1
|
Galluppi GR, Ahamadi M, Bhattacharya S, Budha N, Gheyas F, Li CC, Chen Y, Dosne AG, Kristensen NR, Magee M, Samtani MN, Sinha V, Taskar K, Upreti VV, Yang J, Cook J. Considerations for Industry-Preparing for the FDA Model-Informed Drug Development (MIDD) Paired Meeting Program. Clin Pharmacol Ther 2024. [PMID: 38519861 DOI: 10.1002/cpt.3245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/01/2024] [Indexed: 03/25/2024]
Abstract
A recent industry perspective published in this journal describes the benefits received by drug companies from participation in the MIDD Pilot Program. Along with the primary objectives of supporting good decision-making in drug development, there were substantial savings in time and development costs. Furthermore, many sponsors reported qualitative benefits such as new learnings and clarity on MIDD strategies and methodology that could be applied to other development programs. Based on the success of the Pilot Program, the FDA recently announced the continuation of the MIDD Paired Meeting Program as part of the Prescription Drug User Fee Act (PDUFA VII). In this report, we describe the collective experiences of industry participants in the MIDD Program to date, including all aspects of the process from meeting request submission to follow-up actions. The purpose is to provide future participants with information to optimize the value of the MIDD Program.
Collapse
Affiliation(s)
- Gerald R Galluppi
- Sunovion Pharmaceuticals Inc. a U.S. subsidiary of Sumitomo Pharma America, Marlborough, Massachusetts, USA
| | | | | | | | | | - Chi-Chung Li
- Genentech Inc, South San Francisco, California, USA
| | - Yuan Chen
- Genentech Inc, South San Francisco, California, USA
| | | | | | | | | | - Vikram Sinha
- Novartis Pharmaceutical Corporation, Basel, Switzerland
| | | | | | | | | |
Collapse
|
2
|
Schanberg LE, Mulugeta LY, Akinlade B, Brunner HI, Chen J, Colbert RA, Delgaizo V, Gastonguay MR, Glaser R, Imundo L, Lovell DJ, Leu JH, Mostafa NM, Nelson RM, Nigrovic PA, Nikolov NP, Rider LG, Rothwell R, Sahajwalla C, Singh R, Sinha V, Yancey CL, Yao L. Therapeutic Development in Polyarticular Course Juvenile Idiopathic Arthritis: Extrapolation, Dose Selection, and Clinical Trial Design. Arthritis Rheumatol 2023; 75:1856-1866. [PMID: 37067688 DOI: 10.1002/art.42534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/15/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVE Stakeholders met to address persistent challenges facing the development of therapeutics for polyarticular juvenile idiopathic arthritis (pJIA), which result in fewer approved therapies for children with pJIA than adults with rheumatoid arthritis (RA) and long lag times from adult RA approval to pediatric labeling. Ensuring that new medications are authorized in a timely manner to meet the needs of JIA patients worldwide is critically important to multiple stakeholders. METHODS The Food and Drug Administration in collaboration with the University of Maryland Center for Regulatory Science and Innovation held a public workshop entitled "Accelerating Drug Development for pJIA" on October 2, 2019, to address challenges surrounding access to new medications for children and adolescents with pJIA. Regulatory, academic, and industry stakeholders, as well as patient representatives, participated in the workshop, which consisted of 4 sessions, including panel discussions. RESULTS The workshop facilitated broad public discussion of challenges facing the development of pJIA therapeutics, highlighting areas of need and outlining opportunities to expedite development, while underscoring the necessity of close collaboration between all stakeholders, including patients and families. CONCLUSION This report summarizes key aspects of the workshop, including the appropriate application of innovative approaches to the development of pJIA therapeutics, including extrapolation, to address current challenges and provide timely access to newer safe and effective treatments. Long-term safety assessment is of pressing concern to stakeholders and cannot be fully extrapolated from adult studies but requires consistent postmarketing long-term follow-up.
Collapse
Affiliation(s)
- Laura E Schanberg
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Lily Yeruk Mulugeta
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | | | | | - Jianmeng Chen
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Robert A Colbert
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | | | - Rachel Glaser
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Lisa Imundo
- Columbia University Irving Medical Center, New York, New York
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jocelyn H Leu
- Janssen Research and Development, Spring House, Pennsylvania
| | | | | | - Peter A Nigrovic
- Division of Immunology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School and Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Nikolay P Nikolov
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, NIH, Bethesda, Maryland
| | - Rebecca Rothwell
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Chandrahas Sahajwalla
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Renu Singh
- Gilead Sciences, Foster City, California
| | - Vikram Sinha
- Novartis Pharmaceutical Corporation, One Health Plaza, East Hanover NJ, 07936, USA
| | - Carolyn L Yancey
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Lynne Yao
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| |
Collapse
|
3
|
Sinha V, Thompson Z, Vijayan R. Stuck in our ways: is inertia among surgeons the major obstacle to greener surgery? Br J Surg 2023; 110:1224-1225. [PMID: 37463413 DOI: 10.1093/bjs/znad223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 07/20/2023]
Affiliation(s)
- Vikram Sinha
- Department of Palliative Care, East Kent Hospitals University Foundation Trust, Ashford, Kent, UK
| | - Zoe Thompson
- Department of Occupational Therapy, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Roshan Vijayan
- Department of Plastic Surgery, East and North Hertfordshire NHS Foundation Trust, Stevenage, UK
| |
Collapse
|
4
|
Gupta N, Hanley MJ, Griffin RJ, Zhang P, Venkatakrishnan K, Sinha V. Clinical Pharmacology of Brigatinib: A Next-Generation Anaplastic Lymphoma Kinase Inhibitor. Clin Pharmacokinet 2023; 62:1063-1079. [PMID: 37493887 PMCID: PMC10386943 DOI: 10.1007/s40262-023-01284-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/27/2023]
Abstract
Brigatinib, a next-generation anaplastic lymphoma kinase (ALK) inhibitor designed to overcome mechanisms of resistance associated with crizotinib, is approved for the treatment of ALK-positive advanced or metastatic non-small cell lung cancer. After oral administration of single doses of brigatinib 30-240 mg, the median time to reach maximum plasma concentration ranged from 1 to 4 h. In patients with advanced malignancies, brigatinib showed dose linearity over the dose range of 60-240 mg once daily. A high-fat meal had no clinically meaningful effect on systemic exposures of brigatinib (area under the plasma concentration-time curve); thus, brigatinib can be administered with or without food. In a population pharmacokinetic analysis, a three-compartment pharmacokinetic model with transit absorption compartments was found to adequately describe brigatinib pharmacokinetics. In addition, the population pharmacokinetic analyses showed that no dose adjustment is required based on body weight, age, race, sex, total bilirubin (< 1.5× upper limit of normal), and mild-to-moderate renal impairment. Data from dedicated phase I trials have indicated that no dose adjustment is required for patients with mild or moderate hepatic impairment, while a dose reduction of approximately 40% (e.g., from 180 to 120 mg) is recommended for patients with severe hepatic impairment, and a reduction of approximately 50% (e.g., from 180 to 90 mg) is recommended when administering brigatinib to patients with severe renal impairment. Brigatinib is primarily metabolized by cytochrome P450 (CYP) 3A, and results of clinical drug-drug interaction studies and physiologically based pharmacokinetic analyses have demonstrated that coadministration of strong or moderate CYP3A inhibitors or inducers with brigatinib should be avoided. If coadministration with a strong or moderate CYP3A inhibitor cannot be avoided, the dose of brigatinib should be reduced by approximately 50% (strong CYP3A inhibitor) or approximately 40% (moderate CYP3A inhibitor), respectively. Brigatinib is a weak inducer of CYP3A in vivo; data from a phase I drug-drug interaction study showed that coadministration of brigatinib 180 mg once daily reduced the oral midazolam area under the plasma concentration-time curve from time zero to infinity by approximately 26%. Brigatinib did not inhibit CYP1A2, CYP2B6, CYP2C8, CYP2C9, CYP2C19, or CYP2D6 at clinically relevant concentrations in vitro. Exposure-response analyses based on data from the ALTA (ALK in Lung Cancer Trial of AP26113) and ALTA-1L pivotal trials of brigatinib confirm the favorable benefit versus risk profile of the approved titration dosing regimen of 180 mg once daily (after a 7-day lead-in at 90 mg once daily).
Collapse
Affiliation(s)
- Neeraj Gupta
- Takeda Development Center Americas, Inc., Lexington, MA, USA.
- Takeda Development Centers America, Inc., 40 Landsdowne Street, MA, 02139, Cambridge, USA.
| | | | | | - Pingkuan Zhang
- Takeda Development Center Americas, Inc., Lexington, MA, USA
| | - Karthik Venkatakrishnan
- Millennium Pharmaceuticals, Inc., a Wholly Owned Subsidiary of Takeda Pharmaceutical Company Limited, 40 Landsdowne Street, MA, 02139, Cambridge, USA
- EMD Serono Research and Development Institute, Inc., Billerica, MA, USA
| | - Vikram Sinha
- Takeda Development Center Americas, Inc., Lexington, MA, USA
- Novartis Development Corporation, East Hanover, NJ, USA
| |
Collapse
|
5
|
Sinha V, Zolfaghari Y, Vijayan R. The great cover up: Environmental toll of excessive surgical draping in minimally invasive surgery. J Plast Reconstr Aesthet Surg 2023; 82:209-210. [PMID: 37186976 DOI: 10.1016/j.bjps.2023.04.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/16/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Vikram Sinha
- East Kent Hospitals University Foundation Trust, Kent, United Kingdom
| | - Yasmin Zolfaghari
- Medway Maritime Hospital, Medway NHS Foundation Trust, Gillingham, Kent, United Kingdom.
| | - Roshan Vijayan
- East and North Hertfordshire NHS Foundation Trust, Stevenage, United Kingdom
| |
Collapse
|
6
|
Borrelli MR, Spake CSL, Rao V, Sinha V, Crozier JW, Basta MN, Lee GK, Kwan DK, Nazerali R. A Systematic Review and Meta-Analysis Comparing the Clinical Outcomes of Profunda Artery Perforator Versus Gracilis Thigh Flap as a Second Choice for Autologous Breast Reconstruction. Ann Plast Surg 2023; 90:S256-S267. [PMID: 37227406 DOI: 10.1097/sap.0000000000003226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Autologous breast reconstruction remains a versatile option to produce a natural appearing breast after mastectomy. The deep inferior epigastric perforator remains the most commonly used flap choice, but when this donor site is unsuitable or unavailable, the transverse upper gracilis (TUG) or profunda artery perforator (PAP) flaps are popular secondary alternatives. We conduct a meta-analysis to better understand patient outcomes and adverse events in secondary flap selection in breast reconstruction. METHODS A systematic search was conducted on MEDLINE and Embase for all articles published on TUG and/or PAP flaps for oncological breast reconstruction in postmastectomy patients. A proportional meta-analysis was conducted to statistically compare outcomes between PAP and TUG flaps. RESULTS The TUG and PAP flaps were noted to have similar reported rates of success and incidences of hematoma, flap loss, and flap healing (P > 0.05). The TUG flap was noted to have significantly more vascular complications (venous thrombosis, venous congestion, and arterial thrombosis) than the PAP flap (5.0% vs 0.6%, P < 0.01) and significantly greater rates of unplanned reoperations in the acute postoperative period (4.4% vs 1.8%, P = 0.04). Infection, seroma, fat necrosis, donor healing complications, and rates of additional procedures all exhibited high degree of heterogeneity precluding mathematical synthesis of outcomes across studies. CONCLUSIONS Compared with TUG flaps, PAP flaps have fewer vascular complications and fewer unplanned reoperations in the acute postoperative period. There is need for greater homogeneity in reported outcomes between studies to enable for synthesis of other variables important in determining flap success.
Collapse
Affiliation(s)
- Mimi R Borrelli
- From the Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Carole S L Spake
- From the Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Vinay Rao
- From the Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Vikram Sinha
- School of Medical Education, King's College London, London, United Kingdom
| | - Joseph W Crozier
- From the Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Marten N Basta
- From the Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Gordon K Lee
- Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA
| | - Daniel K Kwan
- From the Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Rahim Nazerali
- Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA
| |
Collapse
|
7
|
Ahire M, Sinha V. After-COVID era: Workplace 4.0 as the new revolution of employee experience. CM 2022. [DOI: 10.18137/cardiometry.2022.23.272282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: Analysis of the shift from Employee Engagement to Employee Experience, its effect on Organization Efficiency, and impact on Employee Advocacy. It aims to reframe human resource practices that fit better in the modern workplace. Design/Methodology: Conduct Survey with early adopters or in the stage of adopting Employee Experience concept across different sectors and Systematic & A critical review of Literature on Evolution, Global trends & Impact of Employee Experience. Findings: Employee Experience leads to great customer experience, which creates loyal customers and stronger financial results, resulting in Employee Advocacy and Employer Branding. Practical Applications: Employee Experience is considered the most trending HR practice and has implications on the workplace’s physical, technological & cultural environment. Originality Value: To retain the multigenerational workforce, we need to bring personalization in experiences across different stages of the employment cycle & employee-first approach rather than the traditional customer-first approach.
Collapse
|
8
|
Venkata D, Reddy S, Sinha V, Sriharsha A. To Assess the Factors Affecting Employee Engagement in Organizations during a COVID-19 Crisis. CM 2022. [DOI: 10.18137/cardiometry.2022.23.292309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: To identify the steps taken by organizations during the time of crisis concerning Human Capital and understand the impact each of these steps has on the employee engagement for the employees within the organization. Proposed Design/Methodology/Approach: Post the literature review, qualitative research is conducted through indepth interviews with the Managers, who were part of the decision-making, in the organizations that went through crisis period (Sample size: 20-30) and a quantitative study is conducted to capture the perspectives of the employees from those organizations (Sample size: 70-100). Practical/Theoretical Implication: The study results enable organizations to stay cognizant of the pros and cons of the decisions they make in terms of employee engagement, which helps in successfully overcoming the crisis with minimal traction. Originality/Value: While there are standalone papers on each topic, this paper converges them coherently to study the overall effect from both employee’s and the organization’s perspectives.
Collapse
|
9
|
Bhardwaj S, Sinha V. Organizations Take Initiatives For The Development Of Women Leaders. CM 2022. [DOI: 10.18137/cardiometry.2022.23.283291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: 1) To Understand the male to female ratio prevailing in the organization 2) To Understand how effective are women development initiatives in organizations from a women’s perspective to determine if they will be appreciated and perceived as positive by the women. 3) To understand if the presence of women leaders in the organization leads to better engagement. 4) To understand, as suggested by research, are women leaders warmer and more male leaders more aggressive? Research Methodology: Sample - The sample size would be 50 men and women from all over India belonging to different age groups between 25-50 and are currently working in various corporations • Primary Research: In-Depth Interview, Survey • Secondary research: literature review • Analysis of the collected data Practical Implications: This will help identify why, even though there is awareness about the importance of having women leaders, the initiatives were taken for their development have not contributed significantly. This paper will help understand if these initiatives are enough in the given culture of the organization that has pre-defined norms and expectations from a woman’s standpoint of view. Originality: This research will mainly focus on the view of women about development initiatives in the organization.
Collapse
|
10
|
Mandal S, Sinha V. A review of work-life and well-being of parents. CM 2022. [DOI: 10.18137/cardiometry.2022.22.203206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: The transition from office to work-from-home (WFH) has lead to an increased interest in the effects of this transition, not only on the quality of work obtained but also on the mental health of individuals. Research in this topic is expanding with different perspectives in focus. This review aims to identify the significant factors influenced by WFH and the consequential effects on working parents. Methodology: To write this review, 4 databases are being explored - SCOPUS, Emerald, EBSCO, and Web of Science. Papers reviewed are selected using the keywords work from home, well-being, mental health, work-life balance, and family combined with parents, family, working mother, or working father. The papers have been selected for the past 25 years. An attempt is being made to review at least 53 articles. Findings/Theoretical Implications: This paper will highlight the advantages and disadvantages parents face while balancing work and family. The review will give a comprehensive impression of the mental health state of working parents. Value: The study will enable future researchers to identify currently unexplored issues and design their studies based on the same.
Collapse
|
11
|
Meidan D, Brown SS, Sinha V, Rudich Y. Nocturnal Atmospheric Oxidative Processes in the Indo-Gangetic Plain and Their Variation During the COVID-19 Lockdowns. Geophys Res Lett 2022; 49:e2021GL097472. [PMID: 35601504 PMCID: PMC9111199 DOI: 10.1029/2021gl097472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 06/15/2023]
Abstract
This study investigates selected secondary atmospheric responses to the widely reported emission change attributed to COVID-19 lockdowns in the highly polluted Indo-Gangetic Plain (IGP) using ground-based measurements of trace gases and particulate matter. We used a chemical box-model to show that production of nighttime oxidant, NO3, was affected mainly by emission decrease (average nighttime production rates 1.2, 0.8 and 1.5 ppbv hr-1 before, during and relaxation of lockdown restrictions, respectively), while NO3 sinks were sensitive to both emission reduction and seasonal variations. We have also shown that the maximum potential mixing ratio of nitryl chloride, a photolytic chlorine radical source which has not been previously considered in the IGP, is as high as 5.5 ppbv at this inland site, resulting from strong nitrate radical production and a potentially large particulate chloride mass. This analysis suggests that air quality measurement campaigns and modeling explicitly consider heterogeneous nitrogen oxide and halogen chemistry.
Collapse
Affiliation(s)
- D. Meidan
- Department of Earth and Planetary SciencesWeizmann Institute of ScienceRehovotIsrael
| | - S. S. Brown
- NOAA Chemical Sciences LaboratoryBoulderCOUSA
- Department of ChemistryUniversity of ColoradoBoulderCOUSA
| | - V. Sinha
- Department of Earth and Environmental SciencesIndian Institute of Science Education and Research MohaliMohaliIndia
| | - Y. Rudich
- Department of Earth and Planetary SciencesWeizmann Institute of ScienceRehovotIsrael
| |
Collapse
|
12
|
Gupta N, Hanley MJ, Sinha V. Pharmacometric analyses and clinical evidence for brigatinib dosing in anaplastic lymphoma kinase-positive non-small cell lung cancer. Br J Clin Pharmacol 2022; 88:3922-3923. [PMID: 35350085 DOI: 10.1111/bcp.15322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 01/26/2023] Open
Affiliation(s)
- Neeraj Gupta
- Takeda Development Center Americas, Inc., Lexington, Massachusetts, USA
| | - Michael J Hanley
- Takeda Development Center Americas, Inc., Lexington, Massachusetts, USA
| | - Vikram Sinha
- Takeda Development Center Americas, Inc., Lexington, Massachusetts, USA
| |
Collapse
|
13
|
Raj S, Clay R, Ramji S, Shaunak R, Dadrewalla A, Sinha V, Shaunak S. 660 Trapeziectomy Versus Joint Replacement for First Carpometacarpal (CMC-1) Joint Osteoarthritis: A Systematic Review and Meta-Analysis. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
The challenge of managing first carpometacarpal (CMC-1) joint osteoarthritis is the lack of guidance on which surgical intervention is superior. This systematic review and meta-analysis compares joint replacement (JR) and trapeziectomy techniques to provide an update.
Method
In August 2020, MEDLINE, Embase and Web of Science were searched for eligible studies that compared these two techniques for the treatment of CMC-1 joint osteoarthritis (PROSPERO registration ID: CRD42020189728). Primary outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH and pain visual analogue scale (VAS) scores. Secondary outcomes, such as total complication, dislocation, and revision surgery rates, were also measured.
Results
From 1909 studies identified, 14 studies (1005 patients) were eligible. Our meta-analysis found that post-operative QuickDASH score was lower for patients in the JR group, indicating decreased disability following this technique (5 studies, p = 0.0002). However, pain VAS scores were similar between the two groups (5 studies, p = 0.22). Interestingly, JR techniques had significantly greater odds of overall complications (12 studies; OR 2.27; 95% CI 1.17-4.40, p = 0.02) and significantly greater odds of revision surgery (9 studies; OR 5.14; 95% CI 2.06-12.81, p = 0.0004).
Conclusions
Overall, based on low to moderate quality evidence, we found that JR treatments may result in better function with less disability with comparable pain (VAS) scores; however, JR has greater odds of complications and greater odds of requiring revision surgery. More robust RCTs that compare JR and TRAP with standardised outcome measures and long-term follow-up would add to the overall quality of evidence.
Collapse
Affiliation(s)
- S Raj
- King’s College London, GKT School of Medicine, London, United Kingdom
| | - R Clay
- King’s College London, GKT School of Medicine, London, United Kingdom
| | - S Ramji
- King’s College London, GKT School of Medicine, London, United Kingdom
| | - R Shaunak
- King’s College London, GKT School of Medicine, London, United Kingdom
| | - A Dadrewalla
- King’s College London, GKT School of Medicine, London, United Kingdom
| | - V Sinha
- King’s College London, GKT School of Medicine, London, United Kingdom
| | - S Shaunak
- NHS Kent, Surrey and Sussex Deanery, Department of Trauma and Orthopaedic Surgery, London, United Kingdom
| |
Collapse
|
14
|
MacInnes P, Sinha V, Vijayan R. Reusable surgical drapes in Plastic surgery: What is the sticking point? J Plast Reconstr Aesthet Surg 2021; 75:439-488. [PMID: 34688592 DOI: 10.1016/j.bjps.2021.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/19/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Poppy MacInnes
- Foundation Year 1 Doctor, Royal United Hospital, Bath UK.
| | - Vikram Sinha
- Foundation Year 1 Doctor, King's College Hospital, London UK.
| | - Roshan Vijayan
- ST8 Surgical Registrar, King's College Hospital, London UK.
| |
Collapse
|
15
|
Ahamadi M, Mehrotra N, Hanan N, Lai Yee K, Gheyas F, Anton J, Bani M, Boroojerdi B, Smit H, Weidemann J, Macha S, Thuillier V, Chen C, Yang M, Williams-Gray CH, Stebbins GT, Pagano G, Hang Y, Marek K, Venuto CS, Javidnia M, Dexter D, Pedata A, Stafford B, Akalu M, Stephenson D, Romero K, Sinha V. A Disease Progression Model to Quantify the Nonmotor Symptoms of Parkinson's Disease in Participants With Leucine-Rich Repeat Kinase 2 Mutation. Clin Pharmacol Ther 2021; 110:508-518. [PMID: 33894056 DOI: 10.1002/cpt.2277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/12/2021] [Indexed: 02/02/2023]
Abstract
Leucine-rich repeat kinase 2 (LRRK2) inhibitors are currently in clinical development as interventions to slow progression of Parkinson's disease (PD). Understanding the rate of progression in PD as measured by both motor and nonmotor features is particularly important in assessing the potential therapeutic effect of LRRK2 inhibitors in clinical development. Using standardized data from the Critical Path for Parkinson's Unified Clinical Database, we quantified the rate of progression of the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part I (nonmotor aspects of experiences of daily living) in 158 participants with PD who were carriers and 598 participants with PD who were noncarriers of at least one of three different LRRK2 gene mutations (G2019S, R1441C/G, or R1628P). Age and disease duration were found to predict baseline disease severity, while presence of at least one of these three LRRK2 mutations was a predictor of the rate of MDS-UPDRS Part I progression. The estimated progression rate in MDS-UPDRS Part I was 0.648 (95% confidence interval: 0.544, 0.739) points per year in noncarriers of a LRRK2 mutation and 0.259 (95% confidence interval: 0.217, 0.295) points per year in carriers of a LRRK2 mutation. This analysis demonstrates that the rate of progression based on MDS-UPDRS Part I is ~ 60% lower in carriers as compared with noncarriers of LRRK2 gene mutations.
Collapse
Affiliation(s)
| | | | | | - Ka Lai Yee
- Merck & Co., Inc., Kenilworth, New Jersey, USA
| | | | | | | | | | - Hans Smit
- Union Chimique Belge, Brussels, Belgium
| | | | | | | | | | | | | | | | - Gennaro Pagano
- Neuroscience and Rare Disease Discovery and Translational Area, Roche Pharma Research and Early Development, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Kenneth Marek
- Institute of Neurodegenerative Diseases, New Haven, Connecticut, USA
| | | | | | | | - Anne Pedata
- Critical Path Institute, Tucson, Arizona, USA
| | | | | | | | | | | | | |
Collapse
|
16
|
Rowland Yeo K, Hennig S, Krishnaswami S, Strydom N, Ayyar VS, French J, Sinha V, Sobie E, Zhao P, Friberg LE, Mentré F. CPT: Pharmacometrics & Systems Pharmacology - Inception, Maturation, and Future Vision. CPT Pharmacometrics Syst Pharmacol 2021; 10:649-657. [PMID: 34298582 PMCID: PMC8302238 DOI: 10.1002/psp4.12680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 12/14/2022]
Affiliation(s)
| | | | | | - Natasha Strydom
- Department of Bioengineering and Therapeutic Sciences, School of Pharmacy, University of California, San Francisco, CA, USA
| | | | | | | | - Eric Sobie
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ping Zhao
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Lena E Friberg
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | | |
Collapse
|
17
|
Raj S, Clay R, Ramji S, Shaunak R, Dadrewalla A, Sinha V, Shaunak S. Trapeziectomy versus joint replacement for first carpometacarpal (CMC 1) joint osteoarthritis: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 2021; 32:1001-1021. [PMID: 34244850 PMCID: PMC9279208 DOI: 10.1007/s00590-021-03070-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/28/2021] [Indexed: 01/11/2023]
Abstract
Purpose This systematic review and meta-analysis directly compares joint replacement (JR) and trapeziectomy techniques to provide an update as to which surgical intervention is superior for first carpometacarpal (CMC-1) joint osteoarthritis. Methods In August 2020, MEDLINE, Embase and Web of Science were searched for eligible studies that compared these two techniques for the treatment of CMC-1 joint osteoarthritis (PROSPERO registration ID: CRD42020189728). Primary outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH (QDASH) and pain visual analogue scale (VAS) scores. Secondary outcomes, such as total complication, dislocation and revision surgery rates, were also measured. Results From 1909 studies identified, 14 studies (1005 patients) were eligible. Our meta-analysis found that post-operative QDASH scores were lower for patients in the JR group (five studies, p = 0.0004). Similarly, significantly better postoperative key pinch strength in favour of JR was noted (three studies, p = 0.001). However, pain (VAS) scores were similar between the two groups (five studies, p = 0.21). Moreover, JR techniques had significantly greater odds of overall complications (12 studies; OR 2.12; 95% CI 1.13–3.96, p = 0.02) and significantly greater odds of revision surgery (9 studies; OR 5.14; 95% CI 2.06–12.81, p = 0.0004). Conclusion Overall, based on very low- to moderate-quality evidence, JR treatments may result in better function with less disability with comparable pain (VAS) scores; however, JR has greater odds of complications and greater odds of requiring revision surgery. More robust RCTs that compare JR and TRAP with standardised outcome measures and long-term follow-up would add to the overall quality of evidence.
Collapse
Affiliation(s)
- Siddarth Raj
- King's College London, GKT School of Medicine, London, UK.
| | - Reece Clay
- King's College London, GKT School of Medicine, London, UK
| | - Saajan Ramji
- King's College London, GKT School of Medicine, London, UK
| | - Raghav Shaunak
- King's College London, GKT School of Medicine, London, UK
| | | | - Vikram Sinha
- King's College London, GKT School of Medicine, London, UK
| | - Shalin Shaunak
- Department of Trauma and Orthopaedic Surgery, NHS KSS Deanery, London, UK
| |
Collapse
|
18
|
Jacobs CR, Rapoport BL, Cohen GL, Lala M, Silva CDM, Vaddady P, Gheyas F, de Alwis D, Sinha V, Akala OO, Chartash E, Jain L. Abstract CT143: Pembrolizumab bioavailability after subcutaneous administration: analysis from the KEYNOTE-555 Cohort A in metastatic melanoma. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-ct143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Pembrolizumab is approved for use across multiple cancers at a dose of 200 mg or 2 mg/kg Q3W or 400 mg Q6W administered as an IV infusion. Alternative subcutaneous (SC) formulations can provide added convenience and flexibility in the clinic. KEYNOTE-555 (NCT03665597) Cohort A is an open-label, phase 1 study examining the relative bioavailability of 2 different concentrations of pembrolizumab SC formulations versus pembrolizumab IV. Methods: Patients with advanced melanoma were randomly assigned to receive (in a cross-over design) 1 dose of pembrolizumab 200 mg IV and 2 doses of pembrolizumab 285 mg SC (one of each SC formulation) during the first 3 treatment cycles; thereafter, all patients receive pembrolizumab IV for up to 2 years. Bayesian analysis of pembrolizumab serum concentration data collected from 31 patients through cycles 1, 2, and 3 in the current study and previously published pembrolizumab IV data were used to characterize the pharmacokinetics (PK) of pembrolizumab SC. Distribution and elimination parameters, time-dependent clearance, and covariate effects from the previously established pembrolizumab IV PK model were used, as these phases were expected to be similar for IV and SC administrations. Injection site reactions were evaluated by monitoring patients for local skin reactions approximately 1 hour after pembrolizumab SC or IV administration during the first 3 cycles, and through use of a pt questionnaire following monitoring. Results: The model simultaneously described pembrolizumab PK after IV and SC administrations. The SC absorption was characterized by a first-order absorption rate with lag time and bioavailability parameters. The PK of both pembrolizumab SC formulations were similar with an estimated bioavailability of 64% (95% CI, 54-74); this is consistent with the reported bioavailability of other SC monoclonal antibodies that range from 50% to 85%. Inclusion of a covariate effect of the SC formulation on bioavailability, lag time, or absorption rate was not statistically significant, indicating no significant difference between the 2 SC formulations in the absorption phase. In addition, no anti-drug antibody was observed after 3 treatment cycles. In general, pembrolizumab SC formulations were well tolerated over the first 3 cycles, with no significant injection-site reactions. Two grade 2 adverse events (AEs) of pruritus and rash were reported from the SC formulations and IV infusion, respectively; the other AEs were grade 1. Conclusions: The bioavailability of SC pembrolizumab was characterized from KEYNOTE-555 Cohort A data. SC formulations will be further assessed clinically in other tumor types.
Citation Format: Conrad R. Jacobs, Bernardo Leon Rapoport, Graham Lawrence Cohen, Mallika Lala, Carolina De Miranda Silva, Pavan Vaddady, Ferdous Gheyas, Dinesh de Alwis, Vikram Sinha, Omobolaji Oyekunle Akala, Elliot Chartash, Lokesh Jain. Pembrolizumab bioavailability after subcutaneous administration: analysis from the KEYNOTE-555 Cohort A in metastatic melanoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT143.
Collapse
Affiliation(s)
| | - Bernardo Leon Rapoport
- 2The Medical Oncology Centre of Rosebank/Department of Immunology, Faculty of Health Sciences, University of Pretoria, Johannesburg, South Africa
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Sinha V, Friberg LE, Zhao P. Dr. Hartmut Derendorf, PhD, a world-renowned expert in pharmacokinetics and pharmacometrics (1953-2020). CPT Pharmacometrics Syst Pharmacol 2021. [PMID: 34038619 PMCID: PMC8213411 DOI: 10.1002/psp4.12609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Vikram Sinha
- Quantitative Clinical Pharmacology, Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | | | - Ping Zhao
- Integrated Development, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| |
Collapse
|
20
|
Galluppi GR, Brar S, Caro L, Chen Y, Frey N, Grimm HP, Rudd DJ, Li CC, Magee M, Mukherjee A, Nagao L, Purohit VS, Roy A, Salem AH, Sinha V, Suleiman AA, Taskar KS, Upreti VV, Weber B, Cook J. Industrial Perspective on the Benefits Realized from the FDA's Model-Informed Drug Development Paired Meeting Pilot Program. Clin Pharmacol Ther 2021; 110:1172-1175. [PMID: 33991429 PMCID: PMC8596613 DOI: 10.1002/cpt.2265] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/03/2021] [Indexed: 11/08/2022]
Affiliation(s)
| | - Satjit Brar
- Clinical Pharmacology, Global Product Development, Pfizer Inc., Groton, Connecticut, USA
| | - Luzelena Caro
- Quantitative Pharmacology and Pharmacometrics, Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck Research Laboratories, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Yuan Chen
- Department of Drug Metabolism and Pharmacokinetics, Genentech Inc., a member of the Roche Group, South San Francisco, California, USA
| | - Nicolas Frey
- Roche Pharma Research and Exploratory Development, Pharmaceutical Science, Roche Innovation Center, Basel, Switzerland
| | - Hans Peter Grimm
- Roche Pharma Research and Exploratory Development, Pharmaceutical Science, Roche Innovation Center, Basel, Switzerland
| | - Deanne Jackson Rudd
- Quantitative Pharmacology and Pharmacometrics, Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck Research Laboratories, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Chi-Chung Li
- Department of Clinical Pharmacology, Genentech, member of the Roche group, South San Francisco, California, USA
| | - Mindy Magee
- GlaxoSmithKline, Philadelphia, Pennsylvania, USA
| | - Arnab Mukherjee
- Clinical Pharmacology, Global Product Development, Pfizer Inc., Groton, Connecticut, USA
| | - Lee Nagao
- Faegre Drinker Biddle & Reath, LLP, Washington, DC, USA
| | - Vivek S Purohit
- Clinical Pharmacology, Global Product Development, Pfizer Inc., Groton, Connecticut, USA
| | - Amit Roy
- Bristol Myers, Inc., Woodbury, Connecticut, USA
| | - Ahmed Hamed Salem
- Clinical Pharmacology and Pharmacometrics, AbbVie Inc., North Chicago, Illinois, USA.,Ain Shams University, Cairo, Egypt
| | - Vikram Sinha
- Quantitative Pharmacology and Pharmacometrics, Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck Research Laboratories, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Ahmed A Suleiman
- Clinical Pharmacology and Pharmacometrics, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen am Rhein, Germany
| | | | - Vijay V Upreti
- Clinical Pharmacology Modeling and Simulation, Amgen Inc., South San Francisco, California, USA
| | - Benjamin Weber
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut, USA
| | - Jack Cook
- Clinical Pharmacology, Global Product Development, Pfizer Inc., Groton, Connecticut, USA
| |
Collapse
|
21
|
Sinha V, Sun D, Meijer EJ, Vlugt TJH, Bieberle-Hütter A. A multiscale modelling approach to elucidate the mechanism of the oxygen evolution reaction at the hematite-water interface. Faraday Discuss 2021; 229:89-107. [PMID: 33735341 DOI: 10.1039/c9fd00140a] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Photoelectrochemical (PEC) splitting of water to make hydrogen is a promising clean-energy technology. The oxygen evolution reaction (OER) largely determines the energy efficiency in PEC water-splitting. Hematite, which is a cheap and sustainable semiconductor material with excellent chemical properties, a favourable band gap (2.1 eV) and composed of earth abundant elements is a suitable model photoanode material for studying OER. To understand the design of energy efficient anodes, it is highly desirable to have mechanistic insight into OER at an atomistic level which can be directly connected to experimentally measured quantities. We present a multiscale computational model of OER which connects the thermodynamics and kinetics of elementary charge transfer reactions in OER to kinetics of OER at laboratory length and time scales. We couple density functional theory (DFT) and DFT based molecular dynamics (DFT-MD) simulations with solvent effects at an atomistic level with kinetic Monte Carlo (kMC) simulations at a coarse-grained level in our multiscale model. The time and applied bias potential dependent surface coverage, which are experimentally not known, and the O2 evolution rate during OER at the hematite-water interface are calculated by the multiscale model. Furthermore, the multiscale model demonstrates the effect of explicitly modelling the interaction of water with the electrode surface via direct adsorption.
Collapse
Affiliation(s)
- V Sinha
- Electrochemical Materials and Interfaces, Dutch Institute for Fundamental Energy Research (DIFFER), de Zaale 20, Eindhoven, 5612 AJ, The Netherlands. and Process and Energy Department, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Leeghwaterstraat 39, Delft, 2628CB, The Netherlands.
| | - D Sun
- Amsterdam Center for Multiscale Modelling, van' t Hoff Institute for Molecular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - E J Meijer
- Amsterdam Center for Multiscale Modelling, van' t Hoff Institute for Molecular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - T J H Vlugt
- Process and Energy Department, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Leeghwaterstraat 39, Delft, 2628CB, The Netherlands.
| | - A Bieberle-Hütter
- Electrochemical Materials and Interfaces, Dutch Institute for Fundamental Energy Research (DIFFER), de Zaale 20, Eindhoven, 5612 AJ, The Netherlands.
| |
Collapse
|
22
|
Sinha V, Malik M, Nugent N, Drake P, Cavale N. The Role of Virtual Consultations in Plastic Surgery During COVID-19 Lockdown. Aesthetic Plast Surg 2021; 45:777-783. [PMID: 32869133 PMCID: PMC7458356 DOI: 10.1007/s00266-020-01932-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/16/2020] [Indexed: 12/03/2022]
Abstract
Background COVID-19 has led to government enforced ‘lockdown’ in the UK severely limiting face-to-face patient interaction. Virtual consultations present a means for continued patient access to health care. Our aim was to evaluate the use of virtual consultations (VCons) during lockdown and their possible role in the future. Methods An anonymous survey was disseminated to UK and European plastic surgeons via social media, email sharing and via the European Association of Societies of Aesthetic Plastic Surgery newsletter. Uptake of VCons, modality, effectiveness, safety and future utility were assessed. Results Forty-three senior plastic surgeons responded to the survey. The majority of the respondents (97.7%) reported using VCons during COVID-19 lockdown, of which 74.4% had no prior experience. Two-thirds of surgeons utilised commercial platforms such as Zoom, FaceTime and Skype, 38.1% of respondents did not know about or were unsure about adequate encryption for health care use, and just under a half (47.6%) reported they were unaware of or lacking GDPR compliance. Most (97.6%) say they are likely to use virtual consultations after lockdown. Conclusion Virtual consultations have had a crucial role in patient care during UK lockdown. It is clear that they will serve as an adjunct to face-to-face consultation in the future. Further regulation is required to ensure platforms offer adequate safety and security measures and are compliant with relevant data protection laws. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Electronic supplementary material The online version of this article (10.1007/s00266-020-01932-7) contains supplementary material, which is available to authorized users.
Collapse
|
23
|
Li TR, Chatterjee M, Lala M, Abraham AK, Freshwater T, Jain L, Sinha V, de Alwis DP, Mayawala K. Pivotal Dose of Pembrolizumab: A Dose-Finding Strategy for Immuno-Oncology. Clin Pharmacol Ther 2021; 110:200-209. [PMID: 33462831 DOI: 10.1002/cpt.2170] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/20/2020] [Indexed: 12/16/2022]
Abstract
Despite numerous publications emphasizing the value of dose finding, drug development in oncology is dominated by the mindset that higher dose provides higher efficacy. Examples of dose finding implemented by biopharmaceutical firms can change this mindset. The purpose of this article is to outline a pragmatic dose selection strategy for immuno-oncology (IO) and other targeted monoclonal antibodies (mAbs). The approach was implemented for pembrolizumab. Selecting a recommended phase II dose (RP2D) with a novel mechanism of action is often challenging due to uncertain relationships between pharmacodynamics measurements and clinical end points. Additionally, phase I efficacy and safety data are generally inadequate for RP2D selection for IO mAbs. Here, the RP2D was estimated based on phase I (clinical study KN001 A and A2) pharmacokinetics data as the dose required for target saturation, which represents a surrogate for maximal pharmacological effect for antagonist mAbs. Due to limitations associated with collecting and analyzing tumor biopsies, characterizing intratumoral target engagement (TE) is challenging. To overcome this gap, a physiologically-based pharmacokinetic model was implemented to predict intratumoral TE. As tumors are spatially heterogeneous, TE was predicted in well-vascularized and poorly vascularized tumor regions. Additionally, impact of differences in target expression, for example, due to interindividual variability and cancer type, was simulated. Simulations showed that 200 mg every 3 weeks can achieve ≥ 90% TE in clinically relevant scenarios, resulting in the recommendation of 200 mg every 3 weeks as the RP2D. Randomized dose comparison studies (KN001 B2 and D) showing similar efficacy over a fivefold dose/exposure range confirmed the RP2D as the pivotal dose.
Collapse
Affiliation(s)
- Tommy R Li
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Manash Chatterjee
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Mallika Lala
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Anson K Abraham
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Tomoko Freshwater
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Lokesh Jain
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Vikram Sinha
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Dinesh P de Alwis
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Kapil Mayawala
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Kenilworth, New Jersey, USA
| |
Collapse
|
24
|
Bhatia S, Kumar J, Acharya V, Jalaeian H, Bryant E, Harward S, Sinha V, Kably I, Kava B. 108 Erectile Function Following Prostate Artery Embolization in Patients with Larger Prostate Glands: A Large Single Center Experience. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
25
|
Aggarwal A, Sinha V, Chan E, Parapuram A. An elevated C-reactive protein level in an inpatient rehabilitation setting after joint replacement: To act or not to act? - that is the question. Medicine (Baltimore) 2021; 100:e24584. [PMID: 33663068 PMCID: PMC7909121 DOI: 10.1097/md.0000000000024584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 01/14/2021] [Indexed: 01/05/2023] Open
Abstract
C-reactive protein (CRP) is part of a battery of "routine bloods" performed by residents on patients when they are admitted into a rehabilitation unit. Generally, an elevated CRP is considered to be an indicator of an acute infective process. Numerous studies have indicated that the CRP peaks on the 2nd or 3rd day post total hip arthroplasty (THR) and total knee arthroplasty (TKR) and returns to normal by day 7. When the CRP level remains elevated, it is generally felt that infection should be excluded.We performed a prospective study on 45 consecutive patients admitted into a rehabilitation unit post hip and knee arthroplasty over a 6 months period, to evaluate the incidence of an elevated CRP on admission, to determine whether an isolated elevated CRP on admission to a rehabilitation setting should not be considered as an indicator of an infective process.We found all patients (100%) had elevated CRP's on admission, ranging from 8.6 mg/L to 139.2 mg/L, between days 5-7 post-operatively. By day 14, CRP's reduced, but 91% of patients still had elevated CRP's, ranging from 2.1 mg/L to 47.3 mg/L after THR and 4.8 mg/L to 40 mg/L after TKR at day 14.These results suggest that even in uncomplicated elective joint arthroplasty, CRP's can remain elevated up to 14 days post-procedure, in the absence of an infective process.An isolated elevated CRP on admission to a rehabilitation setting should not be considered as an indicator of an infective process, but rather part of the normal post-operative inflammatory response. The elevated CRP should be monitored and only an upward trend requires further investigation and management.
Collapse
Affiliation(s)
- Arun Aggarwal
- Neurologist and Rehabilitation / Pain Physician, Metropolitan Rehabilitation Hospital & Hunters Hill Private Hospital
| | - Vikram Sinha
- Rehabilitation Medicine Registrar, Metropolitan Rehabilitation Hospital
| | - Eric Chan
- General Practice Registrar, Hunters Hill Private Hospital
| | - Anuka Parapuram
- Rehabilitation Medicine Physician, Metropolitan Rehabilitation Hospital, Sydney, NSW, Australia
| |
Collapse
|
26
|
Iaccarino C, Kolias A, Adelson PD, Rubiano AM, Viaroli E, Buki A, Cinalli G, Fountas K, Khan T, Signoretti S, Waran V, Adeleye AO, Amorim R, Bertuccio A, Cama A, Chesnut RM, De Bonis P, Estraneo A, Figaji A, Florian SI, Formisano R, Frassanito P, Gatos C, Germanò A, Giussani C, Hossain I, Kasprzak P, La Porta F, Lindner D, Maas AIR, Paiva W, Palma P, Park KB, Peretta P, Pompucci A, Posti J, Sengupta SK, Sinha A, Sinha V, Stefini R, Talamonti G, Tasiou A, Zona G, Zucchelli M, Hutchinson PJ, Servadei F. Consensus statement from the international consensus meeting on post-traumatic cranioplasty. Acta Neurochir (Wien) 2021; 163:423-440. [PMID: 33354733 PMCID: PMC7815592 DOI: 10.1007/s00701-020-04663-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/28/2020] [Indexed: 12/26/2022]
Abstract
Background Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach. Methods The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP. Results The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations. Conclusions This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.
Collapse
|
27
|
Mishra AK, Sinha B, Kumar R, Barth M, Hakkim H, Kumar V, Kumar A, Datta S, Guenther A, Sinha V. Cropland trees need to be included for accurate model simulations of land-atmosphere heat fluxes, temperature, boundary layer height, and ozone. Sci Total Environ 2021; 751:141728. [PMID: 32890797 DOI: 10.1016/j.scitotenv.2020.141728] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/07/2020] [Accepted: 08/14/2020] [Indexed: 06/11/2023]
Abstract
Trees significantly impact land-atmosphere feedbacks through evapotranspiration, photosynthesis and isoprene emissions. These processes influence the local microclimate, air quality and can mitigate temperature extremes and sequester carbon dioxide. Despite such importance, currently only 5 out of 15 atmospheric chemistry climate models even partially account for the presence of cropland trees. We first show that the tree cover over intensely farmed regions in Asia, Australia and South America is significantly underestimated (e.g. only 1-3% tree cover over north-India) in the Model of Emissions of Gases and Aerosol from Nature (MEGAN) and absent in Noah land-surface module of the Weather Research and Forecasting (WRF-Chem) Model. By including the actual tree cover (~10%) over the north-west Indo Gangetic Plain in the Noah land-surface module of the WRF-Chem and the MEGAN module, during the rice growing monsoon season in August, we find that the latent heat flux alone increases by 100%-300% while sensible heat flux reduces by 50%-100%, leading to a reduction in daytime boundary layer height by 200-400 m. This greatly improves agreement between the modelled and measured temperature, boundary layer height and surface ozone, which were earlier overestimated and isoprene and its oxidation products which were earlier underestimated. Mitigating peak daytime temperatures and ozone improves rice production by 10 to 20%. Our findings from north west Indo-Gangetic Plain establish that such plantations mitigate heat stress, and have beneficial effects on crop yields while also sequestering carbon. Expanding agroforestry practices to 50% of the cropland area could result in up to 40% yield gain regionally. Implementing such strategies globally could increase crop production and sequester 0.3-30 GtC per year, and therefore future climate mitigation and food security efforts should consider stakeholder participation for increased cropland agroforestry in view of its beneficial effects.
Collapse
Affiliation(s)
- A K Mishra
- Department of Earth and Environmental Sciences, Indian Institute of Science Education and Research Mohali, Sector 81, S.A.S Nagar, Manauli PO, Punjab 140306, India
| | - B Sinha
- Department of Earth and Environmental Sciences, Indian Institute of Science Education and Research Mohali, Sector 81, S.A.S Nagar, Manauli PO, Punjab 140306, India
| | - R Kumar
- National Center for Atmospheric Research, Boulder, CO, USA
| | - M Barth
- National Center for Atmospheric Research, Boulder, CO, USA
| | - H Hakkim
- Department of Earth and Environmental Sciences, Indian Institute of Science Education and Research Mohali, Sector 81, S.A.S Nagar, Manauli PO, Punjab 140306, India
| | - V Kumar
- Department of Earth and Environmental Sciences, Indian Institute of Science Education and Research Mohali, Sector 81, S.A.S Nagar, Manauli PO, Punjab 140306, India
| | - A Kumar
- Department of Earth and Environmental Sciences, Indian Institute of Science Education and Research Mohali, Sector 81, S.A.S Nagar, Manauli PO, Punjab 140306, India
| | - S Datta
- Department of Earth and Environmental Sciences, Indian Institute of Science Education and Research Mohali, Sector 81, S.A.S Nagar, Manauli PO, Punjab 140306, India
| | | | - V Sinha
- Department of Earth and Environmental Sciences, Indian Institute of Science Education and Research Mohali, Sector 81, S.A.S Nagar, Manauli PO, Punjab 140306, India.
| |
Collapse
|
28
|
Sinha V, Malik M, Borrelli MR, Sinha A, Cavale N. The quality of online information regarding non-surgical aesthetic procedures. J Plast Reconstr Aesthet Surg 2020; 74:1881-1887. [PMID: 33341383 DOI: 10.1016/j.bjps.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/24/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The rapid growth of non-surgical aesthetics has led to a scarcity of regulation that raises concerns for serious consequences to public health. Services are advertised primarily through websites which are not necessarily centrally monitored or maintained to a set gold standard. We quantitatively assess the quality of online information regarding non-surgical procedures in order to promote patient safety and informed decision making. METHODS Google and Bing, search engines that represent 95.27of global searches, were queried with the expanded search terms "facial filler" and "Botox". The top 100 results were sampled and two validated tools were used to assess the quality of healthcare information retrieved; the DISCERN instrument and the JAMA benchmark criteria. RESULTS Once duplicates were removed, a total of 77 unique websites were retrieved by the search. The majority of websites were published by private marketing firms. The median score for website quality across all included websites was 'fair' (42) when assessed according to the DISCERN instrument, and 'poor' (1) when assessed against the JAMA criteria. Private websites had the lowest quality of information online and institutional websites had the highest. CONCLUSION Non-surgical aesthetics are becoming increasingly popular with patients and clinicians due to their convenience, scope of treatment, and novel and strategic marketing. Online information available to patients, however, is often of poor quality, dominated by private clinics and commercial entities, and thus presents a significant risk of misinforming patients desiring to undertake these procedures. Significant reform and regulation of information is required in order to make this industry safer for patients.
Collapse
Affiliation(s)
- Vikram Sinha
- School of Medical Education, King's College London, London, United Kingdom.
| | - Mohsan Malik
- Department of Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
| | - Mimi R Borrelli
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Ambika Sinha
- Barts health NHS Trust, Royal London hospital, London, United Kingdom
| | - Naveen Cavale
- Surgical Department, King's College Hospital, London, United Kingdom
| |
Collapse
|
29
|
Mishra AK, Sinha V. Emission drivers and variability of ambient isoprene, formaldehyde and acetaldehyde in north-west India during monsoon season. Environ Pollut 2020; 267:115538. [PMID: 33254592 DOI: 10.1016/j.envpol.2020.115538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/13/2020] [Accepted: 08/25/2020] [Indexed: 06/12/2023]
Abstract
Isoprene, formaldehyde and acetaldehyde are important reactive organic compounds which strongly impact atmospheric oxidation processes and formation of tropospheric ozone. Monsoon meteorology and the topography of Himalayan foothills cause surface emissions to get rapidly transported both horizontally and vertically, thereby influencing atmospheric processes in distant regions. Further in monsoon, Indo-Gangetic Plain is a major rice growing region of the world and daytime hourly ozone can frequently exceed phytotoxic dose of 40 ppb O3. However, the sources and ambient variability of these compounds which are potent ozone precursors are unknown. Here, we investigate the sources and photochemical processes driving their emission/formation during monsoon season from a sub-urban site at the foothills of the Himalayas. The measurements were performed in July, August and September using a high sensitivity mass spectrometer. Average ambient mixing ratios (±1σ variability) of isoprene, formaldehyde, acetaldehyde, and the sum of methyl vinyl ketone and methacrolein (MVK+MACR), were 1.4 ± 0.3 ppb, 5.7 ± 0.9 ppb, 4.5 ± 2.0 ppb, 0.75 ± 0.3 ppb, respectively, and much higher than summertime values in May. For isoprene these values were comparable to mixing ratios observed over tropical forests. Surprisingly, despite occurrence of anthropogenic emissions, biogenic emissions were found to be the major source of isoprene with peak daytime isoprene driven by temperature (r ≥ 0.8) and solar radiation. Photo-oxidation of precursor hydrocarbons were the main sources of acetaldehyde, formaldehyde and MVK+MACR. Ambient mixing ratios of all the compounds correlated poorly with acetonitrile (r ≤ 0.2), a chemical tracer for biomass burning suggesting negligible influence of biomass burning during monsoon season. Our results suggest that during monsoon season when radiation and rain are no longer limiting factors and convective activity causes surface emissions to be transported to upper atmosphere, biogenic emissions can significantly impact the remote upper atmosphere, climate and ozone affecting rice yields.
Collapse
Affiliation(s)
- A K Mishra
- Department of Earth and Environmental Sciences, Indian Institute of Science Education and Research Mohali, Sector 81, S. A. S. Nagar, Manauli PO, Punjab, 140306, India
| | - V Sinha
- Department of Earth and Environmental Sciences, Indian Institute of Science Education and Research Mohali, Sector 81, S. A. S. Nagar, Manauli PO, Punjab, 140306, India.
| |
Collapse
|
30
|
Hanan NJ, Sivakumaran S, Sinha V, Haeberlein SB, Gold M, Romero K. Generation of a comprehensive disease progression model across the Alzheimer’s disease continuum. Alzheimers Dement 2020. [DOI: 10.1002/alz.043258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
31
|
Romero K, Hanan NJ, Sivakumaran S, Sinha V, Haeberlein SB, Gold M. Graphical user interfaces for regulatory‐endorsed quantitative drug development tools in Alzheimer’s disease. Alzheimers Dement 2020. [DOI: 10.1002/alz.044029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
32
|
Zhu T, Kayama M, Girish S, Sinha V, Bello A, Kawaguchi A, Czerniak R, Nagao L. Collaborations between Clinical Pharmacologists in Japan and in the United States - Report from the IQ CPLG and JPMA CPTF Meeting in Tokyo, Japan. Clin Transl Sci 2020; 14:102-105. [PMID: 32969589 PMCID: PMC7877837 DOI: 10.1111/cts.12853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/07/2020] [Indexed: 11/30/2022] Open
Abstract
The International Consortium for Innovation and Quality in Pharmaceutical Development (IQ) Clinical Pharmacology Leadership Group (CPLG) held its first meeting of Japan-based representatives at Astellas Pharma headquarters in Tokyo on October 1, 2019. The meeting was also attended by Japan Pharmaceutical Manufactures Association (JPMA) Clinical Pharmacology Task Force (CPTF) members. Overall, nearly 30 clinical pharmacologists representing 14 companies attended the event. The meeting met its goal of enhancing mutual understanding of each organization's activities. In a number of break-out sessions, participants identified scientific topics for potential future collaboration between JPMA CPTF and IQ CPLG.
Collapse
Affiliation(s)
- Tong Zhu
- Astellas Pharma Global Development, Northbrook, Illinois, USA
| | | | | | | | | | | | | | - Lee Nagao
- Faegre Drinker Biddle & Reath LLP, Washington, DC, USA
| |
Collapse
|
33
|
Rosenbloom DS, Zhao P, Sinha V. Initiation of Antiviral Treatment in SARS-CoV2: Modeling Viral Dynamics and Drug Properties. CPT Pharmacometrics Syst Pharmacol 2020; 9:481-483. [PMID: 32700405 PMCID: PMC7405045 DOI: 10.1002/psp4.12550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
- Daniel Scholes Rosenbloom
- Quantitative Pharmacology and Pharmacometrics, Pharmacokinetics, Pharmacodynamics, and Drug Metabolism (PPDM), Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Ping Zhao
- The Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Vikram Sinha
- Quantitative Pharmacology and Pharmacometrics, Pharmacokinetics, Pharmacodynamics, and Drug Metabolism (PPDM), Merck & Co., Inc., Kenilworth, New Jersey, USA
| |
Collapse
|
34
|
Kulkarni SH, Ghude SD, Jena C, Karumuri RK, Sinha B, Sinha V, Kumar R, Soni VK, Khare M. How Much Does Large-Scale Crop Residue Burning Affect the Air Quality in Delhi? Environ Sci Technol 2020; 54:4790-4799. [PMID: 32189491 DOI: 10.1021/acs.est.0c00329] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Elevated PM2.5 concentrations frequently cause severe air pollution events in Delhi. Till recently, the effect of crop residue burning on the air quality in Delhi has not been fully quantified and the approaches to control the impact of fire emissions have not been effective. In this study, for the first time, we quantified the statewise contribution of post-monsoon crop residue burning in the northwestern states of India to surface PM2.5 concentrations in Delhi using several sensitivity experiments with the Weather Research and Forecasting model coupled with Chemistry (WRF-Chem) and FINNv1.5 fire emission inventory. Results were evaluated with ground-based observations in Delhi (21 stations), Punjab, and Haryana (14 stations). On average, ∼20% of PM2.5 concentration in Delhi during the post-monsoon season (October-November) was found to be contributed by nonlocal fire emissions. However, on typical air pollution events, fire emissions contributed as high as 50-75% (80-120 μg/m3) to PM2.5 in Delhi, highlighting the importance of both external transport and local emissions to PM2.5 pollution in Delhi.
Collapse
Affiliation(s)
- Santosh H Kulkarni
- Centre for Development of Advanced Computing (C-DAC), Pune 411007, Maharashtra, India
| | - Sachin D Ghude
- Indian Institute of Tropical Meteorology, Pune 411008, Maharashtra, India
| | - Chinmay Jena
- Indian Institute of Tropical Meteorology, Pune 411008, Maharashtra, India
| | - Rama K Karumuri
- Indian Institute of Tropical Meteorology, Pune 411008, Maharashtra, India
| | - Baerbel Sinha
- Indian Institute of Science Education and Research, Mohali, Punjab 140306, India
| | - V Sinha
- Indian Institute of Science Education and Research, Mohali, Punjab 140306, India
| | - Rajesh Kumar
- National Center for Atmospheric Research, Boulder, Colorado 80305, United States
| | - V K Soni
- India Meteorological Department, New Delhi 110003, India
| | - Manoj Khare
- Centre for Development of Advanced Computing (C-DAC), Pune 411007, Maharashtra, India
| |
Collapse
|
35
|
Ahamadi M, Conrado DJ, Macha S, Sinha V, Stone J, Burton J, Nicholas T, Gallagher J, Dexter D, Bani M, Boroojerdi B, Smit H, Weidemann J, Chen C, Yang M, Maciuca R, Lawson R, Burn D, Marek K, Venuto C, Stafford B, Akalu M, Stephenson D, Romero K. Development of a Disease Progression Model for Leucine-Rich Repeat Kinase 2 in Parkinson's Disease to Inform Clinical Trial Designs. Clin Pharmacol Ther 2020; 107:553-562. [PMID: 31544231 PMCID: PMC7939141 DOI: 10.1002/cpt.1634] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/05/2019] [Indexed: 11/06/2022]
Abstract
A quantitative assessment of Parkinson's disease (PD) progression is critical for optimizing clinical trials design. Disease progression model was developed using pooled data from the Progression Marker Initiative study and the Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation in Parkinson's Disease study. Age, gender, concomitant medication, and study arms were predictors of baseline. A mutation in the leucine-rich repeat kinase 2 (LRRK2) encoding gene was associated with the disease progression rate. The progression rate in subjects with PD who carried LRRK2 mutation was slightly slower (~0.170 points/month) than that in PD subjects without the mutation (~0.222 points/month). For a nonenriched placebo-controlled clinical trial, approximately 70 subjects/arm would be required to detect a drug effect of 50% reduction in the progression rate with 80% probability, whereas 85, 93, and 100 subjects/arm would be required for an enriched clinical trial with 30%, 50%, and 70% subjects with LRRK2 mutations, respectively.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rachael Lawson
- Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation in Parkinson’s Disease
| | - David Burn
- Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation in Parkinson’s Disease
| | - Kenneth Marek
- Institute of Neurodegenerative Diseases, New Haven, CT, USA
| | | | | | | | | | | |
Collapse
|
36
|
Momper JD, Heinrichs MT, Krudys K, Griebel D, Kumar S, Kim I, Mehrotra N, Mulberg AE, Garimella N, Nelson R, Reaman G, Sinha V, Yao L, Zineh I, Burckart G, Sachs H, Mulugeta Y. Extrapolation of Adult Efficacy to Pediatric Patients With Chemotherapy‐Induced Nausea and Vomiting. J Clin Pharmacol 2020; 60:775-784. [DOI: 10.1002/jcph.1577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/11/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Jeremiah D. Momper
- Skaggs School of Pharmacy and Pharmaceutical SciencesUniversity of CaliforniaSan Diego La Jolla California USA
| | | | - Kevin Krudys
- US Food and Drug Administration Silver Spring Maryland USA
| | - Donna Griebel
- US Food and Drug Administration Silver Spring Maryland USA
| | - Shaun Kumar
- US Food and Drug Administration Silver Spring Maryland USA
| | - Insook Kim
- US Food and Drug Administration Silver Spring Maryland USA
| | - Nitin Mehrotra
- US Food and Drug Administration Silver Spring Maryland USA
| | | | | | - Robert Nelson
- US Food and Drug Administration Silver Spring Maryland USA
| | - Gregory Reaman
- US Food and Drug Administration Silver Spring Maryland USA
| | - Vikram Sinha
- US Food and Drug Administration Silver Spring Maryland USA
| | - Lynne Yao
- US Food and Drug Administration Silver Spring Maryland USA
| | - Issam Zineh
- US Food and Drug Administration Silver Spring Maryland USA
| | | | - Hari Sachs
- US Food and Drug Administration Silver Spring Maryland USA
| | - Yeruk Mulugeta
- US Food and Drug Administration Silver Spring Maryland USA
| |
Collapse
|
37
|
Conrado DJ, Burton J, Hill D, Willis B, Sinha V, Stone J, Coello N, Wang W, Chen D, Nicholas T, Gold M, Hartley E, Kern VD, Romero K. Hippocampal Neuroimaging-Informed Clinical Trial Enrichment Tool for Amnestic Mild Cognitive Impairment Using Open Data. Clin Pharmacol Ther 2020; 107:903-914. [PMID: 31899810 DOI: 10.1002/cpt.1766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/08/2019] [Indexed: 11/05/2022]
Abstract
Our goal was to assess the enrichment utility of hippocampal volume (HV) as an enrichment biomarker in amnestic mild cognitive impairment (aMCI) clinical trials, and, hence, develop an HV neuroimaging-informed clinical trial enrichment tool. Modeling of integrated longitudinal patient-level data came from open-access natural history studies in patients diagnosed with aMCI-the Alzheimer's Disease Neuroimaging Initiative (ADNI)-1 and ADNI-2-and indicated that a decrease of 1 cm3 with respect to the analysis dataset median baseline intracranial volume-adjusted HV (ICV-HV; ~ 5 cm3 ) is associated with > 50% increase in disease progression rate as measured by the Clinical Dementia Rating Scale-Sum of Boxes. Clinical trial simulations showed that the inclusion of aMCI subjects with baseline ICV-HV below the 84th or 50th percentile allowed an approximate reduction in trial size of at least 26% and 55%, respectively. This clinical trial enrichment tool can help design more efficient and informative clinical trials.
Collapse
Affiliation(s)
| | | | - Derek Hill
- Panoramic Digital Health, Grenoble, France.,Critical Path Institute, Tucson, Arizona, USA
| | - Brian Willis
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Vikram Sinha
- Merck & Co. Inc., Philadelphia, Pennsylvania, USA
| | - Julie Stone
- Merck & Co. Inc., Philadelphia, Pennsylvania, USA
| | - Neva Coello
- Novartis Pharmaceuticals, Basel, Switzerland
| | - Wenping Wang
- Novartis Pharmaceuticals, Philadelphia, Pennsylvania, USA
| | - Danny Chen
- Pfizer Inc, Cambridge, Massachusetts, USA
| | | | | | | | | | | |
Collapse
|
38
|
Borrelli MR, Sinha V, Landin ML, Chicco M, Echlin K, Agha RA, Ross AM. A systematic review and meta-analysis of antibiotic prophylaxis in skin graft surgery: A protocol. Int J Surg Protoc 2019; 14:14-18. [PMID: 31851735 PMCID: PMC6913549 DOI: 10.1016/j.isjp.2019.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 01/26/2019] [Accepted: 02/02/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction There is little evidence-based guidance on the use of prophylactic antibiotics in skin surgery; whilst antibiotics may protect against surgical site infections (SSI), they have associated side effects, increase the risk of adverse events, and can propagate antibiotic resistance. We present a protocol for a systematic review to establish whether the benefit of prophylactic antibiotics overrides the risk, for patients undergoing autograft surgery. Methods The systematic review will be registered a priori on researchregistry.com and will be conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). A search strategy will be devised to investigate 'skin graft surgery and use of antibiotics'. The following electronic databases will be searched, 1979-2018: PubMed, MEDLINE®, EMBASE, SCOPUS, CINAHL, PsychINFO, SciELO, The Cochrane Library, including the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effect (DARE), the Cochrane Methodology Register, Health Technology Assessment Database, the NHS Economic Evaluation Databases and Cochrane Groups, ClinicalTrials.gov, Current Controlled Trials Database, the World Health Organisation (WHO) International Clinical Trials Registry Platform, UpToDate.com, NHS Evidence and the York Centre for Reviews and Dissemination. Grey literature will be searched. All comparative study designs reporting on the use of antibiotics in skin graft surgery will be considered for inclusion, namely randomized controlled trials (RCTs). Two trained independent teams will screen all titles and abstracts, followed by relevant full texts, for eligibility. Data will be extracted under standardized extraction fields into a preformatted database. Note will be made of the indication for skin graft surgery (traumatic, congenital, malignant, benign), the graft site (head & neck, trunk, upper extremities, lower extremities), type of skin graft (split thickness, full-thickness). The primary outcome will be occurrence of SSI at the donor and/or recipient sites. Secondary outcomes, if reported, will include: length of hospital stay, revision surgery required, cost of medical care, time to wound healing and cosmetic outcome. Ethics and dissemination The systematic review will be published in a peer-reviewed journal and presented at national and international meetings within fields of plastic, reconstructive, and aesthetic surgery. The work will be disseminated electronically and in print. Brief reports of the review and findings will be disseminated to interested parties through email and direct communication. The review aims to guide healthcare practice and policy.
Collapse
Affiliation(s)
- Mimi R. Borrelli
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA, United States
- Corresponding author.
| | - Vikram Sinha
- King’s College London, Guy’s, King’s and St Thomas’ School of Medicine, Guy’s Campus, Great Maze Pond, London SE1 9RT, UK
| | - Madeleine L. Landin
- King’s College London, Guy’s, King’s and St Thomas’ School of Medicine, Guy’s Campus, Great Maze Pond, London SE1 9RT, UK
| | - Maria Chicco
- Northwick Park Hospital, London North West University Healthcare NHS Trust, Watford Rd, Harrow HA1 3UJ, UK
| | - Kezia Echlin
- Birmingham Children’s Hospital, Steelhouse Ln, Birmingham B4 6NH, UK
| | - Riaz A. Agha
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Rd, Chelsea, London SW10 9NH, UK
| | - Alastair MacKenzie Ross
- St Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
| |
Collapse
|
39
|
Sinha V, Gonzales M, Payton E. Datasets acquired with correlative microscopy method for delineation of prior austenite grain boundaries and characterization of prior austenite grain size in a low-alloy high-performance steel. Data Brief 2019; 27:104471. [PMID: 31656829 PMCID: PMC6806460 DOI: 10.1016/j.dib.2019.104471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/12/2019] [Accepted: 08/26/2019] [Indexed: 12/01/2022] Open
Abstract
Prior studies on martensitic steel microstructures have either delineated the prior austenite grain boundaries via chemical etching or reconstructed the prior austenite grains from crystallographic orientations measured with electron backscattered diffraction (EBSD). To appropriately validate the reconstruction algorithms, the EBSD data need to be collected on martensitic microstructures, where the prior austenite grain boundaries are delineated with techniques such as chemical etching that can serve as ground truth for comparison with the reconstructed prior austenite grains. In this article, the method of correlative microscopy is employed to collect scanning electron microscope (SEM) image and automated EBSD scan data from the same region of an appropriately etched steel specimen. The SEM images and automated EBSD scan data are presented for five different fields of view in the specimen. These datasets are analyzed and discussed in the accompanying article titled "Correlative microscopy for quantification of prior austenite grain size in AF9628 steel" [1].
Collapse
Affiliation(s)
- V. Sinha
- Air Force Research Laboratory, Materials and Manufacturing Directorate, AFRL/RXCM, Wright-Patterson Air Force Base, OH 45433, USA
- UES, Inc., 4401 Dayton-Xenia Road, Dayton, OH 45432, USA
| | - M. Gonzales
- Air Force Research Laboratory, Materials and Manufacturing Directorate, AFRL/RXCM, Wright-Patterson Air Force Base, OH 45433, USA
| | - E.J. Payton
- Air Force Research Laboratory, Materials and Manufacturing Directorate, AFRL/RXCM, Wright-Patterson Air Force Base, OH 45433, USA
| |
Collapse
|
40
|
Mentré F, Friberg LE, Duffull S, French J, Lauffenburger DA, Li L, Mager DE, Sinha V, Sobie E, Zhao P. Pharmacometrics and Systems Pharmacology 2030. Clin Pharmacol Ther 2019; 107:76-78. [DOI: 10.1002/cpt.1683] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 08/31/2019] [Indexed: 11/09/2022]
Affiliation(s)
| | - Lena E. Friberg
- Department of Pharmaceutical Biosciences Uppsala University Uppsala Sweden
| | | | | | | | - Lang Li
- The Ohio State University Columbus Ohio USA
| | - Donald E. Mager
- University at BuffaloState University of New York (UB) Buffalo New York USA
| | | | - Eric Sobie
- Icahn School of Medicine at Mount Sinai New York New York USA
| | - Ping Zhao
- Bill & Melinda Gates Foundation Seattle Washington USA
| |
Collapse
|
41
|
Hakkim H, Sinha V, Chandra BP, Kumar A, Mishra AK, Sinha B, Sharma G, Pawar H, Sohpaul B, Ghude SD, Pithani P, Kulkarni R, Jenamani RK, Rajeevan M. Volatile organic compound measurements point to fog-induced biomass burning feedback to air quality in the megacity of Delhi. Sci Total Environ 2019; 689:295-304. [PMID: 31276997 DOI: 10.1016/j.scitotenv.2019.06.438] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 06/09/2023]
Abstract
We report the first ambient measurements of thirteen VOCs for investigations of emissions and air quality during fog and non-fog wintertime conditions at a tower site (28.57° N, 77.11° E, 220 m amsl) in the megacity of Delhi. Measurements of acetonitrile (biomass burning (BB) tracer), isoprene (biogenic emission tracer in daytime), toluene (a traffic exhaust tracer) and benzene (emitted from BB and traffic), together with soluble and reactive oxygenated VOCs such as methanol, acetone and acetaldehyde were performed during the winters of 2015-16 and 2016-17, using proton transfer reaction mass spectrometry. Remarkably, ambient VOC composition changes during fog were not governed by solubility. Acetaldehyde, toluene, sum of C8-aromatics (e.g. xylenes), sum of C9-aromatics (e.g. trimethyl benzenes) decreased by ≥30% (>95% confidence interval), whereas acetonitrile and benzene showed significant increases by 20% (>70% confidence interval), even after accounting for boundary layer dilution. During fog, the lower temperatures appeared to induce an emissions feedback from enhanced open BB within Delhi for warming, releasing both gaseous and aerosol pollutants with consequences for fog chemistry, sustenance and intensity. The potential feedback is important to consider for improving current emission parametrizations in models used for predicting air quality and fog in such atmospheric environments.
Collapse
Affiliation(s)
- H Hakkim
- Department of Earth and Environmental Sciences, Indian Institute of Science Education and Research Mohali, Sector 81, S.A.S. Nagar, Manauli PO, Punjab, 140306, India
| | - V Sinha
- Department of Earth and Environmental Sciences, Indian Institute of Science Education and Research Mohali, Sector 81, S.A.S. Nagar, Manauli PO, Punjab, 140306, India.
| | - B P Chandra
- Department of Earth and Environmental Sciences, Indian Institute of Science Education and Research Mohali, Sector 81, S.A.S. Nagar, Manauli PO, Punjab, 140306, India
| | - A Kumar
- Department of Earth and Environmental Sciences, Indian Institute of Science Education and Research Mohali, Sector 81, S.A.S. Nagar, Manauli PO, Punjab, 140306, India
| | - A K Mishra
- Department of Earth and Environmental Sciences, Indian Institute of Science Education and Research Mohali, Sector 81, S.A.S. Nagar, Manauli PO, Punjab, 140306, India
| | - B Sinha
- Department of Earth and Environmental Sciences, Indian Institute of Science Education and Research Mohali, Sector 81, S.A.S. Nagar, Manauli PO, Punjab, 140306, India
| | - G Sharma
- Department of Earth and Environmental Sciences, Indian Institute of Science Education and Research Mohali, Sector 81, S.A.S. Nagar, Manauli PO, Punjab, 140306, India
| | - H Pawar
- Department of Earth and Environmental Sciences, Indian Institute of Science Education and Research Mohali, Sector 81, S.A.S. Nagar, Manauli PO, Punjab, 140306, India
| | - B Sohpaul
- Department of Earth and Environmental Sciences, Indian Institute of Science Education and Research Mohali, Sector 81, S.A.S. Nagar, Manauli PO, Punjab, 140306, India
| | - Sachin D Ghude
- Indian Institute of Tropical Meteorology, Pashan, Pune 411008, India
| | - P Pithani
- Indian Institute of Tropical Meteorology, Pashan, Pune 411008, India
| | - R Kulkarni
- Indian Institute of Tropical Meteorology, Pashan, Pune 411008, India; Savitribai Phule Pune University, Pune, India
| | - R K Jenamani
- Indian Meteorological Department, New Delhi 110003, India
| | - M Rajeevan
- Ministry of Earth Sciences, Government of India, New Delhi 110003, India
| |
Collapse
|
42
|
Bokvist K, Ding Y, Landschulz WH, Sinha V, Pastrak A, Belin RM. Gastrin analogue administration adds no significant glycaemic benefit to a glucagon-like peptide-1 receptor agonist acutely or after washout of both analogues. Diabetes Obes Metab 2019; 21:1606-1614. [PMID: 30848033 DOI: 10.1111/dom.13695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/18/2019] [Accepted: 02/28/2019] [Indexed: 01/09/2023]
Abstract
AIM To determine if a 4-week course of 14 mg weekly GLP-1 agonist LY2428757 combined with 3 mg or 2 mg daily gastrin analogue TT223 (LY+TT223) results in long-term glycaemic changes. MATERIALS AND METHODS Patients with in adequately-controlled type 2 diabetes mellitus ±metformin (N=151) were randomized to a 4-week course of LY+TT223 (3 mg), LY+TT223 (2 mg), LY+TT223 placebo (LY-only) or LY placebo+TT223 placebo (placebo). The primary objective was change in HbA1c from baseline to 5 month safter completion of therapy (i.e. at 6 months) and safety and tolerability with LY+TT223 versus LY-only. RESULTS LY groups showed HbA1c reductions during the active treatment phase. These did not persist during follow-up phase. Combining TT223 with LY did not result in additional glycaemic effects during treatment or follow-up. At 6 months, LSM ± SE for change in HbA1c from baseline was: LY+TT223 (3 mg): -0.1 ± 0.2%; LY+TT223 (2 mg): 0.1 ± 0.2%; LY-only: -0.2 ± 0.2%; placebo: 0.04 ± 0.2%. Secondary analyses were consistent with primary results. LY+TT223 was not superior to LY for other time points or end points, including insulin secretory response to mixed meal tolerance tests. The most common adverse events (nausea and vomiting) were more frequent with LY+TT223 versus LY-only. The safety profile was consistent with previous findings. CONCLUSION GLP-1+gastrin combination therapy did not improve glycaemic control versus GLP-1 alone.
Collapse
Affiliation(s)
- Krister Bokvist
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana
- Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Ying Ding
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Vikram Sinha
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana
- Quantitative Pharmacology & Pharmacometrics, Merck & Co., Kenilworth, New Jersey
| | - Aleksandra Pastrak
- Clinical Development, Transition Therapeutics ULC - OPKO Subsidiary, Toronto, Canada
| | - Ruth M Belin
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana
| |
Collapse
|
43
|
Topp B, Trujillo ME, Sinha V. Industrialization of Quantitative Systems Pharmacology. CPT Pharmacometrics Syst Pharmacol 2019; 8:356-358. [PMID: 31087476 PMCID: PMC6617811 DOI: 10.1002/psp4.12427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 05/04/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Brian Topp
- Quantitative Pharmacology and Pharmacometrics, Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck Research Laboratories, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Maria E Trujillo
- Quantitative Pharmacology and Pharmacometrics, Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck Research Laboratories, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Vikram Sinha
- Quantitative Pharmacology and Pharmacometrics, Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck Research Laboratories, Merck & Co., Inc., Kenilworth, New Jersey, USA
| |
Collapse
|
44
|
Heinemann L, Beals JM, Malone J, Anderson J, Jacobson JG, Sinha V, Corrigan SM. Concentrated insulins: History and critical reappraisal. J Diabetes 2019; 11:292-300. [PMID: 30264527 DOI: 10.1111/1753-0407.12861] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/03/2018] [Accepted: 09/22/2018] [Indexed: 02/02/2023] Open
Abstract
The earliest marketed insulins were crude acidic formulations with concentrations of ≤10 units/mL. Since the early 1920s, insulins have improved continually, via bioengineering, process, and chemical modifications. Today, most insulin formulations have a concentration of 100 units/mL (U100). However, more concentrated insulin formulations (200, 300, and 500 units/mL; U200, U300, and U500, respectively) are also available. There is a tendency to assume that concentrated insulins are similar, both to each other and to their U100 counterparts, but this is not always the case: two concentrated insulins, namely insulin degludec U200 and insulin lispro U200, are bioequivalent to their U100 counterparts, whereas regular human insulin U500 and insulin glargine U300 are not. The advent of these concentrated insulins offers greater opportunities to provide tailored therapy for patients; it also introduces potential confusion, and highlights the need for prescriber and patient education. Precise and accurate dedicated insulin delivery devices are also necessary for the safe use of these concentrated insulins. Although some clinicians only use concentrated insulin with obese and severely insulin-resistant patients, other patients would also benefit from the reduced injection volume associated with concentrated insulins, or the modified time-action profile of some concentrated insulins. The aim of this review is to enhance understanding of the historic development and the safe and effective use of concentrated insulins in clinical practice.
Collapse
Affiliation(s)
| | - John M Beals
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| | - James Malone
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| | - James Anderson
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| | - Jennie G Jacobson
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| | | | - Sheila M Corrigan
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| |
Collapse
|
45
|
Romero K, Conrado D, Burton J, Nicholas T, Sinha V, Macha S, Ahamadi M, Cedarbaum J, Seibyl J, Marek K, Basseches P, Hill D, Somer E, Gallagher J, Dexter DT, Roach A, Stephenson D. Molecular Neuroimaging of the Dopamine Transporter as a Patient Enrichment Biomarker for Clinical Trials for Early Parkinson's Disease. Clin Transl Sci 2019; 12:240-246. [PMID: 30706986 PMCID: PMC6510371 DOI: 10.1111/cts.12619] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/21/2018] [Indexed: 01/28/2023] Open
Abstract
The Critical Path for Parkinson's (CPP) Imaging Biomarker and Modeling and Simulation working groups aimed to achieve qualification opinion by the European Medicines Agency (EMA) Committee for Medical Products for Human Use (CHMP) for the use of baseline dopamine transporter neuroimaging for patient selection in early Parkinson's disease clinical trials. This paper describes the regulatory science strategy to achieve this goal. CPP is an international consortium of three Parkinson's charities and nine pharmaceutical partners, coordinated by the Critical Path Institute.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - John Seibyl
- Molecular Neuroimaging, New Haven, Connecticut, USA
| | | | | | - Derek Hill
- Panoramic Digital Health, Saint Pierre de Chartreuse, France
| | - Ed Somer
- General Electric, Little Chalfont, UK
| | | | | | | | | | | | | |
Collapse
|
46
|
Mulberg AE, Bucci-Rechtweg C, Giuliano J, Jacoby D, Johnson FK, Liu Q, Marsden D, McGoohan S, Nelson R, Patel N, Romero K, Sinha V, Sitaraman S, Spaltro J, Kessler V. Regulatory strategies for rare diseases under current global regulatory statutes: a discussion with stakeholders. Orphanet J Rare Dis 2019; 14:36. [PMID: 30736861 PMCID: PMC6368795 DOI: 10.1186/s13023-019-1017-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 01/31/2019] [Indexed: 12/20/2022] Open
Abstract
Rare or orphan diseases often are inherited and overwhelmingly affect children. Many of these diseases have no treatments, are incurable, and have a devastating impact on patients and their families. Regulatory standards for drug approval for rare diseases must ensure that patients receive safe and efficacious treatments. However, regulatory bodies have shown flexibility in applying these standards to drug development in rare diseases, given the unique challenges that hinder efficient and effective traditional clinical trials, including low patient numbers, limited understanding of disease pathology and progression, variability in disease presentation, and a lack of established endpoints. To take steps toward improving rare disease clinical development strategies under current global regulatory statutes, Amicus Therapeutics, Inc. and BioNJ convened a 1-day meeting that included representatives from the Food and Drug Administration (FDA), biopharmaceutical industry, and not-for-profit agencies. The meeting focused on orphan diseases in pediatric and adult patients and was intended to identify potential strategies to overcome regulatory hurdles through open collaboration. During this meeting, several strategies were identified to minimize the limitations associated with low patient numbers in rare diseases, including the use of natural history to generate historical control data in comparisons, simulations, and identifying inclusion/exclusion criteria and appropriate endpoints. Novel approaches to clinical trial design were discussed to minimize patient exposure to placebo and to reduce the numbers of patients and clinical trials needed for providing substantial evidence. Novel statistical analysis approaches were also discussed to address the inherent challenges of small patient numbers. Areas of urgent unmet need were identified, including the need to develop registries that protect patient identities, to establish close collaboration and communication between the sponsor and regulatory bodies to address methodological and statistical challenges, to collaborate in pre-competitive opportunities within multiple sponsors and in conjunction with academia and disease-specific patient advocacy groups for optimal data sharing, and to develop harmonized guidelines for data extrapolation from source to target pediatric populations. Ultimately, these innovations will help in solving many regulatory challenges in rare disease drug development and encourage the availability of new treatments for patients with rare diseases.
Collapse
Affiliation(s)
- Andrew E Mulberg
- Amicus Therapeutics, Inc., 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA.
| | | | - Joseph Giuliano
- Amicus Therapeutics, Inc., 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| | - David Jacoby
- BioMarin Pharmaceutical Inc., 770 Lindaro St, San Rafael, CA, 94901, USA
| | - Franklin K Johnson
- Amicus Therapeutics, Inc., 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| | - Qing Liu
- Amicus Therapeutics, Inc., 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| | - Deborah Marsden
- Ultragenyx Pharmaceutical, Inc., 60 Leveroni Ct, Novato, CA, 94949, USA
| | - Scott McGoohan
- Vertex Pharmaceuticals, 50 Northern Ave, Boston, MA, 02210, USA
| | - Robert Nelson
- Johnson & Johnson, 920 Route 202 South, Raritan, NJ, 08869, USA
| | - Nita Patel
- Amicus Therapeutics, Inc., 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| | - Klaus Romero
- Critical Path Institute, 1730 East River Rd, Tucson, AZ, 85718, USA
| | - Vikram Sinha
- Merck & Co, Inc. 351 North Sumneytown Pike, North Wales, PA, 19454, USA
| | - Sheela Sitaraman
- Amicus Therapeutics, Inc., 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| | - John Spaltro
- Amicus Therapeutics, Inc., 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| | - Vivian Kessler
- Amicus Therapeutics, Inc., 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| |
Collapse
|
47
|
Jain L, Mehrotra N, Wenning L, Sinha V. PDUFA VI: It Is Time to Unleash the Full Potential of Model-Informed Drug Development. CPT Pharmacometrics Syst Pharmacol 2018; 8:5-8. [PMID: 30370642 PMCID: PMC6363279 DOI: 10.1002/psp4.12365] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/12/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Lokesh Jain
- Quantitative Pharmacology and PharmacometricsPharmacokinetics Pharmacodynamics and Drug MetabolismMerck & Co., Inc.KenilworthNew JerseyUSA
| | - Nitin Mehrotra
- Quantitative Pharmacology and PharmacometricsPharmacokinetics Pharmacodynamics and Drug MetabolismMerck & Co., Inc.KenilworthNew JerseyUSA
| | - Larissa Wenning
- Quantitative Pharmacology and PharmacometricsPharmacokinetics Pharmacodynamics and Drug MetabolismMerck & Co., Inc.KenilworthNew JerseyUSA
| | - Vikram Sinha
- Quantitative Pharmacology and PharmacometricsPharmacokinetics Pharmacodynamics and Drug MetabolismMerck & Co., Inc.KenilworthNew JerseyUSA
| |
Collapse
|
48
|
Khurana M, Zadezensky I, Lowy N, Roman D, Guettier JM, Li L, Florian J, Sahajwalla CG, Sinha V, Mehrotra N. Use of a Systems Pharmacology Model Based Approach Toward Dose Optimization of Parathyroid Hormone Therapy in Hypoparathyroidism. Clin Pharmacol Ther 2018; 105:710-718. [PMID: 30350311 DOI: 10.1002/cpt.1200] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We present an application of a quantitative systems pharmacology (QSP) model to support a regulatory decision, specifically in assessing the adequacy of the proposed dosing regimen. On January 23, 2015, the US Food and Drug Administration (FDA) approved Natpara (human parathyroid hormone (PTH)) to control hypocalcemia in patients with hypoparathyroidism. Clinical trial results indicated that although once-daily PTH reduced calcium and vitamin D dose requirement while maintaining the normocalcemia, the regimen was not adequate to control hypercalciuria. We hypothesized that the lack of control on urinary calcium excretion was due to the short half-life of PTH. The QSP model-based simulations indicated that a more frequent dosing regimen may provide better control on hypercalciuria while maintaining normocalcemia. A postmarketing trial was recommended to assess pharmacokinetics (PKs) and pharmacodynamics (PDs) of PTH dose and dosing regimen. Although other modeling approaches may be feasible, in this specific case, QSP model-based simulations fulfilled the information gap to support recommendations of this postmarketing trial.
Collapse
Affiliation(s)
- Manoj Khurana
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration (FDA), Silver Spring, Maryland,, USA
| | | | - Naomi Lowy
- Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration (FDA), Silver Spring, Maryland,, USA
| | - Dragos Roman
- Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration (FDA), Silver Spring, Maryland,, USA
| | - Jean-Marc Guettier
- Sanofi-Aventis Deutschland GmbH, Industriepark Hoechst, Frankfurt, Germany
| | - Liang Li
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration (FDA), Silver Spring, Maryland,, USA
| | - Jeffry Florian
- Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration (FDA), Silver Spring, Maryland,, USA
| | - Chandrahas G Sahajwalla
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration (FDA), Silver Spring, Maryland,, USA
| | | | | |
Collapse
|
49
|
Conrado DJ, Nicholas T, Burton J, Arnerić SP, Chen D, Stone JA, Sinha V, Willis BA, Kern VD, Hill DL, Novak GP, Gold LH, Cole PE, Matthews DC, Xie Z, Wang W, Hendrix J, Wolz R, Gordon MF, Romero K. P3‐031: THE CRITICAL PATH FOR ALZHEIMER'S DISEASE: HIPPOCAMPAL VOLUME AS AN ENRICHMENT BIOMARKER IN TRIALS OF PATIENTS WITH MILD COGNITIVE IMPAIRMENT. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | - Danny Chen
- Pfizer Early Clinical DevelopmentCambridgeMAUSA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Turner DC, Kondic AG, Anderson KM, Robinson AG, Garon EB, Riess JW, Jain L, Mayawala K, Kang J, Ebbinghaus SW, Sinha V, de Alwis DP, Stone JA. Pembrolizumab Exposure-Response Assessments Challenged by Association of Cancer Cachexia and Catabolic Clearance. Clin Cancer Res 2018; 24:5841-5849. [PMID: 29891725 DOI: 10.1158/1078-0432.ccr-18-0415] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/12/2018] [Accepted: 06/05/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the relationship of pembrolizumab pharmacokinetics (PK) and overall survival (OS) in patients with advanced melanoma and non-small cell lung cancer (NSCLC). PATIENTS AND METHODS PK dependencies in OS were evaluated across three pembrolizumab studies of either 200 mg or 2 to 10 mg/kg every 3 weeks (Q3W). Kaplan-Meier plots of OS, stratified by dose, exposure, and baseline clearance (CL0), were assessed per indication and study. A Cox proportional hazards model was implemented to explore imbalances of typical prognostic factors in high/low NSCLC CL0 subgroups. RESULTS A total of 1,453 subjects were included: 340 with pembrolizumab-treated melanoma, 804 with pembrolizumab-treated NSCLC, and 309 with docetaxel-treated NSCLC. OS was dose independent from 2 to 10 mg/kg for pembrolizumab-treated melanoma [HR = 0.98; 95% confidence interval (CI), 0.94-1.02] and NSCLC (HR = 0.98; 95% CI, 0.95-1.01); however, a strong CL0-OS association was identified for both cancer types (unadjusted melanoma HR = 2.56; 95% CI, 1.72-3.80 and NSCLC HR = 2.64; 95% CI, 1.94-3.57). Decreased OS in subjects with higher pembrolizumab CL0 paralleled disease severity markers associated with end-stage cancer anorexia-cachexia syndrome. Correction for baseline prognostic factors did not fully attenuate the CL0-OS association (multivariate-adjusted CL0 HR = 1.64; 95% CI, 1.06-2.52 for melanoma and HR = 1.88; 95% CI, 1.22-2.89 for NSCLC). CONCLUSIONS These data support the lack of dose or exposure dependency in pembrolizumab OS for melanoma and NSCLC between 2 and 10 mg/kg. An association of pembrolizumab CL0 with OS potentially reflects catabolic activity as a marker of disease severity versus a direct PK-related impact of pembrolizumab on efficacy. Similar data from other trials suggest such patterns of exposure-response confounding may be a broader phenomenon generalizable to antineoplastic mAbs.See related commentary by Coss et al., p. 5787.
Collapse
Affiliation(s)
| | | | | | - Andrew G Robinson
- Cancer Centre of Southeastern Ontario at Kingston General Hospital, Ontario, Canada
| | - Edward B Garon
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | | | | | | | | | | | | | | |
Collapse
|