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Littlejohn G, Leadbetter J, Butcher B, Feletar M, Osullivan C, Smith T, Witcombe D, Yin H, Youssef P. POS1019 REAL-WORLD EVALUATION OF TREATMENT PATTERNS AND PERSISTENCE OF TOFACITINIB IN TREATMENT OF PSORIATIC ARTHRITIS IN AUSTRALIA: AN ANALYSIS OF THE OPAL DATASET. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundTofacitinib (TOF), a potent selective inhibitor of Janus kinase (JAK), is an approved treatment of psoriatic arthritis (PsA). In Australia, patients with active PsA despite six months of therapy with a pre-specified combination of csDMARDs are eligible to receive subsidised b/tsDMARDs. The clinician can prescribe the b/tsDMARD they deem to be the most clinically appropriate for the patient. Limited data exist to describe the real-world treatment patterns, characteristics and clinical outcomes of patients with PsA who receive TOF in the real-world setting.ObjectivesTo describe real-world treatment patterns and treatment persistence among patients with PsA treated with TOF in the Australian post-approval setting using the OPAL dataset.MethodsThe OPAL dataset is a collection of deidentified clinical data derived from the electronic medical records of 112 rheumatologists at 43 sites around Australia. Adult patients with a diagnosis of PsA who received at least one prescription of TOF, a tumour necrosis factor inhibitor (TNFi) or an interleukin 17 inhibitor (IL-17Ai) between May 2019 and Sept 2020 were eligible, with data up to Sept 2021 included in the analysis. Results were summarised descriptively. Treatment persistence was summarised using Kaplan-Meier methods.ResultsOf 16,692 patients with PsA identified in the OPAL dataset, 1,486 (TOF n=406, IL-17Ai n=416, and TNFi n=664) were eligible for inclusion in this study. At the time of treatment initiation, the mean (SD) age of TOF, IL-17Ai and TNFi treated patients was 55.56 (12.68), 52.65 (12.72) and 50.32 (14.57) years, respectively. 19.2% of patients receiving TOF were first line compared with 41.8% of IL-17Ai and 62.8% of TNFi treated patients. The mean (SD) time from symptom onset to treatment initiation was longest for patients receiving TOF in first line (153.29 (127.50) months) compared to first line IL-17Ai (116.83 (113.97) months) and TNFi treated patients (92.37 (89.01) months). Overall, 34.2% of TOF, 32.9% of IL-17Ai and 26.4% of TNFi treated patients initiated therapy without concomitant cDMARDs being recorded.Overall median persistence was 16.54 months (95% CI 13.84, 19.53) for TOF treated patients, 17.65 months (95% CI, 15.75, 19.56) for IL-17Ai treated patients and 17.16 months (95% CI 14.86, 20.48) for TNFi treated patients. As expected, persistence was generally longer in patients treated as first line (Figure 1) with patients receiving TOF observed to have slightly higher persistence in the first 15 months of treatment.Figure 1.Treatment persistence of patients receiving TOF, IL-17Ai and TNFi as first line therapy. Plot curtailed at 15 months as relatively few patients have information past this point. Where no stop date was recorded, censoring occurs at last recorded visitConclusionIn this analysis of a large Australian real-world dataset, TOF was more commonly utilised as a later line therapy for patients with PsA. Patients receiving TOF were observed to have slightly higher persistence within the first 15 months of starting first line therapy in this preliminary analysis.AcknowledgementsThe authors acknowledge the members of OPAL Rheumatology Ltd and their patients for providing clinical data for this study, and Software4Specialists Pty Ltd for providing the Audit4 platform. Financial support was provided by Pfizer AustraliaDisclosure of InterestsGeoff Littlejohn Consultant of: Abbvie, Janssen, Bristol Myers Squibb, Gilead, Eli Lilly, and MSD, Jo Leadbetter: None declared, Belinda Butcher: None declared, Marie Feletar: None declared, Catherine OSullivan: None declared, Tegan Smith: None declared, David Witcombe Employee of: Pfizer Australia, Ho Yin Employee of: Pfizer Australia, Peter Youssef Speakers bureau: AbbVie, Novartis, Janssen and Eli Lilly
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Turtle L, Bhalla N, Willett A, Biggar R, Leadbetter J, Georgiou G, Wilson JM, Vivekanandan S, Hawkins MA, Brada M, Fenwick JD. Cardiac-sparing radiotherapy for locally advanced non-small cell lung cancer. Radiat Oncol 2021; 16:95. [PMID: 34082782 PMCID: PMC8176693 DOI: 10.1186/s13014-021-01824-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/25/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We have carried out a study to determine the scope for reducing heart doses in photon beam radiotherapy of locally advanced non-small cell lung cancer (LA-NSCLC). MATERIALS AND METHODS Baseline VMAT plans were created for 20 LA-NSCLC patients following the IDEAL-CRT isotoxic protocol, and were re-optimized after adding an objective limiting heart mean dose (MDHeart). Reductions in MDHeart achievable without breaching limits on target coverage or normal tissue irradiation were determined. The process was repeated for objectives limiting the heart volume receiving ≥ 50 Gy (VHeart-50-Gy) and left atrial wall volume receiving ≥ 63 Gy (VLAwall-63-Gy). RESULTS Following re-optimization, mean MDHeart, VHeart-50-Gy and VLAwall-63-Gy values fell by 4.8 Gy and 2.2% and 2.4% absolute respectively. On the basis of associations observed between survival and cardiac irradiation in an independent dataset, the purposefully-achieved reduction in MDHeart is expected to lead to the largest improvement in overall survival. It also led to useful knock-on reductions in many measures of cardiac irradiation including VHeart-50-Gy and VLAwall-63-Gy, providing some insurance against survival being more strongly related to these measures than to MDHeart. The predicted hazard ratio (HR) for death corresponding to the purposefully-achieved mean reduction in MDHeart was 0.806, according to which a randomized trial would require 1140 patients to test improved survival with 0.05 significance and 80% power. In patients whose baseline MDHeart values exceeded the median value in a published series, the average MDHeart reduction was particularly large, 8.8 Gy. The corresponding predicted HR is potentially testable in trials recruiting 359 patients enriched for greater MDHeart values. CONCLUSIONS Cardiac irradiation in RT of LA-NSCLC can be reduced substantially. Of the measures studied, reduction of MDHeart led to the greatest predicted increase in survival, and to useful knock-on reductions in other cardiac irradiation measures reported to be associated with survival. Potential improvements in survival can be trialled more efficiently in a population enriched for patients with greater baseline MDHeart levels, for whom larger reductions in heart doses can be achieved.
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Affiliation(s)
- Louise Turtle
- Department of Radiotherapy, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, CH63 4JY, Wirral, UK.
| | - Neeraj Bhalla
- Department of Radiotherapy, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, CH63 4JY, Wirral, UK
| | - Andrew Willett
- Department of Radiotherapy, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, CH63 4JY, Wirral, UK
| | - Robert Biggar
- Medical Physics, Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - Jonathan Leadbetter
- Department of Radiotherapy, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, CH63 4JY, Wirral, UK
| | - Georgios Georgiou
- Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Royal Liverpool University Hospital, Liverpool, L69 3GA, UK
| | - James M Wilson
- Medical Physics and Biomedical Engineering, University College London, Gower Street, London, WC1E 6BT, UK
- University College London Hospital NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK
| | - Sindu Vivekanandan
- Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Maria A Hawkins
- Medical Physics and Biomedical Engineering, University College London, Gower Street, London, WC1E 6BT, UK
- University College London Hospital NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK
| | - Michael Brada
- Department of Radiotherapy, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, CH63 4JY, Wirral, UK
| | - John D Fenwick
- Department of Radiotherapy, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, CH63 4JY, Wirral, UK
- Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Royal Liverpool University Hospital, Liverpool, L69 3GA, UK
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Turtle L, Willett A, Leadbetter J, Brada M, Fenwick J. OC-0307 Feasibility of cardiac sparing in isotoxic dose escalated radiotherapy for NSCLC. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30727-3] [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: 11/27/2022]
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Amelina E, Flume P, Krasko V, Carryer B, Charlton B, Leadbetter J, Miller J, Aitken M. WS14.2 Phase 3 randomised controlled study of the efficacy and safety of inhaled mannitol in adults with cystic fibrosis. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30197-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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De Boeck K, Haarman E, Hull J, Lands LC, Moeller A, Munck A, Riethmüller J, Tiddens H, Volpi S, Leadbetter J, Charlton B, Malfroot A. Inhaled dry powder mannitol in children with cystic fibrosis: A randomised efficacy and safety trial. J Cyst Fibros 2017; 16:380-387. [DOI: 10.1016/j.jcf.2017.02.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/21/2016] [Accepted: 02/03/2017] [Indexed: 11/30/2022]
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Boeck KD, Haarman E, Hull J, Lands L, Moeller A, Munck A, Riethmüller J, Tiddens H, Volpi S, Leadbetter J, Charlton B, Malfroot A. WS03.3 A phase II, randomised, double-blind, placebo-controlled, crossover study of dry powder mannitol in children with cystic fibrosis (CF). J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30074-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
The effects of increasing quantities of oat bran on plasma lipids were examined in 40 hypercholesterolemic men and women. Using a four-by-four Latin-square design, subjects added 30, 60, and 90 g oat bran/d or no oat bran to their usual diet for 1-mo experimental periods. Self-selected background diets remained unchanged and weight did not change significantly. No differences in plasma total or low-density-lipoprotein cholesterol were found. Supplementation of the usual diet with less than or equal to 90 g oat bran does not appear to significantly lower cholesterol in hypercholesterolemic subjects continuing to follow a diet relatively high in saturated fatty acids.
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Affiliation(s)
- J Leadbetter
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
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