pneumologie), Klinikum der Universität München, Munich, Germany
| | - Petra Hoffknecht
- Zentrum Klinik für Thoraxonkologie im Franziskus-Hospital Harderberg, Georgsmarienhütte, Germany
| | - Bernhard Ulm
- Unabhängige statistische Beratung Bernhard Ulm, Munich, Germany
| | - Fabian Reich
- Nuremberg Lung Cancer Center, Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Joachim H Ficker
- Nuremberg Lung Cancer Center, Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Eckart Laack
- Hämato-Onkologie Hamburg, Praxis, Hamburg, Germany
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Gotthardt P, Baumgärtel M, Geise A, Ficker JH. [Respiratory emergency after chest drain for spontaneous pneumothorax-re-expansion pulmonary oedema meets anaphylaxis]. Med Klin Intensivmed Notfmed 2020; 116:354-356. [PMID: 32778910 DOI: 10.1007/s00063-020-00692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/25/2020] [Accepted: 04/02/2020] [Indexed: 11/24/2022]
Affiliation(s)
- P Gotthardt
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland.
| | - M Baumgärtel
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
| | - A Geise
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
| | - J H Ficker
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
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Baumgärtel M, Würflein D, Neff U, Böhm J, Ficker JH, Swol J. Bridging Whole-Lung Lavage with Venovenous Extracorporeal Life Support for Pulmonary Alveolar Proteinosis. J Cardiothorac Vasc Anesth 2020; 34:1115-1117. [DOI: 10.1053/j.jvca.2019.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022]
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Fietze I, Ficker JH, Heiser C, Hofauer B, Schädlich S, Warmuth R, Stuck BA. Wenn CPAP nicht genutzt oder nicht vertragen wird – Vorschlag für eine standardisierte Terminologie. Somnologie 2020. [DOI: 10.1007/s11818-020-00233-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Zusammenfassung
Hintergrund
Die Standardtherapie einer obstruktiven Schlafapnoe (OSA) ist die nächtliche positive Überdruckbeatmung (PAP). Sie ist in der Regel nebenwirkungsarm und stellt eine Langzeittherapie dar. Doch nicht jeder Patient toleriert oder akzeptiert die Therapie oder möchte sie fortführen. Andere müssen sie aus objektiven Gründen beenden.
Fragestellung
Klare Begrifflichkeiten für eine Nicht-Anwendung der PAP-Therapie sind bisher nicht in den Leitlinien definiert. Ziel dieses Beitrags ist es, einheitliche Definitionen einzuführen, die eine Vorlage für klinisches Handeln und wissenschaftliche Ansätze sein können.
Material und Methode
Ein Expertengremium hat sich intensiv mit der Literatur, Definitionen und Hintergrundinformationen hinsichtlich des Themas befasst. Es wurden verschiedene Möglichkeiten der PAP-Nicht-Nutzung bzw. der Beendigung der Therapie betrachtet und dementsprechend Kategorien und Definitionen zusammengestellt.
Ergebnisse
Dies sind die vom Expertengremium vorgeschlagenen Kategorien für eine PAP-Nichtbenutzung: PAP-Inakzeptanz, PAP-Unverträglichkeit, PAP-Intoleranz, PAP-Versagen und PAP-Abbruch.
Diskussion
Diese Kategorien inklusive Definition können die Grundlage für ein einheitliches Management bei Patienten/Patientinnen mit obstruktiver Schlafapnoe (OSA) sein, die auf eine PAP-Therapie eingestellt werden bzw. wurden.
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Marietta von Siemens S, Alter P, Lutter JI, Kauczor HU, Jobst B, Bals R, Trudzinski FC, Söhler S, Behr J, Watz H, Waschki B, Bewig B, Jones PW, Welte T, Vogelmeier CF, Jörres RA, Kahnert K, Stefan A, Robert B, Jürgen B, Kathrin K, Burkhard B, Roland B, Ralf E, Beate S, Ficker JH, Manfred G, Christian G, Rainer H, Matthias H, Berthold J, Markus H, Felix H, Gerd H, Katus Hugo A, Anne-Marie K, Henrik W, Rembert K, Klaus K, Juliane K, Cornelia KS, Christoph L, Peter Z, Michael P, Randerath Winfried J, Werner S, Michael S, Christian T, Helmut T, Hartmut T, Christian VJ, Claus V, Ulrich W, Tobias W, Hubert W, Lehnert D, Struck B, Krabbe L, Arikan B, Tobias J, Speth K, Pieper J, Gleiniger M, Markworth B, Hinz Z, Burmann E, Wons K, Rieber U, Schaufler B, Schwedler K, Michalewski S, Rohweder S, Berger P, Schottel D, Janke V, Untsch R, Graf J, Reichel A, Weiß G, Traugott E, Kietzmann I, Schrade-Illmann M, Polte B, Hübner G. CAT score single item analysis in patients with COPD: Results from COSYCONET. Respir Med 2019; 159:105810. [DOI: 10.1016/j.rmed.2019.105810] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/31/2019] [Accepted: 11/02/2019] [Indexed: 12/14/2022]
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Graf J, Jörres RA, Lucke T, Nowak D, Vogelmeier CF, Ficker JH. Medical Treatment of COPD. Dtsch Arztebl Int 2019; 155:599-605. [PMID: 30282573 DOI: 10.3238/arztebl.2018.0599] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 01/19/2018] [Accepted: 05/03/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is common around the world and carries a high morbidity and mortality. Symptom- and risk-oriented drug treatment is recommended, both in Germany and in other countries. It is not yet known to what extent the treatment that is actually delivered in Germany corresponds to the current recommendations in the guidelines. METHODS As recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in 2017, 2281 patients of the national COPD cohort COSYCONET (COPD and Systemic Consequences-Comorbidities Network) were classified into Gold classes A-D on the basis of disease-specific manifestations and the frequency of exacerbations. Moreover, the regular use of medications was documented and categorized according to active substance groups. For all groups, the documented treatment that was actually given was compared to the recommended treatment. RESULTS 67.6% of the patients received a combination of a long-acting anticholinergic drug (LAMA) and a long-acting beta-mimetic drug (LABA), while 65.8% received inhaled corticosteroids (ICS), 11.7% theophylline, and 12.6% oral corticosteroids (OCS). Despite recommendations to the contrary, 66% of the patients in Groups A and B (low exacerbation rates) were treated with ICS; some of these patients carried an additional diagnosis of bronchial asthma. There was evidence of undertreatment mainly in groups C and D (high exacerbation rate), because many of the patients in these groups were not treated with LAMA or LAMA/LABA as recommended. CONCLUSION The observed deviations from the recommended treatment, some of which were substantial, might lead to suboptimal treatment outcomes as well as to avoidable side effects of medication.
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Affiliation(s)
- Jana Graf
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich, German Center for Lung Research (DZL), Munich, Germany; Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, University Hospitals of Gießen and Marburg, Marburg site, German Center for Lung Research (DZL); Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nürnberg, Paracelsus Medical University, Nürnberg, Germany
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Abstract
Dyspnea is a leading symptom in COPD. Bronchodilators (long acting anticholinergics and long acting beta agonists) are the mainstay of medical treatment. Non pharmacological therapies like pulmonary rehabilitation, long-term oxygen therapy or lung volume reduction can help to further improve dyspnea. Nevertheless, patients with advanced disease may develop refractory dyspnea. Randomized controlled trials demonstrated that the palliative treatment with low-dose systemic opioids is an effective treatment option in these patients. A low starting dose (e. g. 1.0 mg morphine, immediate release) is recommended. Subsequent doses are titrated to achieve the lowest effective dose based on whether dyspnea relief has been achieved and whether any side effects have developed. This low-dose opioid treatment has been demonstrated to be safe for symptom reduction in severe COPD and is not associated with increased hospital admissions or deaths. Physicians should offer a trial of low-dose oral opioids to patients with refractory dyspnea that affects their daily activities and quality of life.
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Parsch W, Welker J, H. Ficker J. Complete Cast of the Bronchial Tree. Dtsch Arztebl Int 2019; 116:318. [PMID: 31219030 PMCID: PMC6620760 DOI: 10.3238/arztebl.2019.0316a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Wolfgang Parsch
- *Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität,
| | - Jan Welker
- *Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität,
| | - Joachim H. Ficker
- *Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität,
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Affiliation(s)
- Justyna Swol
- *Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Klinikum Nürnberg Nord,
| | - Joachim H. Ficker
- *Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Klinikum Nürnberg Nord,
| | - Bianca Mannke
- **Klinik für Innere Medizin 6, Schwerpunkte Gastroenterologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Klinikum Nürnberg Nord
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Horváth I, Canotilho M, Chlumský J, Chorostowska-Wynimko J, Corda L, Derom E, Ficker JH, Kneussl M, Miravitlles M, Sucena M, Thabut G, Turner AM, van ’t Wout E, McElvaney NG. Diagnosis and management of α 1-antitrypsin deficiency in Europe: an expert survey. ERJ Open Res 2019; 5:00171-2018. [PMID: 30863774 PMCID: PMC6409083 DOI: 10.1183/23120541.00171-2018] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 09/24/2018] [Accepted: 12/12/2018] [Indexed: 01/09/2023] Open
Abstract
Despite recent improvements, α1-antitrypsin deficiency (AATD) remains a rarely diagnosed and treated condition. To assess the variability of AATD diagnosis/treatment in Europe, and to evaluate clinicians' views on methods to optimise management, specialist AATD clinicians were invited to complete a web-based survey. Surveys were completed by 15 physicians from 14 centres in 13 European countries. All respondents perceived the AATD diagnosis rate to be low in their country; 77% of physicians believed that ∼15% of cases were diagnosed. Low awareness was perceived as the greatest barrier to diagnosis. Spirometry was considered more practical than quantitative computed tomography (QCT) for monitoring AATD patients in clinical practice; QCT was considered more useful in trials. AAT therapy provision was reported to be highly variable: France and Germany were reported to treat the highest proportion (∼60%) of diagnosed patients, in contrast to the UK and Hungary, where virtually no patients receive AAT therapy. Most clinicians supported self-administration and extended dosing intervals to improve convenience of AAT therapy. This survey indicates that AATD diagnosis and management are highly heterogeneous in Europe; European cooperation is essential to generate data to support access to AAT therapy. Improving convenience of AAT therapy is an ongoing objective.
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Affiliation(s)
- Ildikó Horváth
- Dept of Pulmonology, National Koranyi Institute for Pulmonology in Budapest, Budapest, Hungary
| | - Maria Canotilho
- Dept of Pneumology, Hospital of Santo Andre – Centro Hospitalar de Leiria, Leiria, Portugal
| | - Jan Chlumský
- Dept of Pneumology, Thomayer Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Joanna Chorostowska-Wynimko
- Dept of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Luciano Corda
- Dept of Internal Medicine, Respiratory Disease Unit, Spedali Civili, Brescia, Italy
| | - Eric Derom
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Joachim H. Ficker
- 3rd Medical Dept, Nuremberg General Hospital/Paracelsus Medical University, Nuremberg, Germany
| | - Meinhard Kneussl
- Dept of Internal Medicine II and Pneumology at Wilhelminenspital Wien, Vienna, Austria
| | - Marc Miravitlles
- Pulmonology Dept, University Hospital Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Maria Sucena
- Pulmonology Dept, Centro Hospitalar de São João, Porto, Portugal
| | - Gabriel Thabut
- Dept of Pneumology and Lung Transplantation, Bichat Hospital, Paris, France
| | - Alice M. Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emily van ’t Wout
- Leiden University Medical Centre, Dept of Pulmonology, Leiden, Netherlands
| | - N. Gerard McElvaney
- Dept of Respiratory Medicine, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
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Königsdorfer N, Jörres RA, Söhler S, Welte T, Behr J, Ficker JH, Bals R, Watz H, Lutter JI, Lucke T, Biertz F, Alter P, Vogelmeier CF, Kahnert K. Adherence To Respiratory And Nonrespiratory Medication In Patients With COPD: Results Of The German COSYCONET Cohort. Patient Prefer Adherence 2019; 13:1711-1721. [PMID: 31631986 PMCID: PMC6791408 DOI: 10.2147/ppa.s223438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/13/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Adherence to COPD medication is often considered to be lower than in other chronic diseases. In view of the frequent comorbidities of COPD, the economic impact of nonadherence and the potential for adverse effects, a direct comparison between the adherence to respiratory and nonrespiratory medication in the same patients seems of particular interest. OBJECTIVES We aimed to investigate the intake of respiratory and nonrespiratory medication in the same patients with COPD and frequent comorbidities. METHOD Within the COPD cohort COSYCONET, we contacted 1042 patients, mailing them a list with all medication regarding all their diseases, asking for regular, irregular and non-intake. RESULTS Valid responses were obtained in 707 patients covering a wide spectrum of drugs. Intake of LABA, LAMA or ICS was regular in 91.9% of patients, even higher for cardiovascular and antidiabetes medication but lower for hyperlipidemia and depression/anxiety medication. Regular intake of respiratory medication did not depend on GOLD groups A-D or grades 1-4, was highest in patients with concomitant cardiovascular disorders and was lowest for concomitant asthma. It was slightly larger for LAMA and LABA administered via combined compared to single inhalers, and lower when similar compounds were prescribed twice. Most differences did not reach statistical significance owing to the overall high adherence. CONCLUSION Our results indicate a high adherence to respiratory medication in participants of a COPD cohort, especially in those with cardiovascular comorbidities. Compared to the lower adherence reported in the literature for COPD patients, our observations still suggest some room for improvement, possibly through disease management programs.
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Affiliation(s)
- Norbert Königsdorfer
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Munich80336, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Munich80336, Germany
| | - Sandra Söhler
- ASCONET Study Coordination Office, University of Marburg, Marburg35043, Germany
| | - Tobias Welte
- Department of Pneumology, Hannover Medical School, Hannover30625, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Munich80336, Germany
| | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuernberg, Paracelsus Medical University, Nuernberg, Germany
| | - Robert Bals
- Department of Internal Medicine V, Pneumology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Homburg66424, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf22927, Germany
| | - Johanna I Lutter
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH – German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Munich85764, Germany
| | - Tanja Lucke
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Munich80336, Germany
| | - Frank Biertz
- Institute for Biostatistics, Hannover Medical School, Hannover30625, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Marburg35043, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Marburg35043, Germany
| | - Kathrin Kahnert
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Munich80336, Germany
- Correspondence: Kathrin Kahnert Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, Munich80336, GermanyTel +49 89 4400 2590 Email
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Brückl WM, Ficker JH, Tiemann M, Schumann C, Reinmuth N, Heigener D, Schütte W, Eberhardt R, Darwiche K, Wagner M. [Rebiopsy for Patients with Lung Cancer - Joint Opinion from both the Endoscopic and Thoracic Oncology Sections of the German Society of Pneumology (DGP)]. Pneumologie 2018; 72:617-623. [PMID: 30071539 DOI: 10.1055/a-0632-9174] [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: 10/28/2022]
Abstract
Performing rebiopsies for primary lung cancer and/or their metastases is becoming more and more prominent in daily practice, as the therapeutical spectrum increases and some newer strategies are dependent on immunohistochemical and/or molecular factors. In general, nearly all recurrent lesions or metastases can be reached. However, frequently invasive procedures are necessary with the need to carefully weigh risks and benefits of rebiopsies for the patient in each case. In this review indications for recurrent and progressive disease as well as risks are discussed and alternatives to rebiopsies are shown. This work is the joint opinion from both the endoscopic and thoracic oncology sections of the German Society of Pneumology (DGP).
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Affiliation(s)
- W M Brückl
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg
| | - J H Ficker
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg
| | - M Tiemann
- GMS Gemeinnütziges Molekularpathologisches Forschungslabor, Hamburg
| | - C Schumann
- Klinikverbund Kempten-Oberallgäu, Klinik für Pneumologie, Thoraxonkologie, Schlaf- und Beatmungsmedizin, Immenstadt
| | - N Reinmuth
- Asklepios Fachkliniken München-Gauting, Thorakale Onkologie, Gauting
| | - D Heigener
- LungenClinic Großhansdorf, Deutsches Zentrum für Lungenforschung und Christian-Albrechts-Universität zu Kiel, Hamburg
| | - W Schütte
- Klinik für Innere Medizin II, Krankenhaus Martha-Maria Halle-Dölau, Halle (Saale)
| | - R Eberhardt
- Abteilung für Innere Medizin - Pneumologie, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg
| | - K Darwiche
- Sektion für Interventionelle Bronchologie, Ruhrlandklinik - Universitätsmedizin Essen, Universitätsklinik Essen
| | - M Wagner
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg
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Mayer G, Arzt M, Braumann B, Ficker JH, Fietze I, Frohnhofen H, Galetke W, Maurer JT, Orth M, Penzel T, Pistner H, Randerath W, Rösslein M, Sitter H, Stuck BA. Erratum to: German S3 Guideline Nonrestorative Sleep/Sleep Disorders, chapter “Sleep-Related Breathing Disorders in Adults,” short version. Somnologie 2018. [DOI: 10.1007/s11818-018-0157-5] [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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Parsch W, Wirtz RM, Braunecker B, Würflein D, Albrecht C, Kraus D, Papadopoulos T, Ficker JH, Brueckl WM. Prognostic value of CXLC 9 in patients undergoing neoadjuvant radiochemotherapy and surgery in stage IIIA NSCLC. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e24156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Wolfgang Parsch
- Paracelsus Medical University Nuremberg General Hospital Department of Respiratory Medicine, Allergology and Sleep Medicine, Nuremberg, Germany
| | - Ralph M Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | - Bettina Braunecker
- Paracelsus Medical University Nuremberg General Hospital Department of Pathology, Nuremberg, Germany
| | - Dieter Würflein
- Paracelsus Medical University Nuremberg General Hospital Department of Respiratory Medicine, Allergology and Sleep Medicine, Nuremberg, Germany
| | - Clemens Albrecht
- Paracelsus Medical University Nuremberg General Hospital Department of Radiooncology, Nuremberg, Germany
| | - Dietmar Kraus
- Paracelsus Medical University Nuremberg General Hospital Department of Abdominal and Thoracic Surgery, Nuremberg, Germany
| | - Thomas Papadopoulos
- Paracelsus Medical University Nuremberg General Hospital Department of Pathology, Nuremberg, Germany
| | - Joachim H Ficker
- Paracelsus Medical University Nuremberg General Hospital Department of Respiratory Medicine, Allergology and Sleep Medicine, Nuremberg, Germany
| | - Wolfgang M. Brueckl
- Paracelsus Medical University Nuremberg General Hospital Department of Respiratory Medicine, Allergology and Sleep Medicine, Nuremberg, Germany
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Brueckl WM, Achenbach HJ, Ficker JH, Schuette W. Erlotinib treatment after platinum-based therapy in elderly patients with non-small-cell lung cancer in routine clinical practice - results from the ElderTac study. BMC Cancer 2018; 18:333. [PMID: 29587656 PMCID: PMC5870245 DOI: 10.1186/s12885-018-4208-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 11/03/2017] [Accepted: 03/09/2018] [Indexed: 02/06/2023] Open
Abstract
Background In this prospective non-interventional study, the effectiveness and tolerability of erlotinib in elderly patients with non-small-cell lung cancer (NSCLC) after ≥1 platinum-based chemotherapy were assessed. Methods A total of 385 patients ≥65 years of age with advanced NSCLC receiving erlotinib were observed over 12 months. The primary endpoint was the 1-year overall survival (OS) rate. Results Patients were predominantly Caucasian (99.2%), a mean of 73 years old; 24.7% had an Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2. Most common tumor histologies were adenocarcinoma (64.9%) and squamous cell carcinoma (22.3%). Of 119 patients tested, 15.1% had an activating epidermal growth factor receptor gene (EGFR) mutation. The 1-year OS rate was 31% (95% CI 25–36) with a median OS of 7.1 months (95% CI 6.0–7.9). OS was significantly better in females than males (p = 0.0258) and in patients with an EGFR mutation compared to EGFR wild-type patients (p = 0.0004). OS was not affected by age (p = 0.3436) and ECOG PS (p = 0.5364). Patients with squamous NSCLC tended to live longer than patients with non-squamous EGFR wild-type tumors (median OS: 8.6 vs 5.5 months). Cough and dyspnea improved during the observation period. The erlotinib safety profile was comparable to that in previous studies with rash (45.2%) and diarrhea (22.6%) being the most frequently reported adverse events. Conclusions Erlotinib represents a suitable palliative treatment option in further therapy lines for elderly patients with advanced NSCLC. The results obtained under real-life conditions add to our understanding of the benefits and risks of erlotinib in routine clinical practice. Trial registration BfArM (https://www.bfarm.de; ML23023); ClinicalTrials.gov (NCT01535729; 20 Feb 2012).
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Affiliation(s)
- Wolfgang M Brueckl
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuernberg, General Hospital Nuernberg, Prof.-Ernst-Nathan-Str. 1, Nuremberg, Germany.
| | - H Jost Achenbach
- Lung Clinic Lostau, Department of Thoracic Oncology, Lindenstr. 2, Lostau, Nuremberg, Germany
| | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuernberg, General Hospital Nuernberg, Prof.-Ernst-Nathan-Str. 1, Nuremberg, Germany
| | - Wolfgang Schuette
- Hospital Martha-Maria Halle-Doelau, Klinik für Innere Medizin II, Röntgenstr. 1, Halle, Germany
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Ficker JH, Chapman KR, Turner A, Sandhaus RA, Vit O, Fries M, McElvaney NG, Wencker M. Behandlung mit Alpha-1 Antitrypsin verlangsamt die Emphysemprogession unabhängig von der Ausgangs-FEV1. Pneumologie 2018. [DOI: 10.1055/s-0037-1619399] [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: 10/28/2022]
Affiliation(s)
- JH Ficker
- Pneumologie, Medizinische Klinik 3, Klinikum Nürnberg; Universitätsklinik der Paracelsus Medizinischen Privatuniversität
| | - KR Chapman
- Department of Medicine, University of Toronto
| | - A Turner
- Institute of Inflammation and Ageing, Centre for Translational Inflammation Research, Queen Elizabeth Hospital Birmingham
| | - RA Sandhaus
- National Jewish Health, Denver, Colorado, USA
| | - O Vit
- Clinical Research and Development, CSL Behring, Bern
| | - M Fries
- Clinical Strategy and Development, CSL Behring, King of Prussia, USA
| | - NG McElvaney
- Department of Respiratory Medicine, Beaumont Hospital, Royal College of Surgeons in Ireland
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Herkenrath SD, Treml M, Grote L, Hedner J, Sommermeyer D, Ficker JH, Nilius G, Randerath WJ. Prospektive Studie zum Einfluss der CPAP-Therapie bei Schlafapnoe auf einzelne Parameter der nächtlichen Pulswelle. Pneumologie 2018. [DOI: 10.1055/s-0037-1619316] [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: 10/28/2022]
Affiliation(s)
- SD Herkenrath
- Institut für Pneumologie an der Universität zu Köln; Klinik für Lungen- und Bronchialerkrankungen, Krankenhaus Bethanien gGmbH
| | - M Treml
- Institut für Pneumologie an der Universität zu Köln
| | - L Grote
- Dept. of Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J Hedner
- Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - D Sommermeyer
- Fakultät für Informationstechnik, Hochschule Mannheim
| | - JH Ficker
- Südmedizinische Klinik III, Paracelsus Medizinische Privatuniversität Nürnberg, Klinikum Nürnberg
| | - G Nilius
- Helios-Klinik Hagen Ambrock, Universität Witten/Herdecke
| | - WJ Randerath
- Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Krankenhaus Bethanien GmbH
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Abstract
There is a wide spectrum of severities in patients with pulmonary bleeding with a range from mild haemoptysis to severe bleeding with an acute risk of asphyxiation. For the management of acute pulmonary haemorrhage, it is essential to identify the underlying cause in order to initiate a target-oriented or causal therapy. The most common causes of localized pulmonary bleeding are lung cancer as well as infections, anticoagulant therapy or bronchiectasis. Diffuse alveolar haemorrhage is mostly due to pulmonary vasculitis or connective tissue disease, but may also occur in pulmonary metastasis, congestive heart failure, coagulation disorders and from many other causes. In a case of severe pulmonary bleeding it is essential to secure the airways and ensure sufficient ventilation, i. e. by intubation with a double-lumen endotracheal tube and by appropriate positioning of the patient. Stabilizing haemodynamics is crucial. Simultaneously basic diagnostic measures, i. e. appropriate laboratory tests, chest X‑ray, computed tomography scan of the chest and bronchoscopy, are performed. Localized pulmonary bleeding usually requires local treatment, like bronchoscopic therapy, bronchial artery embolization or surgery. Diffuse alveolar haemorrhage must be treated systemically, i. e. by immunosuppressive therapy in cases of vasculitis or by medical treatment of coagulation disorders. Even with optimal interdisciplinary management the in-hospital mortality of severe pulmonary bleeding remains high. There is a significant risk of recurrent bleeding depending on the cause of haemorrhage. In patients with "cryptogenic" haemoptysis there is an increased rate of lung cancer within the following years and follow-up of these patients is recommended.
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Affiliation(s)
- J H Ficker
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Allergologie, Schlafmedizin, Intensivmedizin, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland.
| | - W M Brückl
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Allergologie, Schlafmedizin, Intensivmedizin, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
| | - J Suc
- Medizinische Klinik 2, Schwerpunkt Geriatrie, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität Nürnberg, Nürnberg, Deutschland
| | - A Geise
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Allergologie, Schlafmedizin, Intensivmedizin, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
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Graf J, Lucke T, Herrera R, Watz H, Holle R, Vogelmeier C, Ficker JH, Jörres RA. Compatibility of medication with PRISCUS criteria and identification of drug interactions in a large cohort of patients with COPD. Pulm Pharmacol Ther 2018; 49:123-129. [PMID: 29421666 DOI: 10.1016/j.pupt.2018.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/31/2018] [Indexed: 10/18/2022]
Abstract
Patients with COPD are often of advanced age and have a high number of medications due to their lung disease and comorbidities. Thus they are at risk for unwanted effects from drugs, either due to age or due to interactions between drugs. These issues are not clarified. We therefore assessed the number of medications and potential adverse effects in a large cohort of patients with COPD. The analysis was performed in 2741 patients of the German COPD cohort COSYCONET, using baseline data (visit 1) and follow-up data after about 1.5 years (visit 3). Spirometric GOLD grades 1-4 were found in 8/35/32/9% of patients and GOLD groups ABCD in 7/25/4/48% of patients, while the remaining patients (n = 450, 16.4%) could not be classified according to GOLD criteria. The compatibility of medication with age was evaluated via the PRISCUS list, drug interactions via the AiD clinic system, whereby only drug combinations occurring in at least 10 patients were considered (nine unwanted interactions, one wanted interaction). The median numbers of medications were 5 or more in all patient categories, among them 3 or more non-respiratory medications. In the total population there were 153 patients (10.2%) aged ≥65 years who had any medication of the PRISCUS list with intermediate or low risk. Serious adverse combinations of drugs according to AiD occurred in 114 patients (4.2%), while the number of unwanted but only potentially clinically relevant combinations was 175 (6.4%). The number of wanted combinations was 219 (8.0%). These numbers did not markedly change when restricting the analysis to patients of GOLD grades 1-4. Moreover, the results were similar for visit 1 and visit 3. We conclude that in a large cohort of COPD patients about 10% of patients aged at least 65 years had medications that could interfere with their age and that the proportions of patients with either unwanted or wanted drug interactions were both in the range of 8-10%. These results suggest that problems arising from the high number of medications were not very frequent in the COPD cohort analysed.
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Affiliation(s)
- Jana Graf
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich, München, Germany; Comprehensive Pneumology Center Munich, DZL, German Center for Lung Research, München, Germany
| | - Tanja Lucke
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich, München, Germany; Comprehensive Pneumology Center Munich, DZL, German Center for Lung Research, München, Germany
| | - Ronald Herrera
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich, München, Germany; Center for International Health, Ludwig-Maximilians-University (LMU) Munich, München, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, Wöhrendamm 80, 22927, Grosshansdorf, Germany
| | - Rolf Holle
- German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Neuherberg, Germany
| | - Claus Vogelmeier
- Pulmonary and Critical Care Medicine, Department of Medicine, University Medical Center Giessen and Marburg, Philipps-University, Marburg, Germany
| | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Klinikum Nuremberg, Nürnberg, Germany; Paracelsus Medical University Nuremberg, Nürnberg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital LMU Munich, München, Germany; Comprehensive Pneumology Center Munich, DZL, German Center for Lung Research, München, Germany.
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Woehrle H, Arzt M, Graml A, Fietze I, Young P, Teschler H, Ficker JH. Effect of a patient engagement tool on positive airway pressure adherence: analysis of a German healthcare provider database. Sleep Med 2018; 41:20-26. [DOI: 10.1016/j.sleep.2017.07.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 10/18/2022]
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Erber R, Stöhr R, Herlein S, Giedl C, Rieker RJ, Fuchs F, Ficker JH, Hartmann A, Veltrup E, Wirtz RM, Brueckl WM. Comparison of PD-L1 mRNA Expression Measured with the CheckPoint Typer® Assay with PD-L1 Protein Expression Assessed with Immunohistochemistry in Non-small Cell Lung Cancer. Anticancer Res 2017; 37:6771-6778. [PMID: 29187455 DOI: 10.21873/anticanres.12137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 09/21/2017] [Accepted: 09/27/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Immunohistochemical (IHC) assessment of programmed death-ligand 1 (PD-L1) in non-small cell lung cancer (NSCLC) has become important since the development of anti-PD-1/-PD-L1 directed drugs. Various PD-L1 antibodies and cut-offs have been used in different trials to predict response to these drugs, thus comparison of those studies is difficult. We compared PD-L1 mRNA expression measured by RT-qPCR with PD-L1 protein expression evaluated by IHC. Moreover, we investigated the impact of different tumour tissue acquisition methods on the reliability of PD-L1 measurement techniques. MATERIALS AND METHODS NSCLC cases (N=22), including n=9 mediastinal lymph node biopsies acquired by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and n=5 metastases, were evaluated prospectively for PD-L1 protein on tumor cells (TC) and immune cells (IC) using E1L3N and 28-8 antibodies and PD-L1 mRNA using the CheckPoint TYPER® assay. RESULTS In primary NSCLC tissues, agreement between PD-L1 mRNA and TC staining using the 28-8 antibody was excellent (ĸ=0.85, p=0.0002). Comparing both PD-L1 antibodies against each other showed a kappa value of 0.58 (p=0.0106). In EBUS-TBNA, PD-L1 mRNA correlated perfectly with the 28-8 antibody (ĸ=1.0, p=0.0023). PD-L1 mRNA levels significantly differed when comparing 28-8 TC staining of tumours >49% with 1-49% and 0% (p=0.0040; p=0.0081, respectively). In metastatic lesions, differences between PD-L1 mRNA and IHC became apparent (ĸ=0.2, p=0.2525). CONCLUSION Testing of PD-L1 mRNA and 28-8 IHC showed an excellent agreement in NSCLC samples including mediastinal lymph node biopsies. Since PD-L1 expression in >50% TC detected by 28-8 IHC can be reliably detected by RT-qPCR, quantitative PD-L1 mRNA determination should be considered as an alternative to IHC as there is no interobserver variability in RNA results.
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Affiliation(s)
- Ramona Erber
- Institute of Pathology, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Robert Stöhr
- Institute of Pathology, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stefanie Herlein
- Institute of Pathology, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Claudia Giedl
- Institute of Pathology, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ralf Joachim Rieker
- Institute of Pathology, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Florian Fuchs
- Department of Medicine 1 - Gastroenterology, Pneumonology and Endocrinology, University Hospital, Friedrich-Alexander University Erlangen- Nürnberg (FAU), Erlangen, Germany
| | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuernberg, General Hospital Nuernberg, Nürnberg, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Elke Veltrup
- STRATIFYER Molecular Pathology GmbH, Köln, Germany
| | - Ralph M Wirtz
- STRATIFYER Molecular Pathology GmbH, Köln, Germany.,Institute of Pathology, St. Elisabeth Hospital, Köln, Germany
| | - Wolfgang M Brueckl
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuernberg, General Hospital Nuernberg, Nürnberg, Germany
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Klok FA, Ageno W, Barco S, Binder H, Brenner B, Duerschmied D, Empen K, Faggiano P, Ficker JH, Galiè N, Ghuysen A, Held M, Heydenreich N, Huisman MV, Jiménez D, Kozak M, Lang IM, Lankeit M, Münzel T, Petris A, Pruszczyk P, Quitzau K, Schellong S, Schmidt KH, Stefanovic BS, Verschuren F, Wolf-Puetz A, Meyer G, Konstantinides SV. Dabigatran after Short Heparin Anticoagulation for Acute Intermediate-Risk Pulmonary Embolism: Rationale and Design of the Single-Arm PEITHO-2 Study. Thromb Haemost 2017; 117:2425-2434. [PMID: 29212130 DOI: 10.1160/th17-06-0434] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patients with intermediate-risk pulmonary embolism (PE) may, depending on the method and cut-off values used for definition, account for up to 60% of all patients with PE and have an 8% or higher risk of short-term adverse outcome. Although four non-vitamin K-dependent direct oral anticoagulants (NOACs) have been approved for the treatment of venous thromboembolism, their safety and efficacy as well as the optimal anticoagulation regimen using these drugs have not been systematically investigated in intermediate-risk PE. Moreover, it remains unknown how many patients with intermediate-high-risk and intermediate-low-risk PE were included in most of the phase III NOAC trials. The ongoing Pulmonary Embolism International Thrombolysis 2 (PEITHO-2) study is a prospective, multicentre, multinational, single-arm trial investigating whether treatment of acute intermediate-risk PE with parenteral heparin anticoagulation over the first 72 hours, followed by the direct oral thrombin inhibitor dabigatran over 6 months, is effective and safe. The primary efficacy outcome is recurrent symptomatic venous thromboembolism or death related to PE within the first 6 months. The primary safety outcome is major bleeding as defined by the International Society on Thrombosis and Haemostasis. Secondary outcomes include all-cause mortality, the overall duration of hospital stay (index event and repeated hospitalizations) and the temporal pattern of recovery of right ventricular function over the 6-month follow-up period. By applying and evaluating a contemporary risk-tailored treatment strategy for acute PE, PEITHO-2 will implement the recommendations of current guidelines and contribute to their further evolution.
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Affiliation(s)
- Frederikus A Klok
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Walter Ageno
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - Stefano Barco
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Harald Binder
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University, Mainz, Germany
- Institute for Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | - Benjamin Brenner
- Department of Hematology and Bone Marrow Transplantation, Ruth and Bruce Rappaport Faculty of Medicine, Rambam Health Care Campus, Technion, Haifa, Israel
| | - Daniel Duerschmied
- Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Empen
- Department of Cardiology, University Hospital, Greifswald, Germany
| | | | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuernberg, Paracelsus Medical University, Nuernberg, Germany
| | - Nazzareno Galiè
- Department of Investigational, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alexandre Ghuysen
- Emergency Care, Department of Medicine, University Hospital Centre, Liège, Belgium
| | - Matthias Held
- Medical Mission Hospital, Department of Internal Medicine, Center for Pulmonary Hypertension and Pulmonary Vascular Disease, Academic Teaching Hospital, Julius-Maximilian University of Wuerzburg, Wuerzburg, Germany
| | - Nadine Heydenreich
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - David Jiménez
- Department of Respiratory Diseases, Ramon y Cajal Institute for Health Research, Madrid, Spain
| | - Matija Kozak
- Department of Vascular Diseases, University Medical Center, Ljubljana, Slovenia
| | - Irene M Lang
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Mareike Lankeit
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- Division of Cardiology, Medical Department, Charité Campus Virchow -Klinikum, Berlin, Germany
| | - Thomas Münzel
- Department of Cardiology University Medical Center, Mainz, Germany
| | - Antoniu Petris
- Cardiology Clinic, St. Spiridon Clinical Emergency Hospital, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Kurt Quitzau
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | | | - Kai-Helge Schmidt
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- Department of Cardiology University Medical Center, Mainz, Germany
| | - Branislav S Stefanovic
- Coronary Care Unit, Cardiology Clinic, Emergency Center, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Franck Verschuren
- Emergency Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | - Guy Meyer
- Pulmonology and Intensive Care Service, Assistance Publique Hôpitaux de Paris, Georges Pompidou European Hospital, Paris, France
- Paris Descartes University, Paris, France
- INSERM UMR S 970, Paris, INNOVTE, France
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
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Twardella D, Geiss K, Radespiel-Tröger M, Benner A, Ficker JH, Meyer M. [Trends in incidence of lung cancer according to histological subtype among men and women in Germany : Analysis of cancer registry data with the application of multiple imputation techniques]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 61:20-31. [PMID: 29181809 DOI: 10.1007/s00103-017-2659-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Lung cancer can be described by histological subtype, of which small cell, squamous cell and adenocarcinoma are the most common. International data show that adenocarcinoma is becoming the dominant histological subtype of lung cancer although the relative risk due to smoking has been found to be smaller than that for other histological subtypes. OBJECTIVE The aim of the analysis was to describe the time trends in incidence of lung cancer among women and men in Germany according to histological subtype. MATERIALS AND METHODS All lung cancer cases (ICD-10 C33-C34) newly diagnosed between 2003 and 2012 and collected by the epidemiologic cancer registries of the German federal states with average completeness of registration of at least 90% were considered and grouped into histologic subtypes. If data on tumor histology were not microscopically verified or unspecific, multiple imputation techniques were applied to estimate the histologic subtype. RESULTS Among women age-standardized lung cancer rates increased considerably between 2003 and 2012 (annual percent change APC = 2.7%), mostly driven by a rising adenocarcinoma incidence (APC = 4.7%). Among men overall lung cancer rates decreased during the same time (APC = -1.7%). Still, a slight increase in adenocarcinoma incidence was also observed in men (APC = 1.0%). CONCLUSION The rising incidence of adenocarcinoma of the lung is alarming. The cancer registry data do not allow risk factor analysis. In the international discussion, the introduction of filter cigarettes as well as the changing composition of cigarettes has been hypothesized as being responsible. Further epidemiologic studies are strongly needed.
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Affiliation(s)
- Dorothee Twardella
- Zentrum für Krebsfrüherkennung und Krebsregistrierung, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Schweinauer Hauptstraße 80, 90441, Nürnberg, Deutschland.
| | - Karla Geiss
- Zentrum für Krebsfrüherkennung und Krebsregistrierung, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Schweinauer Hauptstraße 80, 90441, Nürnberg, Deutschland
| | - Martin Radespiel-Tröger
- Zentrum für Krebsfrüherkennung und Krebsregistrierung, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Schweinauer Hauptstraße 80, 90441, Nürnberg, Deutschland
| | - Axel Benner
- Abteilung Biostatistik, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - Joachim H Ficker
- Universitätsklinik für Innere Medizin 3, Schwerpunkt Pneumologie, Allergologie, Schlafmedizin, Klinikum Nürnberg/Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland
| | - Martin Meyer
- Zentrum für Krebsfrüherkennung und Krebsregistrierung, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Schweinauer Hauptstraße 80, 90441, Nürnberg, Deutschland
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Mayer G, Arzt M, Braumann B, Ficker JH, Fietze I, Frohnhofen H, Galetke W, Maurer JT, Orth M, Penzel T, Pistner H, Randerath W, Rösslein M, Sitter H, Stuck BA. German S3 Guideline Nonrestorative Sleep/Sleep Disorders, chapter "Sleep-Related Breathing Disorders in Adults," short version: German Sleep Society (Deutsche Gesellschaft für Schlafforschung und Schlafmedizin, DGSM). Somnologie (Berl) 2017; 21:290-301. [PMID: 29213210 PMCID: PMC5705734 DOI: 10.1007/s11818-017-0136-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kahnert K, Lucke T, Huber RM, Behr J, Biertz F, Vogt A, Watz H, Alter P, Fähndrich S, Bals R, Holle R, Karrasch S, Söhler S, Wacker M, Ficker JH, Parhofer K, Vogelmeier C, Jörres RA. Relationship of hyperlipidemia to comorbidities and lung function in COPD: results of the COSYCONET cohort. Epidemiology 2017. [DOI: 10.1183/1393003.congress-2017.oa1787] [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: 11/05/2022]
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Ficker JH, Rabe KF, Welte T. Role of dual bronchodilators in COPD: A review of the current evidence for indacaterol/glycopyrronium. Pulm Pharmacol Ther 2017; 45:19-33. [DOI: 10.1016/j.pupt.2017.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/29/2017] [Accepted: 04/01/2017] [Indexed: 01/22/2023]
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Valipour A, Slebos DJ, Herth F, Darwiche K, Wagner M, Ficker JH, Petermann C, Hubner RH, Stanzel F, Eberhardt R. Endobronchial Valve Therapy in Patients with Homogeneous Emphysema. Results from the IMPACT Study. Am J Respir Crit Care Med 2017; 194:1073-1082. [PMID: 27580428 DOI: 10.1164/rccm.201607-1383oc] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
RATIONALE Endobronchial valves (EBVs) have been successfully used in patients with severe heterogeneous emphysema to improve lung physiology. Limited available data suggest that EBVs are also effective in homogeneous emphysema. OBJECTIVES To evaluate the efficacy and safety of EBVs in patients with homogeneous emphysema with absence of collateral ventilation assessed with the Chartis system. METHODS Prospective, multicenter, 1:1 randomized controlled trial of EBV plus standard of care (SoC) or SoC alone. Primary outcome was the percentage change in FEV1 (liters) at 3 months relative to baseline in the EBV group versus the SoC group. Secondary outcomes included changes in FEV1, St. George's Respiratory Questionnaire (SGRQ), 6-minute-walk distance (6MWD), and target lobe volume reduction. MEASUREMENTS AND MAIN RESULTS Ninety-three subjects (age, 63.7 ± 6.1 yr [mean ± SD]; FEV1, % predicted, 29.3 ± 6.5; residual volume, % predicted, 275.4 ± 59.4) were allocated to either the EBV group (n = 43) or the SoC group (n = 50). In the intention-to-treat population, at 3 months postprocedure, improvement in FEV1 from baseline was 13.7 ± 28.2% in the EBV group and -3.2 ± 13.0% in the SoC group (mean between-group difference, 17.0%; P = 0.0002). Other variables demonstrated statistically and clinically significant changes from baseline to 3 months (EBV vs. SoC, respectively: SGRQ, -8.63 ± 11.25 vs. 1.01 ± 9.36; and 6MWD, 22.63 ± 66.63 m vs. -17.34 ± 52.8 m). Target lobe volume reduction at 3 months was -1,195 ± 683 ml (P < 0.0001). Of the EBV subjects, 97.2% achieved volume reduction in the target lobe (P < 0.0001). Procedure-related pneumothoraces occurred in 11 subjects (25.6%). Five subjects required removal/replacement of one or more valves. One subject experienced two valve migration events requiring removal/replacement of valves. CONCLUSIONS EBV in patients with homogeneous emphysema without collateral ventilation results in clinically meaningful benefits of improved lung function, exercise tolerance, and quality of life.
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Affiliation(s)
- Arschang Valipour
- 1 Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Spital, Vienna, Austria
| | - Dirk-Jan Slebos
- 2 Department of Pulmonary Diseases, University of Groningen, and University Medical Center Groningen, Groningen, the Netherlands
| | - Felix Herth
- 3 Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Kaid Darwiche
- 4 Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Clinic Essen, Essen, Germany
| | - Manfred Wagner
- 5 Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuernberg, and Paracelsus Medical University, Nuremberg, Germany
| | - Joachim H Ficker
- 5 Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuernberg, and Paracelsus Medical University, Nuremberg, Germany
| | - Christoph Petermann
- 6 Lungenabteilung, Thoraxzentrum Hamburg, Asklepios Klinik, Hamburg, Germany
| | | | | | - Ralf Eberhardt
- 3 Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
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Kahnert K, Lucke T, Huber RM, Behr J, Biertz F, Vogt A, Watz H, Alter P, Fähndrich S, Bals R, Holle R, Karrasch S, Söhler S, Wacker M, Ficker JH, Parhofer KG, Vogelmeier C, Jörres RA. Relationship of hyperlipidemia to comorbidities and lung function in COPD: Results of the COSYCONET cohort. PLoS One 2017; 12:e0177501. [PMID: 28505167 PMCID: PMC5432186 DOI: 10.1371/journal.pone.0177501] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/30/2017] [Indexed: 11/18/2022] Open
Abstract
Although hyperlipidemia is common in COPD, its relationship to comorbidities, risk factors and lung function in COPD has not been studied in detail. Using the baseline data of the COSYCONET cohort we addressed this question. Data from 1746 COPD patients (GOLD stage 1-4; mean age 64.6 y, mean FEV1%pred 57%) were evaluated, focusing on the comorbidities hyperlipidemia, diabetes and cardiovascular complex (CVC; including arterial hypertension, cardiac failure, ischemic heart disease). Risk factors comprised age, gender, BMI, and packyears of smoking. The results of linear and logistic regression analyses were implemented into a path analysis model describing the multiple relationships between parameters. Hyperlipidemia (prevalence 42.9%) was associated with lower intrathoracic gas volume (ITGV) and higher forced expiratory volume in 1 second (FEV1) when adjusting for its multiple relationships to risk factors and other comorbidities. These findings were robust in various statistical analyses. The associations between comorbidities and risk factors were in accordance with previous findings, thereby underlining the validity of our data. In conclusion, hyperlipidemia was associated with less hyperinflation and airway obstruction in patients with COPD. This surprising result might be due to different COPD phenotypes in these patients or related to effects of medication.
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Affiliation(s)
- Kathrin Kahnert
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Munich, Germany
- * E-mail:
| | - Tanja Lucke
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Rudolf M. Huber
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Munich, Germany
| | - Frank Biertz
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Anja Vogt
- Stoffwechselambulanz, Klinik und Poliklinik der Universität München, Munich, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Sebastian Fähndrich
- Department of Internal Medicine V – Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Robert Bals
- Department of Internal Medicine V – Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (CPC-M), Neuherberg, Germany
| | - Stefan Karrasch
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Sandra Söhler
- ASCONET Study Coordination Office, University of Marburg, Marburg, Germany
| | - Margarethe Wacker
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (CPC-M), Neuherberg, Germany
| | - Joachim H. Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuernberg, Paracelsus Medical University, Nuernberg, Germany
| | - Klaus G. Parhofer
- Department of Internal Medicine IV, University of Munich, Munich, Germany
| | - Claus Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Rudolf A. Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
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Woehrle H, Arzt M, Teschler H, Graml A, Fietze I, Young P, Ficker JH. Einfluss einer internetbasierten Patientenunterstützung auf die Therapiecompliance während der Einleitungsphase einer PAP-Therapie zusätzlich zu einer telemedizinbasierten proaktiven Versorgung. Pneumologie 2017. [DOI: 10.1055/s-0037-1598289] [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: 10/20/2022]
Affiliation(s)
- H Woehrle
- Schlaf- und Beatmungszentrum Blaubeuren, Lungenzentrum Ulm; Resmed Science Center, Resmed Germany
| | - M Arzt
- Schlafmedizinisches Zentrum, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg
| | - H Teschler
- Department of Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen
| | - A Graml
- Resmed Science Center, Resmed Germany
| | - I Fietze
- Centrum für Herz- Kreislauf- und Gefäßmedizin, Interdisziplinäres Schlafmedizinisches Zentrum, Charité-Universitätsmedizin Berlin
| | - P Young
- Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen, Universitätsklinikum Münster
| | - JH Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuremberg, Paracelsus Medical University
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Brückl WM, Wirtz RM, Bertsch T, Ficker JH, Jung A. [Liquid Biopsy: Detection of Molecular Markers for Treatment Decisions in Lung Cancer]. Pneumologie 2017; 71:151-163. [PMID: 28196386 DOI: 10.1055/s-0042-123803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Personalized, individualized, targeted therapy has successfully found entrance in the palliative treatment of lung cancer as they enable a personalized and individualized strategy going ahead with biomarker testing. Due to the crescending amount of predictive molecular and immunhistochemical analyses at different time points during therapy the need for more and actual tumor tissue increases; however these samples cannot always be obtained without major discomfort for the patients. Therefore, analyses from blood, the so called "liquid biopsy", is an alternative or additional method. Activating mutations in the EGFR gene and the inhibitory mutation T790 M can already be detected from blood during clinical routine. This review presents the status of liquid biopsy for diagnosis, prognosis and as predictive parameter during the course of therapy in lung cancer and gives an outlook on future developments.
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Affiliation(s)
- W M Brückl
- Universitätsklinik für Pneumologie, Allergologie und Schlafmedizin, Paracelsus Medizinische Privatuniversität, Nürnberg
| | - R M Wirtz
- Institut für Pathologie, St. Elisabeth Krankenhaus, Köln
| | - T Bertsch
- Universitätsinstitut für Klinische Chemie, Laboratoriumsmedizin und Transfusionsmedizin - Zentrallaboratorium, Paracelsus Medizinische Privatuniversität, Nürnberg
| | - J H Ficker
- Universitätsklinik für Pneumologie, Allergologie und Schlafmedizin, Paracelsus Medizinische Privatuniversität, Nürnberg
| | - A Jung
- Pathologisches Institut der Ludwig-Maximilians Universität München
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Büstgens FA, Loose R, Ficker JH, Wucherer M, Uder M, Adamus R. Stent Implantation for Superior Vena Cava Syndrome of Malignant Cause. ROFO-FORTSCHR RONTG 2017; 189:423-430. [PMID: 28152555 DOI: 10.1055/s-0042-122147] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose The purpose of this paper is the retrospective analysis of endovascular therapy for the treatment of superior vena cava syndrome (SVCS) of malignant cause. This study focuses on the effectiveness of the therapy regarding the duration of remission, symptom control and practicability. Materials and Methods From January 2003 to November 2012, therapeutic implantation of one or more stents was performed in 141 patients suffering from SVCS. The medical history was retrospectively researched using digitalized patient files. If those were incomplete, secondary research was conducted using the cancer registry of the General Hospital Nuremberg, the cancer registry of the tumor center at Friedrich-Alexander-University Erlangen-Nuremberg (FAU) or information given by physicians in private practice. This data was collected using Microsoft Office Excel® and statistically analyzed using IBM SPSS Statistics 22®. Results 168 stents were implanted in 141 patients (median age: 64.6 years; range: 36 - 84), 86 being male and 55 being female. In 121 patients, SVCS was caused by lung cancer (85.8 %), in 9 patients by mediastinal metastasis of an extrathoracic carcinoma (6.4 %), in 3 patients by mesothelioma of the pleura (2.1 %) and in 1 patient by Hodgkin's disease (0.7 %). There was no histological diagnosis in 7 cases (4.9 %). The primary intervention was successful in 138 patients (97.9 %). Immediate thrombosis in the stent occurred in the remaining 3 cases. Recurrence of SVCS was observed in 22 patients (15.6 %), including 5 early and 17 late occlusions. Stent dislocation or breakage was not observed. As expected, the survival after implantation was poor. The median survival was 101 days, and the median occlusion-free survival was 80 days. Conclusion The symptomatic therapy of SVCS with endovascular stents is effective and safe. Despite effective symptom control and a low rate of recurrence, the patients' prognosis is poor. Key Points: · Patients with SVCS of malignant cause have a poor prognosis.. · Lung cancer is the most common cause for SVCS.. · Endovascular therapy is safe and effective.. Citation Format · Büstgens FA, Loose R, Ficker JH et al. Stent Implantation for Superior Vena Cava Syndrome of Malignant Cause. Fortschr Röntgenstr 2017; 189: 423 - 430.
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Affiliation(s)
- Felix A Büstgens
- Department of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Reinhard Loose
- Department of Radiology and Nuclear Medicine, Paracelsus Medical University Nuremberg, General Hospital Nuremberg, Germany
| | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuremberg, General Hospital Nuremberg, Germany
| | - Michael Wucherer
- Institute of Medical Physics, General Hospital Nuremberg, Germany
| | - Michael Uder
- Department of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Ralf Adamus
- Department of Radiology and Nuclear Medicine, Paracelsus Medical University Nuremberg, General Hospital Nuremberg, Germany
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