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Bardia A, Sun S, Thimmiah N, Coates JT, Wu B, Abelman RO, Spring L, Moy B, Ryan P, Melkonyan MN, Partridge A, Juric D, Peppercorn J, Parsons H, Wander SA, Attaya V, Lormil B, Shellock M, Nagayama A, Bossuyt V, Isakoff SJ, Tolaney SM, Ellisen LW. Antibody Drug Conjugate Sacituzumab Govitecan Enables A Sequential TOP1/PARP Inhibitor Cancer Therapy Strategy in Breast Cancer Patients. Clin Cancer Res 2024:745191. [PMID: 38709212 DOI: 10.1158/1078-0432.ccr-24-0428] [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] [Received: 02/05/2024] [Revised: 04/17/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE The Antibody-Drug Conjugate (ADC) Sacituzumab govitecan (SG) comprises the topoisomerase 1 (TOP1) inhibitor SN-38, coupled to a monoclonal antibody targeting trophoblast cell surface antigen 2 (TROP-2). Poly (ADP-ribose) polymerase (PARP) inhibition may synergize with TOP1 inhibitors and SG, but previous studies combining systemic PARP and TOP1 inhibitors failed due to dose-limiting myelosuppression. Here, we assess proof-of-mechanism and clinical feasibility for SG and talazoparib employing an innovative sequential dosing schedule. PATIENTS AND METHODS In vitro models tested pharmacodynamic endpoints, and in a phase 1b clinical trial (NCT04039230) 30 patients with metastatic Triple-Negative Breast Cancer (mTNBC) received SG and talazoparib using a concurrent (N=7) or sequential (N=23) schedule. Outcome measures included safety, tolerability, preliminary efficacy and establishment of a recommended phase 2 dose (RP2D). RESULTS We hypothesized that tumor-selective delivery of TOP1i via SG would reduce non-tumor toxicity and create a temporal window, enabling sequential dosing of SG and PARP inhibition. In vitro, sequential SG followed by talazoparib delayed TOP1 cleavage complex clearance, increased DNA damage and promoted apoptosis. In the clinical trial, sequential SG/talazoparib successfully met primary objectives and demonstrated median PFS of 7.6 months without Dose-Limiting Toxicities (DLTs), while concurrent dosing yielded 2.3 months PFS and multiple DLTs including severe myelosuppression. CONCLUSIONS While SG dosed concurrently with talazoparib is not tolerated clinically due to an insufficient therapeutic window, sequential dosing of SG then talazoparib proved a viable strategy. These findings support further clinical development of the combination and suggest that ADC-based therapy may facilitate novel, mechanism-based dosing strategies.
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Affiliation(s)
- Aditya Bardia
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Sheng Sun
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | | | - James T Coates
- Massachusetts General Hospital, Boston, MA, United States
| | - Bogang Wu
- Massachusetts General Hospital, Boston, United States
| | - Rachel O Abelman
- Massachusetts General Hospital Cancer Center, Boston, MA, United States
| | - Laura Spring
- Massachusetts General Hospital Cancer Center, Boston, United States
| | - Beverly Moy
- Massachusetts General Hospital, Boston, MA, United States
| | - Phoebe Ryan
- Massachusetts General Hospital Cancer Center, Boston, MA, United States
| | | | | | - Dejan Juric
- Massachusetts General Hospital Cancer Center, Boston, MA, United States
| | | | | | - Seth A Wander
- Massachusetts General Hospital Cancer Center, Boston, MA, United States
| | - Victoria Attaya
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States
| | - Brenda Lormil
- Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Maria Shellock
- Massachusetts General Hospital Cancer Center, Boston, MA, United States
| | - Aiko Nagayama
- Massachusetts General Hospital, Boston, MA, United States
| | - Veerle Bossuyt
- Massachusetts General Hospital, Boston, MA, United States
| | | | - Sara M Tolaney
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States
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Spring LM, Tolaney SM, Fell G, Bossuyt V, Abelman RO, Wu B, Maheswaran S, Trippa L, Comander A, Mulvey T, McLaughlin S, Ryan P, Ryan L, Abraham E, Rosenstock A, Garrido-Castro AC, Lynce F, Moy B, Isakoff SJ, Tung N, Mittendorf EA, Ellisen LW, Bardia A. Response-guided neoadjuvant sacituzumab govitecan for localized triple-negative breast cancer: results from the NeoSTAR trial. Ann Oncol 2024; 35:293-301. [PMID: 38092228 DOI: 10.1016/j.annonc.2023.11.018] [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: 08/29/2023] [Revised: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Sacituzumab govitecan (SG), a novel antibody-drug conjugate (ADC) targeting TROP2, is approved for pre-treated metastatic triple-negative breast cancer (mTNBC). We conducted an investigator-initiated clinical trial evaluating neoadjuvant (NA) SG (NCT04230109), and report primary results. PATIENTS AND METHODS Participants with early-stage TNBC received NA SG for four cycles. The primary objective was to assess pathological complete response (pCR) rate in breast and lymph nodes (ypT0/isN0) to SG. Secondary objectives included overall response rate (ORR), safety, event-free survival (EFS), and predictive biomarkers. A response-guided approach was utilized, and subsequent systemic therapy decisions were at the discretion of the treating physician. RESULTS From July 2020 to August 2021, 50 participants were enrolled (median age = 48.5 years; 13 clinical stage I disease, 26 stage II, 11 stage III). Forty-nine (98%) completed four cycles of SG. Overall, the pCR rate with SG alone was 30% [n = 15, 95% confidence interval (CI) 18% to 45%]. The ORR per RECIST V1.1 after SG alone was 64% (n = 32/50, 95% CI 77% to 98%). Higher Ki-67 and tumor-infiltrating lymphocytes (TILs) were predictive of pCR to SG (P = 0.007 for Ki-67 and 0.002 for TILs), while baseline TROP2 expression was not (P = 0.440). Common adverse events were nausea (82%), fatigue (76%), alopecia (76%), neutropenia (44%), and rash (48%). With a median follow-up time of 18.9 months (95% CI 16.3-21.9 months), the 2-year EFS for all participants was 95%. Among participants with a pCR with SG (n = 15), the 2-year EFS was 100%. CONCLUSIONS In the first NA trial with an ADC in localized TNBC, SG demonstrated single-agent efficacy and feasibility of response-guided escalation/de-escalation. Further research on optimal duration of SG as well as NA combination strategies, including immunotherapy, are needed.
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Affiliation(s)
- L M Spring
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - S M Tolaney
- Dana-Farber Cancer Institute, Harvard Medical School, Boston
| | - G Fell
- Dana-Farber Cancer Institute, Harvard Medical School, Boston
| | - V Bossuyt
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - R O Abelman
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - B Wu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - S Maheswaran
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - L Trippa
- Dana-Farber Cancer Institute, Harvard Medical School, Boston
| | - A Comander
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - T Mulvey
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - S McLaughlin
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - P Ryan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - L Ryan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - E Abraham
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - A Rosenstock
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | | | - F Lynce
- Dana-Farber Cancer Institute, Harvard Medical School, Boston
| | - B Moy
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - S J Isakoff
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - N Tung
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - E A Mittendorf
- Brigham and Women's Hospital, Harvard Medical School, Boston
| | - L W Ellisen
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston; Ludwig Center, Harvard Medical School, Boston, USA
| | - A Bardia
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston.
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Valencia J, Vázquez L, Lazarus JV, Cuevas G, Torres-Macho J, Domingorena J, Castrillo M, Ryan P. On-site testing and treatment of sexually transmitted infections among female sex workers using molecular point-of-care testing integrated into harm reduction services in Madrid, Spain. Int J Drug Policy 2024; 123:104281. [PMID: 38056222 DOI: 10.1016/j.drugpo.2023.104281] [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: 06/16/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION This study aimed to evaluate the feasibility of molecular point-of-care testing for STIs, the prevalence of STIs and associated factors, and testing and treatment uptake among street-based female sex workers (FSWs) attending a mobile harm reduction unit in Madrid, Spain. METHODS This was a prospective, longitudinal study. From August 15th to December 6th, 2022, participants were screened for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis using molecular testing (Xpert) on self-collected urine samples at a mobile harm reduction unit. Additionally, rapid tests were used to screen participants for HIV, hepatitis C virus (HCV), and syphilis. On-site same-day results and treatment for those infected were offered. RESULTS Among 77 FSWs included the median age was 40 (range, 33-48), 64 % were homeless, and 84 % reported drug use in the past six months. Four participants self-reported having HIV, of whom all were on antiretroviral therapy, and 14 (18 %) had HCV antibodies, including three with current infection. The prevalence of at least one STI was 66 %. When categorized by type of STI, the prevalences were as follows: 15 % for CT, 15 % for NG, 51 % for TV, and 21 % for syphilis. Notably, the prevalence of STIs was higher among FSW with recent drug use, with no cases of CT or NG detected among FSWs who did not recently use drugs. In adjusted analysis, drug use was associated an increased odds of having an STI (adjusted odds ratio, 10.47; 95 % CI: 1.67-65.42). All participants consented to screening, and all but one received on-site result-based linkage to treatment. CONCLUSIONS This study demonstrates the feasibility, high STI prevalence, and high linkage to testing and treatment following point-of-care molecular testing among street-based FSWs who have recently used drugs in Madrid, Spain.
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Affiliation(s)
- J Valencia
- Infanta Leonor Hospital, Madrid, Spain; Harm Reduction Unit "SMASD", Addictions and Mental Health Office, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Spain.
| | - L Vázquez
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - J V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, USA
| | - G Cuevas
- Infanta Leonor Hospital, Madrid, Spain
| | | | - J Domingorena
- Harm Reduction Unit "SMASD", Addictions and Mental Health Office, Madrid, Spain
| | - M Castrillo
- Harm Reduction Unit "SMASD", Addictions and Mental Health Office, Madrid, Spain
| | - P Ryan
- Infanta Leonor Hospital, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Spain
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Oladeru OT, Dunn SA, Li J, Coles CE, Yamauchi C, Chang JS, Cheng SHC, Kaidar-Person O, Meattini I, Ramiah D, Kirby A, Hijal T, Marta GN, Poortmans P, Isern-Verdum J, Zissiadis Y, Offersen BV, Refaat T, Elsayad K, Hijazi H, Dengina N, Belkacemi Y, Luo FD, Lu S, Griffin C, Collins M, Ryan P, Larios D, Warren LE, Punglia RS, Wong JS, Spiegel DY, Jagsi R, Taghian A, Bellon JR, Ho AY. Looking Back: International Practice Patterns in Breast Radiation Oncology From a Case-Based Survey Across 54 Countries During the First Surge of the COVID-19 Pandemic. JCO Glob Oncol 2023; 9:e2300010. [PMID: 37471670 PMCID: PMC10581620 DOI: 10.1200/go.23.00010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/16/2023] [Indexed: 07/22/2023] Open
Abstract
PURPOSE The COVID-19 pandemic has profoundly affected cancer care worldwide, including radiation therapy (RT) for breast cancer (BC), because of risk-based resource allocation. We report the evolution of international breast RT practices during the beginning of the pandemic, focusing on differences in treatment recommendations between countries. MATERIALS AND METHODS Between July and November 2020, a 58-question survey was distributed to radiation oncologists (ROs) through international professional societies. Changes in RT decision making during the first surge of the pandemic were evaluated across six hypothetical scenarios, including the management of ductal carcinoma in situ (DCIS), early-stage, locally advanced, and metastatic BC. The significance of changes in responses before and during the pandemic was examined using chi-square and McNemar-Bowker tests. RESULTS One thousand one hundred three ROs from 54 countries completed the survey. Incomplete responses (254) were excluded from the analysis. Most respondents were from the United States (285), Japan (117), Italy (63), Canada (58), and Brazil (56). Twenty-one percent (230) of respondents reported treating at least one patient with BC who was COVID-19-positive. Approximately 60% of respondents reported no change in treatment recommendation during the pandemic, except for patients with metastatic disease, for which 57.7% (636/1,103; P < .0005) changed their palliative practice. Among respondents who noted a change in their recommendation during the first surge of the pandemic, omitting, delaying, and adopting short-course RT were the most frequent changes, with most transitioning to moderate hypofractionation for DCIS and early-stage BC. CONCLUSION Early in the COVID-19 pandemic, significant changes in global RT practice patterns for BC were introduced. The impact of published results from the FAST FORWARD trial supporting ultrahypofractionation likely confounded the interpretation of the pandemic's independent influence on RT delivery.
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Affiliation(s)
| | - Samantha A. Dunn
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Jian Li
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Charlotte E. Coles
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Chikako Yamauchi
- Department of Radiation Oncology, Shiga General Hospital, Shiga, Japan
- The Corona Countermeasures Executing Group of the Japanese Society for Radiation Oncology, Japan
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Seoul, South Korea
| | - Skye Hung-Chun Cheng
- Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Orit Kaidar-Person
- Department of Radiation Oncology, Sheba Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- GROW-School for Oncology and Developmental Biology or GROW (Maastro), Maastricht University, Maastricht, The Netherlands
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences “M. Serio,” University of Florence, Florence, Italy
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Duvern Ramiah
- Division of Radiation Oncology, University of the Witwatersrand, Johannesburg, South Africa
| | - Anna Kirby
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Tarek Hijal
- Division of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Philip Poortmans
- Iridium Netwerk and University of Antwerp, Wilrijk Antwerp, Belgium
| | - Josep Isern-Verdum
- Department of Radiation Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Tamer Refaat
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - Khaled Elsayad
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Hussam Hijazi
- Department of Radiation Oncology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Natalia Dengina
- Department of Radiotherapy, Ulyanovsk Regional Cancer Center, Ulyanovsk Oblast, Russia
| | - Yazid Belkacemi
- Department of Radiation Oncology and Henri Mondor Breast Center, INSERM 955 i-Biot Unit, University of Paris-Est (UPEC), Creteil, France
| | - Feng Deng Luo
- Department of Radiation Oncology and Henri Mondor Breast Center, INSERM 955 i-Biot Unit, University of Paris-Est (UPEC), Creteil, France
| | - Shun Lu
- Department of Radiation Oncology Center, Sichuan Cancer Center, Chengdu, China
| | - Colleen Griffin
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Maya Collins
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Phoebe Ryan
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Dalia Larios
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Laura E. Warren
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana Farber Cancer Institute, Boston, MA
| | - Rinaa S. Punglia
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana Farber Cancer Institute, Boston, MA
| | - Julia S. Wong
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana Farber Cancer Institute, Boston, MA
| | - Daphna Y. Spiegel
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Reshma Jagsi
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA
| | - Alphonse Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Jennifer R. Bellon
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana Farber Cancer Institute, Boston, MA
| | - Alice Y. Ho
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC
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Keenan JC, Medford AJ, Oshry LJ, Boyraz B, Dai CS, Kiedrowski LA, Menshikova S, Butusova A, Gogakos T, Occhiogrosso R, Ryan P, Lennerz J, Spring LM, Moy B, Ellisen L, Bardia A. Abstract P5-02-13: TRK inhibitor in a patient with metastatic triple negative breast cancer and NTRK fusions identified via cell-free DNA analysis. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p5-02-13] [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: 03/06/2023]
Abstract
Abstract
Introduction: Tissue-agnostic indications for targeted therapies are expanding options for patients with advanced solid tumors. The FDA approvals of the PD-1 inhibitor pembrolizumab and the TRK inhibitors larotrectinib and entrectinib provide rationale for next generation sequencing (NGS) in effectively all advanced solid tumor patients, as findings may indicate targeted therapy even in disease that may seem otherwise refractory. Here, we present the case of a post-menopausal woman with metastatic triple negative breast cancer (TNBC) who had disease progression on multiple lines of therapy prior to the identification of two actionable NTRK mutations, identified via cell-free DNA (cfDNA) and tissue-based NGS. She was subsequently started on the TRK inhibitor larotrectinib and had a marked clinical response. Case Presentation: A 64-year-old woman presented with metastatic TNBC five years after being treated for a localized breast cancer. The cancer rapidly progressed through 4 lines of therapy in the metastatic setting, including immunotherapy [atezolizumab/nab-paclitaxel (progression after 5 months)], antibody-drug conjugate-based therapy [sacituzumab govitecan (progression after 2 months)], and chemotherapy [gemcitabine/carboplatin (progression after 3 months), eribulin (progression after 2 months)]. Her CA 15-3 had also been consistently increasing to a peak of 206 IU/mL. Germline genetic testing was negative. Ultimately, NGS evaluation of cfDNA via an 83-gene assay (Guardant Health, Inc.) identified two NTRK3 fusions: an ETV6-NTRK3 fusion [mutant allele fraction (MAF) = 10.9%] associated with the rare secretory breast carcinoma, and CRTC3-NTRK3 (MAF = 3.2%), a fusion partner previously undescribed in breast cancer. Liver biopsy was sent for whole exome sequencing and RNA-seq analysis (BostonGene, Inc), which provided orthogonal confirmation of both the ETV6-NTRK3 and CRTC3-NTRK3 fusions. Review of the tumor pathology showed invasive ductal carcinoma with secretory features; this pathology and the ETV6-NTRK3 fusion were consistent with a diagnosis of secretory breast carcinoma. She was started on the TRK inhibitor larotrectinib, and she had a significant clinical and radiographic response after only two months of therapy. Recheck of her CA 15-3 showed a decrease to 48 IU/mL, the lowest level in our records. Repeat cfDNA testing showed a decrease of the ETV6-NTRK3 fusion to MAF 0.40% and the CRTC3-NTRK3 fusion to MAF 0.07%. The patient took larotrectinib for 7 months with good disease control. Unfortunately, unrelated to her therapy, she had experienced multiple fractures secondary to her existing osseous metastases, and these led to significant morbidity. She and her family elected to transition to comfort measures, after which she passed away. Discussion: In the presented case, the identification of NTRK fusions by plasma-based genotyping resulted in matched selection of genotype-directed therapy, and this otherwise refractory TNBC exhibited marked response to targeted therapy. While TNBC had historically been considered a subtype of breast cancer without targetable options, the expanding roles of NGS testing and targeted therapies are changing the paradigm. The actionability of rare genomic events such as NTRK fusions makes identifying them critical for individual patients, particularly in heterogeneous diseases such as TNBC. Tissue-agnostic targeted therapies now give reason for NGS testing in most solid tumors, as reflected in updated consensus guidelines. This case demonstrates the significant potential benefits of NGS testing in advanced and refractory cancers.
Citation Format: Jennifer C. Keenan, Arielle J. Medford, Lauren J. Oshry, Baris Boyraz, Charles S. Dai, Lesli A. Kiedrowski, Sofia Menshikova, Anna Butusova, Tasos Gogakos, Rachel Occhiogrosso, Phoebe Ryan, Jochen Lennerz, Laura M. Spring, Beverly Moy, Leif Ellisen, Aditya Bardia. TRK inhibitor in a patient with metastatic triple negative breast cancer and NTRK fusions identified via cell-free DNA analysis. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-02-13.
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Affiliation(s)
| | - Arielle J. Medford
- 2Massachusetts General Hospital Cancer Center/Dana Farber Cancer Institute
| | | | | | | | | | | | | | | | | | | | | | - Laura M. Spring
- 13Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | | | - Leif Ellisen
- 15Massachusetts General Hospital, Boston, Massachusetts
| | - Aditya Bardia
- 16Massachusetts General Hospital Cancer Center, Boston, Massachusetts
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Ryan P, Huins CT, O'Brien KJ, Misra S, Birman CS. Cochlear nerve dysplasia in unilateral severe to profound congenital sensorineural hearing loss - Prevalence in Australian children and the impact of socioeconomic disadvantage on its management. Int J Pediatr Otorhinolaryngol 2023; 165:111445. [PMID: 36630865 DOI: 10.1016/j.ijporl.2023.111445] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/21/2022] [Accepted: 01/06/2023] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Congenital unilateral sensorineural hearing loss (cuSNHL) carries potentially significant social, educational, and developmental consequences. Early diagnosis enables investigation, and consideration of options for management and early intervention, helping to mitigate the effects of hearing loss. Cochlear nerve dysplasia (CND) is a prominent cause of cuSNHL and may affect candidacy for cochlear implantation. Socioeconomic disadvantage may impact on a patient's family's capacity to participate in necessary intervention and follow-up. METHODS Infants with severe-profound cuSNHL referred to a large Australian quaternary pediatric center between October 2004 and December 2020 were retrospectively included. Audiometric and clinical data, and the presence of hearing loss risk factors were obtained from a prospectively collated database. In Australia MRI scans are provided free-of-charge to citizens and residents. MRI scans were reviewed to determine the status of the nerves within the internal acoustic meatus (IAM grade) along with attendance rates. Travel distance to the hospital was also calculated. Reasons for non-attendance at MRI were obtained from patient medical records and correspondence. Socioeconomic, educational, and occupational indices, and travel distances were obtained using patient residential postcodes with reference to Australian Bureau of Statistics data. RESULTS A total of 98 patients were reviewed, 64.3% (n = 63) of whom underwent MRI. The median age at diagnosis was 40 days (IQR 27). The prevalence of CND was 75% (n = 47). Importantly, there was no significant difference in the degree of hearing loss between IAM grades (F(4,57) = 1.029, p = 0.405). Socioeconomic indices were significantly lower in patients not attending MRI investigations compared with patients who did attend. Travel distance was not significantly different between the two groups. CONCLUSION CND is a prominent cause of cuSNHL in Australian infants. MRI at a young age allows parent education regarding management options and timely intervention where indicated. Socioeconomic disadvantage significantly impacts on participation in further routine assessment of cuSNHL, potentially limiting management options for these children long term.
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Affiliation(s)
- P Ryan
- Department of Otolaryngology and Head & Neck Surgery, The Children's Hospital at Westmead, NSW, Australia.
| | - C T Huins
- Department of Otolaryngology and Head & Neck Surgery, The Children's Hospital at Westmead, NSW, Australia; Queen Elizabeth Hospital, Birmingham, UK
| | - K J O'Brien
- Department of Audiology, The Children's Hospital at Westmead, NSW, Australia
| | - S Misra
- Department of Otolaryngology and Head & Neck Surgery, The Children's Hospital at Westmead, NSW, Australia
| | - C S Birman
- Department of Otolaryngology and Head & Neck Surgery, The Children's Hospital at Westmead, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, Sydney University, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Australia
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7
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Medford AJ, Oshry L, Boyraz B, Kiedrowski L, Menshikova S, Butusova A, Dai CS, Gogakos T, Keenan JC, Occhiogrosso RH, Ryan P, Lennerz JK, Spring LM, Moy B, Ellisen LW, Bardia A. TRK inhibitor in a patient with metastatic triple-negative breast cancer and NTRK fusions identified via cell-free DNA analysis. Ther Adv Med Oncol 2023; 15:17588359231152844. [PMID: 36743521 PMCID: PMC9893401 DOI: 10.1177/17588359231152844] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/05/2023] [Indexed: 02/04/2023] Open
Abstract
Tissue-agnostic indications for targeted therapies have expanded options for patients with advanced solid tumors. The Food and Drug Administration approvals of the programmed death-ligand 1 inhibitor pembrolizumab and the TRK inhibitors larotrectinib and entrectinib provide rationale for next-generation sequencing (NGS) in effectively all advanced solid tumor patients given potential for clinical responses even in otherwise refractory disease. As proof of concept, this case report describes a 64-year-old woman with triple-negative breast cancer refractory to multiple lines of therapy, found to have a rare mutation on NGS which led to targeted therapy with meaningful response. She initially presented with metastatic recurrence 5 years after treatment for a localized breast cancer, with rapid progression through four lines of therapy in the metastatic setting, including immunotherapy, antibody-drug conjugate-based therapy, and chemotherapy. Germline genetic testing was normal. Ultimately, NGS evaluation of cell-free DNA via an 83-gene assay (Guardant Health, Inc.) identified two NTRK3 fusions: an ETV6-NTRK3 fusion associated with the rare secretory breast carcinoma, and CRTC3-NTRK3, a novel fusion partner not previously described in breast cancer. Liver biopsy was sent for whole exome sequencing and RNA-seq analysis of tissue (BostonGene, Inc., Boston, MA, USA), which provided orthogonal confirmation of both the ETV6-NTRK3 and CRTC3-NTRK3 fusions. She was started on the TRK inhibitor larotrectinib with a marked clinical and radiographic response after only 2 months of therapy. The patient granted verbal consent to share her clinical story, images, and data in this case report. This case demonstrates the significant potential benefits of NGS testing in advanced cancer and the lessons we may learn from individual patient experiences.
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Affiliation(s)
| | - Lauren Oshry
- Boston Medical Center, Boston, MA, USA,Boston University School of Medicine, Boston, MA, USA
| | - Baris Boyraz
- Massachusetts General Hospital Cancer Center, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | | | | | | | - Charles S. Dai
- Massachusetts General Hospital Cancer Center, Boston, MA, USA,Dana Farber Cancer Institute, Boston, MA, USA
| | - Tasos Gogakos
- Massachusetts General Hospital Cancer Center, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | | | - Rachel H. Occhiogrosso
- Massachusetts General Hospital Cancer Center, Boston, MA, USA,Dana Farber Cancer Institute, Boston, MA, USA
| | - Phoebe Ryan
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Jochen K. Lennerz
- Massachusetts General Hospital Cancer Center, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Laura M. Spring
- Massachusetts General Hospital Cancer Center, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Beverly Moy
- Massachusetts General Hospital Cancer Center, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Leif W. Ellisen
- Massachusetts General Hospital Cancer Center, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Aditya Bardia
- Massachusetts General Hospital Cancer Center, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
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8
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Hughes N, Rijnbeek PR, van Bochove K, Duarte-Salles T, Steinbeisser C, Vizcaya D, Prieto-Alhambra D, Ryan P. Evaluating a novel approach to stimulate open science collaborations: a case series of "study-a-thon" events within the OHDSI and European IMI communities. JAMIA Open 2022; 5:ooac100. [PMID: 36406796 PMCID: PMC9670330 DOI: 10.1093/jamiaopen/ooac100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 10/09/2023] Open
Abstract
OBJECTIVE We introduce and review the concept of a study-a-thon as a catalyst for open science in medicine, utilizing harmonized real world, observation health data, tools, skills, and methods to conduct network studies, generating insights for those wishing to use study-a-thons for future research. MATERIALS AND METHODS A series of historical study-a-thons since 2017 to present were reviewed for thematic insights as to the opportunity to accelerate the research method to conduct studies across therapeutic areas. Review of publications and experience of the authors generated insights to illustrate the conduct of study-a-thons, key learning, and direction for those wishing to conduct future such study-a-thons. RESULTS A review of six study-a-thons have provided insights into their scientific impact, and 13 areas of insights for those wishing to conduct future study-a-thons. Defining aspects of the study-a-thon method for rapid, collaborative research through network studies reinforce the need to clear scientific rationale, tools, skills, and methods being collaboratively to conduct a focused study. Well-characterized preparatory, execution and postevent phases, coalescing skills, experience, data, clinical input (ensuring representative clinical context to the research query), and well-defined, logical steps in conducting research via the study-a-thon method are critical. CONCLUSIONS A study-a-thon is a focused multiday research event generating reliable evidence on a specific medical topic across different countries and health systems. In a study-a-thon, a multidisciplinary team collaborate to create an accelerated contribution to scientific evidence and clinical practice. It critically accelerates the research process, without inhibiting the quality of the research output and evidence generation, through a reproducible process.
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Affiliation(s)
- N Hughes
- Epidemiology, Janssen R&D, Beerse, Belgium
| | - P R Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - T Duarte-Salles
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | | | - D Vizcaya
- Bayer Pharmaceuticals, Sant Joan Despi, Spain
| | | | - P Ryan
- Epidemiology, Janssen R&D, Titusville, New Jersey, USA
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9
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Stockmann-Juvala H, Karjalainen A, Ryan P, Jones S. P19-11 EU-wide occupational exposure limits – preparation of scientific opinions. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Bardia A, Coates JT, Spring L, Sun S, Juric D, Thimmiah N, Niemierko A, Ryan P, Partridge A, Peppercorn J, Parsons H, Wander S, Pierce K, Attaya V, Fitzgerald D, Lormil B, Shellock M, Nagayama A, Bossuyt V, Moy B, Tolaney S, Ellisen L. Abstract 2638: Sacituzumab Govitecan, combination with PARP inhibitor, Talazoparib, in metastatic triple-negative breast cancer (TNBC): Translational investigation. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-2638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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
Abstract
Background: Sacituzumab Govitecan (SG), the first antibody-drug conjugate approved for metastatic TNBC (mTNBC), is comprised of SN-38 (active metabolite of irinotecan), a topoisomerase I (TOP1) inhibitor, coupled via a hydrolyzable linker to monoclonal antibody targeting trophoblast cell surface antigen 2 (Trop-2), an antigen overexpressed in mTNBC. Poly (ADP-ribose) polymerase inhibitors (PARPi) block resolution of TOP1 cleavage complexes (TOP1CCs) induced by TOP1 inhibitors, thus unmasking the inability of remaining pathways to repair DNA damage. However, previous clinical trials combining PARPi with standard TOP1 inhibitors (irinotecan, topotecan) were terminated early due to dose-limiting myelosuppression. We evaluated the combination of SG with PARP inhibitor in both pre-clinical models and phase 1b clinical trial.
Methods and Results: In pre-clinical models we demonstrated that the targeted antibody-based delivery of SN-38 increased the ratio of tumor-to-normal cell SN-38, resulting in stabilized TOP1CCs, enhanced DNA damage and increased cytotoxicity with the combination, selectively in tumor cells but not normal cells, despite temporal separation of SG and PARPi exposure. To validate the hypothesis, we conducted a phase 1b investigator-initiated clinical trial combining SG with PARPi (talazoparib) in patients with mTNBC (NCT04039230). Inclusion criteria included female patients ≥ 18 years of age with mTNBC (per ASCO/CAP guidelines) and previous treatment with at least one prior therapeutic regimen for mTNBC. Clinical outcomes were assessed by Objective Response Rate per RECIST v1.1. In the phase 1b clinical trial (SG day 18, every 21 days with talazoparib), the staggered schedule with supportive therapy was relatively well-tolerated without DLTs, as predicted by the pre-clinical models. Furthermore, the staggered schedule demonstrated promising clinical activity. Molecular analysis of paired pre-treatment and on-treatment specimens demonstrated γ-H2AX accumulation, confirming pharmacodynamic inhibition with combination therapy. The dose-escalation portion of clinical trial successfully completed enrollment with a recommended phase-2 dose (R2PD) of sequential SG (10 mg/kg on days 1,8) with talazoparib (1 mg on days 15-21), every 21 days.
Conclusion: Staggered dosing of SG and PARPi, leveraging the selective drug delivery mechanism of SG to minimize toxicity while maintaining efficacy, was feasible and demonstrated encouraging evidence of clinical activity with objective responses among patients with mTNBC. The translational study highlights how mechanistic insights and innovative scheduling could be utilized to develop promising drug combinations, including previously rejected combinations, for patients with mTNBC.
Citation Format: Aditya Bardia, James T. Coates, Laura Spring, Sheng Sun, Dejan Juric, Nayana Thimmiah, Andrzej Niemierko, Phoebe Ryan, Ann Partridge, Jeffrey Peppercorn, Heather Parsons, Seth Wander, Kelsey Pierce, Victoria Attaya, Donna Fitzgerald, Brenda Lormil, Maria Shellock, Aiko Nagayama, Veerle Bossuyt, Bev Moy, Sara Tolaney, Leif Ellisen. Sacituzumab Govitecan, combination with PARP inhibitor, Talazoparib, in metastatic triple-negative breast cancer (TNBC): Translational investigation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2638.
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Affiliation(s)
- Aditya Bardia
- 1Massachusetts General Hospital Cancer Center, Boston, MA
| | | | - Laura Spring
- 1Massachusetts General Hospital Cancer Center, Boston, MA
| | - Sheng Sun
- 1Massachusetts General Hospital Cancer Center, Boston, MA
| | - Dejan Juric
- 1Massachusetts General Hospital Cancer Center, Boston, MA
| | | | | | - Phoebe Ryan
- 1Massachusetts General Hospital Cancer Center, Boston, MA
| | | | | | | | - Seth Wander
- 1Massachusetts General Hospital Cancer Center, Boston, MA
| | | | | | | | - Brenda Lormil
- 1Massachusetts General Hospital Cancer Center, Boston, MA
| | - Maria Shellock
- 1Massachusetts General Hospital Cancer Center, Boston, MA
| | - Aiko Nagayama
- 1Massachusetts General Hospital Cancer Center, Boston, MA
| | - Veerle Bossuyt
- 1Massachusetts General Hospital Cancer Center, Boston, MA
| | - Bev Moy
- 1Massachusetts General Hospital Cancer Center, Boston, MA
| | | | - Leif Ellisen
- 1Massachusetts General Hospital Cancer Center, Boston, MA
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11
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Andrinopoulou ER, Afonso PM, Szczesniak R, Zhou G, Clancy J, Palipana A, Rasnick E, Brokamp C, Ryan P, Keogh R. WS07.05 Investigating the relationship between lung function decline and time to death or lung transplantation, accounting for geographical variability. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00193-x] [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: 11/30/2022]
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12
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Afonso PM, Szczesniak R, Zhou G, Clancy J, Palipana A, Rasnick E, Brokamp C, Ryan P, Keogh R, Andrinopoulou ER. WS15.02 A joint model for lung function and nutritional status decline with recurrent pulmonary exacerbations, death, and lung transplantation using cystic fibrosis patient Registry data. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00238-7] [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: 11/15/2022]
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13
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Spring L, Tolaney SM, Desai NV, Fell G, Trippa L, Comander AH, Mulvey TM, McLaughlin S, Ryan P, Rosenstock AS, Garrido-Castro AC, Lynce F, Moy B, Isakoff SJ, Tung NM, Mittendorf EA, Ellisen LW, Bardia A. Phase 2 study of response-guided neoadjuvant sacituzumab govitecan (IMMU-132) in patients with localized triple-negative breast cancer: Results from the NeoSTAR trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.512] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
512 Background: Sacituzumab govitecan (SG), a novel antibody-drug conjugate in which the topoisomerase 1 inhibitor SN-38 (active metabolite of irinotecan) is linked to a humanized monoclonal antibody targeting the tumor antigen Trop2, is currently approved for treatment of patients (pts) with pre-treated metastatic triple negative breast cancer (TNBC). We conducted a phase 2 study evaluating neoadjuvant (NA) SG as upfront therapy for pts with localized TNBC (NCT04230109). The primary objective was to assess pathological complete response (pCR) rate in breast and lymph nodes (ypT0/isN0) with SG. Secondary objectives included assessment of radiological response rate, evaluation of the safety and tolerability (CTCAE v5.0) and event-free survival (EFS). Methods: Patients with localized TNBC (tumor size ≥1cm, or any size if node positive) with no prior treatment were eligible. SG was administered IV on Days 1, 8 of each 21-day cycle at a starting dose of 10 mg/kg for 4 cycles. After 4 cycles, patients with biopsy-proven residual disease, considered as no pCR for primary endpoint, had the option to receive additional NA therapy at the discretion of the treating physician. Radiologic response (US or MRI) was defined by RECIST version 1.1 using a composite response of CR & PR. Standard descriptive statistics were utilized, including 95% binomial confidence intervals for all rates estimated. Results: From 7/14/20 – 8/31/21, 50 pts were enrolled (median age = 48.5; 11 stage I disease, 24 stage II, 11 stage III, 4 unknown; 62% node negative). The majority (98%; n = 49) of pts completed 4 cycles of SG. Overall, the radiological response rate with SG alone was 62% (n = 31, 95% CI 48%, 77%). 26 pts proceeded directly to surgery after SG. Overall, the pCR rate with SG alone was 30% (n = 15/50, 95% CI 18%, 45%). The other 11 pts had RCB-1 (n = 3), RCB-2 (n = 5), and RCB-3 (n = 3) disease, respectively. Of the 24 pts who received additional NA therapy, 6 had a pCR (3 received anthracycline-based regimen, 2 carboplatin/taxane, and 1 docetaxel/cyclophosphamide). Among pts with a germline BRCA mutation (n = 8), 7 proceeded directly to surgery after SG and 6 had a pCR (86%, 95% CI 42%, 99%). The most common AEs with SG were nausea (82%, n = 41), fatigue (78%, n = 39), alopecia (76%, n = 38), neutropenia (58%, n = 29), anemia (36%, n = 18), and rash (48%, n = 24). 6% of pts required dose-reduction. No pts discontinued SG therapy due to disease progression or AEs; 1 discontinued due to minimal response per investigator preference. At the time of data cut-off (1/18/22), no pts experienced disease recurrence. Updated biomarker and EFS results will be presented at the meeting. Conclusions: In the first neoadjuvant trial in TNBC with an ADC, SG demonstrated single agent efficacy in localized TNBC. Further research on optimal duration of SG as well as NA combination strategies, including immunotherapy, are needed. Clinical trial information: NCT04230109.
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Affiliation(s)
- Laura Spring
- Massachusetts General Hospital Cancer Center, Boston, MA
| | | | | | - Geoffrey Fell
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Lorenzo Trippa
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | | | | | | | | - Beverly Moy
- Massachusetts General Hospital Cancer Center, Boston, MA
| | | | | | | | | | - Aditya Bardia
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
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14
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Feugang J, Ishak G, Pechan T, Pechanova O, Gastal M, Ryan P, Gastal E. 105 Proteome profiling of equine follicular fluid before, during, and after selection of the dominant follicle. Reprod Fertil Dev 2021; 34:289. [PMID: 35231241 DOI: 10.1071/rdv34n2ab105] [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: 11/23/2022] Open
Affiliation(s)
- J Feugang
- Mississippi State University, Mississippi State, MS, USA
| | - G Ishak
- University of Baghdad, Baghdad, Iraq
| | - T Pechan
- Mississippi State University, Mississippi State, MS, USA
| | - O Pechanova
- Mississippi State University, Mississippi State, MS, USA
| | - M Gastal
- Southern Illinois University, Carbondale, IL, USA
| | - P Ryan
- Mississippi State University, Mississippi State, MS, USA
| | - E Gastal
- Southern Illinois University, Carbondale, IL, USA
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15
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Mustafa W, O'Byrne R, Okpaje B, Gabr A, Ali B, Mohamed A, Cameron S, Leahy A, Fernandes L, Mannion M, Ryan P, Ryan S, Peters C, Shanahan E, Galvin R, O'Connor M. 233 BISPHOSPHONATES: ANOTHER COMPLEX DRUG TO PRESCRIBE. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.233] [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: 02/25/2023] Open
Abstract
Abstract
Background
Bisphosphonates provide effective treatment for osteoporosis. They accumulate a bone reservoir lasting for 3 years and beyond. The 2021 NICE guidelines recommend a medication review and a ‘drug holiday’ after 5 years of oral bisphosphonate therapy for low-fracture risk patients. Continuing treatment for high risk individuals is advised: age=/>75, previous hip or vertebral fracture, one or more fractures during treatment, recent DEXA scan with T score =/<−2.5, and/or current treatment with oral glucocorticoids. This retrospective audit aimed to assess compliance with NICE guidelines in a primary care setting.
Methods
Data were collected using the Health One online medical record system in an urban general practice. Inclusion criteria: all patients =/> 65 years old, prescribed oral bisphosphonate therapy for osteoporosis for >5 years. Exclusion criteria: deceased, did not attend clinic >1 year, patients on bisphosphonate treatment for conditions other than osteoporosis.
Results
137 patients with a history of bisphosphonate therapy were identified. 76 patients were on bisphosphonate treatment for greater than 5 years. Of the 76 patients, 33 were classified as low-fracture risk and appropriately commenced a drug holiday, while 22 correctly remained on bisphosphonates due to a high fracture risk. The remaining 21 patients inappropriately continued therapy without receiving a medication review, repeat DEXA or fracture-risk assessment.
Conclusion
One third of patients on bisphosphonates beyond 5 years were not assessed for a drug holiday. The aim of a bisphosphonate ‘drug holiday’ is to reduce poly-pharmacy and prevent rare but serious long-term adverse events (such as atypical fractures, osteonecrosis of the jaw, gastric cancer and atrial fibrillation). Factors which had an impact on inappropriate prescribing should be assessed. Incorporating computer-based prescribing alerts could support safe prescribing practices.
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Affiliation(s)
- W Mustafa
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - R O'Byrne
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - B Okpaje
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - A Gabr
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - B Ali
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - A Mohamed
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - S Cameron
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - A Leahy
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - L Fernandes
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - M Mannion
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - P Ryan
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - S Ryan
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - C Peters
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - E Shanahan
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - R Galvin
- School of Allied Health , HRI, , Limerick, Ireland
- University of Limerick , HRI, , Limerick, Ireland
| | - M O'Connor
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
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16
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Ryan P, Twomey G, Falvey É. Assessment of Layperson Knowledge of AED use in Sports Clubs. Ir Med J 2021; 114:405. [PMID: 34520604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Aims To investigate knowledge and attitudes among sports club members toward AEDs, and to examine the potential benefits of an educational programme as an intervention for increasing awareness and willingness to use an AED. Methods A number of selected sports clubs were visited, and participants aged ≥16 were asked to complete a questionnaire relating to current awareness and attitudes toward AEDs, and their willingness to use the device. Each participant then attended a 2-hour small-group teaching session where they were educated on the role and use of an AED, with opportunity to practice AED use in a controlled environment. After receiving teaching, each individual again completed the questionnaire. Results 142 people participated in the study. Before teaching, the average level of knowledge regarding AED use was relatively low. The most common reason identified for unwillingness to operate an AED was lack of knowledge on how to correctly use the device. Paired data analysis showed that attendance at a 2-hour educational programme led to a significant improvement in layperson awareness and understanding of AED use. After teaching, 77.5%(n=110) of participants reported that they would definitely be willing to use an AED, compared with 20.4%(n=30) before teaching. Conclusion A structured educational programme can increase layperson awareness, confidence and willingness to operate an AED.
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Affiliation(s)
- P Ryan
- Department of Anaesthesia and Intensive Care, Cork University Hospital, Ireland
| | - G Twomey
- National Ambulance Service Ireland
| | - É Falvey
- Department of Sports and Exercise Medicine, University College Cork, Ireland
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17
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Cartledge S, Rawstorn J, Tran M, Ryan P, Howden E, Jackson A. Throwing cardiac rehabilitation into the 21st Century: a focus group study exploring the impact of COVID-19 on cardiac rehabilitation delivery in Victoria, Australia. Eur J Cardiovasc Nurs 2021. [PMCID: PMC8344710 DOI: 10.1093/eurjcn/zvab060.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Funding Acknowledgements Type of funding sources: None. Background Cardiac rehabilitation (CR) education and exercise are predominantly delivered in group face-to-face settings. This delivery model was challenged during the COVID-19 pandemic due to government enforced lockdowns which restricted the delivery of these models of care. The Australian state of Victoria experienced the longest and most severe local restrictions and was in lockdown for approximately 26 weeks of 2020. Purpose We aimed to explore the experience, barriers and enablers of delivering CR during a pandemic, and identify strategies for future COVID-safe programs among cardiac rehabilitation clinicians. Methods Victorian members of the Australian Cardiovascular Health and Rehabilitation Association (ACRA) were invited to attend an exploratory qualitative online focus group in November 2020. An inductive thematic analysis was undertaken before deductively applying the Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework to identify barriers and enablers for technology adoption in CR. Results 30 members participated in a 106 minute focus group. 17 members who provided demographics represented multiple disciplines (nursing n = 13, exercise physiology n = 3, physiotherapy n = 1) and geographical settings (metropolitan n = 10, regional n = 4, rural n = 3). Four main themes were identified: Consequences of sudden service delivery change; Technology use – challenges and benefits; Capacity (program and staff); and The way forward. The deductive NASSS analysis demonstrated the main challenges of continuing remotely delivered CR lie with all adopters (staff, patients, carers) and with organisations. Future CR strategies included the importance of resuming face-to-face programs but important barriers including finding capacity, particularly staffing, to run concurrent telehealth programs remain to be addressed. Conclusion The COVID-19 pandemic forced and expedited significant changes to CR delivery models. While clinicians agreed that delivery of CR via telehealth will continue, it is now timely to review remote models of care and plan how they will integrate alongside traditional face-to-face programs.
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Affiliation(s)
- S Cartledge
- Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia
| | - J Rawstorn
- Deakin University, Institute for Physical Activity and Nutrition, Melbourne, Australia
| | - M Tran
- St Vincent"s Hospital, Cardiopulmonary Rehabilitation , Melbourne, Australia
| | - P Ryan
- Heart Foundation , Melbourne, Australia
| | - E Howden
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - A Jackson
- Australian Centre for Heart Health, Melbourne, Australia
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18
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Simón MA, Rojo O, Ryan P. Patients' preferences for treatment with the new direct acting antiviral therapies for chronic hepatitis C virus infection. ACTA ACUST UNITED AC 2021; 23:67-75. [PMID: 34279534 PMCID: PMC8592264 DOI: 10.18176/resp.00033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/09/2021] [Accepted: 04/10/2021] [Indexed: 11/26/2022]
Abstract
Objectives: The efficacy of new direct-acting antivirals (DAAs) in treating hepatitis C infection can depend on treatment adherence, which may be influenced by the patient’s current lack of awareness of the disease. This study set out to understand the treatment naïve chronic hepatitis C patients’ preferences for new DAAs (attributes) and to compile information about the diagnosis process. Material and method: Spanish quantitative market research study conducted between November 2018 and January 2019 to assess the posology preferences of treatment-naïve patients with chronic hepatitis C before starting treatment (seen by hepatologists and infectious diseases specialists). A telephone interview was carried out to collect demographic, diagnostic and treatment preference data, consisting of two dosing OPTIONS: 1) three tablets/day (single dose), at the same time, with food (8 weeks). 2) single tablet/day, at any time with/without food (12 weeks). A descriptive analysis of pooled results was performed. Results: 104 patients (mean age: 49 years) with hepatitis C diagnosed 7.3±9.7 years ago (average), mainly in primary care (PC) (42%). The most common reasons for not having started treatment were health problems/comorbidities (31%). Fifty-eight percent of patients were not informed about the available treatments. Seventy-two percent of patients preferred a simple tablet/day, at any time, with/without food (12 weeks), and considered compatibility with other treatments, side effects, ease of administration, treatment duration and the number of tablets to be very important. Discussion: Patient preferences are mainly driven by dosing flexibility and simplicity, including freedom to take the medication with/without food. The role of PC in the diagnosis should be taken into account. There are still patients who are untreated after diagnosis.
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Affiliation(s)
- M A Simón
- Department of Gastroenterology. Hospital Clínico Universitario Lozano Blesa. Instituto de Investigación Sanitaria (IIS) Aragón. Zaragoza
| | - O Rojo
- Quantitative Technical Department. Amber Marketing Research, S.L. Madrid
| | - P Ryan
- Department of Internal Medicine. Hospital Universitario Infanta Leonor. Madrid
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Cartledge S, Rawstorn J, Ryan P, Tran M, Howden E, Jackson A. Cardiac Rehabilitation During COVID-19 in Victoria, Australia: Telehealth is Here to Stay but it is Not Without Challenges. A Focus Group Study. Heart Lung Circ 2021. [PMCID: PMC8608273 DOI: 10.1016/j.hlc.2021.06.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Broe M, Ryan J, Lynch O, Ryan P, Hegazy M, Mulvin D, McGuire B. More Than Just a UPJ Problem: Robotic-Assisted Pyeloplasty with Description of Technique for Reconstruction of Large Renal Pelvis. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35293-9] [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: 11/16/2022] Open
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Bardia A, Spring L, Juric D, Partridge A, Ligibel J, Kuter I, Peppercorn J, Parsons H, Ryan P, Chawla D, Attaya V, Fitzgerald D, Viscosi E, Lormill B, Shellock M, Moy B, Tolaney S, Ellisen L. 358TiP Phase Ib/II study of antibody-drug conjugate, sacituzumab govitecan, in combination with the PARP inhibitor, talazoparib, in metastatic triple-negative breast cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.460] [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: 10/23/2022] Open
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Yang C, Williams R, Swerdel J, Jani M, Duarte-Salles T, Chatzidionysiou K, Prieto-Alhambra D, Ryan P, Rijnbeek P. OP0216 DEVELOPMENT AND VALIDATION OF PATIENT-LEVEL PREDICTION MODELS FOR ADVERSE HEALTH OUTCOMES AMONGST ADULT RA PATIENTS INITIATING FIRST-LINE TREATMENT OF METHOTREXATE MONOTHERAPY: A MULTINATIONAL REAL-WORLD COHORT ANALYSIS INCLUDING 164,735 SUBJECTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3606] [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:EULAR guidelines recommend the early initiation of methotrexate (MTX) monotherapy as soon as possible after the diagnosis of rheumatoid arthritis (RA). Evaluating patient-level risks for adverse outcomes after MTX initiation would allow clinicians to provide more personalised care.Objectives:To develop and validate patient-level prediction models for adverse health outcomes including leukopenia, pancytopenia, infection (serious, opportunistic, all), cardiovascular disease (CVD) (myocardial infarction (MI), stroke), and cancer (breast, colorectal, uterus) in adult RA patients initiating first-line treatment of MTX monotherapyMethods:Health data from claims and electronic health records were used including patients from 7 European countries (Spain, Estonia, Netherlands, Belgium, Germany, France, and the UK), the United States of America, Australia, and Japan. All RA patients initiating first-line treatment of MTX monotherapy with at least one year of prior observation were included. Prediction models for the outcomes were developed for a time at risk of 3 months (infections, leukopenia, pancytopenia), 2 years (MI and stroke), and 5 years (cancers) on the Optum© De-Identified Clinformatics® Data Mart Database. Models were developed using LASSO logistic regression and were evaluated using the area under the receiver operator characteristic curve (AUROC) for discrimination and graphically assessed for calibration. The models were externally validated on all other databases.Results:A total of 21,307 subjects were used for training and validated against 143,427 patients from 14 sites. MI (AUROC internal 0.77, AUROC external ranging from 0.49 to 0.78), stroke (AUROC internal 0.78, AUROC external ranging from 0.68 to 0.79) and serious infection (AUROC internal 0.75, AUROC external ranging from 0.63 to 0.79) had good predictive validity [Table 1]. Discrimination for all other outcomes was lower, with all AUC<0.7 in internal validation. For detailed results see:https://data.ohdsi.org/ehdenRaPrediction/Table 1.Internal (Optum) and external validation results: AUC ROC for discriminationDatabaseAcute MI within 2yStroke within 2ySerious Infection within 3mOptum (internal)0.770.780.75PanTher0.760.780.74IQVIA_AMBEMR0.760.72CCAE0.730.730.66IQVIA_GERMANY0.640.70IQVIA_THIN0.620.65MDCR0.680.680.67IQVIA_HOSPITAL0.670.630.61MDCD0.720.790.63JMDC0.490.750.71IQVIA_LPDFRANCE0.69Estonia0.670.770.82IQVIA_AUS0.58IPCI0.68SIDIAP0.650.75Conclusion:Clinical tools were developed that successfully identify subjects at risk of MI, stroke and serious infection at the initiation of first-line MTX therapy. The developed algorithms had good transportability and generally, the models with high AUROC had adequate internal calibration although some external validations show they could benefit from recalibration. For short-term opportunistic and all infections, as well as 5-year cancer models, we were unable to achieve a high enough AUROC to warrant validating externally.Disclosure of Interests:Cynthia Yang: None declared, Ross Williams: None declared, Joel Swerdel Shareholder of: J&J shares, Grant/research support from: Full-time employment salary from Janssen, Consultant of: Janssen employee, Employee of: Janssen, Paid instructor for: Janssen employee, have instructed at conferences, Speakers bureau: Janssen employee, have spoken at conferences, Meghna Jani Speakers bureau: Grifols, Talita Duarte-Salles: None declared, Katerina Chatzidionysiou Consultant of: AbbVie, Pfizer, Lilly., Daniel Prieto-Alhambra Grant/research support from: Professor Prieto-Alhambra has received research Grants from AMGEN, UCB Biopharma and Les Laboratoires Servier, Consultant of: DPA’s department has received fees for consultancy services from UCB Biopharma, Speakers bureau: DPA’s department has received fees for speaker and advisory board membership services from Amgen, Patrick Ryan: None declared, Peter Rijnbeek: None declared
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Duarte-Salles T, Recalde M, Weaver J, Burn E, Marinier K, Díaz Y, Illingens B, Vizcaya D, Chatzidionysiou K, Ryan P, Prieto-Alhambra D. SAT0134 COMPARATIVE RISK OF CANCER ASSOCIATED WITH FIRST-LINE DMARDS USE IN RHEUMATOID ARTHRITIS: REAL WORLD EVIDENCE FROM THE OHDSI NETWORK. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3866] [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: 11/03/2022]
Abstract
Background:Conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) are recommended as first line treatment for rheumatoid arthritis (RA) patients, but limited information exists on the comparative risk of cancer associated with their use.Objectives:To compare the risk of incident overall (excluding non-melanoma skin) and site-specific cancers (colorectal, lung, lymphoma, leukaemia) associated with first-line use of csDMARDs in patients with RA.Methods:We conducted a multinational cohort study informed by data from 7 healthcare databases including claims and electronic medical records from 4 countries (SIDIAP-Spain, MDCR-US Optum-US, CCAE-US, IQVIA AMBEMR-US, IQVIA-Germany, THIN-UK) part of the Observational Health Data Sciences and Informatics (OHDSI) network. All patients aged ≥18 years who initiated methotrexate (MTX), hydroxychloroquine (HCQ), sulphasalazine (SSZ), or leflunomide (LEF) as first-line monotherapy after a diagnosis of RA between 2005 to 2018 were eligible. Individuals with a prior diagnosis of another inflammatory arthropathy or cancer, or <1 year of follow-up were excluded. Patients were followed from 1-year after treatment initiation to the earliest of incident cancer, loss to follow-up, or 5-years. Cox proportional-hazard models for MTX against each other csDMARD were performed after propensity score stratification. A large set of negative control outcomes were analysed to calibrate hazard ratios (cHRs). Estimates were pooled where homogeneity across sources was adequate (I2<0.4).Results:Across the databases, 127,547 RA patients initiating csDMARD therapy were included in the analyses (MTX: 73,996, HCL: 36,381 SSZ: 9,383 LEF: 7,787). The pooled incidence rate of overall cancer for MTX was 22.8 per 1,000 person years. The pooled summary and source-specific estimated cHRs for overall cancer are shown below in Figure 1. While little difference was seen for HCQ and SSZ compared to MTX, LEF was consistently associated with a reduced cancer risk: pooled cHR (95% CI) 0.67 (0.59 to 0.76) and cHRs ranged from 0.53 (0.36 to 0.80) in CCAE-US to 0.84 (0.58 to 1.22) in SIDIAP-Spain. There were insufficient cases to look site-specific cancers within data sources, although pooled results suggest little risk difference in leukemia, lymphoma, colorectal, or lung cancers.Figure 1.Calibrated hazard ratios (cHRs) of overall cancer risk with their respective confidence intervals (95%CI) by study database. Database estimates not reported where adequate covariate balance not attained. Meta-analysis results not reported where I2>0.4.Conclusion:Compared to MTX users, patients treated with LEF had a lower risk of overall cancer. Risk of four specific cancers did not differ by first line csDMARD exposure.Disclosure of Interests: :Talita Duarte-Salles: None declared, Martina Recalde: None declared, James Weaver Shareholder of: J&J Shares, Grant/research support from: Full-time employment salary from Janssen, Consultant of: Janssen employee, Employee of: Janssen, Paid instructor for: Janssen employee, have instructed at conferences, Speakers bureau: Janssen employee, have spoken at conferences, Edward Burn: None declared, Karine Marinier Employee of: Servier, Yesika Díaz: None declared, Ben Illingens: None declared, David Vizcaya Employee of: Bayer, Katerina Chatzidionysiou Consultant of: AbbVie, Pfizer, Lilly., Patrick Ryan: None declared, Daniel Prieto-Alhambra Grant/research support from: Professor Prieto-Alhambra has received research Grants from AMGEN, UCB Biopharma and Les Laboratoires Servier, Consultant of: DPA’s department has received fees for consultancy services from UCB Biopharma, Speakers bureau: DPA’s department has received fees for speaker and advisory board membership services from Amgen
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Sena AG, Granados D, Hughes N, Fakhouri W, Hottgenroth A, Kolde R, Reisberg S, Torre CO, Duarte-Salles T, Díaz Y, Golib-Dzib JF, Brouwer ES, Burn E, Lane J, Vizcaya D, Bruce Wirta S, De Wilde M, Verhamme K, Rijnbeek P, Theander E, Chatzidionysiou K, Prieto-Alhambra D, Ryan P. THU0212 FIRST LINE TREATMENT WITH CONVENTIONAL SYNTHETIC DISEASE MODIFYING ANTIRHEUMATIC DRUGS IN RHEUMATOID ARTHRITIS: A MULTINATIONAL POPULATION-BASED COHORT FROM 14 REAL WORLD HEALTHCARE DATABASES AND 9 COUNTRIES - REALITY VERSUS GUIDELINES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3131] [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:Treatment guidelines recommend early initiation of csDMARDs following diagnosis of rheumatoid arthritis (RA), with methotrexate (MTX) as first-line therapy. Scarce evidence exists on adherence to this guidanceObjectives:To characterize first-line csDMARD treatment during the first year following an RA diagnosis.Methods:14 real world databases (3 Primary care, 6 primary/secondary care records, 5 claims) from 9 countries were included, all mapped to the OMOP common data model.Patients were included on the earliest event of: 1st diagnosis of RA or 1st DMARD prescription with an RA diagnosis within 30 days. Patients were >18 years-old, required 1+ year pre-index data, and at least 1-year follow-up. Study period covered 2000-2018. Previous users of DMARDs or non-RA inflammatory arthritis history were excluded. Only MTX, Hydroxychloroquine (HCQ), Sulfasalazine (SSZ) and Leflunomide (LEF) were available in all databases.Results:We identified 323,547 eligible participants. Large variation was observed internationally (Figure 1). MTX as first-line monotherapy ranged from 33.3% to 74.5%, and in combination with HCQ from 2.1% to 6.7%. Three additional csDMARDs were used as first-line: HCQ in 10.1% to 30.2%, SSZ in 0.9% to 28.7%, and LEF in 1.8% to 15.2%.Figure 1.First line csDMARD treatment during 1yr from first observed RA diagnosisConclusion:We report wide heterogeneity of first-line csDMARDs regimens internationally. Despite recommendations for MTX to be first line therapy, data suggest that a large proportion of patients receive alternative csDMARD.Disclosure of Interests: :Anthony G Sena Shareholder of: J&J shares, Grant/research support from: Full-time employment salary from Janssen, Consultant of: Full-time employment salary from Janssen, Employee of: Janssen employee, Paid instructor for: Janssen employee, Speakers bureau: Janssen employee, Denis Granados: None declared, Nigel Hughes Shareholder of: J&J shares, Grant/research support from: Full-time employment salary from Janssen, Consultant of: Janssen employee, Employee of: Janssen employee, Paid instructor for: Janssen employee, Speakers bureau: Janssen employee, WALID FAKHOURI Shareholder of: E Lilly Shares, Employee of: Eli Lilly and Company, Antje Hottgenroth Shareholder of: Eli Lilly shares, Employee of: Lilly Deutschland GmbH, Raivo Kolde: None declared, Sulev Reisberg: None declared, Carmen Olga Torre: None declared, Talita Duarte-Salles: None declared, Yesika Díaz: None declared, Jose Felipe Golib-Dzib Grant/research support from: Full-time employment salary from Janssen, Employee of: Yes, Janssen employee, Paid instructor for: Janssen Employee, Speakers bureau: Janssen Employee, Emily S. Brouwer Shareholder of: J&J shares, Takeda shares, Grant/research support from: Full-time employment salary from Janssen, Consultant of: Janssen employee, Employee of: Janssen employee, Paid instructor for: Janssen Employee, Speakers bureau: Janssen Employee, Edward Burn: None declared, Jennifer Lane: None declared, David Vizcaya Employee of: Bayer, Sara Bruce Wirta Employee of: Janssen-Cilag Sweden AB, Marcel de Wilde: None declared, Katia Verhamme: None declared, Peter Rijnbeek: None declared, Elke Theander Employee of: Janssen-Cilag Sweden AB, Katerina Chatzidionysiou Consultant of: AbbVie, Pfizer, Lilly., Daniel Prieto-Alhambra Grant/research support from: Professor Prieto-Alhambra has received research Grants from AMGEN, UCB Biopharma and Les Laboratoires Servier, Consultant of: DPA’s department has received fees for consultancy services from UCB Biopharma, Speakers bureau: DPA’s department has received fees for speaker and advisory board membership services from Amgen, Patrick Ryan: None declared
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Prats-Uribe A, Illingens B, Vizcaya D, Weaver J, Burn E, Sawant R, Marinier K, Ryan P, Prieto-Alhambra D. SAT0131 CARDIO- AND CEREBROVASCULAR RISK WITH CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (CSDMARDS) IN RHEUMATOID ARTHRITIS (RA): A REAL-WORLD COMPARATIVE ASSESSMENT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3463] [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: 11/03/2022]
Abstract
Background:RA is associated with an increased cardiovascular (CV) risk. csDMARDs are first-line treatments for RA and can mitigate this risk, but limited data exist on their CV effects. Previous trials have reported protective effects for methotrexate (MTX) and hydroxychloroquine (HCQ), but no similar data exist on sulfasalazine (SSZ) or leflunomide (LEF).Objectives:To assess the comparative effect of csDMARDs on the risk of myocardial infarction (MI) and stroke in RA patientsMethods:Data from 6 claims/electronic health records databases across Germany, US, and UK, all mapped to the Observational Medical Outcomes Partnership (OMOP) common data model. A cohort study was conducted including patients ≥18 years old, with first RA diagnosis in 2005-2019, initiating csDMARD monotherapy with MTX, HCQ, SSZ, or LEF. Those with a prior diagnosis of other inflammatory arthritis or <1 year prior follow-up were excluded. Patients were followed until first outcome, death, loss of or 5 years follow-up. Propensity score stratification was used, and hazard ratios (HR) estimated for HCQ, SSZ and LEF compared to MTX in each dataset using Cox regression. HR were calibrated (cHR) for residual confounding using negative control outcomes. Estimates were pooled where I2for heterogeneity <0.4. Intention to treat and an on treatment analyses are reported.Results:145,248 patients were included (MTX: 73,996, HCQ: 49,752, SSZ: 12,256, LEF: 9,244). Pooled rates of MI and stroke for MTX were 7.64 and 10.26 per 1,000 person years respectively. Detailed estimate cHRs are shown in Figure 1 for the intention to treat analysis. MI risk with SSZ and LEF was comparable to MTX. Risk of stroke was similar between LEF and MTX, but reduced for HCQ and SSZ compared to MTX, with pooled cHR (95% CI) 0.86 (0.78 to 0.95) and 0.71 (0.52 to 0.98) for HCQ and SSZ respectively. Similar results were found for “on treatment” analyses.Figure 1.Calibrated hazard ratios (cHRs) for MI and strokeConclusion:Overall, all four csDMARDs had similar effects on MI risk. HCQ and SSZ use were associated with a decreased risk of stroke compared to MTX. The observed differences may be attributable to differential effects on the atherosclerotic process, differential disease control, or both.Database estimates not reported where adequate covariate balance not attained. Meta-analysis results not reported where I2>0.4. MEDICARE did not pass diagnostics for SSZ and LEF analyses. cHR: calibrated Hazard Ratio; CI: Confidence Interval; MTX: Methotrexate; HCQ: Hydroxychloroquine; SSZ: sulphasalazine; LEF: Leflunomide; THIN: The Health Improvement Network (UK); Optum: Optum de-identified Clinformatics Datamart (US); MDCR: Medicare (US); GERMANY: IQVIA Disease Analyzer EMR (Germany); CCAE: IBM MarketScan Commercial Claims and Encounters (US); AMBEMR: IQVIA Ambulatory EMR (US)Database estimates not reported where adequate covariate balance not attained. Meta-analysis results not reported where I2>0.4. MEDICARE did not pass diagnostics for SSZ and LEF analyses. cHR: calibrated Hazard Ratio; CI: Confidence Interval; MTX: Methotrexate; HCQ: Hydroxychloroquine; SSZ: sulphasalazine; LEF: Leflunomide; THIN: The Health Improvement Network (UK); Optum: Optum de-identified Clinformatics Datamart (US); MDCR: Medicare (US); GERMANY: IQVIA Disease Analyzer EMR (Germany); CCAE: IBM MarketScan Commercial Claims and Encounters (US); AMBEMR: IQVIA Ambulatory EMR (US)Disclosure of Interests: :Albert Prats-Uribe: None declared, Ben Illingens: None declared, David Vizcaya Employee of: Bayer, James Weaver Shareholder of: J&J Shares, Grant/research support from: Full-time employment salary from Janssen, Consultant of: Janssen employee, Employee of: Janssen, Paid instructor for: Janssen employee, have instructed at conferences, Speakers bureau: Janssen employee, have spoken at conferences, Edward Burn: None declared, Ruta Sawant Shareholder of: AbbVie, Employee of: AbbVie, Karine Marinier Employee of: Servier, Patrick Ryan: None declared, Daniel Prieto-Alhambra Grant/research support from: Professor Prieto-Alhambra has received research Grants from AMGEN, UCB Biopharma and Les Laboratoires Servier, Consultant of: DPA’s department has received fees for consultancy services from UCB Biopharma, Speakers bureau: DPA’s department has received fees for speaker and advisory board membership services from Amgen
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Carmona L, Weaver J, Burn E, Illingens B, Vizcaya D, Sawant R, Duarte-Salles T, Ryan P, Prieto-Alhambra D. SAT0138 DRUG-RELATED PANCYTOPENIA AND LEUKOPENIA IN RHEUMATOID ARTHRITIS: ARE ALL CSDMARDS EQUAL? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4075] [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: 11/03/2022]
Abstract
Background:Cytopenia is a known side-effect of conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) in rheumatoid arthritis (RA). There is a lack of data on the comparative risk of cytopenia with different csDMARDs.Objectives:To assess the comparative risk of leukopenia and pancytopenia for the most frequently used first-line csDMARDs: methotrexate (MTX), hydroxychloroquine (HCQ), sulphasalazine (SSZ), and leflunomide (LEF).Methods:The study used data from 7 databases from 4 countries: CCAE, MDCR, Optum, IQVIA Ambulatory EMR (US); IQVIA THIN IMRD EMR (UK); IQVIA Disease Analyzer EMR (Germany); and SIDIAP (Spain). Cohorts included adult patients with a diagnosis of RA from 2005 to 2019 with at least one-year prior follow-up, no prior inflammatory arthritis, initiaton of first-line csDMARD, and no cytopenia in the preceding 30 days. Participants were followed from one day after treatment initiation to the earliest of event occurrence, treatment discontinuation/switching plus 14 days in the on-treatment analysis, five years in the intent-to-treat (ITT) analysis, or loss to follow-up. MTX was used as reference group. Cox models were fitted with propensity score stratification for observed confounding and negative control outcomes calibration for residual error. Estimates across database were pooled where I2<40% was seen.Results:Overall 166,347 patients were included. Pooled rates of leukopenia and pancytopenia for MTX were 10.9 and 3.2 per 1,000 person years, respectively. Figure 1 and 2 show the results for the different databases and pooled estimates where applicable. Database estimates are not reported where adequate covariate balance not attained, and meta-analysis not shown where I2>0.4. MTX showed slightly higher hazards of leukopenia and of pancytopenia compared to LEF but no consistently differential risks compared to HCQ or SSZ.Figure 1.Calibrated hazard ratios (95% CI) vs MTX, on-treatment analysisConclusion:Cytopaenia is rare, and apparently more frequent with MTX and less with LEF. Since prior full blood counts were inconsistently obtained in fewer than 50% of csDMARD new users (e.g. more frequent in MTX [42%] than HCQ [32%] in CCAE and Optum; roughly equal in MDCR), these results should inform future monitoring recommendations.Figure 2.Calibrated hazard ratios (95% CI) vs MTX, ITT analysisDisclosure of Interests:Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), James Weaver Shareholder of: J&J Shares, Grant/research support from: Full-time employment salary from Janssen, Consultant of: Janssen employee, Employee of: Janssen, Paid instructor for: Janssen employee, have instructed at conferences, Speakers bureau: Janssen employee, have spoken at conferences, Edward Burn: None declared, Ben Illingens: None declared, David Vizcaya Employee of: Bayer, Ruta Sawant Shareholder of: AbbVie, Employee of: AbbVie, Talita Duarte-Salles: None declared, Patrick Ryan: None declared, Daniel Prieto-Alhambra Grant/research support from: Professor Prieto-Alhambra has received research Grants from AMGEN, UCB Biopharma and Les Laboratoires Servier, Consultant of: DPA’s department has received fees for consultancy services from UCB Biopharma, Speakers bureau: DPA’s department has received fees for speaker and advisory board membership services from Amgen
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Mulcaire J, Hayward NE, Sless RT, Ryan P, McGovern D, Sheehan M, Whooley PJ, Deasy C. The Impact of the Storm Emma on Irish Emergency Department Attendances. Ir Med J 2020; 113:35. [PMID: 32815677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Aim The impact of severe weather events on Irish EDs has not yet been characterised. The aim of this study was to examine the impact of Storm Emma on the attendance patterns to an Irish ED. Methods Data was collected for 64hrs prior to the red alert (Pre-Red), 38hrs of the red alert (Red) and for the 256 hrs (10 days) post the red alert (Post-Red) during Storm Emma. A Comparison was made with the same time periods in 2017. Results There was a statistically significant decrease in attendance during the Red period in 2018, compared with 2017 (119 vs. 234, p<0.001), with a rebound surge in attendances in the Post-Red period (1,861 vs 1,578, p<0.001). Mean patient experience times were significantly longer in the Post-Red period in 2018 (9.5+/-9.5hrs vs 7.9+/-8.2hrs, p<0.001). Conclusion This study has detailed the impact of a severe weather event on an Irish ED and will help inform preparedness for the future.
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Affiliation(s)
- J Mulcaire
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
| | - N E Hayward
- School of Medicine, University College Cork, Cork, Ireland
| | - R T Sless
- School of Medicine, University College Cork, Cork, Ireland
| | - P Ryan
- School of Medicine, University College Cork, Cork, Ireland
| | - D McGovern
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
| | - M Sheehan
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
| | - P J Whooley
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
| | - C Deasy
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
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Abstract
Peritoneal transfer rates of urea, creatinine, glucose, protein potassium, and sodium as well as drain and residual volumes were measured during 103 equilibration tests performed in 18 diabetic and 68 nondiabetic patients. Equilibration test was performed over a 4-hour dwell exchange with 2 L of 2.5% Dianeal solution. Excellent reproducibility was seen after tests were standardized for length of preceding exchange, times of inflow and drainage, patient position, methods of obtaining and processing samples and laboratory assays. Diabetics did not have lower peritoneal solute transfers than nondiabetics. Wide variations were found in the study population. Measurements of creatinine, glucose and sodium transfer were particularly useful in predicting the patient's response to the standard CAPO. The patients with highaverage peritoneal solute transport did well on standard CAPO even after losing residual renal function. Patients with high peritoneal solute transfer rates were likely to have inadequate ultrafiltration on standard CAPO. These patients did much better on dialysis modalities with short dwell exchanges, i.e. nightly peritoneal dialysis (NPO) or daytime ambulatory peritoneal dialysis (OAPO). Patients with low average, and particularly low peritoneal transport rates were likely to develop symptoms and signs of inadequate dialysis as their residual renal function became negligible, particularly in individuals with high body surface area. Repeated tests were helpful in evaluating causes of insufficient ultrafiltration and/or inadequate dialysis.
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Affiliation(s)
- Zbylut J. Twardowski Karl
- From the Division or Nephrology, Department or Medicine, University or Missouri, Veterans Administration Hospital, Dalton Research Center and Diaclin Laboratory, Columbia, MO 65212
| | - O. Nolph Ramesh Khanna
- From the Division or Nephrology, Department or Medicine, University or Missouri, Veterans Administration Hospital, Dalton Research Center and Diaclin Laboratory, Columbia, MO 65212
| | - Barbara F. Prowant Leonor
- From the Division or Nephrology, Department or Medicine, University or Missouri, Veterans Administration Hospital, Dalton Research Center and Diaclin Laboratory, Columbia, MO 65212
| | - P. Ryan
- From the Division or Nephrology, Department or Medicine, University or Missouri, Veterans Administration Hospital, Dalton Research Center and Diaclin Laboratory, Columbia, MO 65212
| | - Harold L. Moore
- From the Division or Nephrology, Department or Medicine, University or Missouri, Veterans Administration Hospital, Dalton Research Center and Diaclin Laboratory, Columbia, MO 65212
| | - Marc P. Nielsen
- From the Division or Nephrology, Department or Medicine, University or Missouri, Veterans Administration Hospital, Dalton Research Center and Diaclin Laboratory, Columbia, MO 65212
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Abstract
Retrospective analysis of the results of several break-in techniques in our institution revealed that a 10 day delay in CAPD initiation after a midline Tenckhoff catheter insertion is sufficient to prevent leakage in patients maintained on intermittent peritoneal dialysis. A leak or obstruction related to an insufficient surgical technique can be promptly diagnosed and corrected. An irrigation technique seems to be useful in non-uremic patients, but frequently fails to disclose a one-way obstruction with a consequent delay in a surgical correction. Recently we have introduced a modification of this technique in which the patency of the catheter is checked with one in and out exchange using a small volume of dialysate during outpatient clinic visits every 2– 3 days.
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Affiliation(s)
- J. Zbylut
- Division of Nephrology, Department of Medicine, University of Missouri, Health Sciences Center, Columbia, Missouri 65212
| | - Twardowski Leonor
- Division of Nephrology, Department of Medicine, University of Missouri, Health Sciences Center, Columbia, Missouri 65212
| | - P. Ryan
- Division of Nephrology, Department of Medicine, University of Missouri, Health Sciences Center, Columbia, Missouri 65212
| | - Juanita M. Kennedy
- Division of Nephrology, Department of Medicine, University of Missouri, Health Sciences Center, Columbia, Missouri 65212
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Cagle-Holtcamp K, Nicodemus M, Gilmore A, Christiansen D, Galarneau K, Phillips T, Rude B, Ryan P, Sansing W. Relationship between development of equine knowledge and feelings of emotional safety in college students enrolled in animal science courses. J Equine Vet Sci 2019. [DOI: 10.1016/j.jevs.2019.03.165] [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: 10/26/2022]
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Ryan P, McBride A, Ray D, Pulgar S, Ramirez RA, Elquza E, Favaro JP, Dranitsaris G. Lanreotide vs octreotide LAR for patients with advanced gastroenteropancreatic neuroendocrine tumors: An observational time and motion analysis. J Oncol Pharm Pract 2019; 25:1425-1433. [PMID: 30924737 PMCID: PMC6643159 DOI: 10.1177/1078155219839458] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 12/22/2022]
Abstract
BACKGROUND Lanreotide and octreotide acetate suspension for injectable (LAR) are both recommended for clinical use in patients with locally advanced or metastatic gastroenteropancreatic neuroendocrine tumors. However, each agent possesses unique attributes in terms of their drug-delivery characteristics. The study objective was to compare overall drug-delivery efficiency between lanreotide and octreotide LAR in gastroenteropancreatic neuroendocrine tumor patients. METHODS This study employed an observational time and motion design among patients treated with lanreotide or octreotide LAR across five US cancer centers. Baseline patient data collection included age, disease grade and duration, prior therapies and performance status. Drug-delivery time (drug preparation and administration), total patient time and resource use data were collected for gastroenteropancreatic neuroendocrine tumors receiving lanreotide (n = 22) or octreotide LAR (n = 22). Following each administration, qualitative data on the drug-delivery experience was collected from patients and nurses. RESULTS Lanreotide was associated with a significant reduction in mean delivery time (2.5 min; 95% CI:2.0 to 3.1) compared to octreotide LAR (6.2 min; 95%CI: 4.4 to 7.9; p = 0.004). The mean total patient time for lanreotide and octreotide LAR was comparable between groups (32.1 vs. 36.6 minutes; p = 0.97). Nurses reported increased concerns with octreotide LAR related to needle clogging (p = 0.034) and device failures (p = 0.057). Overall, lanreotide had a median satisfaction score of 5.0 compared to a score of 4.0 with octreotide LAR (p = 0.03). CONCLUSIONS Lanreotide was associated with significant reductions in drug-delivery time compared to octreotide LAR, which contributed to an improvement in overall healthcare efficiency. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03017690.
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Affiliation(s)
- P Ryan
- 1 Ochsner Medical Center, Kenner, LA, USA
| | - A McBride
- 2 University of Arizona Cancer Center, Tucson, AZ, USA
| | - D Ray
- 3 Ipsen Biopharmaceuticals, Inc., Basking Ridge, NJ, USA
| | - S Pulgar
- 3 Ipsen Biopharmaceuticals, Inc., Basking Ridge, NJ, USA
| | | | - E Elquza
- 2 University of Arizona Cancer Center, Tucson, AZ, USA
| | - J P Favaro
- 4 Oncology Specialists of Charlotte, Charlotte, NC, USA
| | - G Dranitsaris
- 5 Augmentium Pharma Consulting Inc., Toronto, Canada
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Ranguis S, Ryan P, Cheng AT. Ovine model as a surgical simulator for pediatric laryngotracheal reconstruction. Int J Pediatr Otorhinolaryngol 2019; 118:181-184. [PMID: 30639989 DOI: 10.1016/j.ijporl.2019.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES There are increasing pressures on the health system and training programs to provide adequate training opportunities for surgical trainees. This is particularly true with respect to complex procedures that are performed less commonly. We sought to develop an ovine model for the simulation of pediatric laryngotracheal reconstruction (LTR) and validate its use for training. METHODS Knee-high lamb specimens were sourced from an accredited Australian abattoir that included structures of the neck, cervical spine and subcutaneous tissues from the thyroid cartilage to the carina. Specimens were positioned and draped to simulate surgical exposure. Otorhinolaryngology residents and consultants performed two LTRs on separate specimens that were video recorded for assessment of performance. RESULTS Sixteen LTRs were performed by eight participants. Performance of experienced (advanced) participants was significantly better than novice participants (p = 0.001). There was a strong linear association between general surgical competence and procedural performance (r = 0.88). The developed assessment scales demonstrated strong reliability and internal consistency (Cronbach's α = 0.83). CONCLUSIONS The complexity of pediatric airway surgery makes simulation an attractive option for developing skills that are transferrable to the operating setting. The ovine model presented here has similarities in size, structure and tissue characteristics to the pediatric airway that make it an ideal model for simulating pediatric LTR. It is a low-cost, readily available option for otorhinolaryngology residents to develop and refine essential skills throughout their training.
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Affiliation(s)
- S Ranguis
- Department of Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia.
| | - P Ryan
- Department of Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - A T Cheng
- Department of Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia; Discipline of Child and Adolescent Health, The University of Sydney, NSW, Australia
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Hegazy M, Broe M, Ryan P, Murray T, Forde J, Creagh T. Outcomes after urinary diversion for benign disease. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.603] [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: 11/25/2022]
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Sellberg MM, Ryan P, Borgström ST, Norström AV, Peterson GD. From resilience thinking to Resilience Planning: Lessons from practice. J Environ Manage 2018; 217:906-918. [PMID: 29665570 DOI: 10.1016/j.jenvman.2018.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 03/26/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
Resilience thinking has frequently been proposed as an alternative to conventional natural resource management, but there are few studies of its applications in real-world settings. To address this gap, we synthesized experiences from practitioners that have applied a resilience thinking approach to strategic planning, called Resilience Planning, in regional natural resource management organizations in Australia. This case represents one of the most extensive and long-term applications of resilience thinking in the world today. We conducted semi-structured interviews with Resilience Planning practitioners from nine organizations and reviewed strategic planning documents to investigate: 1) the key contributions of the approach to their existing strategic planning, and 2) what enabled and hindered the practitioners in applying and embedding the new approach in their organizations. Our results reveal that Resilience Planning contributed to developing a social-ecological systems perspective, more adaptive and collaborative approaches to planning, and that it clarified management goals of desirable resource conditions. Applying Resilience Planning required translating resilience thinking to practice in each unique circumstance, while simultaneously creating support among staff, and engaging external actors. Embedding Resilience Planning within organizations implied starting and maintaining longer-term change processes that required sustained multi-level organizational support. We conclude by identifying four lessons for successfully applying and embedding resilience practice in an organization: 1) to connect internal "entrepreneurs" to "interpreters" and "networkers" who work across organizations, 2) to assess the opportunity context for resilience practice, 3) to ensure that resilience practice is a learning process that engages internal and external actors, and 4) to develop reflective strategies for managing complexity and uncertainty.
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Affiliation(s)
- M M Sellberg
- Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, SE-114 19, Stockholm, Sweden.
| | - P Ryan
- Australian Resilience Centre, PO Box 271, Beechworth, VIC 3747, Australia
| | - S T Borgström
- Department of Sustainable Development, Environmental Science and Engineering, Royal Institute of Technology (KTH), Teknikringen 10B, Level 3, SE-100 44, Stockholm, Sweden
| | - A V Norström
- Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, SE-114 19, Stockholm, Sweden
| | - G D Peterson
- Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, SE-114 19, Stockholm, Sweden
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Olveira A, Domínguez L, Troya J, Arias A, Pulido F, Ryan P, Benítez LM, González-García J, Montes ML. Persistently altered liver test results in hepatitis C patients after sustained virological response with direct-acting antivirals. J Viral Hepat 2018; 25:818-824. [PMID: 29476581 DOI: 10.1111/jvh.12883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/16/2018] [Indexed: 12/30/2022]
Abstract
Guidelines recommend evaluating persistent alteration of liver tests in HCV-infected patients after sustained virological response (SVR) and its influence on liver disease progression. We studied the prevalence, etiology, associated factors and evolutionary implications of persistent alteration of liver tests in HCV patients after direct-acting antivirals (DAA)-induced SVR. This was a prospective study of HCV-infected patients and SVR after DAA. Those with another previously diagnosed liver disease were excluded. Persistent alteration of liver tests was defined as any increase in ALT, AST or GGT at SVR12 and SVR24. Causes were determined according to standard clinical practice, including liver biopsy and follow-up transient elastography. A total of 1112 patients were included (70.8% males, median age 53 years, 38.8% cirrhosis, 34.9% interferon-experienced, 56.8% HIV-coinfected). Persistent alteration of liver tests was detected in 130/1112 patients (11.7% [95%CI: 9.7-13.6]). Its frequency differed between HCV-monoinfected (45/480: 9.4% [95%CI: 6.7-12.1]) and HIV-coinfected (85/632: 13.5% [95%CI: 10.7-16.2]) (P = .046). In multivariable analysis, cirrhosis (OR 2.12; 95%CI: 1.28-3.53; P = .004) and baseline transient elastography values (OR 1.03; 95%CI: 1.01-1.04; P = .000) were associated with persistent alteration of liver tests. The main etiologies were clinical diagnosis suggestive of nonalcoholic fatty liver disease in 47 (36.2%), alcohol in 30 (23.1%) and drug consumption in 19 (14.6%). Baseline and follow-up transient elastography was performed in 594 patients and showed a significantly different decrease in patients who did or did not have a persistent alteration of liver tests (-21.1% vs -30%, respectively; P = .003), independently of sex, HIV status or baseline TE value. In conclusion, persistent alteration of liver tests is not infrequent after SVR. It is associated with cirrhosis and baseline transient elastography, and the main cause is fatty liver. According to transient elastography changes, persistent alteration of liver tests seems to affect the course of liver disease.
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Affiliation(s)
- A Olveira
- Servicio de Aparato Digestivo, Hospital La Paz, Madrid, Spain
| | - L Domínguez
- Unidad VIH, Servicio de Medicina Interna, Instituto de Investigación Biomédica del Hospital 12 de Octubre (imas12), Madrid, Spain
| | - J Troya
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - A Arias
- Servicio Medicina Interna, Unidad de trasplante hepático, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - F Pulido
- Unidad VIH, Servicio de Medicina Interna, Instituto de Investigación Biomédica del Hospital 12 de Octubre (imas12), Madrid, Spain
| | - P Ryan
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - L M Benítez
- Servicio Medicina Interna, Unidad de trasplante hepático, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - J González-García
- Unidad VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - M L Montes
- Unidad VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
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Plenge U, Nortje MB, Marais LC, Jordaan JD, Parker R, van der Westhuizen N, van der Merwe JF, Marais J, September WV, Davies GL, Pretorius T, Solomon C, Ryan P, Torborg AM, Farina Z, Smit R, Cairns C, Shanahan H, Sombili S, Mazibuko A, Hobbs HR, Porrill OS, Timothy NE, Siebritz RE, van der Westhuizen C, Troskie AJ, Blake CA, Gray LA, Munting TW, Steinhaus HKS, Rowe P, van der Walt JG, Isaacs Noordien R, Theron A, Biccard BM. Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study. BMC Musculoskelet Disord 2018; 19:140. [PMID: 29743063 PMCID: PMC5944094 DOI: 10.1186/s12891-018-2062-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/26/2018] [Indexed: 12/30/2022] Open
Abstract
Background A structured approach to perioperative patient management based on an enhanced recovery pathway protocol facilitates early recovery and reduces morbidity in high income countries. However, in low- and middle-income countries (LMICs), the feasibility of implementing enhanced recovery pathways and its influence on patient outcomes is scarcely investigated. To inform similar practice in LMICs for total hip and knee arthroplasty, it is necessary to identify potential factors for inclusion in such a programme, appropriate for LMICs. Methods Applying a Delphi method, 33 stakeholders (13 arthroplasty surgeons, 12 anaesthetists and 8 physiotherapists) from 10 state hospitals representing 4 South African provinces identified and prioritised i) risk factors associated with poor outcomes, ii) perioperative interventions to improve outcomes and iii) patient and clinical outcomes necessary to benchmark practice for patients scheduled for primary elective unilateral total hip and knee arthroplasty. Results Thirty of the thirty-three stakeholders completed the 3 months Delphi study. The first round yielded i) 36 suggestions to preoperative risk factors, ii) 14 (preoperative), 18 (intraoperative) and 23 (postoperative) suggestions to best practices for perioperative interventions to improve outcomes and iii) 25 suggestions to important postsurgical outcomes. These items were prioritised by the group in the consecutive rounds and consensus was reached for the top ten priorities for each category. Conclusion The consensus derived risk factors, perioperative interventions and important outcomes will inform the development of a structured, perioperative multidisciplinary enhanced patient care protocol for total hip and knee arthroplasty. It is anticipated that this study will provide the construct necessary for developing pragmatic enhanced care pathways aimed at improving patient outcomes after arthroplasty in LMICs.
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Affiliation(s)
- U Plenge
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - M B Nortje
- Department of Orthopaedic Surgery, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - L C Marais
- Department of Orthopaedic surgery, School of Clinical Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - J D Jordaan
- Department of Orthopaedic Surgery, Tygerberg Medical School, University of Stellenbosch, Cape Town, South Africa
| | - R Parker
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - N van der Westhuizen
- Department Anaesthesia, University of the Free State, Bloemfontein, South Africa
| | - J F van der Merwe
- Department of Orthopaedic surgery, University of the Free State, Bloemfontein, South Africa
| | - J Marais
- Department of Physiotherapy, Paarl Provincial Hospital, Paarl, South Africa
| | - W V September
- Department of Physiotherapy, Paarl Provincial Hospital, Paarl, South Africa
| | - G L Davies
- Department of Anaesthesia, Paarl Provincial Hospital, Paarl, South Africa
| | - T Pretorius
- Department of Anaesthesia, Paarl Provincial Hospital, Paarl, South Africa
| | - C Solomon
- Department of Orthopaedics, Paarl Provincial Hospital, Paarl, South Africa
| | - P Ryan
- Arthroplasty and Sports Medicine unit, Department of Orthopaedics, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Durban, South Africa
| | - A M Torborg
- Department of Anaesthesia, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Durban, South Africa
| | - Z Farina
- Department of Anaesthesia, Critical Care and Pain Management, Grey's Hospital, Pietermaritzburg, South Africa
| | - R Smit
- Department of Orthopaedic surgery, Grey's Hospital, Pietermaritzburg, South Africa
| | - C Cairns
- Greys Pain clinic, Department of Anaesthesia, Grey's Hospital, Pietermaritzburg, South Africa
| | - H Shanahan
- Department of Physiotherapy, Grey's Hospital, Pietermaritzburg, South Africa
| | - S Sombili
- Department of Orthopaedic surgery, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - A Mazibuko
- Department of Anaesthesia, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - H R Hobbs
- Department of Orthopaedic Surgery, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - O S Porrill
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - N E Timothy
- Department of Physiotherapy, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - R E Siebritz
- Department of Physiotherapy, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - A J Troskie
- Department of Orthopaedic Surgery, Worcester Hospital, Worcester, South Africa
| | - C A Blake
- Department of Orthopaedic Surgery, Worcester Hospital, Worcester, South Africa
| | - L A Gray
- Department of Physiotherapy, New Somerset Hospital, Cape Town, South Africa
| | - T W Munting
- Department of Orthopaedics, New Somerset Hospital and Christiaan Barnard Memorial Hospital, Cape Town, South Africa
| | - H K S Steinhaus
- Department of Anaesthesia, New Somerset Hospital, Cape Town, South Africa
| | - P Rowe
- Department of Orthopaedic surgery, Victoria Hospital, Cape Town, South Africa
| | - J G van der Walt
- Department of Anaesthesia, Victoria Hospital, Cape Town, South Africa
| | - R Isaacs Noordien
- Department of Physiotherapy, Victoria Hospital, Cape Town, South Africa
| | - A Theron
- Department of Anaesthesiology and Critical Care, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa
| | - B M Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Decatris M, Hayes M, Reed N, Bhalla V, Thomas J, Gaikwad K, Birchall K, Phillips A, Ryan P, Du Rand I, Taniere P. Programmed death-ligand 1 (PD-L1) expression and testing experience in a cohort of advanced non-small cell lung cancer (NSCLC) patients. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30126-0] [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]
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Wark S, McKay K, Ryan P, Müller A. Suicide amongst people with intellectual disability: An Australian online study of disability support staff experiences and perceptions. J Intellect Disabil Res 2018; 62:1-9. [PMID: 29119644 DOI: 10.1111/jir.12442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 04/12/2017] [Accepted: 10/13/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Individuals with intellectual disability (ID) have a higher likelihood of exposure to identified risk factors for suicide when compared with the general community and have been recognised as being both capable of forming intent for suicide and acting on this intent. However, in spite of research outlining these concerns from the 1970s, there remains a dearth of studies that examine suicide amongst the population of people with ID. METHOD An online cross-sectional survey was purposively developed, with questions aimed at identifying both the experiences and current practices of support staff who assist people with ID in relation to suicide, suicidal behaviour and suicide assessment. It was undertaken across both rural and metropolitan areas in Australia. The survey was open for a period of 12 months. A total of 139 respondents (109 female/30 male), with a mean age of 41 and an average 12 years of experience in supporting people with ID, completed the tool. RESULTS A total of nine suicides by people with ID were reported. Seventy-seven per cent of the respondents reported that they had individuals with ID display suicidal behaviours, and 76% noted that a person had specifically talked about wishing to end their life. Only four participants (3%) noted that they did not support individuals with a dual diagnosis of ID and mental health concern. Sixty per cent of participants reported that no one in their organisation had ever completed a suicide risk assessment, and only 28% reported that they would do a suicide risk assessment if an individual that they supported was diagnosed with a mental health issue. CONCLUSIONS The current findings indicate that support staff recognise the capacity of people with ID to conceptualise suicide, note the existence of suicidal discussions and behaviours and report on actual suicides. This represents one of the few Australian studies that has specifically considered suicide amongst this cohort of people and reinforces the fact that suicide is not unknown in this population. The data indicate a possible divide between the reports of people with ID actively talking about and acting on suicidal thoughts and the lack of any proactive use of any tools to assess for this risk.
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Affiliation(s)
- S Wark
- School of Rural Medicine, University of New England, Armidale, NSW, Australia
| | - K McKay
- School of Education, University of New England, Armidale, NSW, Australia
| | - P Ryan
- School of Rural Medicine, University of New England, Armidale, NSW, Australia
| | - A Müller
- School of Rural Medicine, University of New England, Armidale, NSW, Australia
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Carrillo M, Cartelle B, Arquero M, Carbonero L, Domínguez-Domínguez L, Ryan P, Santos I, Fuente S, Bisbal O, Matarranz M, Lagarde M, Moreno A, Castro J, Mateos E, Alcamí J, Resino S, Rodríguez A, Coiras M, Briz V. Differences in the proviral HIV DNA between HIV monoinfected and HIV/HCV coinfected individuals. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30613-0] [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: 11/29/2022] Open
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O'Hara N, Ryan P. Diagnosis and Treatment of Urinary Tract Infections Over the Course of One Year at a Urology Tertiary Referral Centre: Assessment of Compliance With National Guidelines. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.497] [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: 10/18/2022]
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Schulze A, Loo R, Ryan P, Wormington M, Favia P, Witters L, Collaert N, Bender H, Vandervorst W, Caymax M. Observation and understanding of anisotropic strain relaxation in selectively grown SiGe fin structures. Nanotechnology 2017; 28:145703. [PMID: 28186001 DOI: 10.1088/1361-6528/aa5fbb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The performance of heterogeneous 3D transistor structures critically depends on the composition and strain state of the buffer, channel and source/drain regions. In this paper we used an in-line high resolution x-ray diffraction (HRXRD) tool to study in detail the composition and strain in selectively grown SiGe/Ge fin structures with widths down to 20 nm. For this purpose we arranged fins of identical dimensions into larger arrays which were then analyzed using an x-ray beam several tens of micrometers in size. Asymmetric reciprocal space maps measured both parallel and perpendicular to the fins allowed us to extract the lattice parameters in all three spatial directions. Our results demonstrate an anisotropic in-plane strain state of the selectively grown SiGe buffer in case of narrower fins with significantly reduced relaxation in the direction along the fin. This observation was verified using nano-beam electron diffraction, and is explained based on the reduced probability for dislocation half-loops to evolve in trenches narrower than a few times the critical radius. Moreover, we introduce and discuss in detail a methodology for the determination of the composition in case of an anisotropic in-plane strain state which differs from the procedure commonly used for blanket layers. Our findings verify the importance of in-line HRXRD measurements for process development and monitoring as well as the fundamental study of relaxation and defect formation in confined volumes.
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Affiliation(s)
- A Schulze
- imec, Kapeldreef 75, B-3001 Leuven, Belgium
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Ryan P, Skally M, Duffy F, Farrelly M, Gaughan L, Flood P, McFadden E, Fitzpatrick F. Evaluation of fixed and variable hospital costs due to Clostridium difficile infection: institutional incentives and directions for future research. J Hosp Infect 2017; 95:415-420. [PMID: 28320542 DOI: 10.1016/j.jhin.2017.01.016] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/30/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Economic analysis of Clostridium difficile infection (CDI) should consider the incentives facing institutional decision-makers. To avoid overstating the financial benefits of infection prevention, fixed and variable costs should be distinguished. AIM To quantify CDI fixed and variable costs in a tertiary referral hospital during August 2015. METHODS A micro-costing analysis estimated CDI costs per patient, including the additional costs of a CDI outbreak. Resource use was quantified after review of patient charts, pharmacy data, administrative resource input, and records of salary and cleaning/decontamination expenditure. FINDINGS The incremental cost of CDI was €75,680 (mean: €5,820 per patient) with key cost drivers being cleaning, pharmaceuticals, and length of stay (LOS). Additional LOS ranged from 1.75 to 22.55 days. For seven patients involved in a CDI outbreak, excluding the value of the 58 lost bed-days (€34,585); costs were 30% higher (€7,589 per patient). Therefore, total spending on CDI was €88,062 (mean: €6,773 across all patients). Potential savings from variable costs were €1,026 (17%) or €1,768 (26%) if outbreak costs were included. Investment in an antimicrobial pharmacist would require 47 CDI cases to be prevented annually. Prevention of 5%, 10% and 20% CDI would reduce attributable costs by €4,403, €8,806 and €17,612. Increasing the incremental LOS attributable to CDI to seven days per patient would have increased costs to €7,478 or €8,431 (if outbreak costs were included). CONCLUSION As much CDI costs are fixed, potential savings from infection prevention are limited. Future analysis must consider more effectively this distinction and its impact on institutional decision-making.
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Affiliation(s)
- P Ryan
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - M Skally
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
| | - F Duffy
- Department of Infection Prevention and Control, Beaumont Hospital, Dublin, Ireland
| | - M Farrelly
- Department of Finance, Beaumont Hospital, Dublin, Ireland
| | - L Gaughan
- Department of Pharmacy, Beaumont Hospital, Dublin, Ireland
| | - P Flood
- General Services Department, Beaumont Hospital, Dublin, Ireland
| | - E McFadden
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
| | - F Fitzpatrick
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland.
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Abughalya MS, Ryan P, Goga IE. The radiological outcome of uncemented femoral stems in rheumatoid patients undergoing total hip arthroplasty: results at minimum eight years. SA orthop j 2017. [DOI: 10.17159/2309-8309/2017/v16n3a1] [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: 11/05/2022] Open
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Decatris M, Reed N, Bhalla V, Birchall K, Phillips A, Ryan P, Hedges A, Hayes M, Thomas J, Du Rand I. 85: Single MDT 30-day mortality after systemic anticancer therapy (SACT) for lung cancer in an NHS trust serving an English and Welsh population. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30135-6] [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: 11/29/2022]
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Caughey GE, Vitry AI, Ramsay EN, Gilbert AL, Shakib S, Ryan P, Esterman A, McDermott RA, Roughead EE. Effect of a general practitioner management plan on health outcomes and hospitalisations in older patients with diabetes. Intern Med J 2016; 46:1430-1436. [PMID: 27718515 DOI: 10.1111/imj.13286] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 09/25/2016] [Accepted: 09/25/2016] [Indexed: 01/15/2023]
Affiliation(s)
- G. E. Caughey
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute of Health Sciences University of South Australia Adelaide South Australia Australia
| | - A. I. Vitry
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute of Health Sciences University of South Australia Adelaide South Australia Australia
| | - E. N. Ramsay
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute of Health Sciences University of South Australia Adelaide South Australia Australia
| | - A. L. Gilbert
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute of Health Sciences University of South Australia Adelaide South Australia Australia
| | - S. Shakib
- Clinical Pharmacology Royal Adelaide Hospital Adelaide South Australia Australia
- Discipline of Clinical Pharmacology University of Adelaide Adelaide South Australia Australia
| | - P. Ryan
- School of Public Health University of Adelaide Adelaide South Australia Australia
| | - A. Esterman
- Sansom Institute of Health Service Research and School of Nursing and Midwifery University of South Australia Adelaide South Australia Australia
- Centre for Research Excellence in Chronic Disease Prevention, The Cairns Institute James Cook University Cairns Queensland Australia
| | - R. A. McDermott
- School of Population Health University of South Australia Adelaide South Australia Australia
- Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences James Cook University Cairns Queensland Australia
| | - E. E. Roughead
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute of Health Sciences University of South Australia Adelaide South Australia Australia
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Ryan P. Embedded microcontrollers: a hidden time bomb? Health Informatics J 2016. [DOI: 10.1177/146045829700300312] [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: 11/16/2022]
Affiliation(s)
- P. Ryan
- Division of Professions Allied to Medicine South Bank
University 103 Borough Road London SE I 0AA, UK
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Cañamares-Orbis I, Izquierdo-Garcia E, Escobar I, Esteban-Alba C, Saez J, Such-Diaz A, Barrueco-Fernandez N, Ryan P, Troya J. CP-226 Safety of direct acting antiviral and antiretrovirals drugs in HCV patients co-infected with HIV-1: Clinical practice experience. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.226] [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] Open
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Tantowijoyo W, Arguni E, Johnson P, Budiwati N, Nurhayati PI, Fitriana I, Wardana S, Ardiansyah H, Turley AP, Ryan P, O'Neill SL, Hoffmann AA. Spatial and Temporal Variation in Aedes aegypti and Aedes albopictus (Diptera: Culicidae) Numbers in the Yogyakarta Area of Java, Indonesia, With Implications for Wolbachia Releases. J Med Entomol 2016; 53:188-98. [PMID: 26576934 DOI: 10.1093/jme/tjv180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
of mosquito vector populations, particularly through Wolbachia endosymbionts. The success of these strategies depends on understanding the dynamics of vector populations. In preparation for Wolbachia releases around Yogyakarta, we have studied Aedes populations in five hamlets. Adult monitoring with BioGent- Sentinel (BG-S) traps indicated that hamlet populations had different dynamics across the year; while there was an increase in Aedes aegypti (L.) and Aedes albopictus (Skuse) numbers in the wet season, species abundance remained relatively stable in some hamlets but changed markedly (>2 fold) in others. Local rainfall a month prior to monitoring partly predicted numbers of Ae. aegypti but not Ae. albopictus. Site differences in population size indicated by BG-S traps were also evident in ovitrap data. Egg or larval collections with ovitraps repeated at the same location suggested spatial autocorrelation (<250 m) in the areas of the hamlets where Ae. aegypti numbers were high. Overall, there was a weak negative association (r<0.43) between Ae. aegypti and Ae. albopictus numbers in ovitraps when averaged across collections. Ae. albopictus numbers in ovitraps and BG-S traps were positively correlated with vegetation around areas where traps were placed, while Ae. aegypti were negatively correlated with this feature. These data inform intervention strategies by defining periods when mosquito densities are high, highlighting the importance of local site characteristics on populations, and suggesting relatively weak interactions between Ae. aegypti and Ae. albopictus. They also indicate local areas within hamlets where consistently high mosquito densities may influence Wolbachia invasions and other interventions.
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