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Lebwohl M, Merola JF, Strober B, Armstrong A, Yoshizaki A, Gisondi P, Szilagyi B, Peterson L, de Cuyper D, Cross N, Davies O, Gottlieb AB. Bimekizumab safety in moderate to severe plaque psoriasis: Rates of hepatic events and changes in liver parameters over 2 years in randomized phase 3/3b trials. J Am Acad Dermatol 2024:S0190-9622(24)00568-1. [PMID: 38588819 DOI: 10.1016/j.jaad.2024.03.041] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/23/2024] [Accepted: 03/12/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Patients with psoriasis are at increased risk of liver function abnormalities. OBJECTIVE Explore rates of hepatic treatment-emergent adverse events (TEAEs) and changes in liver parameters in bimekizumab-treated patients with psoriasis. METHODS Data are reported from five phase 3/3b trials over 2 years. Hepatic TEAEs, laboratory elevations in alanine aminotransferase (ALT) or aspartate aminotransferase (AST), and changes in clinical markers of liver fibrosis (Fibrosis-4 [FIB-4] Index and AST to Platelet Ratio Index [APRI]) are reported. TEAEs are presented using exposure-adjusted incidence rates (EAIRs) per 100 patient-years (PY). RESULTS 2,186 patients received ≥1 bimekizumab dose. Over 2 years, the EAIR of hepatic TEAEs was 3.5/100 PY and did not increase from first to second year. 2-year EAIRs of ALT/AST elevations >3x and >5x ULN were 2.3 and 0.6/100 PY; rates were similar to placebo, adalimumab, secukinumab, and ustekinumab during controlled study periods. FIB-4 and APRI scores did not increase through 2 years, regardless of fibrosis risk at baseline. LIMITATIONS Obesity, diabetes, dyslipidemia, chronic alcohol consumption, and medication changes are confounding factors for hepatic dysfunction. CONCLUSION Rates of hepatic adverse events with bimekizumab were consistent through 2 years; incidences of transaminase elevations were similar to comparators during phase 3/3b controlled study periods.
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Affiliation(s)
- Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA;.
| | - Joseph F Merola
- Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Bruce Strober
- Department of Dermatology, Yale University, New Haven, Connecticut, USA;; Central Connecticut Dermatology Research, Cromwell, Connecticut, USA
| | - April Armstrong
- University of California Los Angeles (UCLA), Los Angeles, California, USA
| | - Ayumi Yoshizaki
- Department of Dermatology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan;; Department of Clinical Cannabinoid Research, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | | | | | | | - Nancy Cross
- UCB Pharma, Morrisville, North Carolina, USA
| | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Gordon KB, Langley RG, Warren RB, Okubo Y, Rosmarin D, Lebwohl M, Peterson L, Madden C, de Cuyper D, Davies O, Thaçi D. Bimekizumab safety in patients with moderate-to-severe plaque psoriasis: pooled data from up to 3 years of treatment in randomized phase III trials. Br J Dermatol 2024; 190:477-485. [PMID: 37950894 DOI: 10.1093/bjd/ljad429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/16/2023] [Accepted: 10/29/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Patients with psoriasis require long-term management; therefore, understanding the long-term safety of new treatments, such as bimekizumab (BKZ), is crucial. OBJECTIVES To evaluate BKZ's 3-year safety profile in patients with moderate-to-severe plaque psoriasis. METHODS Three years of safety data were pooled from three phase III trials (BE VIVID, BE READY and BE SURE) and their ongoing open-label extension (BE BRIGHT). Treatment-emergent adverse events (TEAEs) are reported using exposure-adjusted incidence rates (EAIRs) per 100 patient-years (PY). RESULTS In total, 1495 patients received at least one BKZ dose; total BKZ exposure was 3876.4 PY. The overall EAIR of TEAEs was 175.5/100 PY and decreased with longer exposure to BKZ. The most commonly reported TEAEs were nasopharyngitis, oral candidiasis and upper respiratory tract infection (EAIRs of 15.0/100 PY, 10.1/100 PY and 6.5/100 PY, respectively); 99.3% of oral candidiasis events were mild or moderate in severity, none were serious and few led to discontinuation. EAIRs of other TEAEs of interest were low, including serious infections (1.2/100 PY), adjudicated inflammatory bowel disease (0.2/100 PY) and laboratory elevations in aspartate aminotransferase or alanine aminotransferase (> 5 × upper limit of normal: 0.6/100 PY). CONCLUSIONS In these analyses pooled across 3 years, no new safety signals were observed with longer exposure to BKZ. The vast majority of oral candidiasis events were mild or moderate in severity, as reported previously.
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Affiliation(s)
| | | | - Richard B Warren
- Dermatology Centre, Northern Care Alliance NHS Foundation Trust, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - David Rosmarin
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | - Diamant Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
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Blauvelt A, Armstrong A, Merola JF, Strober B, de Cuyper D, Peterson L, Davies O, Stark JL, Lebwohl M. Mental health outcomes in patients with moderate to severe psoriasis treated with bimekizumab: Analysis of phase 2/3 randomized trials. J Am Acad Dermatol 2024:S0190-9622(24)00438-9. [PMID: 38447700 DOI: 10.1016/j.jaad.2024.02.039] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/08/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Patients with psoriasis have increased risk of suicidal ideation and behavior (SIB) and depression. Bimekizumab, a biologic that inhibits interleukin (IL)-17A and IL-17F, received Food and Drug Administration approval in 2023 for moderate to severe plaque psoriasis, following 2021 European Medicines Agency approval. OBJECTIVE To report SIB and depression in patients with moderate to severe psoriasis treated in bimekizumab clinical trials. METHODS Mental health changes, including neuropsychiatric events, were actively monitored across 9 bimekizumab clinical trials in psoriasis phase 2/3 trials. The patient-reported electronic Columbia-Suicide Severity Rating Scale (measuring SIB) and Patient Health Questionnaire-9 (measuring depression) were administered, monitored by an independent Neuropsychiatric Adjudication Committee. RESULTS Throughout 7166 patient-years (PY) of bimekizumab exposure, the adjudicated SIB rate was 0.13/100PY; SIB ranges for the general psoriasis population and patients receiving anti-IL-17A/anti-IL-23 therapies are 0.09 to 0.54/100PY and 0.09 to 0.19/100PY, respectively. At week 16, 92.9% vs 81.1% of bimekizumab- vs placebo-treated patients had no/minimal depression. Newonset positive electronic Columbia-Suicide Severity Rating Scale responses and mean Patient Health Questionnaire-9 scores were low for bimekizumab-treated patients. LIMITATIONS Patient exclusion for significant/severe prespecified SIB/depression history. CONCLUSION The long-term adjudicated SIB rate with bimekizumab was low and within ranges reported in the general psoriasis patient population and psoriasis patients treated with anti-IL-17A/anti-IL-23 biologics. Screening/monitoring questionnaires reported low SIB and depression levels.
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Affiliation(s)
| | - April Armstrong
- University of California Los Angeles (UCLA), Los Angeles, California
| | - Joseph F Merola
- Division of Rheumatology, Departments of Dermatology and Medicine, Division of Rheumatology, Departments of Dermatology and Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Bruce Strober
- Department of Dermatology, Yale University, New Haven, Connecticut; Central Connecticut Dermatology Research, Cromwell, Connecticut
| | | | | | | | | | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
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Mebarek S, Buchet R, Pikula S, Strzelecka-Kiliszek A, Brizuela L, Corti G, Collacchi F, Anghieri G, Magrini A, Ciancaglini P, Millan JL, Davies O, Bottini M. Do Media Extracellular Vesicles and Extracellular Vesicles Bound to the Extracellular Matrix Represent Distinct Types of Vesicles? Biomolecules 2023; 14:42. [PMID: 38254642 PMCID: PMC10813234 DOI: 10.3390/biom14010042] [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: 11/16/2023] [Revised: 12/15/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
Mineralization-competent cells, including hypertrophic chondrocytes, mature osteoblasts, and osteogenic-differentiated smooth muscle cells secrete media extracellular vesicles (media vesicles) and extracellular vesicles bound to the extracellular matrix (matrix vesicles). Media vesicles are purified directly from the extracellular medium. On the other hand, matrix vesicles are purified after discarding the extracellular medium and subjecting the cells embedded in the extracellular matrix or bone or cartilage tissues to an enzymatic treatment. Several pieces of experimental evidence indicated that matrix vesicles and media vesicles isolated from the same types of mineralizing cells have distinct lipid and protein composition as well as functions. These findings support the view that matrix vesicles and media vesicles released by mineralizing cells have different functions in mineralized tissues due to their location, which is anchored to the extracellular matrix versus free-floating.
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Affiliation(s)
- Saida Mebarek
- Institut de Chimie et Biochimie Moléculaires et Supramoléculaires, UMR CNRS 5246, Université de Lyon, Université Claude Bernard Lyon 1, 69 622 Villeurbanne Cedex, France; (R.B.); (L.B.)
| | - Rene Buchet
- Institut de Chimie et Biochimie Moléculaires et Supramoléculaires, UMR CNRS 5246, Université de Lyon, Université Claude Bernard Lyon 1, 69 622 Villeurbanne Cedex, France; (R.B.); (L.B.)
| | - Slawomir Pikula
- Laboratory of Biochemistry of Lipids, Nencki Institute of Experimental Biology, Polish Academy of Sciences, 3 Pasteur Street, 02-093 Warsaw, Poland; (S.P.); (A.S.-K.)
| | - Agnieszka Strzelecka-Kiliszek
- Laboratory of Biochemistry of Lipids, Nencki Institute of Experimental Biology, Polish Academy of Sciences, 3 Pasteur Street, 02-093 Warsaw, Poland; (S.P.); (A.S.-K.)
| | - Leyre Brizuela
- Institut de Chimie et Biochimie Moléculaires et Supramoléculaires, UMR CNRS 5246, Université de Lyon, Université Claude Bernard Lyon 1, 69 622 Villeurbanne Cedex, France; (R.B.); (L.B.)
| | - Giada Corti
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (G.C.); (F.C.)
| | - Federica Collacchi
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (G.C.); (F.C.)
| | - Genevieve Anghieri
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE113TU, UK; (G.A.); (O.D.)
| | - Andrea Magrini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Pietro Ciancaglini
- Departamento de Química, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto 14040-901, São Paulo, Brazil;
| | - Jose Luis Millan
- Sanford Children’s Health Research Center, Sanford Burnham Prebys, La Jolla, CA 92037, USA;
| | - Owen Davies
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE113TU, UK; (G.A.); (O.D.)
| | - Massimo Bottini
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (G.C.); (F.C.)
- Sanford Children’s Health Research Center, Sanford Burnham Prebys, La Jolla, CA 92037, USA;
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FitzGerald O, Behrens F, Barton A, Bertheussen H, Boutouyrie-Dumont B, Coates L, Davies O, de Wit M, Fagni F, Goodyear CS, Gurke R, Hahnefeld L, Huppertz C, Ioannidis V, Ibberson M, Katz A, Klippstein M, Koehm M, Korish S, Mackay S, Martin DA, O’Sullivan D, Patel K, Rueping S, Schett G, Scholich K, Schwenk JM, Siebert S, Simon D, Vivekanantham A, Pennington SR. Application of clinical and molecular profiling data to improve patient outcomes in psoriatic arthritis. Ther Adv Musculoskelet Dis 2023; 15:1759720X231192315. [PMID: 37694182 PMCID: PMC10492462 DOI: 10.1177/1759720x231192315] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/19/2023] [Indexed: 09/12/2023] Open
Abstract
Achieving a good outcome for a person with Psoriatic Arthritis (PsA) is made difficult by late diagnosis, heterogenous clinical disease expression and in many cases, failure to adequately suppress inflammatory disease features. Single-centre studies have certainly contributed to our understanding of disease pathogenesis, but to adequately address the major areas of unmet need, multi-partner, collaborative research programmes are now required. HIPPOCRATES is a 5-year, Innovative Medicines Initiative (IMI) programme which includes 17 European academic centres experienced in PsA research, 5 pharmaceutical industry partners, 3 small-/medium-sized industry partners and 2 patient-representative organizations. In this review, the ambitious programme of work to be undertaken by HIPPOCRATES is outlined and common approaches and challenges are identified. It is expected that, when completed, the results will ultimately allow for changes in the approaches to diagnosing, managing and treating PsA allowing for better short-term and long-term outcomes.
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Affiliation(s)
- Oliver FitzGerald
- School of Medicine, UCD Conway Institute for Biomolecular Research, University College Dublin, Ireland
| | - Frank Behrens
- Translational Rheumatology, Immunology – Inflammation Medicine, University Hospital Goethe-University, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP and Fraunhofer Cluster of Excellence Immune Mediated Diseases, Frankfurt, Germany
| | - Anne Barton
- Centre for Musculoskeletal Research, the University of Manchester, Manchester, UK
| | | | | | - Laura Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Maarten de Wit
- GRAPPA Patient Research Partner, Zaltbommel, the Netherlands
| | - Filippo Fagni
- Department of Internal Medicine 3 – Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Carl S. Goodyear
- School of Infection & Immunity, College of Medical, Veterinar & Life Sciences, University of Glasgow, Glasgow, UK
| | - Robert Gurke
- Pharmazentrum frankfurt/ZAFES, Institute of Clinical Pharmacology, Johann Wolfgang Goethe University, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP and Fraunhofer Cluster of Excellence Immune Mediated Diseases, Frankfurt, Germany
| | - Lisa Hahnefeld
- Pharmazentrum frankfurt/ZAFES, Institute of Clinical Pharmacology, Johann Wolfgang Goethe University, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP and Fraunhofer Cluster of Excellence Immune Mediated Diseases, Frankfurt, Germany
| | | | - Vassilios Ioannidis
- Vital-IT Group, SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Mark Ibberson
- Vital-IT Group, SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | | | - Maximilian Klippstein
- Translational Rheumatology, Immunology – Inflammation Medicine, University Hospital Goethe-University, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP and Fraunhofer Cluster of Excellence Immune Mediated Diseases, Frankfurt, Germany
| | - Michaela Koehm
- Translational Rheumatology, Immunology – Inflammation Medicine, University Hospital Goethe-University, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP and Fraunhofer Cluster of Excellence Immune Mediated Diseases, Frankfurt, Germany
| | | | - Sina Mackay
- Fraunhofer Institute for Intelligent Analysis and Information Systems IAIS, Sankt Augustin and Fraunhofer Cluster of Excellence Immune Mediated Diseases, Frankfurt, Germany
| | - David A. Martin
- Pfizer Immunology & Inflammation Research Unit, Cambridge, MA, USA
| | | | - Khadijah Patel
- Centre for Musculoskeletal Research, the University of Manchester, Manchester, UK
| | - Stefan Rueping
- Fraunhofer Institute for Intelligent Analysis and Information Systems IAIS, Sankt Augustin and Fraunhofer Cluster of Excellence Immune Mediated Diseases, Frankfurt, Germany
| | - Georg Schett
- Department of Internal Medicine 3 – Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Klaus Scholich
- Pharmazentrum frankfurt/ZAFES, Institute of Clinical Pharmacology, Johann Wolfgang Goethe University, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP and Fraunhofer Cluster of Excellence Immune Mediated Diseases, Frankfurt, Germany
| | - Jochen M. Schwenk
- Affinity Proteomics, Science for Life Laboratory, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Solna, Sweden
| | - Stefan Siebert
- School of Infection & Immunity, College of Medical, Veterinar & Life Sciences, University of Glasgow, Glasgow, UK
| | - David Simon
- Department of Internal Medicine 3 – Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arani Vivekanantham
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Stephen R. Pennington
- School of Medicine, UCD Conway Institute for Biomolecular Research, University College Dublin, Ireland
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Roberts E, Shirlow A, Cox A, Davies O. Multiple myeloma involving the gastrointestinal tract in an English Springer Spaniel. Vet Med Sci 2022; 8:2273-2276. [PMID: 36054812 PMCID: PMC9677411 DOI: 10.1002/vms3.927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A 10‐year‐old, entire male, English Springer Spaniel was referred for evaluation of weight loss, polyuria, polydipsia and gastrointestinal tract signs including melena/haematochezia for the previous six months. Results of serum protein electrophoresis, urine analysis, computed tomography of the thorax/abdomen, bone marrow aspiration and core biopsy, and splenic and mesenteric lymph node cytology were consistent with multiple myeloma. Endoscopically obtained gastrointestinal tract biopsies identified marked plasma cell infiltration within the duodenum, ileum and colon; immunohistochemistry showed positive labelling to MUM1 and Lambda confirming clonal plasma cell involvement. The dog entered complete clinical remission seven weeks after starting a melphalan/prednisolone protocol. The dog was euthanised 475 days after starting treatment due to cervical pain and collapse. At the time of euthanasia, blood work was not supportive of a relapse of multiple myeloma. To the authors’ knowledge, this is the first report of multiple myeloma involving the gastrointestinal tract in a dog.
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Affiliation(s)
- Emma Roberts
- Highcroft Veterinary Referrals Bristol United Kingdom
| | - Alex Shirlow
- Highcroft Veterinary Referrals Bristol United Kingdom
| | | | - Owen Davies
- Highcroft Veterinary Referrals Bristol United Kingdom
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Siegel D, Partan E, Davies O, Chamlin S, Drolet B, Mancini A, Sundaram L, Tutaj M, Frieden I, Metry D, Blei F, Lin C, Wang K, Karakikes I, Urban A, Oro A, Sobreira N. 480 The spectrum of oligogenic variants in the RAS pathway in a PHACE cohort. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.489] [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: 10/17/2022]
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Tollefson M, Davies O, Drolet B. 149 Dermatologic manifestations of PIK3CA-related Overgrowth Spectrum (PROS). J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Coates LC, Merola JF, Kavanaugh A, Mease PJ, Davies O, Irvin-Sellers O, Nurminen T, Van der Heijde D. FRI0333 ACHIEVEMENT OF VERY LOW DISEASE ACTIVITY AND REMISSION TREATMENT TARGETS IS ASSOCIATED WITH REDUCED RADIOGRAPHIC PROGRESSION IN PATIENTS WITH PSORIATIC ARTHRITIS TREATED WITH CERTOLIZUMAB PEGOL. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Several disease activity measures and thresholds have been recommended as psoriatic arthritis (PsA) treatment targets, although consensus on the most appropriate assessment tool is lacking.1Reports suggest low disease activity (LDA) and remission may be associated with minimal structural progression in PsA.2Objectives:To report the relationship between PsA disease activity and structural progression over 216 weeks’ (wks) treatment with certolizumab pegol (CZP), an Fc-free, PEGylated, tumour necrosis factor inhibitor (TNFi) that has shown long-term efficacy and safety in PsA.3Methods:Patients (pts) enrolled in RAPID-PsA (NCT01087788) with active PsA (≥3 tender joints; ≥3 swollen joints; ESR ≥28 mm/hour and/or CRP >upper limit of normal) who had failed treatment with ≥1 csDMARD were randomised 1:1:1 to CZP 200 mg every 2 wks (Q2W), CZP 400 mg every 4 wks (Q4W), or placebo (PBO). All CZP pts received CZP 400 mg at Wks 0/2/4. PBO pts were re-randomised to CZP 200 mg Q2W or 400 mg Q4W at Wk 16 or 24.3Pts were heterogenous for structural damage and disease duration at baseline. Disease activity was assessed using minimal disease activity (MDA) criteria (MDA: 5–6/7 criteria; very LDA [VLDA]: 7/7 criteria), Psoriatic Arthritis Disease Activity Score (PASDAS) (LDA: >1.9–≤3.2; remission: ≤1.9), or Disease Activity Index for Psoriatic Arthritis (DAPSA) (LDA: >4–≤14; remission: ≤4). Radiographs were read in four reading campaigns using the van der Heijde modified Total Sharp Score (mTSS) for PsA. A risk of structural progression (RSP) subgroup (baseline mTSS >median for all pts) was also assessed. Mean change from baseline (CFB) in mTSS and associations with disease activity states were estimated using a hierarchical linear mixed effects model (fixed effects: reading campaign/interactions of concurrent disease activity levels with time; random effects: pt/reading campaign nested within pt) which allowed mean mTSS trajectory, and impact of disease activity levels on this, to differ over time.Results:407/409 randomised pts were assessed for mTSS at least once. At Wk 0, mean (standard deviation) DAPSA=44.5 (22.7), PASDAS=6.0 (1.1). 3/409 (0.7%) pts reported MDA. The proportion of pts achieving remission/VLDA states increased to Wk 216, as did estimated mean mTSS. Estimated mean mTSS CFB remained low overall (0.46 at Wk 216; standard error 0.16;Figure). Across disease activity measures, remission/VLDA states were associated with mTSS estimated mean CFB ≤0 in both the overall group and RSP subgroup (Table).Conclusion:These data indicate that achievement of remission in PsA is important to prevent further structural damage, particularly in pts with pre-existing structural changes. This supports the rationale for strict disease activity targets.References:[1]Coates L. Arthritis Rheumatol 2018;70:345–55;2.Tucker LJ. Curr Rheumatol Rep 2018;20:71;3.van der Heijde D. RMD Open 2018;4:e000582.Table.Estimated mTSS (mixed effects model)mTSS estimated mean CFB (standard error)All patients(N=407)RSP(n=202)PASDASRemission-0.20 (0.25)-0.55 (0.49)LDA0.01 (0.23)-0.07 (0.47)>LDA1.31 (0.22)2.54 (0.43)DAPSARemission-0.34 (0.23)-0.67 (0.46)LDA0.40 (0.22)0.81 (0.44)>LDA1.37 (0.24)2.46 (0.48)MDAVLDA-0.40 (0.28)-0.84 (0.55)MDA0.39 (0.24)0.55 (0.48)>MDA0.89 (0.20)1.73 (0.39)mTSS estimated mean CFB: ≤0; ≤0.5; >0.5. Data to Wk 216 pooled for all pts randomised.Acknowledgments:This study was funded by UCB Pharma. Editorial services were provided by Costello Medical.Disclosure of Interests:Laura C Coates: None declared, Joseph F. Merola Consultant of: Merck, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB Pharma, Celgene, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres and LEO Pharma, Arthur Kavanaugh Grant/research support from: Abbott, Amgen, AstraZeneca, BMS, Celgene Corporation, Centocor-Janssen, Pfizer, Roche, UCB – grant/research support, Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, Owen Davies Employee of: UCB Pharma, Oscar Irvin-Sellers Employee of: UCB Pharma, Tommi Nurminen Employee of: UCB Pharma, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead Sciences, Inc., Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma; Director of Imaging Rheumatology BV
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Killington M, Davies O, Crotty M, Crane R, Pratt N, Mills K, McInnes A, Kurrle S, Cameron ID. People living in nursing care facilities who are ambulant and fracture their hips: description of usual care and an alternative rehabilitation pathway. BMC Geriatr 2020; 20:128. [PMID: 32272888 PMCID: PMC7147061 DOI: 10.1186/s12877-019-1321-x] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about treatment provided to people living in nursing care facilities (NCFs) after hospital admission for hip fracture. In addition, there are no clinical guidelines for rehabilitation and recovery following hip fracture for nursing home residents. METHODS As part of a randomised trial (SACRED trial), which investigated the efficacy of a four week in-reach rehabilitation program, data were collected which described routine care for 240 people living in 76 nursing care facilities in South Australia who fractured their hips. The in-reach rehabilitation provided to 119 intervention participants is described, including intensity, type and methods used to encourage participation in rehabilitation. Adverse events that occurred, in particular falls, are also reported. RESULTS NCF records indicated that, over the four weeks following discharge from hospital after hip fracture, 76% of patients receiving usual care had a consultation with their general practitioner. Physiotherapy was provided to 79% of patients in usual care (median of 1.96 h over the 4 weeks, which is less than 30 min each week of physiotherapy). In-reach rehabilitation was provided by the hospital team for 13 h over the 4 weeks with almost full attendance at physiotherapy sessions (median of 1 missed session, range 0-7 with a median of 14 physiotherapy sessions attended by participants, range 1-18). Experienced therapists provided a flexible approach to the rehabilitation to account for patients' dementia and associated neuropsychiatric symptoms while providing dietetic support, mobility training and education to nursing home staff. The number of falls experienced by those in the intervention group was higher compared to those in usual care (Relative Risk 1.38 (95%CI 1.04-1.84, p = 0.03). CONCLUSIONS Rehabilitation can be provided to people living in NCFs following hip fracture, even when they have moderate to severe dementia but the model needs to be flexible. Provision of rehabilitation may increase the rate of falls in this population. Further studies are required to establish the feasibility of the intervention in other long term care settings. (327 words). TRIAL REGISTRATION ACTRN12612000112864 registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR).
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Affiliation(s)
- Maggie Killington
- Flinders University, South Australia, Australia. .,Southern Adelaide Local Health Network, South Australia, Australia.
| | - Owen Davies
- Flinders University, South Australia, Australia.,Southern Adelaide Local Health Network, South Australia, Australia
| | - Maria Crotty
- Flinders University, South Australia, Australia.,Southern Adelaide Local Health Network, South Australia, Australia
| | - Rhiannon Crane
- Southern Adelaide Local Health Network, South Australia, Australia
| | - Naomi Pratt
- Southern Adelaide Local Health Network, South Australia, Australia
| | - Kylie Mills
- Southern Adelaide Local Health Network, South Australia, Australia
| | - Arabella McInnes
- Southern Adelaide Local Health Network, South Australia, Australia
| | - Susan Kurrle
- Cognitive Decline Partnership Centre, University of Sydney, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
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Purzycka K, Peters LM, Desmas I, Davies O, Chang YM, Lara-Garcia A. Clinicopathological characteristics and prognostic factors for canine multicentric non-indolent T-cell lymphoma: 107 cases. Vet Comp Oncol 2020; 18:656-663. [PMID: 32163214 DOI: 10.1111/vco.12589] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 12/25/2019] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 01/12/2023]
Abstract
Canine lymphoma, as the most common haematopoietic malignancy, encompasses a group of heterogeneous diseases and even within the T-cell immunophenotype, differences in clinical presentation and responses to treatment exist. The aim of this retrospective study was to determine outcomes and prognostic factors of 107 dogs with multicentric non-indolent T-cell lymphoma (TCL) receiving lomustine-based (70%) and non-lomustine-based (30%) treatment. The majority were Labradors, Boxers, mixed-breed dogs and Dogue de Bordeaux. Eighty-six percent were substage b, 77% had mediastinal involvement, 15% had suspected bone marrow involvement and 12% had other extra-nodal sites of disease. The overall response rate to induction therapy was 80%; dogs receiving procarbazine in the induction protocol (P = .042), dogs with neutrophil concentration below 8.7 × 10e9 /L (P = .006) and mitotic rate below 10 per 5 high power field (P = .013), had greater response rates. Median progression-free survival (PFS) for the first remission was 105 days; lack of expression of CD3 on flow cytometry (P < .0001) and pretreatment with steroid (P = .012) were significantly associated with shorter PFS. Median overall survival time (OST) was 136 days; co-expression of CD79a (P = .002), lack of CD3 expression on flow cytometry, presence of anaemia (P = .007), and monocytopenia (P = .002) were predictive of shorter OST. Multicentric non-indolent TCL in dogs is an aggressive cancer with new possible prognostic factors.
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Affiliation(s)
- Katarzyna Purzycka
- Queen Mother Hospital for Animals, Royal Veterinary College, University of London, North Mymms, UK.,Anderson Moores Veterinary Specialists, The Granary, Bunstead Barns, Winchester, UK
| | - Laureen M Peters
- Department of Pathobiology & Population Sciences, Royal Veterinary College, University of London, North Mymms, UK
| | | | | | - Yu-Mei Chang
- Research Support Office, Royal Veterinary College, London, UK
| | - Ana Lara-Garcia
- Queen Mother Hospital for Animals, Royal Veterinary College, University of London, North Mymms, UK
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Davies O, Taylor AJ. Refining the "double two-thirds" rule: Genotype-based breed grouping and clinical presentation help predict the diagnosis of canine splenic mass lesions in 288 dogs. Vet Comp Oncol 2020; 18:548-558. [PMID: 32043696 DOI: 10.1111/vco.12574] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 12/17/2022]
Abstract
Prediction of the likely histopathological diagnosis of canine splenic masses can guide appropriate decision-making. This study explores the predictive effect of breed and clinical presentation on the diagnosis of a canine splenic mass. Records from the Royal Veterinary College, United Kingdom (2007-2017) were reviewed. Dogs with a histopathologic or cytologic diagnosis from a splenic mass, or imaging findings consistent with disseminated metastatic disease, were included. Signalment, physical examination, haematology results, imaging findings and pathology reports were recorded. Breeds were grouped according to several permutations of their phenotype and then by clustering of breeds based on single nucleotide polymorphism analysis. Binary logistic regression was performed to identify predictors of malignancy and haemangiosarcoma. Two hundred and eighty-eight dogs were identified: 27% female and 63% male, 21% entire and 79% neutered; German Shepherd was the most common breed (11%). Median age was 10 years and median bodyweight 25 kg. Thirty-eight percent of dogs presented with haemoabdomen; a splenic mass was found incidentally in 28%. Sixty percent had a malignant tumour of which haemangiosarcoma comprised 66%. On multivariable analysis, genotype-based breed group (P = .004), haemoabdomen (P < .001) and neutrophil count (P = .025) predicted malignancy, and genotype-based breed group (P < .001) and haemoabdomen (P < .001) predicted haemangiosarcoma. Genotype-based breed group and occurrence of haemoabdomen may have predictive value to diagnose malignant splenic masses and more specifically haemangiosarcoma. The effect of genotype-based breed grouping was a superior predictor of the diagnosis of a canine splenic mass lesion compared with all phenotype-based groupings tested.
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Affiliation(s)
| | - Angela J Taylor
- Queen Mother Hospital for Animals, Royal Veterinary College, University of London, North Mymms, UK
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Davies O, James S. 52 A Community Cure for Frequent Reattenders: Developing An Interface Geriatrics Service. Age Ageing 2020. [DOI: 10.1093/ageing/afz186.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Topic
Setting up an interface geriatrics service in a seaside area with a large elderly population. Many elderly patients are readmitted due to the challenge of managing their chronic health conditions in the community. These patients are frail, with frequently exacerbated chronic conditions causing regular readmissions. We noted that treatment was rarely changed during these admissions and patients were not uniformly managed.
Aims
Aims for this project were to improve care for older people, reduce readmissions and produce clear patient care plans.
Interventions
Our first PDSA cycle involved implementing geriatrician presence at community MDTs (involving social services, GPs, intermediate care teams, and various others). This generated home visits to several patients, with a mix of acute and chronic issues. We offered Advance Care planning where appropriate to these patients. We noted several patients were repeatedly discussed at MDT. This brought into focus frequent attenders who were usually well-known to the community. In the next cycle we introduced ‘frequent attender’ plans for these patients, ensuring a unified approach to their management. Subsequent cycles involved geriatrician presence at the ‘frequent attenders’ steering group, and further links with community teams. Our primary intervention has been Advance care & frequent attender plans offering tailored management for complex patients. These are completed by a geriatrician discussing patients wishes for treatment and future care.
Improvements
Readmission rates show up to 90% reduction in admissions/ED attendances for patients following care plan implementation. Feedback from families and patients is positive – the service is ‘pragmatic and supportive’, delivering ‘empathetic care’.
Discussion
Implementing an interface geriatrics service highlights the importance of caring for frail patients in their preferred place of care, reducing unnecessary/inappropriate hospitalisations. Geriatrician presence at community MDTs has improved care by offering prompt access to medical advice and review of complex patients. It highlights patients presenting frequently to services, allowing us to work with patients and families to improve management. A frequent attender list generated by the hospital helps target patients for whom intervention will give significant benefit. We plan to extend this further by working with nursing homes that have high conveyancing rates. The service is being extended to more areas within our region, and we are working with GPs and care homes to further offer advance care planning to vulnerable and frail patients.
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Affiliation(s)
- O Davies
- Poole Hospital NHS Foundation Trust
| | - S James
- Poole Hospital NHS Foundation Trust
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Prior C, Pohl E, Davies O. AB Initio Tertiary Structure Prediction from Small Angle Scattering Data. Biophys J 2020. [DOI: 10.1016/j.bpj.2019.11.2666] [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: 12/01/2022] Open
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Crotty M, Killington M, Liu E, Cameron ID, Kurrle S, Kaambwa B, Davies O, Miller M, Chehade M, Ratcliffe J. Should we provide outreach rehabilitation to very old people living in Nursing Care Facilities after a hip fracture? A randomised controlled trial. Age Ageing 2019; 48:373-380. [PMID: 30794284 PMCID: PMC6503935 DOI: 10.1093/ageing/afz005] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 05/20/2018] [Revised: 12/11/2018] [Accepted: 01/22/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE to determine whether a 4-week postoperative rehabilitation program delivered in Nursing Care Facilities (NCFs) would improve quality of life and mobility compared with receiving usual care. DESIGN parallel randomised controlled trial with integrated health economic study. SETTING NCFs, in Adelaide South Australia. SUBJECTS people aged 70 years and older who were recovering from hip fracture surgery and were walking prior to hip fracture. MEASUREMENTS primary outcomes: mobility (Nursing Home Life-Space Diameter (NHLSD)) and quality of life (DEMQOL) at 4 weeks and 12 months. RESULTS participants were randomised to treatment (n = 121) or control (n = 119) groups. At 4 weeks, the treatment group had better mobility (NHLSD mean difference -1.9; 95% CI: -3.3, -0.57; P = 0.0055) and were more likely to be alive (log rank test P = 0.048) but there were no differences in quality of life. At 12 months, the treatment group had better quality of life (DEMQOL sum score mean difference = -7.4; 95% CI: -12.5 to -2.3; P = 0.0051), but there were no other differences between treatment and control groups. Quality adjusted life years (QALYs) gained over 12 months were 0.0063 higher per participant (95% CI: -0.0547 to 0.0686). The resulting incremental cost effectiveness ratios (ICERs) were $5,545 Australian dollars per unit increase in the NHLSD (95% CI: $244 to $15,159) and $328,685 per QALY gained (95% CI: $82,654 to $75,007,056). CONCLUSIONS the benefits did not persist once the rehabilitation program ended but quality of life at 12 months in survivors was slightly higher. The case for funding outreach home rehabilitation in NCFs is weak from a traditional health economic perspective. TRIAL REGISTRATION ACTRN12612000112864 registered on the Australian and New Zealand Clinical Trials Registry. Trial protocol available at https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id = 361980.
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Affiliation(s)
- Maria Crotty
- Rehabilitation, Aged and Extended Care, Flinders University, Finders Medical Centre, Level 4 Rehabilitation Building, Flinders Drive, Bedford Park SA, Australia
| | - Maggie Killington
- Rehabilitation, Aged and Extended Care, Flinders University, Finders Medical Centre, Level 4 Rehabilitation Building, Flinders Drive, Bedford Park SA, Australia
| | - Enwu Liu
- Rehabilitation, Aged and Extended Care, Flinders University, Finders Medical Centre, Level 4 Rehabilitation Building, Flinders Drive, Bedford Park SA, Australia
- Musculoskeletal Health and Ageing Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne Vic, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, University of Sydney, Royal North Shore Hospital, St Leonards NSW, Australia
| | - Susan Kurrle
- Cognitive Decline Partnership Centre, University of Sydney, Hornsby Ku-ring-gai Hospital, Hornsby NSW, Australia
| | - Billingsley Kaambwa
- Health Economics Unit, Flinders University, Health Sciences Building, Sturt Road, Bedford Park SA, Australia
| | - Owen Davies
- Rehabilitation, Aged and Extended Care, Flinders University, Finders Medical Centre, Level 4 Rehabilitation Building, Flinders Drive, Bedford Park SA, Australia
| | - Michelle Miller
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park SA, Australia
| | - Mellick Chehade
- Centre for Orthopaedic Trauma and Research, University of Adelaide, Adelaide SA, Australia
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide SA, Australia
- Centre of Research Excellence in Frailty and Healthy Ageing, University of Adelaide, Adelaide SA, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Flinders University, Sturt Road, Bedford Park SA, Australia
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Landewé R, Nurminen T, Davies O, Baeten D. A single determination of C-reactive protein does not suffice to declare a patient with a diagnosis of axial spondyloarthritis 'CRP-negative'. Arthritis Res Ther 2018; 20:209. [PMID: 30217232 PMCID: PMC6137888 DOI: 10.1186/s13075-018-1707-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/27/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To be eligible to receive treatment with an anti-tumour necrosis factor (TNF), non-radiographic axial spondyloarthritis (nr-axSpA) patients require either elevated levels of C-reactive protein (CRP) (CRP > upper limit of normal (ULN)) or magnetic resonance imaging assessment showing inflammation of the sacroiliac joints, in addition to meeting criteria for high disease activity. Many axSpA patients are classified as 'CRP-negative', or CRP normal, despite having levels close to the ULN, and are therefore formally ineligible for treatment. The aim of this study was to investigate the likelihood of a CRP test indicating elevated levels in axSpA patients that have previously tested CRP normal. METHODS RAPID-axSpA (NCT01087762) enrolled patients who were either magnetic resonance imaging positive or had elevated CRP (> ULN: 7.9 mg/L). CRP data from the double-blind period for placebo-randomised patients until re-randomisation to certolizumab pegol (week 16 for ASAS20 non-responders/week 24 for ASAS20 responders) were analysed. CRP was assessed at screening, baseline, and nine time points to week 24. Linear mixed models were used to investigate time trends, variability, and correlations of CRP data. RESULTS Of 106 placebo-randomised patients with baseline CRP assessments, 26 (25%) tested CRP normal at baseline, of whom 13 (50%) had ≥ 1 test indicating elevated CRP to week 16. Of 80/106 (75%) patients with elevated baseline CRP, 25 (31%) had ≥ 1 normal CRP test to week 16. Linear mixed models did not reveal changes in mean CRP across placebo patients from baseline to week 24. CONCLUSIONS In axSpA patients with CRP < ULN the CRP test should be repeated after ≥ 4 weeks as there is a substantial chance of finding a positive result for elevated CRP at subsequent testing, thereby allowing the patient access to treatment. TRIAL REGISTRATION ClinicalTrials.gov, NCT01087762 . Registered on 16 March 2010.
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Affiliation(s)
- Robert Landewé
- Clinical Immunology and Rheumatology, Amsterdam Rheumatology & Immunology Center and Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
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17
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Wang Y, Xiao LD, Luo Y, Xiao SY, Whitehead C, Davies O. Community health professionals' dementia knowledge, attitudes and care approach: a cross-sectional survey in Changsha, China. BMC Geriatr 2018; 18:122. [PMID: 29801476 PMCID: PMC5970511 DOI: 10.1186/s12877-018-0821-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community health professionals play a significant role in dementia care. However, little is known about community health professionals' capacity in dementia care, especially in low and middle-income countries. The aim of the present study was to assess community health professionals' dementia knowledge, attitudes and care approach in China, a country with the largest population of people with dementia in the world and where community based dementia care services are much needed. METHODS A cross-sectional survey was conducted. 450 health professionals were recruited into the study using random sampling from community health service centres in Changsha, China. Their knowledge, attitudes and care approach were assessed utilising the Chinese version of the Alzheimer's Disease Knowledge Scale, Dementia Care Attitude Scale and Approach to Advanced Dementia Care Questionnaire respectively. RESULTS A total of 390 participants returned the questionnaire (response rate 87%). Age, education, professional group and care experience were associated with knowledge scores, and overall dementia knowledge was poor. Attitudes were generally positive and influenced by age, professional group, gender and care experience. The experience of caring for people with dementia was positively associated with a person-centred care approach, although the participants tended not to use a person-centred care approach. A statistically significant association was found between knowledge and attitudes (r = 0.379, P < 0.001), and between attitudes and care approach (r = 0.143, P < 0.001). However, dementia knowledge has no relationship with a person-centred approach. CONCLUSIONS Community health professionals showed generally positive attitudes towards people with dementia. However, they demonstrated poor dementia knowledge and tended not to use a person-centred care approach. The results suggest that a multifaceted approach consisting of educational interventions for community health professionals, and policy and resource development to meet the demand for community dementia care services, is urgently needed in China.
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Affiliation(s)
- Yao Wang
- Xiang Ya School of Nursing, Central South University, Changsha, Hunan Province, China.,Xiang Ya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
| | - Yang Luo
- Xiang Ya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - Shui-Yuan Xiao
- Xiang Ya School of Public Health, Central South University, Changsha, Hunan Province, China.
| | - Craig Whitehead
- Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
| | - Owen Davies
- Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
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Abstract
Three dogs were investigated for chronic unilateral nasal discharge. In all cases CT imaging showed an intranasal mass causing turbinate lysis and no evidence of metastasis. Cytology in cases 1 (a 14-year-old neutered male crossbreed dog) and 2 (a five-year-old neutered male German Shepherd dog) demonstrated a pleomorphic cell population with variable intracellular pigment suspicious of melanocytic neoplasia. Histopathology with immunohistochemistry (Melan-A and vimentin, plus PNL-2 in one case) confirmed the diagnosis of melanoma in all dogs. All dogs were treated with megavoltage radiotherapy using linear accelerators. Cases 1 and 3 (a nine-year-old neutered female beagle dog) received a hypofractionated (4 × 8 Gy) protocol and case 2 received a definitive (12 × 4 Gy) protocol. Complete remission was demonstrated on repeat CT scan five months after diagnosis in case 1 and seven months in case 2. Stable disease was documented on CT at four months for case 3; however, clinical signs in this dog remained controlled for 10 months in total. Case 1 died of unrelated causes five months after diagnosis, case 2 was euthanased due to the development of seizures 13 months after diagnosis, and case 3 was lost to follow-up 12 months after diagnosis. Melanoma should be considered as a rare differential diagnosis for primary nasal neoplasia in the dog and radiation therapy can be used as effective local therapy.
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Affiliation(s)
- Owen Davies
- a Queen Mother Hospital for Animals, Royal Veterinary College , University of London , North Mymms , UK
| | - Sarah Spencer
- b School of Veterinary Sciences , University of Bristol , Langford , UK
| | | | - Emma Holmes
- d Department of Pathology & Infectious Diseases, Royal Veterinary College , University of London , North Mymms , UK
| | - Angela Taylor
- a Queen Mother Hospital for Animals, Royal Veterinary College , University of London , North Mymms , UK
| | - Laura Blackwood
- e Small Animal Teaching Hospital , University of Liverpool, Leahurst Campus , Neston , UK
| | - Ana Lara-Garcia
- a Queen Mother Hospital for Animals, Royal Veterinary College , University of London , North Mymms , UK
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Davies O, Szladovits B, Polton G, Garden OA, Leo C, Lara-Garcia A. Prognostic significance of clinical presentation, induction and rescue treatment in 42 cases of canine centroblastic diffuse large B-cell multicentric lymphoma in the United Kingdom. Vet Comp Oncol 2017; 16:276-287. [PMID: 29271043 DOI: 10.1111/vco.12378] [Citation(s) in RCA: 22] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 10/16/2017] [Accepted: 11/18/2017] [Indexed: 12/28/2022]
Abstract
Canine lymphoma is a heterogeneous group of diseases and many previous studies have evaluated the response of a mixed population of lymphoma cases to one specific treatment protocol. The aim of this retrospective study was to describe the outcome and prognostic factors in 42 cases of multicentric centroblastic diffuse large B-cell lymphoma treated with either a COP-type (35%) or CHOP-type (64%) induction chemotherapy. The objective response rate to induction therapy was 94%; entire dogs had a greater rate of complete vs partial remissions than neutered dogs (P = .017). Median progression-free survival for the first remission (PFS1) was 182 days; absence of anaemia at diagnosis (P = .002) and pretreatment neutrophil:lymphocyte ratio (NLR) below 9.44 (P = .015) were independently predictive of longer PFS1. Fifty-eight percent of dogs received rescue protocols with an objective response rate of 81%; 31% of dogs received further rescue protocols (up to a total of 5) and the median number of protocols administered were 2. Median overall survival (OS) was 322 days, the 1-year survival rate was 38% and the 2-year survival rate was 9%. Lymphocyte:monocyte ratio above 1.43 (P = .031), NLR below 11.44 (P = .009), the combination of induction and rescue therapy (P = .030) and the total number of doxorubicin doses used (P = .002) were independently predictive of longer OS. Use of a COP-type protocol induction compared with CHOP did not undermine OS providing doxorubicin was used as rescue therapy.
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Affiliation(s)
- O Davies
- Highcroft Veterinary Referrals, Bristol, UK
| | - B Szladovits
- Department of Pathobiology & Population Sciences, Royal Veterinary College, University of London, Hatfield, UK
| | - G Polton
- North Downs Specialist Referrals, Bletchingley, UK
| | - O A Garden
- Department of Clinical Studies - Philadelphia, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, Pennsylvania
| | - C Leo
- Istituto Veterinario di Novara, Granozzo con Monticello, Novara, Italy
| | - A Lara-Garcia
- Queen Mother Hospital for Animals, Royal Veterinary College, University of London, North Mymms, UK
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van der Heijde D, Dougados M, Landewé R, Sieper J, Maksymowych WP, Rudwaleit M, Van den Bosch F, Braun J, Mease PJ, Kivitz AJ, Walsh J, Davies O, Bauer L, Hoepken B, Peterson L, Deodhar A. Sustained efficacy, safety and patient-reported outcomes of certolizumab pegol in axial spondyloarthritis: 4-year outcomes from RAPID-axSpA. Rheumatology (Oxford) 2017; 56:1498-1509. [PMID: 28498975 PMCID: PMC5850296 DOI: 10.1093/rheumatology/kex174] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [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: 01/23/2017] [Indexed: 02/07/2023] Open
Abstract
Objective The aim was to assess the long-term safety and efficacy of certolizumab pegol over 4 years of continuous treatment in patients with axial spondyloarthritis (axSpA), including both AS and non-radiographic (nr-) axSpA. Methods RAPID-axSpA was a phase 3 randomized trial, double blind and placebo controlled to week 24, dose blind to week 48 and open label to week 204. Patients had a clinical diagnosis of axSpA, meeting Assessment of SpondyloArthritis international Society (ASAS) criteria, and had active disease. The assessed outcomes included ASAS20, ASAS40, AS DAS (ASDAS), BASDAI, BASFI and BASMI scores, along with selected measures of remission. Further patient-reported outcomes, peripheral arthritis, enthesitis, uveitis and quality-of-life measures are also reported. Results Two hundred and eighteen of 325 patients randomized (AS: 121; nr-axSpA: 97) received certolizumab pegol from week 0. Of these, 65% remained in the study at week 204 (AS: 67%; nr-axSpA: 63%). Across all outcomes, for AS and nr-axSpA, sustained improvements were observed to week 204 [week 204 overall axSpA: ASAS20: 54.1% (non-responder imputation); 83.7% (observed case, OC); ASAS40: 44.0% (non-responder imputation); 68.1% (OC); ASDAS inactive disease: 32.1% (last observation carried forward); 31.4% (OC)]. In the safety set (n = 315), there were 292.8 adverse events and 10.4 serious adverse events per 100 patient-years. No deaths were reported. Conclusion In the first study to evaluate the efficacy of an anti-TNF across both axSpA subpopulations, improvements in clinical and patient-reported outcomes at 24 and 96 weeks were sustained through 4 years of treatment, with no new safety signals. Trial registration ClinicalTrials.gov, http://clinicaltrials.gov, NCT01087762.
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Affiliation(s)
| | | | - Robert Landewé
- Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam.,Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Joachim Sieper
- Rheumatology Department, Charité - University Medicine, Berlin, Germany
| | | | - Martin Rudwaleit
- Department of Internal Medicine and Rheumatology, Klinikum Bielefeld, Bielefeld, Germany
| | | | | | - Philip J Mease
- Swedish Medical Center, University of Washington, Seattle, WA
| | - Alan J Kivitz
- Altoona Center for Clinical Research, Duncansville, PA
| | - Jessica Walsh
- Division of Rheumatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | | | | | | | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR, USA
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Rudwaleit M, Rosenbaum JT, Landewé R, Marzo-Ortega H, Sieper J, van der Heijde D, Davies O, Bartz H, Hoepken B, Nurminen T, Deodhar A. Observed Incidence of Uveitis Following Certolizumab Pegol Treatment in Patients With Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2017; 68:838-44. [PMID: 26815944 PMCID: PMC5089650 DOI: 10.1002/acr.22848] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 12/07/2015] [Accepted: 01/19/2016] [Indexed: 12/22/2022]
Abstract
Objective Axial spondyloarthritis (axial SpA) is characterized by inflammation of the spine and sacroiliac joints and can also affect extraarticular sites, with the most common manifestation being uveitis. Here we report the incidence of uveitis flares in axial SpA patients from the RAPID‐axSpA trial, including ankylosing spondylitis (AS) and nonradiographic (nr) axial SpA. Methods The RAPID‐axSpA (NCT01087762) trial is double‐blind and placebo‐controlled to week 24, dose‐blind to week 48, and open‐label to week 204. Patients were randomized to certolizumab pegol (CZP) or placebo. Placebo patients entering the dose‐blind phase were re‐randomized to CZP. Uveitis events were recorded on extraarticular manifestation or adverse event forms. Events were analyzed in patients with/without history of uveitis, and rates reported per 100 patient‐years. Results At baseline, 38 of 218 CZP‐randomized patients (17.4%) and 31 of 107 placebo‐randomized patients (29.0%) had past uveitis history. During the 24‐week double‐blind phase, the rate of uveitis flares was lower in CZP (3.0 [95% confidence interval (95% CI) 0.6–8.8] per 100 patient‐years) than in placebo (10.3 [95% CI 2.8–26.3] per 100 patient‐years). All cases observed during the 24‐week double‐blind phase were in patients with a history of uveitis; in these patients, rates were similarly lower for CZP (17.1 [95% CI 3.5–50.1] per 100 patient‐years) than placebo (38.5 [95% CI 10.5–98.5] per 100 patient‐years). Rates of uveitis flares remained low up to week 96 (4.9 [95% CI 3.2–7.4] per 100 patient‐years) and were similar between AS (4.4 [95% CI 2.3–7.7] per 100 patient‐years) and nr‐axial SpA (5.6 [95% CI 2.9–9.8] per 100 patient‐years). Conclusion The rate of uveitis flares was lower for axial SpA patients treated with CZP than placebo during the randomized controlled phase. Incidence of uveitis flares remained low to week 96 and was comparable to rates reported for AS patients receiving other anti–tumor necrosis factor antibodies.
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Affiliation(s)
| | - J T Rosenbaum
- Devers Eye Institute, Legacy Health System, Portland, Oregon, and Oregon Health & Science University, Portland
| | - R Landewé
- Academic Medical Center, Amsterdam and Atrium Medical Center, Heerlen, the Netherlands
| | - H Marzo-Ortega
- Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - J Sieper
- University Hospital Charité, Berlin, Germany
| | | | | | - H Bartz
- UCB Pharma, Monheim, Germany
| | | | | | - A Deodhar
- Oregon Health & Science University, Portland
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Kaambwa B, Ratcliffe J, Killington M, Liu E, Cameron I, Kurrle S, Davies O, Crotty M. IS HIP FRACTURE REHABILITATION FOR NURSING HOME RESIDENTS COST-EFFECTIVE? RESULTS FROM AN RCT. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B. Kaambwa
- Flinders Health Economics Group, Flinders University, Adelaide, South Australia, Australia,
| | - J. Ratcliffe
- Flinders Health Economics Group, Flinders University, Adelaide, South Australia, Australia,
| | - M. Killington
- Flinders Health Economics Group, Flinders University, Adelaide, South Australia, Australia,
| | - E. Liu
- Flinders Health Economics Group, Flinders University, Adelaide, South Australia, Australia,
| | - I. Cameron
- University of Sydney, Sydney, New South Wales, Australia
| | - S. Kurrle
- University of Sydney, Sydney, New South Wales, Australia
| | - O. Davies
- Flinders Health Economics Group, Flinders University, Adelaide, South Australia, Australia,
| | - M. Crotty
- Flinders Health Economics Group, Flinders University, Adelaide, South Australia, Australia,
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Ratcliffe J, Flint T, Easton T, Killington M, Cameron I, Davies O, Whitehead C, Kurrle S, Miller M, Liu E, Crotty M. An Empirical Comparison of the EQ-5D-5L, DEMQOL-U and DEMQOL-Proxy-U in a Post-Hospitalisation Population of Frail Older People Living in Residential Aged Care. Appl Health Econ Health Policy 2017; 15:399-412. [PMID: 27882528 DOI: 10.1007/s40258-016-0293-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To empirically compare the measurement properties of the DEMQOL-U and DEMQOL-Proxy-U instruments to the EQ-5D-5L and its proxy version (CEQ-5D-5L) in a population of frail older people living in residential aged care in the post-hospitalisation period following a hip fracture. METHODS A battery of instruments to measure health-related quality of life (HRQoL), cognition, and clinical indicators of depression, pain and functioning were administered at baseline and repeated at 4 weeks' follow-up. Descriptive summary statistics were produced and psychometric analyses were conducted to assess the levels of agreement, convergent validity and known group validity between clinical indicators and HRQoL measures. RESULTS There was a large divergence in mean (SD) utility scores at baseline for the EQ-5D-5L and DEMQOL-U [EQ-5D-5L mean 0.21 (0.19); DEMQOL-U mean 0.79 (0.14)]. At 4 weeks' follow-up, there was a marked improvement in EQ-5D-5L scores whereas DEMQOL-U scores had deteriorated. [EQ-5D-5L mean 0.45 (0.38); DEMQOL-U mean 0.58 (0.38)]. The EQ-5D and CEQ-5D-5L were more responsive to the physical recovery trajectory experienced by frail older people following surgery to repair a fractured hip, whereas the DEMQOL-U and DEMQOL-Proxy-U appeared more responsive to the changes in delirium and dementia symptoms often experienced by frail older people in this period. CONCLUSIONS This study presents important insights into the HRQoL of a relatively under-researched population of post-hospitalisation frail older people in residential care. Further research should investigate the implications for economic evaluation of self-complete versus proxy assessment of HRQoL and the choice of preference-based instrument for the measurement and valuation of HRQoL in older people exhibiting cognitive decline, dementia and other co-morbidities.
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Affiliation(s)
- Julie Ratcliffe
- Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, SA, Australia.
| | - Thomas Flint
- Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Tiffany Easton
- Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia
| | - Maggie Killington
- Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia
| | - Ian Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - Owen Davies
- Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia
| | - Craig Whitehead
- Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia
| | - Susan Kurrle
- John Walsh Centre for Rehabilitation Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - Michelle Miller
- Department of Nutrition and Dietetics, School of Health Sciences, Flinders University, Adelaide, Australia
| | - Enwu Liu
- Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia
| | - Maria Crotty
- Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia
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Braun J, Baraliakos X, Hermann KG, Landewé R, Machado PM, Maksymowych WP, Davies O, Hoepken B, Nurminen T, Stach C, van der Heijde D. Effect of certolizumab pegol over 96 weeks of treatment on inflammation of the spine and sacroiliac joints, as measured by MRI, and the association between clinical and MRI outcomes in patients with axial spondyloarthritis. RMD Open 2017; 3:e000430. [PMID: 28848654 PMCID: PMC5566980 DOI: 10.1136/rmdopen-2017-000430] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 01/03/2017] [Revised: 03/08/2017] [Accepted: 03/21/2017] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To report MRI outcomes and explore the relationship between clinical remission and MRI inflammation in patients with axial spondyloarthritis (axSpA) from the RAPID-axSpA trial, including radiographic (r-)axSpA and non-radiographic (nr-)axSpA. METHODS RAPID-axSpA (NCT01087762) was double-blind and placebo-controlled to week 24, dose-blind to week 48 and open-label to week 204. Patients were randomised to certolizumab pegol (CZP) or placebo. Placebo patients entering dose-blind were rerandomised to CZP. MRIs performed at baseline, weeks 12, 48 and 96 were scored by 2 reviewers independently: Spondyloarthritis Research Consortium of Canada (SPARCC) for sacroiliac (SI) joints; Berlin modification of the Ankylosing Spondylitis spine MRI scoring system for disease activity (Berlin) for spine. Inflammation thresholds: SPARCC≥2; Berlin>2. Remission thresholds: SPARCC<2 (SI joints); Berlin≤2 (spine); Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease (<1.3, clinical). RESULTS Across 163 patients in the MRI set (109 CZP; 54 placebo), week 12 mean changes from baseline in MRI scores were greater for CZP versus placebo: SPARCC: -4.8 (SD 8.6) vs -1.6 (7.8; p<0.001); Berlin: -2.9 (4.2) vs 0.2 (4.8; p<0.001). Improvements were maintained to week 96. Week 12 MRI remission was achieved by 52.6% of patients with baseline MRI inflammation in SI joints, 62.0% in the spine and 37.9% of patients with both. MRI remission rates were sustained to week 96, with similar trends in r-axSpA and nr-axSpA. At week 96, 57.5% vs 65.9% of patients achieving versus not achieving clinical remission had MRI remission. CONCLUSIONS CZP reduced inflammation in the spine and SI joints in patients with r-axSpA and nr-axSpA, with improvements maintained over 96 weeks. Substantial proportions of patients achieved MRI remission. Concordance between clinical remission and current definitions of absence of MRI inflammation was limited. TRIAL REGISTRATION NUMBER NCT01087762; Post-results.
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Affiliation(s)
| | | | | | - Robert Landewé
- Academic Medical Center Amsterdam & Atrium Medical Center Heerlen, Amsterdam, The Netherlands
| | - Pedro M Machado
- Centre for Rheumatology Research & MRC Centre for Neuromuscular Diseases, University College London, London, UK
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van der Heijde D, Deodhar A, Fleischmann R, Mease PJ, Rudwaleit M, Nurminen T, Davies O. Early Disease Activity or Clinical Response as Predictors of Long-Term Outcomes With Certolizumab Pegol in Axial Spondyloarthritis or Psoriatic Arthritis. Arthritis Care Res (Hoboken) 2016; 69:1030-1039. [PMID: 27696727 PMCID: PMC5518306 DOI: 10.1002/acr.23092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 04/05/2016] [Revised: 07/21/2016] [Accepted: 09/13/2016] [Indexed: 01/17/2023]
Abstract
Objective Early identification of patients unlikely to achieve good long‐term disease control with anti–tumor necrosis factor therapy in axial spondyloarthritis (SpA) and psoriatic arthritis (PsA) is important for physicians following treat‐to‐target recommendations. Here we assess associations between disease activity or clinical response during the first 12 weeks of treatment and attainment of treatment targets at week 48 in axial SpA and PsA patients receiving certolizumab pegol. Methods The relationship between disease activity or clinical response during the first 12 weeks of treatment and achievement of week‐48 targets (for axial SpA: inactive disease based on Ankylosing Spondylitis Disease Activity Score [ASDAS] using the C‐reactive protein [CRP] level, or Bath Ankylosing Spondylitis Disease Activity Index <2 with normal CRP level; and for PsA: minimal disease activity) was assessed post hoc using RAPID‐axSpA and RAPID‐PsA trial data. Results A clear relationship between disease activity from week 2 to 12 and achievement of week‐48 treatment targets was observed in both axial SpA and PsA populations. In axial SpA, week‐48 ASDAS inactive disease was achieved by 0% of patients (0 of 21) with ASDAS very high disease activity at week 12, compared to 68% of patients (34 of 50) with week‐12 ASDAS inactive disease. For PsA, week‐48 minimal disease activity was achieved by 0% of patients (0 of 26) with Disease Activity Score in 28 joints (DAS28) using the CRP level >5.1 at week 12, compared to 73% of patients (57 of 78) with DAS28‐CRP <2.6. Similar results were observed regardless of the disease activity measure used. Clinical response at week 12 also predicted week‐48 outcomes, though to a lesser extent than disease activity. Conclusion Using disease activity and the clinical response state during the first 12 weeks of certolizumab pegol treatment, it was possible to identify a subset of axial SpA and PsA patients unlikely to achieve long‐term treatment goals.
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Affiliation(s)
| | - A Deodhar
- Oregon Health and Science University, Portland
| | | | - P J Mease
- Swedish Medical Center and University of Washington, Seattle
| | - M Rudwaleit
- Klinikum Bielefeld and Charité Berlin, Berlin, Germany, and Ghent University, Ghent, Belgium
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van der Heijde D, Dougados M, Landewé R, Sieper J, Maksymowych W, Rudwaleit M, van den Bosch F, Braun J, Mease P, Davies O, Hoepken B, Peterson L, Deodhar A. SAT0375 Certolizumab Pegol for The Treatment of Axial Spondyloarthritis: 4-Year Outcomes from The Rapid-AXSPA Trial. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3142] [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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Landewé R, Nurminen T, Davies O, Turina M, Baeten D. THU0380 A Single Determination of C-Reactive Protein Does Not Suffice To Declare A Patient with A Diagnosis of Axial SPA “CRP-Negative”. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3176] [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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Varma DD, Kim S, Hakendorf P, Horwood C, Cheruvu L, Davies O, Whitehead C, Chen CS, Lee AW. Abstract TP297: Stroke Outcomes When Stroke is Treated by a Stroke Physician: A Prospective Cohort Study. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.tp297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Stroke unit care is an established intervention for all stroke patients where the benefits derive from having a system which integrates acute reperfusion with secondary prevention and rehabilitation as needed. While most stroke units are staffed by dedicated stroke neurologists, in many parts of the world non-neurologist stroke physicians are in charge of stroke care.
Hypothesis:
As the benefits of a stroke unit are due to an organized system, we hypothesize that irrespective of the physician looking after the stroke, the more organized the system, the better the outcome.
Methods:
To test this hypothesis, a cohort study comprising of consecutive ischemic stroke patients presenting to a tertiary stroke centre between 2000 - 2015 was analysed. During this time, there was an evolution of stroke systems from admitting strokes under general medical units, to admitting strokes to a dedicated centre where stroke patients are looked after by a single stroke specialist. The specialists are geriatricians who work under the governance of a stroke neurologist director. Outcomes such as mortality, length of stay, discharge destination were analysed.
Results:
4794 stroke patients were analyzed. Median length of stay (LOS) prior to appointment of a stroke director was 7.3 days. An immediate reduction of 1.2 days to 6.3 days LOS (p=0.02) occurred in the first year after this appointment (2009-2010). Since SU care began (2010-2014), LOS has further reduced to 4.7 days (p=0.001), with mortality (OR=0.72, 95% CI=0.56-0.91, p=0.007) and transfers to aged care facilities (OR=0.50, 95% CI=0.38-0.67, p=0.001) also significantly decreasing. Transfers to rehabilitation hospitals also significantly increased from 19.6% to 34.5% (p=0.007).
Conclusion:
In this large cohort study involving a tertiary stroke centre with regional responsibility for stroke care, we demonstrate that stroke outcomes improve with better governance and adherence to strict protocols. The most dramatic improvement occurs following the appointment of a stroke director and outcomes continue to improve even when the physician looking after a stroke is a non-neurologist. Hence it is the comprehensive system and not the type of physician that makes the difference.
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Affiliation(s)
- Daniel D Varma
- Dept of Neurology, Flinders Med Cntr and Flinders Univ, Adelaide, Australia
| | - Susan Kim
- Dept of Medicine, Rsch Fellow (Biostatistician) Flinders Cntr for Epidemiology and Biostatistics
Sch of Medicine Flinders Univ, Adelaide, Australia
| | - Paul Hakendorf
- Dept of Epidemiology, Flinders Med Cntr and Flinders Univ, Adelaide, Australia
| | - Chris Horwood
- Dept of Epidemiology, Flinders Med Cntr and Flinders Univ, Adelaide, Australia
| | - Lata Cheruvu
- Dept of Internal Medicine, Flinders Med Cntr and Flinders Univ, Adelaide, Australia
| | - Owen Davies
- Dept of Geriatrics, Flinders Med Cntr and Flinders Univ, Adelaide, Australia
| | - Craig Whitehead
- Dept of Geriatrics, Flinders Med Cntr and Flinders Univ, Adelaide, Australia
| | - Celia S Chen
- Dept of Ophthalmology, Flinders Med Cntr and Flinders Univ, Adelaide, Australia
| | - Andrew W Lee
- Dept of Neurology, Flinders Med Cntr and Flinders Univ, Adelaide, Australia
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Kaambwa B, Ratcliffe J, Bradley SL, Masters S, Davies O, Whitehead C, Milte C, Cameron ID, Young T, Gordon J, Crotty M. Costs and advance directives at the end of life: a case of the 'Coaching Older Adults and Carers to have their preferences Heard (COACH)' trial. BMC Health Serv Res 2015; 15:545. [PMID: 26645745 PMCID: PMC4673742 DOI: 10.1186/s12913-015-1201-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 11/30/2015] [Indexed: 12/31/2022] Open
Abstract
Background Total costs associated with care for older people nearing the end of life and the cost variations related with end of life care decisions are not well documented in the literature. Healthcare utilisation and associated health care costs for a group of older Australians who entered Transition Care following an acute hospital admission were calculated. Costs were differentiated according to a number of health care decisions and outcomes including advance directives (ADs). Methods Study participants were drawn from the Coaching Older Adults and Carers to have their preferences Heard (COACH) trial funded by the Australian National Health and Medical Research Council. Data collected included total health care costs, the type of (and when) ADs were completed and the place of death. Two-step endogenous treatment-regression models were employed to test the relationship between costs and a number of variables including completion of ADs. Results The trial recruited 230 older adults with mean age 84 years. At the end of the trial, 53 had died and 80 had completed ADs. Total healthcare costs were higher for younger participants and those who had died. No statistically significant association was found between costs and completion of ADs. Conclusion For our frail study population, the completion of ADs did not have an effect on health care utilisation and costs. Further research is needed to substantiate these findings in larger and more diverse clinical cohorts of older people. Trial registration This study was registered on 13/12/2007 with the Australian New Zealand Clinical Trial Registry (ACTRN12607000638437).
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Affiliation(s)
- Billingsley Kaambwa
- Flinders Health Economics group, Flinders University, A Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Adelaide, Australia. .,Billingsley Kaambwa, Flinders Health Economics Group, School of Medicine, Flinders University, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Australia.
| | - Julie Ratcliffe
- Flinders Health Economics group, Flinders University, A Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Adelaide, Australia.
| | - Sandra L Bradley
- CareSearch, Palliative care knowledge network, Palliative and Supportive Services, Flinders University, PO Box 2100, Adelaide, SA, 5001, Australia.
| | - Stacey Masters
- The Discipline of General Practice, Health Sciences Building, Flinders University, GPO Box 2100, SA, 5001, Adelaide, Australia.
| | - Owen Davies
- Department of Rehabilitation and Aged Care, Flinders University, C Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Adelaide, Australia.
| | - Craig Whitehead
- Department of Rehabilitation and Aged Care, Flinders University, C Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Adelaide, Australia.
| | - Catherine Milte
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, VIC, 3125, Melbourne, Australia.
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, University of Sydney, Level 13, Kolling Institute of Medical Research, Corner Reserve Road and Westbourne Avenue, Royal North Shore Hospital, St Leonards, NSW, 2065, Sydney, Australia.
| | - Tracey Young
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Jason Gordon
- Discipline of Public Health, University of Adelaide, 178 North Terrace, Terrace Towers, SA, 5005, Adelaide, Australia.
| | - Maria Crotty
- Department of Rehabilitation and Aged Care, Flinders University, C Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Adelaide, Australia.
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Weinblatt ME, Fleischmann R, van Vollenhoven RF, Emery P, Huizinga TWJ, Cutolo M, van der Heijde D, Duncan B, Davies O, Luijtens K, Dougados M. Twenty-eight-week results from the REALISTIC phase IIIb randomized trial: efficacy, safety and predictability of response to certolizumab pegol in a diverse rheumatoid arthritis population. Arthritis Res Ther 2015; 17:325. [PMID: 26568428 PMCID: PMC4644627 DOI: 10.1186/s13075-015-0841-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 07/20/2015] [Accepted: 10/29/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION This 28-week, phase IIIb study assessed safety and maintenance of response to certolizumab pegol (CZP) in a diverse population of rheumatoid arthritis (RA) patients, stratified by prior anti-TNF exposure, concomitant methotrexate (MTX) use and disease duration. The ability to predict achievement of low disease activity (LDA) at week 28 from improvements in Disease Activity Score 28 (DAS28), erythrocyte sedimentation rate (ESR), swollen joint count (SJC) and Clinical Disease Activity Index (CDAI) up to week 12 was assessed. METHODS The 28-week study population included all patients who completed the double-blind (DB) phase and entered the open-label (OL) phase, receiving 200 mg CZP every 2 weeks (Q2W) ≥16 weeks. In the 12-week DB period, patients with active RA and an inadequate response to ≥1 disease-modifying antirheumatic drug (DMARD) were randomized 4:1 to CZP (400 mg at weeks 0, 2 and 4 then 200 mg Q2W) or placebo (Q2W), stratified by prior anti-TNF use, concomitant use of MTX and disease duration (<2 years vs. ≥2 years). RESULTS A total of 955 patients entered the OL phase. At week 28, similar clinical improvements were seen in those receiving CZP throughout (CZP → CZP; n = 771) and those receiving placebo during the DB phase and switching to CZP in the OL phase (placebo → CZP; n = 184) (ACR20 response rate = 59.7% vs. 53.3%; ACR50/ACR70 response rates were also similar). Effect of CZP treatment was similar regardless of prior anti-TNF use, disease duration and concomitant DMARDs, based on ACR20 response rates. The percentage of patients achieving DAS28(ESR) LDA at week 28 was calculated for DAS28(ESR), SJC or CDAI responders at earlier time points. Reductions from baseline (Δ) of DAS28(ESR) <1.2, ΔSJC <25% or ΔCDAI <10 by week 12 were associated with <9% chance of achieving LDA at week 28 regardless of prior anti-TNF exposure. Adverse event rates were similar for placebo → CZP and CZP → CZP patients, with no new safety signals identified. CONCLUSIONS A diverse population of RA patients with varying disease duration showed rapid and sustained clinical improvements on CZP treatment, regardless of prior anti-TNF or concomitant DMARD use. Failure to achieve improvements in DAS28(ESR), SJC or CDAI within the first 12 weeks of CZP therapy was associated with a low chance of achieving LDA at week 28. No new safety signals were observed. TRIAL REGISTRATION ClinicalTrials.gov, NCT00717236 , 15 July 2008.
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Affiliation(s)
| | - Roy Fleischmann
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 8144 Walnut Hill Lane, Dallas, TX, 75231, USA.
| | | | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK. .,NIHR Leeds Musculoskeletal and Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK.
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Maurizio Cutolo
- Research Laboratory and Academic Unit of Clinical Rheumatology, University of Genova, Viale Benedetto XV, 6, 16132, Genova, Italy.
| | - Désirée van der Heijde
- Department of Rheumatology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Benjamin Duncan
- UCB Pharma, 8010 Arco Corporate Drive, Raleigh, NC, 27617, USA.
| | - Owen Davies
- UCB Pharma, Allée de la Recherche 60, 1070, Brussels, Belgium.
| | | | - Maxime Dougados
- Paris-Descartes University, 12 Rue de l'École de Médecine, 75006, Paris, France. .,Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
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Davies O, Hole B. Hyponatraemia in neurosurgical patients, audit and creation of a clinical tool. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.346] [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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Davies O, Matteoni F. 'A virtue beyond all medicine': The Hanged Man's Hand, Gallows Tradition and Healing in Eighteenth- and Nineteenth-century England. Soc Hist Med 2015; 28:686-705. [PMID: 26516298 PMCID: PMC4623855 DOI: 10.1093/shm/hkv044] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
From the eighteenth century through to the abolition of public executions in England in 1868, the touch of a freshly hanged man's hand was sought after to cure a variety of swellings, wens in particular. While the healing properties of corpse hands in general were acknowledged and experimented with in early modern medicine, the gallows cure achieved prominence during the second half of the eighteenth century. What was it about the hanged man's hand (and it always was a male appendage) that gave it such potency? While frequently denounced as a disgusting 'superstition' in the press, this popular medical practice was inadvertently legitimised and institutionalised by the authorities through changes in execution procedure.
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Affiliation(s)
- Owen Davies
- School of Humanities, University of Hertfordshire, Hatfield, Herts AL10 9AB, UK.
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Lee A, Gaekwad A, Bronca M, Cheruvu L, Davies O, Whitehead C, Agzarian M, Chen C. Author reply. Intern Med J 2015; 45:988. [DOI: 10.1111/imj.12851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- A. Lee
- Flinders Stroke Centre; Flinders University and Medical Centre; Adelaide South Australia Australia
| | - A. Gaekwad
- Flinders Stroke Centre; Flinders University and Medical Centre; Adelaide South Australia Australia
| | - M. Bronca
- Flinders Stroke Centre; Flinders University and Medical Centre; Adelaide South Australia Australia
| | - L. Cheruvu
- Flinders Stroke Centre; Flinders University and Medical Centre; Adelaide South Australia Australia
- Department of Rehabilitation and Aged Care; Repatriation General Hospital; Adelaide South Australia Australia
| | - O. Davies
- Flinders Stroke Centre; Flinders University and Medical Centre; Adelaide South Australia Australia
- Department of Rehabilitation and Aged Care; Repatriation General Hospital; Adelaide South Australia Australia
- Flinders Clinical Effectiveness; Flinders University; Adelaide South Australia Australia
| | - C. Whitehead
- Flinders Stroke Centre; Flinders University and Medical Centre; Adelaide South Australia Australia
| | - M. Agzarian
- Radiology; Flinders University and Medical Centre; Adelaide South Australia Australia
| | - C. Chen
- Department of Ophthalmology; Flinders University and Medical Centre; Adelaide South Australia Australia
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Braun J, Maksymowych W, Landewé R, Baraliakos X, Hermann KG, Machado P, Hoepken B, Stach C, Davies O, Nurminen T, van der Heijde D. OP0171 Achievement of Remission of Inflammation in the Spine and Sacroiliac Joints Measured by Magnetic Resonance Imaging (MRI) in Patients with Axial Spondyloarthritis, and Associations Between MRI and Clinical Remission, Over 96 Weeks of Treatment with Certolizumab Pegol. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1791] [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: 11/04/2022]
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van der Heijde D, Maksymowych W, Landewé R, Stach C, Hoepken B, Davies O, Nurminen T, Braun J. THU0201 Factors Associated with Structural Damage in the Spine, as Measured by X-ray, in Patients with Axial Spondyloarthritis Treated with Certolizumab Pegol Over 96 Weeks. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1792] [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: 11/04/2022]
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Khraishi M, Hoepken B, Davies O, Arledge T, Peterson L, Mease P. THU0427 Sustained Improvements in Skin Outcomes Following Certolizumab Pegol Treatment of Psoriatic Arthritis Patients with Prior Anti-TNF Exposure or Severe Skin Involvement at Baseline. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1840] [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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Furst DE, Shaikh SA, Greenwald M, Bennett B, Davies O, Luijtens K, Staelens F, Koetse W, Bertin P. Two dosing regimens of certolizumab pegol in patients with active rheumatoid arthritis. Arthritis Care Res (Hoboken) 2015; 67:151-60. [PMID: 25302624 PMCID: PMC4329409 DOI: 10.1002/acr.22496] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 12/18/2013] [Accepted: 10/07/2014] [Indexed: 11/10/2022]
Abstract
Objective To investigate clinical efficacy and safety of 2 certolizumab pegol (CZP) maintenance dosing regimens plus methotrexate (MTX) in active rheumatoid arthritis (RA) patients achieving the American College of Rheumatology 20% improvement criteria (ACR20) after the CZP 200 mg every 2 weeks open-label run-in period. Methods DOSEFLEX (dosing flexibility) was a double-blind, placebo-controlled randomized study with an open-label run-in phase. During the run-in phase, all patients received CZP 400 mg (weeks 0, 2, and 4) and 200 mg every 2 weeks to week 16. Week 16 ACR20 responders were randomized 1:1:1 at week 18 to CZP 200 mg every 2 weeks, 400 mg every 4 weeks, or placebo. Results A total of 209 (of 333) patients were randomized at week 18 (CZP: 200 mg, n = 70; 400 mg, n = 70; placebo, n = 69). Groups had similar baseline characteristics (week 0). Week 34 ACR20 response rates were comparable between the CZP 200 mg every 2 weeks and the 400 mg every 4 weeks groups (67.1% versus 65.2%), which was significantly higher than placebo (44.9%; P = 0.009 and P = 0.017). ACR50/70 and remission criteria were met more frequently in CZP groups than placebo at week 34, with similar responses between anti–tumor necrosis factor–experienced and naive patients. Improvements from baseline Disease Activity Score in 28 joints using the erythrocyte sedimentation rate and Health Assessment Questionnaire disability index scores were maintained in CZP groups from week 16 to 34 while worsening on placebo. Adverse event (AE) rates in the double-blind phase were 62.9% versus 60.9% versus 62.3%; serious AE rates were 7.1% versus 2.9% versus 0.0% (CZP 200 mg, 400 mg, and placebo groups). Conclusion In active RA patients with an incomplete MTX response, CZP 200 mg every 2 weeks and 400 mg every 4 weeks were comparable and better than placebo for maintaining clinical response to week 4 following a 16-week, open-label run-in phase.
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Affiliation(s)
- D E Furst
- University of California, Los Angeles
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Lee A, Gaekwad A, Bronca M, Cheruvu L, Davies O, Whitehead C, Agzarian M, Chen C. Stroke physician versus stroke neurologist: can anyone thrombolyse? Intern Med J 2014; 45:305-9. [PMID: 25533873 DOI: 10.1111/imj.12673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 10/02/2014] [Accepted: 12/17/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIM The aim of this study is to compare the outcomes of thrombolysis under standard clinical settings between subjects treated by a stroke neurologist versus those treated by a non-neurologist stroke physician. METHODS Single-centre, observational cohort study of subjects thrombolysed in a calendar year, stratified according to the physician type authorising thrombolysis. Endpoints measured include proportion of subjects with symptomatic intracranial haemorrhage, door-to-needle time, change in National Institute of Health Stroke Scale and discharge destination. RESULTS Forty-nine subjects with a mean age 76 ± 16 years underwent thrombolysis, 21 were under the care of a stroke neurologist and 28 by a non-neurologist stroke physician. No symptomatic intracranial haemorrhages were observed. There was no difference in terms of door-to-needle time, proportion of individuals with haemorrhagic transformation, mortality or discharge destination between the two groups. CONCLUSION Due to the single-centre, observational nature of this study, the equivalent outcomes between those thrombolysed by a stroke neurologist versus those thrombolysed by a stroke physician must be interpreted with caution pending further studies. Nevertheless, in the current setting, no signal for harm has been detected. This study is unique as it is the first to our knowledge comparing outcomes between a neurologist and non-neurologist following thrombolysis.
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Affiliation(s)
- A Lee
- Flinders Comprehensive Stroke Centre, Flinders University of South Australia and Flinders Medical Centre, Adelaide, South Australia, Australia
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van der Heijde D, Deodhar A, Davies O, Nurminen T, Rudwaleit M. SAT0338 Disease Activity and Clinical Response Early in the Course of Treatment PREDICT Long-Term Outcomes in Axial Spondyloarthritis Patients Treated with Certolizumab Pegol. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1564] [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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Mease P, Dougados M, Davies O, Nurminen T, Sieper J. SAT0362 Certolizumab Pegol Rapidly Reduces Peripheral Enthesitis and the Incidence of Tender and Swollen Joints in Patients with Active Axial Spondyloarthritis, Including Both Ankylosing Spondylitis and Non-Radiographic Axial Spondyloarthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1558] [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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Mease P, Fleischmann R, Davies O, Nurminen T, van der Heijde D. SAT0405 Disease Activity and Clinical Response Early in the Course of Treatment PREDICT Long-Term Outcomes in Psoriatic Arthritis Patients Treated with Certolizumab Pegol. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1651] [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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Rudwaleit M, Landewé R, Marzo-Ortega H, Sieper J, van der Heijde D, Rosenbaum J, Davies O, Stach C, Nurminen T, Deodhar A. SAT0355 Observed Incidence Rates of Uveitis following Certolizumab Pegol Treatment in Patients with Axial Spondyloarthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1806] [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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Weinblatt M, Fleischmann R, Davies O, Luijtens K, van der Heijde D. SAT0145 Timing and magnitude of initial response to certolizumab pegol in a broad population of patients with active rheumatoid arthritis predicts likelihood of LDA at week 28:. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.3092] [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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Fleischmann R, van Vollenhoven R, Vencovsky J, Alten R, Davies O, Stach C, de Longueville M, van Lunen B, Choy E. SAT0151 Long-term safety of 4-weekly certolizumab pegol in rheumatoid arthritis: 5 year results from an open label extension study:. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.3098] [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: 11/04/2022]
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Smolen J, Emery P, Ferraccioli G, Samborski W, Berenbaum F, Davies O, Koetse W, Bennett B, Burkhardt H. FRI0150 Maintenance of remission in rheumatoid arthritis patients with low-moderate disease activity following withdrawal of certolizumab PEGOL treatment: Week 52 results from the certain study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.2607] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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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Fleischmann R, van Vollenhoven R, Vencovsky J, Alten R, Davies O, Stach C, de Longueville M, VanLunen B, Choy E. FRI0186 Long-term safety and efficacy of 4-weekly certolizumab pegol monotherapy and combination therapy in rheumatoid arthritis: 5-year results from an open-label extension study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.1313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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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Schiff M, Davies O, Bennett B, Luijtens K, Furst D. AB0480 Certolizumab pegol plus methotrexate is similarly effective in active rheumatoid arthritis regardless of prior TNF inhibitor use: Analysis of the doseflex PHASE IIIB study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.480] [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: 11/03/2022]
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Davies O, Batajoo-Shrestha B, Sosa-Popoteur J, Olibrice M. Full recovery after severe serotonin syndrome, severe rhabdomyolysis, multi-organ failure and disseminated intravascular coagulopathy from MDMA. Heart Lung 2013; 43:117-9. [PMID: 24373952 DOI: 10.1016/j.hrtlng.2013.11.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/21/2013] [Accepted: 11/27/2013] [Indexed: 11/24/2022]
Abstract
3, 4-methylenedioxymethamphetamine (MDMA), popularly known as "ecstasy" is a synthetic, psychoactive drug used recreationally for its euphoric and "energy increasing" effects. MDMA has been linked to several severe adverse effects including the development of serotonin syndrome and sudden death. Individuals of Asian descent have been shown to have a predisposition for these severe adverse effects. We present a case of a young Asian-American male who following MDMA ingestion presented with severe rhabdomyolysis (CK 130,350 U/L), multiple organ failure and severe serotonin syndrome with one of the highest recorded temperatures '108.9 °F (42.7 °C)' in a survivor of severe serotonin syndrome. The patient initially received supportive care including ventilatory support; he eventually needed hemodialysis, but went on to make a full recovery within 3 weeks. This case shows and emphasizes the importance of 'aggressive' supportive care on patient prognosis particularly for patients on the extreme end of the serotonin syndrome.
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Affiliation(s)
- O Davies
- Internal Medicine Department, Columbia University at Harlem Hospital Center, 506 Lenox Avenue, MLK 14-106, New York, NY 10037, USA.
| | - B Batajoo-Shrestha
- Internal Medicine Department, Columbia University at Harlem Hospital Center, 506 Lenox Avenue, MLK 14-106, New York, NY 10037, USA
| | - J Sosa-Popoteur
- Internal Medicine Department, Columbia University at Harlem Hospital Center, 506 Lenox Avenue, MLK 14-106, New York, NY 10037, USA
| | - M Olibrice
- Pulmonary and Critical Care Medicine Department, Columbia University at Harlem Hospital Center, 506 Lenox Avenue, MLK 14-108, New York, NY 10037, USA
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Schiff M, Luijtens K, Davies O, Yazici Y. AB0317 Association of ACR clinical responses with CDAI (clinical disease activity index) and RAPID3 (routine assessment of patient index data 3) indices of disease activity in rheumatoid arthritis patients treated with certolizumab pegol plus methotrexate:. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.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: 11/03/2022]
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Milte CM, Ratcliffe J, Davies O, Whitehead C, Masters S, Crotty M. Family meetings for older adults in intermediate care settings: the impact of patient cognitive impairment and other characteristics on shared decision making. Health Expect 2013; 18:1030-40. [PMID: 23683120 DOI: 10.1111/hex.12076] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2013] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Clinicians, older adults and caregivers frequently meet to make decisions around treatment and lifestyle during an acute hospital admission. Patient age, psychological status and health locus of control (HLC) influence patient preference for consultation involvement and information but overall, a shared-decision-making (SDM) approach is favoured. However, it is not known whether these characteristics and the presence of cognitive impairment influence SDM competency during family meetings. OBJECTIVE To describe meetings between older adults, caregivers and geriatricians in intermediate care and explore patient and meeting characteristics associated with a SDM communication style. METHODS Fifty-nine family meetings involving geriatricians, patients in an intermediate care setting following an acute hospital admission and their caregivers were rated using the OPTION system for measuring clinician SDM behaviour. The geriatric depression scale and multidimensional HLC scale were completed by patients. The mini-mental state exam (MMSE) assessed patient's level of cognitive impairment. RESULTS Meetings lasted 38 min (SD 13) and scored 41 (SD 17) of 100 on the OPTION scale. Nine (SD 2.2) topics were discussed during each meeting, and most were initiated by the geriatrician. Meeting length was an important determinant of OPTION score, with higher SDM competency displayed in longer meetings. Patient characteristics, including MMSE, HLC and depression did not explain SDM competency. CONCLUSION Whilst SDM can be achieved during consultations frail older patients and their caregivers, an increased consultation time is a consequence of this approach.
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Affiliation(s)
- Catherine M Milte
- Department of Rehabilitation and Aged Care, Repatriation General Hospital, Flinders University, Adelaide, SA, Australia.,Clinical Effectiveness Cluster, Flinders University, Adelaide, SA, Australia
| | - Julie Ratcliffe
- Clinical Effectiveness Cluster, Flinders University, Adelaide, SA, Australia
| | - Owen Davies
- Department of Rehabilitation and Aged Care, Repatriation General Hospital, Flinders University, Adelaide, SA, Australia.,Clinical Effectiveness Cluster, Flinders University, Adelaide, SA, Australia
| | - Craig Whitehead
- Department of Rehabilitation and Aged Care, Repatriation General Hospital, Flinders University, Adelaide, SA, Australia.,Clinical Effectiveness Cluster, Flinders University, Adelaide, SA, Australia
| | - Stacey Masters
- Discipline of General Practice, Flinders University, Adelaide, SA, Australia
| | - Maria Crotty
- Department of Rehabilitation and Aged Care, Repatriation General Hospital, Flinders University, Adelaide, SA, Australia.,Clinical Effectiveness Cluster, Flinders University, Adelaide, SA, Australia
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