1
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Cohen JA, Cameron MH, Goldman MD, Goodman AD, Miller AE, Rollins A, Llorens L, Patni R, Elfont R, Johnson R. A Phase 3, double-blind, placebo-controlled efficacy and safety study of ADS-5102 (Amantadine) extended-release capsules in people with multiple sclerosis and walking impairment. Mult Scler 2021; 28:817-830. [PMID: 34449295 PMCID: PMC8978468 DOI: 10.1177/13524585211035333] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: ADS-5102, a delayed-release, extended-release (DR/ER) amantadine, improved
walking speed in MS in a Phase 2 trial. Objective: The aim of this study was to present primary results of a Phase 3,
double-blind, ADS-5102 trial (INROADS) for walking speed. Methods: Adult participants with MS and walking impairment, not currently using
amantadine or dalfampridine, underwent 4-week placebo run-in before
randomization 1:1:1 to placebo, 137 or 274 mg/day ADS-5102 for 12 weeks.
Primary outcome was the proportion of responders (20% increase in Timed
25-Foot Walk (T25FW) speed) for 274 mg ADS-5102 versus placebo at end of
double-blind (Study Week 16). Additional measures included Timed Up and Go
(TUG), 2-Minute Walk Test (2MWT), and 12-item Multiple Sclerosis Walking
Scale (MSWS-12). Results: In total, 558 participants were randomized and received double-blind
treatment. Significantly more participants responded with 274 mg ADS-5102
(21.1%) versus placebo (11.3%). Mean T25FW speed also significantly improved
(0.19 ft/s) versus placebo (0.07 ft/s). Other measures were not significant
using prespecified hierarchical testing procedure. Adverse events led to
discontinuation for 3.8% (placebo), 6.4% (137 mg ADS-5102), and 20.5%
(274 mg ADS-5102). Conclusion: INROADS met its primary endpoint, showing a significantly greater proportion
of participants with meaningful improvement in walking speed for 274 mg
ADS-5102 versus placebo. Numeric dose response was seen for some secondary
efficacy outcomes and adverse events.
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Affiliation(s)
- Jeffrey A Cohen
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michelle H Cameron
- Veterans Affairs Portland Health Care System/Oregon Health & Science University, Portland, OR, USA
| | | | | | - Aaron E Miller
- The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anne Rollins
- Adamas Pharmaceuticals, Inc., Emeryville, CA, USA
| | - Lily Llorens
- Adamas Pharmaceuticals, Inc., Emeryville, CA, USA
| | - Rajiv Patni
- Adamas Pharmaceuticals, Inc., Emeryville, CA, USA
| | | | - Reed Johnson
- Adamas Pharmaceuticals, Inc., Emeryville, CA, USA
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2
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Hauser RA, Kremens DE, Elmer LW, Kreitzman DL, Walsh RR, Johnson R, Howard R, Nguyen JT, Patni R. Prevalence of Dyskinesia and OFF by 30-Minute Intervals Through the Day and Assessment of Daily Episodes of Dyskinesia and OFF: Novel Analyses of Diary Data from Gocovri Pivotal Trials. J Parkinsons Dis 2020; 9:591-600. [PMID: 31081793 PMCID: PMC6700613 DOI: 10.3233/jpd-181565] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Parkinson’s disease (PD) patients using levodopa commonly develop dyskinesia and OFF episodes that reduce quality of life. Objective: Evaluate prevalence of troublesome dyskinesia and OFF through the day, assessed by 30-minute intervals, as well as the mean number and duration of troublesome dyskinesia and OFF episodes, transitions between PD states, and effects of Gocovri® (amantadine) extended release capsules on these episodes. Methods: Evaluate diary data from pooled Gocovri phase 3, placebo-controlled trials—analyzed for 17 hours following wake-up—at baseline and week 12. Results: Diaries were evaluable for 162 patients. At baseline, 67% of patients woke up OFF, with prevalence decreasing to 13% at 2 hours and then remaining relatively steady at ∼12% (range, 6–17%) across half-hour intervals thereafter. Troublesome dyskinesia prevalence rose steadily from 5% to 24% over the first 2 hours, then fluctuated between 20% and 44% through the rest of the waking day. At baseline, patients experienced a mean of 3.0 daily episodes of troublesome dyskinesia (average duration 2.0 hours each), and 2.2 daily episodes of OFF (average duration 1.1 hour each). At week 12, Gocovri-treated patients showed greater reductions than placebo in troublesome dyskinesia and OFF episodes per day (treatment difference: –1.0 episodes and –0.4 episodes, respectively) and average episode duration (treatment difference: –0.6 hours and –0.3 hours, respectively). Mean duration of individual episodes of ON without troublesome dyskinesia (Good ON) increased by 5.0 hours for Gocovri, compared with 2.0 hours for placebo. Patients taking Gocovri experienced 2.2 fewer transitions between states than patients taking placebo. Conclusions: Troublesome dyskinesia and OFF occurred in the morning and throughout the waking day. Gocovri-treated patients experienced fewer, shorter episodes of both troublesome dyskinesia and OFF, thereby increasing the duration of continuous Good ON episodes and reducing the frequency of transitions between motor states.
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Affiliation(s)
| | | | | | - David L Kreitzman
- Parkinson's Disease and Movement Disorders Center of Long Island, Commack, NY, USA
| | - Ryan R Walsh
- Muhammad Ali Parkinson Center at Barrow Neurological Institute, Phoenix, AZ, USA
| | - Reed Johnson
- Adamas Pharmaceuticals, Inc., Emeryville, CA, USA
| | | | | | - Rajiv Patni
- Adamas Pharmaceuticals, Inc., Emeryville, CA, USA
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3
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Hauser RA, Pahwa R, Wargin WA, Souza-Prien CJ, McClure N, Johnson R, Nguyen JT, Patni R, Went GT. Pharmacokinetics of ADS-5102 (Amantadine) Extended Release Capsules Administered Once Daily at Bedtime for the Treatment of Dyskinesia. Clin Pharmacokinet 2020; 58:77-88. [PMID: 29777529 PMCID: PMC6325984 DOI: 10.1007/s40262-018-0663-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preclinical and clinical studies suggest amantadine immediate-release (IR) may reduce dyskinesia in Parkinson's disease (PD), although higher doses are associated with increased CNS adverse events (AEs). ADS-5102 is an extended release amantadine capsule formulation, designed for once-daily dosing at bedtime (qhs) to provide high concentrations upon waking and throughout the day, with lower concentrations in the evening. The pharmacokinetics (PK) of ADS-5102 were assessed in two phase I studies in healthy subjects, and a blinded, randomized phase II/III dose-finding study in PD patients. METHODS The first phase I study assessed single ADS-5102 doses (68.5, 137, and 274 mg) in a crossover design, whereas the second phase I study evaluated ADS-5102 137 mg for 7 days followed by amantadine IR 81 mg twice daily (or reverse order). In the phase II/III double-blind study, PD patients with dyskinesia were randomized to ADS-5102 (210, 274, or 338 mg) or placebo for 8 weeks. RESULTS Single ADS-5102 doses resulted in a slow initial rise in amantadine plasma concentration, with delayed time to maximum concentration (12-16 h). Amantadine plasma concentrations were higher in PD patients versus healthy volunteers. The steady-state profile of once-daily ADS-5102 was significantly different from that of twice-daily amantadine IR, such that the two formulations are not bioequivalent. PK modeling suggested the recommended daily ADS-5102 dosage (274 mg qhs) resulted in 1.4- to 2.0-fold higher amantadine plasma concentrations during the day versus amantadine IR. CONCLUSIONS ADS-5102 can be administered once-daily qhs to achieve high amantadine plasma concentrations in the morning and throughout the day, when symptoms of dyskinesia occur.
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Affiliation(s)
- Robert A Hauser
- USF Parkinson's Disease and Movement Disorders Center, Parkinson Foundation Center of Excellence, USF Health Byrd Institute, 4001 E. Fletcher Ave, 6th Floor, Tampa, FL, 33613, USA.
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, 3599 Rainbow Boulevard, Mailstop 3042, Kansas City, KS, 66160, USA
| | - William A Wargin
- Nuventra Pharma Sciences, 2525 Meridian Parkway, Suite 280, Durham, NC, 27713, USA
| | - Cindy J Souza-Prien
- Adamas Pharmaceuticals, Inc, 1900 Powell Street, Suite 750, Emeryville, CA, 94608, USA
| | - Natalie McClure
- Adamas Pharmaceuticals, Inc, 1900 Powell Street, Suite 750, Emeryville, CA, 94608, USA
| | - Reed Johnson
- Adamas Pharmaceuticals, Inc, 1900 Powell Street, Suite 750, Emeryville, CA, 94608, USA
| | - Jack T Nguyen
- Adamas Pharmaceuticals, Inc, 1900 Powell Street, Suite 750, Emeryville, CA, 94608, USA
| | - Rajiv Patni
- Adamas Pharmaceuticals, Inc, 1900 Powell Street, Suite 750, Emeryville, CA, 94608, USA.
| | - Gregory T Went
- Adamas Pharmaceuticals, Inc, 1900 Powell Street, Suite 750, Emeryville, CA, 94608, USA
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4
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Pahwa R, Isaacson S, Jimenez-Shaheed J, Malaty IA, Deik A, Johnson R, Patni R. Impact of dyskinesia on activities of daily living in Parkinson's disease: Results from pooled phase 3 ADS-5102 clinical trials. Parkinsonism Relat Disord 2019; 60:118-125. [DOI: 10.1016/j.parkreldis.2018.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/07/2018] [Accepted: 09/04/2018] [Indexed: 12/22/2022]
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5
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Isaacson SH, Fahn S, Pahwa R, Tanner CM, Espay AJ, Trenkwalder C, Adler CH, Patni R, Johnson R. Parkinson's Patients with Dyskinesia Switched from Immediate Release Amantadine to Open-label ADS-5102. Mov Disord Clin Pract 2018; 5:183-190. [PMID: 29780852 PMCID: PMC5947645 DOI: 10.1002/mdc3.12595] [Citation(s) in RCA: 12] [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: 10/18/2017] [Revised: 01/09/2018] [Accepted: 01/20/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND ADS-5102 (amantadine) extended release capsules (GOCOVRI™) are a treatment for dyskinesia in patients with Parkinson's disease (PD). ADS-5102 reduced dyskinesia and OFF time in phase 3 controlled trials of up to six months. Amantadine immediate release (IR) is used for dyskinesia, but suboptimal durability and tolerability limit its clinical utility. METHODS In an ongoing, open-label, phase 3 study in the US and Western Europe (NCT02202551), patients with PD received 274 mg of ADS-5102 (equivalent to 340 mg amantadine HCl) once daily at bedtime for up to two years. Study outcomes included safety and assessment of motor complications, as measured by the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part IV. This manuscript focuses on those patients switched to ADS-5102 from amantadine IR. Results in two groups of patients who previously completed a randomized controlled trial (EASE LID or EASE LID 3) are also presented according to use of ADS-5102 or placebo in that study before enrollment in the open-label study. RESULTS Change in MDS-UPDRS Part IV at week 8 was -0.3 in the previous ADS-5102 subgroup (n = 61), -3.4 in the previous placebo subgroup (n = 79), and -3.4 in the previous amantadine IR subgroup (n = 32). Effects were maintained to week 64. In the previous amantadine IR subgroup (mean treatment duration, 2.5 years), mean amantadine IR dose was 221 mg. Safety data were consistent with previous randomized controlled trials of ADS-5102. CONCLUSION These open-label data suggest ADS-5102 provides incremental reduction from baseline in MDS-UDPRS Part IV score in patients switched directly from amantadine IR, without exacerbating adverse events.
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Affiliation(s)
- Stuart H. Isaacson
- Parkinson's Disease and Movement Disorders Center of Boca RatonBoca RatonFLUSA
| | | | - Rajesh Pahwa
- University of Kansas Medical CenterKansas CityKSUSA
| | - Caroline M. Tanner
- University of California, San Francisco and San Francisco Veterans Affairs Medical CenterSan FranciscoCAUSA
| | - Alberto J. Espay
- Gardner Center for Parkinson's Disease and Movement DisordersUniversity of CincinnatiCincinnatiOHUSA
| | - Claudia Trenkwalder
- Paracelsus‐Elena‐Klinik, Kassel and Clinic NeurosurgeryUniversity Medical CenterGoettingenGermany
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6
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Cohen JA, Hunter SF, Brown TR, Gudesblatt M, Thrower BW, Llorens L, Souza-Prien CJ, Ruby AE, Chernoff DN, Patni R. Safety and efficacy of ADS-5102 (amantadine) extended release capsules to improve walking in multiple sclerosis: A randomized, placebo-controlled, phase 2 trial. Mult Scler 2018; 25:601-609. [PMID: 29368539 DOI: 10.1177/1352458518754716] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Walking impairment causes disability and reduced quality of life in patients with multiple sclerosis (MS). OBJECTIVE Characterize the safety and efficacy of ADS-5102 (amantadine) extended release capsules, 274 mg administered once daily at bedtime in patients with MS with walking impairment. METHODS This randomized, double-blind, placebo-controlled, 4-week study was conducted at 14 trial sites in the United States. Study objectives included safety and tolerability of ADS-5102, and efficacy assessments (Timed 25-Foot Walk (T25FW), Timed Up and Go (TUG), 2-Minute Walk Test, and Multiple Sclerosis Walking Scale-12). Fatigue, depression, and cognition also were assessed. RESULTS A total of 60 patients were randomized (30 to ADS-5102 and 30 to placebo); 59 of whom were treated. The most frequent adverse events (AEs) were dry mouth, constipation, and insomnia. Five ADS-5102 patients and no placebo patients discontinued treatment due to AEs. One patient in the ADS-5102 group experienced a serious AE-suspected serotonin syndrome. A 16.6% placebo-adjusted improvement was seen in the T25FW test ( p < 0.05). A 10% placebo-adjusted improvement in TUG was also observed. No changes in fatigue, depression, or cognition were observed. CONCLUSION ADS-5102 was generally well tolerated. These data demonstrate an effect of ADS-5102 on walking speed. Further studies are warranted to confirm these observations.
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Affiliation(s)
- Jeffrey A Cohen
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Mark Gudesblatt
- Comprehensive Multiple Sclerosis Care Center, South Shore Neurologic Associates, P.C., Patchogue, NY, USA
| | - Ben W Thrower
- Crawford Research Institute, Shepherd Center, Atlanta, GA, USA
| | - Lily Llorens
- Adamas Pharmaceuticals, Inc., Emeryville, CA, USA
| | | | - April E Ruby
- Adamas Pharmaceuticals, Inc., Emeryville, CA, USA
| | | | - Rajiv Patni
- Adamas Pharmaceuticals, Inc., Emeryville, CA, USA
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7
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Elmer LW, Juncos JL, Singer C, Truong DD, Criswell SR, Parashos S, Felt L, Johnson R, Patni R. Author Correction to: Pooled Analyses of Phase III Studies of ADS-5102 (Amantadine) Extended-Release Capsules for Dyskinesia in Parkinson's Disease. CNS Drugs 2018; 32:399-400. [PMID: 29637528 PMCID: PMC6828147 DOI: 10.1007/s40263-018-0510-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An Online First version of this article was made available online at http://link.springer.com/journal/40263/onlineFirst/page/1 on 12 March 2018. An error was subsequently identified in the article, and the following correction should be noted.
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Affiliation(s)
- Lawrence W. Elmer
- Department of Neurology, University of Toledo College of Medicine, 3120 Glendale Avenue, Toledo, OH 43614 USA
| | - Jorge L. Juncos
- Department of Neurology and Movement Disorders, Emory University School of Medicine, Atlanta, GA USA
| | - Carlos Singer
- Department of Neurology, University of Miami, Miami, FL USA
| | - Daniel D. Truong
- The Parkinson’s and Movement Disorder Institute, Fountain Valley, CA USA
| | | | | | - Larissa Felt
- Adamas Pharmaceuticals, Inc., Emeryville, CA USA
| | - Reed Johnson
- Adamas Pharmaceuticals, Inc., Emeryville, CA USA
| | - Rajiv Patni
- Adamas Pharmaceuticals, Inc., Emeryville, CA USA
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8
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Elmer LW, Juncos JL, Singer C, Truong DD, Criswell SR, Parashos S, Felt L, Johnson R, Patni R. Pooled Analyses of Phase III Studies of ADS-5102 (Amantadine) Extended-Release Capsules for Dyskinesia in Parkinson's Disease. CNS Drugs 2018; 32. [PMID: 29532440 PMCID: PMC5934466 DOI: 10.1007/s40263-018-0498-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Although levodopa is considered the most effective pharmacotherapy for motor symptoms of Parkinson's disease (PD), chronic use is associated with motor complications, including fluctuating response and unpredictable, involuntary movements called dyskinesia. ADS-5102 (amantadine) extended-release (ER) capsules (GOCOVRITM) is a recent US FDA-approved treatment for dyskinesia in PD patients. ADS-5102 is a high-dose, ER formulation of amantadine, administered orally once daily at bedtime, that achieves high plasma drug concentrations throughout the day. OBJECTIVE In this study, we present pooled results from two randomized, double-blind, placebo-controlled, phase III ADS-5102 trials. PATIENTS AND METHODS The two studies in PD patients with dyskinesia shared design and eligibility criteria, differing only in treatment duration. Results from common assessment time points were pooled. RESULTS At 12 weeks, the least squares (LS) mean change in total score on the Unified Dyskinesia Rating Scale among 100 patients randomized to ADS-5102 and 96 patients randomized to placebo was - 17.7 (standard error [SE] 1.3) vs. - 7.6 (1.3) points, respectively (- 10.1 points, 95% confidence interval [CI] - 13.8, - 6.5; p < 0.0001). The relative treatment difference between groups was 27.3% (p < 0.0001). At 12 weeks, the LS mean change in OFF time was - 0.59 (0.21) vs. +0.41 (0.20) h/day, a difference of - 1.00 h/day (95% CI - 1.57, - 0.44; p = 0.0006). For both efficacy measures, a significant difference from placebo was attained by two weeks, the first post-baseline assessment, and was maintained throughout 12 weeks. In the pooled ADS-5102 group, the most common adverse events were hallucination, dizziness, dry mouth, peripheral edema, constipation, falls, and orthostatic hypotension. CONCLUSIONS These analyses provide further evidence supporting ADS-5102 as an adjunct to levodopa for treating both dyskinesia and OFF time in PD patients with dyskinesia. Clinicaltrials.gov identifier: NCT02136914 and NCT02274766.
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Affiliation(s)
- Lawrence W. Elmer
- Department of Neurology, University of Toledo College of Medicine, 3120 Glendale Avenue, Toledo, OH 43614 USA
| | - Jorge L. Juncos
- Department of Neurology and Movement Disorders, Emory University School of Medicine, Atlanta, GA USA
| | - Carlos Singer
- Department of Neurology, University of Miami, Miami, FL USA
| | - Daniel D. Truong
- The Parkinson’s and Movement Disorder Institute, Fountain Valley, CA USA
| | | | | | - Larissa Felt
- Adamas Pharmaceuticals, Inc., Emeryville, CA USA
| | - Reed Johnson
- Adamas Pharmaceuticals, Inc., Emeryville, CA USA
| | - Rajiv Patni
- Adamas Pharmaceuticals, Inc., Emeryville, CA USA
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9
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Isaacson S, Pahwa R, Tanner C, Fahn S, Espay A, Trenkwalder C, Patni R. ADS-5102 provided reduction in motor complications in Parkinson’s disease patients with levodopa-induced dyskinesia switched from amantadine IR: Subgroup analysis from open-label study (ease LID 2). J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.1008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Jaffer U, Aslam M, Kasivisvanathan V, Patni R, Midwinter M, Standfield N. Evaluation of rapid training in ultrasound guided tourniquet application skills. Int J Surg 2012; 10:563-7. [DOI: 10.1016/j.ijsu.2012.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 07/17/2012] [Accepted: 08/22/2012] [Indexed: 11/25/2022]
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Asghar Nawaz M, Patni R, Chan KMJ, Lockwood G, Punjabi P. Hyperinflation of lungs during redo-sternotomy, a safer technique. Heart Lung Circ 2011; 20:722-3. [PMID: 21855410 DOI: 10.1016/j.hlc.2011.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/15/2011] [Accepted: 07/22/2011] [Indexed: 11/18/2022]
Abstract
Increasing numbers of patients are being referred for repeat cardiac procedures and redo-sternotomy is technically more arduous as well as time consuming. We describe our unique technique to overcome this challenging task by hyperinflating the lungs as a useful manoeuvre.
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Affiliation(s)
- Muhammad Asghar Nawaz
- Cardiothoracic Surgery, Imperial College Healthcare NHS, Hammersmith Hospital, DuCane Road, London, UK.
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12
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Abstract
BACKGROUND Heart transplantation is optimal treatment for many patients with end-stage heart failure. Current data report 1-year graft survival rates of 85% after transplantation. The success of transplantation in large part is attributable to immunosuppression, including steroids, one of the mainstay agents. Despite its efficacy to treat acute graft rejection, steroids show numerous adverse effects. With newer immunosuppressive agents, steroid withdrawal is possible. MATERIAL AND METHODS We compared cardiac transplant patients who died versus survived between 2001 and 2006. We obtained Personal, transplant, occurrence of and cause of death data as well as postoperative intervals. Steroid therapy details were gathered, particularly whether the patient had been weaned off these agents. We calculated steroid doses and steroid-free years, as well as the steroid therapy status of posttransplant patients who remained alive in 2006. RESULTS Fifty cardiac transplant patients died between 2001 and 2006 excluding 6 who had graft failure and 2 who died of multiorgan failure before initial discharge. Of the 42 patient who died, 29 (69%) were on and 13 (31%) had been withdrawn from steroid therapy at time of death. There were 132 posttransplant patients currently alive in April 2006, including 43 (33%) on and 89 (67%) withdrawn from steroids. The percentages of patients who were on versus off steroids were compared for main causes of death. Thirty-eight percent of patients on steroids at the time of death died of graft vasculopathy compared with 46% of patients who had been weaned off steroids. Fifteen percent of deceased patients taking steroids at the time of death died of chronic rejection. DISCUSSION The current literature focuses on early withdrawal or reduction of steroids or steroid avoidance after organ transplantation. Although steroid avoidance remains controversial, steroid withdrawal has been generally incorporated into immunosuppressive protocols. Early steroid withdrawal has a positive influence on the emergence of de novo osteoporosis and cataracts. The benefits of steroid avoidance versus withdrawal are controversial topics being currently debated.
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Affiliation(s)
- M Asghar Nawaz
- Golden Jubilee National Hospital Glasgow, United Kingdom.
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13
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Fattouch K, Runza G, Moscarelli M, Trumello C, Incalcatera E, Corrado E, La Grutta L, Patni R, Midiri M, Novo S, Ruvolo G. Graft patency and late outcomes for patients with ST-segment elevation myocardial infarction who underwent coronary surgery. Perfusion 2011; 26:401-8. [DOI: 10.1177/0267659111411354] [Citation(s) in RCA: 6] [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: 11/15/2022]
Abstract
Objective: The aim of our study was to assess the long-term clinical outcomes and the grafts patency rates of patients with ST-segment elevation myocardial infarction (STEMI) who underwent urgent or emergency coronary artery bypass grafting (CABG). Materials: Participants in two previous studies comprising 207 STEMI patients undergoing on-pump (145 patients) or off-pump (62 patients) coronary artery bypass graft (CABG) surgery in our institution were prospectively followed to assess late mortality, graft patency, and major adverse cardiac-related event (MACE) rates. Graft patency was evaluated by multi-detector computed tomography angiography 64-slice scan. Mean times of graft implantation were 38±16 months and 37±14 months in on-pump and off-pump, respectively. Follow-up data were obtained in all patients and was 100% complete. Results: Late mortality rate was 7.4% (10 patients) in the on-pump and 6.5% (4 patients) in off-pump groups (p=0.45). Five-year overall survival rate (±SE) was 93.5±2.1% and 92.6±1.9% in the off-pump vs on-pump, respectively. Five years’ freedom from cardiac-related death was 94.9±2.9% in the on-pump group vs 96.8±3.2% in the off-pump group (p=0.25). Five years’ freedom from cardiac-related events was 89.7±1.6% in the on-pump group versus 93.5±1.8% in the off-pump group (p=0.32). In all patients, a total of 449/491 (91.5%) grafts were patent. Percentages of overall grafts classified as patent were similar in the on-pump group (90.7% - 322/355 conduits) versus the off-pump group (91% - 133/146 conduits). Graft patency rates were also similar between the two groups with regard to arterial and saphenous vein conduits, and with regard to different branches of the coronary arteries grafted. Conclusion: Our data suggest that off-pump CABG patients have the same late mortality, MACEs, and graft patency rates as conventional cardioplegic cardiac arrest CABG patients. In our opinion, urgent or emergency CABG for patients with STEMI can be done either way.
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Affiliation(s)
- K Fattouch
- Department of Cardiac Surgery, University of Palermo, Palermo, Italy
| | - G Runza
- Department of Radiology, University of Palermo, Palermo, Italy
| | - M Moscarelli
- Department of Cardiac Surgery, University of Palermo, Palermo, Italy
| | - C Trumello
- Department of Cardiac Surgery, University of Palermo, Palermo, Italy
| | - E Incalcatera
- Department of Internal Medicine and Cardiovascular Diseases, University of Palermo, Palermo, Italy
| | - E Corrado
- Department of Internal Medicine and Cardiovascular Diseases, University of Palermo, Palermo, Italy
| | - L La Grutta
- Department of Radiology, University of Palermo, Palermo, Italy
| | - R Patni
- Cardiothoracic Surgery, Hammersmith Hospital, London, UK
| | - M Midiri
- Department of Radiology, University of Palermo, Palermo, Italy
| | - S Novo
- Department of Internal Medicine and Cardiovascular Diseases, University of Palermo, Palermo, Italy
| | - G Ruvolo
- Department of Cardiac Surgery, University of Palermo, Palermo, Italy
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Tobe S, Kawecka-Jaszcz K, Zannad F, Vetrovec G, Patni R, Shi H. Amlodipine Added to Quinapril vs Quinapril Alone for the Treatment of Hypertension in Diabetes: The Amlodipine in Diabetes (ANDI) Trial. J Clin Hypertens (Greenwich) 2007; 9:120-7. [PMID: 17272962 PMCID: PMC8110104 DOI: 10.1111/j.1524-6175.2007.06949.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This randomized, comparative, parallel-group trial investigated strategies of blood pressure (BP)-lowering in patients with diabetes and hypertension. Patients not reaching goal BP (<130/80 mm Hg) after 4-week open-label treatment with quinapril 20 mg/d (n=374) received 40 mg/d quinapril (n=167) or 20 mg/d quinapril plus amlodipine besylate (5 mg/d; n=162) for 6 weeks. Patients receiving combination therapy vs monotherapy had significantly greater reductions in mean +/- SE sitting systolic BP (9.9+/-1.0 mm Hg vs 4.3+/-1.1 mm Hg; P<.001) and diastolic BP (6.5+/-0.6 mm Hg vs 2.7+/-0.6 mm Hg; P<.001). No significant differences between groups were observed in percentage of patients achieving goal BP (10.1% with combination therapy vs 8.2% with monotherapy). A clinically neutral effect was observed on high-sensitivity C-reactive protein in both groups. Treatments were well tolerated; fewer than 3% of patients in any group discontinued due to treatment-emergent or treatment-related adverse events. In diabetic hypertensive patients, 20 mg/d quinapril plus 5 mg/d amlodipine besylate was a more effective BP-lowering strategy than monotherapy with 40 mg/d quinapril.
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Affiliation(s)
- Sheldon Tobe
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Epstein M, Williams GH, Weinberger M, Lewin A, Krause S, Mukherjee R, Patni R, Beckerman B. Selective aldosterone blockade with eplerenone reduces albuminuria in patients with type 2 diabetes. Clin J Am Soc Nephrol 2006; 1:940-51. [PMID: 17699311 DOI: 10.2215/cjn.00240106] [Citation(s) in RCA: 294] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Previous studies have shown that the selective aldosterone blocker eplerenone, in doses of up to 200 mg/d, reduces albuminuria in patients with type 2 diabetes. This study was conducted to ascertain whether lower doses of eplerenone (50 or 100 mg/d) co-administered with the angiotensin-converting enzyme (ACE) inhibitor enalapril would produce a similar antialbuminuric effect while obviating the hyperkalemia observed previously. After open-label run-in with enalapril 20 mg/d, patients with diabetes and a urinary albumin:creatinine ratio (UACR) > or = 50 mg/g were randomly assigned to receive enalapril plus one of three double-blind daily treatments for 12 wk: placebo, eplerenone 50 mg (EPL50), or eplerenone 100 mg (EPL100). After week 4, amlodipine 2.5 to 10 mg/d was allowed for BP control (systolic/diastolic BP < or = 130/80 mmHg). The primary study end points were the percentage change from baseline at week 12 in UACR and the incidence of hyperkalemia. Secondary end points included percentage changes from baseline in UACR at weeks 4 and 8 and changes from baseline in systolic and diastolic BP. Treatment with EPL50 or EPL100 but not placebo significantly reduced albuminuria from baseline. By week 12, UACR was reduced by 7.4% in the placebo group, by 41.0% in the EPL50 group, and by 48.4% in the EPL100 group (both eplerenone groups, P < 0.001 versus placebo). The incidences of sustained and severe hyperkalemia were not significantly different in any of the three treatment arms and did not differ on the basis of quartile of estimated GFR (all NS). For the secondary end points, both eplerenone treatment groups significantly reduced albuminuria from baseline as early as week 4 (P < 0.001), whereas placebo treatment (including enalapril) did not result in any significant decreases in UACR. Systolic BP decreased significantly in all treatment groups at all time points, but, generally, all treatment groups experienced similar decreases in BP. Co-administration of EPL50 or EPL100 with an ACE inhibitor as compared with an ACE inhibitor alone significantly reduces albuminuria in patients with diabetes without producing significant increases in hyperkalemia.
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Affiliation(s)
- Murray Epstein
- University of Miami School of Medicine, Miami, Florida, USA.
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Zannad F, Ketelslegers JM, Schiffrin EL, Williams G, Garthwaite S, He W, Patni R, Pitt B. 1108-123 The effect of eplerenone on markers of cardiac fibrosis: Insights from EPHESUS. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)90850-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Joshi KC, Patni R, Chand P, Sharma V, Bhattacharya SK, Rao YV. Synthesis and central nervous system activities of certain fluorine-containing 3-substituted indol-2-ones. Pharmazie 1984; 39:153-5. [PMID: 6728885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Several fluorine-containing 3- aroylmethyl -3-hydroxyindol-2-ones (4a-g), 3- aroylmethyleneindol -2-ones (5a-g) and 3- aroylmethylindol -2-ones (6a-g) were synthesized from the corresponding fluorine-containing indole-2,3-diones and appropriate ketones. The compounds were characterized by spectral studies. Representative compounds of each series were tested on mice for CNS activities, viz. analgesic and anticonvulsant and the effects were also observed against amphetamine-induced stereotypy, on conditioned avoidance response and on potentiation of pentobarbitone sodium hypnosis. Of the compounds examined, the greatest degree of activity was observed in 3- aroyl - methyleneindol -2-ones with a pronounced unsaturation in the system.
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