1
|
Ivanova A, Israel E, LaVange LM, Peters MC, Denlinger LC, Moore WC, Bacharier LB, Marquis MA, Gotman NM, Kosorok MR, Tomlinson C, Mauger DT, Georas SN, Wright RJ, Noel P, Rosner GL, Akuthota P, Billheimer D, Bleecker ER, Cardet JC, Castro M, DiMango EA, Erzurum SC, Fahy JV, Fajt ML, Gaston BM, Holguin F, Jain S, Kenyon NJ, Krishnan JA, Kraft M, Kumar R, Liu MC, Ly NP, Moy JN, Phipatanakul W, Ross K, Smith LJ, Szefler SJ, Teague WG, Wechsler ME, Wenzel SE, White SR. The precision interventions for severe and/or exacerbation-prone asthma (PrecISE) adaptive platform trial: statistical considerations. J Biopharm Stat 2020; 30:1026-1037. [PMID: 32941098 PMCID: PMC7954787 DOI: 10.1080/10543406.2020.1821705] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 07/13/2020] [Accepted: 08/17/2020] [Indexed: 12/24/2022]
Abstract
The Precision Interventions for Severe and/or Exacerbation-prone Asthma (PrecISE) study is an adaptive platform trial designed to investigate novel interventions to severe asthma. The study is conducted under a master protocol and utilizes a crossover design with each participant receiving up to five interventions and at least one placebo. Treatment assignments are based on the patients' biomarker profiles and precision health methods are incorporated into the interim and final analyses. We describe key elements of the PrecISE study including the multistage adaptive enrichment strategy, early stopping of an intervention for futility, power calculations, and the primary analysis strategy.
Collapse
Affiliation(s)
| | - Elliot Israel
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Patricia Noel
- Division of Lung Diseases, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD
| | | | - Praveen Akuthota
- Asthma and Airway Disease Research Center, University of Arizona, Tucson
| | - Dean Billheimer
- Asthma and Airway Disease Research Center, University of Arizona, Tucson
| | | | | | | | | | | | | | - Merritt L. Fajt
- Wells Center for Pediatric Research, Indiana University, Indianapolis
| | | | | | | | | | - Jerry A. Krishnan
- Asthma and Airway Disease Research Center, University of Arizona, Tucson
| | | | | | | | - Ngoc P. Ly
- Rush University Medical Center, Chicago, IL
| | - James N. Moy
- Boston Children’s Hospital and Harvard Medical School, Boston, MA
| | - Wanda Phipatanakul
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Kristie Ross
- UH Rainbow Babies and Children’s Hospitals, Cleveland, OH
| | | | - Stanley J. Szefler
- Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, CO
| | | | | | - Sally E. Wenzel
- National Jewish Health, Denver, CO, and University of Colorado School of Medicine, Aurora, CO
| | | |
Collapse
|
2
|
Schirmer M, Denson L, Vlamakis H, Franzosa EA, Thomas S, Gotman NM, Rufo P, Baker SS, Sauer C, Markowitz J, Pfefferkorn M, Oliva-Hemker M, Rosh J, Otley A, Boyle B, Mack D, Baldassano R, Keljo D, LeLeiko N, Heyman M, Griffiths A, Patel AS, Noe J, Kugathasan S, Walters T, Huttenhower C, Hyams J, Xavier RJ. Compositional and Temporal Changes in the Gut Microbiome of Pediatric Ulcerative Colitis Patients Are Linked to Disease Course. Cell Host Microbe 2018; 24:600-610.e4. [PMID: 30308161 PMCID: PMC6277984 DOI: 10.1016/j.chom.2018.09.009] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [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: 03/19/2018] [Revised: 06/28/2018] [Accepted: 09/03/2018] [Indexed: 12/11/2022]
Abstract
Evaluating progression risk and determining optimal therapy for ulcerative colitis (UC) is challenging as many patients exhibit incomplete responses to treatment. As part of the PROTECT (Predicting Response to Standardized Colitis Therapy) Study, we evaluated the role of the gut microbiome in disease course for 405 pediatric, new-onset, treatment-naive UC patients. Patients were monitored for 1 year upon treatment initiation, and microbial taxonomic composition was analyzed from fecal samples and rectal biopsies. Depletion of core gut microbes and expansion of bacteria typical of the oral cavity were associated with baseline disease severity. Remission and refractory disease were linked to species-specific temporal changes that may be implicative of therapy efficacy, and a pronounced increase in microbiome variability was observed prior to colectomy. Finally, microbial associations with disease-associated serological markers suggest host-microbial interactions in UC. These insights will help improve existing treatments and develop therapeutic approaches guiding optimal medical care.
Collapse
Affiliation(s)
- Melanie Schirmer
- The Broad Institute of MIT and Harvard, Infectious Disease and Microbiome, Cambridge, MA 02142, USA; Harvard T.H. Chan School of Public Health, Biostatistics Department, Boston, MA 02115, USA
| | - Lee Denson
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Hera Vlamakis
- The Broad Institute of MIT and Harvard, Infectious Disease and Microbiome, Cambridge, MA 02142, USA; Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Molecular Biology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Eric A Franzosa
- The Broad Institute of MIT and Harvard, Infectious Disease and Microbiome, Cambridge, MA 02142, USA; Harvard T.H. Chan School of Public Health, Biostatistics Department, Boston, MA 02115, USA
| | - Sonia Thomas
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina, Chapel Hill, NC 27516, USA; RTI International, Biostatistics and Epidemiology Division, Research Triangle Park, NC 27709, USA
| | - Nathan M Gotman
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina, Chapel Hill, NC 27516, USA
| | - Paul Rufo
- Children's Hospital Boston, Boston, MA 02115, USA
| | - Susan S Baker
- Women and Children's Hospital of Buffalo WCHOB, Buffalo, NY 14222, USA
| | - Cary Sauer
- Emory Children's Center, Atlanta, GA 30322, USA
| | - James Markowitz
- Cohen Children's Medical Center, Pediatric Gastroenterology, New York, NY 11040, USA
| | - Marian Pfefferkorn
- Riley Children's Hospital Indiana University, School of Medicine, Section of Gastroenterology/Hepatology/Nutrition, Indianapolis, IN 46202, USA
| | - Maria Oliva-Hemker
- Johns Hopkins Children's Center, Department of Pediatrics, Baltimore, MD 21287, USA
| | - Joel Rosh
- Goryeb Children's Hospital/Atlantic Health, Pediatric Gastroenterology, Morristown, NJ 07960, USA
| | - Anthony Otley
- IWK Health Centre, Division of Gastroenterology and Nutrition, Halifax, NS B3K 6R8, Canada
| | - Brendan Boyle
- Nationwide Children's Hospital, Pediatrics, Columbus, OH 43205, USA
| | - David Mack
- Children's Hospital of Eastern Ontario and University of Ottawa, Department of Pediatrics, Ottawa, ON K1H 8L1, Canada
| | - Robert Baldassano
- Children's Hospital of Philadelphia CHOP, Pediatric Gastroenterologist, Philadelphia, PA 19104, USA
| | - David Keljo
- UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, Pittsburgh, PA 15224, USA
| | - Neal LeLeiko
- Hasbro Children's Hospital, Pediatric Gastroenterology, Providence, RI 02903, USA
| | - Melvin Heyman
- University of California at San Francisco, Pediatric Gastroenterology, San Francisco, CA 94158, USA
| | - Anne Griffiths
- Sickkids Hospital, University of Toronto, Gastroenterology, Hepatology and Nutrition, Toronto, ON M5G 1X8, Canada
| | - Ashish S Patel
- UT Southwestern, Department of Pediatrics, Dallas, TX 75390, USA
| | - Joshua Noe
- Medical College of Wisconsin, Gastroenterology, Milwaukee, WI 53226, USA
| | | | - Thomas Walters
- Sickkids Hospital, University of Toronto, Gastroenterology, Hepatology and Nutrition, Toronto, ON M5G 1X8, Canada
| | - Curtis Huttenhower
- The Broad Institute of MIT and Harvard, Infectious Disease and Microbiome, Cambridge, MA 02142, USA; Harvard T.H. Chan School of Public Health, Biostatistics Department, Boston, MA 02115, USA
| | - Jeffrey Hyams
- Connecticut Children's Medical Center, Division of Digestive Diseases, Hartford, CT 06106, USA
| | - Ramnik J Xavier
- The Broad Institute of MIT and Harvard, Infectious Disease and Microbiome, Cambridge, MA 02142, USA; Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, MA 02114, USA; Gastrointestinal Unit and Center for the Study of Inflammatory Bowel Disease, Massachusetts General Hospital, Boston, MA 02114, USA; Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Molecular Biology, Massachusetts General Hospital, Boston, MA 02114, USA.
| |
Collapse
|
3
|
Meyer ML, Gotman NM, Soliman EZ, Whitsel EA, Arens R, Cai J, Daviglus ML, Denes P, González HM, Moreiras J, Talavera GA, Heiss G. Association of glucose homeostasis measures with heart rate variability among Hispanic/Latino adults without diabetes: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Cardiovasc Diabetol 2016; 15:45. [PMID: 26983644 PMCID: PMC4793505 DOI: 10.1186/s12933-016-0364-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 03/09/2016] [Indexed: 12/28/2022] Open
Abstract
Background Reduced heart rate variability (HRV), a measure of cardiac autonomic function, is associated with an increased risk of cardiovascular disease (CVD) and mortality. Glucose homeostasis measures are associated with reduced cardiac autonomic function among those with diabetes, but inconsistent associations have been reported among those without diabetes. This study aimed to examine the association of glucose homeostasis measures with cardiac autonomic function among diverse Hispanic/Latino adults without diabetes. Methods The Hispanic community Health Study/Study of Latinos (HCHS/SOL; 2008–2011) used two-stage area probability sampling of households to enroll 16,415 self-identified Hispanics/Latinos aged 18–74 years from four USA communities. Resting, standard 12-lead electrocardiogram recordings were used to estimate the following ultrashort-term measures of HRV: RR interval (RR), standard deviation of all normal to normal RR (SDNN) and root mean square of successive differences in RR intervals (RMSSD). Multivariable regression analysis was used to estimate associations between glucose homeostasis measures with HRV using data from 11,994 adults without diabetes (mean age 39 years; 52 % women). Results Higher fasting glucose was associated with lower RR, SDNN, and RMSSD. Fasting insulin and the homeostasis model assessment of insulin resistance was negatively associated with RR, SDNN, and RMSSD, and the association was stronger among men compared with women. RMSSD was, on average, 26 % lower in men with higher fasting insulin and 29 % lower in men with lower insulin resistance; for women, the corresponding estimates were smaller at 4 and 9 %, respectively. Higher glycated hemoglobin was associated with lower RR, SDNN, and RMSSD in those with abdominal adiposity, defined by sex-specific cut-points for waist circumference, after adjusting for demographics and medication use. There were no associations between glycated hemoglobin and HRV measures among those without abdominal adiposity. Conclusions Impairment in glucose homeostasis was associated with lower HRV in Hispanic/Latino adults without diabetes, most prominently in men and individuals with abdominal adiposity. These results suggest that reduced cardiac autonomic function is associated with metabolic impairments before onset of overt diabetes in certain subgroups, offering clues for the pathophysiologic processes involved as well as opportunity for identification of those at high risk before autonomic control is manifestly impaired.
Collapse
Affiliation(s)
- Michelle L Meyer
- University of North Carolina at Chapel Hill, 137 E. Franklin St, Suite 306, Chapel Hill, NC, 27514, USA.
| | - Nathan M Gotman
- University of North Carolina at Chapel Hill, 137 E. Franklin St, Suite 306, Chapel Hill, NC, 27514, USA
| | | | - Eric A Whitsel
- University of North Carolina at Chapel Hill, 137 E. Franklin St, Suite 306, Chapel Hill, NC, 27514, USA
| | - Raanan Arens
- Division of Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jianwen Cai
- University of North Carolina at Chapel Hill, 137 E. Franklin St, Suite 306, Chapel Hill, NC, 27514, USA
| | - Martha L Daviglus
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | | | | | | | | | - Gerardo Heiss
- University of North Carolina at Chapel Hill, 137 E. Franklin St, Suite 306, Chapel Hill, NC, 27514, USA
| |
Collapse
|
4
|
Ricardo AC, Flessner MF, Eckfeldt JH, Eggers PW, Franceschini N, Go AS, Gotman NM, Kramer HJ, Kusek JW, Loehr LR, Melamed ML, Peralta CA, Raij L, Rosas SE, Talavera GA, Lash JP. Prevalence and Correlates of CKD in Hispanics/Latinos in the United States. Clin J Am Soc Nephrol 2015; 10:1757-66. [PMID: 26416946 DOI: 10.2215/cjn.02020215] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 07/13/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES The prevalence of ESRD among Hispanics/Latinos is 2-fold higher than in non-Hispanic whites. However, little is known about the prevalence of earlier stages of CKD among Hispanics/Latinos. This study estimated the prevalence of CKD in US Hispanics/Latinos. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This was a cross-sectional study of 15,161 US Hispanic/Latino adults of Cuban, Dominican, Mexican, Puerto Rican, Central American, and South American backgrounds enrolled in the multicenter, prospective, population-based Hispanic Community Health Study/Study of Latinos (HCHS/SOL). In addition, the prevalence of CKD in Hispanics/Latinos was compared with other racial/ethnic groups in the 2007-2010 National Health and Nutrition Examination Survey (NHANES). Prevalent CKD was defined as an eGFR <60 ml/min per 1.73 m(2) (estimated with the 2012 Chronic Kidney Disease Epidemiology Collaboration eGFR creatinine-cystatin C equation) or albuminuria based on sex-specific cut points determined at a single point in time. RESULTS The overall prevalence of CKD among Hispanics/Latinos was 13.7%. Among women, the prevalence of CKD was 13.0%, and it was lowest in persons with South American background (7.4%) and highest (16.6%) in persons with Puerto Rican background. In men, the prevalence of CKD was 15.3%, and it was lowest (11.2%) in persons with South American background and highest in those who identified their Hispanic background as "other" (16.0%). The overall prevalence of CKD was similar in HCHS/SOL compared with non-Hispanic whites in NHANES. However, prevalence was higher in HCHS/SOL men and lower in HCHS/SOL women versus NHANES non-Hispanic whites. Low income, diabetes mellitus, hypertension, and cardiovascular disease were each significantly associated with higher risk of CKD. CONCLUSIONS Among US Hispanic/Latino adults, there was significant variation in CKD prevalence among Hispanic/Latino background groups, and CKD was associated with established cardiovascular risk factors.
Collapse
Affiliation(s)
- Ana C Ricardo
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
| | - Michael F Flessner
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - John H Eckfeldt
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Paul W Eggers
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Nora Franceschini
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Alan S Go
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Nathan M Gotman
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Holly J Kramer
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - John W Kusek
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Laura R Loehr
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Michal L Melamed
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Carmen A Peralta
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Leopoldo Raij
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Sylvia E Rosas
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Gregory A Talavera
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - James P Lash
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| |
Collapse
|