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Martínez-Cibrián N, Ortiz-Maldonado V, Español-Rego M, Blázquez A, Cid J, Lozano M, Magnano L, Giné E, Correa JG, Mozas P, Rodríguez-Lobato LG, Rivero A, Montoro-Lorite M, Ayora P, Navarro S, Alserawan L, González-Navarro EA, Castellà M, Sánchez-Castañón M, Cabezón R, Benítez-Ribas D, Setoaín X, Rodríguez S, Brillembourg H, Varea S, Olesti E, Guillén E, Sáez-Peñataro J, de Larrea CF, López-Guillermo A, Pascal M, Urbano-Ispizua Á, Juan M, Delgado J. The academic point-of-care anti-CD19 chimeric antigen receptor T-cell product varnimcabtagene autoleucel (ARI-0001 cells) shows efficacy and safety in the treatment of relapsed/refractory B-cell non-Hodgkin lymphoma. Br J Haematol 2024; 204:525-533. [PMID: 37905734 DOI: 10.1111/bjh.19170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 11/02/2023]
Abstract
Varnimcabtagene autoleucel (var-cel) is an academic anti-CD19 chimeric antigen receptor (CAR) product used for the treatment of non-Hodgkin lymphoma (NHL) in the CART19-BE-01 trial. Here we report updated outcomes of patients with NHL treated with var-cel. B-cell recovery was compared with patients with acute lymphoblastic leukaemia (ALL). Forty-five patients with NHL were treated. Cytokine release syndrome (any grade) occurred in 84% of patients (4% grade ≥3) and neurotoxicity in 7% (2% grade ≥3). The objective response rate was 73% at Day +100, and the 3-year duration of response was 56%. The 3-year progression-free and overall survival were 40% and 52% respectively. High lactate dehydrogenase was the only covariate with an impact on progression-free survival. The 3-year incidence of B-cell recovery was lower in patients with NHL compared to ALL (25% vs. 60%). In conclusion, in patients with NHL, the toxicity of var-cel was manageable, while B-cell recovery was significantly prolonged compared to ALL. This trial was registered as NCT03144583.
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Affiliation(s)
| | - Valentín Ortiz-Maldonado
- Department of Hematology, Hospital Clínic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Español-Rego
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Immunology, Hospital Clínic, Barcelona, Spain
| | | | - Joan Cid
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Apheresis Unit, Hospital Clínic, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Apheresis Unit, Hospital Clínic, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Laura Magnano
- Department of Hematology, Hospital Clínic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eva Giné
- Department of Hematology, Hospital Clínic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- CIBERONC, Madrid, Spain
| | - Juan G Correa
- Department of Hematology, Hospital Clínic, Barcelona, Spain
| | - Pablo Mozas
- Department of Hematology, Hospital Clínic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Luis Gerardo Rodríguez-Lobato
- Department of Hematology, Hospital Clínic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Andrea Rivero
- Department of Hematology, Hospital Clínic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Pilar Ayora
- Department of Hematology, Hospital Clínic, Barcelona, Spain
| | - Sergio Navarro
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Immunology, Hospital Clínic, Barcelona, Spain
| | | | | | - Maria Castellà
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Immunology, Hospital Clínic, Barcelona, Spain
| | | | - Raquel Cabezón
- Department of Immunology, Hospital Clínic, Barcelona, Spain
| | - Daniel Benítez-Ribas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Immunology, Hospital Clínic, Barcelona, Spain
| | - Xavier Setoaín
- University of Barcelona, Barcelona, Spain
- Department of Nuclear Medicine, Hospital Clínic, Barcelona, Spain
- CIBERBBN, Madrid, Spain
| | | | | | - Sara Varea
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Clinical Pharmacology, Hospital Clínic, Barcelona, Spain
| | - Eulalia Olesti
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Department of Clinical Pharmacology, Hospital Clínic, Barcelona, Spain
| | - Elena Guillén
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Clinical Pharmacology, Hospital Clínic, Barcelona, Spain
| | - Joaquín Sáez-Peñataro
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Clinical Pharmacology, Hospital Clínic, Barcelona, Spain
| | - Carlos Fernández de Larrea
- Department of Hematology, Hospital Clínic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Armando López-Guillermo
- Department of Hematology, Hospital Clínic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- CIBERONC, Madrid, Spain
| | - Mariona Pascal
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Immunology, Hospital Clínic, Barcelona, Spain
| | - Álvaro Urbano-Ispizua
- Department of Hematology, Hospital Clínic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Manel Juan
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Immunology, Hospital Clínic, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Julio Delgado
- Department of Hematology, Hospital Clínic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- CIBERONC, Madrid, Spain
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Nogal A, Alkis T, Lee Y, Kifer D, Hu J, Murphy RA, Huang Z, Wang-Sattler R, Kastenmüler G, Linkohr B, Barrios C, Crespo M, Gieger C, Peters A, Price J, Rexrode KM, Yu B, Menni C. Predictive metabolites for incident myocardial infarction: a two-step meta-analysis of individual patient data from six cohorts comprising 7897 individuals from the COnsortium of METabolomics Studies. Cardiovasc Res 2023; 119:2743-2754. [PMID: 37706562 PMCID: PMC10757581 DOI: 10.1093/cvr/cvad147] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/28/2023] [Accepted: 07/18/2023] [Indexed: 09/15/2023] Open
Abstract
AIMS Myocardial infarction (MI) is a major cause of death and disability worldwide. Most metabolomics studies investigating metabolites predicting MI are limited by the participant number and/or the demographic diversity. We sought to identify biomarkers of incident MI in the COnsortium of METabolomics Studies. METHODS AND RESULTS We included 7897 individuals aged on average 66 years from six intercontinental cohorts with blood metabolomic profiling (n = 1428 metabolites, of which 168 were present in at least three cohorts with over 80% prevalence) and MI information (1373 cases). We performed a two-stage individual patient data meta-analysis. We first assessed the associations between circulating metabolites and incident MI for each cohort adjusting for traditional risk factors and then performed a fixed effect inverse variance meta-analysis to pull the results together. Finally, we conducted a pathway enrichment analysis to identify potential pathways linked to MI. On meta-analysis, 56 metabolites including 21 lipids and 17 amino acids were associated with incident MI after adjusting for multiple testing (false discovery rate < 0.05), and 10 were novel. The largest increased risk was observed for the carbohydrate mannitol/sorbitol {hazard ratio [HR] [95% confidence interval (CI)] = 1.40 [1.26-1.56], P < 0.001}, whereas the largest decrease in risk was found for glutamine [HR (95% CI) = 0.74 (0.67-0.82), P < 0.001]. Moreover, the identified metabolites were significantly enriched (corrected P < 0.05) in pathways previously linked with cardiovascular diseases, including aminoacyl-tRNA biosynthesis. CONCLUSIONS In the most comprehensive metabolomic study of incident MI to date, 10 novel metabolites were associated with MI. Metabolite profiles might help to identify high-risk individuals before disease onset. Further research is needed to fully understand the mechanisms of action and elaborate pathway findings.
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Affiliation(s)
- Ana Nogal
- Department of Twin Research, King’s College London, St Thomas’ Hospital Campus, Westminster Bridge Road, SE1 7EH London, UK
| | - Taryn Alkis
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler St, Suite E407, Houston, 77030 TX, USA
| | - Yura Lee
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler St, Suite E407, Houston, 77030 TX, USA
| | - Domagoj Kifer
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Jie Hu
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Rachel A Murphy
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Zhe Huang
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Rui Wang-Sattler
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gabi Kastenmüler
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Birgit Linkohr
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Clara Barrios
- Department of Nephrology, Hospital del Mar, Institut Hospital del Mar d´Investigacions Mediques, Barcelona, Spain
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Institut Hospital del Mar d´Investigacions Mediques, Barcelona, Spain
| | - Christian Gieger
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jackie Price
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Kathryn M Rexrode
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Bing Yu
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler St, Suite E407, Houston, 77030 TX, USA
| | - Cristina Menni
- Department of Twin Research, King’s College London, St Thomas’ Hospital Campus, Westminster Bridge Road, SE1 7EH London, UK
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Guarga L, Badia X, Obach M, Fontanet M, Prat A, Vallano A, Torrent J, Pontes C. Implementing reflective multicriteria decision analysis (MCDA) to assess orphan drugs value in the Catalan Health Service ( CatSalut). Orphanet J Rare Dis 2019; 14:157. [PMID: 31248421 PMCID: PMC6598260 DOI: 10.1186/s13023-019-1121-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 06/07/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Orphan medicines show some characteristics that hinder the evaluation of their clinical added value. The often low level of evidence available for orphan drugs, together with a high budget impact and an incremental cost-effectiveness ratio many times higher than drugs used for non-orphan diseases, represent challenges in their appraisal and effective access to clinical use. In order to explore how to handle these hurdles, the Catalan Health Service (CatSalut) began an initiative on a multidimensional assessment of drugs value during the appraisal process. Reflective multicriteria decision analysis (MCDA) using analytical methods was chosen, since it may help to standardise and contextualize all the relevant data related with the drug that could contribute to a decision. The aim of the study was to determine whether the implementation of reflective MCDA methodology could support the decision-making process about orphan medicines in the context of CatSalut. METHODS The assessment and decision-making process for orphan drugs in the Programa d'Harmonització Farmacoterapeutica (PHF) of CatSalut was prioritized to test the implementation of the reflective MCDA both a qualitative and quantitatively. A staged approach was used with the following main steps: selection and structuration of quantitative criteria (Core Model) and qualitative criteria (Contextual Tool), framework scoring and assessment of three orphan drug case studies. This proof-of-concept would grant a continued refinement of the methodology and, if and when validated, its potential integration to other therapeutic areas of the PHF. RESULTS The final framework was composed by 10 quantitative criteria (Core Model) and 4 qualitative criteria (Contextual Tool) according to the PHF goals being the most important criteria "disease severity", "unmet need", "comparative effectiveness" and "comparative safety /tolerability". The matrix developed for the case studies served as a guide for the selection of the essential information that the decision-makers were expected to include in a framework. The reflective discussion was considered the most relevant phase of the approach to support inputs for health decision-making processes reflecting both drug value and place in therapy. CONCLUSIONS The study showed that reflective MCDA methodology could be implemented to complement the decision-making process in CatSalut, as an aid to determine the clinical added value for orphan medicines. MCDA provided transparency and a structured discussion during the committee meetings, thus increasing transparency and predictability of the relevant items supporting the agreements adopted on orphan drugs access.
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Affiliation(s)
- Laura Guarga
- Àrea del Medicament, Servei Català de la Salut (CatSalut), Travessera de les Corts, 131-159, 08028 Barcelona, Spain
- Omakase Consulting S.L., Entença street 332334 Floor 6, door 4, 08029 Barcelona, Spain
| | - Xavier Badia
- Omakase Consulting S.L., Entença street 332334 Floor 6, door 4, 08029 Barcelona, Spain
| | - Mercè Obach
- Àrea del Medicament, Servei Català de la Salut (CatSalut), Travessera de les Corts, 131-159, 08028 Barcelona, Spain
| | - Manel Fontanet
- Àrea del Medicament, Servei Català de la Salut (CatSalut), Travessera de les Corts, 131-159, 08028 Barcelona, Spain
- Departament de Farmacologia, de Terapèutica i de Toxicologia, Universitat Autònoma de Barcelona, Av. de Can Domènech, 737, 08193 Cerdanyola del Vallès (Barcelona), Spain
| | - Alba Prat
- Àrea del Medicament, Servei Català de la Salut (CatSalut), Travessera de les Corts, 131-159, 08028 Barcelona, Spain
| | - Atonio Vallano
- Àrea del Medicament, Servei Català de la Salut (CatSalut), Travessera de les Corts, 131-159, 08028 Barcelona, Spain
| | - Josep Torrent
- Àrea del Medicament, Servei Català de la Salut (CatSalut), Travessera de les Corts, 131-159, 08028 Barcelona, Spain
| | - Caridad Pontes
- Àrea del Medicament, Servei Català de la Salut (CatSalut), Travessera de les Corts, 131-159, 08028 Barcelona, Spain
- Departament de Farmacologia, de Terapèutica i de Toxicologia, Universitat Autònoma de Barcelona, Av. de Can Domènech, 737, 08193 Cerdanyola del Vallès (Barcelona), Spain
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