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Chua L, Friedrich S, Zhang XC. Mirikizumab Pharmacokinetics in Patients with Moderately to Severely Active Ulcerative Colitis: Results from Phase III LUCENT Studies. Clin Pharmacokinet 2023; 62:1479-1491. [PMID: 37610533 PMCID: PMC10520102 DOI: 10.1007/s40262-023-01281-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND AND OBJECTIVE Mirikizumab is a humanized anti-interleukin-23-p19 monoclonal antibody being developed for ulcerative colitis and Crohn's disease. This analysis characterized mirikizumab pharmacokinetics using phase II and III trial data from patients with moderately to severely active ulcerative colitis. METHODS Serum pharmacokinetic data in patients receiving mirikizumab 50-1000 mg intravenously every 4 weeks as induction treatment and mirikizumab 200 mg subcutaneously every 4 or 12 weeks as maintenance treatment across three trials (N = 1362) were analyzed using non-linear mixed-effects modeling. Covariate effects on mirikizumab exposure were evaluated using simulation-based estimations. RESULTS Mirikizumab pharmacokinetics was best described by a linear two-compartment model with first-order absorption. Clearance, volume of distribution for central and peripheral compartments, and half-life were estimated at approximately 0.022 L/h (linear), 3.11 L and 1.69 L, and 9.5 days, respectively. Statistically significant effects of body weight and serum albumin levels on clearance, body weight on central and peripheral volumes of distribution, and body mass index on bioavailability were observed but effects were small relative to random inter-individual variability (% coefficient of variation: 18-64%). The subcutaneous bioavailability of mirikizumab was 48%. CONCLUSIONS Mirikizumab displayed pharmacokinetic characteristics typical of a monoclonal antibody where clearance increased with body weight and decreased with the albumin level, and bioavailability decreased with body mass index. These effects were small relative to random variability, indicating that a dose adjustment for patient factors is not required. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT02589665 (28 October, 2015), NCT03518086 (8 May, 2018), NCT03524092 (14 May, 2018).
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Affiliation(s)
- Laiyi Chua
- Global PK/PD and Pharmacometrics, Eli Lilly and Company, 893 Delaware Street, Indianapolis, IN, 46225, USA
| | - Stuart Friedrich
- Global PK/PD and Pharmacometrics, Eli Lilly and Company, 893 Delaware Street, Indianapolis, IN, 46225, USA
| | - Xin Cindy Zhang
- Global PK/PD and Pharmacometrics, Eli Lilly and Company, 893 Delaware Street, Indianapolis, IN, 46225, USA.
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Gueorguieva I, Willis BA, Chua L, Chow K, Ernest CS, Wang J, Shcherbinin S, Sims JR, Chigutsa E. Donanemab exposure and efficacy relationship using modeling in Alzheimer's disease. Alzheimers Dement (N Y) 2023; 9:e12404. [PMID: 37388759 PMCID: PMC10301702 DOI: 10.1002/trc2.12404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/19/2023] [Accepted: 05/31/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Donanemab is an amyloid-targeting therapy that specifically targets brain amyloid plaques. The objective of these analyses was to characterize the relationship of donanemab exposure with plasma biomarkers and clinical efficacy through modeling. METHODS Data for the analyses were from participants with Alzheimer's disease from the phase 1 and TRAILBLAZER-ALZ studies. Indirect-response models were used to fit plasma phosphorylated tau 217 (p-tau217) and plasma glial fibrillated acidic protein (GFAP) data over time. Disease-progression models were developed using pharmacokinetic/pharmacodynamic modeling. RESULTS The plasma p-tau217 and plasma GFAP models adequately predicted the change over time, with donanemab resulting in decreased plasma p-tau217 and plasma GFAP concentrations. The disease-progression models confirmed that donanemab significantly reduced the rate of clinical decline. Simulations revealed that donanemab slowed disease progression irrespective of baseline tau positron emission tomography (PET) level within the evaluated population. DISCUSSION The disease-progression models show a clear treatment effect of donanemab on clinical efficacy regardless of baseline disease severity.
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Affiliation(s)
| | - Brian A. Willis
- Former Employee of Eli Lilly and CompanyIndianapolisIndianaUSA
| | | | - Kay Chow
- Eli Lilly and CompanyBracknellUK
| | | | - Jian Wang
- Eli Lilly and CompanyIndianapolisIndianaUSA
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Gueorguieva I, Willis BA, Chua L, Chow K, Ernest CS, Shcherbinin S, Ardayfio P, Mullins GR, Sims JR. Donanemab Population Pharmacokinetics, Amyloid Plaque Reduction, and Safety in Participants with Alzheimer's Disease. Clin Pharmacol Ther 2023; 113:1258-1267. [PMID: 36805552 DOI: 10.1002/cpt.2875] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/13/2023] [Indexed: 02/20/2023]
Abstract
Donanemab is an amyloid-targeting therapy that resulted in robust amyloid plaque reduction and slowed Alzheimer's disease (AD) progression compared with placebo in the phase II TRAILBLAZER-ALZ study (NCT03367403). The objectives of the current analyses are to characterize (i) the population pharmacokinetics of donanemab, (ii) the relationship between donanemab exposure and amyloid plaque reduction (response), and (iii) the relationship between donanemab exposure and amyloid-related imaging abnormalities with edema or effusions (ARIA-E). Model development included data from participants with mild cognitive impairment or mild to moderate dementia due to AD from the phase Ib study on donanemab (NCT02624778) and participants with early symptomatic AD from the TRAILBLAZER-ALZ study. The analysis showed donanemab has a terminal elimination half-life of 11.8 days. Body weight and antidrug antibody titer impact donanemab exposure but not the pharmacodynamic response. Maintaining a donanemab serum concentration above 4.43 μg/mL (95% confidence interval: 0.956, 10.4) is associated with amyloid plaque reduction. The time to achieve amyloid plaque clearance (amyloid plaque level < 24.1 Centiloids) varied depending on the baseline amyloid level, where higher baseline levels were associated with fewer participants achieving amyloid clearance. The majority of participants achieved amyloid clearance by 52 weeks on treatment. Apolipoprotein ε4 carriers, irrespective of donanemab serum exposure, were 4 times more likely than noncarriers to have an ARIA-E event by 24 weeks.
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Affiliation(s)
| | - Brian A Willis
- Former Employee of Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Laiyi Chua
- Eli Lilly and Company, Singapore, Singapore
| | - Kay Chow
- Eli Lilly and Company, Bracknell, UK
| | | | | | | | | | - John R Sims
- Eli Lilly and Company, Indianapolis, Indiana, USA
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Gueorguieva I, Chua L, Willis BA, Sims JR, Wessels AM. Disease progression model using the integrated Alzheimer's Disease Rating Scale. Alzheimers Dement 2022. [DOI: 10.1002/alz.12876] [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] [Received: 06/24/2022] [Revised: 09/27/2022] [Accepted: 10/21/2022] [Indexed: 12/03/2022]
Affiliation(s)
| | - Laiyi Chua
- Eli Lilly and Company Indianapolis Indiana USA
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Jackson K, Chua L, Velez de Mendizabal N, Pitou C, Rodriguez Capriles C, Paller AS, Lansang P, Seyger MMB, Papp K. Population pharmacokinetic and exposure-efficacy analysis of ixekizumab in paediatric patients with moderate-to-severe plaque psoriasis (IXORA-PEDS). Br J Clin Pharmacol 2022; 88:1074-1086. [PMID: 34378230 PMCID: PMC9291793 DOI: 10.1111/bcp.15034] [Citation(s) in RCA: 3] [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: 03/30/2021] [Revised: 07/23/2021] [Accepted: 07/31/2021] [Indexed: 12/24/2022] Open
Abstract
AIMS Ixekizumab is a high-affinity monoclonal antibody that selectively targets interleukin-17A used in the treatment of adult and paediatric patients with moderate-to-severe psoriasis. This analysis evaluated the pharmacokinetics (PK) of ixekizumab and the exposure-efficacy relationship in paediatric patients aged 6 to <18 years with psoriasis. METHODS Population PK and exposure-efficacy models were developed. The models used data from paediatric patients with psoriasis participating in the Phase 3 IXORA-PEDS trial in which patients were dosed according to weight categories. The exposure-efficacy model is a Psoriasis Area and Severity Index (PASI) time course model using data up to Week 12, a co-primary efficacy endpoint. RESULTS A 2-compartment population PK model describes the PK of ixekizumab in paediatric patients with the effect of body weight incorporated on clearance and volume terms using an allometric relationship. The weight category-based dosing ensured that ixekizumab mean trough serum concentrations in paediatric patients with psoriasis (3.20-3.33 μg/mL) were within the range of concentrations observed in adult patients with psoriasis (mean [standard deviation]: 3.48 [2.16] μg/mL) administered an efficacious dosing regimen. The observed PASI response rates at Week 12 in paediatric patients (91.9/81.8/52.5% for PASI75/90/100) are well predicted by the final exposure-efficacy model and response rates are similar or higher than those achieved in adults (86.2/66.6/35.0% for PASI75/90/100). CONCLUSION This analysis is the first to describe the PK and exposure-efficacy relationship of ixekizumab in paediatric patients with psoriasis. The analyses support the selection of the weight category-based ixekizumab dosing regimens approved for use in paediatric patients with psoriasis.
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Affiliation(s)
| | - Laiyi Chua
- Lilly Centre for Clinical PharmacologySingaporeSingapore
| | | | | | | | - Amy S. Paller
- Department of DermatologyNorthwestern University Feinberg School of MedicineChicagoILUSA
| | | | - Marieke M. B. Seyger
- Department of DermatologyRadboud University Medical CentreNijmegenThe Netherlands
| | - Kim Papp
- K Papp Clinical Research and Probity Medical ResearchWaterlooONCanada
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Lowe SL, Duggan Evans C, Shcherbinin S, Cheng YJ, Willis BA, Gueorguieva I, Lo AC, Fleisher AS, Dage JL, Ardayfio P, Aguiar G, Ishibai M, Takaichi G, Chua L, Mullins G, Sims JR. Donanemab (LY3002813) Phase 1b Study in Alzheimer's Disease: Rapid and Sustained Reduction of Brain Amyloid Measured by Florbetapir F18 Imaging. J Prev Alzheimers Dis 2021; 8:414-424. [PMID: 34585215 DOI: 10.14283/jpad.2021.56] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Donanemab (LY3002813) is an IgG1 antibody directed at an N‑terminal pyroglutamate of amyloid beta epitope that is present only in brain amyloid plaques. OBJECTIVES To assess effects of donanemab on brain amyloid plaque load after single and multiple intravenous doses, as well as pharmacokinetics, safety/tolerability, and immunogenicity. DESIGN Phase 1b, investigator- and patient-blind, randomized, placebo-controlled study. SETTING Patients recruited at clinical research sites in the United States and Japan. PARTICIPANTS 61 amyloid plaque-positive patients with mild cognitive impairment due to Alzheimer's disease and mild-to-moderate Alzheimer's disease dementia. INTERVENTION Six cohorts were dosed with donanemab: single dose 10-, 20- or 40- mg/kg (N = 18), multiple doses of 10-mg/kg every 2 weeks for 24 weeks (N = 10), and 10- or 20-mg/kg every 4 weeks for 72 weeks (N=18) or placebo (N = 15). MEASUREMENTS Brain amyloid plaque load, using florbetapir positron emission tomography, was assessed up to 72 weeks. Safety was evaluated by occurrence of adverse events, magnetic resonance imaging, electrocardiogram, vital signs, laboratory testing, neurological monitoring, and immunogenicity. RESULTS Treatment with donanemab resulted in rapid reduction of amyloid, even after a single dose. By 24 weeks, amyloid positron emission tomography mean changes from baseline for single donanemab doses in Centiloids were: -16.5 (standard error 11.22) 10-mg/kg intravenous; 40.0 (standard error 11.23) 20 mg/kg intravenous; and -49.6 (standard error 15.10) 40-mg/kg intravenous. Mean reduction of amyloid plaque in multiple dose cohorts by 24 weeks in Centiloids were: 55.8 (standard error 9.51) 10-mg/kg every 2 weeks; -50.2 (standard error 10.54) 10-mg/kg every 4 weeks; and -58.4 (standard error 9.66) 20-mg/kg every 4 weeks. Amyloid on average remained below baseline levels up to 72 weeks after a single dose of donanemab. Repeated dosing resulted in continued florbetapir positron emission tomography reductions over time compared to single dosing with 6 out of 28 patients attaining complete amyloid clearance within 24 weeks. Within these, 5 out of 10 patients in the 20 mg/kg every 4 weeks cohort attained complete amyloid clearance within 36 weeks. When dosing with donanemab was stopped after 24 weeks of repeat dosing in the 10 mg every 2 weeks cohort, florbetapir positron emission tomography reductions were sustained up to 72 weeks. For the single dose cohorts on day 1, dose proportional increases in donanemab pharmacokinetics were observed from 10 to 40 mg/kg. Dose proportional increases in pharmacokinetics were also observed at steady state with the multiple dose cohorts. Donanemab clearance was comparable across the dose levels. Mean donanemab elimination-half-life following 20 mg/kg single dose was 9.3 days with range of 5.6 to 16.2 days. Greater than 90% of patients had positive treatment-emergent antidrug antibodies with donanemab. However, overall, the treatment-emergent antidrug antibodies did not have a significant impact on pharmacokinetics. Donanemab was generally well tolerated. Amongst the 46 participants treated with donanemab, the following amyloid-related imaging abnormalities, common to the drug class, were observed: 12 vasogenic cerebral edema events (12 [19.7%] patients), 10 cerebral microhemorrhage events (6 [13.0%] patients), and 2 superficial siderosis events (2 [4.3%] patients). CONCLUSIONS Single and multiple doses of donanemab demonstrated a rapid, robust, and sustained reduction up to 72 weeks in brain amyloid plaque despite treatment-emergent antidrug antibodies detected in most patients. Amyloid-related imaging abnormalities were the most common treatment-emergent event.
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Affiliation(s)
- S L Lowe
- John R. Sims, Eli Lilly and Company, Lilly Corporate Center DC 1532, Indianapolis, IN, 46285, Telephone: 317-655-2206, e-mail:
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Liu H, Wang F, Ji Y, Ma T, Li H, Linnebjerg H, Chua L, Tham LS, Yu Y. A Euglycemic Glucose Clamp Study to Evaluate the Bioavailability of LY2963016 Relative to Insulin Glargine in Healthy Chinese Subjects. Clin Pharmacol Drug Dev 2021; 10:1452-1459. [PMID: 34410042 DOI: 10.1002/cpdd.1014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/26/2021] [Indexed: 02/05/2023]
Abstract
Insulin glargine (IGlar) and LY2963016 (LY IGlar) are long-acting insulin analogs with identical primary amino acid sequences. We conducted a randomized, open-label, 2-treatment, 2-period, crossover study in healthy Chinese subjects to evaluate the relative bioavailability of LY IGlar to IGlar and pharmacokinetic (PK) and pharmacodynamic (PD) characteristics of LY IGlar. Subjects (n = 58) were randomized to receive single subcutaneous doses (0.5 U/kg) of LY IGlar and IGlar with a ≥7-day washout period between study treatments. Serum was collected before and up to 24 hours after dosing to assess PK characteristics. PD characteristics were assessed by euglycemic clamp up to 24 hours after dosing. Linear mixed-effects models were used to fit the log-transformed primary PK (maximum observed concentration and area under the concentration-time curve from time 0 to 24 hours) and PD parameters (maximum glucose infusion rate and total amount of glucose infused during clamp period). The geometric least squares means ratios (90% confidence interval) of LY IGlar to IGlar for maximum observed concentration and area under the concentration-time curve from time 0 to 24 hours were 0.961 (0.887-1.04) and 0.941 (0.872-1.01), respectively. The geometric least squares means ratios (90% confidence interval) of LY IGlar to IGlar were 0.91 (0.85-0.98) for maximum glucose infusion rate and 0.89 (0.82-0.97) for total amount of glucose infused during clamp period. LY IGlar demonstrated similarity to IGlar in PK and PD characteristics following single-dose (0.5 U/kg) administration in healthy Chinese subjects.
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Affiliation(s)
- Hui Liu
- Department of General Practice, West China Hospital of Sichuan University, Chengdu, China
| | - Feng Wang
- Lilly Suzhou Pharmaceutical Co. Ltd., Shanghai, China
| | - Yongjia Ji
- Lilly Suzhou Pharmaceutical Co. Ltd., Shanghai, China
| | - Tianyang Ma
- Lilly Suzhou Pharmaceutical Co. Ltd., Shanghai, China
| | - Hongying Li
- Lilly Suzhou Pharmaceutical Co. Ltd., Shanghai, China
| | | | - Laiyi Chua
- Lilly Centre for Clinical Pharmacology, Singapore, Singapore
| | - Lai San Tham
- Lilly Centre for Clinical Pharmacology, Singapore, Singapore
| | - Yerong Yu
- Department of Endocrinology, West China Hospital of Sichuan University, Chengdu, China
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Lowe SL, Willis BA, Hawdon A, Natanegara F, Chua L, Foster J, Shcherbinin S, Ardayfio P, Sims JR. Donanemab (LY3002813) dose-escalation study in Alzheimer's disease. Alzheimers Dement (N Y) 2021; 7:e12112. [PMID: 33614890 PMCID: PMC7882532 DOI: 10.1002/trc2.12112] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study explored the safety and tolerability features of donanemab (LY3002813) in patients with mild cognitive impairment due to Alzheimer's disease (AD) or mild to moderate AD dementia. METHODS Patients with AD were enrolled into the single-ascending dose phase and were administered a single, intravenous (IV) dose of donanemab (five dosing cohorts from 0.1 to 10 mg/kg) or placebo followed by a 12-week follow-up period for each dose level. After the follow-up period, the same patients proceeded into the multiple-ascending dose (MAD) phase (five cohorts) and were administered IV doses of donanemab (0.3 to 10 mg/kg) or placebo approximately once per month for up to four doses depending on the initial doses (only cohort 1 went from 0.1 mg/kg to a higher dose of 0.3 mg/kg during the MAD phase). This phase concluded with a 12-week follow-up period. The relative exposure assessment of an unblinded, single, subcutaneous 3-mg/kg dose of donanemab in patients with AD was also performed, followed by a 12-week follow-up period. One cohort of healthy subjects received an unblinded, single, IV 1-mg/kg dose of donanemab. These two cohorts did not continue to the MAD phase. RESULTS Donanemab was generally well tolerated up to 10 mg/kg. After single-dose administration from 0.1 to 3.0 mg/kg, the mean terminal elimination half-life was ≈4 days, increasing to ≈10 days at 10 mg/kg. Only the 10-mg/kg dose showed changes in amyloid positron emission tomography. Amyloid reduction of 40% to 50% was achieved. Approximately 90% of subjects developed anti-drug antibodies at 3 months after a single intravenous dose. DISCUSSION Intravenous donanemab 10 mg/kg can reduce amyloid deposits in AD despite having a shorter than expected half-life.
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Affiliation(s)
| | - Brian A. Willis
- Eli Lilly and CompanyLilly Corporate Center DC 1532IndianapolisIndianaUSA
| | - Anne Hawdon
- Eli Lilly and Company LimitedErl Wood Manor, WindleshamUnited Kingdom
| | - Fanni Natanegara
- Eli Lilly and CompanyLilly Corporate Center DC 1532IndianapolisIndianaUSA
| | - Laiyi Chua
- Eli Lilly and CompanyLilly Corporate Center DC 1532IndianapolisIndianaUSA
| | - Joanne Foster
- Eli Lilly and Company LimitedErl Wood Manor, WindleshamUnited Kingdom
| | - Sergey Shcherbinin
- Eli Lilly and CompanyLilly Corporate Center DC 1532IndianapolisIndianaUSA
| | - Paul Ardayfio
- Eli Lilly and CompanyLilly Corporate Center DC 1532IndianapolisIndianaUSA
| | - John R. Sims
- Eli Lilly and CompanyLilly Corporate Center DC 1532IndianapolisIndianaUSA
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Chigutsa E, Velez de Mendizabal N, Chua L, Heathman M, Friedrich S, Jackson K, Reich K. Exposure-Response Modeling to Characterize the Relationship Between Ixekizumab Serum Drug Concentrations and Efficacy Responses at Week 12 in Patients With Moderate to Severe Plaque Psoriasis. J Clin Pharmacol 2018; 58:1489-1500. [DOI: 10.1002/jcph.1268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/10/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Emmanuel Chigutsa
- Global PKPD and Pharmacometrics; Eli Lilly and Company; Indianapolis IN USA
| | | | - Laiyi Chua
- Lilly-NUS Centre for Clinical Pharmacology; Singapore
| | - Michael Heathman
- Global PKPD and Pharmacometrics; Eli Lilly and Company; Indianapolis IN USA
| | - Stuart Friedrich
- Global PKPD and Pharmacometrics; Eli Lilly and Company; Indianapolis IN USA
| | - Kimberley Jackson
- Global PKPD and Pharmacometrics; Eli Lilly and Company; Windlesham UK
| | - Kristian Reich
- Dermatologikum Berlin and SCIderm Research Institute; Hamburg Germany
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Zhang X, Chua L, Ernest C, Macias W, Rooney T, Tham LS. Dose/Exposure-Response Modeling to Support Dosing Recommendation for Phase III Development of Baricitinib in Patients with Rheumatoid Arthritis. CPT Pharmacometrics Syst Pharmacol 2017; 6:804-813. [PMID: 28891251 PMCID: PMC5744177 DOI: 10.1002/psp4.12251] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 01/05/2023]
Abstract
Baricitinib is an oral inhibitor of Janus kinases (JAKs), selective for JAK1 and 2. It demonstrated dose‐dependent efficacy in patients with moderate‐to‐severe rheumatoid arthritis (RA) in a phase IIb study up to 24 weeks. Population pharmacokinetic/pharmacodynamic (PopPK/PD) models were developed to characterize concentration‐time profiles and dose/exposure‐response (D/E‐R) relationships for the key efficacy (proportion of patients achieving American College of Rheumatology 20%, 50%, or 70% response rate) and safety endpoints (incidence of anemia) for the phase IIb study. The modeling suggested that 4 mg q.d. was likely to offer the optimum risk/benefit balance, whereas 2 mg q.d. had the potential for adequate efficacy. In addition, at the same total daily dose, a twice‐daily regimen is not expected to provide an advantage over q.d. dosing for the efficacy or safety endpoints. The model‐based simulations formed the rationale for key aspects of dosing, such as dose levels and dosing frequency for phase III development.
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Affiliation(s)
- Xin Zhang
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Laiyi Chua
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | | | - Lai San Tham
- Eli Lilly and Company, Indianapolis, Indiana, USA
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Zhang X, Lam ECQ, Seger ME, Coutant D, Chua L, Tan LH, Soon D, Linnebjerg H. LY2963016 Insulin Glargine and Insulin Glargine (Lantus) Produce Comparable Pharmacokinetics and Pharmacodynamics at Two Dose Levels. Clin Pharmacol Drug Dev 2017; 6:556-563. [PMID: 28940840 DOI: 10.1002/cpdd.392] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 07/28/2016] [Accepted: 08/02/2017] [Indexed: 11/06/2022]
Abstract
LY2963016 (LY IGlar) and Lantus (IGlar) are insulin glargine products with identical amino acid sequences. This was a phase 1 single-site, randomized, subject- and investigator-blinded, 4-treatment, 4-period crossover study to compare the pharmacokinetic (PK) and pharmacodynamic (PD) properties of LY IGlar and IGlar at 2 different doses. Fasted healthy subjects were randomly assigned to receive 2 single doses of LY IGlar and IGlar (0.3 and 0.6 U/kg for each product). Blood samples were collected up to 24 hours postdose to assess PK, and a euglycemic clamp lasting up to 24 hours postdose was conducted to assess PD. Twenty-four healthy subjects aged 23 to 52 years participated in the study. The primary PK parameters (area under the concentration versus time curve from 0 to 24 hours [AUC0-24 ] and maximum observed drug concentration [Cmax ]) and PD parameters (total amount of glucose infused during the clamp [Gtot ] and maximum glucose infusion rate [Rmax ]) were not statistically different between LY IGlar and IGlar at either dose. No safety concerns were noted with either drug. The study demonstrated that the PK and PD parameters for LY IGlar and IGlar were comparable following single doses at both 0.3 and 0.6 U/kg.
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Affiliation(s)
- Xin Zhang
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Eric Chen Quin Lam
- Formerly of Lilly-NUS Centre for Clinical Pharmacology, Singapore, Singapore
| | - Mary E Seger
- Formerly of Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Laiyi Chua
- Lilly-NUS Centre for Clinical Pharmacology, Singapore, Singapore
| | - Lai Hock Tan
- Lilly-NUS Centre for Clinical Pharmacology, Singapore, Singapore
| | - Danny Soon
- Formerly of Lilly-NUS Centre for Clinical Pharmacology, Singapore, Singapore
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Willis BA, Ferguson‐Sells LR, Chua L, Siemers ER, Dean RA, Lachno DR, Carlson CD, Hake AM, Hoffmann VP, Friedrich SW. [P1–042]: PLASMA PHARMACOKINETICS AND PHARMACODYNAMICS OF SOLANEZUMAB IN MILD AND MODERATE AD PATIENTS. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.109] [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: 10/18/2022]
Affiliation(s)
| | | | - Laiyi Chua
- Lilly – National University of Singapore Centre for Clinical PharmacologySingaporeSingapore
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Linnebjerg H, Lam ECQ, Zhang X, Seger ME, Coutant D, Chua L, Kapitza C, Heise T. Duration of action of two insulin glargine products, LY2963016 insulin glargine and Lantus insulin glargine, in subjects with type 1 diabetes mellitus. Diabetes Obes Metab 2017; 19:33-39. [PMID: 27484286 PMCID: PMC5215447 DOI: 10.1111/dom.12759] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/22/2016] [Accepted: 07/24/2016] [Indexed: 11/30/2022]
Abstract
AIMS LY2963016 (LY IGlar) and Lantus (IGlar) are insulin glargine products manufactured by distinct processes, but with identical amino acid sequences. This study compared the duration of action of LY IGlar and IGlar in subjects with type 1 diabetes mellitus (T1DM). MATERIALS AND METHODS This was a randomized, double-blind, single-dose, two-period, crossover study. Twenty subjects underwent 42-hour euglycaemic clamps after a single subcutaneous 0.3-U/kg dose of LY IGlar or IGlar. In this study, the duration of action was defined as the time required for blood glucose levels to rise consistently above a predefined cut-off of 8.3 mmol/L (150 mg/dL) from a state of euglycaemia. Blood samples were collected to measure blood glucose for pharmacodynamic (PD) evaluations. RESULTS End of action was reached within 42 hours in 26 of 40 clamps (13 LY IGlar and 13 IGlar). The median duration of action for all subjects was 37.1 and 40.0 hours, and the mean duration of action (calculated using only patients who reached end of action) was 23.8 and 25.5 hours for LY IGlar and IGlar, respectively. The duration of action was demonstrated to be similar between the treatments using time-to-event analysis (log-rank test of equality p = .859). Following administration of LY IGlar and IGlar, the PD parameters of maximum glucose infusion rate (R max ) and total glucose infusion during the clamp (G tot ) were comparable. CONCLUSION LY IGlar and IGlar had similar duration of action and comparable PD parameters in subjects with T1DM.
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Affiliation(s)
| | | | - Xin Zhang
- Eli Lilly and CompanyIndianapolisIndiana
| | | | | | - Laiyi Chua
- Lilly‐NUS Centre for Clinical PharmacologySingaporeSingapore
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Linnebjerg H, Lam ECQ, Seger ME, Coutant D, Chua L, Chong CL, Ferreira MM, Soon D, Zhang X. Comparison of the Pharmacokinetics and Pharmacodynamics of LY2963016 Insulin Glargine and EU- and US-Approved Versions of Lantus Insulin Glargine in Healthy Subjects: Three Randomized Euglycemic Clamp Studies. Diabetes Care 2015; 38:2226-33. [PMID: 26307603 DOI: 10.2337/dc14-2623] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 07/21/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE LY2963016 (LY IGlar) and Lantus (IGlar) are insulin glargine products manufactured by distinct processes but with identical amino acid sequences. Three studies evaluated the pharmacokinetic (PK) and pharmacodynamic (PD) similarity of LY IGlar and the European Union- and US-approved versions of IGlar. RESEARCH DESIGN AND METHODS These were three single-site, randomized, double-blind, two-treatment, four-period, crossover, euglycemic clamp studies. In each study, fasted healthy subjects received 0.5 units/kg s.c. doses of two different insulin glargine products on two occasions each, following a randomized sequence. A ≥7-day washout period separated the doses. Blood samples were collected predose and up to 24 h postdose to assess PK; PD was assessed by a euglycemic clamp lasting up to 24 h. RESULTS A total of 211 subjects participated in the three studies. The PK (area under the curve [AUC]; maximum observed concentration [Cmax]) and PD (maximum glucose infusion rate [Rmax]; total glucose infusion during the clamp [Gtot]) were similar between LY IGlar and IGlar, with the ratios of geometric means ranging from 0.90 to 0.95 for PK parameters and from 0.91 to 0.99 for PD parameters across studies. In all cases, the 90% CIs for the ratios of geometric means were completely contained in the prespecified acceptance limits of 0.80-1.25. Adverse events were similar between treatments. CONCLUSIONS These studies demonstrated that the PK and PD properties of LY IGlar and IGlar were similar after single 0.5 units/kg s.c. doses in healthy subjects, contributing to the totality of evidence supporting similarity of these products.
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Affiliation(s)
| | | | | | | | - Laiyi Chua
- Lilly-NUS Centre for Clinical Pharmacology, Singapore
| | | | - Maria M Ferreira
- PAREXEL International Bloemfontein Early Phase Unit, Bloemfontein, South Africa
| | - Danny Soon
- Lilly-NUS Centre for Clinical Pharmacology, Singapore
| | - Xin Zhang
- Eli Lilly and Company, Indianapolis, IN
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Thalayasingam M, Gerez IFA, Yap GC, Llanora GV, Chia IP, Chua L, Lee CJAO, Ta LDH, Cheng YK, Thong BYH, Tang CY, Van Bever HPS, Shek LP, Curotto de Lafaille MA, Lee BW. Clinical and immunochemical profiles of food challenge proven or anaphylactic shrimp allergy in tropical Singapore. Clin Exp Allergy 2015; 45:687-97. [PMID: 25257922 DOI: 10.1111/cea.12416] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [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: 03/19/2014] [Revised: 06/24/2014] [Accepted: 08/12/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Shellfish allergy in Singapore is highly prevalent, and shrimp allergy is the most common. OBJECTIVE This study aims to evaluate the clinical characteristics and immunological phenotype of shellfish allergy in this population. METHODS Patients with self-reported shellfish allergy were recruited from outpatient clinics of three large hospitals and from a population survey. Open oral food challenges (OFC) to glass prawn (Litopenaeus vannamei) and tiger prawn (Penaeus monodon) were carried out on all patients except for those who had a history of severe anaphylaxis. Skin prick tests (SPT) and specific IgE to crude and recombinant allergens were carried out to evaluate shrimp and dust mite sensitization. Immunoblots were used to assess IgE-binding proteins. RESULTS The 104 patients recruited were categorized into shellfish allergic (SA) when OFC was positive or had a history of severe anaphylaxis (n = 39), shellfish tolerant (ST) when OFC was negative (n = 27), and house dust mite positive controls (HDM(+) ) who were ST (n = 38). Oral symptoms (87.1%) were the predominant clinical manifestation. Positive challenge doses ranged from 2 to 80 g of cooked shrimp, with 25/52 patients reacting to either one or both shrimps challenged. The presence of specific IgE to shrimp either by SPT and/or ImmunoCAP(®) assay provided diagnostic test sensitivity of 82% and specificity of 22.2%. The inclusion of specific IgE to shrimp tropomyosin and IgE immunoblots with shrimp extracts did not improve the diagnostic proficiency substantially. CONCLUSIONS AND CLINICAL RELEVANCE This study highlights the predominance of oral symptoms in shrimp allergy in tropical Asia and that a high provocation dose may be necessary to reveal shrimp allergy. Furthermore, specific IgE diagnostic tests and immunoblots were of limited use in this population.
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Affiliation(s)
- M Thalayasingam
- Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
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Savaraj N, Dinh V, Chua L, Bustillo P, Nissim K. Role of concurrent chemoradiotherapy in organ preservation for locally advanced head and neck cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e17044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17044 Background: Optimal management for head and neck cancer is controversial. Standard of care has been surgery followed by radiotherapy, but is done with the risk of organ resection. The VA larynx study, EORTC 24891, and 91–11 US Intergroup trial have shown that chemoradiotherapy is comparable to surgery with radiotherapy in laryngeal cancers while preserving organ function. It is unclear, though, whether this could be accomplished in other tumor sites without sacrificing locoregional control and/or survival. Methods: We performed a retrospective chart review of patients who were treated at the Miami VA Medical Center with chemoradiotherapy for advanced staged head and neck cancers from 1996 to 2008. The majority of patients (84%) received 5FU and cisplatin. The choice of chemoradiotherapy was either determined by patients’ choice or their comorbidities, such as pulmonary disease and cardiac disease, precluded them from undergoing major surgery. Primary endpoints included death, relapse rates, and disease-free survival; secondary endpoints were toxicities associated with treatment and diminished organ function. Results: A total of 62 patients were included. Out of these patients, 52% had stage III disease and 50% had primary sites in the oropharynx; the remaining included larynx and hypopharynx. 20% of patients required salvage neck dissection. Complications included severe mucositis (69%), dysphagia (19% short term, 34% long term), hoarseness (13%), and dry mouth (24%). 27% had relapse of disease and median time for disease-free survival was 26 months. A total of 35 patients had died with a 2-year survival rate of 59.6%. Overall survival was best for laryngeal and oropharyngeal cancer (63 and 46 months, respectively) compared to hypopharyngeal cancer (22 months). Conclusions: Concurrent chemoradiotherapy is a valid option for treatment of locally advanced head and neck cancers especially for laryngeal and possibly oropharyngeal primaries with significant but tolerable toxicities. Although organ preservation is possible for the majority of patients with locally advanced head and neck cancer, however, the poor survival seen in hypopharyngeal cancer needs further investigation. No significant financial relationships to disclose.
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17
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Toms AD, Barker RL, McClelland D, Chua L, Spencer-Jones R, Kuiper JH. Repair of defects and containment in revision total knee replacement. ACTA ACUST UNITED AC 2009; 91:271-7. [PMID: 19190067 DOI: 10.1302/0301-620x.91b2.21415] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The treatment of bony defects of the tibia at the time of revision total knee replacement is controversial. The place of compacted morsellised bone graft is becoming established, particularly in contained defects. It has previously been shown that the initial stability of impaction-grafted trays in the contained defects is equivalent to that of an uncemented primary knee replacement. However, there is little biomechanical evidence on which to base a decision in the treatment of uncontained defects. We undertook a laboratory-based biomechanical study comparing three methods of graft containment in segmental medial tibial defects and compared them with the use of a modular metal augment to bypass the defect. Using resin models of the proximal tibia with medial defects representing either 46% or 65% of the medial cortical rim, repair of the defect was accomplished using mesh, cement or a novel bag technique, after which impaction bone grafting was used to fill the contained defects and a tibial component was cemented in place. As a control, a cemented tibial component with modular metal augments was used in identical defects. All specimens were submitted to cyclical mechanical loading, during which cyclical and permanent tray displacement were determined. The results showed satisfactory stability with all the techniques except the bone bag method. Using metal augments gave the highest initial stability, but obviously lacked any potential for bone restoration.
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Affiliation(s)
| | - R. L. Barker
- The Hip Unit, Princess Elizabeth Orthopaedic Centre, Barrack Road, Exeter EX2 5DW, UK
| | - D. McClelland
- North Staffordshire Royal Infirmary, Princes Road, Stoke-on-Trent, Staffordshire ST4 7LN, UK
| | - L. Chua
- The Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire SY10 7AG, UK
| | - R. Spencer-Jones
- The Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire SY10 7AG, UK
| | - J.-H. Kuiper
- The Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire SY10 7AG, UK
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Ogden R, McGough HN, Cowan RS, Chua L, Groves M, McEwing R. SNP-based method for the genetic identification of ramin Gonystylus spp. timber and products: applied research meeting CITES enforcement needs. ENDANGER SPECIES RES 2008. [DOI: 10.3354/esr00141] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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19
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Affiliation(s)
- C. Leucht
- Königinstrasse 51, Munich 80539, Germany,To whom correspondence should be addressed; tel: 089-4140-4249, e-mail:
| | - M. Kitzmantel
- Klinik für Psychiatrie und Psychotherapie der TU-München, Klinikum rechts der Isar, Ismaningerstrasse 22, 81675 München, Germany
| | - L. Chua
- Lynfield Mount Hospital, Heights Lane, Bradford BD9 6DP, UK
| | - J. Kane
- The Zucker Hillside Hospital, Psychiatry Research, Glen Oaks, NY 11004
| | - S. Leucht
- Klinik für Psychiatrie und Psychotherapie der TU-München, Klinikum rechts der Isar, Ismaningerstrasse 22, 81675 München, Germany
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Abstract
BACKGROUND Chlorpromazine and haloperidol are benchmark antipsychotic drugs. Both are said to be equally effective when used at equivalent doses, but have different side-effect profiles. OBJECTIVES To compare the effects of haloperidol and chlorpromazine for people with schizophrenia and schizophrenia-like psychoses. SEARCH STRATEGY We searched the Cochrane Schizophrenia Group's register (August 2006). We searched references of all included studies for further trials. We contacted pharmaceutical companies and authors of relevant trials. SELECTION CRITERIA We included all randomised controlled trials that compared haloperidol with chlorpromazine for people with schizophrenia and/or schizophrenia-like psychoses. DATA COLLECTION AND ANALYSIS Citations and, where possible, abstracts were independently inspected by at least two reviewers, papers ordered, re-inspected and quality assessed. We independently extracted data. For dichotomous data we calculated the relative risk (RR), 95% confidence interval (CI) and, where appropriate, the number needed to treat (NNT) on an intention-to-treat basis using a random-effects model. For continuous data, we calculated weighted mean differences (WMD). MAIN RESULTS We found 14 relevant studies, mostly of short duration, poorly reported and conducted in the 1970s (total n=794 participants). Nine of these compared oral formulations of both compounds, and five compared intramuscular formulations. Haloperidol was associated with significantly fewer people leaving the studies early (13 RCTs, n=476, RR 0.26 CI 0.08 to 0.82). The efficacy outcome 'no significant improvement' tended to favour haloperidol, but this difference was not statistically significant (9 RCTs, n=400, RR 0.81 CI 0.64 to 1.04). Movement disorders were more frequent in the haloperidol groups ('at least one extrapyramidal side effect': 6 RCTs, n=37, RR 2.2 CI 1.1 to 4.4, NNH 5 CI 3 to 33), while chlorpromazine was associated with more frequent hypotension (5 RCTs, n=175, RR 0.31 CI 0.11 to 0.88, NNH 7 CI 4 to 25). Similar trends were found when studies comparing intramuscular formulations and studies comparing oral formulations were analysed separately. AUTHORS' CONCLUSIONS Given that haloperidol and chlorpromazine are global standard antipsychotic treatments for schizophrenia, it is surprising that less than 800 people have been randomised to a comparison and that incomplete reporting still makes it difficult for anyone to draw clear conclusions on the comparative effects of these drugs. However, it seems that haloperidol causes more movement disorders than chlorpromazine, while chlorpromazine is significantly more likely to lead to hypotonia. We are surprised to have to say that we feel further, large, well designed, conducted and reported studies are required.
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Zhong L, Chua L, Ng EYK, Ghista D, Lim S, Tan R. A non-invasive system for assessment of aortic stiffness in clinical practice. Conf Proc IEEE Eng Med Biol Soc 2007; 2005:2248-51. [PMID: 17282680 DOI: 10.1109/iembs.2005.1616911] [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] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Previously aortic stiffness is frequently assessed through pulse pressure and pulse wave velocity (PWV) measurements. However, these methods need aortic pressure obtained by catheterization. A new model has been developed to rapidly determine the aortic pressure profile and simultaneously calculate aortic stiffness. Comparison between the aortic pressure result obtained from this and catheterization data demonstrates good agreement, while this method is non-invasive. This totally non-invasive method should be useful in assessing arteriosclerotic disease in clinical setting.
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Affiliation(s)
- L Zhong
- Sch. of Mechanical & Aerosp. Eng., Nanyang Technol. Univ
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22
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Fleisher AS, Lowe SL, Liu P, Shcherbinin S, Li L, Chua L, Nakano M, Hawdon A, Willis BA, Schwarz AJ, Demattos RB, Mintun MA, Irizarry MC. O1‐09‐01: SIGNIFICANT AND SUSTAINED FLORBETAPIR F18 UPTAKE REDUCTION IN PATIENTS WITH SYMPTOMATIC ALZHEIMER'S DISEASE WITH LY3002813, A β‐AMYLOID PLAQUE‐SPECIFIC ANTIBODY. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2018.06.2378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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)
| | | | - Peng Liu
- Eli Lilly and CompanyIndianapolisINUSA
| | | | - Li Li
- Eli Lilly and CompanyIndianapolisINUSA
| | - Laiyi Chua
- Lilly – National University of Singapore Centre for Clinical PharmacologySingaporeSingapore
| | | | - Anne Hawdon
- Eli Lilly and CompanyWindleshamUnited Kingdom
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23
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Robles C, Vale C, Dinh V, Savaraj N, Spector S, Chua L, Bustillo P, Furst A. Retrospective review of locally advanced head and neck cancer treated with concomitant chemoradiotherapy at the Miami VA Medical Center. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.15541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15541 Management of Stage III or IV Head and Neck (H&N) cancer is debatable. Standard of care is Radical Surgery (Sx) followed by Radiotherapy (XRT). However, cosmetic and functional complications are distressing and result in decreased quality of life. Therefore, organ preservation has become important when deciding best management. The VA larynx study, the EORTC 24891 and the 91–11 US intergroup trial have shown efficacy of organ preserving chemoradiotherapy (Cx+Rx) comparable to Sx and XRT. These studies are limited to laryngeal and hypopharyngeal cancers and whether same principles can be applied to other H&N sites is unknown. We conducted a retrospective study of stage III & IV H&N cancer treated at our Institution between 1996–2004 to evaluate survival, organ preservation and toxicities. 45 males between 47 to 83 years (median 59.6) were studied. 87% were white and 13% black. 82% had history of tobacco and alcohol abuse, 4% tobacco only, 11% alcohol only and 2% never smoked or drank. The sites of disease were: nasopharynx 1 (2%), oropharynx 19 (42%), base of tongue 10 (22%), larynx 6 (13%) and pharynx 9 (20%). 15 patients (33%) where stage III and 30 (67%) stage IV. The treatment was combined Cx+Rx. The mean dose of XRT was 6697 Cgy and mean cycles of chemotherapy (Cx) were 2.2. Of those, 42 patients (93%) received cisplatin and 5FU, 2 (4%) carboplatin and 5FU and 1 (2%) carbo only. 10 patients (22%) received additional Cx and 14 (31%) underwent additional Sx (neck dissection). 19 patients (42%) are alive, 19 (42%) are death and 7 (16%) were lost to f/u. Median survival is 30.6 months. 1 patient was refractory and 6 relapsed in less than a year. Among them, 4 were local relapses, 1 a neck recurrence (no prior dissection) and 1 a distant relapse. The most common acute toxicities were: Anemia 87%, neutropenia 64%, hyperglycemia 82%, transient elevation of BUN 60% and creatinine 36%, hypo/hypernatremia 64%, severe mucositis 71%, weight loss 76%, N/V 47% and severe dysphagia 27%. Cx+Rx appears to be a safe, feasible and comparable alternative to Sx regardless of the anatomical origin in locally advanced H&N cancer, with the advantage of organ preservation. Additional XRT boost, Cx or Sx could decrease relapses. Further studies are warranted to validate these hypotheses. No significant financial relationships to disclose.
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Affiliation(s)
- C. Robles
- Miami Veterans Administration Medical Center, Miami, FL; VA Medical Center, Miami, FL
| | - C. Vale
- Miami Veterans Administration Medical Center, Miami, FL; VA Medical Center, Miami, FL
| | - V. Dinh
- Miami Veterans Administration Medical Center, Miami, FL; VA Medical Center, Miami, FL
| | - N. Savaraj
- Miami Veterans Administration Medical Center, Miami, FL; VA Medical Center, Miami, FL
| | - S. Spector
- Miami Veterans Administration Medical Center, Miami, FL; VA Medical Center, Miami, FL
| | - L. Chua
- Miami Veterans Administration Medical Center, Miami, FL; VA Medical Center, Miami, FL
| | - P. Bustillo
- Miami Veterans Administration Medical Center, Miami, FL; VA Medical Center, Miami, FL
| | - A. Furst
- Miami Veterans Administration Medical Center, Miami, FL; VA Medical Center, Miami, FL
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24
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Toms AD, McClelland D, Chua L, de Waal Malefijt M, Verdonschot N, Spencer Jones R, Kuiper JH. Mechanical testing of impaction bone grafting in the tibia. ACTA ACUST UNITED AC 2005; 87:656-63. [PMID: 15855367 DOI: 10.1302/0301-620x.87b5.15860] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Clinical experience of impaction bone grafting for revision knee arthroplasty is limited, with initial stability of the tibial tray emerging as a major concern. The length of the stem and its diameter have been altered to improve stability. Our aim was to investigate the effect of the type of stem, support of the rim and graft impaction on early stability of the tray. We developed a system for impaction grafting of trays which we used with morsellised bone in artificial tibiae. Trays with short, long thick or long thin stems were implanted, with or without support of the rim. They were cyclically loaded while measuring relative movement. Long-stemmed trays migrated 4.5 times less than short-stemmed trays, regardless of diameter. Those with support migrated 2.8 times less than those without. The migration of short-stemmed trays correlated inversely with the density of the impacted groups. That of impaction-grafted tibial trays was in the range reported for uncemented primary trays. Movements of short-stemmed trays without cortical support were largest and sensitive to the degree of compaction of the graft. If support of the rim was sufficient or a long stem was used, impacted morsellised bone graft achieved adequate initial stability.
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Affiliation(s)
- A D Toms
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire SY10 7AG, UK.
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25
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Robles C, Furst AJ, Sriratana P, Lai S, Chua L, Donnelly E, Solomon J, Sundaram M, Feun L, Savaraj N. Phase II study of vinorelbine with low dose prednisone in the treatment of hormone-refractory metastatic prostate cancer. Oncol Rep 2003; 10:885-9. [PMID: 12792740 DOI: 10.3892/or.10.4.885] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A phase II trial of vinorelbine and low dose prednisone in hormone-refractory metastatic prostate cancer was conducted in order to investigate its safety, efficacy and impact on quality of life. Vinorelbine was administered at the dose of 25 mg/m(2) i.v. weekly for 12 weeks and then biweekly, along with 10 mg of daily oral prednisone until time of progression. Fourteen patients, median age of 74 years, were treated. The treatment was generally well tolerated with leukopenia and anemia as the major side effects. One patient achieved partial remission and eleven remained with stable disease. One of the eleven patients with stable disease had a dramatic PSA response from 1000 to 236 ng/ml; seven of these progressed after week twelve when vinorelbine was given biweekly. PSA response occurred in 5 of 14 patients. The median time to progression was 28 weeks and the median survival was 17 months. Nine out of the 14 accrued patients were evaluable for quality of life assessment. Five of them improved, three remained unchanged and two had a slight worsening. Four patients had improvement in pain control and fatigue. Our preliminary data suggest that the combination of vinorelbine/prednisone has modest activity in metastatic prostate cancer with a very favorable toxicity profile and is very well tolerated in this group of elderly patients.
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Affiliation(s)
- C Robles
- VA Medical Center, 1201 NW 16th Avenue D1010 (111k), Miami, FL 33125, USA.
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Chua L, Chong SA, Pang E, Ng VP, Chan YH. The effect of risperidone on cognitive functioning in a sample of Asian patients with schizophrenia in Singapore. Singapore Med J 2001; 42:243-6. [PMID: 11547959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
OBJECTIVE To evaluate the effect of risperidone treatment on the cognitive functioning in a group of Asian patients with schizophrenia METHOD Patients with DSM-IIIR schizophrenia were recruited from Woodbridge Hospital. Several domains of cognitive functions were assessed at baseline before washout, at 8 weeks and 6 months after initiation of treatment on risperidone. Clinical outcome was assessed on the Positive and Negative Syndrome Scale (PANSS). RESULTS Significant improvements were found in verbal fluency and certain aspects of memory 8 weeks after risperidone treatment. There were significant improvements in executive and memory functioning after 6 months. Improvements were also noted in attention and perceptual/motor processes although these did not reach significant levels. Treatment on risperidone also resulted in significant reduction in the PANSS score. CONCLUSION Our results are consistent with those found in other studies in which risperidone was shown to be effective in improving several aspects of cognitive functioning. There were corresponding effectiveness in treating positive and negative symptoms of schizophrenia. Such improvements can have positive implications on vocational and social functioning.
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Affiliation(s)
- L Chua
- Institute of Mental Health, Woodbridge Hospital, Singapore.
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27
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Spée R, Chua L, Nosé L. Patient-focused care. A dialogue with your patient. Can Nurse 2001; 97:19-22. [PMID: 11865603] [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] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Affiliation(s)
- R Spée
- Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario
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Silverman MA, Zaidi U, Barnett S, Robles C, Khurana V, Manten H, Barnes D, Chua L, Roos BA. Cancer screening in the elderly population. Hematol Oncol Clin North Am 2000; 14:89-112, ix. [PMID: 10680074 DOI: 10.1016/s0889-8588(05)70280-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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: 01/11/2023]
Abstract
This article reviews the current state of knowledge regarding cancer screening in the geriatric population. Care of the elderly requires knowledge of underlying physiologic changes, comorbidities, quality-of-life factors, and life expectancies. There is always the danger that ageism may prevent elderly cancer patients from receiving the proper treatment. On the other hand, overzealous treatment can lead to adverse results if elderly patients are not properly targeted based on current evidence of the benefits and risks of specific screening practices.
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Affiliation(s)
- M A Silverman
- Division of Gerontology, University of Miami School of Medicine, Florida, USA
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Porteous S, Torban E, Cho NP, Cunliffe H, Chua L, McNoe L, Ward T, Souza C, Gus P, Giugliani R, Sato T, Yun K, Favor J, Sicotte M, Goodyer P, Eccles M. Primary renal hypoplasia in humans and mice with PAX2 mutations: evidence of increased apoptosis in fetal kidneys of Pax2(1Neu) +/- mutant mice. Hum Mol Genet 2000; 9:1-11. [PMID: 10587573 DOI: 10.1093/hmg/9.1.1] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.4] [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: 11/12/2022] Open
Abstract
PAX2 mutations cause renal-coloboma syndrome (RCS), a rare multi-system developmental abnormality involving optic nerve colobomas and renal abnormalities. End-stage renal failure is common in RCS, but the mechanism by which PAX2 mutations lead to renal failure is unknown. PAX2 is a member of a family of developmental genes containing a highly conserved 'paired box' DNA-binding domain, and encodes a transcription factor expressed primarily during fetal development in the central nervous system, eye, ear and urogenital tract. Presently, the role of PAX2 during kidney development is poorly understood. To gain insight into the cause of renal abnormalities in patients with PAX2 mutations, kidney anomalies were analyzed in patients with RCS, including a large Brazilian kindred in whom a new PAX2 mutation was identified. In a total of 29 patients, renal hypoplasia was the most common congenital renal abnormality. To determine the direct effects of PAX2 mutations on kidney development fetal kidneys of mice carrying a Pax2 (1Neu)mutation were examined. At E15, heterozygous mutant kidneys were approximately 60% of the size of wild-type littermates, and the number of nephrons was strikingly reduced. Heterozygous 1Neu mice showed increased apoptotic cell death during fetal kidney development, but the increased apoptosis was not associated with random stochastic inactivation of Pax2 expression in mutant kidneys; Pax2 was shown to be biallelically expressed during kidney development. These findings support the notion that heterozygous mutations of PAX2 are associated with increased apoptosis and reduced branching of the ureteric bud, due to reduced PAX2 dosage during a critical window in kidney development.
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Affiliation(s)
- S Porteous
- Cancer Genetics Laboratory, Department of Biochemistry, University of Otago, Dunedin, New Zealand
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Chong SA, Chua L. Clozapine, Chinese and blood. Br J Psychiatry 1997; 171:89-90. [PMID: 9328508 DOI: 10.1192/bjp.171.1.89b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Ardalan B, Chua L, Tian EM, Reddy R, Sridhar K, Benedetto P, Richman S, Legaspi A, Waldman S, Morrell L. A phase II study of weekly 24-hour infusion with high-dose fluorouracil with leucovorin in colorectal carcinoma. J Clin Oncol 1991; 9:625-30. [PMID: 2066758 DOI: 10.1200/jco.1991.9.4.625] [Citation(s) in RCA: 144] [Impact Index Per Article: 4.4] [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: 12/30/2022] Open
Abstract
Twenty-two patients with advanced colorectal carcinoma were enrolled in this study. Ten patients had received prior chemotherapy that included the combination of fluorouracil (5-FU) and leucovorin (LV). All patients required subcutaneous port insertion and portable external infusion pumps to allow outpatient treatment. 5-FU (2,600 mg/m2) was administered concurrently with LV (500 mg/m2) over 24 hours of continuous infusion. The mean steady-state plasma concentration of 5-FU was 10 mumol/L (range, 7 to 14 mumol/L). The 5-FU dose was based on our previous phase I study, in which maximum-tolerated dose (MTD) of 5-FU was determined to be 2,600 mg/m2 in combination with a fixed dose of LV at 500 mg/m2. The treatment was repeated weekly. Twenty-two patients received a total of 560 courses of treatment. Eleven instances of grade 2-3 toxicity were observed: diarrhea (five), stomatitis (three), hand/foot syndrome (three). The overall objective response was 45% (10 of 22) and among previously untreated patients was 58%. Three of the responders achieved complete response (CR), with lung and liver as the metastatic sites. The median duration of survival for the previously untreated patients was not reached at 22 months, and was 10 months for the previously treated patients. These results suggest that short-term infusional therapy of 5-FU and LV in patients with advanced metastatic colorectal cancer generates acceptable toxicity, with equivalent or superior survivability in previously treated and untreated patients versus alternative methods of administration of the two agents.
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Affiliation(s)
- B Ardalan
- Sylvester Comprehensive Cancer Center, University of Miami, FL 33136
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Kennedy M, Chua L. Unifying the Tank and Hopfield linear programming circuit and the canonical nonlinear programming circuit of Chua and Lin. ACTA ACUST UNITED AC 1987. [DOI: 10.1109/tcs.1987.1086095] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Huertas J, Chua L, Rodriguez-Vazquez A, Rueda A. Nonlinear switched-capacitor networks: Basic principles and piecewise-linear design. ACTA ACUST UNITED AC 1985. [DOI: 10.1109/tcs.1985.1085722] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Keshishian JM, Smyth NP, Maxwell DD, Chua L. Dilation of difficult strictures of the esophagus. Surg Gynecol Obstet 1984; 158:81-5. [PMID: 6691169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In managing difficult esophageal strictures not amenable to the usual methods of dilation, a technique of fluoroscopic placement of a guide wire followed by controlled gradual dilation of the stricture has been described. The method is fully explained and is easily performed by a team of endoscopists-radiologists. Since this article was submitted, six additional patients have been dilated by the authors. In each, a stent was used to maintain patency of the strictured lumen.
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