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Raghu G, Ghazipura M, Fleming TR, Aronson KI, Behr J, Brown KK, Flaherty KR, Kazerooni EA, Maher TM, Richeldi L, Lasky JA, Swigris JJ, Busch R, Garrard L, Ahn DH, Li J, Puthawala K, Rodal G, Seymour S, Weir N, Danoff SK, Ettinger N, Goldin J, Glassberg MK, Kawano-Dourado L, Khalil N, Lancaster L, Lynch DA, Mageto Y, Noth I, Shore JE, Wijsenbeek M, Brown R, Grogan D, Ivey D, Golinska P, Karimi-Shah B, Martinez FJ. Meaningful Endpoints for Idiopathic Pulmonary Fibrosis (IPF) Clinical Trials: Emphasis on 'Feels, Functions, Survives'. Report of a Collaborative Discussion in a Symposium with Direct Engagement from Representatives of Patients, Investigators, the National Institutes of Health, a Patient Advocacy Organization, and a Regulatory Agency. Am J Respir Crit Care Med 2024; 209:647-669. [PMID: 38174955 DOI: 10.1164/rccm.202312-2213so] [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: 12/04/2023] [Accepted: 01/02/2024] [Indexed: 01/05/2024] Open
Abstract
Background: Idiopathic pulmonary fibrosis (IPF) carries significant mortality and unpredictable progression, with limited therapeutic options. Designing trials with patient-meaningful endpoints, enhancing the reliability and interpretability of results, and streamlining the regulatory approval process are of critical importance to advancing clinical care in IPF. Methods: A landmark in-person symposium in June 2023 assembled 43 participants from the US and internationally, including patients with IPF, investigators, and regulatory representatives, to discuss the immediate future of IPF clinical trial endpoints. Patient advocates were central to discussions, which evaluated endpoints according to regulatory standards and the FDA's 'feels, functions, survives' criteria. Results: Three themes emerged: 1) consensus on endpoints mirroring the lived experiences of patients with IPF; 2) consideration of replacing forced vital capacity (FVC) as the primary endpoint, potentially by composite endpoints that include 'feels, functions, survives' measures or FVC as components; 3) support for simplified, user-friendly patient-reported outcomes (PROs) as either components of primary composite endpoints or key secondary endpoints, supplemented by functional tests as secondary endpoints and novel biomarkers as supportive measures (FDA Guidance for Industry (Multiple Endpoints in Clinical Trials) available at: https://www.fda.gov/media/162416/download). Conclusions: This report, detailing the proceedings of this pivotal symposium, suggests a potential turning point in designing future IPF clinical trials more attuned to outcomes meaningful to patients, and documents the collective agreement across multidisciplinary stakeholders on the importance of anchoring IPF trial endpoints on real patient experiences-namely, how they feel, function, and survive. There is considerable optimism that clinical care in IPF will progress through trials focused on patient-centric insights, ultimately guiding transformative treatment strategies to enhance patients' quality of life and survival.
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Affiliation(s)
- Ganesh Raghu
- Center for Interstitial Lung Diseases, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine
- Department of Laboratory Medicine and Pathology, and
| | - Marya Ghazipura
- ZS Associates, Global Health Economics and Outcomes Research, New York, New York
- Division of Epidemiology and
- Division of Biostatistics, Department of Population Health, New York University Langone Health, New York, New York
| | - Thomas R Fleming
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Kerri I Aronson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Jürgen Behr
- Department of Medicine V, LMU University Hospital, Ludwig-Maximilians-University Munich, Member of the German Center for Lung Research, Munich, Germany
| | | | - Kevin R Flaherty
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ella A Kazerooni
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Health System, Detroit, Michigan
| | - Toby M Maher
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Luca Richeldi
- Divisione di Medicina Polmonare, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Joseph A Lasky
- Department of Medicine, Tulane University, New Orleans, Louisiana
| | | | - Robert Busch
- Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, and
| | - Lili Garrard
- Division of Biometrics III, Office of Biostatistics, Office of Translational Sciences, Center for Drug Evaluation and Research, and
| | - Dong-Hyun Ahn
- Division of Biometrics III, Office of Biostatistics, Office of Translational Sciences, Center for Drug Evaluation and Research, and
| | - Ji Li
- Division of Clinical Outcome Assessment, Office of Drug Evaluation Sciences, Office of New Drugs, and
| | - Khalid Puthawala
- Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, and
| | - Gabriela Rodal
- Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Sally Seymour
- Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, and
| | - Nargues Weir
- Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Sonye K Danoff
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Neil Ettinger
- Division of Pulmonary Medicine, St. Luke's Hospital, Chesterfield, Missouri
| | - Jonathan Goldin
- Department of Radiology, University of California, Los Angeles, Los Angeles, California
| | - Marilyn K Glassberg
- Department of Medicine, Stritch School of Medicine, Loyola Chicago, Chicago, Illinois
| | - Leticia Kawano-Dourado
- Hcor Research Institute - Hcor Hospital, São Paolo, Brazil
- Pulmonary Division, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | - Nasreen Khalil
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Lancaster
- Division of Pulmonary, Critical Care, and Sleep Medicine, Vanderbilt University, Nashville, Tennessee
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado
| | - Yolanda Mageto
- Division of Pulmonary, Critical Care, and Sleep Medicine, Baylor University, Dallas, Texas
| | - Imre Noth
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, Virginia
| | | | - Marlies Wijsenbeek
- Centre of Interstitial Lung Diseases, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Robert Brown
- Patient representative and patient living with IPF, Lovettsville, Virginia
| | - Daniel Grogan
- Patient representative and patient living with IPF, Charlottesville, Virginia; and
| | - Dorothy Ivey
- Patient representative and patient living with IPF, Richmond, Virginia
| | - Patrycja Golinska
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Banu Karimi-Shah
- Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, and
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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Mellish MA, Lucas Z, Lancaster L, Stull JW, Floyd A. Visual and morphometric description of feral horse hooves from Sable Island National Park Reserve. Can Vet J 2023; 64:1028-1034. [PMID: 37915781 PMCID: PMC10581359] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Objective To visually evaluate and morphometrically describe a sample of abnormal hooves from Sable Island horses that died between 2007 and 2013. Animal Equine. Procedure An opportunistic sample of 356 abnormal hooves from horses inhabiting Sable Island National Park Reserve (Canada) was collected postmortem between 2007 and 2013 from 101 Sable Island horses. These hooves were assessed for abnormalities in conformation through visual and morphometric evaluation. Results On visual and morphometric evaluation, 100% of horses (101/101) had abnormal hoof conformation when compared to a domestic horse hoof model. Specific abnormalities from visual evaluation included long heels (85%); medial, lateral, and dorsal flares (45, 78, and 46% of horses, respectively); and cracking (62%). Specific abnormalities determined from morphometry of the hooves included contracted heels (87%), hoof imbalances including mediolateral imbalance (61%), and hoof length greater than width (100%). Conclusion Sable Island horses had various hoof abnormalities such as hoof capsule flaring; long, contracted heels; and mediolateral imbalance. These abnormalities have been observed in other feral horse populations living on soft substrates. Given the potential impact of hoof abnormalities on the welfare status of the Sable Island horses, further studies are warranted, including estimation of the prevalence of hoof abnormalities and direct observation of horse gait and behavior. Clinical relevance The significance of the hoof abnormalities for the health of the Sable Island horses is difficult to determine but the issue highlights the importance of further study to investigate the impact on the horses' welfare.
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Affiliation(s)
- Martha A Mellish
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island C1A 4P3 (Mellish, Stull, Floyd); Sable Island Institute, P.O. Box 11, Halifax Central, Halifax, Nova Scotia B3J 2L4 (Lucas); Lancaster Veterinary Services, Denver, Colorado 80222, USA (Lancaster)
| | - Zoe Lucas
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island C1A 4P3 (Mellish, Stull, Floyd); Sable Island Institute, P.O. Box 11, Halifax Central, Halifax, Nova Scotia B3J 2L4 (Lucas); Lancaster Veterinary Services, Denver, Colorado 80222, USA (Lancaster)
| | - Lisa Lancaster
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island C1A 4P3 (Mellish, Stull, Floyd); Sable Island Institute, P.O. Box 11, Halifax Central, Halifax, Nova Scotia B3J 2L4 (Lucas); Lancaster Veterinary Services, Denver, Colorado 80222, USA (Lancaster)
| | - Jason W Stull
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island C1A 4P3 (Mellish, Stull, Floyd); Sable Island Institute, P.O. Box 11, Halifax Central, Halifax, Nova Scotia B3J 2L4 (Lucas); Lancaster Veterinary Services, Denver, Colorado 80222, USA (Lancaster)
| | - Anya Floyd
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island C1A 4P3 (Mellish, Stull, Floyd); Sable Island Institute, P.O. Box 11, Halifax Central, Halifax, Nova Scotia B3J 2L4 (Lucas); Lancaster Veterinary Services, Denver, Colorado 80222, USA (Lancaster)
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Behr J, Nathan SD, Costabel U, Albera C, Wuyts WA, Glassberg MK, Haller H, Alvaro G, Gilberg F, Samara K, Lancaster L. Efficacy and Safety of Pirfenidone in Advanced Versus Non-Advanced Idiopathic Pulmonary Fibrosis: Post-Hoc Analysis of Six Clinical Studies. Adv Ther 2023; 40:3937-3955. [PMID: 37391667 PMCID: PMC10427557 DOI: 10.1007/s12325-023-02565-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/18/2023] [Indexed: 07/02/2023]
Abstract
INTRODUCTION In the European Union (EU), the indication for the antifibrotic pirfenidone prior to April 2023 did not include patients with advanced idiopathic pulmonary fibrosis (IPF). This analysis compared the efficacy and safety of pirfenidone in advanced IPF versus non-advanced IPF. METHODS Data were included from the following studies of pirfenidone: ASCEND (NCT01366209); CAPACITY (004 [NCT00287716] and 006 [NCT00287729]); RECAP (NCT00662038; advanced IPF defined as percent predicted forced vital capacity [%FVC] < 50% and/or percent predicted carbon monoxide diffusing capacity [%DLco] < 35% at baseline); PASSPORT (NCT02699879; advanced IPF defined as baseline %FVC < 50%); and SP-IPF (NCT02951429; patients with advanced IPF [defined as %DLco ≤ 40% at screening] at risk of group 3 pulmonary hypertension). RESULTS In the pooled ASCEND/CAPACITY studies, the annual mean rate of FVC decline from baseline to Week 52 was significantly lower for pirfenidone versus placebo in advanced (p = 0.0035) and non-advanced IPF (p = 0.0001). Rate of all-cause mortality over 52 weeks was numerically lower for pirfenidone versus placebo in advanced and non-advanced IPF. In RECAP, the mean annual rate of FVC decline from baseline to Week 180 of pirfenidone treatment was similar in patients with advanced (- 141.5 mL) and non-advanced IPF (- 153.5 mL). In SP-IPF, the mean annual rate of FVC decline and rate of all-cause mortality from baseline to Week 52 in patients treated with placebo + pirfenidone were - 93.0 mL and 20.2%, respectively. No new safety signals were identified, and the safety profile of pirfenidone in patients with advanced IPF was generally consistent with that of non-advanced IPF. CONCLUSIONS These results highlight the benefit of pirfenidone treatment in patients with advanced and non-advanced IPF. As such, the indication for pirfenidone in the EU has now been updated to include the treatment of adult patients with advanced IPF. TRIAL REGISTRATIONS ASCEND (NCT01366209), CAPACITY 004 (NCT00287716), CAPACITY 006 (NCT00287729), RECAP (NCT00662038), PASSPORT (NCT02699879), and SP-IPF (NCT02951429).
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Affiliation(s)
- Jürgen Behr
- Department of Medicine V, University Hospital, LMU Munich and Asklepios Fachkliniken Gauting, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Munich, Germany.
| | - Steven D Nathan
- Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Ulrich Costabel
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Carlo Albera
- Department of Medical Sciences, School of Medicine, University of Turin, Turin, Italy
| | - Wim A Wuyts
- Department of Pulmonary Medicine, Unit for Interstitial Lung Diseases, University Hospitals Leuven, Leuven, Belgium
| | | | | | | | | | | | - Lisa Lancaster
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Farber HW, Chakinala MM, Cho M, Frantz RP, Frick A, Lancaster L, Milligan S, Oudiz R, Panjabi S, Tsang Y, Nathan SD. Characteristics of patients with pulmonary arterial hypertension from an innovative, comprehensive real-world patient data repository. Pulm Circ 2023; 13:e12258. [PMID: 37427090 PMCID: PMC10326474 DOI: 10.1002/pul2.12258] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/24/2023] [Accepted: 06/17/2023] [Indexed: 07/11/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare, life-limiting disease. PAH registries provide real-world data that complement clinical trial data and inform treatment decisions. The TRIO comprehensive, integrated patient data repository (TRIO CIPDR), is an innovative US repository capturing data on contemporary patients diagnosed with pulmonary hypertension and receiving US Food and Drug Administration-approved PAH therapies. This repository uniquely combines clinical data from electronic medical records with the ability to track drug-prescription and drug-dispensing characteristics, and includes 946 adult patients with PAH (data collected January 2019 to December 2020) enrolled from nine representative US specialist tertiary care centers. Potentially eligible patients were identified based on dispensing data from specialty pharmacies. Hemodynamic and clinical data, as well as dispensing information on prescribed PAH medications, were provided by tertiary centers. At enrollment, 75% of patients were female, 67% were White, median age at PAH diagnosis was 53 years (median time from diagnosis to enrollment was 5 years), and 37% were obese. Comorbidity profiles were as expected for a PAH population, although the proportion with atrial fibrillation (34%) was higher than expected. Overall, 38% of patients had idiopathic PAH and 30% had connective tissue disease-related PAH. Among 917 patients receiving PAH-specific therapy, 40% were on monotherapy, 43% on dual therapy, and 17% on triple therapy. Longitudinal data from this repository will allow tracking of the PAH treatment journey in relation to clinical characteristics and outcomes.
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Affiliation(s)
- Harrison W. Farber
- Division of Pulmonary, Critical Care and Sleep MedicineTufts Medical CenterBostonMassachusettsUSA
| | - Murali M. Chakinala
- Division of Pulmonary and Critical Care MedicineWashington University School of MedicineSt LouisMissouriUSA
| | - Michelle Cho
- Actelion Pharmaceuticals US, Inc.TitusvilleNew JerseyUSA
| | - Robert P. Frantz
- Department of Cardiovascular MedicineMayo ClinicRochesterMinnesotaUSA
| | | | - Lisa Lancaster
- Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | | | - Ronald Oudiz
- Division of CardiologyLundquist Institute for Biomedical Research at Harbor‐UCLA Medical CenterTorranceCaliforniaUSA
| | | | - Yuen Tsang
- Janssen Scientific AffairsTitusvilleNew JerseyUSA
| | - Steven D. Nathan
- Advanced Lung Disease and Transplant ProgramInova Fairfax HospitalFalls ChurchVirginiaUSA
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5
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Oldham JM, Allen RJ, Lorenzo-Salazar JM, Molyneaux PL, Ma SF, Joseph C, Kim JS, Guillen-Guio B, Hernández-Beeftink T, Kropski JA, Huang Y, Lee CT, Adegunsoye A, Pugashetti JV, Linderholm AL, Vo V, Strek ME, Jou J, Muñoz-Barrera A, Rubio-Rodriguez LA, Hubbard R, Hirani N, Whyte MKB, Hart S, Nicholson AG, Lancaster L, Parfrey H, Rassl D, Wallace W, Valenzi E, Zhang Y, Mychaleckyj J, Stockwell A, Kaminski N, Wolters PJ, Molina-Molina M, Banovich NE, Fahy WA, Martinez FJ, Hall IP, Tobin MD, Maher TM, Blackwell TS, Yaspan BL, Jenkins RG, Flores C, Wain LV, Noth I. PCSK6 and Survival in Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med 2023; 207:1515-1524. [PMID: 36780644 PMCID: PMC10263132 DOI: 10.1164/rccm.202205-0845oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 02/13/2023] [Indexed: 02/15/2023] Open
Abstract
Rationale: Idiopathic pulmonary fibrosis (IPF) is a devastating disease characterized by limited treatment options and high mortality. A better understanding of the molecular drivers of IPF progression is needed. Objectives: To identify and validate molecular determinants of IPF survival. Methods: A staged genome-wide association study was performed using paired genomic and survival data. Stage I cases were drawn from centers across the United States and Europe and stage II cases from Vanderbilt University. Cox proportional hazards regression was used to identify gene variants associated with differential transplantation-free survival (TFS). Stage I variants with nominal significance (P < 5 × 10-5) were advanced for stage II testing and meta-analyzed to identify those reaching genome-wide significance (P < 5 × 10-8). Downstream analyses were performed for genes and proteins associated with variants reaching genome-wide significance. Measurements and Main Results: After quality controls, 1,481 stage I cases and 397 stage II cases were included in the analysis. After filtering, 9,075,629 variants were tested in stage I, with 158 meeting advancement criteria. Four variants associated with TFS with consistent effect direction were identified in stage II, including one in an intron of PCSK6 (proprotein convertase subtilisin/kexin type 6) reaching genome-wide significance (hazard ratio, 4.11 [95% confidence interval, 2.54-6.67]; P = 9.45 × 10-9). PCSK6 protein was highly expressed in IPF lung parenchyma. PCSK6 lung staining intensity, peripheral blood gene expression, and plasma concentration were associated with reduced TFS. Conclusions: We identified four novel variants associated with IPF survival, including one in PCSK6 that reached genome-wide significance. Downstream analyses suggested that PCSK6 protein plays a potentially important role in IPF progression.
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Affiliation(s)
- Justin M. Oldham
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Richard J. Allen
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Jose M. Lorenzo-Salazar
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain
| | - Philip L. Molyneaux
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Shwu-Fan Ma
- Division of Pulmonary and Critical Care Medicine and
| | | | - John S. Kim
- Division of Pulmonary and Critical Care Medicine and
| | - Beatriz Guillen-Guio
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Tamara Hernández-Beeftink
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- Research Unit, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Jonathan A. Kropski
- Division of Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, Tennessee
| | - Yong Huang
- Division of Pulmonary and Critical Care Medicine and
| | - Cathryn T. Lee
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois
| | - Ayodeji Adegunsoye
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois
| | - Janelle Vu Pugashetti
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Davis, Davis, California
| | - Angela L. Linderholm
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Davis, Davis, California
| | - Vivian Vo
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Davis, Davis, California
| | - Mary E. Strek
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois
| | - Jonathan Jou
- Department of Surgery, College of Medicine, University of Illinois, Peoria, Illinois
| | - Adrian Muñoz-Barrera
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain
| | - Luis A. Rubio-Rodriguez
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain
| | - Richard Hubbard
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Nik Hirani
- Medical Research Council Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Moira K. B. Whyte
- Medical Research Council Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Simon Hart
- Respiratory Research Group, Hull York Medical School, Castle Hill Hospital, Cottingham, United Kingdom
| | - Andrew G. Nicholson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Lisa Lancaster
- Division of Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, Tennessee
| | - Helen Parfrey
- Cambridge Interstitial Lung Disease Service, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Doris Rassl
- Cambridge Interstitial Lung Disease Service, Royal Papworth Hospital, Cambridge, United Kingdom
| | - William Wallace
- Medical Research Council Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Eleanor Valenzi
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yingze Zhang
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Josyf Mychaleckyj
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia
| | | | - Naftali Kaminski
- Section of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Paul J. Wolters
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, California
| | - Maria Molina-Molina
- Servei de Pneumologia, Laboratori de Pneumologia Experimental, Instituto de Investigación Biomédica de Bellvitge, Campus de Bellvitge, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | | | - William A. Fahy
- Discovery Medicine, GlaxoSmithKline, Stevenage, United Kingdom
| | | | - Ian P. Hall
- Division of Respiratory Medicine and
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Martin D. Tobin
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research, Leicester Respiratory Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Toby M. Maher
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Division of Pulmonary and Critical Care Medicine, University of Southern California, Los Angeles, California; and
| | - Timothy S. Blackwell
- Division of Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, Tennessee
| | | | - R. Gisli Jenkins
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Carlos Flores
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Facultad de Ciencias de la Salud, Universidad Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain
| | - Louise V. Wain
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research, Leicester Respiratory Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Imre Noth
- Division of Pulmonary and Critical Care Medicine and
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Chioma OS, Mallott E, Shah-Gandhi B, Wiggins Z, Langford M, Lancaster AW, Gelbard A, Wu H, Johnson JE, Lancaster L, Wilfong EM, Crofford LJ, Montgomery CG, Van Kaer L, Bordenstein S, Newcomb DC, Drake WP. Low Gut Microbial Diversity Augments Estrogen-Driven Pulmonary Fibrosis in Female-Predominant Interstitial Lung Disease. Cells 2023; 12:766. [PMID: 36899902 PMCID: PMC10000459 DOI: 10.3390/cells12050766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/19/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023] Open
Abstract
Although profibrotic cytokines, such as IL-17A and TGF-β1, have been implicated in the pathogenesis of interstitial lung disease (ILD), the interactions between gut dysbiosis, gonadotrophic hormones and molecular mediators of profibrotic cytokine expression, such as the phosphorylation of STAT3, have not been defined. Here, through chromatin immunoprecipitation sequencing (ChIP-seq) analysis of primary human CD4+ T cells, we show that regions within the STAT3 locus are significantly enriched for binding by the transcription factor estrogen receptor alpha (ERa). Using the murine model of bleomycin-induced pulmonary fibrosis, we found significantly increased regulatory T cells compared to Th17 cells in the female lung. The genetic absence of ESR1 or ovariectomy in mice significantly increased pSTAT3 and IL-17A expression in pulmonary CD4+ T cells, which was reduced after the repletion of female hormones. Remarkably, there was no significant reduction in lung fibrosis under either condition, suggesting that factors outside of ovarian hormones also contribute. An assessment of lung fibrosis among menstruating females in different rearing environments revealed that environments favoring gut dysbiosis augment fibrosis. Furthermore, hormone repletion following ovariectomy further augmented lung fibrosis, suggesting pathologic interactions between gonadal hormones and gut microbiota in relation to lung fibrosis severity. An analysis of female sarcoidosis patients revealed a significant reduction in pSTAT3 and IL-17A levels and a concomitant increase in TGF-β1 levels in CD4+ T cells compared to male sarcoidosis patients. These studies reveal that estrogen is profibrotic in females and that gut dysbiosis in menstruating females augments lung fibrosis severity, supporting a critical interaction between gonadal hormones and gut flora in lung fibrosis pathogenesis.
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Affiliation(s)
- Ozioma S. Chioma
- Departments of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Elizabeth Mallott
- Department of Biology, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Binal Shah-Gandhi
- Departments of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - ZaDarreyal Wiggins
- Departments of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Madison Langford
- Departments of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | | | - Alexander Gelbard
- Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Hongmei Wu
- Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Joyce E. Johnson
- Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Lisa Lancaster
- Departments of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Erin M. Wilfong
- Departments of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Leslie J. Crofford
- Departments of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
- Department of Biology, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Courtney G. Montgomery
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Luc Van Kaer
- Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Seth Bordenstein
- Department of Biology and Entomology, Pennsylvania State University, College Station, PA 16801, USA
| | - Dawn C. Newcomb
- Departments of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
- Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Wonder Puryear Drake
- Departments of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
- Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
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7
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Chioma OS, Mallott E, Shah-Gandhi B, Wiggins Z, Langford M, Lancaster AW, Gelbard A, Wu H, Johnson JE, Lancaster L, Wilfong EM, Crofford LJ, Montgomery CG, Van Kaer L, Bordenstein S, Newcomb DC, Drake WP. Low Gut Microbial Diversity Augments Estrogen-driven Pulmonary Fibrosis in Female-Predominant Interstitial Lung Disease. bioRxiv 2023:2023.02.15.528630. [PMID: 36824732 PMCID: PMC9948999 DOI: 10.1101/2023.02.15.528630] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Although profibrotic cytokines such as IL-17A and TGF-β1 have been implicated in interstitial lung disease (ILD) pathogenesis, interactions between gut dysbiosis, gonadotrophic hormones and molecular mediators of profibrotic cytokine expression, such as phosphorylation of STAT3, have not been defined. Here we show by chromatin immunoprecipitation sequencing (ChIP-seq) analysis of primary human CD4+ T cells that regions within the STAT3 locus are significantly enriched for binding by the transcription factor estrogen receptor alpha (ERa). Using the murine model of bleomycin-induced pulmonary fibrosis, we found significantly increased regulatory T cells compared to Th17 cells in the female lung. Genetic absence of ESR1 or ovariectomy in mice significantly increased pSTAT3 and IL-17A expression in pulmonary CD4+ T cells, which was reduced after repletion of female hormones. Remarkably, there was no significant reduction in lung fibrosis under either condition, suggesting that factors outside of ovarian hormones also contribute. Assessment of lung fibrosis among menstruating females in different rearing environments revealed that environments favoring gut dysbiosis augment fibrosis. Furthermore, hormone repletion following ovariectomy further augmented lung fibrosis, suggesting pathologic interactions between gonadal hormones and gut microbiota on lung fibrosis severity. Analysis in female sarcoidosis patients revealed a significant reduction in pSTAT3 and IL-17A levels and a concomitant increase in TGF-β1 levels in CD4+ T cells, compared to male sarcoidosis patients. These studies reveal that estrogen is profibrotic in females and that gut dysbiosis in menstruating females augments lung fibrosis severity, supporting a critical interaction between gonadal hormones and gut flora in lung fibrosis pathogenesis.
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Kolb M, Orfanos SE, Lambers C, Flaherty K, Masters A, Lancaster L, Silverstein A, Nathan SD. The Antifibrotic Effects of Inhaled Treprostinil: An Emerging Option for ILD. Adv Ther 2022; 39:3881-3895. [PMID: 35781186 PMCID: PMC9402520 DOI: 10.1007/s12325-022-02229-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/15/2022] [Indexed: 11/27/2022]
Abstract
Interstitial lung diseases (ILD) encompasses a heterogeneous group of parenchymal lung diseases characterized by variable amounts of inflammation and fibrosis. The targeting of fibroblasts and myofibroblasts with antifibrotic treatments is a potential therapeutic target for these potentially fatal diseases. Treprostinil is unique among the prostacyclin mimetics in that it has distinct actions at additional prostaglandin receptors. Preclinical and clinical evidence suggests that treprostinil has antifibrotic effects through the activation of the prostaglandin E receptor 2 (EP2), the prostaglandin D receptor 1 (DP1), and peroxisome proliferator-activated receptors (PPAR). In vivo studies of EP2 and the DP1 have found that administration of treprostinil resulted in a reduction in cell proliferation, reduced collagen secretion and synthesis, and reduced lung inflammation and fibrosis. In vitro and in vivo studies of PPARβ and PPARγ demonstrated that treprostinil inhibited fibroblast proliferation in a dose-dependent manner. Clinical data from a post hoc analysis of the INCREASE trial found that inhaled treprostinil improved forced vital capacity in the overall population as well as in idiopathic interstitial pneumonia and idiopathic pulmonary fibrosis subgroups. These preclinical and clinical findings suggest a dual benefit of treprostinil through the amelioration of both lung fibrosis and pulmonary hypertension.
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Affiliation(s)
- Martin Kolb
- Firestone Institute for Respiratory Health, Hamilton, ON, Canada
- McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Stylianos E Orfanos
- 1st Department of Critical Care, National and Kapodistrian University of Athens Medical School, Athens, Greece
- Pulmonary Hypertension Center Evangelismos Hospital, Athens, Greece
| | - Chris Lambers
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
- Department of Pneumology, Ordensklinikum Linz/Elisabethinen, Linz, Austria
| | | | - Alison Masters
- United Therapeutics Corporation, Research Triangle Park, NC, USA
| | - Lisa Lancaster
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adam Silverstein
- United Therapeutics Corporation, Research Triangle Park, NC, USA
| | - Steven D Nathan
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA.
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Nathan SD, Behr J, Cottin V, Lancaster L, Smith P, Deng CQ, Pearce N, Bell H, Peterson L, Flaherty KR. Study design and rationale for the TETON phase 3, randomised, controlled clinical trials of inhaled treprostinil in the treatment of idiopathic pulmonary fibrosis. BMJ Open Respir Res 2022; 9:9/1/e001310. [PMID: 35787522 PMCID: PMC9255390 DOI: 10.1136/bmjresp-2022-001310] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 05/18/2022] [Accepted: 06/17/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Idiopathic pulmonary fibrosis (IPF) greatly impacts quality of life and eventually leads to premature death from respiratory failure. Inhaled treprostinil was associated with improvements in forced vital capacity (FVC) and reduced exacerbations of underlying lung disease in post hoc analyses from a phase 3 study in patients with precapillary pulmonary hypertension due to interstitial lung disease. These results, combined with preclinical evidence of treprostinil’s antifibrotic activity, support its investigation in the treatment of IPF. Methods and analysis The TETON programme consists of two replicate, 52-week, randomised, double-blind placebo-controlled, phase 3 studies, each enrolling 396 subjects (NCT04708782, NCT05255991). Eligible subjects must have a diagnosis of IPF confirmed by central imaging review, along with an FVC ≥45%. Stable background use of pirfenidone or nintedanib is allowed. The primary endpoint is change in absolute FVC at week 52. Secondary endpoints include time to clinical worsening (first event of death, respiratory hospitalisation or ≥10% decline in % predicted FVC), time to first acute exacerbation of IPF, overall survival, change in % predicted FVC and change in the King’s Brief Interstitial Lung Disease Questionnaire at week 52. Safety parameters include adverse events, hospitalisations, oxygenation and laboratory parameters. Patients who complete week 52 will be eligible to enter an open-label extension study. Ethics and dissemination Studies will be conducted in accordance with the International Conference on Harmonisation Guideline for Good Clinical Practice, Declaration of Helsinki principles, and local regulatory, ethical and legal requirements. Results will be published in a peer-reviewed publication.
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Affiliation(s)
- Steven D Nathan
- Lung Transplant Program, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Jurgen Behr
- Department of Medicine V, University Hospital, Ludwig Maximilians University Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Vincent Cottin
- Service de pneumologie, Hospices Civils de Lyon, Hôpital Louis Pradel, National des maladies pulmonaires ra, Lyon, France
| | - Lisa Lancaster
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peter Smith
- Product Development, United Therapeutics Corp Research and Development, Research Triangle Park, North Carolina, USA
| | - C Q Deng
- Product Development, United Therapeutics Corp Research and Development, Research Triangle Park, North Carolina, USA
| | - Natalie Pearce
- Product Development, United Therapeutics Corp Research and Development, Research Triangle Park, North Carolina, USA
| | - Heidi Bell
- Product Development, United Therapeutics Corp Research and Development, Research Triangle Park, North Carolina, USA
| | - Leigh Peterson
- Product Development, United Therapeutics Corp Research and Development, Research Triangle Park, North Carolina, USA
| | - Kevin R Flaherty
- Division of Pulmonary and Critical Care Medicine, University of Michigan Hospital, Ann Arbor, Michigan, USA
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Corte TJ, Lancaster L, Swigris JJ, Maher TM, Goldin JG, Palmer SM, Suda T, Ogura T, Minnich A, Zhan X, Tirucherai GS, Elpers B, Xiao H, Watanabe H, Smith RA, Charles ED, Fischer A. Phase 2 trial design of BMS-986278, a lysophosphatidic acid receptor 1 (LPA 1) antagonist, in patients with idiopathic pulmonary fibrosis (IPF) or progressive fibrotic interstitial lung disease (PF-ILD). BMJ Open Respir Res 2022; 8:8/1/e001026. [PMID: 34969771 PMCID: PMC8718498 DOI: 10.1136/bmjresp-2021-001026] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/12/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction Idiopathic pulmonary fibrosis (IPF) and non-IPF, progressive fibrotic interstitial lung diseases (PF-ILD), are associated with a progressive loss of lung function and a poor prognosis. Treatment with antifibrotic agents can slow, but not halt, disease progression, and treatment discontinuation because of adverse events is common. Fibrotic diseases such as these can be mediated by lysophosphatidic acid (LPA), which signals via six LPA receptors (LPA1–6). Signalling via LPA1 appears to be fundamental in the pathogenesis of fibrotic diseases. BMS-986278, a second-generation LPA1 antagonist, is currently in phase 2 development as a therapy for IPF and PF-ILD. Methods and analysis This phase 2, randomised, double-blind, placebo-controlled, parallel-group, international trial will include adults with IPF or PF-ILD. The trial will consist of a 42-day screening period, a 26-week placebo-controlled treatment period, an optional 26-week active-treatment extension period, and a 28-day post-treatment follow-up. Patients in both the IPF (n=240) and PF-ILD (n=120) cohorts will be randomised 1:1:1 to receive 30 mg or 60 mg BMS-986278, or placebo, administered orally two times per day for 26 weeks in the placebo-controlled treatment period. The primary endpoint is rate of change in per cent predicted forced vital capacity from baseline to week 26 in the IPF cohort. Ethics and dissemination This study will be conducted in accordance with Good Clinical Practice guidelines, Declaration of Helsinki principles, and local ethical and legal requirements. Results will be reported in a peer-reviewed publication. Trial registration number NCT04308681.
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Affiliation(s)
- Tamera J Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital and Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Lancaster
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey J Swigris
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Toby M Maher
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Southern California, Los Angeles, California, USA
| | - Jonathan G Goldin
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA.,MedQIA, LLC, Los Angeles, California, USA
| | - Scott M Palmer
- Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Anne Minnich
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | | | | | | | - Hong Xiao
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | | | - R Adam Smith
- Bristol Myers Squibb, Princeton, New Jersey, USA
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11
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Lancaster L, Bonella F, Inoue Y, Cottin V, Siddall J, Small M, Langley J. Idiopathic pulmonary fibrosis: Physician and patient perspectives on the pathway to care from symptom recognition to diagnosis and disease burden. Respirology 2021; 27:66-75. [PMID: 34611971 PMCID: PMC9135122 DOI: 10.1111/resp.14154] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/23/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Idiopathic pulmonary fibrosis (IPF) is a chronic progressive disease that requires ongoing care and is associated with considerable socioeconomic burden. We evaluated the IPF care pathway from symptom recognition to treatment. We describe the impact of IPF on healthcare resource use (HCRU), quality of life (QoL) and work impairment, and report differences in patient and physician perspectives using real-world data from France, Germany, Japan and the United States. METHODS Quantitative, point-in-time data were collected as part of the Adelphi IPF II Disease Specific Programme™. Physician-reported data (patient demographics, medical history, diagnoses, treatment) were matched to patient-reported data (HCRU, QoL, work impairment). HCRU was measured as physician visits and hospitalizations. QoL and work impairment were measured using the EuroQol-5 Dimensions (EQ-5D) and Work Productivity and Activity Impairment questionnaires. RESULTS Overall, 244 physicians reported data on 1249 patients, 739 of whom self-reported data. Diagnostic delays of 0.8 (Germany) to 2.0 (Japan) years after symptom onset were reported; treatment initiation was further delayed. In all countries, patients more often reported symptoms in the survey than did their physicians. On average, patients underwent 7-10 clinical tests before diagnosis. Antifibrotic use increased from 57% (2016) to 69% (2019); only 50% of patients with moderate/severe IPF were satisfied with their treatment. The 12-month hospitalization rates were 24% (Japan) to 64% (United States). Patients reported low QoL (mean EQ-5D visual analogue scale: 61.7/100). CONCLUSION Patients with IPF experience considerable diagnostic and treatment delays. More effective therapies and management are needed to reduce the disease burden.
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Affiliation(s)
- Lisa Lancaster
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik University Hospital, University Duisburg-Essen, Essen, Germany
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Vincent Cottin
- National Coordinating Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, University of Lyon, Lyon, France
| | - James Siddall
- Respiratory Research, Adelphi Real World, Bollington, UK
| | - Mark Small
- Respiratory Research, Adelphi Real World, Bollington, UK
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12
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Richeldi L, Scholand MB, Lynch DA, Colby TV, Myers JL, Groshong SD, Chung JH, Benzaquen S, Nathan SD, Davis JR, Schmidt SL, Hagmeyer L, Sonetti D, Hetzel J, Criner GJ, Case AH, Ramaswamy M, Calero K, Gauhar UA, Patel NM, Lancaster L, Choi Y, Pankratz DG, Walsh PS, Lofaro LR, Huang J, Bhorade SM, Kennedy GC, Martinez FJ, Raghu G. Utility of a Molecular Classifier as a Complement to High-Resolution Computed Tomography to Identify Usual Interstitial Pneumonia. Am J Respir Crit Care Med 2021; 203:211-220. [PMID: 32721166 DOI: 10.1164/rccm.202003-0877oc] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Rationale: Usual interstitial pneumonia (UIP) is the defining morphology of idiopathic pulmonary fibrosis (IPF). Guidelines for IPF diagnosis conditionally recommend surgical lung biopsy for histopathology diagnosis of UIP when radiology and clinical context are not definitive. A "molecular diagnosis of UIP" in transbronchial lung biopsy, the Envisia Genomic Classifier, accurately predicted histopathologic UIP.Objectives: We evaluated the combined accuracy of the Envisia Genomic Classifier and local radiology in the detection of UIP pattern.Methods: Ninety-six patients who had diagnostic lung pathology as well as a transbronchial lung biopsy for molecular testing with Envisia Genomic Classifier were included in this analysis. The classifier results were scored against reference pathology. UIP identified on high-resolution computed tomography (HRCT) as documented by features in local radiologists' reports was compared with histopathology.Measurements and Main Results: In 96 patients, the Envisia Classifier achieved a specificity of 92.1% (confidence interval [CI],78.6-98.3%) and a sensitivity of 60.3% (CI, 46.6-73.0%) for histology-proven UIP pattern. Local radiologists identified UIP in 18 of 53 patients with UIP histopathology, with a sensitivity of 34.0% (CI, 21.5-48.3%) and a specificity of 96.9% (CI, 83.8-100%). In conjunction with HRCT patterns of UIP, the Envisia Classifier results identified 24 additional patients with UIP (sensitivity 79.2%; specificity 90.6%).Conclusions: In 96 patients with suspected interstitial lung disease, the Envisia Genomic Classifier identified UIP regardless of HRCT pattern. These results suggest that recognition of a UIP pattern by the Envisia Genomic Classifier combined with HRCT and clinical factors in a multidisciplinary discussion may assist clinicians in making an interstitial lung disease (especially IPF) diagnosis without the need for a surgical lung biopsy.
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Affiliation(s)
- Luca Richeldi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mary Beth Scholand
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | | | - Thomas V Colby
- Division of Pathology, National Jewish Health, Denver, Colorado
| | - Jeffrey L Myers
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Steve D Groshong
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Jonathan H Chung
- Department of Radiology, University of Chicago, Chicago, Illinois
| | - Sadia Benzaquen
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Steven D Nathan
- Inova Heart and Vascular Institute, Inova Fairfax Hospital, Annandale, Virginia
| | - J Russell Davis
- Department of Surgery, St. Luke's Hospital, Chesterfield, Missouri
| | - Shelley L Schmidt
- Department of Medical Specialties, Spectrum Health Medical Group, Grand Rapids, Michigan
| | - Lars Hagmeyer
- Hospital Bethanien Solingen, Institute of Pneumology, University of Cologne, Solingen, Germany
| | - David Sonetti
- Department of Medicine, University of Wisconsin, Madison, Wisconsin
| | - Jurgen Hetzel
- Department of Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pennsylvania
| | - Amy H Case
- Pulmonary, Critical Care, and Sleep Medicine, Piedmont Healthcare, Atlanta, Georgia
| | - Murali Ramaswamy
- Department of Medicine, Pulmonix LLC, Greensboro, North Carolina
| | - Karel Calero
- Department of Medicine, University of South Florida, Tampa, Florida
| | - Umair A Gauhar
- Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Nina M Patel
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Lisa Lancaster
- Department of Medicine, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee
| | | | | | | | | | - Jing Huang
- Veracyte, Inc., San Francisco, California
| | | | | | - Fernando J Martinez
- Department of Medicine, Weill Cornell Medical College, New York, New York; and
| | - Ganesh Raghu
- Department of Medicine, University of Washington, Seattle, Washington
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13
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Lancaster L, Fieuw A, Meulemans J, Ford P, Nathan SD. Standardization of the 6-min walk test in clinical trials of idiopathic pulmonary fibrosis. Contemp Clin Trials 2020; 100:106227. [PMID: 33246099 DOI: 10.1016/j.cct.2020.106227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/27/2022]
Abstract
The 6-min walk test (6MWT) is an important measure of functional capacity in idiopathic pulmonary fibrosis (IPF) and has been an endpoint of several IPF clinical trials. However, current guidance for the 6MWT offers insufficient advice on standardization, particularly oxygen supplementation, for clinical trials. Three physicians experienced with the 6MWT and IPF developed a standardized protocol for the 6MWT based on existing clinical guidelines and published literature. The protocol comprises guidance on test conditions, pre-defined parameters to measure at specified timepoints, and step-by-step instructions on conducting the test. The standardized test will be evaluated in the large-scale phase 3 ISABELA trials (NCT03711162; NCT03733444). The test is conducted indoors, using standardized equipment, along a flat, straight, 30-m unobstructed corridor; tests for each individual are performed by the same administrators at the same time of day; warm-up prior to testing is prohibited; supplemental oxygen tanks are permitted and moved by the patient in the same manner for each test; precise wording is used to instruct and encourage patients. Contraindications and stopping criteria are specified. Key assessments include: 6-min walk distance, distance walked at 1 and 3 min, the Borg CR10 scale, heart rate, blood pressure, and oxygen desaturation levels. A standardized 6MWT for IPF will enable more reliable comparisons between clinical trials and limit variability, optimizing use as an endpoint. Application of the standardized 6MWT in the ISABELA program will allow its correlation with other clinically important endpoints and may lead to novel composite endpoints for use in future trials. Submission category: Study Design, Statistical Design, Study Protocols. Submission classifications: Clinical study methodology; Clinical trial design; Clinical trials; Pulmonary disease; Pulmonary disease clinical trial; Respiratory medicine.
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Affiliation(s)
- Lisa Lancaster
- Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Ann Fieuw
- Clinical Research, Galapagos NV, Mechelen, Belgium
| | | | - Paul Ford
- Clinical Development, Galapagos NV, Mechelen, Belgium
| | - Steven D Nathan
- Advanced Lung Disease and Transplant Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, VA, USA
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14
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Lancaster L, Goldin J, Trampisch M, Kim GH, Ilowite J, Homik L, Hotchkin DL, Kaye M, Ryerson CJ, Mogulkoc N, Conoscenti CS. Effects of Nintedanib on Quantitative Lung Fibrosis Score in Idiopathic Pulmonary Fibrosis. Open Respir Med J 2020; 14:22-31. [PMID: 33088361 PMCID: PMC7539538 DOI: 10.2174/1874306402014010022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/17/2020] [Accepted: 07/02/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Nintedanib slows disease progression in patients with Idiopathic Pulmonary Fibrosis (IPF) by reducing decline in Forced Vital Capacity (FVC). The effects of nintedanib on abnormalities on high-resolution computed tomography scans have not been previously studied. Objective: We conducted a Phase IIIb trial to assess the effects of nintedanib on changes in Quantitative Lung Fibrosis (QLF) score and other measures of disease progression in patients with IPF. Methods: 113 patients were randomized 1:1 to receive nintedanib 150 mg bid or placebo double-blind for ≥6 months, followed by open-label nintedanib. The primary endpoint was the relative change from baseline in QLF score (%) at month 6. Analyses were descriptive and exploratory. Results: Adjusted mean relative changes from baseline in QLF score at month 6 were 11.4% in the nintedanib group (n=42) and 14.6% in the placebo group (n=45) (difference 3.2% [95% CI: −9.2, 15.6]). Adjusted mean absolute changes from baseline in QLF score at month 6 were 0.98% and 1.33% in these groups, respectively (difference 0.35% [95% CI: −1.27, 1.96]). Adjusted mean absolute changes from baseline in FVC at month 6 were −14.2 mL and −83.2 mL in the nintedanib (n=54) and placebo (n=54) groups, respectively (difference 69.0 mL [95% CI: −8.7, 146.8]). Conclusion: Exploratory data suggest that in patients with IPF, 6 months’ treatment with nintedanib was associated with a numerically smaller degree of fibrotic change in the lungs and reduced FVC decline versus placebo. These data support previous findings that nintedanib slows the progression of IPF.
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Affiliation(s)
- Lisa Lancaster
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan Goldin
- Department of Radiology, University of California, Los Angeles, California, USA
| | | | - Grace Hyun Kim
- Department of Radiology, University of California, Los Angeles, California, USA.,Department of Biostatistics, University of California, Los Angeles, California, USA
| | - Jonathan Ilowite
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York
| | - Lawrence Homik
- Department of Respiratory Medicine and Bronchoscopy, Winnipeg Clinic, Winnipeg, Manitoba, Canada
| | - David L Hotchkin
- The Oregon Clinic, Division of Pulmonary, Critical Care & Sleep Medicine, Portland, Oregon, USA
| | - Mitchell Kaye
- Department of Pulmonary Medicine, Minnesota Lung Center, Ltd., Minneapolis, Minnesota, USA
| | - Christopher J Ryerson
- Department of Medicine & Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Nesrin Mogulkoc
- Department of Pulmonology, Ege University Hospital, Bornova, Izmir, Turkey
| | - Craig S Conoscenti
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, USA
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15
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Nathan SD, Flaherty KR, Glassberg MK, Raghu G, Swigris J, Alvarez R, Ettinger N, Loyd J, Fernandes P, Gillies H, Kim B, Shah P, Lancaster L. A Randomized, Double-Blind, Placebo-Controlled Study of Pulsed, Inhaled Nitric Oxide in Subjects at Risk of Pulmonary Hypertension Associated With Pulmonary Fibrosis. Chest 2020; 158:637-645. [PMID: 32092321 DOI: 10.1016/j.chest.2020.02.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/28/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The interstitial lung diseases include a variety of disorders, many of which are characterized by fibrotic changes (fILD). Of the fILDs, Idiopathic pulmonary fibrosis is the most common. Pulmonary hypertension (PH) frequently complicates fILD and is associated with impaired functional capability, lower physical activity, and significantly reduced life expectancy. There is no proven treatment for patients with fILD-PH. We report results from the first cohort of a phase 2b/3 trial with pulsed inhaled nitric oxide (iNO) in patients with fILD-PH. METHODS Subjects in cohort 1 were randomized to iNO 30 μg/kg ideal body weight/h (iNO30) or placebo for 8 weeks of blinded treatment; subjects then transitioned to open-label extension (OLE) on iNO30 followed by dose escalation to iNO45 then iNO75. Activity monitoring was used to assess changes in daily activity. Safety and efficacy were evaluated. RESULTS Twenty-three patients were randomized to iNO30 and 18 to placebo. During blinded treatment, iNO30 subjects showed an average improvement in moderate/vigorous physical activity (MVPA) and remained stable in overall activity. Placebo subjects showed an average drop of 26% in MVPA and a 12% drop in overall activity. The iNO group had an improvement in oxygen saturation. During OLE, subjects maintained their activity levels including placebo subjects who transitioned from a decline to a maintenance in all activity parameters. Inhaled nitric oxide at all doses (30, 45, and 75) was safe and well tolerated. CONCLUSIONS Treatment with iNO30 demonstrated clinically and statistically significant benefit in MVPA and clinically significant benefit in overall activity. In the OLE, higher doses of iNO were also safe and well tolerated while showing maintenance in activity parameters.
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Affiliation(s)
- Steven D Nathan
- Advanced Lung Disease and Transplant Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Richmond, VA; Virginia Commonwealth University, Richmond, VA.
| | | | | | - Ganesh Raghu
- the University of Arizona College of Medicine - Phoenix and Banner; University of Washington Medical Center, Seattle, WA
| | | | - Roger Alvarez
- University of Miami Miller School of Medicine, Miami, FL
| | | | - Jim Loyd
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Bo Kim
- Bellerophon Therapeutics, Warren, NJ
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Nathan S, Flaherty K, Raghu G, Swigris J, Alvarez R, Ettinger N, Loyd J, Fernandes P, Gillies H, Shah P, Lancaster L, Glassberg M. OPEN-LABEL DOSE-ESCALATION DATA FROM THE RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY TO ASSESS THE SAFETY AND EFFICACY OF PULSED, INHALED NITRIC OXIDE (INO) IN SUBJECTS AT RISK OF PULMONARY HYPERTENSION ASSOCIATED WITH PULMONARY FIBROSIS (PH-PF) ON LONG TERM OXYGEN THERAPY. Chest 2019. [DOI: 10.1016/j.chest.2019.08.308] [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: 11/26/2022] Open
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Rahman M, Stott MA, Harrington M, Li Y, Sampad MJN, Lancaster L, Yuzvinsky TD, Noller HF, Hawkins AR, Schmidt H. On demand delivery and analysis of single molecules on a programmable nanopore-optofluidic device. Nat Commun 2019; 10:3712. [PMID: 31420559 PMCID: PMC6697697 DOI: 10.1038/s41467-019-11723-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 07/19/2019] [Indexed: 12/29/2022] Open
Abstract
Nanopore-based single nanoparticle detection has recently emerged as a vibrant research field with numerous high-impact applications. Here, we introduce a programmable optofluidic chip for nanopore-based particle analysis: feedback-controlled selective delivery of a desired number of biomolecules and integration of optical detection techniques on nanopore-selected particles. We demonstrate the feedback-controlled introduction of individual biomolecules, including 70S ribosomes, DNAs and proteins into a fluidic channel where the voltage across the nanopore is turned off after a user-defined number of single molecular insertions. Delivery rates of hundreds/min with programmable off-times of the pore are demonstrated using individual 70S ribosomes. We then use real-time analysis of the translocation signal for selective voltage gating of specific particles from a mixture, enabling selection of DNAs from a DNA-ribosome mixture. Furthermore, we report optical detection of nanopore-selected DNA molecules. These capabilities point the way towards a powerful research tool for high-throughput single-molecule analysis on a chip.
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Affiliation(s)
- M Rahman
- School of Engineering, University of California Santa Cruz, 1156 High Street, Santa Cruz, CA, 95064, USA
| | - M A Stott
- ECEn Department, Brigham Young University, 459 Clyde Building, Provo, UT, 84602, USA
| | - M Harrington
- School of Engineering, University of California Santa Cruz, 1156 High Street, Santa Cruz, CA, 95064, USA
| | - Y Li
- School of Engineering, University of California Santa Cruz, 1156 High Street, Santa Cruz, CA, 95064, USA
| | - M J N Sampad
- School of Engineering, University of California Santa Cruz, 1156 High Street, Santa Cruz, CA, 95064, USA
| | - L Lancaster
- Department of Molecular, Cell and Developmental Biology and Center for Molecular Biology of RNA, University of California at Santa Cruz, 1156 High Street, Santa Cruz, CA, 95064, USA
| | - T D Yuzvinsky
- School of Engineering, University of California Santa Cruz, 1156 High Street, Santa Cruz, CA, 95064, USA
| | - H F Noller
- Department of Molecular, Cell and Developmental Biology and Center for Molecular Biology of RNA, University of California at Santa Cruz, 1156 High Street, Santa Cruz, CA, 95064, USA
| | - A R Hawkins
- ECEn Department, Brigham Young University, 459 Clyde Building, Provo, UT, 84602, USA
| | - H Schmidt
- School of Engineering, University of California Santa Cruz, 1156 High Street, Santa Cruz, CA, 95064, USA.
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Lancaster L, Crestani B, Hernandez P, Inoue Y, Wachtlin D, Loaiza L, Quaresma M, Stowasser S, Richeldi L. Safety and survival data in patients with idiopathic pulmonary fibrosis treated with nintedanib: pooled data from six clinical trials. BMJ Open Respir Res 2019; 6:e000397. [PMID: 31179001 PMCID: PMC6530503 DOI: 10.1136/bmjresp-2018-000397] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/26/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Nintedanib slows disease progression in patients with idiopathic pulmonary fibrosis (IPF) by reducing the rate of decline in forced vital capacity, with an adverse event profile that is manageable for most patients. We used data from six clinical trials to characterise the safety and tolerability profile of nintedanib and to investigate its effects on survival. Methods Data from patients treated with ≥1 dose of nintedanib 150 mg two times per day or placebo in the 52-week TOMORROW trial and/or its open-label extension; the two 52-week INPULSIS trials and/or their open-label extension, INPULSIS-ON; and a Phase IIIb trial with a placebo-controlled period of ≥6 months followed by open-label nintedanib were pooled. All adverse events, irrespective of causality, were included in descriptive analyses. Parametric survival distributions were fit to pooled Kaplan-Meier survival data from the trials and extrapolated to estimate long-term survival. Results There were 1126 patients in the pooled nintedanib group and 565 patients in the pooled placebo group. The mean duration of nintedanib treatment was 28 months. No new safety signals were observed. Incidence rates of bleeding, liver enzyme elevations and cardiovascular events were consistent with those observed in the INPULSIS trials. Diarrhoea was reported at a lower event rate in the pooled nintedanib group than in nintedanib-treated patients in the INPULSIS trials (76.5 vs 112.6 events per 100 patient exposure-years) and infrequently led to permanent treatment discontinuation (3.6 events per 100 patient exposure-years). Based on the Weibull distribution, mean (95% CI) survival was estimated as 11.6 (9.6, 14.1) years in nintedanib-treated patients and 3.7 (2.5, 5.4) years in placebo-treated patients. Conclusions Based on pooled data from six clinical trials, the adverse event profile of nintedanib was manageable for most patients. Exploratory analyses based on extrapolation of survival data suggest that nintedanib extends life expectancy in patients with IPF.
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Affiliation(s)
- Lisa Lancaster
- Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bruno Crestani
- APHP, Service de Pneumologie, Hôpital Bichat, Paris, France; Université Paris Diderot, Paris, France
| | - Paul Hernandez
- QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Yoshikazu Inoue
- Diffuse Lung Diseases and Respiratory Failure, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Daniel Wachtlin
- Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim am Rhein, Germany
| | - Lazaro Loaiza
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Manuel Quaresma
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Susanne Stowasser
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Luca Richeldi
- Fondazione Policlinico A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Abstract
The six-minute walk test (6MWT) is a simple test that is widely used to assess functional exercise capacity in patients with idiopathic pulmonary fibrosis (IPF). Patients with IPF have reduced exercise capacity due to a number of factors, such as impaired respiratory mechanics and circulatory problems. As a self-paced and usually submaximal exercise test, the 6MWT reflects the exercise level of everyday activities. Variables measured during the 6MWT, such as six-minute walk distance (6MWD) and desaturation, are strong predictors of mortality in patients with IPF. However, the results of a 6MWT are affected by numerous factors, including age, body size, comorbidities and the use of supplemental oxygen during the test, and these need to be borne in mind when interpreting the results of individual and serial tests. Clinical studies, including trials of potential therapies for IPF, have differed in the methodology used to implement the 6MWT, hindering the comparison of results across studies. In this review, I describe the utility of the 6MWT in patients with IPF and provide recommendations for standardisation of the test for use both in clinical practice and research. A brief video
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deAndrade J, Conoscenti C, Flaherty K, Holtze C, Lancaster L, Neely M, Snyder L, Yow E, Whelan T. Time From First Imaging Showing Pulmonary Fibrosis to Diagnosis of Idiopathic Pulmonary Fibrosis: Data From the IPF-PRO Registry. Chest 2017. [DOI: 10.1016/j.chest.2017.08.472] [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: 11/24/2022] Open
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Lancaster L, Morrison L, Auais A, Ding B, Iqbal A, Polman B, Flaherty KR. Safety of Pirfenidone in Patients with Idiopathic Pulmonary Fibrosis: Experience from 92 Sites in an Open-Label US Expanded Access Program. Pulm Ther 2017; 3:317-325. [PMID: 32026347 PMCID: PMC6964201 DOI: 10.1007/s41030-017-0049-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Indexed: 11/25/2022] Open
Abstract
Introduction In phase 3 clinical trials, pirfenidone significantly slowed disease progression with a well-defined and medically manageable safety profile in patients with idiopathic pulmonary fibrosis (IPF). This study examined safety events related to pirfenidone in patients with IPF in an expanded access program in the US. Methods The Expanded Access Program allowed patients with IPF access to pirfenidone prior to US Food and Drug Administration approval. Patients had an IPF diagnosis including a definite or possible usual interstitial pneumonia (UIP) pattern, predicted forced vital capacity ≥50%, and predicted diffusing capacity for carbon monoxide ≥30%. Clinical laboratory data and adverse drug reactions (ADRs) deemed causally related to pirfenidone were analyzed using descriptive summary statistics. Results Of the 1620 patients treated, 1221 (75.4%) completed the program: 66.5% had definite UIP, and 33.2% had possible UIP. Mean (SD) pirfenidone exposure was 22.8 (9.6) weeks, and mean (SD) daily dose during the course of treatment was 2058.7 (399.2) mg. ADRs occurred in 64.9% of patients: 3.3% were severe and 0.2% life threatening. The most common ADRs were nausea (22.6%) and fatigue (19.6%); 13.0% of patients discontinued due to ADRs. Serious ADRs occurred in 24 patients (1.5%), which were primarily related to elevated liver function enzymes (ten patients, 0.6%). No ADRs led to death. Conclusions In this open-label study of 1620 patients with IPF, including those with possible UIP, the safety profile of pirfenidone was consistent with that of earlier clinical trials, and no new safety signals were identified. NCT02141087. Funding Genentech, Inc., a member of the Roche group.
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Affiliation(s)
- Lisa Lancaster
- Department of Medicine, Vanderbilt University, Nashville, TN, USA.
| | - Lake Morrison
- Department of Medicine, Duke University, Durham, NC, USA
| | | | | | - Ahmar Iqbal
- Genentech, Inc., South San Francisco, CA, USA
| | | | - Kevin R Flaherty
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Costabel U, Nathan SD, Lancaster L, Albera C, Glassberg MK, Swigris JJ, Gilberg F, Kirchgaessler KU, Petzinger U, Noble PW. Dose modifications and dose intensity during treatment with pirfenidone. Pneumologie 2017. [DOI: 10.1055/s-0037-1598499] [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)
- U Costabel
- Interstitielle und Seltene Lungenkrankheiten, Interstitial and Rare Lung Disease Unit, Ruhrlandklinik
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Noble PW, Albera C, Lancaster L, Hormel P, Hulter H, Costabel U. P169 Long-term safety of pirfenidone in patients with idiopathic pulmonary fibrosis: pooled analysis of 4 clinical trials. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.312] [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: 11/04/2022]
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Wells AU, Albera C, Costabel U, Glaspole I, Glassberg MK, Lancaster L, Lederer DJ, Pereira CA, Swigris JJ, Day BM, Chou W, Nathan SD. P174 Effect of continued treatment with pirfenidone following a ≥10% relative decline in percent predicted forced vital capacity (%FVC) in patients with idiopathic pulmonary fibrosis (IPF). Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.317] [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: 11/04/2022]
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Noble PW, Albera C, Chou W, Costabel U, Day B, Glaspole I, Glassberg MK, Lancaster L, Lederer DJ, Nathan SD, Pereira CA, Stauffer J, Swigris JJ. S97 Annual rate of fvc decline in various patient sub-groups with idiopathic pulmonary fibrosis treated with pirfenidone: pooled analysis from 3 pivotal studies. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Albera C, Costabel U, Fagan EA, Glassberg MK, Gorina E, Lancaster L, Lederer DJ, Nathan SD, Spirig D, Swigris JJ. Efficacy of pirfenidone in patients with idiopathic pulmonary fibrosis with more preserved lung function. Eur Respir J 2016; 48:843-51. [DOI: 10.1183/13993003.01966-2015] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/25/2016] [Indexed: 11/05/2022]
Abstract
This post hoc analysis examined the differences in idiopathic pulmonary fibrosis disease progression and the effects of pirfenidone in patients stratified by more preserved versus less preserved baseline lung function status using forced vital capacity (FVC) or GAP (gender, age and physiology) index stage.Efficacy outcomes, i.e. FVC, 6-min walking distance (6MWD) and dyspnoea (University of California San Diego Shortness of Breath Questionnaire (UCSD SOBQ)), were analysed at 12 months in patients randomised to pirfenidone 2403 mg·day−1 or placebo in the pooled phase 3 CAPACITY/ASCEND population (n=1247), with subgroups stratified by baseline FVC ≥80% versus <80% or GAP stage I versus II–III. Treatment-by-subgroup interaction was tested based on a rank ANCOVA model; factors in the model included study, region, treatment, subgroup and treatment-by-subgroup interaction term.Patients with both more preserved (FVC ≥80% or GAP stage I) and less preserved (FVC <80% or GAP stage II–III) lung function at baseline demonstrated clinically significant disease progression at 12 months in terms of categorical decline in FVC, 6MWD and UCSD SOBQ. The magnitude of pirfenidone treatment effect was comparable between subgroups, regardless of whether lung function was classified using FVC or GAP index stage.These findings support the initiation of treatment with pirfenidone, irrespective of stage of baseline lung function in this patient population.
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Nathan SD, Albera C, Bradford WZ, Costabel U, du Bois RM, Fagan EA, Fishman RS, Glaspole I, Glassberg MK, Glasscock KF, King TE, Lancaster L, Lederer DJ, Lin Z, Pereira CA, Swigris JJ, Valeyre D, Noble PW, Wells AU. Effect of continued treatment with pirfenidone following clinically meaningful declines in forced vital capacity: analysis of data from three phase 3 trials in patients with idiopathic pulmonary fibrosis. Thorax 2016; 71:429-35. [PMID: 26968970 PMCID: PMC4862066 DOI: 10.1136/thoraxjnl-2015-207011] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [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: 03/04/2015] [Accepted: 02/13/2016] [Indexed: 12/02/2022]
Abstract
Background The assessment of treatment response in idiopathic pulmonary fibrosis (IPF) is complicated by the variable clinical course. We examined the variability in the rate of disease progression and evaluated the effect of continued treatment with pirfenidone in patients who experienced meaningful progression during treatment. Methods The source population included patients enrolled in the ASCEND and CAPACITY trials (N=1247). Pearson's correlation coefficients were used to characterise the relationship between changes in FVC during consecutive 6-month intervals in the placebo population. Outcomes following a ≥10% decline in FVC were evaluated by comparing the proportion of patients in the pirfenidone and placebo groups who experienced a ≥10% decline in FVC or death during the subsequent 6 months. Results A weak negative correlation was observed between FVC changes during consecutive intervals in the placebo population (coefficient, −0.146, p<0.001), indicating substantial variability. Thirty-four (5.5%) and 68 (10.9%) patients in the pirfenidone and placebo groups, respectively, experienced a ≥10% decline in FVC by month 6. During the subsequent 6 months, fewer patients in the pirfenidone group compared with placebo experienced a ≥10% decline in FVC or death (5.9% vs 27.9%; relative difference, 78.9%). There was one (2.9%) death in the pirfenidone group and 14 (20.6%) deaths in the placebo group (relative difference, 85.7%). Conclusions Longitudinal FVC data from patients with IPF showed substantial intrasubject variability, underscoring the inability to reliably assess therapeutic response using serial FVC trends. In patients who progressed during treatment, continued treatment with pirfenidone resulted in a lower risk of subsequent FVC decline or death. Trial registration numbers NCT01366209, NCT00287729, NCT00287716.
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Affiliation(s)
- Steven D Nathan
- Inova Fairfax Hospital, Heart and Lung Transplant Center, Falls Church, Virginia, USA
| | - Carlo Albera
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | - Ulrich Costabel
- Department of Pneumology/Allergy, Ruhrlandklinik, Essen, Germany
| | | | | | | | - Ian Glaspole
- Alfred Hospital and Monash University, Melbourne, Australia
| | | | | | | | - Lisa Lancaster
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Carlos A Pereira
- Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Jeffrey J Swigris
- Interstitial Lung Disease Program, National Jewish Health, Denver, Colorado, USA
| | - Dominique Valeyre
- Assistance Publique-Hôpitaux de Paris, Avicenne University Hospital, Bobigny, France
| | - Paul W Noble
- Cedars Sinai Medical Center, Los Angeles, California, USA
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Raghu G, Scholand MB, de Andrade J, Lancaster L, Mageto Y, Goldin J, Brown KK, Flaherty KR, Wencel M, Wanger J, Neff T, Valone F, Stauffer J, Porter S. FG-3019 anti-connective tissue growth factor monoclonal antibody: results of an open-label clinical trial in idiopathic pulmonary fibrosis. Eur Respir J 2016; 47:1481-91. [PMID: 26965296 DOI: 10.1183/13993003.01030-2015] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 01/11/2016] [Indexed: 12/20/2022]
Abstract
FG-3019 is a fully human monoclonal antibody that interferes with the action of connective tissue growth factor, a central mediator in the pathogenesis of fibrosis.This open-label phase 2 trial evaluated the safety and efficacy of two doses of FG-3019 administered by intravenous infusion every 3 weeks for 45 weeks in patients with idiopathic pulmonary fibrosis (IPF). Subjects had a diagnosis of IPF within the prior 5 years defined by either usual interstitial pneumonia (UIP) pattern on a recent high-resolution computed tomography (HRCT) scan, or a possible UIP pattern on HRCT scan and a recent surgical lung biopsy showing UIP pattern. Pulmonary function tests were performed every 12 weeks, and changes in the extent of pulmonary fibrosis were measured by quantitative HRCT scans performed at baseline and every 24 weeks.FG-3019 was safe and well-tolerated in IPF patients participating in the study. Changes in fibrosis were correlated with changes in pulmonary function.Further investigation of FG-3019 in IPF with a placebo-controlled clinical trial is warranted and is underway.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jack Wanger
- Pulmonary Function and Clinical Trial Consultant, Rochester, MN, USA
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Costabel U, Albera C, Bradford WZ, Fagan EA, Glaspole I, Glassberg MK, Gorina E, Kardatzke D, King TE, Lancaster L, Lederer DJ, Nathan SD, Pereira CA, Spirig D, Swigris JJ, Valeyre D, Noble PW. Pirfenidone is Efficacious in Patients with Idiopathic Pulmonary Fibrosis (IPF) and Mild Restrictive Disease. Pneumologie 2016. [DOI: 10.1055/s-0036-1572064] [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: 10/22/2022]
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Costabel U, Nathan SD, Albera C, Bradford WZ, Fagan EA, Glaspole I, Glassberg MK, Kardatzke D, King TE, Kirchgaessler KU, Lancaster L, Lederer DJ, Pereira CA, Swigris JJ, Valeyre D, Noble PW. Effect of Pirfenidone on Treatment-emergent (TE) All-cause Mortality (ACM) in Patients with Idiopathic Pulmonary Fibrosis (IPF): Pooled Data Analysis from ASCEND and CAPACITY. Pneumologie 2016. [DOI: 10.1055/s-0036-1572066] [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: 10/22/2022]
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Costabel U, Nathan SD, Albera C, Bradford WZ, Fagan EA, Glaspole I, Glassberg MK, King TE, Lancaster L, Lederer DJ, Lin Z, Pereira CA, Swigris JJ, Valeyre D, Noble PW. Effect of continued treatment with pirfenidone following a clinically meaningful decline in percent predicted forced vital capacity in patients with idiopathic pulmonary fibrosis (IPF). Pneumologie 2016. [DOI: 10.1055/s-0036-1572141] [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: 10/22/2022]
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Costabel U, Lancaster L, Albera C, Bradford WZ, Fagan EA, Fishman R, Glaspole I, Glassberg MK, King TE, Lederer DJ, Lin Z, Nathan SD, Pereira CA, Swigris JJ, Valeyre D, Noble PW. Safety of pirfenidone in patients with idiopathic pulmonary fibrosis (IPF): Integrated analysis of cumulative data from 5 clinical trials. Pneumologie 2016. [DOI: 10.1055/s-0036-1572063] [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: 10/22/2022]
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Lancaster L, Albera C, Bradford WZ, Costabel U, du Bois RM, Fagan EA, Fishman RS, Glaspole I, Glassberg MK, King TE, Lederer DJ, Lin Z, Nathan SD, Pereira CA, Swigris JJ, Valeyre D, Noble PW. Safety of pirfenidone in patients with idiopathic pulmonary fibrosis: integrated analysis of cumulative data from 5 clinical trials. BMJ Open Respir Res 2016; 3:e000105. [PMID: 26835133 PMCID: PMC4716177 DOI: 10.1136/bmjresp-2015-000105] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [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: 08/14/2015] [Accepted: 10/08/2015] [Indexed: 11/18/2022] Open
Abstract
Background Pirfenidone is an oral antifibrotic agent that has been shown to reduce the decline in lung function in patients with idiopathic pulmonary fibrosis (IPF). We performed an integrated analysis of safety data from five clinical trials evaluating pirfenidone in patients with IPF. Methods All patients treated with pirfenidone in the three multinational Phase 3 studies (CAPACITY (studies 004 and 006), ASCEND (study 016)) and two ongoing open-label studies (study 002 and study 012 (RECAP)) were included in the analysis. Safety outcomes were assessed during the period from the first dose until 28 days after the last dose of study drug. Results A total of 1299 patients were included in the analysis. The cumulative total exposure to pirfenidone was 3160 person exposure years (PEY). The median duration of exposure was 1.7 years (range 1 week to 9.9 years), and the mean (±SD) daily dose was 2053.8 (±484.9) mg. Gastrointestinal events (nausea (37.6%), diarrhoea (28.1%), dyspepsia (18.4%), vomiting (15.9%)) and rash (25.0%) were the most common adverse events; these were generally mild to moderate in severity and without significant clinical consequence. Elevations in alanine aminotransferase or aspartate aminotransferase greater than three times the upper limit of normal occurred in 40/1299 (3.1%) patients (adjusted incidence, 2.3 per 100 PEY). Elevations were generally transient and reversible with dose modification or discontinuation. Conclusions A comprehensive analysis of safety outcomes in a large and well-defined cohort of 1299 patients with IPF who were followed prospectively for up to 9.9 years demonstrated that long-term treatment with pirfenidone is safe and generally well tolerated. Trial registration numbers NCT00287716, NCT00287729, NCT00662038, NCT01366209.
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Affiliation(s)
- Lisa Lancaster
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlo Albera
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | - Ulrich Costabel
- Department of Pneumology and Allergy, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Roland M du Bois
- Emeritus Professor of Respiratory Medicine, Imperial College, London, UK
| | | | | | - Ian Glaspole
- AIRMED, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Marilyn K Glassberg
- Department of Medicine and Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Talmadge E King
- Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, USA
| | - David J Lederer
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | | | - Steven D Nathan
- Lung Transplant Program, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Carlos A Pereira
- Lung Disease Department, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Jeffrey J Swigris
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Dominique Valeyre
- Pneumology Service, Assistance Publique-Hôpitaux de Paris, Avicenne University Hospital, Bobigny, France
| | - Paul W Noble
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
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Noble PW, Albera C, Bradford WZ, Costabel U, du Bois RM, Fagan EA, Fishman RS, Glaspole I, Glassberg MK, Lancaster L, Lederer DJ, Leff JA, Nathan SD, Pereira CA, Swigris JJ, Valeyre D, King TE. Pirfenidone for idiopathic pulmonary fibrosis: analysis of pooled data from three multinational phase 3 trials. Eur Respir J 2015; 47:243-53. [PMID: 26647432 PMCID: PMC4697914 DOI: 10.1183/13993003.00026-2015] [Citation(s) in RCA: 294] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 09/01/2015] [Indexed: 11/05/2022]
Abstract
Pirfenidone is an antifibrotic agent that has been evaluated in three multinational phase 3 trials in patients with idiopathic pulmonary fibrosis (IPF). We analysed pooled data from the multinational trials to obtain the most precise estimates of the magnitude of treatment effect on measures of disease progression.All patients randomised to pirfenidone 2403 mg·day(-1) or placebo in the CAPACITY or ASCEND studies were included in the analysis. Pooled analyses of outcomes at 1 year were based on the pre-specified end-points and analytic methods described in the ASCEND study protocol.A total of 1247 patients were included in the analysis. At 1 year, pirfenidone reduced the proportion of patients with a ≥10% decline in per cent predicted forced vital capacity or death by 43.8% (95% CI 29.3-55.4%) and increased the proportion of patients with no decline by 59.3% (95% CI 29.0-96.8%). A treatment benefit was also observed for progression-free survival, 6-min walk distance and dyspnoea. Gastrointestinal and skin-related adverse events were more common in the pirfenidone group, but rarely led to discontinuation.Analysis of data from three phase 3 trials demonstrated that treatment with pirfenidone for 1 year resulted in clinically meaningful reductions in disease progression in patients with IPF.
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Affiliation(s)
- Paul W Noble
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Ulrich Costabel
- Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | | | | | | | - Ian Glaspole
- Alfred Hospital and Monash University, Melbourne, Australia
| | | | - Lisa Lancaster
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | - Carlos A Pereira
- Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | | | - Dominique Valeyre
- Assistance Publique-Hôpitaux de Paris, Avicenne University Hospital, Bobigny, France
| | - Talmadge E King
- University of California, San Francisco, San Francisco, CA, USA
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Noble PW, Bradford WZ, Costabel U, Glaspole I, Glassberg MK, Gorina E, Kardatzke D, Lancaster L, Lederer DJ, Nathan SD, Pereira C, Spirig D, Swigris JJ, Valeyre D, Albera C. P14 Pirfenidone is efficacious in patients with idiopathic pulmonary fibrosis (IPF) with more preserved lung function. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.151] [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: 11/03/2022]
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Noble PW, Albera C, Bradford WZ, Costabel U, Glaspole I, Glassberg MK, Lancaster L, Lederer DJ, Lin Z, Pereira CA, Swigris JJ, Valeyre D, Nathan SD. S109 Effect of continued treatment with pirfenidone following a clinically meaningful decline in percent predicted forced vital capacity in patients with idiopathic pulmonary fibrosis (IPF): Abstract S109 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.115] [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: 11/03/2022]
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Noble PW, Albera C, Bradford WZ, Costabel U, Glaspole I, Glassberg MK, Lederer DJ, Lin Z, Nathan SD, Pereira CA, Swigris JJ, Valeyre D, Lancaster L. P13 Safety of pirfenidone in patients with idiopathic pulmonary fibrosis (IPF): Integrated analysis of cumulative data from 5 clinical trials: Abstract P13 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.150] [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: 11/04/2022]
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Raghu G, Martinez FJ, Brown KK, Costabel U, Cottin V, Wells AU, Lancaster L, Gibson KF, Haddad T, Agarwal P, Mack M, Dasgupta B, Nnane IP, Flavin SK, Barnathan ES. CC-chemokine ligand 2 inhibition in idiopathic pulmonary fibrosis: a phase 2 trial of carlumab. Eur Respir J 2015; 46:1740-50. [PMID: 26493793 DOI: 10.1183/13993003.01558-2014] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 07/12/2015] [Indexed: 11/05/2022]
Abstract
The objective of this study was to determine the safety and efficacy of carlumab in the treatment of idiopathic pulmonary fibrosis (IPF).A phase 2, randomised, double-blind placebo-controlled dose-ranging study was conducted in patients with IPF (n=126). Patients were randomised to carlumab (1 mg·kg(-1), 5 mg·kg(-1), or 15 mg·kg(-1)) or placebo every 4 weeks. The primary endpoint was the rate of percentage change in forced vital capacity (FVC). Secondary endpoints were time to disease progression, absolute change in FVC, relative change in diffusing capacity of the lung for carbon monoxide (DLCO), and St George's Respiratory Questionnaire (SGRQ) total score.Due to a pre-planned, unfavourable interim benefit-risk analysis, dosing was suspended. The rate of percentage change in FVC showed no treatment effect (placebo -0.582%, 1 mg·kg(-1) -0.533%, 5 mg·kg(-1) -0.799% and 15 mg·kg(-1) -0.470%; p=0.261). All active treatment groups showed a greater decline in FVC (1 mg·kg(-1) -290 mL, 5 mg·kg(-1) -370 mL and 15 mg·kg(-1) -320 mL) compared with placebo (-130 mL). No effect on disease progression, DLCO, infection rates or mortality was observed. SGRQ scores showed a nonsignificant trend toward worsening with active treatment. Unexpectedly, free CC-chemokine ligand 2 levels were elevated above baseline at both 24 and 52 weeks. A higher proportion of patients with one or more serious adverse events was observed in the 5 mg·kg(-1) group (53.1%) compared with 1 mg·kg(-1) (15.2%), 15 mg·kg(-1) (21.9%) and placebo (46.4%), although no unexpected serious adverse events were noted.Although dosing was stopped prematurely, it is unlikely that carlumab provides benefit to IPF patients.
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Affiliation(s)
- Ganesh Raghu
- Division of Pulmonary and Critical Care Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kevin K Brown
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Ulrich Costabel
- Ruhrlandklinik, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Vincent Cottin
- National Reference Centre, Department of Respiratory Medicine, Claude Bernard Lyon 1 University, Hospices Civils de Lyon, Lyon, France
| | - Athol U Wells
- Royal Brompton Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Lisa Lancaster
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, TN, USA
| | - Kevin F Gibson
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | - Michael Mack
- Janssen Research & Development LLC, Spring House, PA, USA
| | | | - Ivo P Nnane
- Janssen Research & Development LLC, Spring House, PA, USA
| | - Susan K Flavin
- Janssen Research & Development LLC, Spring House, PA, USA
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Nathan S, Albera C, Bradford W, Kardatzke D, Costabel U, du Bois R, Glaspole I, Glassberg M, King T, Kirchgaessler KU, Lancaster L, Lederer D, Pereira C, Swigris J, Valeyre D, Noble P. Effect of Pirfenidone on IPF-Related Mortality Outcome Measures in Patients With Idiopathic Pulmonary Fibrosis (IPF): Pooled Data Analysis From the ASCEND and CAPACITY Trials. Chest 2015. [DOI: 10.1378/chest.2278579] [Citation(s) in RCA: 2] [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: 11/01/2022] Open
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Nathan S, Albera C, Bradford W, Costabel U, Daigl M, Kirchgaessler KU, du Bois R, Glaspole I, Glassberg M, King T, Lancaster L, Lederer D, Pereira C, Swigris J, Valeyre D, Noble P. Effect of Pirfenidone on All-Cause Mortality in Patients With Idiopathic Pulmonary Fibrosis (IPF): Comparison of Pooled Analysis With Meta-analysis From the ASCEND and CAPACITY Trials. Chest 2015. [DOI: 10.1378/chest.2250247] [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: 11/01/2022] Open
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King TE, Bradford WZ, Castro-Bernardini S, Fagan EA, Glaspole I, Glassberg MK, Gorina E, Hopkins PM, Kardatzke D, Lancaster L, Lederer DJ, Nathan SD, Pereira CA, Sahn SA, Sussman R, Swigris JJ, Noble PW. A phase 3 trial of pirfenidone in patients with idiopathic pulmonary fibrosis. N Engl J Med 2014; 370:2083-92. [PMID: 24836312 DOI: 10.1056/nejmoa1402582] [Citation(s) in RCA: 2497] [Impact Index Per Article: 249.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In two of three phase 3 trials, pirfenidone, an oral antifibrotic therapy, reduced disease progression, as measured by the decline in forced vital capacity (FVC) or vital capacity, in patients with idiopathic pulmonary fibrosis; in the third trial, this end point was not achieved. We sought to confirm the beneficial effect of pirfenidone on disease progression in such patients. METHODS In this phase 3 study, we randomly assigned 555 patients with idiopathic pulmonary fibrosis to receive either oral pirfenidone (2403 mg per day) or placebo for 52 weeks. The primary end point was the change in FVC or death at week 52. Secondary end points were the 6-minute walk distance, progression-free survival, dyspnea, and death from any cause or from idiopathic pulmonary fibrosis. RESULTS In the pirfenidone group, as compared with the placebo group, there was a relative reduction of 47.9% in the proportion of patients who had an absolute decline of 10 percentage points or more in the percentage of the predicted FVC or who died; there was also a relative increase of 132.5% in the proportion of patients with no decline in FVC (P<0.001). Pirfenidone reduced the decline in the 6-minute walk distance (P=0.04) and improved progression-free survival (P<0.001). There was no significant between-group difference in dyspnea scores (P=0.16) or in rates of death from any cause (P=0.10) or from idiopathic pulmonary fibrosis (P=0.23). However, in a prespecified pooled analysis incorporating results from two previous phase 3 trials, the between-group difference favoring pirfenidone was significant for death from any cause (P=0.01) and from idiopathic pulmonary fibrosis (P=0.006). Gastrointestinal and skin-related adverse events were more common in the pirfenidone group than in the placebo group but rarely led to treatment discontinuation. CONCLUSIONS Pirfenidone, as compared with placebo, reduced disease progression, as reflected by lung function, exercise tolerance, and progression-free survival, in patients with idiopathic pulmonary fibrosis. Treatment was associated with an acceptable side-effect profile and fewer deaths. (Funded by InterMune; ASCEND ClinicalTrials.gov number, NCT01366209.).
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Affiliation(s)
- Talmadge E King
- From the University of California, San Francisco, San Francisco (T.E.K.), InterMune, Brisbane (W.Z.B., E.A.F., E.G., D.K.), and Cedars-Sinai Medical Center, Los Angeles (P.W.N.) - all in California; Neumocare, Clínica San Borja, Lima, Peru (S.C.-B.); Alfred Hospital, Melbourne, VIC (I.G.), and Prince Charles Hospital, Brisbane, QLD (P.M.H.) - both in Australia; University of Miami Miller School of Medicine, Miami (M.K.G.); Vanderbilt University Medical Center, Nashville (L.L.); Columbia University Medical Center, New York (D.J.L.); Inova Fairfax Hospital, Falls Church, VA (S.D.N.); Paulista School of Medicine, Federal University of São Paulo, São Paulo (C.A.P.); Medical University of South Carolina, Charleston (S.A.S.); Atlantic Health System-Overlook Medical Center, Summit, NJ (R.S.); and National Jewish Health, Denver (J.J.S.)
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du Bois RM, Weycker D, Albera C, Bradford WZ, Costabel U, Kartashov A, King TE, Lancaster L, Noble PW, Sahn SA, Thomeer M, Valeyre D, Wells AU. Forced Vital Capacity in Patients with Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med 2011; 184:1382-9. [DOI: 10.1164/rccm.201105-0840oc] [Citation(s) in RCA: 336] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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du Bois RM, Weycker D, Albera C, Bradford WZ, Costabel U, Kartashov A, Lancaster L, Noble PW, Raghu G, Sahn SA, Szwarcberg J, Thomeer M, Valeyre D, King TE. Ascertainment of individual risk of mortality for patients with idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2011; 184:459-66. [PMID: 21616999 DOI: 10.1164/rccm.201011-1790oc] [Citation(s) in RCA: 309] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Several predictors of mortality in patients with idiopathic pulmonary fibrosis have been described; however, there is a need for a practical and accurate method of quantifying the prognosis of individual patients. OBJECTIVES Develop a practical mortality risk scoring system for patients with idiopathic pulmonary fibrosis. METHODS We used a Cox proportional hazards model and data from two clinical trials (n = 1,099) to identify independent predictors of 1-year mortality among patients with idiopathic pulmonary fibrosis. From the comprehensive model, an abbreviated clinical model comprised of only those predictors that are readily and reliably ascertained by clinicians was derived. Beta coefficients for each predictor were then used to develop a practical mortality risk scoring system. MEASUREMENTS AND MAIN RESULTS Independent predictors of mortality included age, respiratory hospitalization, percent predicted FVC, 24-week change in FVC, percent predicted carbon monoxide diffusing capacity, 24-week change in percent predicted carbon monoxide diffusing capacity, and 24-week change in health-related quality of life. An abbreviated clinical model comprising only four predictors (age, respiratory hospitalization, percent predicted FVC, and 24-wk change in FVC), and the corresponding risk scoring system produced estimates of 1-year mortality risk consistent with observed data (9.9% vs. 9.7%; C statistic = 0.75; 95% confidence interval, 0.71–0.79). CONCLUSIONS The prognosis for patients with idiopathic pulmonary fibrosis may be accurately determined using four readily ascertainable predictors. Our simplified scoring system may be a valuable tool for determining prognosis and guiding clinical management. Additional research is needed to validate the applicability and accuracy of the scoring system.
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Noble PW, Albera C, Bradford WZ, Costabel U, Glassberg MK, Kardatzke D, King TE, Lancaster L, Sahn SA, Szwarcberg J, Valeyre D, du Bois RM. Pirfenidone in patients with idiopathic pulmonary fibrosis (CAPACITY): two randomised trials. Lancet 2011; 377:1760-9. [PMID: 21571362 DOI: 10.1016/s0140-6736(11)60405-4] [Citation(s) in RCA: 1354] [Impact Index Per Article: 104.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis is a progressive and fatal lung disease with inevitable loss of lung function. The CAPACITY programme (studies 004 and 006) was designed to confirm the results of a phase 2 study that suggested that pirfenidone, a novel antifibrotic and anti-inflammatory drug, reduces deterioration in lung function in patients with idiopathic pulmonary fibrosis. METHODS In two concurrent trials (004 and 006), patients (aged 40-80 years) with idiopathic pulmonary fibrosis were randomly assigned to oral pirfenidone or placebo for a minimum of 72 weeks in 110 centres in Australia, Europe, and North America. In study 004, patients were assigned in a 2:1:2 ratio to pirfenidone 2403 mg/day, pirfenidone 1197 mg/day, or placebo; in study 006, patients were assigned in a 1:1 ratio to pirfenidone 2403 mg/day or placebo. The randomisation code (permuted block design) was computer generated and stratified by region. All study personnel were masked to treatment group assignment until after final database lock. Treatments were administered orally, 801 mg or 399 mg three times a day. The primary endpoint was change in percentage predicted forced vital capacity (FVC) at week 72. Analysis was by intention to treat. The studies are registered with ClinicalTrials.gov, numbers NCT00287729 and NCT00287716. FINDINGS In study 004, 174 of 435 patients were assigned to pirfenidone 2403 mg/day, 87 to pirfenidone 1197 mg/day, and 174 to placebo. In study 006, 171 of 344 patients were assigned to pirfenidone 2403 mg/day, and 173 to placebo. All patients in both studies were analysed. In study 004, pirfenidone reduced decline in FVC (p=0·001). Mean FVC change at week 72 was -8·0% (SD 16·5) in the pirfenidone 2403 mg/day group and -12·4% (18·5) in the placebo group (difference 4·4%, 95% CI 0·7 to 9·1); 35 (20%) of 174 versus 60 (35%) of 174 patients, respectively, had a decline of at least 10%. A significant treatment effect was noted at all timepoints from week 24 and in an analysis over all study timepoints (p=0·0007). Mean change in percentage FVC in the pirfenidone 1197 mg/day group was intermediate to that in the pirfenidone 2403 mg/day and placebo groups. In study 006, the difference between groups in FVC change at week 72 was not significant (p=0·501). Mean change in FVC at week 72 was -9·0% (SD 19·6) in the pirfenidone group and -9·6% (19·1) in the placebo group, and the difference between groups in predicted FVC change at week 72 was not significant (0·6%, -3·5 to 4·7); however, a consistent pirfenidone effect was apparent until week 48 (p=0·005) and in an analysis of all study timepoints (p=0·007). Patients in the pirfenidone 2403 mg/day group had higher incidences of nausea (125 [36%] of 345 vs 60 [17%] of 347), dyspepsia (66 [19%] vs 26 [7%]), vomiting (47 [14%] vs 15 [4%]), anorexia (37 [11%] vs 13 [4%]), photosensitivity (42 [12%] vs 6 [2%]), rash (111 [32%] vs 40 [12%]), and dizziness (63 [18%] vs 35 [10%]) than did those in the placebo group. Fewer overall deaths (19 [6%] vs 29 [8%]) and fewer deaths related to idiopathic pulmonary fibrosis (12 [3%] vs 25 [7%]) occurred in the pirfenidone 2403 mg/day groups than in the placebo groups. INTERPRETATION The data show pirfenidone has a favourable benefit risk profile and represents an appropriate treatment option for patients with idiopathic pulmonary fibrosis. FUNDING InterMune.
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Affiliation(s)
- Paul W Noble
- Duke University School of Medicine, Durham, NC 27710, USA.
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du Bois RM, Weycker D, Albera C, Bradford WZ, Costabel U, Kartashov A, Lancaster L, Noble PW, Sahn SA, Szwarcberg J, Thomeer M, Valeyre D, King TE. Six-minute-walk test in idiopathic pulmonary fibrosis: test validation and minimal clinically important difference. Am J Respir Crit Care Med 2010; 183:1231-7. [PMID: 21131468 DOI: 10.1164/rccm.201007-1179oc] [Citation(s) in RCA: 291] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE The 6-minute-walk test (6MWT) is a practical and clinically meaningful measure of exercise tolerance with favorable performance characteristics in various cardiac and pulmonary diseases. Performance characteristics in patients with idiopathic pulmonary fibrosis (IPF) have not been systematically evaluated. OBJECTIVES To assess the reliability, validity, and responsiveness of the 6MWT and estimate the minimal clinically important difference (MCID) in patients with IPF. METHODS The study population included all subjects completing a 6MWT in a clinical trial evaluating interferon gamma-1b (n = 822). Six-minute walk distance (6MWD) and other parameters were measured at baseline and at 24-week intervals using a standardized protocol. Parametric and distribution-independent correlation coefficients were used to assess the strength of the relationships between 6MWD and measures of pulmonary function, dyspnea, and health-related quality of life. Both distribution-based and anchor-based methods were used to estimate the MCID. MEASUREMENTS AND MAIN RESULTS Comparison of two proximal measures of 6MWD (mean interval, 24 d) demonstrated good reliability (coefficient = 0.83; P < 0.001). 6MWD was weakly correlated with measures of physiologic function and health-related quality of life; however, values were consistently and significantly lower for patients with the poorest functional status, suggesting good construct validity. Importantly, change in 6MWD was highly predictive of mortality; a 24-week decline of greater than 50 m was associated with a fourfold increase in risk of death at 1 year (hazard ratio, 4.27; 95% confidence interval, 2.57- 7.10; P < 0.001). The estimated MCID was 24-45 m. CONCLUSIONS The 6MWT is a reliable, valid, and responsive measure of disease status and a valid endpoint for clinical trials in IPF.
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Affiliation(s)
- Roland M du Bois
- National Heart & Lung Institute, Imperial College, London, United Kingdom.
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King TE, Albera C, Bradford WZ, Costabel U, Hormel P, Lancaster L, Noble PW, Sahn SA, Szwarcberg J, Thomeer M, Valeyre D, du Bois RM. Effect of interferon gamma-1b on survival in patients with idiopathic pulmonary fibrosis (INSPIRE): a multicentre, randomised, placebo-controlled trial. Lancet 2009; 374:222-8. [PMID: 19570573 DOI: 10.1016/s0140-6736(09)60551-1] [Citation(s) in RCA: 364] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis is a fatal disease for which no effective treatment exists. We assessed whether treatment with interferon gamma-1b improved survival compared with placebo in patients with idiopathic pulmonary fibrosis and mild-to-moderate impairment of pulmonary function. METHODS 826 patients with idiopathic pulmonary fibrosis were enrolled from 81 centres in seven European countries, the USA, and Canada. Patients were randomly assigned (double-blind) in a 2:1 ratio to receive 200 microg interferon gamma-1b (n=551) or equivalent placebo (n=275) subcutaneously, three times per week. Eligible patients were aged 40-79 years, had been diagnosed in the past 48 months, had a forced vital capacity of 55-90% of the predicted value, and a haemoglobin-corrected carbon monoxide diffusing capacity of 35-90% of the predicted value. The primary endpoint was overall survival time from randomisation measured at the second interim analysis, when the proportion of deaths had reached 75% of those expected by the study conclusion. This study is registered with ClinicalTrials.gov, number NCT00075998. FINDINGS At the second interim analysis, the hazard ratio for mortality in patients on interferon gamma-1b showed absence of minimum benefit compared with placebo (1.15, 95% CI 0.77-1.71, p=0.497), and indicated that the study should be stopped. After a median duration of 64 weeks (IQR 41-84) on treatment, 80 (15%) patients on interferon gamma-1b and 35 (13%) on placebo had died. Almost all patients reported at least one adverse event, and more patients on interferon gamma-1b group had constitutional signs and symptoms (influenza-like illness, fatigue, fever, and chills) than did those on placebo. Occurrence of serious adverse events (eg, pneumonia, respiratory failure) was similar for both treatment groups. Treatment adherence was good and few patients discontinued treatment prematurely in either group. INTERPRETATION We cannot recommend treatment with interferon gamma-1b since the drug did not improve survival for patients with idiopathic pulmonary fibrosis, which refutes previous findings from subgroup analyses of survival in studies of patients with mild-to-moderate physiological impairment of pulmonary function. FUNDING InterMune.
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Affiliation(s)
- Talmadge E King
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143-0120, USA.
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King TE, Behr J, Brown KK, du Bois RM, Lancaster L, de Andrade JA, Stähler G, Leconte I, Roux S, Raghu G. BUILD-1: a randomized placebo-controlled trial of bosentan in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2007; 177:75-81. [PMID: 17901413 DOI: 10.1164/rccm.200705-732oc] [Citation(s) in RCA: 355] [Impact Index Per Article: 20.9] [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: 02/03/2023] Open
Abstract
RATIONALE Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal lung disease lacking effective treatment. OBJECTIVES To determine the effects of bosentan on exercise capacity and time to disease progression in patients with IPF. METHODS In a double-blind, multicenter trial, patients with IPF were randomized to receive oral bosentan 62.5 mg twice daily for 4 weeks, increased to 125 mg twice daily thereafter, or placebo, for 12 months or longer. The primary efficacy endpoint was change from baseline up to Month 12 in exercise capacity, as measured by a modified six-minute-walk test. Secondary endpoints were time to death or disease progression (worsening pulmonary function tests [PFTs] or acute decompensation), change in PFT scores, and quality of life (QOL) assessed using Short-Form 36 and St. George's Respiratory Questionnaire. MEASUREMENTS AND MAIN RESULTS A total of 158 patients randomly received bosentan (n = 74) or placebo (n = 84). Bosentan showed no superiority over placebo in six-minute-walk distance (6MWD) up to Month 12, the primary efficacy endpoint. A trend in favor of bosentan was observed in the secondary endpoint of time to death or disease progression (hazard ratio [HR], 0.613; 95% confidence interval [CI], 0.328-1.144; P = 0.119), which was more pronounced in a patient subgroup diagnosed using surgical lung biopsy (post hoc analysis; HR, 0.315; 95% CI, 0.126-0.789; P = 0.009). Changes from baseline up to Month 12 in assessments of dyspnea and QOL favored treatment with bosentan. No unexpected adverse events were reported. CONCLUSIONS Bosentan treatment in patients with IPF did not show superiority over placebo on 6MWD. A trend in delayed time to death or disease progression, and improvement in QOL, was observed with bosentan. The more pronounced treatment effect in patients with biopsy-proven IPF warrants further investigation. Clinical trial registered with www.clinicaltrials.gov (NCT 00071461).
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Affiliation(s)
- Talmadge E King
- Department of Medicine, UCSF, 505 Parnassus Avenue, Room M994, San Francisco, CA 94110, USA.
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Noller HF, Yusupov MM, Yusupova GZ, Baucom A, Lieberman K, Lancaster L, Dallas A, Fredrick K, Earnest TN, Cate JH. Structure of the ribosome at 5.5 A resolution and its interactions with functional ligands. Cold Spring Harb Symp Quant Biol 2003; 66:57-66. [PMID: 12762008 DOI: 10.1101/sqb.2001.66.57] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- H F Noller
- Center for Molecular Biology of RNA, Sinsheimer Laboratories, University of California at Santa Cruz, California 95064, USA
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Lancaster L, Culver GM, Yusupova GZ, Cate JH, Yusupov MM, Noller HF. The location of protein S8 and surrounding elements of 16S rRNA in the 70S ribosome from combined use of directed hydroxyl radical probing and X-ray crystallography. RNA 2000; 6:717-729. [PMID: 10836793 PMCID: PMC1369952 DOI: 10.1017/s1355838200000303] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Ribosomal protein S8, which is essential for the assembly of the central domain of 16S rRNA, is one of the most thoroughly studied RNA-binding proteins. To map its surrounding RNA in the ribosome, we carried out directed hydroxyl radical probing of 16S rRNA using Fe(II) tethered to nine different positions on the surface of protein S8 in 70S ribosomes. Hydroxyl radical-induced cleavage was observed near the classical S8-binding site in the 620 stem, and flanking the other S8-footprinted regions of the central domain at the three-helix junction near position 650 and the 825 and 860 stems. In addition, cleavage near the 5' terminus of 16S rRNA, in the 300 region of its 5' domain, and in the 1070 region of its 3'-major domain provide information about the proximity to S8 of RNA elements not directly involved in its binding. These data, along with previous footprinting and crosslinking results, allowed positioning of protein S8 and its surrounding RNA elements in a 7.8-A map of the Thermus thermophilus 70S ribosome. The resulting model is in close agreement with the extensive body of data from previous studies using protein-protein and protein-RNA crosslinking, chemical and enzymatic footprinting, and genetics.
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Affiliation(s)
- L Lancaster
- Center for Molecular Biology of RNA, Sinsheimer Laboratories, University of California, Santa Cruz 95064, USA
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