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Nielsen SM, Boers M, de Wit M, Shea B, van der Windt DA, Reeves BC, Beaton D, Alten R, Toupin April K, Boonen A, Escorpizo R, Flurey C, Furst DE, Guillemin F, Leong A, Pohl C, Rasmussen MU, Singh JA, Smolen JS, Strand V, Verstappen SMM, Voshaar M, Woodworth TG, Ellingsen T, March L, Wells GA, Tugwell P, Christensen R. OMERACT consensus-based operational definition of contextual factors in rheumatology clinical trials: A mixed methods study. Semin Arthritis Rheum 2021; 51:601-606. [PMID: 33875246 DOI: 10.1016/j.semarthrit.2021.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To develop an operational definition of contextual factors (CF) [1]. METHODS Based on previously conducted interviews, we presented three CF types in a Delphi survey; Effect Modifying -, Outcome Influencing - and Measurement Affecting CFs. Subsequently, a virtual Special Interest Group (SIG) session was held for in depth discussion of Effect Modifying CFs. RESULTS Of 161 Delphi participants, 129 (80%) completed both rounds. After two rounds, we reached consensus (≥70% agreeing) for all but two statements. The 45 SIG participants were broadly supportive. CONCLUSION Through consensus we developed an operational definition of CFs, which was well received by OMERACT members.
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Affiliation(s)
- Sabrina Mai Nielsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Maarten Boers
- Department of Epidemiology & Data Science, and Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Maarten de Wit
- OMERACT Patient Research Partner, Amsterdam, the Netherlands
| | - Beverly Shea
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Barnaby C Reeves
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Dorcas Beaton
- Institute for Work and Health, and Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute and the Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rieke Alten
- Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik Charité, University Medicine Berlin, Germany
| | - Karine Toupin April
- Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, VT, United States; Swiss Paraplegic Research, Nottwil, Switzerland
| | - Caroline Flurey
- Department of Health and Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom
| | - Daniel E Furst
- Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, CA, United States; University of Washington, Seattle, California, United States; University of Florence, Florence, Italy
| | | | - Amye Leong
- Healthy Motivation, and Bone and Joint Decade, the Global Alliance for Musculoskeletal Health, Santa Barbara, CA, United States
| | - Christoph Pohl
- Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik Charité, University Medicine Berlin, Germany
| | - Marianne Uggen Rasmussen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jasvinder A Singh
- Medicine Service, VA Medical Center, 700 19th St S, Birmingham 35233, AL United States; Department of Medicine at the School of Medicine, University of Alabama at Birmingham (UAB), 1720 Second Ave. South, Birmingham, AL 35294-0022, United States; Department of Epidemiology at the UAB School of Public Health, 1665 University Blvd., Ryals Public Health Building, Room 220, Birmingham, AL 35294-0022, United States
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA, United States
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom
| | - Marieke Voshaar
- Department of Pharmacy, Sint Maartenskliniek, The Netherlands. Department of Pharmacy, Radboudumc, Nijmegen, the Netherlands
| | - Thasia G Woodworth
- Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Torkell Ellingsen
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Lyn March
- Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - George A Wells
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark.
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2
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Berthelsen DB, Woodworth TG, Goel N, Ioannidis JPA, Tugwell P, Devoe D, Williamson P, Terwee CB, Suarez-Almazor ME, Strand V, Leong AL, Conaghan PG, Boers M, Shea BJ, Brooks PM, Simon LS, Furst DE, Christensen R. Harms reported by patients in rheumatology drug trials: a systematic review of randomized trials in the cochrane library from an OMERACT working group. Semin Arthritis Rheum 2021; 51:607-617. [PMID: 33483129 DOI: 10.1016/j.semarthrit.2020.09.023] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 09/30/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Underreporting of harms in randomized controlled trials (RCTs) may lead to incomplete or erroneous assessments of the perceived benefit-to-harm profile of an intervention. To compare benefit with harm in clinical practice and future clinical studies, adverse event (AE) profiles including severity need to be understood. Even though patients report harm symptoms earlier and more frequently than clinicians, rheumatology RCTs currently do not provide a reporting framework from the patient's perspective regarding harms. Our objective for this meta-research project was to identify AEs in order to determine harm clusters and whether these could be self-reported by patients. Our other objective was to examine reported severity grading of the reported harms. METHODS We considered primary publications of RCTs eligible if they were published between 2008 and 2018 evaluating pharmacological interventions in patients with a rheumatic or musculoskeletal condition and if they were included in Cochrane reviews. We extracted data on harms such as reported AE terms together with severity (if described), and categorized AE- and severity-terms into overall groups. We deemed all AEs with felt components appropriate for patient self-reporting. RESULTS The literature search identified 187 possible Cochrane reviews, of which 94 were eligible for evaluation, comprising 1,297 articles on individual RCTs. Of these RCTs, 93 pharmacological trials met our inclusion criteria (including 31,023 patients; representing 20,844 accumulated patient years), which reported a total of 21,498 AEs, corresponding to 693 unique reported terms for AEs. We further sub-categorized these terms into 280 harm clusters (i.e., themes). AEs appropriate for patient self-reporting accounted for 58% of the AEs reported. Among the reported AEs, we identified medical terms for all of the 117 harm clusters appropriate for patient reporting and lay language terms for 86%. We intended to include severity grades of the reported AEs, but there was no evidence for systematic reporting of clinician- or patient-reported severity in the primary articles of the 93 trials. However, we identified 33 terms suggesting severity, but severity grading was discernible in only 9%, precluding a breakdown by severity in this systematic review. CONCLUSIONS Our results support the need for a standardized framework for patients' reporting of harms in rheumatology trials. Reporting of AEs with severity should be included in future reporting of harms, both from the patients' and investigators' perspectives. REGISTRATION PROSPERO: CRD42018108393.
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Affiliation(s)
- Dorthe B Berthelsen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Rehabilitation, Municipality of Guldborgsund, Nykoebing F, Denmark
| | | | - Niti Goel
- Duke University School of Medicine, Durham, NC, USA
| | - John P A Ioannidis
- Departments of Medicine, Epidemiology and Population Health, Biomedical Data Science and Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, California, USA
| | - Peter Tugwell
- Department of Medicine, School of Epidemiology, Public Health and Community Medicine, University of Ottawa, Canada
| | - Dan Devoe
- Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - Paula Williamson
- MRC North West Hub for Trials Methodology Research, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Caroline B Terwee
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics and the Amsterdam Public Health Research Institute, Amsterdam, NL
| | - Maria E Suarez-Almazor
- Department of Health Services Research and Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Centre, Houston, TX, USA
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto CA, USA
| | - Amye L Leong
- Healthy Motivation; Global Alliance for Musculoskeletal Health, Bone and Joint Decade, Santa Barbara, California USA
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Maarten Boers
- Department of Epidemiology and Biostatistics and the Amsterdam Rheumatology and immunology Centre, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, NL
| | - Beverley J Shea
- Ottawa Hospital Research Institute, Clinical Epidemiology Program and School of Epidemiology and Public Health, University of Ottawa, Canada
| | - Peter M Brooks
- Centre for Health Policy Melbourne School of Population and Global Health University of Melbourne and Northern Health, Australia
| | | | - Daniel E Furst
- David Geffen School of Med. Division Rheumatology. UCLA, USA
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark.
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3
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Nielsen SM, Uggen Rasmussen M, Boers M, A van der Windt D, de Wit M, G Woodworth T, A Flurey C, Beaton D, Shea B, Escorpizo R, Furst DE, Smolen JS, Toupin-April K, Boonen A, Voshaar M, Ellingsen T, Wells GA, Reeves BC, March L, Tugwell P, Christensen R. Towards consensus in defining and handling contextual factors within rheumatology trials: an initial qualitative study from an OMERACT working group. Ann Rheum Dis 2020; 80:242-249. [PMID: 33055082 DOI: 10.1136/annrheumdis-2020-217895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/25/2020] [Accepted: 09/04/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The Outcome Measures in Rheumatology Initiative established the Contextual Factors Working Group to guide the understanding, identification and handling of contextual factors for clinical trials. In clinical research, different uses of the term 'contextual factors' exist. This study explores the perspectives of researchers (including clinicians) and patients in defining 'contextual factor' and its related terminology, identifying such factors and accounting for them in trials across rheumatology. METHODS We conducted individual semistructured interviews with researchers (including clinicians) who have experience within the field of contextual factors in clinical trials or other potentially relevant areas, and small focus group interviews with patients with rheumatic conditions. We transcribed the interviews and applied qualitative content analysis. RESULTS We interviewed 12 researchers and 7 patients. Researcher's and patient's descriptions of contextual factors were categorised into two broad themes, each comprising two contextual factors types. The 'treatment effect' theme focused on factors explaining variations in treatment effects (A) among patients and (B) among studies. The 'outcome measurement' theme focused on factors that explain (C) variations in the measurement result itself (apart from actual changes/differences in the outcome) and (D) variations in the outcome itself (beside treatment of interest). Methods for identifying and handling contextual factors differed among these themes and types. CONCLUSIONS Two main themes for contextual factors with four types of contextual factors were identified based on input from researchers and patients. This will guide operationalisation of contextual factors. Further research should refine our findings and establish consensus among relevant stakeholders.
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Affiliation(s)
- Sabrina Mai Nielsen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark .,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Marianne Uggen Rasmussen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Maarten Boers
- Department of Epidemiology & Data Science; and Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Danielle A van der Windt
- School of Medicine; Primary Care Centre Versus Arthritis; and Centre for Prognosis Research, Faculty of Medicine and Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Maarten de Wit
- OMERACT Patient Research Partner, Amsterdam, The Netherlands
| | - Thasia G Woodworth
- Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Caroline A Flurey
- Department of Health and Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Dorcas Beaton
- Institute for Work and Health, and Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute and the Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Beverley Shea
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Daniel E Furst
- Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, California, USA.,Division of Rheumatology, University of Washington, Seattle, Washington, USA.,University of Florence, Florence, Italy
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Karine Toupin-April
- Children's Hospital of Eastern Ontario Research Institute; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Marieke Voshaar
- University of Twente, Enschede, Faculty of Behavioural Management and Social sciences, Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Torkell Ellingsen
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - George A Wells
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Barnaby C Reeves
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lyn March
- Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
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4
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Nielsen SM, Storgaard H, Ellingsen T, Shea BJ, Wells GA, Welch VA, Furst DE, de Wit M, Voshaar M, Juhl CB, Boers M, Escorpizo R, Woodworth TG, Boonen A, Bliddal H, March LM, Tugwell P, Christensen R. Population characteristics as important contextual factors in rheumatological trials: an exploratory meta-epidemiological study from an OMERACT Working Group. Ann Rheum Dis 2020; 79:1269-1276. [PMID: 32606042 DOI: 10.1136/annrheumdis-2020-217237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/24/2020] [Accepted: 06/02/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To explore whether trial population characteristics modify treatment responses across various interventions, comparators and rheumatic conditions. METHODS In this meta-epidemiological study, we included trials from systematic reviews available from the Cochrane Musculoskeletal Group published up to 23 April 2019 in Cochrane Library with meta-analyses of five or more randomised controlled trials (RCTs) published from year 2000. From trial reports, we extracted data on 20 population characteristics. For characteristics with sufficient data (ie, available for ≥2/3 of the trials), we performed multilevel meta-epidemiological analyses. RESULTS We identified 19 eligible systematic reviews contributing 187 RCTs (212 comparisons). Only age and sex were explicitly reported in ≥2/3 of the trials. Using information about the country of the trials led to sufficient data for five further characteristics, that is, 7 out of 20 (35%) protocolised characteristics were analysed. The meta-regressions showed effect modification by economic status, place of residence, and, nearly, from healthcare system (explaining 4.8%, 0.9% and 1.5% of the between-trial variation, respectively). No effect modification was demonstrated from age, sex, patient education/health literacy or predominant religion. CONCLUSIONS This study demonstrates the scarce reporting of most population characteristics, hampering investigation of their impact with meta-research. Our sparse results suggest that place of residence (ie, continent of the trial), economic status (based on World Bank classifications) and healthcare system (based on WHO index for health system performance) may be important in explaining the variation in treatment response across trials. There is an urgent need for consistent reporting of important population characteristics in trials. PROSPERO REGISTRATION NUMBER CRD42019127642.
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Affiliation(s)
- Sabrina Mai Nielsen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark .,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Helene Storgaard
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Torkell Ellingsen
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Beverley J Shea
- Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - George A Wells
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Vivian Andrea Welch
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Daniel E Furst
- David Geffen School of Medicine, Division of Rheumatology, UCLA, Los Angeles, California, USA.,University of Washington, Seattle, Washington, USA.,University of Florence, Florence, Italy
| | - Maarten de Wit
- OMERACT Patient Research Partner, Zaltbommel, The Netherlands
| | - Marieke Voshaar
- Department Psychology, Health and Technology, University of Twente, Twente, The Netherlands
| | - Carsten Bogh Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev & Gentofte, Denmark
| | - Maarten Boers
- Department of Epidemiology & Biostatistics, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Thasia G Woodworth
- David Geffen School of Medicine, Division of Rheumatology, UCLA, Los Angeles, California, USA
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), 6229 ER Maastricht University, Maastricht, The Netherlands
| | - Henning Bliddal
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lyn M March
- Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Tugwell
- Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
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5
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Verhoef LM, den Broeder N, Thurlings RM, van der Laan WH, van der Weele W, Kok MR, Bernelot Moens HJ, Woodworth TG, van den Bemt BJF, van den Hoogen FHJ, den Broeder AA. Ultra-low doses of rituximab for continued treatment of rheumatoid arthritis (REDO study): a randomised controlled non-inferiority trial. Lancet Rheumatol 2019; 1:e145-e153. [PMID: 38229391 DOI: 10.1016/s2665-9913(19)30066-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Rituximab is an effective treatment for rheumatoid arthritis, given as either two doses of 1000 mg (2 weeks apart) every 6 months (the dose recommended by the US Food and Drug Administration and European Medicines Agency) or two doses of 500 mg (2 weeks apart) or one dose of 1000 mg (a standard low dose) every 6 months. Findings of several small uncontrolled studies suggest that doses lower than the recommended dose or standard low dose might be sufficient for maintenance treatment, potentially improving safety and reducing costs. Therefore, we aimed to compare the efficacy of ultra-low doses of rituximab (one dose of 500 mg or 200 mg) with a standard low dose of rituximab (one dose of 1000 mg) for patients with rheumatoid arthritis who respond to standard doses of rituximab. METHODS The REDO study is a randomised, double-blind, non-inferiority trial done at five centres in the Netherlands. Adults (aged ≥18 years) with rheumatoid arthritis responding well to rituximab were randomly allocated (1:2:2) to receive intravenous rituximab as one dose of either 1000 mg, 500 mg, or 200 mg, respectively. Volumes of all doses were equal to achieve masking. Randomisation lists were computer-generated and stratified by rheumatoid factor or anti-citrullinated protein antibody status (positive or negative) and concomitant use of conventional synthetic disease modifying antirheumatic drugs (yes or no). The primary analysis was a per-protocol hierarchical testing procedure comparing ultra-low doses with a standard low dose (500 mg vs 1000 mg at 3 months, followed by 500 mg vs 1000 mg at 6 months, 200 mg vs 1000 mg at 3 months, and 200 mg vs 1000 mg at 6 months), using a non-inferiority margin of 0·60 on change from baseline in the 28-joint disease activity score based on C-reactive protein levels (DAS28-CRP). The study is registered at www.trialregister.nl, NTR6117. FINDINGS Between Dec 15, 2016, and Sept 20, 2018, 142 patients were randomly allocated to either 1000 mg rituximab (n=29), 500 mg rituximab (n=58), or 200 mg rituximab (n=55). The 500 mg dose was non-inferior to 1000 mg at 3 months (mean change from baseline in DAS28-CRP, -0·07, 95% CI -0·41 to 0·27) but not at 6 months (0·29, -0·08 to 0·65). Because of the hierarchical testing procedure, non-inferiority could not be tested for the 200 mg dose. 13 patients had serious adverse events, three (10%) in the 1000 mg group, six (10%) in the 500 mg group, and four (7%) in the 200 mg group. The most frequently reported serious adverse events were cardiovascular. No deaths occurred during the study. A significantly lower incidence of infections was seen in the ultra-low-dose groups compared with the standard dose group (1·10 infections per patient-year with the 1000 mg dose vs 0·52 per patient-year with the 500 mg dose and 0·51 per patient-year with the 200 mg dose; rate ratio 0·47, 95% CI 0·21-0·83; p=0·013 for 500 mg vs 1000 mg; 0·44, 0·22-0·88; p=0·019 for 200 mg vs 1000 mg). INTERPRETATION Our study did not show non-inferiority of ultra-low doses of rituximab for continued treatment of patients with rheumatoid arthritis. Nonetheless, in clinical practice, a strategy with an ultra-low dose of rituximab might be considered after evaluation of risks and benefits, although further studies are needed to establish non-inferiority. Further analyses and a 2-year observational extension are ongoing and should provide further insight into efficacy and safety. FUNDING Menzis and Centraal Ziekenfonds.
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Affiliation(s)
- Lise M Verhoef
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, Netherlands.
| | | | | | | | | | - Marc R Kok
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, Netherlands
| | | | - Thasia G Woodworth
- Department of Medicine/Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Bart J F van den Bemt
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, Netherlands; Department of Pharmacy, Radboudumc, Nijmegen, Netherlands
| | - Frank H J van den Hoogen
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, Netherlands; Department of Rheumatic Diseases, Radboudumc, Nijmegen, Netherlands
| | - Alfons A den Broeder
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, Netherlands; Department of Rheumatic Diseases, Radboudumc, Nijmegen, Netherlands
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6
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Barroso N, Woodworth TG, Furst DE, Guillemin F, Fautrel BJ, Borazan N, Kafaja S, Brook J, Elashoff DA, Ranganath VK. The American English version of the validated French Flare Assessment in RA Questionnaire (FLARE-RA). Clin Rheumatol 2019; 39:189-199. [PMID: 31493148 DOI: 10.1007/s10067-019-04755-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/06/2019] [Accepted: 08/19/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate use of a British English version of the validated French FLARE-RA questionnaire among American English speaking patients. In addition, to create a culturally adapted American English (AmE) FLARE-RA questionnaire and to examine its attributes of patient-reported RA flare status. METHODS Using standardized cultural adaptation guidelines, we cognitively debriefed 25 American English speaking rheumatoid arthritis (RA) outpatients and created AmE-FLARE-RA with their input. One hundred three additional RA patients were recruited. Patients completed the Routine Assessment of Patient Index Data 3 (RAPID3), patient global visual analogue scale (VAS), AmE-FLARE-RA, and self-reports of flare. Physician global VAS, physician-assessed flare, swollen and tender joint count (TJC), and clinical disease activity index (CDAI) were documented. AmE-FLARE-RA and disease activity measures were compared between patient-reported and physician-reported flare categories. RESULTS Patients were female (89%), with mean (SD) age 51.1 (± 15.3) years and mean disease duration (SD) 11.9 (± 10.1) years, with 26% in remission/low disease activity. Total AmE-FLARE-RA scores, RAPID3, CDAI, and patient global VAS were significantly higher for both patient-reported flares and physician-reported flares compared with non-flaring patients by self- or physician report (p < 0.05). Total AmE-FLARE-RA scores correlated significantly with RAPID3 (corr = 0.50, p < 0.0001) and with CDAI (corr = 0.45, p < 0.0001). Across "no flares," "one flare," and "several flare" groups, there was a non-significant increase in AmE-FLARE-RA scores (p = 0.07). CONCLUSION The British English FLARE-RA was successfully adapted for AmE-speaking RA patients. AmE-FLARE-RA significantly correlated with RAPID3 and CDAI and distinguished between patient-reported and physician-reported flares, making it useful to detect flares in American RA patients.Key Points• The American English FLARE-RA (AmE-FLARE-RA) questionnaire is the result of cognitive debriefing with American RA patients using the British English version of the validated French FLARE-RA and incorporates patient-recommended language modifications..• Patients self-reporting flares had significantly higher AmE-FLARE-RA scores, compared with those without flares at the time of visit. AmE-FLARE-RA scores correlate with RAPID3 and CDAI.• There was a non-statistically significant trend using the AmE-FLARE-RA scores when examining patients with no flare, one flare, or several flares.• AmE-FLARE-RA total scores are uniformly elevated (~ 6.0 on a 0-10 scale), regardless of discordance between patient and MD assessment of flare at time of visit (~ 30%).
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Affiliation(s)
- N Barroso
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - T G Woodworth
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - D E Furst
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, USA.,University of Washington, Seattle, Washington, USA.,University of Florence, Florence, Italy
| | - F Guillemin
- Inserm CIC 1433 Clinical Epidemiology, University Hospital, Nancy, France.,Université de Lorraine, EA 4360 APEMAC, Nancy, France
| | - B J Fautrel
- UPMC, GRC08, Pierre Louis Institute of Epidémiology and Public Health, 56 Boulevard Vincent Auriol, Paris, France.,Department of Rheumatology, APHP, Pitié-Salpétrière University Hospital, 47-83 Boulevard de l'Hôpital, Paris, France
| | - N Borazan
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - S Kafaja
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - J Brook
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - D A Elashoff
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - V K Ranganath
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, USA.
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Woodworth TG, Furst DE. Timely renal transplantation for scleroderma end-stage kidney disease patients can improve outcomes and quality of life. Ann Transl Med 2019; 7:60. [PMID: 30906764 DOI: 10.21037/atm.2018.12.64] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Thasia G Woodworth
- Department of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Daniel E Furst
- Department of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Division of Rheumatology, Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Experimental Medicine, University of Florence, Florence, Italy
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8
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Nielsen SM, Tugwell P, de Wit MP, Boers M, Beaton DE, Woodworth TG, Escorpizo R, Shea B, Toupin-April K, Guillemin F, Strand V, Singh JA, Kloppenburg M, Furst DE, Wells GA, Smolen JS, Veselý R, Boonen A, Storgaard H, Voshaar M, March L, Christensen R. Identifying Provisional Generic Contextual Factor Domains for Clinical Trials in Rheumatology: Results from an OMERACT Initiative. J Rheumatol 2019; 46:1159-1163. [DOI: 10.3899/jrheum.181081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2018] [Indexed: 01/13/2023]
Abstract
Objective.The Contextual Factors Working Group aims to provide guidance on addressing contextual factors in rheumatology trials within OMERACT.Methods.During the Special Interest Group session at OMERACT 2018, preliminary results were presented from a case scenario survey and semistructured interviews, including contextual factors mentioned in these. A group-based exercise sought to identify and rank important generic contextual factors.Results.A total of 79 candidate factors were listed. Across the 3 groups, gender/sex, comorbidities, and the healthcare system were ranked as most important.Conclusion.The identified important contextual factor domains may be considered a provisional list pending further research.
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Bartlett SJ, Barbic SP, Bykerk VP, Choy EH, Alten R, Christensen R, den Broeder A, Fautrel B, Furst DE, Guillemin F, Hewlett S, Leong AL, Lyddiatt A, March L, Montie P, Pohl C, Scholte Voshaar M, Woodworth TG, Bingham CO. Content and Construct Validity, Reliability, and Responsiveness of the Rheumatoid Arthritis Flare Questionnaire: OMERACT 2016 Workshop Report. J Rheumatol 2017; 44:1536-1543. [PMID: 28811351 DOI: 10.3899/jrheum.161145] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The Outcome Measures in Rheumatology (OMERACT) Rheumatoid Arthritis (RA) Flare Group was established to develop a reliable way to identify and measure RA flares in randomized controlled trials (RCT). Here, we summarized the development and field testing of the RA Flare Questionnaire (RA-FQ), and the voting results at OMERACT 2016. METHODS Classic and modern psychometric methods were used to assess reliability, validity, sensitivity, factor structure, scoring, and thresholds. Interviews with patients and clinicians also assessed content validity, utility, and meaningfulness of RA-FQ scores. RESULTS People with RA in observational trials in Canada (n = 896) and France (n = 138), and an RCT in the Netherlands (n = 178) completed 5 items (11-point numerical rating scale) representing RA Flare core domains. There was moderate to high evidence of reliability, content and construct validity, and responsiveness. Factor analysis supported unidimensionality. Rasch analysis showed acceptable fit to the Rasch model, with items and people covering a broad measurement continuum and evidence of appropriate targeting of items to people, ordered thresholds, minimal differential item functioning by language, sex, or age. A summative score across items is defensible, yielding an interval score (0-50) where higher scores reflect worsening flare. The RA-FQ received endorsement from 88% of attendees that it passed the OMERACT Filter 2.0 "Eyeball Test" for instrument selection. CONCLUSION The RA-FQ has been developed to identify and measure RA flares. Its review through OMERACT Filter 2.0 shows evidence of reliability, content and construct validity, and responsiveness. These properties merit its further validation as an outcome for clinical trials.
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Affiliation(s)
- Susan J Bartlett
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia. .,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University.
| | - Skye P Barbic
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Vivian P Bykerk
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Ernest H Choy
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Rieke Alten
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Robin Christensen
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Alfons den Broeder
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Bruno Fautrel
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Daniel E Furst
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Francis Guillemin
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Sarah Hewlett
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Amye L Leong
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Anne Lyddiatt
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Lyn March
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Pamela Montie
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Christoph Pohl
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Marieke Scholte Voshaar
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Thasia G Woodworth
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
| | - Clifton O Bingham
- From McGill University, Montreal, Quebec; University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York; University of California, Los Angeles; Healthy Motivation, Santa Barbara, California, USA; Cardiff University, Cardiff; University of the West of England, Bristol, UK; Schlosspark-Klinik University Medicine, Berlin, Germany; Parker Institute, Copenhagen University, Copenhagen, Denmark; Sint Maartenskliniek, Nijmege; Vrije Universiteit (VU), Amsterdam, the Netherlands; Pierre et Marie Curie University, Paris; University of Lorraine, Lorraine, France; University of Sydney, Sydney, Australia.,S.J. Bartlett, PhD, McGill University, and Johns Hopkins University; S.P. Barbic, PhD, University of British Columbia; V.P. Bykerk, MD, Hospital for Special Surgery; E.H. Choy, MD, Cardiff University; R. Alten, MD, Schlosspark-Klinik University Medicine; R. Christensen, PhD, Parker Institute, Copenhagen University; A. den Broeder, MD, PhD, Sint Maartenskliniek; B. Fautrel, MD, PhD, Pierre et Marie Curie University; D.E. Furst, MD, University of California; F. Guillemin, MD, PhD, University of Lorraine; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, MBA, Healthy Motivation; A. Lyddiatt, Patient Research Partner; L. March, MD, PhD, University of Sydney; P. Montie, Patient Research Partner; C. Pohl, MD, Schlosspark-Klinik University Medicine; M. Scholte Voshaar, MSc, VU; T.G. Woodworth, MD, University of California; C.O. Bingham III, MD, Johns Hopkins University
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Woodworth TG, Morgacheva O, Pimienta OL, Troum OM, Ranganath VK, Furst DE. Examining the validity of the rheumatoid arthritis magnetic resonance imaging score according to the OMERACT filter-a systematic literature review. Rheumatology (Oxford) 2017; 56:1177-1188. [PMID: 28398508 PMCID: PMC5850856 DOI: 10.1093/rheumatology/kew445] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 11/01/2016] [Indexed: 02/05/2023] Open
Abstract
Objective To examine whether the RA MRI score (RAMRIS) for RA of the wrist/hand meets the OMERACT filter criteria-truth (validity), discrimination and feasibility. Methods We conducted a systematic literature review in PubMed and Scopus, from 1970 through June 2014, focused on MRI measures of synovitis, osteitis/bone marrow oedema, erosions and/or joint space narrowing in RA randomized controlled trials and observational studies with cohort size ⩾10. Strength of evidence was assessed using the Cochrane Handbook criteria. Results Of 634 MRI titles/abstracts, 202 met the review criteria, with 92 providing at least 1 type of validity. Four articles provided criterion validity, and 26 articles utilized RAMRIS to assess 1.5 T MRI images. Histopathology data showed inflammation corresponding to MRI of synovitis and osteitis. MRI erosions corresponded to those identified with CT. Content and construct validity for RAMRIS synovitis, osteitis and erosions were documented by correlations with clinical, laboratory and/or radiographic data. Each measure was sensitive to change and responsive to therapy. RAMRIS synovitis and osteitis were able to discriminate between the efficacy of treatments vs placebo in 12-week studies, whereas RAMRIS erosions required studies of ⩾24 weeks. Conclusion RAMRIS synovitis, osteitis and erosions imaged with 1.5 T MRI are valid and useful for evaluating joint inflammation and damage for RA of the wrist/hand, according to the OMERACT filter.
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Affiliation(s)
- Thasia G. Woodworth
- Department of Medicine, Division of Rheumatology, David Geffen School of
Medicine, UCLA, Los Angeles
| | - Olga Morgacheva
- Department of Medicine, Division of Rheumatology, David Geffen School of
Medicine, UCLA, Los Angeles
| | - Olga L. Pimienta
- Keck School of Medicine, University of Southern California, Santa Monica,
CA, USA
| | - Orrin M. Troum
- Keck School of Medicine, University of Southern California, Santa Monica,
CA, USA
| | - Veena K. Ranganath
- Department of Medicine, Division of Rheumatology, David Geffen School of
Medicine, UCLA, Los Angeles
| | - Daniel E. Furst
- Department of Medicine, Division of Rheumatology, David Geffen School of
Medicine, UCLA, Los Angeles
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Finger ME, Boonen A, Woodworth TG, Escorpizo R, Christensen R, Nielsen SM, Leong AL, Scholte Voshaar M, Flurey CA, Milman N, Verstappen SM, Alten R, Guillemin F, Kloppenburg M, Beaton DE, Tugwell PS, March LM, Furst DE, Pohl C. An OMERACT Initiative Toward Consensus to Identify and Characterize Candidate Contextual Factors: Report from the Contextual Factors Working Group. J Rheumatol 2017; 44:1734-1739. [DOI: 10.3899/jrheum.161200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 01/21/2023]
Abstract
Objective.The importance of contextual factors (CF) for appropriate patient-specific care is widely acknowledged. However, evidence in clinical trials on how CF influence outcomes remains sparse. The 2014 Outcome Measures in Rheumatology (OMERACT) Handbook introduced the role of CF in outcome assessment and defined them as “potential confounders and/or effect modifiers of outcomes in randomized controlled trials.” Subsequently, the CF Methods Group (CFMG) was formed to develop guidance on how to address CF in clinical trials.Methods.First, the CFMG conducted an e-mail survey of OMERACT working groups (WG) to analyze how they had addressed CF in outcome measurement so far. The results facilitated an informed discussion at the OMERACT 2016 CFMG Special Interest Group (SIG) session, with the aim of gaining preliminary consensus regarding an operational definition of CF and to make a first selection of potentially relevant CF.Results.The survey revealed that the WG had mostly used the OMERACT Handbook and/or the International Classification of Functioning, Disability and Health (ICF) definition. However, significant heterogeneity was found in the methods used to identify, refine, and categorize CF candidates. The SIG participants agreed on using the ICF as a framework along with the OMERACT Handbook definition. A list with 28 variables was collected including person-related factors and physical and social environments. Recommendations from the SIG guided the CFMG to formulate 3 preliminary projects on how to identify and analyze CF.Conclusion.New methods are urgently needed to assist researchers to identify and characterize CF that significantly influence the interpretation of results in clinical trials. The CFMG defined first steps to develop further guidance.
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Mahler E, den Broeder AA, Woodworth TG, Busch V, van den Hoogen FH, Bijlsma J, van den Ende C. How should worsening in osteoarthritis be defined? Development and initial validation of preliminary criteria for clinical worsening in knee and hip osteoarthritis. Scand J Rheumatol 2017; 46:396-406. [PMID: 28276959 DOI: 10.1080/03009742.2016.1235226] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES There is a need to define and validate measures of clinical worsening in knee and hip osteoarthritis (OA). The objectives of this exploratory project were: (i) to characterize worsening criteria in knee and hip OA using psychometric methods; (ii) to estimate their sensitivity and specificity; and (iii) to validate and compare these criteria with worsening criteria previously described in the literature. METHOD An Expert Group reached consensus on 10 sets of worsening criteria to be tested in observational data sets of patients with knee or hip OA who received multimodal conservative treatment. These sets included 219 patients (derivation cohort) and 296 patients (validation cohort). We estimated minimal clinically important worsening (MCIW) values for pain, function, stiffness, and patient global assessment, and tested candidate worsening criteria in the derivation cohort. Finally, using patient judgement, we examined the sensitivity and specificity of literature-based as well as candidate worsening criteria in the validation cohort. RESULTS Literature-based worsening criteria were found to have high specificity (range 60-92%) but low sensitivity (range 22-59%). Two out of 10 candidate worsening criteria constructed by the Expert Group showed an acceptable combination of sensitivity and specificity in the derivation cohort, which was confirmed in the validation cohort (ranging from 54% to 65% and 67% to 74%, respectively). CONCLUSIONS This is the first study to describe symptomatic worsening criteria based on expert consensus after examining the performance of candidate criteria derived from the literature applied to data in an observational study. The newly proposed worsening criteria show an acceptable combination of sensitivity and specificity.
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Affiliation(s)
- Eam Mahler
- a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands
| | - A A den Broeder
- a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands
| | - T G Woodworth
- b Division of Rheumatology , Geffen School of Medicine UCLA , Los Angeles , CA , USA
| | - Vjjf Busch
- c Department of Orthopedics , Sint Maartenskliniek , Nijmegen , The Netherlands
| | - F H van den Hoogen
- a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands.,d Department of Rheumatology , Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Jwj Bijlsma
- e Department of Rheumatology and Clinical Immunology , University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Chm van den Ende
- a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands
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13
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Bijlsma JWJ, Welsing PMJ, Woodworth TG, Middelink LM, Pethö-Schramm A, Bernasconi C, Borm MEA, Wortel CH, Ter Borg EJ, Jahangier ZN, van der Laan WH, Bruyn GAW, Baudoin P, Wijngaarden S, Vos PAJM, Bos R, Starmans MJF, Griep EN, Griep-Wentink JRM, Allaart CF, Heurkens AHM, Teitsma XM, Tekstra J, Marijnissen ACA, Lafeber FPJ, Jacobs JWG. Early rheumatoid arthritis treated with tocilizumab, methotrexate, or their combination (U-Act-Early): a multicentre, randomised, double-blind, double-dummy, strategy trial. Lancet 2016; 388:343-355. [PMID: 27287832 DOI: 10.1016/s0140-6736(16)30363-4] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [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] [Indexed: 02/08/2023]
Abstract
BACKGROUND For patients with newly diagnosed rheumatoid arthritis, treatment aim is early, rapid, and sustained remission. We compared the efficacy and safety of strategies initiating the interleukin-6 receptor-blocking monoclonal antibody tocilizumab with or without methotrexate (a conventional synthetic disease-modifying antirheumatic drug [DMARD]), versus initiation of methotrexate monotherapy in line with international guidelines. METHODS We did a 2-year, multicentre, randomised, double-blind, double-dummy, strategy study at 21 rheumatology outpatient departments in the Netherlands. We included patients who had been diagnosed with rheumatoid arthritis within 1 year before inclusion, were DMARD-naive, aged 18 years or older, met current rheumatoid arthritis classification criteria, and had a disease activity score assessing 28 joints (DAS28) of at least 2·6. We randomly assigned patients (1:1:1) to start tocilizumab plus methotrexate (the tocilizumab plus methotrexate arm), or tocilizumab plus placebo-methotrexate (the tocilizumab arm), or methotrexate plus placebo-tocilizumab (the methotrexate arm). Tocilizumab was given at 8 mg/kg intravenously every 4 weeks with a maximum of 800 mg per dose. Methotrexate was started at 10 mg per week orally and increased stepwise every 4 weeks by 5 mg to a maximum of 30 mg per week, until remission or dose-limiting toxicity. We did the randomisation using an interactive web response system. Masking was achieved with placebos that were similar in appearance to the active drug; the study physicians, pharmacists, monitors, and patients remained masked during the study, and all assessments were done by masked assessors. Patients not achieving remission on their initial regimen switched from placebo to active treatments; patients in the tocilizumab plus methotrexate arm switched to standard of care therapy (typically methotrexate combined with a tumour necrosis factor inhibitor). When sustained remission was achieved, methotrexate (and placebo-methotrexate) was tapered and stopped, then tocilizumab (and placebo-tocilizumab) was also tapered and stopped. The primary endpoint was the proportion of patients achieving sustained remission (defined as DAS28 <2·6 with a swollen joint count ≤four, persisting for at least 24 weeks) on the initial regimen and during the entire study duration, compared between groups with a two-sided Cochran-Mantel-Haenszel test. Analysis was based on an intention-to-treat method. This trial was registered at ClinicalTrials.gov, number NCT01034137. FINDINGS Between Jan 13, 2010, and July 30, 2012, we recruited and assigned 317 eligible patients to treatment (106 to the tocilizumab plus methotrexate arm, 103 to the tocilizumab arm, and 108 to the methotrexate arm). The study was completed by a similar proportion of patients in the three groups (range 72-78%). The most frequent reasons for dropout were adverse events or intercurrent illness: 27 (34%) of dropouts, and insufficient response: 26 (33%) of dropouts. 91 (86%) of 106 patients in the tocilizumab plus methotrexate arm achieved sustained remission on the initial regimen, compared with 86 (84%) of 103 in the tocilizumab arm, and 48 (44%) of 108 in the methotrexate arm (relative risk [RR] 2·00, 95% CI 1·59-2·51 for tocilizumab plus methotrexate vs methotrexate, and 1·86, 1·48-2·32 for tocilizumab vs methotrexate, p<0·0001 for both comparisons). For the entire study, 91 (86%) of 106 patients in the tocilizumab plus methotrexate arm, 91 (88%) of 103 in the tocilizumab arm, and 83 (77%) of 108 in the methotrexate arm achieved sustained remission (RR 1·13, 95% CI 1·00-1·29, p=0·06 for tocilizumab plus methotrexate vs methotrexate, 1·14, 1·01-1·29, p=0·0356 for tocilizumab vs methotrexate, and p=0·59 for tocilizumab plus methotrexate vs tocilizumab). Nasopharyngitis was the most common adverse event in all three treatment groups, occurring in 38 (36%) of 106 patients in the tocilizumab plus methotrexate arm, 40 (39%) of 103 in the tocilizumab arm, and 37 (34%) of 108 in the methotrexate arm. The occurrence of serious adverse events did not differ between the treatment groups (17 [16%] of 106 patients in the tocilizumab plus methotrexate arm vs 19 [18%] of 103 in the tocilizumab arm and 13 [12%] of 108 in the methotrexate arm), and no deaths occurred during the study. INTERPRETATION For patients with newly diagnosed rheumatoid arthritis, strategies aimed at sustained remission by immediate initiation of tocilizumab with or without methotrexate are more effective, and with a similar safety profile, compared with initiation of methotrexate in line with current standards. FUNDING Roche Nederland BV.
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Affiliation(s)
- Johannes W J Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Thasia G Woodworth
- Division of Rheumatology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Reinhard Bos
- Medical Center Leeuwarden, Leeuwarden, Netherlands
| | | | | | | | | | | | - Xavier M Teitsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Janneke Tekstra
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Anne Carien A Marijnissen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Floris P J Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands.
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Woodworth TG, den Broeder AA. Treating to target in established rheumatoid arthritis: Challenges and opportunities in an era of novel targeted therapies and biosimilars. Best Pract Res Clin Rheumatol 2016; 29:543-9. [PMID: 26697765 DOI: 10.1016/j.berh.2015.10.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There is increasing consensus that periodic monitoring of disease activity status in rheumatoid arthritis (RA) patients to achieve and maintain remission, or at least low disease activity (LDA), the so-called treat to target (T2T) improves outcomes regardless of the duration of disease. Based on systematic literature reviews (SLRs) of clinical trials and registries, International Recommendations published in 2015 represent expert opinion describing efficacy and safety of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologic DMARDs (bDMARDs). A total of 10 recommendations are detailed from four "Overarching Principles": (1) treatment decisions are shared between patient and rheumatologist; (2) the primary goalv is to maximize long-term quality of life by controlling the symptoms, preventing joint damage, and by normalizing the function and social and work participation; (3) abrogation (not just control) of inflammation is the most effective method to achieve this goal; (4) T2T by measuring disease activity regularly and adjusting therapy to achieve remission/LDA optimizes outcomes in RA. The SLRs provide solid evidence that methotrexate is the "anchor" of csDMARD and that step-up therapy by adding/substituting other csDMARDs, such as sulfasalazine (SSZ), hydroxychloroquine (HCQ), or/and leflunomide (LEF) is as effective as combination therapy to initiate. Tofacitinib, a recently marketed csDMARD, may be more effective in comparison to MTX, and can be used in combination. Rapid disease control can be achieved by "bridging" with various regimens of glucocorticoids (GCs), but tapering to doses ≤7.5 mg/day is critical to limit side effects. In practice settings, use of bDMARDs is influenced by reimbursement. Tumor necrosis factor inhibitors (TNFi) are highly used, but as more data emerge, there appear to be no major differences to more recently available targeted bDMARD monoclonal antibodies such as abatacept (co-stimulation blockade), rituximab (B cell depleting), tocilizumab (TCZ) (interleukin (IL)-6 receptor blockade). Rituximab appears to be most effective for seropositive patients, and tocilizumab may be more effective as a monotherapy in patients intolerant to csDMARDs. Besides T2T, attention to managing treatment and optimizing outcomes should take into account potential adverse effects, such as risk of serious infection, as well as potential morbidity/mortality related to cardiovascular events, pulmonary disease, osteoporosis, diabetes, and fibromyalgia which often influence some measures, such as the Health Assessment Questionnaire (HAQ).
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Affiliation(s)
- Thasia G Woodworth
- Division of Rheumatology, David Geffen School of Medicine, University of California (UCLA), Los Angeles, USA.
| | - Alfons A den Broeder
- Dept. of Rheumatology, Sint Maartenskliniek, PO Box 9011, 6500 GM, Nijmegen, The Netherlands
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den Broeder AA, Woodworth TG. Preface. Best Pract Res Clin Rheumatol 2015; 29:525-6. [DOI: 10.1016/j.berh.2015.09.008] [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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Bartlett SJ, Bykerk VP, Cooksey R, Choy EH, Alten R, Christensen R, Furst DE, Guillemin F, Halls S, Hewlett S, Leong AL, Lyddiatt A, March L, Montie P, Orbai AM, Pohl C, Voshaar MS, Woodworth TG, Bingham CO. Feasibility and Domain Validation of Rheumatoid Arthritis (RA) Flare Core Domain Set: Report of the OMERACT 2014 RA Flare Group Plenary. J Rheumatol 2015; 42:2185-9. [PMID: 25684764 DOI: 10.3899/jrheum.141169] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [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: 12/15/2022]
Abstract
OBJECTIVE The Outcome Measures in Rheumatology (OMERACT) Rheumatoid Arthritis (RA) Flare Group was established to develop an approach to identify and measure RA flares. An overview of our OMERACT 2014 plenary is provided. METHODS Feasibility and validity of flare domains endorsed at OMERACT 11 (2012) were described based on initial data from 3 international studies collected using a common set of questions specific to RA flare. Mean flare frequency, severity, and duration data were presented, and domain scores were compared by flare status to examine known-groups validity. Breakout groups provided input for stiffness, self-management, contextual factors, and measurement considerations. RESULTS Flare data from 501 patients in an observational study indicated 39% were in flare, with mean (SD) severity of 6.0 (2.6) and 55% lasting > 14 days. Pain, physical function, fatigue, participation, and stiffness scores averaged ≥ 2 times higher (2 of 11 points) in flaring individuals. Correlations between flare domains and corresponding legacy instruments were obtained: r = 0.46 to 0.93. A combined definition (patient report of flare and 28-joint Disease Activity Score increase) was evaluated in 2 other trials, with similar results. Breakout groups debated specific measurement issues. CONCLUSION These data contribute initial evidence of feasibility and content validation of the OMERACT RA Flare Core Domain Set. Our research agenda for OMERACT 2016 includes establishing duration/intensity criteria and developing criteria to identify RA flares using existing disease activity measures. Ongoing work will also address discordance between patient and physician ratings, facilitate application of flare criteria to clinical care, elucidate the role of self-management, and finalize recommendations for RA flare measurement.
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Affiliation(s)
- Susan J Bartlett
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University.
| | - Vivian P Bykerk
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Roxanne Cooksey
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Ernest H Choy
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Rieke Alten
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Robin Christensen
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Daniel E Furst
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Francis Guillemin
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Serena Halls
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Sarah Hewlett
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Amye L Leong
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Anne Lyddiatt
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Lyn March
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Pamela Montie
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Ana Maria Orbai
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Christoph Pohl
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Marieke Scholte Voshaar
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Thasia G Woodworth
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
| | - Clifton O Bingham
- From McGill University, Montreal, Quebec, Canada; Johns Hopkins University, Baltimore, Maryland; Hospital for Special Surgery, New York, New York, USA; Swansea University, Swansea; Cardiff University, Cardiff, UK; Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany; The Parker Institute, Copenhagen University Hospital at Frederiksberg, Copenhagen, Denmark; University of California, Los Angeles, California, USA; University of Lorraine, Nancy, France; University of the West of England, Bristol, UK; Healthy Motivation, Santa Barbara, California, USA; University of Sydney, Sydney, Australia; and University of Twente, Enschede, The Netherlands.S.J. Bartlett, PhD, McGill University; and Johns Hopkins University; V.P. Bykerk, MD, Hospital for Special Surgery; R. Cooksey, MSc, Swansea University; E.H. Choy, MD, Cardiff University; R. Alten, Schlosspark-Klinik, University Medicine Berlin; R. Christensen, PhD, Parker Institute, Copenhagen University Hospital at Frederiksberg; D.E. Furst, MD, University of California, Los Angeles; F. Guillemin, MD, PhD, University of Lorraine; S. Halls, MSc; S. Hewlett, PhD, RN, University of the West of England; A.L. Leong, Healthy Motivation; A. Lyddiatt; University of Sydney; L. March, MD, PhD; P. Montie; A.M. Orbai, MD, MHS, Johns Hopkins University; C. Pohl, MD, Schlosspark-Klinik, University Medicine; M. Scholte Voshaar, University of Twente; T.G. Woodworth, MD, University of California, Los Angeles; and C.O. Bingham 3rd, MD, Johns Hopkins University
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Woodworth TG, Furst DE. Safety and feasibility of umbilical cord mesenchymal stem cells in treatment-refractory systemic lupus erythematosus nephritis: time for a double-blind placebo-controlled trial to determine efficacy. Arthritis Res Ther 2014; 16:113. [PMID: 25166210 PMCID: PMC4261567 DOI: 10.1186/ar4677] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
As translational clinical researchers familiar with the risk-benefit of hematopoietic stem cell transplantation in autoimmune diseases, we are intrigued by the recent report of umbilical cord mesenchymal stem cell (UC-MSC) transplantation in treatment-refractory systemic lupus erythematosus nephritis by Wang and colleagues. They report the results of an open-label single-arm multicenter phase I/II study. This stimulated us to examine whether collective data from this group provide sufficient evidence for the feasibility, safety, dose rationale, and potential efficacy of UC-MSCs to conduct a randomized controlled trial in such patients. Results, though confounded by variable baseline prednisone and immuno-suppressive treatment, appear to indicate near-term response rates of approximately 50%, which are comparable to those seen with hematopoietic stem cell transplantation but with less morbidity and mortality.
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Volkmann ER, Rezai S, Tarp S, Woodworth TG, Furst DE. We still don't know how to taper glucocorticoids in rheumatoid arthritis, and we can do better. J Rheumatol 2014; 40:1646-9. [PMID: 24085754 DOI: 10.3899/jrheum.130019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Elizabeth R Volkmann
- Division of Rheumatology, Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
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Lie E, Woodworth TG, Christensen R, Kvien TK, Bykerk V, Furst DE, Bingham CO, Choy EH. Validation of OMERACT preliminary rheumatoid arthritis flare domains in the NOR-DMARD study. Ann Rheum Dis 2013; 73:1781-7. [DOI: 10.1136/annrheumdis-2013-203496] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bartlett SJ, Hewlett S, Bingham CO, Woodworth TG, Alten R, Pohl C, Choy EH, Sanderson T, Boonen A, Bykerk V, Leong AL, Strand V, Furst DE, Christensen R. Identifying core domains to assess flare in rheumatoid arthritis: an OMERACT international patient and provider combined Delphi consensus. Ann Rheum Dis 2012; 71:1855-60. [PMID: 22772326 DOI: 10.1136/annrheumdis-2011-201201] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE For rheumatoid arthritis (RA), there is no consensus on how to define and assess flare. Variability in flare definitions impairs understanding of findings across studies and limits ability to pool results. The OMERACT RA Flare Group sought to identify domains to define RA flares from patient and healthcare professional (HCP) perspectives. METHODS Flare was described as a worsening of disease activity of sufficient intensity and duration to consider a change in therapy. International patients and HCPs participated in separate and combined rounds of Delphi exercises to rate candidate flare domains previously generated in patient focus groups. Core domains were defined as those with ≥70% ratings of being 'essential' according to the third/final Delphi exercise. RESULTS The final Delphi included 125 RA patients from 10 countries and 108 HCPs from 23 countries who rated 14 domains. Patients had a mean (±SD) age of 56±12 years and disease duration of 18±12 years. HCPs included physicians from clinical practice/research and industry, allied health providers and researchers with 17±11 years experience. Core domains comprised: pain (93%), function (89%), swollen joints (84%), tender joints (81%), participation (81%), stiffness (79%), patient global assessment (76%) and self-management (75%). Fatigue (68%), which did not reach group consensus, will receive additional consideration. CONCLUSIONS As part of the process to develop a measure for RA flare, patients and HCPs agreed on eight core domains. Next steps include identifying items to assess domains and conducting studies to validate and refine a new measure.
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Affiliation(s)
- Susan J Bartlett
- Department of Medicine, McGill University, Royal Victoria Hospital, Ross 4.31, Montreal, Quebec H3A 1A1, Canada.
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Bingham CO, Alten R, Bartlett SJ, Bykerk VP, Brooks PM, Choy E, Christensen R, Furst DE, Hewlett SE, Leong A, May JE, Montie P, Pohl C, Sanderson TC, Strand V, Woodworth TG. Identifying preliminary domains to detect and measure rheumatoid arthritis flares: report of the OMERACT 10 RA Flare Workshop. J Rheumatol 2012; 38:1751-8. [PMID: 21807797 DOI: 10.3899/jrheum.110401] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND While disease flares in rheumatoid arthritis (RA) are a recognized aspect of the disease process, there is limited formative research to describe them. METHODS The Outcome Measures in Rheumatology Clinical Trials (OMERACT) RA Flare Definition Working Group is conducting an international research project to understand the specific characteristics and impact of episodic disease worsening, or "flare," so that outcome measures can be developed or modified to reflect this uncommonly measured, but very real and sometimes disabling RA disease feature. Patient research partners provided critical insights into the multidimensional nature of flare. The perspectives of patients and healthcare and research professionals are being integrated to ensure that any outcome measurement to detect flares fulfills the first OMERACT criteria of Truth. Through an iterative data-driven Delphi process, a preliminary list of key domains has been identified to evaluate flare. RESULTS At OMERACT 10, consensus was achieved identifying features of flare in addition to the existing core set for RA, including fatigue, stiffness, symptom persistence, systemic features, and participation. Patient self-report of flare was identified as a component of the research agenda needed to establish criterion validity for a flare definition; this can be used in prospective studies to further evaluate the Discrimination and Feasibility components of the OMERACT filter for a flare outcome measure. CONCLUSION Our work to date has provided better understanding of key aspects of the RA disease process as episodic, potentially disabling disease worsening even when a patient is in low disease activity. It also highlights the importance of developing ways to enhance communication between patients and clinicians and improve the ability to achieve "tight control" of disease.
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Bingham CO, Pohl C, Woodworth TG, Hewlett SE, May JE, Rahman MU, Witter JP, Furst DE, Strand CV, Boers M, Alten RE. Developing a standardized definition for disease "flare" in rheumatoid arthritis (OMERACT 9 Special Interest Group). J Rheumatol 2009; 36:2335-41. [PMID: 19684147 DOI: 10.3899/jrheum.090369] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Traditional outcome measures in randomized controlled trials (RCT) include well-established response criteria as well as ACR EULAR responses using Disease Activity Score 44 (DAS44)/DAS28 to assess improvement; however, a measure to assess worsening of disease has yet to be developed. This special interest group (SIG) was established to develop an evidence-based, consensus-driven standard definition of "flare" in rheumatoid arthritis (RA). METHODS At OMERACT 8, the need for a standardized definition of RA flare was recognized; interested individuals developed a proposal to form a SIG. A literature review was performed to identify publications and abstracts with flare definitions applied in RA, JIA, and lupus RCT as well as concerning patient perspectives on disease worsening. A SIG was held at OMERACT 9 with breakout sessions for patients and investigators. RESULTS The RA flare SIG was attended by about 120 participants, including 11 patients. Patients and investigators held separate breakout sessions to discuss various aspects of disease worsening. The following consensus was obtained at OMERACT 9: a working definition of flare should indicate worsening of disease activity (88%), persistence, and duration as critical elements (77%), and consideration of change or increase in therapy (74%). CONCLUSION A working definition of RA flare was developed based on these votes: flare is any worsening of disease activity that would, if persistent, in most cases lead to initiation or change of therapy; and a flare represents a cluster of symptoms of sufficient duration and intensity to require initiation, change, or increase in therapy. Using this working definition, evaluation of candidate domains will be conducted via Delphi exercise and further informed by patient focus groups. Validation of candidate definitions in appropriate RCT will be required.
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Affiliation(s)
- Clifton O Bingham
- Division of Rheumatology, Johns Hopkins University, 5200 Eastern Avenue, Mason Lord Center Tower, Room 404, Baltimore, MD 21224, USA.
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Alten R, Gram H, Joosten LA, van den Berg WB, Sieper J, Wassenberg S, Burmester G, van Riel P, Diaz-Lorente M, Bruin GJM, Woodworth TG, Rordorf C, Batard Y, Wright AM, Jung T. The human anti-IL-1 beta monoclonal antibody ACZ885 is effective in joint inflammation models in mice and in a proof-of-concept study in patients with rheumatoid arthritis. Arthritis Res Ther 2008; 10:R67. [PMID: 18534016 PMCID: PMC2483458 DOI: 10.1186/ar2438] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Revised: 04/16/2008] [Accepted: 06/05/2008] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION IL-1beta is a proinflammatory cytokine driving joint inflammation as well as systemic signs of inflammation, such as fever and acute phase protein production. METHODS ACZ885, a fully human monoclonal antibody that neutralizes the bioactivity of human IL-1beta, was generated to study the potent and long-lasting neutralization of IL-1beta in mechanistic animal models as well as in a proof-of-concept study in patients with rheumatoid arthritis (RA). RESULTS The mouse IL-1 receptor cross-reacts with human IL-1beta, and it was demonstrated that ACZ885 can completely suppress IL-1beta-mediated joint inflammation and cartilage destruction in mice. This observation prompted us to study the safety, tolerability and pharmacodynamic activity of ACZ885 in RA patients in a small proof-of-concept study--the first to be conducted in humans. Patients with active RA despite treatment with stable doses of methotrexate were enrolled in this dose escalation study. The first 32 patients were split into four cohorts of eight patients each (six were randomly assigned to active treatment and two to placebo). ACZ885 doses were 0.3, 1, 3 and 10 mg/kg, administered intravenously on days 1 and 15. To explore efficacy within 6 weeks of treatment, an additional 21 patients were randomly assigned to the 10 mg/kg cohort, resulting in a total of 20 patients dosed with 10 mg/kg and 15 patients treated with placebo. There was clinical improvement (American College of Rheumatology 20% improvement criteria) at week 6 in the 10 mg/kg treatment group; however, this did not reach statistical significance (P = 0.085). A statistically significant reduction in disease activity score was observed after 4 weeks in the 10 mg/kg group. Onset of action was rapid, because most responders exhibited improvement in their symptoms within the first 3 weeks. C-reactive protein levels decreased in patients treated with ACZ885 within 1 week. ACZ885 was well tolerated. Three patients receiving ACZ885 developed infectious episodes that required treatment. No anti-ACZ885 antibodies were detected during the study. CONCLUSION ACZ885 administration to methotrexate-refractory patients resulted in clinical improvement in a subset of patients. Additional studies to characterize efficacy in RA and to determine the optimal dose regimen appear warranted. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT00619905.
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Affiliation(s)
- Rieke Alten
- Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Teaching Hospital Charité University Medicine Berlin, Heubnerweg, D-14059 Berlin, Germany
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Lassere MND, Johnson KR, Boers M, Carlton K, Day RO, de Wit M, Edwards IR, Fries JF, Furst DE, Kirwan JR, Tugwell PS, Woodworth TG, Brooks PM. Standardized assessment of adverse events in rheumatology clinical trials: summary of the OMERACT 7 drug safety module update. J Rheumatol 2005; 32:2037-41. [PMID: 16206366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
A presentation, demonstration, and discussion of recently developed adverse event instruments were the topics for the OMERACT 7 Drug Safety Module. The module began with a plenary introducing the needs and challenges of adverse event ascertainment. It was followed by a review of module work from previous OMERACT meetings on a prototype coding instrument (Rheumatology Common Toxicity Criteria), then a brief description of the process behind the recently developed patient self-report and investigator report adverse event instruments. These current instruments are designed for use in controlled trials although they could be used in other settings. The instruments rely primarily on patient self-reporting using a checklist, which the investigator then folds into a parallel structured but more medically sophisticated instrument. In pilot testing, this innovative dual-use system has shown reliability and acceptability, while preserving validity. A "stakeholder panel" of representatives from 8 sectors followed--patient, nurse investigator, regulator, clinician scientist, industry, OMERACT, global public health/WHO, and Cochrane Collaboration--for their perspectives on the needs, challenges, and potential ways forward for adverse event ascertainment and reporting in clinical trials. At the breakout session small focus groups participated in hands-on interactive testing of one of 3 versions of the instruments, which differ in degree of comprehensiveness. Each focus group had a participatory patient with rheumatoid arthritis. At a second plenary there was group feedback by rapporteurs and presentation of results from pilot studies of iterative testing of validity, reliability, and feasibility of the instruments. During plenary discussion a frequent suggestion for improvement was to refine the process so that event ascertainment could be done entirely using the patient instrument with minimal input from the investigator at the visit, if patient-investigator agreement was high. Most found the patient checklist attractive, particularly if the patient instrument was shown to be reliable and valid. Finally, a future research agenda was discussed.
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Affiliation(s)
- Marissa N D Lassere
- Department of Rheumatology, University of New South Wales, St. George Hospital, Belgrave Street, Kogarah, Sydney, 2127 NSW, Australia.
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Lassere MND, Johnson KR, Woodworth TG, Furst DE, Fries JF, Kirwan JR, Tugwell PS, Day RO, Brooks PM. Challenges and progress in adverse event ascertainment and reporting in clinical trials. J Rheumatol 2005; 32:2030-2. [PMID: 16206364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Toxicity, safety, and tolerability are integral facets of patient risk/benefit decisions, yet the capacity to define, measure, and compare these aspects is underdeveloped compared to aspects of efficacy. There are many reasons for this, scientific and administrative, but all are surmountable. Probably the greatest primary obstacle is the absence of a measurement instrument designed specifically for this purpose. There are increasing calls from various stakeholders for better evidence, and therefore better ascertainment, in this area, especially in randomized trials, and for these reasons OMERACT began deliberations about these concepts in 1994. A prototype coding instrument (the Rheumatology Common Toxicity Criteria) was developed and discussed at OMERACT 5. In the 2 years before OMERACT 7, a process of concept development and iterative design and testing were conducted to develop a patient self-report and investigator-reported adverse event instruments designed for use in trials at the time of visit. The predominant workload is performed by the patient in a self-report checklist, which is then mapped by the trialist onto a medically sophisticated version. This article presents background on the process of developing a dual adverse event instrument, which was presented and critically discussed in detail at OMERACT 7.
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Affiliation(s)
- Marissa N D Lassere
- Department of Rheumatology, University of New South Wales, St. George Hospital, Belgrave Street, Kogarah, Sydney, 2127 NSW, Australia.
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Ayral X, Pickering EH, Woodworth TG, Mackillop N, Dougados M. Synovitis: a potential predictive factor of structural progression of medial tibiofemoral knee osteoarthritis -- results of a 1 year longitudinal arthroscopic study in 422 patients. Osteoarthritis Cartilage 2005; 13:361-7. [PMID: 15882559 DOI: 10.1016/j.joca.2005.01.005] [Citation(s) in RCA: 418] [Impact Index Per Article: 22.0] [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: 05/26/2004] [Accepted: 01/04/2005] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the prevalence of synovitis in painful medial tibiofemoral knee osteoarthritis (OA) and to evaluate correlation between synovitis and the structural severity and progression of tibiofemoral cartilage damage. STUDY Multicenter, longitudinal, 1-year duration. PATIENTS Primary painful knee OA (ACR criteria) of the medial tibiofemoral compartment, with pain of the signal knee on at least 30 days in the past 2 months, medial joint space width > or = 2mm, at least 10% of one cartilage surface of the medial compartment affected by superficial fibrillation or worse at baseline arthroscopy. ARTHROSCOPIC PARAMETERS: Knee arthroscopy under local anesthesia was performed and videorecorded at entry and after 1 year. Medial chondropathy was scored by using Societe Francaise d'Arthroscopie (SFA) score (0-100) and reader's overall assessment (VAS score, 100 mm). Progression of medial chondropathy was defined by a change in SFA and VAS scores over 4.5 and 8.0 mm after 1 year, respectively. Medial perimeniscal synovium was scored as normal (few translucent and slender villi, fine vascular network), reactive (proliferation of opaque villi), or inflammatory (hypervascularization and/or proliferation of hypertrophic and hyperemic villi). Medial chondropathy and synovitis were scored by a single reader blind to chronology of paired videotapes. RESULTS Four hundred and twenty-two patients were enrolled (mean age: 61 years, females: 59%, body mass index: 31, mean disease duration: 4 years) and completed the 1-year study. Synovial abnormalities were present in 50% of the patients with reactive and inflammatory aspects in 29% and 21% of the patients, respectively. Patients with a reactive or inflammatory medial synovium had a more severe medial chondropathy. The worsening in medial chondropathy after 1 year was statistically more severe in the group of patients with an inflammatory perimeniscal synovial membrane at baseline compared to patients with normal and reactive aspects, with no difference between these two latter groups. The odds ratio for progression in VAS score after 1 year was 3.11 (95% CI [1.07, 5.69]) for patients with inflammatory synovium at baseline compared to patients with normal synovium. CONCLUSIONS This study suggests that abnormalities of the medial perimeniscal synovium are a common feature of painful medial knee OA, associated with more severe medial chondropathy. It also suggests that an inflammatory aspect of the medial perimeniscal synovium could be considered as a predictive factor of subsequent increased degradation of medial chondropathy.
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Affiliation(s)
- X Ayral
- Service de Rhumatologie B, Hôpital Cochin, AP-HP, Université René Descartes, Paris, France.
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Kornaat PR, Ceulemans RYT, Kroon HM, Riyazi N, Kloppenburg M, Carter WO, Woodworth TG, Bloem JL. MRI assessment of knee osteoarthritis: Knee Osteoarthritis Scoring System (KOSS)--inter-observer and intra-observer reproducibility of a compartment-based scoring system. Skeletal Radiol 2005; 34:95-102. [PMID: 15480649 DOI: 10.1007/s00256-004-0828-0] [Citation(s) in RCA: 225] [Impact Index Per Article: 11.8] [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: 10/06/2003] [Revised: 01/05/2004] [Accepted: 06/01/2004] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop a scoring system for quantifying osteoarthritic changes of the knee as identified by magnetic resonance (MR) imaging, and to determine its inter- and intra-observer reproducibility, in order to monitor medical therapy in research studies. DESIGN AND PATIENTS Two independent observers evaluated 25 consecutive MR examinations of the knee in patients with previously defined clinical symptoms and radiological signs of osteoarthritis. We acquired on a 1.5 T system: coronal and sagittal proton density- and T2-weighted dual spin echo (SE) images, sagittal three-dimensional T1-weighted gradient echo (GE) images with fat suppression, and axial dual turbo SE images with fat suppression. Images were scored for the presence of cartilaginous lesions, osteophytes, subchondral cysts, bone marrow edema, and for meniscal abnormalities. Presence and size of effusion, synovitis and Baker's cyst were recorded. All parameters were ranked on a previously defined, semiquantitative scale, reflecting increasing severity of findings. Kappa, weighted kappa and intraclass correlation coefficient (ICC) were used to determine inter- and intra-observer variability. RESULTS Inter-observer reproducibility was good (ICC value 0.77). Inter- and intra-observer reproducibility for individual parameters was good to very good (inter-observer ICC value 0.63-0.91; intra-observer ICC value 0.76-0.96). CONCLUSION The presented comprehensive MR scoring system for osteoarthritic changes of the knee has a good to very good inter-observer and intra-observer reproducibility. Thus the score form with its definitions can be used for standardized assessment of osteoarthritic changes to monitor medical therapy in research studies.
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Affiliation(s)
- Peter R Kornaat
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
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Changelian PS, Flanagan ME, Ball DJ, Kent CR, Magnuson KS, Martin WH, Rizzuti BJ, Sawyer PS, Perry BD, Brissette WH, McCurdy SP, Kudlacz EM, Conklyn MJ, Elliott EA, Koslov ER, Fisher MB, Strelevitz TJ, Yoon K, Whipple DA, Sun J, Munchhof MJ, Doty JL, Casavant JM, Blumenkopf TA, Hines M, Brown MF, Lillie BM, Subramanyam C, Shang-Poa C, Milici AJ, Beckius GE, Moyer JD, Su C, Woodworth TG, Gaweco AS, Beals CR, Littman BH, Fisher DA, Smith JF, Zagouras P, Magna HA, Saltarelli MJ, Johnson KS, Nelms LF, Des Etages SG, Hayes LS, Kawabata TT, Finco-Kent D, Baker DL, Larson M, Si MS, Paniagua R, Higgins J, Holm B, Reitz B, Zhou YJ, Morris RE, O'Shea JJ, Borie DC. Prevention of organ allograft rejection by a specific Janus kinase 3 inhibitor. Science 2003; 302:875-8. [PMID: 14593182 DOI: 10.1126/science.1087061] [Citation(s) in RCA: 553] [Impact Index Per Article: 26.3] [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: 01/03/2023]
Abstract
Because of its requirement for signaling by multiple cytokines, Janus kinase 3 (JAK3) is an excellent target for clinical immunosuppression. We report the development of a specific, orally active inhibitor of JAK3, CP-690,550, that significantly prolonged survival in a murine model of heart transplantation and in cynomolgus monkeys receiving kidney transplants. CP-690,550 treatment was not associated with hypertension, hyperlipidemia, or lymphoproliferative disease. On the basis of these preclinical results, we believe JAK3 blockade by CP-690,550 has potential for therapeutically desirable immunosuppression in human organ transplantation and in other clinical settings.
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Affiliation(s)
- Paul S Changelian
- Immunology Group, Department of Antibacterials and Immunology, Pfizer Global Researchand Development, Groton, CT 06340, USA.
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Woodward RS, Schnitzler MA, Baty J, Lowell JA, Lopez-Rocafort L, Haider S, Woodworth TG, Brennan DC. Incidence and cost of new onset diabetes mellitus among U.S. wait-listed and transplanted renal allograft recipients. Am J Transplant 2003; 3:590-8. [PMID: 12752315 DOI: 10.1034/j.1600-6143.2003.00082.x] [Citation(s) in RCA: 286] [Impact Index Per Article: 13.6] [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: 01/25/2023]
Abstract
This study sought to determine 1) the incidence and costs of new onset diabetes mellitus (NODM) associated with maintenance immunosuppression regimens following renal transplantation and 2) whether the mode of dialysis pretransplant or the type of calcineurin inhibition used for maintenance immunosuppression affected either the incidence or cost of NODM. The study examined the United States Renal Data System's clinical and financial records from 1994 to 1998 of all adult, first, single-organ, renal transplantations in either 1996 or 1997 with adequate financial records. It used the second diagnosis of diabetes in previously nondiabetic patients to identify NODM. While NODM had an incidence of approximately 6% per year among wait-listed dialysis patients, NODM over the first 2 years post-transplant had an incidence of almost 18% and 30% among patients receiving cyclosporine and tacrolimus, respectively. By 2 years post-transplant, Medicare paid an extra $21 500 per newly diabetic patient. We estimated the cost of diabetes attributable to maintenance immunosuppression regimens to be $2025 and $3308 for each tacrolimus patient and $1137 and $1611 for each cyclosporine patient at 1 and 2 years post-transplant, respectively.
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Affiliation(s)
- Robert S Woodward
- Department of Health Management and Policy, University of New Hampshire, Durham, NH, USA.
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Woodworth TG, Furst DE, Strand V, Kempeni J, Fenner H, Lau CS, Miller F, Day R, Lipani J, Brooks P. Standardizing assessment of adverse effects in rheumatology clinical trials. Status of OMERACT Toxicity Working Group March 2000: towards a common understanding of comparative toxicity/safety profiles for antirheumatic therapies. J Rheumatol 2001; 28:1163-9. [PMID: 11361207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
This paper describes the background and current status of an OMERACT facilitated effort to improve the consistency of adverse event reporting in rheumatology clinical trials. The overall goal is the development of an adverse event assessment tool that would provide a basis for use of common terminology and improve the consistency of reporting severity of side effects within rheumatology clinical trials and during postmarketing surveillance. The resulting Rheumatology Common Toxicity Criteria Index encompassed the following organ systems: allergic/immunologic, cardiac, ENT, gastrointestinal, musculoskeletal, neuropsychiatric, ophthalmologic, pulmonary and skin/integument. Before this tool is widely accepted, its validity, consistency, and feasibility need to be assessed in clinical trials.
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31
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Lee SC, Brummet ME, Shahabuddin S, Woodworth TG, Georas SN, Leiferman KM, Gilman SC, Stellato C, Gladue RP, Schleimer RP, Beck LA. Cutaneous injection of human subjects with macrophage inflammatory protein-1 alpha induces significant recruitment of neutrophils and monocytes. J Immunol 2000; 164:3392-401. [PMID: 10706735 DOI: 10.4049/jimmunol.164.6.3392] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Macrophage inflammatory protein (MIP-1 alpha), a member of the CC chemokine subfamily, has been shown to attract T cells and monocytes in vitro and to be expressed at sites of inflammation. Although the in vitro activities of MIP-1 alpha have been well documented, the in vivo biological activities of MIP-1 alpha in humans have not been studied. To address this, we challenged human subjects by intradermal injection with up to 1000 pmol of MIP-1 alpha and performed biopsies 2, 10, and 24 h later. Although no acute cutaneous or systemic reactions were noted, endothelial cell activation, as indicated by the expression of E-selectin, was observed. In agreement with its in vitro activity, monocyte, lymphocyte, and, to a lesser degree, eosinophil infiltration was observed, peaking at 10-24 h. Surprisingly, in contrast to its reported lack of in vitro neutrophil-stimulating activity, a rapid infiltration of neutrophils was observed in vivo. This neutrophil infiltration occurred as early as 2 h, preceding the appearance of other cells, and peaked at 10 h. Interestingly, we found that neutrophils in whole blood, but not after isolation, expressed CCR1 on their cell surface. This CCR1 was thought to be functional as assessed by neutrophil CD11b up-regulation following whole-blood MIP-1 alpha stimulation. These studies substantiate the biological effects of MIP-1 alpha on monocytes and lymphocytes and uncover the previously unrecognized activity of MIP-1 alpha to induce neutrophil infiltration and endothelial cell activation, underscoring the need to evaluate chemokines in vivo in humans.
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Affiliation(s)
- S C Lee
- Johns Hopkins Asthma and Allergy Center, Baltimore, MD 21224, USA
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32
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Schrohenloher RE, Koopman WJ, Woodworth TG, Moreland LW. Suppression of in vitro IgM rheumatoid factor production by diphtheria toxin interleukin 2 recombinant fusion protein (DAB 486IL-2) in patients with refractory rheumatoid arthritis. J Rheumatol 1996; 23:1845-8. [PMID: 8923354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the effect of diphtheria toxin interleukin 2 recombinant fusion protein (DAB 486IL-2) on in vitro synthesis of immunoglobulin and rheumatoid factor (RF) in patients with severe refractory rheumatoid arthritis (RA) enrolled in a phase II, double blind, placebo controlled study. METHODS Anticoagulated venous blood samples were obtained before (Day 1) and after (Day 28) intravenous infusion of either DAB 486IL-2 at 0.075 mg/kg/day (12 patients) or saline placebo (10 patients) on Days 1-5. Peripheral blood leukocytes (PBL) were prepared by density gradient centrifugation, cultured in the presence and absence of pokeweed mitogen (PWM) for one week, and culture supernatants assayed for immunoglobulins and IgM RF by ELISA. RESULTS Compared to placebo treated patients, PWM induced IgM RF synthesis by PBL decreased after treatment with DAB 486IL-2 (p = 0.043). However, there was no apparent correlation with clinical improvement. PWM induced IgM, IgA, and IgG synthesis also tended to decrease, although the changes did not attain statistical significance. In contrast, PWM induced IgM RF, IgM, IgA, and IgG synthesis by PBL from patients treated with placebo tended to increase during the observation period. Spontaneous immunoglobulin and IgM RF production by PBL from either the DAB 486IL-2 or placebo patients remained stable. CONCLUSION These observations raise the possibility that DAB 486IL-2 may diminish B cell function either directly or indirectly through effects on T cell function, but the change may not correspond to clinical response.
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Affiliation(s)
- R E Schrohenloher
- Department of Medicine, University of Alabama at Birmingham 35294-7201, USA
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Miller DD, Bach RG, Tio FO, Bailey SR, Waters CA, Woodworth TG, Nichols JC, Paige SB, Farrar M. Interleukin-2 receptor-specific fusion toxin inhibits barotrauma-induced arterial atherosclerosis. Atherosclerosis 1996; 126:1-14. [PMID: 8879429 DOI: 10.1016/0021-9150(96)05843-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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] [Indexed: 02/02/2023]
Abstract
Immunocytochemical analyses of human plaques and experimental arterial lesions have implicated activated lymphocytes and monocytes in the pathogenesis of atherosclerosis, as demonstrated by the expression of interleukin-2 (IL-2) membrane receptors and major histocompatibility complex class II epitopes. The objective is to determine if targeting these cells with an IL-2 receptor-specific chimeric toxin, DAB486-IL-2, can inhibit experimental post-angioplasty vascular neointimal thickening. Twenty-two atherogenically modeled rabbits were treated in vivo with DAB486-IL-2 (0.1 mg/kg per day i.v.; n = 11) or placebo (n = 11) for 10 days following aortic balloon angioplasty (4 atm x 30 s each x 2 dilatations). In vitro 3H-leucine incorporation studies of mononuclear leukocyte and vascular smooth muscle cell protein synthesis inhibition by DAB486-IL-2 were also performed. Angioplasty sites were examined for evidence of hyperproliferative atherosclerotic narrowing by quantitative angiography and histomorphometry of neointimal cross-sectional area at baseline and 6 weeks after injury. In vitro Concanavalin-A stimulated rabbit mononuclear leukocyte protein synthesis was 50% inhibited by DAB486-IL-2 at a concentration (IC50) of 6 x 10(-11) M. Rabbit vascular smooth muscle cells were approximately 150-fold less sensitive to DAB486-IL-2 (IC50 = 10(-8) M). In vivo studies showed no change in angioplasty site angiographic minimum luminal diameter at 6 weeks in DAB486-IL-2 treated animals (from 2.96 +/- 0.52 to 2.96 +/- 0.48 mm; percent cross-sectional area reduction = 1 +/- 10%; P = N.S.). In control animals, luminal diameter decreased from 2.79 +/- 0.4 to 2.32 +/- 0.52 mm at 6 weeks, and percent cross-sectional area was reduced by 34 +/- 14% (P < 0.01 vs. placebo). Quantitative histomorphometric angioplasty segmental intimal cross-sectional area reduction of treated and placebo vessels also differed significantly (19 +/- 16% vs. 31 +/- 21%; P < 0.05). DAB486-IL-2 caused no adverse effects on animal survival, weight or hepatic transaminase levels. We conclude that post-angioplasty administration of the chimeric toxin DAB486-IL-2 inhibits angiographic narrowing and neointimal thickening in the atherogenic rabbit model. Although this IL-2 receptor-specific molecule was cytotoxic in vitro for activated mononuclear leukocytes and vascular smooth muscle cells, systemic toxicity did not occur in vivo at a dose comparable to that evaluated in clinical trials of this agent. Potential anti-proliferative effects of this chimeric toxin may be mediated by direct local inhibition of leukocyte-mediated inflammation, or through the indirect modification of vascular cell mitogenesis and cytokine release.
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MESH Headings
- Angioplasty, Balloon/adverse effects
- Animals
- Aorta, Abdominal/injuries
- Aorta, Abdominal/pathology
- Arteriosclerosis/etiology
- Arteriosclerosis/prevention & control
- Arteriosclerosis/therapy
- Concanavalin A/pharmacology
- Cytotoxins/pharmacology
- Cytotoxins/therapeutic use
- Diet, Atherogenic
- Diphtheria Toxin/genetics
- Diphtheria Toxin/pharmacology
- Diphtheria Toxin/therapeutic use
- Female
- Iliac Artery/injuries
- Iliac Artery/pathology
- Interleukin-2/genetics
- Interleukin-2/pharmacology
- Interleukin-2/therapeutic use
- Leukocytes, Mononuclear/drug effects
- Leukocytes, Mononuclear/immunology
- Lymphocyte Activation/drug effects
- Male
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/pathology
- Rabbits
- Receptors, Interleukin-2/drug effects
- Recombinant Fusion Proteins/genetics
- Recombinant Fusion Proteins/pharmacology
- Recombinant Fusion Proteins/therapeutic use
- Recurrence
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Affiliation(s)
- D D Miller
- Department of Internal Medicine, St. Louis University Medical Center, MO 63110-0250, USA
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Moreland LW, Sewell KL, Trentham DE, Bucy RP, Sullivan WF, Schrohenloher RE, Shmerling RH, Parker KC, Swartz WG, Woodworth TG. Interleukin-2 diphtheria fusion protein (DAB486IL-2) in refractory rheumatoid arthritis. A double-blind, placebo-controlled trial with open-label extension. Arthritis Rheum 1995; 38:1177-86. [PMID: 7575710 DOI: 10.1002/art.1780380902] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE This pilot phase II, double-blind, placebo-controlled trial of 1 month duration, with a 2-3-month open-label extension, evaluated the safety, tolerability, biologic effects, and efficacy of interleukin-2 diphtheria fusion protein (DAB486IL-2) in refractory rheumatoid arthritis (RA). METHODS Forty-five RA patients were enrolled in the trial, and were randomized, after a 3-4-week disease-modifying antirheumatic drug washout, to receive a daily intravenous dose of either DAB486IL-2 or placebo (saline) for 5 days. A blinded, third-party observer evaluated arthritis activity. Clinical response was defined as > or = 25% improvement in swollen and tender joints and > or = 25% improvement in at least 2 of 6 additional parameters. The double-blind phase was 4 weeks; placebo patients could cross over to receive open-label treatment for a maximum of 3 monthly DAB486IL-2 cycles. RESULTS In the double-blind phase, 4 of 22 patients (18%) in the treated group and none in the placebo group (P = 0.05) met the criteria for clinical response. During the open-label treatment phase, 11 of 36 patients (31%) and 11 of 33 patients (33%) had a clinical response after completing 2 and 3 courses of DAB486IL-2, respectively. Adverse events included transient fever/chills (45%), nausea/vomiting (50%), elevated (< or = 3 x normal) transaminases (55%), and increased joint pain (45%). Twelve patients (8 placebo, 4 DAB486IL-2) did not complete 3 treatment cycles. No apparent differences were noted in CD4+ CD25+ cells of responders versus nonresponders, or of DAB486IL-2-treated versus placebo-treated patients. CONCLUSION Clinical responses were noted in patients treated with DAB486IL-2 (18%) compared with placebo (0%) in the double-blind phase. In the open-label phase, 33% of patients completing 3 monthly DAB486IL-2 cycles had improvement in arthritis activity. Further studies of IL-2 diphtheria fusion proteins are warranted to elucidate factors that may predict clinical response and define mechanism(s) of action.
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Affiliation(s)
- L W Moreland
- Division of Clinical Immunology/Rheumatology, SRC 068, UAB Station 35294-7201, USA
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35
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Gottlieb SL, Gilleaudeau P, Johnson R, Estes L, Woodworth TG, Gottlieb AB, Krueger JG. Response of psoriasis to a lymphocyte-selective toxin (DAB389IL-2) suggests a primary immune, but not keratinocyte, pathogenic basis. Nat Med 1995; 1:442-7. [PMID: 7585092 DOI: 10.1038/nm0595-442] [Citation(s) in RCA: 413] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Psoriasis is a hyperproliferative and inflammatory skin disorder of unknown aetiology. A fusion protein composed of human interleukin-2 and fragments of diphtheria toxin (DAB389IL-2), which selectively blocks the growth of activated lymphocytes but not keratinocytes, was administered systemically to ten patients to gauge the contribution of activated T cells to the disease. Four patients showed striking clinical improvement and four moderate improvement, after two cycle of low dose IL-2-toxin. The reversal of several molecular markers of epidermal dysfunction was associated with a marked reduction in intraepidermal CD3+ and CD8+ T cells, suggesting a primary immunological basis for this widespread disorder.
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Affiliation(s)
- S L Gottlieb
- Laboratory for Investigative Dermatology, Rockefeller University, New York, New York 10021-6399, USA
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36
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Platanias LC, Ratain MJ, O'Brien S, Larson RA, Vardiman JW, Shaw JP, Williams SF, Baron JM, Parker K, Woodworth TG. Phase I trial of a genetically engineered interleukin-2 fusion toxin (DAB486IL-2) as a 6 hour intravenous infusion in patients with hematologic malignancies. Leuk Lymphoma 1994; 14:257-62. [PMID: 7950914 DOI: 10.3109/10428199409049676] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [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
DAB486IL-2 is a recombinant fusion toxin, created by replacement of the receptor binding domain sequences of the diphtheria toxin gene with the sequences for human interleukin-2 (IL-2). It selectively binds to and intoxicates cells expressing the high-affinity IL-2 receptor. A total of 17 patients with refractory hematologic malignancies were entered in a phase I study of DAB486IL-2, administered as a 6 hour continuous intravenous infusion on days 1, 2, 8, 9, 15, and 16 of each 28 day cycle. Cohorts of 3 to 6 patients were treated with escalating doses. The starting dose was 0.1 mg/kg/day with increments of 0.1 mg/kg/day per dose level up to 0.3 mg/kg/day. Significant adverse effects included transient asymptomatic elevation of liver transaminases, hypersensitivity, anemia, thrombocytopenia, fever, and creatinine elevation. A partial response of approximately nine months duration was observed in a patient with small cell lymphocytic non-Hodgkin's lymphoma, previously refractory to high-dose chemotherapy and autologous bone marrow transplantation. The observance of antitumor activity in a patient highly refractory to chemotherapy suggests that DAB486IL-2 may have efficacy in selected patients whose malignant cells express the IL-2 receptor.
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Affiliation(s)
- L C Platanias
- Department of Medicine, University of Chicago, Pritzker School of Medicine, Illinois
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37
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Tepler I, Schwartz G, Parker K, Charette J, Kadin ME, Woodworth TG, Schnipper LE. Phase I trial of an interleukin-2 fusion toxin (DAB486IL-2) in hematologic malignancies: complete response in a patient with Hodgkin's disease refractory to chemotherapy. Cancer 1994; 73:1276-85. [PMID: 8313331 DOI: 10.1002/1097-0142(19940215)73:4<1276::aid-cncr2820730424>3.0.co;2-d] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [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: 01/29/2023]
Abstract
BACKGROUND DAB486IL-2 is a recombinant fusion toxin in which the native diphtheria toxin-receptor binding-domain has been replaced with human interleukin-2 (IL-2). This molecule is specifically cytotoxic in vitro within 30 minutes for cells that express the high-affinity IL-2 receptor (IL-2R). METHODS This was a Phase I/II study of DAB486IL-2 as a brief infusion in 15 patients with refractory lymphoid malignancies. Five patients per cohort received DAB486IL-2 as a 30-60 minute intravenous infusion at dose levels of 0.075, 0.115, and 0.2 mg/kg daily for 5 days. RESULTS The maximal tolerated dose (MTD) of DAB486IL-2 was determined to be 0.2 mg/kg daily on the basis of hypersensitivity-like symptoms and reversible hepatic transaminase elevations. Other adverse effects included mild creatinine elevations, proteinuria, and hypoalbuminemia. The presence of antibodies to diphtheria toxin or DAB486IL-2 was correlated with hypersensitivity-like effects but did not prevent an antitumor effect. One complete response was observed in a patient with Hodgkin's disease in relapse with bilateral pulmonary nodules after autologous bone marrow transplantation. He remains free of disease more than 2 years after completion of therapy. CONCLUSIONS The dramatic antitumor response seen in one patient and the relative tolerability of DAB486IL-2 indicates the potential utility of this targeted agent in IL-2-expressing hematologic malignancies.
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Affiliation(s)
- I Tepler
- Division of Hematology/Oncology, Beth Israel Hospital, Harvard Medical School, Boston, MA 02215
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38
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Sewell KL, Parker KC, Woodworth TG, Reuben J, Swartz W, Trentham DE. DAB486IL-2 fusion toxin in refractory rheumatoid arthritis. Arthritis Rheum 1993; 36:1223-33. [PMID: 8216416 DOI: 10.1002/art.1780360907] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the safety and antiarthritic effects of DAB486IL-2. This agent is a fusion toxin and the product of a synthetic gene, engineered by replacing the codons for the receptor-binding domain of diphtheria toxin (DT) with the codons for human interleukin-2 (IL-2). DAB486IL-2 targets cells expressing the 2-chain, high-affinity form of the IL-2 receptor (IL-2R), and achieves selective diphtheria toxin-mediated cytotoxicity of activated T cells by inhibition of protein synthesis. METHODS Nineteen patients with rheumatoid arthritis (RA) that had been refractory to methotrexate participated in an open-label, phase I/II trial evaluating 3 dose levels of intravenous DAB486IL-2 given for 5 or 7 consecutive days. Thirteen patients received additional courses, at higher doses if the original response had been inadequate or at an equivalent dose if the original course produced a response, for a total of 38 courses. Arthritis response was assessed at 28 days, with biweekly followup of patients with substantial response (> or = 50% improved) or meaningful response (> or = 25% improved). Laboratory monitoring included measurement of CD4+ cells and circulating shed IL-2R. RESULTS Nine of 19 patients treated with high- or medium-dose DAB486IL-2 had a substantial or meaningful response after 1 or 2 treatment courses. No significant responses occurred with the low-dose regimen. Clinical benefit was rapid, with full effect noted by 14 days following completion of infusions. Antibodies to DT developed in all patients, or levels of preexisting antibodies were boosted. Adverse effects included transient elevation of transaminase levels (55% of the patients), fever (40%), nausea or anorexia (30%), hypersensitivity (6%), and thrombocytopenia (5%). Repeat courses were associated with less transaminase elevation and were clinically effective despite induction of anti-DT antibodies. CONCLUSION The results of this open trial provide preliminary evidence for a potential therapeutic effect of DAB486IL-2 in RA, with an acceptable safety profile. Reversible transaminase elevations limit escalation of the dosage beyond 0.1 mg/kg/day. A controlled study of DAB486IL-2 is required to determine the efficacy of this high-affinity IL-2R-targeted fusion toxin in the treatment of RA.
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Affiliation(s)
- K L Sewell
- Department of Medicine, Beth Israel Hospital, Boston, MA 02215
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39
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Woodworth TG. Early clinical studies of IL-2 fusion toxin in patients with severe rheumatoid arthritis and recent onset insulin-dependent diabetes mellitus. Clin Exp Rheumatol 1993; 11 Suppl 8:S177-80. [PMID: 8324945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
DAB486IL-2 is the first of a new class of targeted biologicals called fusion toxins. This agent is an interleukin-2 receptor (IL-2R)-targeted cytotoxin which kills activated IL-2R-expressing lymphocytes at 10(-10) M concentrations. Since activated lymphocytes are thought to play a role in many autoimmune conditions, DAB486IL-2 has been evaluated in patients with severe rheumatoid arthritis and recent onset autoimmune insulin-dependent diabetes mellitus. Initial safety, pharmacokinetics and evidence of IL-2R specific cytotoxicity were obtained in patients with IL-2 receptor expressing malignancies; these studies served as a basis for the initiation of an open label phase I/II evaluation of DAB486IL-2 in patients with severe, methotrexate refractory rheumatoid arthritis. This pilot study provided preliminary evidence of acceptable safety at doses which induced meaningful (> 25%) or substantial (> 50%) improvement in 9 of 18 patients who received a mid (130 kU/kg/d) or a high (260 kU/kg/d) dose daily for 5 to 7 days. The most frequent adverse effects were transient hepatic transminase elevation and fever. Although some patients noted a transient increase in joint pain, onset of improvement occurred within 7 to 14 days of initiation of DAB486IL-2. Because of these results, a two-center, double-blind, placebo-controlled trial was conducted from December 1991 to December 1992. Forty-five patients with active severe RA unresponsive to at least 2 DMARDS were randomized to placebo or DAB486IL-2 following a 3 to 4 week washout/run-in period to establish a stable baseline (< 40% fluctuation in swollen and painful, tender joint counts).(ABSTRACT TRUNCATED AT 250 WORDS)
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Abstract
With the exception of certain hematologic malignancies, the high affinity interleukin-2 (IL-2) receptor is only transiently expressed during the brief antigen-triggered proliferative burst of lymphocytes. Hence, we wondered whether administration of anti-IL-2 receptor (IL-2R) monoclonal antibody (mAb) or chimeric IL-2 toxins would provide a utilitarian way to achieve immunosuppression aimed directly at activated lymphocytes, or whether this approach could be used to treat IL-2R+ leukemia/lymphoma. Studies in preclinical autoimmune and transplant models indicate that this approach can be effective. The results of open, uncontrolled studies provide preliminary evidence that a chimeric IL-2 toxin is well tolerated at doses that may induce improvement in patients with IL-2R+ leukemia/lymphoma, as well as in patients with refractory rheumatoid arthritis or new-onset diabetes mellitus.
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Affiliation(s)
- T B Strom
- Department of Medicine, Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts 02215
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41
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Abstract
The design and construction of a new class of recombinant therapeutic agents, receptor-specific cytotoxins, has occurred within the last 5 years. Development of a number of receptor-targeted fusion toxins has been based on a detailed understanding of the structure-function relationships of both diphtheria toxin and Pseudomonas exotoxin A, and availability of the nucleic acid sequences of each structural gene. A variety of fusion toxins in which the native receptor-binding domain of either diphtheria toxin or Pseudomonas exotoxin A has been genetically replaced with either a polypeptide hormone or growth factor have been constructed. These fusion toxins selectively intoxicate receptor-bearing cells in vitro and are active in a variety of animal model systems. DAB486IL-2, and IL-2 receptor targeted cytotoxin, is the first fusion toxin to be evaluated in patients. Phase I/II clinical trials have been performed in refractory leukemia/lymphoma, severe rheumatoid arthritis, and Type 1 diabetes. DAB486IL-2 has been administered to more than 200 patients, has been well tolerated, and has shown encouraging signs of potential efficacy in all three clinical indications. Thus, DAB486IL-2 represents a new class of targeted biological therapeutic response modifiers whose mode of action is based on selective elimination of target cells.
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42
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Strom TB, Kelley VR, Woodworth TG, Murphy JR. Interleukin-2 receptor-directed immunosuppressive therapies: antibody- or cytokine-based targeting molecules. Immunol Rev 1992; 129:131-63. [PMID: 1464418 DOI: 10.1111/j.1600-065x.1992.tb01422.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- T B Strom
- Department of Medicine, Beth Israel Hospital, Boston, MA
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Woodworth TG, Abuelo JG, Austin HA, Esparza A. Severe glomerulonephritis with late emergence of classic Wegener's granulomatosis. Report of 4 cases and review of the literature. Medicine (Baltimore) 1987; 66:181-91. [PMID: 3574116 DOI: 10.1097/00005792-198705000-00002] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
We have analyzed an unusual group of 19 patients (15 previously reported) with Wegener's granulomatosis, who presented with severe glomerulonephritis and developed diagnostic respiratory lesions only after 4 to 78 months. Necrotizing glomerulonephritis, often with crescents, and rarely with vasculitis, was the predominant renal lesion. Wegener's granulomatosis was unsuspected initially, since systemic manifestations, such as fever, arthralgias, malaise, and even pulmonary hemorrhage, were nonspecific or transient, and because renal biopsy findings resembled those seen in microscopic polyarteritis or idiopathic crescentic nephritis. Despite therapy, usually with corticosteroids, only 4 patients maintained adequate renal function. Most patients were receiving chronic dialysis when respiratory involvement developed. Cavitary nodular pulmonary infiltrates were seen in 12 of the 17 patients with lung involvement, and otorhinological disease occurred in 10 patients. Arthralgias, fever, and cough, with or without hemoptysis, were common. Wegener's granulomatosis was diagnosed by lung biopsy in 15 cases and by nasal biopsy in 4. Specific treatment was required for the respiratory disease and was delayed in many patients, because of lack of awareness that Wegener's granulomatosis may present with primary glomerulonephritis and become active during chronic renal failure or dialysis. Nevertheless, all but 1 patient eventually responded to treatment, although 3 additional patients died of late complications.
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