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Urman RD, Seger DL, Fiskio JM, Neville BA, Harry EM, Weiner SG, Lovelace B, Fain R, Cirillo J, Schnipper JL. The Burden of Opioid-Related Adverse Drug Events on Hospitalized Previously Opioid-Free Surgical Patients. J Patient Saf 2021; 17:e76-e83. [PMID: 30672762 DOI: 10.1097/pts.0000000000000566] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Opioid analgesics are a mainstay for acute pain management, but postoperative opioid administration has risks. We examined the prevalence, risk factors, and consequences of opioid-related adverse drug events (ORADEs) in a previously opioid-free surgical population. METHODS A retrospective, observational, cohort study using administrative, billing, clinical, and medication administration data from two hospitals. Data were collected for all adult patients who were opioid-free at admission, underwent surgery between October 1, 2015, and September 30, 2016, and received postoperative opioids. Potential ORADEs were determined based on inpatient billing codes or postoperative administration of naloxone. We determined independent predictors of ORADE development using multivariable logistic regression. We measured adjusted inpatient mortality, hospital costs, length of hospital stay, discharge destination, and readmission within 30 days for patients with and without ORADEs. RESULTS Among 13,389 hospitalizations where opioid-free patients had a single qualifying surgery, 12,218 (91%) received postoperative opioids and comprised the study cohort. Of these, we identified 1111 (9.1%) with a potential ORADE. Independent predictors of ORADEs included older age, several markers of disease severity, longer surgeries, and concurrent benzodiazepine use. Opioid-related adverse drug events were strongly associated with the route and duration of opioids administered postoperatively: 18% increased odds per day on intravenous opioids. In analyses adjusted for several covariates, presence of an ORADE was associated with 32% higher costs of hospitalization, 45% longer postoperative length of stay, 36% lower odds of discharge home, and 2.2 times the odds of death. CONCLUSIONS We demonstrate a high rate and severe consequences of potential ORADEs in previously opioid-free patients receiving postoperative opioids. Knowledge of risk factors and predictors of ORADEs can help develop targeted interventions to minimize the development of these potentially dangerous and costly events.
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Affiliation(s)
| | | | | | - Bridget A Neville
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital
| | | | | | - Belinda Lovelace
- Mallinckrodt Pharmaceuticals, Health Economics and Outcomes Research Department, Bedminster
| | - Randi Fain
- Mallinckrodt Pharmaceuticals, Medical Affairs Department, Bedminster, New Jersey
| | - Jessica Cirillo
- Mallinckrodt Pharmaceuticals, Health Economics and Outcomes Research Department, Bedminster
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Fain R, Johnstone C, Charlson J, Neilson J, Bedi M. Does Preoperative Hypofractionated Radiation Therapy for Soft Tissue Sarcoma Impact Post-operative Wound Complications? Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fain R, Lorenz J, Wittman D, Zhang Y, Rein L, Banerjee A, Li A, Erickson B, Hall W. Target Volume Differences Between MRI and CT-Based Boost Strategies in Treatment Planning of Rectal Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2140] [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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Urman RD, Böing EA, Khangulov V, Fain R, Nathanson BH, Wan GJ, Lovelace B, Pham AT, Cirillo J. Analysis of predictors of opioid-free analgesia for management of acute post-surgical pain in the United States. Curr Med Res Opin 2019; 35:283-289. [PMID: 29799282 DOI: 10.1080/03007995.2018.1481376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Utilization of opioid-free analgesia (OFA) for post-surgical pain is a growing trend to counter the risks of opioid abuse and opioid-related adverse drug events (ORADEs). However, utilization patterns of OFA have not been examined. In this study, we investigated the utilization patterns and predictors of OFA in a surgical population in the United States. METHODS Analysis of the Cerner Health Facts database (January 2011 to December 2015) was conducted to describe hospital and patient characteristics associated with OFA. Baseline characteristics, such as age, gender, race, discharge status, year of admission and chronic comorbidities at index admission were collected. Hospital characteristics and payer type at index admission were collected as reported in the electronic health record database. Descriptive statistics and logistic regression were used to identify statistically significant predictors of OFA on patient and institutional levels. RESULTS The study identified 10,219 patients, from 187 hospitals, who received post-surgical OFA and 255,196 patients who received post-surgical opioids. OFA rates varied considerably by hospital. Patients more likely to receive OFA were older (OR = 1.06, 95% CI [1.03, 1.10]; p < .001), or had neurological disorders (OR = 1.24, 95% CI [1.10, 1.39]; p < .001), diabetes (OR = 1.20, 95% CI [1.08, 1.33]; p = .001) or psychosis (OR = 1.18, 95% CI [1.01, 1.37]; p = .030). Patients with obesity and depression were less likely to receive OFA (OR = 0.80, 95% CI [0.67, 0.95]; p = .010 OR = 0.85, 95% CI [0.73, 0.98]; p = .030, respectively). CONCLUSIONS Use of post-surgical OFA was limited overall and was not favored in some patient groups prone to ORADEs, indicating missed opportunities to reduce opioid use and ORADE incidence. A substantial proportion of OFA patients was contributed by a few hospitals with especially high rates of OFA, suggesting that hospital policies, institutional structure and cross-functional departmental commitment to reducing opioid use may play a large role in the implementation of OFA.
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Affiliation(s)
- Richard D Urman
- a Harvard Medical School and Brigham and Women's Hospital , Boston , MA , USA
| | - Elaine A Böing
- b Mallinckrodt Pharmaceuticals , Health Economics and Outcomes Research Department , Bedminster , NJ , USA
| | | | - Randi Fain
- d Mallinckrodt Pharmaceuticals , Medical Affairs Department , Bedminster , NJ , USA
| | | | - George J Wan
- b Mallinckrodt Pharmaceuticals , Health Economics and Outcomes Research Department , Bedminster , NJ , USA
| | | | - An T Pham
- f Employee of Mallinckrodt during the conduct of this study
- g School of Pharmacy , University of Washington , Seattle , WA , USA
| | - Jessica Cirillo
- b Mallinckrodt Pharmaceuticals , Health Economics and Outcomes Research Department , Bedminster , NJ , USA
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Urman RD, Boing EA, Pham AT, Khangulov V, Fain R, Nathanson BH, Zhang X, Wan GJ, Lovelace B, Cirillo J. Improved Outcomes Associated With the Use of Intravenous Acetaminophen for Management of Acute Post-Surgical Pain in Cesarean Sections and Hysterectomies. J Clin Med Res 2018; 10:499-507. [PMID: 29707092 PMCID: PMC5916539 DOI: 10.14740/jocmr3380w] [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: 02/08/2018] [Accepted: 02/26/2018] [Indexed: 12/30/2022] Open
Abstract
Background Post-surgical pain impacts many patient outcomes. Effective pain management increasingly relies on multimodal analgesia regimens in which acetaminophen (APAP) is a key component. The aim of our study was to examine the impact of oral APAP versus intravenous (IV) APAP as a component of post-surgical pain management after Cesarean sections and hysterectomies. Methods A retrospective analysis of the Cerner HealthFacts® database (from January, 2011 to December, 2015) was conducted to compare outcomes of Cesarean section and hysterectomy surgery patients who received oral APAP to those who received IV APAP post-surgically. Length of stay (LOS), daily morphine milligram equivalent (MME) consumption, the presence of potential opioid-related adverse events (ORADEs), and total pharmacy costs were assessed. Adjusted results were derived using inverse probability weighted regression adjustment (IPW-RA) estimators based on covariates that included demographics, comorbidities, patient clinical characteristics, and hospital characteristics. Results The study identified 29,124 Cesarean section patients (24,612 oral APAP; 4,512 IV APAP) and 9,767 hysterectomy surgery patients (5,586 oral APAP; 4,181 IV APAP). Compared to the oral APAP group, the IV APAP group had reductions in adjusted LOS (Cesarean section: -11.7% days (P < 0.001), hysterectomy: -11.8% days (P = 0.005)), lowered adjusted daily MME consumption from day 0 to day 3 (Cesarean section: -1.6 mg (P < 0.001), hysterectomy: -1.7 mg (P = 0.014)), and reduced risk of ORADEs for Cesarean sections (relative risk of 0.45, P < 0.001). Total pharmacy costs were not significantly different between the two APAP groups. Conclusions Post-surgical pain managed with IV APAP in patients undergoing Cesarean section or hysterectomy was associated with shorter LOS, reduced risk of ORADEs, and lower opioid consumption compared to patients managed with oral APAP, without adversely impacting total pharmacy costs.
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Affiliation(s)
- Richard D Urman
- Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Elaine A Boing
- Health Economics and Outcomes Research Department, Mallinckrodt Pharmaceuticals, Bedminster, NJ, USA
| | - An T Pham
- School of Pharmacy, University of California San Francisco, San Francisco, CA, USA. This author was an employee of Mallinckrodt Pharmaceuticals during the conduct of this study
| | | | - Randi Fain
- Medical Affairs Department, Mallinckrodt Pharmaceuticals, Bedminster, NJ, USA
| | | | - Xuan Zhang
- Boston Strategic Partners, Inc., Boston, MA, USA
| | - George J Wan
- Health Economics and Outcomes Research Department, Mallinckrodt Pharmaceuticals, Bedminster, NJ, USA
| | - Belinda Lovelace
- Health Economics and Outcomes Research Department, Mallinckrodt Pharmaceuticals, Bedminster, NJ, USA
| | - Jessica Cirillo
- Health Economics and Outcomes Research Department, Mallinckrodt Pharmaceuticals, Bedminster, NJ, USA
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Raffa RB, Pawasauskas J, Pergolizzi JV, Lu L, Chen Y, Wu S, Jarrett B, Fain R, Hill L, Devarakonda K. Pharmacokinetics of Oral and Intravenous Paracetamol (Acetaminophen) When Co-Administered with Intravenous Morphine in Healthy Adult Subjects. Clin Drug Investig 2018; 38:259-268. [PMID: 29214506 PMCID: PMC5834589 DOI: 10.1007/s40261-017-0610-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Several features favor paracetamol (acetaminophen) administration by the intravenous rather than the oral route in the postoperative setting. This study compared the pharmacokinetics and bioavailability of oral and intravenous paracetamol when given with or without an opioid, morphine. METHODS In this randomized, single-blind, parallel, repeat-dose study in healthy adults, subjects received four repeat doses of oral or intravenous 1000 mg paracetamol at 6-h intervals, and morphine infusions (0.125 mg/kg) at the 2nd and 3rd intervals. Comparisons of plasma pharmacokinetic profiles were conducted before, during, and after opioid co-administrations. RESULTS Twenty-two subjects were included in the pharmacokinetic analysis. Observed paracetamol peak concentration (C max) and area under the plasma concentration-time curve over the dosing interval (AUC0-6) were reduced when oral paracetamol was co-administered with morphine (reduced from 11.6 to 7.25 µg/mL and from 31.00 to 25.51 µg·h/mL, respectively), followed by an abruptly increased C max and AUC0-6 upon discontinuation of morphine (to 13.5 µg/mL and 52.38 µg·h/mL, respectively). There was also a significantly prolonged mean time to peak plasma concentration (T max) after the 4th dose of oral paracetamol (2.84 h) compared to the 1st dose (1.48 h). However, pharmacokinetic parameters of paracetamol were not impacted when intravenous paracetamol was co-administered with morphine. CONCLUSIONS Morphine co-administration significantly impacted the pharmacokinetics of oral but not intravenous paracetamol. The abrupt release of accumulated paracetamol at the end of morphine-mediated gastrointestinal inhibition following oral but not intravenous administration of paracetamol suggests that intravenous paracetamol provides a better option for the management of postoperative pain. CLINICALTRIALS. GOV IDENTIFIER NCT02848729.
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Affiliation(s)
- Robert B Raffa
- University of Arizona College of Pharmacy, Tucson, AZ, 85718, USA
| | - Jayne Pawasauskas
- The University of Rhode Island College of Pharmacy, Kingston, RI, 02881, USA
| | | | - Luke Lu
- Mallinckrodt Pharmaceuticals, Perryville III Corporate Park, 53 Frontage Road Third Floor, P.O. Box 9001, Hampton, NJ, 08827-9001, USA
| | - Yin Chen
- Mallinckrodt Pharmaceuticals, Hazelwood, MO, 63042, USA
| | - Sutan Wu
- Mallinckrodt Pharmaceuticals, Hazelwood, MO, 63042, USA
| | - Brant Jarrett
- Mallinckrodt Pharmaceuticals, Perryville III Corporate Park, 53 Frontage Road Third Floor, P.O. Box 9001, Hampton, NJ, 08827-9001, USA
| | - Randi Fain
- Mallinckrodt Pharmaceuticals, Perryville III Corporate Park, 53 Frontage Road Third Floor, P.O. Box 9001, Hampton, NJ, 08827-9001, USA
| | - Lawrence Hill
- Mallinckrodt Pharmaceuticals, Perryville III Corporate Park, 53 Frontage Road Third Floor, P.O. Box 9001, Hampton, NJ, 08827-9001, USA
| | - Krishna Devarakonda
- Mallinckrodt Pharmaceuticals, Perryville III Corporate Park, 53 Frontage Road Third Floor, P.O. Box 9001, Hampton, NJ, 08827-9001, USA.
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Smith SR, Garvey WT, Greenway FL, Zhou S, Fain R, Pilson R, Fujioka K, Aronne LJ. Coadministration of lorcaserin and phentermine for weight management: A 12-week, randomized, pilot safety study. Obesity (Silver Spring) 2017; 25:857-865. [PMID: 28440045 PMCID: PMC5518190 DOI: 10.1002/oby.21811] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/07/2017] [Accepted: 01/30/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the short-term tolerability of lorcaserin alone or with two dose regimens of phentermine. METHODS This was a 12-week, randomized, double-blind, pilot safety study of N = 238 nondiabetic patients with obesity or overweight with ≥1 comorbidity randomized to lorcaserin 10 mg twice daily (BID; LOR BID) alone or with phentermine 15 mg once daily (QD; LOR BID+PHEN QD) or 15 mg twice daily (LOR BID+PHEN BID). Patients reporting ≥ 1 of 9 potentially serotonergic adverse events (AEs), mean weight loss (WL), and ≥5% WL are reported. RESULTS N = 238 were randomized, and N = 235 were treated. N = 94 reported potentially serotonergic AEs: 37.2% LOR BID, 42.3% LOR BID+PHEN QD, and 40.5% LOR BID+PHEN BID. AEs leading to discontinuation were reported approximately twice as often in the LOR BID+PHEN BID group versus the LOR BID group. Mean WL was 3.5 kg/3.3%, 7.0 kg/6.7%, and 7.6 kg/7.2% for LOR BID, LOR BID+PHEN QD, and LOR BID+PHEN BID, respectively. At least 5% WL was achieved by 28.2% LOR BID, 59.0% LOR BID+PHEN QD (P = 0.0002 vs. LOR BID), and 70.9% LOR BID+PHEN BID (P < 0.0001 vs. LOR BID) patients. CONCLUSIONS Phentermine added to lorcaserin enhanced short-term weight loss but did not increase incidence of potentially serotonergic AEs; however, phentermine twice daily increased discontinuation compared to both lorcaserin alone and lorcaserin plus phentermine once daily.
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Affiliation(s)
- Steven R. Smith
- Center for the Metabolic Origins of Disease, Sanford Burnham Prebys Medical Discovery InstituteOrlandoFloridaUSA
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, OrlandoFloridaUSA
| | - W. Timothy Garvey
- Department of Nutrition SciencesUniversity of Alabama at Birmingham, and the Birmingham VA Medical Center, BirminghamAlabamaUSA
| | - Frank L. Greenway
- Pennington Biomedical Research CenterLouisiana State University SystemBaton RougeLouisianaUSA
| | - Sharon Zhou
- Eisai Medical and Scientific Affairs, Eisai Inc.Woodcliff LakeNew JerseyUSA
| | - Randi Fain
- Formerly Eisai Inc.Woodcliff LakeNew JerseyUSA
| | | | - Ken Fujioka
- Department of Diabetes and EndocrinologyScripps ClinicLa JollaCaliforniaUSA
| | - Louis J. Aronne
- Department of MedicineWeill Cornell Medical CollegeNew YorkNew YorkUSA
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Magkos F, Nikonova E, Fain R, Zhou S, Ma T, Shanahan W. Effect of lorcaserin on glycemic parameters in patients with type 2 diabetes mellitus. Obesity (Silver Spring) 2017; 25:842-849. [PMID: 28345809 DOI: 10.1002/oby.21798] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/22/2016] [Accepted: 01/13/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Lorcaserin, a 5-HT2C receptor agonist approved for chronic weight management, is also associated with improvements in glycemic parameters in patients with/without type 2 diabetes mellitus (T2DM), but the extent to which these effects are mediated by weight loss is unknown. This post hoc analysis further examines glycemic data from the Phase III BLOOM-DM study stratified by weight changes. METHODS Patients with T2DM were randomized to lorcaserin 10 mg twice daily or placebo. Glycemic parameters were reported by Week (W) 12 weight loss status ≥5% (Group ≥5%) or <5% (Group <5%). Glycemic parameter changes were analyzed using ANCOVA; the relationship between glycemic parameter changes and percent weight loss was assessed by simple regression modeling. RESULTS Group ≥5% receiving lorcaserin had greater improvements in fasting plasma glucose (FPG) at W2 (prior to significant weight loss) and greater improvements in glycated hemoglobin (HbA1c) at W12 versus placebo. These improvements were maintained through W52 (FPG, -29.3 mg/dL vs. -24.2 mg/dL; HbA1c, -1.2% vs. -1.1%). Group <5% treated with lorcaserin also had larger decreases in FPG (-28.3 mg/dL vs. -10.0 mg/dL) and HbA1c (-0.8% vs. -0.4%) at W52 versus placebo despite limited weight loss. CONCLUSIONS Lorcaserin may have beneficial effects on glycemic control with or without weight loss.
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Affiliation(s)
- Faidon Magkos
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore & Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Elena Nikonova
- Eisai Medical and Scientific Affairs, Eisai Inc, Woodcliff Lake, New Jersey, USA
| | - Randi Fain
- Mallinckrodt Pharmaceuticals, Hampton, New Jersey, USA
| | - Sharon Zhou
- Eisai Medical and Scientific Affairs, Eisai Inc, Woodcliff Lake, New Jersey, USA
| | - Tony Ma
- Janssen Research & Development, LLC, Raritan, New Jersey, USA
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Abstract
OBJECTIVES Lorcaserin is a selective 5-HT2C (5-hydroxytryptamine 2C) receptor agonist indicated for weight management. Here, we assess the impact of lorcaserin on progression from prediabetes to type 2 diabetes (T2D) and on reversion from prediabetes to euglycemia. METHODS This is a post hoc analysis of pooled data from two Phase 3 studies, BLOOM and BLOSSOM (N = 6136), evaluating the impact of lorcaserin on weight and glycemic parameters over 52 weeks in the subpopulation of obese/overweight subjects with prediabetes, alternately defined by fasting plasma glucose (FPG) 100-125 mg/dl or glycated hemoglobin (HbA1c) 5.7-6.4% at baseline. RESULTS At Week 52, in the subpopulation with prediabetes, nearly twice as many lorcaserin-treated subjects achieved ≥5% weight loss versus placebo (HbA1c: 55.6% vs. 27.5%, p < 0.001; FPG: 52.8% vs. 28.8%, p < 0.001), and a significantly lower percentage of lorcaserin-treated subjects progressed to T2D versus placebo based on HbA1c (lorcaserin 3.2%, placebo 5.0%, p = 0.032) but not FPG (lorcaserin 1.6%, placebo 2.6%, p = 0.227). A significantly greater proportion of lorcaserin-treated subjects versus placebo also reverted to euglycemia based on both HbA1c (lorcaserin 40%, placebo 29.5%, p < 0.001) and FPG (lorcaserin 52.4%, placebo 46.5%, p = 0.047). CONCLUSION In subjects with prediabetes, lorcaserin may contribute to weight loss and improve glycemic parameters, and thus may help with preventing progression to T2D and promoting reversion to euglycemia. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov identifiers are NCT00395135 (BLOOM) and NCT00603902 (BLOSSOM).
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Affiliation(s)
- Richard Nesto
- a Department of Cardiovascular Medicine , Lahey Hospital & Medical Center , Burlington , MA , USA
| | - Randi Fain
- b Medical & Scientific Affairs , Eisai Inc ., Woodcliff Lake , NJ , USA
| | - Yuhan Li
- c Formerly of Eisai Inc ., Woodcliff Lake , NJ , USA
| | - William Shanahan
- d Preclinical and Clinical Drug Development, Arena Pharmaceuticals, Inc ., San Diego , CA , USA
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Weissman NJ, Smith SR, Fain R, Hall N, Shanahan WR. Effects of lorcaserin on pre-existing valvulopathy: A pooled analysis of phase 3 trials. Obesity (Silver Spring) 2017; 25:39-44. [PMID: 27888609 PMCID: PMC6680283 DOI: 10.1002/oby.21695] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/24/2016] [Accepted: 09/08/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the effects of lorcaserin in patients with pre-existing Food and Drug Administration (FDA)-defined valvulopathy. METHODS This is a pooled, post hoc analysis of three Phase 3 studies. BLOOM and BLOSSOM patients were 18 to 65 years of age without diabetes and with a body mass index (BMI) of 27 to 29.9 kg/m2 and ≥1 weight-related comorbidity or a BMI of 30 to 45 kg/m2 . BLOOM-DM patients had a BMI of 27 to 45 kg/m2 and type 2 diabetes. Patients were treated with placebo, lorcaserin 10 mg once daily, or lorcaserin 10 mg twice daily. Serial echocardiographs were obtained at baseline and every 6 months. RESULTS Included patients (N = 169) had FDA-defined valvulopathy at baseline and a week 52 echocardiogram. At week 52, 35.5% and 52.7% of patients experienced changes from baseline in aortic and mitral regurgitation, respectively. Numerically greater proportions of patients taking lorcaserin versus placebo had decreases in aortic (33.0% vs. 28.3%) or mitral (41.3% vs. 36.7%) regurgitation. Fewer patients taking lorcaserin versus placebo had increases in aortic (2.8% vs. 6.7%) or mitral (8.3% vs. 21.7%) regurgitation. No adverse event-related discontinuation was due to a valve problem. CONCLUSIONS These data suggest that lorcaserin does not adversely affect valvular disease in patients with pre-existing FDA-defined valvulopathy.
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Affiliation(s)
- Neil J. Weissman
- MedStar Health Research InstituteWashingtonDCUSA
- Regulatory ScienceGeorgetown University School of MedicineWashingtonDCUSA
| | - Steven R. Smith
- Center for the Metabolic Origins of Disease, Sanford Burnham Prebys Medical Discovery InstituteOrlandoFloridaUSA
- Translational Research Institute for Metabolism and Diabetes, Florida HospitalOrlandoFloridaUSA
| | - Randi Fain
- Mallinckrodt PharmaceuticalsHamptonNew JerseyUSA
| | - Nancy Hall
- Medical and Scientific AffairsEisai Inc.Woodcliff LakeNew JerseyUSA
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Leppik IE, Yang H, Williams B, Zhou S, Fain R, Patten A, Bibbiani F, Laurenza A. Analysis of falls in patients with epilepsy enrolled in the perampanel phase III randomized double-blind studies. Epilepsia 2016; 58:51-59. [DOI: 10.1111/epi.13600] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2016] [Indexed: 01/14/2023]
Affiliation(s)
- Ilo E. Leppik
- Department of Neurology and College of Pharmacy; University of Minnesota; Minneapolis Minnesota U.S.A
| | - Haichen Yang
- Formerly of Eisai Inc.; Woodcliff Lake New Jersey U.S.A
| | - Betsy Williams
- Eisai Medical and Scientific Affairs; Eisai Inc.; Woodcliff Lake New Jersey U.S.A
| | - Sharon Zhou
- Eisai Medical and Scientific Affairs; Eisai Inc.; Woodcliff Lake New Jersey U.S.A
| | - Randi Fain
- Formerly of Eisai Inc.; Woodcliff Lake New Jersey U.S.A
| | | | - Francesco Bibbiani
- Eisai Neuroscience and General Medicine PCU; Eisai Inc.; Woodcliff Lake New Jersey U.S.A
| | - Antonio Laurenza
- Eisai Neuroscience and General Medicine PCU; Eisai Inc.; Woodcliff Lake New Jersey U.S.A
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Handelsman Y, Fain R, Wang Z, Li X, Fujioka K, Shanahan W. Lorcaserin treatment allows for decreased number needed to treat for weight and glycemic parameters in week 12 responders with ≥5% weight loss. Postgrad Med 2016; 128:740-746. [PMID: 27659698 DOI: 10.1080/00325481.2016.1240591] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Lorcaserin is a serotonin 2C receptor agonist approved for chronic weight management. This analysis explores the number of patients needed to be treated (NNT) with lorcaserin for one more patient to achieve weight loss and glycemic goals. METHODS This is a post hoc analysis of three Phase 3 studies in adults with and without type 2 diabetes mellitus (T2DM) treated with lorcaserin 10 mg BID or placebo. NNT is reported for patients achieving ≥5% or ≥10% weight loss, achievement of either HbA1c <5.7% or FPG <100 mg/dL in patients with prediabetes, and reduction of HbA1c to <7% in patients with T2DM at Week 52. RESULTS In the modified intention-to-treat (MITT) population, NNTs for ≥5% and ≥10% weight loss were 3.6 and 6.2 (without T2DM) and 4.3 and 7.5 (with T2DM); in Week 12 responders (≥5% weight loss at Week 12), NNTs were 1.7 and 2.6 (without T2DM) and 1.9 and 3.2 (with T2DM). In patients with prediabetes, NNTs to achieve HbA1c <5.7% were 9.9 (MITT) and 5.2 (Week 12 responders). In patients with T2DM, NNTs to achieve HbA1c <7% were 4.2 (MITT) and 2.3 (Week 12 responders). CONCLUSION In addition to weight management, lorcaserin improved glycemic control in patients with prediabetes and facilitated targeted HbA1c reduction in patients with T2DM, especially for those who achieved ≥5% weight loss by Week 12. Assessment of treatment response at Week 12 is a valuable tool to achieve efficient use of healthcare resources. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov identifiers are NCT00395135, NCT00603291, and NCT00603902.
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Affiliation(s)
| | - Randi Fain
- b Department of Medical and Scientific Affairs , Formerly of Eisai Inc. , Woodcliff Lake , NJ , USA
| | - Zhixiao Wang
- c Department of Health Economics & Outcomes Research, Eisai Inc. , Woodcliff Lake , NJ , USA
| | - Xuan Li
- c Department of Health Economics & Outcomes Research, Eisai Inc. , Woodcliff Lake , NJ , USA
| | - Ken Fujioka
- d Department of Diabetes and Endocrinology , Scripps Clinic , La Jolla , CA , USA
| | - William Shanahan
- e Department of Clinical Development , Formerly of Arena Pharmaceuticals, Inc. , San Diego , CA , USA
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Greenway FL, Shanahan W, Fain R, Ma T, Rubino D. Safety and tolerability review of lorcaserin in clinical trials. Clin Obes 2016; 6:285-95. [PMID: 27627785 DOI: 10.1111/cob.12159] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 06/03/2016] [Accepted: 07/04/2016] [Indexed: 12/13/2022]
Abstract
Lorcaserin is a novel selective serotonin 2C receptor agonist indicated by the US Food and Drug Administration for chronic weight management in adults with obesity or overweight with ≥1 comorbidity. The safety and efficacy of lorcaserin were established during two Phase III clinical trials in patients without diabetes (BLOOM and BLOSSOM) and one Phase III clinical trial in patients with type 2 diabetes (BLOOM-DM). Headache was the most common adverse event experienced by patients during all Phase III trials. Additional adverse events occurring in >5% of patients receiving lorcaserin included dizziness, fatigue, nausea, dry mouth and constipation in patients without diabetes, and hypoglycaemia, back pain, cough and fatigue in patients with diabetes. In a pooled analysis of echocardiographic data collected during the three lorcaserin Phase III trials, the incidence of FDA-defined valvulopathy was similar in patients taking lorcaserin and the placebo. Here, the safety profile of lorcaserin at the FDA-approved dose of 10 mg twice daily is reviewed using data from the lorcaserin Phase III programme, with a focus on theoretical adverse events commonly associated with agonists of the serotonin receptor family. Based on the lorcaserin Phase III clinical trial data, lorcaserin is safe and well tolerated in the indicated patient populations.
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Affiliation(s)
- F L Greenway
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA.
| | - W Shanahan
- Formerly of Arena Pharmaceuticals, Inc., San Diego, CA, USA
| | - R Fain
- Formerly of Eisai Inc., Woodcliff Lake, NJ, USA
| | - T Ma
- Formerly of Eisai Inc., Woodcliff Lake, NJ, USA
| | - D Rubino
- Washington Center for Weight Management and Research, Arlington, VA, USA
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15
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Nabavizadeh N, Waller J, Fain R, Chen Y, Elliott D, Mullins B, Patel I, Degnin C, Dyer B, Farsad K, Tanyi J, Fuss M, Thomas C, Hung A. Safety and Efficacy of Stereotactic Body Radiation Therapy of Accelerated Hypofractionation for Hepatocellular Carcinoma in the Setting of Advanced Liver Dysfunction. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.507] [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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16
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Apovian C, Palmer K, Fain R, Perdomo C, Rubino D. Effects of lorcaserin on fat and lean mass loss in obese and overweight patients without and with type 2 diabetes mellitus: the BLOSSOM and BLOOM-DM studies. Diabetes Obes Metab 2016; 18:945-8. [PMID: 27173586 DOI: 10.1111/dom.12690] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 04/15/2015] [Accepted: 07/12/2016] [Indexed: 11/27/2022]
Abstract
Body composition was determined using dual-energy X-ray absorptiometry (DXA) in a subset of patients without (BLOSSOM) and with (BLOOM-DM) type 2 diabetes who received diet and exercise counselling along with either lorcaserin 10 mg twice daily or placebo. DXA scans were performed on study day 1 (baseline), week 24 and week 52. Baseline demographics of the subpopulations (without diabetes, n = 189; with diabetes, n = 63) were similar between studies and representative of their study populations. At week 52, patients without diabetes on lorcaserin lost significantly more fat mass relative to those on placebo (-12.06% vs -5.93%; p = 0.008). In patients with diabetes, fat mass was also decreased with lorcaserin relative to placebo (-9.87% vs -1.65%; p < 0.05). More fat mass was lost in the trunk region with lorcaserin compared with placebo (without diabetes: -3.31% vs -2.05%; with diabetes: -3.65% vs -0.36%). Weight loss with lorcaserin was associated with a greater degree of fat mass loss than lean mass loss, and most of the fat mass lost for patients without and with diabetes was from the central region of the body.
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Affiliation(s)
- C Apovian
- Department of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - K Palmer
- Department of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - R Fain
- Formerly of Eisai Inc., Woodcliff Lake, NJ, USA
| | | | - D Rubino
- Washington Center for Weight Management and Research, Arlington, VA, USA
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Pi-Sunyer X, Shanahan W, Fain R, Ma T, Garvey WT. Impact of lorcaserin on glycemic control in overweight and obese patients with type 2 diabetes: analysis of week 52 responders and nonresponders. Postgrad Med 2016; 128:591-7. [DOI: 10.1080/00325481.2016.1208618] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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18
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Nguyen CT, Zhou S, Shanahan W, Fain R. Lorcaserin in Obese and Overweight Patients Taking Prohibited Serotonergic Agents: A Retrospective Analysis. Clin Ther 2016; 38:1498-1509. [DOI: 10.1016/j.clinthera.2016.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 04/11/2016] [Accepted: 04/14/2016] [Indexed: 01/21/2023]
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19
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Glauser T, Laurenza A, Yang H, Williams B, Ma T, Fain R. Efficacy and tolerability of adjunct perampanel based on number of antiepileptic drugs at baseline and baseline predictors of efficacy: A phase III post-hoc analysis. Epilepsy Res 2016; 119:34-40. [DOI: 10.1016/j.eplepsyres.2015.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/09/2015] [Accepted: 11/13/2015] [Indexed: 01/07/2023]
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20
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Montouris G, Yang H, Williams B, Zhou S, Laurenza A, Fain R. Efficacy and safety of perampanel in patients with drug-resistant partial seizures after conversion from double-blind placebo to open-label perampanel. Epilepsy Res 2015; 114:131-40. [DOI: 10.1016/j.eplepsyres.2015.04.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 04/08/2015] [Accepted: 04/23/2015] [Indexed: 11/17/2022]
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Ettinger AB, LoPresti A, Yang H, Williams B, Zhou S, Fain R, Laurenza A. Psychiatric and behavioral adverse events in randomized clinical studies of the noncompetitive AMPA receptor antagonist perampanel. Epilepsia 2015; 56:1252-63. [PMID: 26140524 PMCID: PMC4758397 DOI: 10.1111/epi.13054] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [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] [Accepted: 05/08/2015] [Indexed: 11/27/2022]
Abstract
Objective Perampanel, a selective, noncompetitive α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionic acid (AMPA) glutamate receptor antagonist, is indicated for adjunctive treatment of partial seizures in patients ≥12 years based on three phase III clinical studies. The perampanel U.S. Prescribing Information includes a boxed warning for serious psychiatric and behavioral adverse reactions. To provide context for this warning, detail on psychiatric and behavioral safety data from perampanel clinical studies is presented. Methods An analysis of pooled safety data from three phase III studies in patients with partial seizures is presented. Data from phase I and phase II studies in patients with and without epilepsy were also analyzed. Psychiatric and behavioral treatment‐emergent adverse events (TEAEs) were evaluated according to Medical Dictionary for Regulatory Activities (MedDRA) terms, using “narrow” and “narrow‐and‐broad” standardized MedDRA queries (SMQs) for TEAEs suggestive of hostility/aggression. Results From the three phase III partial‐seizure studies, the overall rate of psychiatric TEAEs was higher in the 8 mg (17.2%) and 12 mg (22.4%) perampanel groups versus placebo (12.4%). In the “narrow” SMQ, hostility/aggression TEAEs were observed in 2.8% for 8 mg and 6.3% for 12 mg perampanel groups, versus 0.7% of placebo patients. “Narrow‐and‐broad” SMQs for hostility/aggression TEAE rates were 12.3% for 8 mg and 20.4% for 12 mg perampanel groups, versus 5.7% for placebo; rates for events resulting in discontinuation were perampanel = 1.6% versus placebo = 0.7%. For events reported as serious AEs (SAEs), rates were perampanel = 0.7% versus placebo = 0.2%. In nonepilepsy patients, psychiatric TEAEs were similar between patients receiving perampanel and placebo. In phase I subjects/volunteers, all psychiatric TEAEs were mild or moderate. These analyses suggest that psychiatric adverse effects are associated with use of perampanel. Significance Patients and caregivers should be counseled regarding the potential risk of psychiatric and behavioral events with perampanel in patients with partial seizures; patients should be monitored for these events during treatment, especially during titration and at higher doses.
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Affiliation(s)
- Alan B Ettinger
- Department of Clinical Neurology, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Antonia LoPresti
- Eisai Medical and Scientific Affairs, Eisai Inc., Woodcliff Lake, New Jersey, U.S.A
| | - Haichen Yang
- Eisai Neuroscience and General Medicine PCU, Eisai Inc., Woodcliff Lake, New Jersey, U.S.A
| | - Betsy Williams
- Eisai Medical and Scientific Affairs, Eisai Inc., Woodcliff Lake, New Jersey, U.S.A
| | - Sharon Zhou
- Eisai Medical and Scientific Affairs, Eisai Inc., Woodcliff Lake, New Jersey, U.S.A
| | - Randi Fain
- Eisai Medical and Scientific Affairs, Eisai Inc., Woodcliff Lake, New Jersey, U.S.A
| | - Antonio Laurenza
- Eisai Neuroscience and General Medicine PCU, Eisai Inc., Woodcliff Lake, New Jersey, U.S.A
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Rosenfeld W, Conry J, Lagae L, Rozentals G, Yang H, Fain R, Williams B, Kumar D, Zhu J, Laurenza A. Efficacy and safety of perampanel in adolescent patients with drug-resistant partial seizures in three double-blind, placebo-controlled, phase III randomized clinical studies and a combined extension study. Eur J Paediatr Neurol 2015; 19:435-45. [PMID: 25823975 DOI: 10.1016/j.ejpn.2015.02.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [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: 10/08/2014] [Revised: 02/18/2015] [Accepted: 02/21/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Assess perampanel's efficacy and safety as adjunctive therapy in adolescents (ages 12-17) with drug-resistant partial seizures. METHODS Adolescent patients enrolled in multinational, double-blind, placebo-controlled, phase III core studies (studies 304, 305, or 306) completed 19-week, double-blind phase (6-week titration/13-week maintenance) with once-daily perampanel or placebo. Upon completion, patients were eligible for the extension (study 307), beginning with 16-week, blinded conversion, during which placebo patients switched to perampanel. Patients then entered the open-label treatment. RESULTS Of 1480 patients from the core studies, 143 were adolescents. Pooled adolescent data from these core studies demonstrated median percent decreases in seizure frequency for perampanel 8 mg (34.8%) and 12 mg (35.6%) were approximately twice that of placebo (18.0%). Responder rates increased with perampanel 8 mg (40.9%) and 12 mg (45.0%) versus placebo (22.2%). Adolescents receiving concomitant enzyme-inducing antiepileptic drugs (AEDs) had smaller reductions in seizure frequency (8 mg:31.6%; 12 mg:26.8%) than those taking non-inducing AEDs (8 mg:54.6%; 12 mg:52.7%). Relative to pre-perampanel baseline, seizure frequency and responder rates during the extension (Weeks 1-52) improved with perampanel. Most commonly reported adverse events in adolescents during the core studies were dizziness (20.4%), somnolence (15.3%), aggression (8.2%), decreased appetite (6.1%), and rhinitis (5.1%). Dizziness (13.2%), somnolence (11.6%), and aggression (6.6%) most often led to perampanel interruption/dose adjustment during the extension. SIGNIFICANCE Data demonstrated adjunctive perampanel treatment in adolescents with drug-resistant partial seizures produced better seizure control versus placebo, sustained seizure frequency improvements, and a generally favorable safety profile. Results were comparable to the overall study population. CLINICAL TRIAL REGISTRATION clinicaltrials.gov Identifiers: Study 304: NCT00699972; 305: NCT00699582; 306: NCT00700310; Study 307: NCT00735397.
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Affiliation(s)
- William Rosenfeld
- Comprehensive Epilepsy Care Center for Children and Adults, St Louis, MO, USA.
| | - Joan Conry
- Children's National Medical Center, Washington, DC, USA.
| | | | | | - Haichen Yang
- Eisai Neuroscience Product Creation Unit, Woodcliff Lake, NJ, USA.
| | - Randi Fain
- Eisai Medical and Scientific Affairs, Woodcliff Lake, NJ, USA.
| | - Betsy Williams
- Eisai Medical and Scientific Affairs, Woodcliff Lake, NJ, USA.
| | - Dinesh Kumar
- Eisai Neuroscience Product Creation Unit, Woodcliff Lake, NJ, USA.
| | - Jin Zhu
- Formerly Eisai Inc., Woodcliff Lake, NJ, USA.
| | - Antonio Laurenza
- Eisai Neuroscience Product Creation Unit, Woodcliff Lake, NJ, USA.
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Gidal BE, Laurenza A, Hussein Z, Yang H, Fain R, Edelstein J, Kumar D, Ferry J. Perampanel efficacy and tolerability with enzyme-inducing AEDs in patients with epilepsy. Neurology 2015; 84:1972-80. [PMID: 25878177 PMCID: PMC4433458 DOI: 10.1212/wnl.0000000000001558] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 01/28/2015] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Evaluate the impact of concomitant enzyme (CYP3A4)-inducer antiepileptic drugs (EIAEDs) on the efficacy and safety of perampanel in patients from the 3 phase-III clinical trials. METHODS Patients with pharmacoresistant partial-onset seizures in the 3 phase-III clinical studies were aged 12 years and older and receiving 1 to 3 concomitant antiepileptic drugs. Following 6-week baseline, patients were randomized to once-daily, double-blind treatment with placebo or perampanel 8 or 12 mg (studies 304 and 305) or placebo or perampanel 2, 4, or 8 mg (study 306). RESULTS Treatment response assessed by median percent reduction in seizure frequency and responder rates improved with perampanel compared with placebo. However, at 8 and 12 mg, the treatment response was significantly greater in patients receiving non-EIAEDs. The treatment effect (perampanel-placebo) also demonstrated a dose-dependent increase in all patients. The overall incidence of treatment-emergent adverse events was similar regardless of the presence of EIAEDs. Occurrence of some adverse events, such as fatigue, somnolence, dizziness, irritability, was greater in patients receiving non-EIAEDs, as was discontinuation because of adverse events. CONCLUSIONS Perampanel shows efficacy and safety in the presence and absence of EIAEDs. As systemic exposure to perampanel increases, so does efficacy. Given the extensive metabolism of perampanel, systemic exposure is clearly reduced with concomitant administration of CYP3A4 inducers. This supports the strategy of dosing perampanel to clinical effect. Recognition of these pharmacokinetic interactions will be important in the optimization of this novel medication. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that 2 to 12 mg/d doses of perampanel reduced seizure frequency and improved responder rate in the presence and absence of EIAEDs.
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Affiliation(s)
- Barry E Gidal
- From the School of Pharmacy (B.E.G.), University of Wisconsin, Madison; Eisai Neuroscience Product Creation Unit (A.L., J.F., H.Y., D.K.), Woodcliff Lake, NJ; Eisai Ltd. (Z.H.), Hatfield, UK; Eisai Medical and Scientific Affairs (R.F.), Woodcliff Lake, NJ; and formerly of Sui Generis Health (J.E.), New York, NY.
| | - Antonio Laurenza
- From the School of Pharmacy (B.E.G.), University of Wisconsin, Madison; Eisai Neuroscience Product Creation Unit (A.L., J.F., H.Y., D.K.), Woodcliff Lake, NJ; Eisai Ltd. (Z.H.), Hatfield, UK; Eisai Medical and Scientific Affairs (R.F.), Woodcliff Lake, NJ; and formerly of Sui Generis Health (J.E.), New York, NY
| | - Ziad Hussein
- From the School of Pharmacy (B.E.G.), University of Wisconsin, Madison; Eisai Neuroscience Product Creation Unit (A.L., J.F., H.Y., D.K.), Woodcliff Lake, NJ; Eisai Ltd. (Z.H.), Hatfield, UK; Eisai Medical and Scientific Affairs (R.F.), Woodcliff Lake, NJ; and formerly of Sui Generis Health (J.E.), New York, NY
| | - Haichen Yang
- From the School of Pharmacy (B.E.G.), University of Wisconsin, Madison; Eisai Neuroscience Product Creation Unit (A.L., J.F., H.Y., D.K.), Woodcliff Lake, NJ; Eisai Ltd. (Z.H.), Hatfield, UK; Eisai Medical and Scientific Affairs (R.F.), Woodcliff Lake, NJ; and formerly of Sui Generis Health (J.E.), New York, NY
| | - Randi Fain
- From the School of Pharmacy (B.E.G.), University of Wisconsin, Madison; Eisai Neuroscience Product Creation Unit (A.L., J.F., H.Y., D.K.), Woodcliff Lake, NJ; Eisai Ltd. (Z.H.), Hatfield, UK; Eisai Medical and Scientific Affairs (R.F.), Woodcliff Lake, NJ; and formerly of Sui Generis Health (J.E.), New York, NY
| | - Jacob Edelstein
- From the School of Pharmacy (B.E.G.), University of Wisconsin, Madison; Eisai Neuroscience Product Creation Unit (A.L., J.F., H.Y., D.K.), Woodcliff Lake, NJ; Eisai Ltd. (Z.H.), Hatfield, UK; Eisai Medical and Scientific Affairs (R.F.), Woodcliff Lake, NJ; and formerly of Sui Generis Health (J.E.), New York, NY
| | - Dinesh Kumar
- From the School of Pharmacy (B.E.G.), University of Wisconsin, Madison; Eisai Neuroscience Product Creation Unit (A.L., J.F., H.Y., D.K.), Woodcliff Lake, NJ; Eisai Ltd. (Z.H.), Hatfield, UK; Eisai Medical and Scientific Affairs (R.F.), Woodcliff Lake, NJ; and formerly of Sui Generis Health (J.E.), New York, NY
| | - Jim Ferry
- From the School of Pharmacy (B.E.G.), University of Wisconsin, Madison; Eisai Neuroscience Product Creation Unit (A.L., J.F., H.Y., D.K.), Woodcliff Lake, NJ; Eisai Ltd. (Z.H.), Hatfield, UK; Eisai Medical and Scientific Affairs (R.F.), Woodcliff Lake, NJ; and formerly of Sui Generis Health (J.E.), New York, NY
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Aronne L, Shanahan W, Fain R, Glicklich A, Soliman W, Li Y, Smith S. Safety and Efficacy of Lorcaserin: A Combined Analysis of the BLOOM and BLOSSOM Trials. Postgrad Med 2015; 126:7-18. [DOI: 10.3810/pgm.2014.10.2817] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Smith SR, O'Neil PM, Astrup A, Finer N, Sanchez-Kam M, Fraher K, Fain R, Shanahan WR. Early weight loss while on lorcaserin, diet and exercise as a predictor of week 52 weight-loss outcomes. Obesity (Silver Spring) 2014; 22:2137-46. [PMID: 25044799 DOI: 10.1002/oby.20841] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 06/27/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify an early treatment milestone that optimizes sensitivity and specificity for predicting ≥5% weight loss at Week (W) 52 in patients with and without type 2 diabetes on lorcaserin or placebo. METHODS Post hoc area under the curve for receiver operating characteristic analyses of data from three phase 3 trials comparing lifestyle modification+placebo with lifestyle modification+lorcaserin. A total of 6897 patients (18-65 years; BMI, 30-45 or 27-29.9 kg/m(2) with ≥1 comorbidity) were randomized to placebo or lorcaserin 10 mg bid. Changes (baseline to W52) in cardiometabolic parameters were assessed. RESULTS Response (≥5% weight loss from baseline) at W12 was a strong predictor of W52 response. Lorcaserin patients with a W12 response achieved mean W52 weight losses of 10.6 kg (without diabetes) and 9.3 kg (with diabetes). Proportions achieving ≥5% and ≥10% weight loss at W52 were 85.5% and 49.8% (without diabetes), and 70.5% and 35.9% (with diabetes). Lorcaserin patients who did not achieve a W12 response lost 3.2 kg (without diabetes) and 2.8 kg (with diabetes) at W52. Responders had greater improvements in cardiometabolic risk factors than the modified intent-to-treat (MITT) population, consistent with greater weight loss. CONCLUSIONS ≥5% weight loss by W12 predicts robust response to lorcaserin at 1 year.
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Affiliation(s)
- Steven R Smith
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital and the Sanford-Burnham Medical Research Institute, Orlando, Florida, USA
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Gidal BE, Majid O, Ferry J, Hussein Z, Yang H, Zhu J, Fain R, Laurenza A. The practical impact of altered dosing on perampanel plasma concentrations: pharmacokinetic modeling from clinical studies. Epilepsy Behav 2014; 35:6-12. [PMID: 24785428 DOI: 10.1016/j.yebeh.2014.03.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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: 01/16/2014] [Revised: 03/11/2014] [Accepted: 03/15/2014] [Indexed: 10/25/2022]
Abstract
RATIONALE Perampanel is a selective AMPA receptor antagonist approved for adjunctive therapy in patients with refractory partial-onset seizures. Perampanel is metabolized primarily via CYP3A4, yet it has a relatively long half-life of 105h; it is, therefore, recommended that perampanel be given once daily (preferably at bedtime). Many patients occasionally have less-than-perfect adherence to their drug regimen, and given the known pharmacokinetic interactions of perampanel with commonly used enzyme-inducing antiepileptic drugs (EIAEDs), we explored the effects of a missed dose on steady-state perampanel plasma concentrations and the ramifications of "make up" doses in these patients. Although perampanel is approved for once-daily dosing, some clinicians may elect to give perampanel as a divided dose (i.e., twice daily), so we also sought to examine the pharmacokinetic impact of twice- versus once-daily dosing. METHODS Pharmacokinetic simulations were performed using validated perampanel pharmacokinetic parameters, derived from 19 phase I studies in 606 subjects, to investigate the effect on perampanel plasma concentration of (1) missing a dose of perampanel followed by delayed replacement of the missed dose, (2) missing a dose followed by resumption of scheduled therapy, and (3) missing a dose in the presence/absence of carbamazepine. Simulations were done for a typical patient receiving an 8-mg once-daily or a 4-mg twice-daily dose using the nonlinear mixed effects program, NONMEM v7.2, in conjunction with PDx-pop v5. RESULTS Our results corroborate that given the pharmacokinetic characteristics of perampanel, a missed dose is unlikely to cause as much fluctuation in plasma concentration as would be expected for a drug with a short half-life. Importantly, simulations suggest that supplementing a missed dose 6-12h later, followed by continuation of the regular schedule, may not result in any significant "spikes" in perampanel plasma concentrations. Simulations demonstrated that twice-daily dosing offered little advantage in further flattening the concentration-time profile of perampanel in the adherent patient. However, fluctuations in plasma concentrations are minimized by twice-daily dosing in patients receiving concomitant EIAEDs. CONCLUSIONS These pharmacokinetic simulations suggest that the long half-life of perampanel may be advantageous in conferring a relatively smooth concentration-time profile with a once-daily or twice-daily dosing, even in the presence of concomitant EIAEDs. However, the results of the present study suggest that perampanel replacement is recommended for patients taking an EIAED to mitigate the potential risks associated with reduced exposure. Confirmation of the ultimate clinical impact of these findings will require further study.
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Affiliation(s)
- Barry E Gidal
- School of Pharmacy, University of Wisconsin, Madison, WI, USA.
| | | | - Jim Ferry
- Eisai Neuroscience Product Creation Unit, Woodcliff Lake, NJ, USA
| | | | - Haichen Yang
- Eisai Neuroscience Product Creation Unit, Woodcliff Lake, NJ, USA
| | - Jin Zhu
- Eisai Neuroscience Product Creation Unit, Woodcliff Lake, NJ, USA
| | - Randi Fain
- Eisai Medical and Scientific Affairs, Woodcliff Lake, NJ, USA
| | - Antonio Laurenza
- Eisai Neuroscience Product Creation Unit, Woodcliff Lake, NJ, USA
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Sabbagh M, Cummings J, Christensen D, Doody R, Farlow M, Liu L, Mackell J, Fain R. Evaluating the cognitive effects of donepezil 23 mg/d in moderate and severe Alzheimer's disease: analysis of effects of baseline features on treatment response. BMC Geriatr 2013; 13:56. [PMID: 23742728 PMCID: PMC3681558 DOI: 10.1186/1471-2318-13-56] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 05/03/2013] [Indexed: 11/10/2022] Open
Abstract
Background Treatment of Alzheimer’s disease with acetylcholinesterase inhibitors can result in symptomatic benefits, but patients often show variable responses. The objective of this post hoc analysis was to investigate relationships between easily identifiable baseline characteristics/demographics and cognitive response in patients treated with either donepezil 23 mg/d or 10 mg/d and to identify factors potentially influencing response. Methods A post hoc analysis was conducted using data from a large, 24-week, randomized, double-blind, international study enrolling patients with moderate to severe Alzheimer’s disease (baseline Mini-Mental State Examination [MMSE], 0-20) (NCT 00478205). Cognitive changes in subgroups of patients based on selected baseline and demographic characteristics were compared using the least squares mean changes in Severe Impairment Battery scores at Week 24. Univariate and multivariate analyses were also performed. Results Donepezil 23 mg/d provided statistically significant incremental cognitive benefits over donepezil 10 mg/d irrespective of baseline functional severity, measured by scores on the Alzheimer’s Disease Cooperative Study-Activities of Daily Living-severe version (P < 0.05). When patients were categorized by baseline cognitive severity (MMSE score), significant benefits of donepezil 23 mg/d over 10 mg/d were seen in both subgroups when based on MMSE scores of 0-9 versus 10-20 (P < 0.02 and P < 0.01, respectively), and in the more severe subgroup when based on MMSE scores of 0-16 versus 17-20 (P < 0.0001 and P > 0.05). Statistically significant incremental cognitive benefits of donepezil 23 mg/d over 10 mg/d were also observed regardless of age, gender, weight, or prestudy donepezil 10 mg/d treatment duration (P < 0.05). In the multivariate analysis, the only significant interaction was between treatment and baseline MMSE score. Conclusions The cognitive benefits of donepezil 23 mg/d over 10 mg/d were achieved regardless of the patient’s age, gender, weight, duration of prior donepezil 10 mg/d, and functional severity. The influence of baseline cognitive severity on response seemed to be dependent on the level of impairment, with cognitive benefits of donepezil 23 mg/d over 10 mg/d most apparent in those patients at a more advanced stage of disease. These data may be useful in helping practicing physicians make informed decisions for their patients with advanced Alzheimer’s disease.
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Affiliation(s)
- Marwan Sabbagh
- The Cleo Roberts Center for Clinical Research, Banner Sun Health Research Institute, 10515 W, Santa Fe Drive, Sun City, AZ 85351, USA.
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Ferris S, Cummings J, Christensen D, Doody R, Farlow M, Sabbagh M, Liu L, Mackell J, Fain R. Effects of donepezil 23 mg on Severe Impairment Battery domains in patients with moderate to severe Alzheimer's disease: evaluating the impact of baseline severity. Alzheimers Res Ther 2013; 5:12. [PMID: 23433097 PMCID: PMC4055003 DOI: 10.1186/alzrt166] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/17/2012] [Accepted: 01/21/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The US Food and Drug Administration approved a 23 mg daily dose of donepezil for treatment of moderate to severe Alzheimer's disease (AD) based on outcomes from a large trial comparing the 23 mg/day dose with the standard 10 mg/day dose. Results from this study indicated that after 24 weeks, donepezil 23 mg/day provided significant cognitive benefits over donepezil 10 mg/day, measured using the Severe Impairment Battery (SIB). In the analyses reported herein, we further characterize the range of cognitive domains impacted by treatment with donepezil 23 mg/day. METHODS A post hoc analysis was conducted using data from a 24-week, randomized, double-blind trial comparing donepezil 23 mg/day versus 10 mg/day in 1,467 patients with moderate to severe AD (baseline Mini-Mental State Examination (MMSE) score 0 to 20). Changes from baseline to week 24 in the nine SIB domain scores were analyzed in the intent-to-treat (ITT) population (baseline MMSE 0 to 20), in patients with more severe baseline AD (MMSE 0 to 16), and in severity strata based on baseline MMSE scores (0 to 5, 6 to 10, 11 to 15, 16 to 20). RESULTS In the ITT population, changes in six of the nine SIB domains favored donepezil 23 mg/day over donepezil 10 mg/day. LS mean treatment differences were significant for the language, visuospatial ability, and construction domains. In the more advanced cohort of patients (MMSE 0 to 16 at baseline), LS mean treatment differences were statistically significant favoring donepezil 23 mg/day in five of the nine domains: language, memory, visuospatial ability, attention, and construction. Descriptive analysis of LS mean changes in SIB domain scores in the four baseline severity strata showed variable patterns of response; overall, cognitive benefits of donepezil 23 mg/day were greatest in patients with MMSE scores of 0 to 15. CONCLUSIONS These results suggest that donepezil 23 mg/day provides benefits over 10 mg/day across a range of cognitive domains. The magnitude of benefit and domains impacted varied depending on the stage of AD; significant benefits with higher dose donepezil were most apparent at more advanced stages of AD and were most prominent in the language domain.
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Affiliation(s)
- Steven Ferris
- Alzheimer Disease Center, New York University Langone Medical Center, 145 E 32nd St, Room 506, New York, NY 10016, USA
| | - Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville, Las Vegas, NV 89106, USA
| | - Daniel Christensen
- Neuropsychiatric Institute, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Rachelle Doody
- Department of Neurology, Alzheimer's Disease and Memory Disorders Center, Baylor College of Medicine, Houston, TX 07730, USA
| | - Martin Farlow
- Department of Neurology, Indiana University School of Medicine, 541 Clinical Drive, CL299, Indianapolis, IN, 46202, USA
| | - Marwan Sabbagh
- The Cleo Roberts Center for Clinical Research, Banner-Sun Health Research Institute, 10515 W. Santa Fe Drive, Sun City, AZ 85351, USA
| | - Liang Liu
- Eisai Inc., 100 Tice Boulevard, Woodcliff Lake, NJ 07677, USA
| | - Joan Mackell
- Pfizer Inc, 235 East 42nd Street, New York, NY 10017, USA
| | - Randi Fain
- Eisai Inc., 100 Tice Boulevard, Woodcliff Lake, NJ 07677, USA
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Cherry CL, Mobarok M, Wesselingh SL, Fain R, Weinstock S, Tachedjian G, Srivastava S, Tyssen DP, Glass JD, Hooker DJ. Ubisol-Aqua: coenzyme Q10 prevents antiretroviral toxic neuropathy in an in vitro model. Curr HIV Res 2010; 8:232-9. [PMID: 20158454 DOI: 10.2174/157016210791111106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 02/07/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Peripheral neuropathy is the dose-limiting toxicity of stavudine and didanosine (nucleoside analogs used in HIV treatment) and is attributed to mitochondrial toxicity from these drugs. Acetyl L-carnitine (ALC) and co-enzyme Q(10) are proposed as neuropathy treatments, but evidence to support these is limited. METHODS We examined ALC and a water-soluble formulation of co-enzyme Q(10) (H(Q)O) for the prevention of d4T and ddI neurotoxicity using cultured fetal rat DRG as an in vitro model. RESULTS DdI (33microM) and d4T (50microM) caused clear toxicity (impaired neurite growth) by day 8 of DRG culture. H(Q)O at concentrations 1-100microM completely prevented the toxicity of 33microM ddI in vitro and ALC at concentrations 1-100 microM substantially (but incompletely) prevented ddI toxicity in this model. In contrast, ALC was ineffective at all concentrations tested for preventing the toxicity of 50microM d4T. H(Q)O showed dose-dependent efficacy for preventing d4T toxicity. H(Q)O (1microM) partially prevented d4T toxicity while 10 and 100microM H(Q)O completely prevented d4T toxicity in this model. CONCLUSIONS We find H(Q)O is superior to ALC for preventing the neurotoxicity of d4T (the HIV treatment most associated with neuropathy) and ddI in vitro. Further study is needed to clarify any clinical role for co-enzyme Q(10) co-administration with d4T and ddI and to assess whether this compound may have a role in treating established cases of neuropathy.
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Ratner D, Louria D, Sheffet A, Fain R, Curran J, Saed N, Bhaskar S, Quereshi M, Cable G. Wealth from Health: an incentive program for disease and population management: a 12-year project. ACTA ACUST UNITED AC 2006; 6:184-204. [PMID: 16398037 DOI: 10.1097/00129234-200109000-00002] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The future of healthcare is linked with its ability to face the challenges of consumerism. Disease and population management will represent the dominant style of healthcare delivery in the future. This article describes the Wealth from Health programs which utilize current and future technologies to help the healthcare system become a leader in healthcare delivery and to assist many communities at an affordable cost.
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Affiliation(s)
- D Ratner
- Overlook Hospital, 99 Beauvoir Avenue, Summit, NJ 07901, USA
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Sgherza AL, Axen K, Fain R, Hoffman RS, Dunbar CC, Haas F. Effect of naloxone on perceived exertion and exercise capacity during maximal cycle ergometry. J Appl Physiol (1985) 2002; 93:2023-8. [PMID: 12391054 DOI: 10.1152/japplphysiol.00521.2002] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [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: 11/22/2022] Open
Abstract
We assessed the effects of naloxone, an opioid antagonist, on exercise capacity in 13 men and 5 women (mean age = 30.1 yr, range = 21-35 yr) during a 25 W/min incremental cycle ergometer test to exhaustion on different days during familiarization trial and then after 30 mg (iv bolus) of naloxone or placebo (Pl) in a double-blind, crossover design. Minute ventilation (Ve), O(2) consumption (Vo(2)), CO(2) production, and heart rate (HR) were monitored. Perceived exertion rating (0-10 scale) and venous samples for lactate were obtained each minute. Lactate and ventilatory thresholds were derived from lactate and gas-exchange data. Blood pressure was obtained before exercise, 5 min postinfusion, at maximum exercise, and 5 min postexercise. There were no control-Pl differences. The naloxone trial demonstrated decreased exercise time (96% Pl; P < 0.01), total cumulative work (96% Pl; P < 0.002), peak Vo(2) (94% Pl; P < 0.02), and HR (96% Pl; P < 0.01). Other variables were unchanged. HR and Ve were the same at the final common workload, but perceived exertion was higher (8.1 +/- 0.5 vs. 7.1 +/- 0.5) after naloxone than Pl (P < 0.01). The threshold for effort perception amplification occurred at approximately 60 +/- 4% of Pl peak Vo(2). Thus we conclude that peak work capacity was limited by perceived exertion, which can be attenuated by endogenous opioids rather than by physiological limits.
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Affiliation(s)
- Anthony L Sgherza
- Department of Physical Education and Exercise Science, Brooklyn College, Brooklyn, NY 11210, USA
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Miyamoto RT, Wong D, Pisoni DB, Hutchins G, Sehgal M, Fain R. Positron emission tomography in cochlear implant and auditory brain stem implant recipients. Am J Otol 1999; 20:596-601. [PMID: 10503581 PMCID: PMC3482826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether similar cortical regions are activated by speech signals in profoundly deaf patients who have received a multichannel cochlear implant (CI) or auditory brain stem implant (ABI) as in normal-hearing subjects. STUDY DESIGN Positron emission tomography (PET) studies were performed using a variety of discrete stimulus conditions. Images obtained were superimposed on standard anatomic magnetic resonance imaging (MRI) for the CI subjects. The PET images were superimposed on the ABI subject's own MRI. SETTING Academic, tertiary referral center. PATIENTS Five subjects who have received a multichannel CI and one who had received an ABI. INTERVENTION Multichannel CI and ABI. MAIN OUTCOME MEASURE PET images. RESULTS Similar cortical regions are activated by speech stimuli in subjects who have received an auditory prosthesis. CONCLUSIONS Neuroimaging provides a new approach to the study of speech processing in CI and ABI subjects.
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Affiliation(s)
- R T Miyamoto
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis 46202, USA
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Haas F, Salazar-Schicchi J, Axen K, Fain R. Cardiopulmonary Exercise Evaluation. Phys Med Rehabil Clin N Am 1996. [DOI: 10.1016/s1047-9651(18)30395-4] [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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Barling J, Bluen SD, Fain R. Psychological functioning following an acute disaster. J Appl Psychol 1987; 72:683-90. [PMID: 3119558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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