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Caporali R, Fakhouri WKH, Nicolay C, Longley HJ, Losi S, Rogai V. New Rheumatoid Arthritis Treatments for 'Old' Patients: Results of a Systematic Review. Adv Ther 2020; 37:3676-3691. [PMID: 32705531 PMCID: PMC7444401 DOI: 10.1007/s12325-020-01435-6] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION In the last 20 years, biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) have become available for treating rheumatoid arthritis (RA), and a treat-to-target strategy has been introduced. We hypothesise that these advances should have resulted in changes to the characteristics of patients with RA participating in clinical trials of the newest therapies. This study determined whether the baseline characteristics of patients with RA enrolled in clinical trials have changed in the past decade versus patients participating in earlier RA studies. METHODS This secondary analysis was based on randomised controlled trials (RCTs) identified in a systematic literature review. Baseline characteristics of patients with RA with inadequate response to conventional synthetic DMARDs were compared between RCTs published in 1999-2009 and those published in 2010-2017 using random-effects meta-analyses. RESULTS Forty RCTs were analysed: 22 from 1999-2009 and 18 from 2010-2017. No significant difference between the two timeframes and no obvious trend over time were observed for age, gender, disease duration, rheumatoid factor status, tender and swollen joint counts, physician and patient global assessments of disease activity, and pain scores. Variability between RCTs was high. Similar results were observed for Disease Activity Scores and Health Assessment Questionnaire-Disability Index scores, but with low variability between RCTs. CONCLUSION The baseline characteristics of patients with RA participating in RCTs do not appear to have changed in the last decade despite the availability of new treatments and a different treatment approach. Further research should determine the impact of baseline patient characteristics on patients' response to RA treatments.
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Affiliation(s)
- Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Rheumatology Unit, ASST Gaetano Pini-CTO Hospital, Milan, Italy.
| | | | | | | | - Serena Losi
- Eli Lilly Italy S.p.A., Sesto Fiorentino, Italy
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Early JV, Mullen S, Parish T. A rapid, low pH, nutrient stress, assay to determine the bactericidal activity of compounds against non-replicating Mycobacterium tuberculosis. PLoS One 2019; 14:e0222970. [PMID: 31589621 PMCID: PMC6779252 DOI: 10.1371/journal.pone.0222970] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 09/11/2019] [Indexed: 11/18/2022] Open
Abstract
There is an urgent need for new anti-tubercular agents which can lead to a shortened treatment time by targeting persistent or non-replicating bacilli. In order to assess compound activity against non-replicating Mycobacterium tuberculosis, we developed a method to detect the bactericidal activity of novel compounds within 7 days. Our method uses incubation at low pH in order to induce a non-replicating state. We used a strain of M. tuberculosis expressing luciferase; we first confirmed the linear relationship between luminescence and viable bacteria (determined by colony forming units) under our assay conditions. We optimized the assay parameters in 96-well plates in order to achieve a reproducible assay. Our final assay used M. tuberculosis in phosphate-citrate buffer, pH 4.5 exposed to compounds for 7 days; viable bacteria were determined by luminescence. We recorded the minimum bactericidal concentration at pH 4.5 (MBC4.5) representing >2 logs of kill. We confirmed the utility of the assay with control compounds. The ionophores monensin, niclosamide, and carbonyl cyanide 3-chlorophenylhydrazone and the anti-tubercular drugs pretomanid and rifampicin were active, while several other drugs such as isoniazid, ethambutol, and linezolid were not.
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Affiliation(s)
- Julie V. Early
- TB Discovery Research, Infectious Disease Research Institute, Seattle, Washington, United States of America
| | - Steven Mullen
- TB Discovery Research, Infectious Disease Research Institute, Seattle, Washington, United States of America
| | - Tanya Parish
- TB Discovery Research, Infectious Disease Research Institute, Seattle, Washington, United States of America
- * E-mail:
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Okazaki K, Shingaki T, Cai Z, Perez-Nieves M, Fisher L. Successful Healthcare Provider Strategies to Overcome Psychological Insulin Resistance in Japanese Patients with Type 2 Diabetes. Diabetes Ther 2019; 10:1823-1834. [PMID: 31286432 PMCID: PMC6778551 DOI: 10.1007/s13300-019-0664-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION EMOTION was a multinational, noninterventional study surveying current insulin-using adults with type 2 diabetes mellitus (T2D) who were initially reluctant to begin insulin treatment. In this Japanese population subanalysis of EMOTION, we identify the frequency and level of helpfulness of healthcare provider (HCP) actions, and we analyze life events ('actions/events') that assist T2D patients with psychological insulin resistance in the decision to initiate insulin. METHODS Participants were selected from Survey Sampling International and their local partners' market research panels in Japan. Quantitative surveys were administered between December 2016 and August 2017 to patients who met the study criteria. Participants were asked whether 45 actions/events occurred, and to rate the level of helpfulness of the actions/events in contributing to their decision to initiate insulin. RESULTS Among the 594 eligible participating adults in the EMOTION study, 99 were from Japan. Despite initial reluctance to begin insulin treatment, 80.8% of the Japanese participants immediately commenced insulin. Practical demonstrations by HCPs on how to use insulin were rated by participants as most helpful. Examples of such practical demonstrations, reported as helping moderately or a lot, were 'HCP walked patient through the process of exactly how to take insulin' (82.8%), 'HCP showed an insulin pen' (79.7%), and 'HCP helped patient to see how simple it was to inject insulin' (79.1%). CONCLUSION This study identifies actions that HCPs can use to assist Japanese patients in deciding whether to initiate insulin. These findings may aid the development of clinical interventions addressing reluctance to begin insulin treatment among Japanese patients with T2D. FUNDING Eli Lilly and Company and Boehringer Ingelheim. Plain language summary available for this article.
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Affiliation(s)
- Kentaro Okazaki
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Tomotaka Shingaki
- Eli Lilly Japan K.K., 5-1-28 Isogami-dori, Chuo-ku, Kobe, Hyogo, 651-0086, Japan.
| | - Zhihong Cai
- Eli Lilly Japan K.K., 5-1-28 Isogami-dori, Chuo-ku, Kobe, Hyogo, 651-0086, Japan
| | | | - Lawrence Fisher
- Behavioral Diabetes Institute, 5405 Oberlin Drive Suite 100, San Diego, CA, 92121, USA
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Bernardes G, IJzerman RG, Ten Kulve JS, Barkhof F, Diamant M, Veltman DJ, Landeira-Fernandez J, van Bloemendaal L, van Duinkerken E. Cortical and subcortical gray matter structural alterations in normoglycemic obese and type 2 diabetes patients: relationship with adiposity, glucose, and insulin. Metab Brain Dis 2018; 33:1211-1222. [PMID: 29654499 PMCID: PMC6060745 DOI: 10.1007/s11011-018-0223-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 03/26/2018] [Indexed: 01/16/2023]
Abstract
Type 2 diabetes (T2DM) is associated with structural cortical and subcortical alterations, although it is insufficiently clear if these alterations are driven by obesity or by diabetes and its associated complications. We used FreeSurfer5.3 and FSL-FIRST to determine cortical thickness, volume and surface area, and subcortical gray matter volume in a group of 16 normoglycemic obese subjects and 28 obese T2DM patients without clinically manifest micro- and marcoangiopathy, and compared them to 31 lean normoglycemic controls. Forward regression analysis was used to determine demographic and clinical correlates of altered (sub)cortical structure. Exploratively, vertex-wise correlations between cortical structure and fasting glucose and insulin were calculated. Compared with controls, obese T2DM patients showed lower right insula thickness and lower left lateral occipital surface area (PFWE < 0.05). Normoglycemic obese versus controls had lower thickness (PFWE < 0.05) in the right insula and inferior frontal gyrus, and higher amygdala and thalamus volume. Thalamus volume and left paracentral surface area were also higher in this group compared with obese T2DM patients. Age, sex, BMI, fasting glucose, and cholesterol were related to these (sub)cortical alterations in the whole group (all P < 0.05). Insulin were related to temporal and frontal structural deficits (all PFWE < 0.05). Parietal/occipital structural deficits may constitute early T2DM-related cerebral alterations, whereas in normoglycemic obese subjects, regions involved in emotion, appetite, satiety regulation, and inhibition were affected. Central adiposity and elevated fasting glucose may constitute risk factors.
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Affiliation(s)
- Gabriel Bernardes
- Department of Psychology, Pontifíca Universidade Católica - Rio de Janeiro, Rua Marquês de São Vincente, 225, Gávea, Rio de Janeiro, RJ, 22451-900, Brazil
| | - Richard G IJzerman
- Amsterdam Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Jennifer S Ten Kulve
- Amsterdam Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
- Institutes of Neurology and Healthcare Engineering, University College London, London, UK
| | - Michaela Diamant
- Amsterdam Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Jesus Landeira-Fernandez
- Department of Psychology, Pontifíca Universidade Católica - Rio de Janeiro, Rua Marquês de São Vincente, 225, Gávea, Rio de Janeiro, RJ, 22451-900, Brazil
| | - Liselotte van Bloemendaal
- Amsterdam Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Eelco van Duinkerken
- Department of Psychology, Pontifíca Universidade Católica - Rio de Janeiro, Rua Marquês de São Vincente, 225, Gávea, Rio de Janeiro, RJ, 22451-900, Brazil.
- Amsterdam Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands.
- Center for Epilepsy, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brazil.
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Gupta N, Naegeli AN, Turner-Bowker DM, Flood EM, Heath LE, Mays SM, Dampier C. Cognitive Testing of an Electronic Version of the Faces Pain Scale-Revised with Pediatric and Adolescent Sickle Cell Patients. Patient 2018; 9:433-43. [PMID: 27026180 PMCID: PMC5021749 DOI: 10.1007/s40271-016-0166-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient diaries and pain scales can capture the course and complications of pain managed at home in children. The Faces Pain Scale-Revised (FPS-R) is a validated scale showing reliability in children, but it has not been validated in children with sickle cell disease (SCD). OBJECTIVE The purpose of this study was to evaluate comprehension and usability of an electronic modified version of the FPS-R among pediatric patients with SCD. METHODS This was a cross-sectional, qualitative study involving in-person interviews with children/adolescents from the USA and their parents/legal guardians. Interviews involved cognitive debriefing and usability testing of the FPS-R. RESULTS In total, 22 children with SCD aged 4-17 years participated. Children aged 4-6 were generally unable to demonstrate clear understanding of the FPS-R and its response scale. Overall, children aged ≥7 years understood the instrument and could complete it on the electronic device, although children aged 7-8 often needed assistance from the parent. Children aged 9-17 years were able to read and complete the instrument independently. Most participants considered the electronic device easy to use. CONCLUSIONS The FPS-R was shown to be a comprehensible and usable pain measure for children aged 7-17 with SCD and to be beneficial for future clinical studies.
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Affiliation(s)
- Neehar Gupta
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA.
| | - April N Naegeli
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | | | - Emuella M Flood
- ICON plc, Clinical Outcomes Assessments, Gaithersburg, MD, 20878, USA
| | - Lori Ellen Heath
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Shelley M Mays
- Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Atlanta, GA, 30322, USA
| | - Carlton Dampier
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
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Cohn AL, Yoshino T, Heinemann V, Obermannova R, Bodoky G, Prausová J, Garcia-Carbonero R, Ciuleanu T, Garcia-Alfonso P, Portnoy DC, Van Cutsem E, Yamazaki K, Clingan PR, Polikoff J, Lonardi S, O'Brien LM, Gao L, Yang L, Ferry D, Nasroulah F, Tabernero J. Exposure-response relationship of ramucirumab in patients with advanced second-line colorectal cancer: exploratory analysis of the RAISE trial. Cancer Chemother Pharmacol 2017; 80:599-608. [PMID: 28744667 PMCID: PMC5573752 DOI: 10.1007/s00280-017-3380-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/27/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE To characterize ramucirumab exposure-response relationships for efficacy and safety in patients with metastatic colorectal cancer (mCRC) using data from the RAISE study. METHODS Sparse pharmacokinetic samples were collected; a population pharmacokinetic analysis was conducted. Univariate and multivariate Cox proportional hazards models analyzed the relationship between predicted ramucirumab minimum trough concentration at steady state (C min,ss) and survival. Kaplan-Meier analysis was used to evaluate survival from patients in the ramucirumab plus folinic acid, 5-fluorouracil, and irinotecan (FOLFIRI) treatment arm stratified by C min,ss quartiles (Q). An ordered categorical model analyzed the relationship between C min,ss and safety outcomes. RESULTS Pharmacokinetic samples from 906 patients were included in exposure-efficacy analyses; samples from 905 patients were included in exposure-safety analyses. A significant association was identified between C min,ss and overall survival (OS) and progression-free survival (PFS) (p < 0.0001 for both). This association remained significant after adjusting for baseline factors associated with OS or PFS (p < 0.0001 for both). Median OS was 11.5, 12.9, 16.4, and 16.7, and 12.4 months for ramucirumab C min,ss Q1, Q2, Q3, Q4, and placebo group, respectively. Median PFS was 5.4, 4.6, 6.8, 8.5, and 5.2 months for ramucirumab C min,ss Q1, Q2, Q3, Q4, and placebo group, respectively. The risk of Grade ≥3 neutropenia was associated with an increase in ramucirumab exposure. CONCLUSIONS Exploratory exposure-response analyses suggested a positive relationship between efficacy and ramucirumab exposure with manageable toxicities in patients from the RAISE study with mCRC over the ranges of exposures achieved by a dose of 8 mg/kg every 2 weeks in combination with FOLFIRI.
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Affiliation(s)
- Allen Lee Cohn
- Rocky Mountain Cancer Center, 1800 Williams Street, Denver, CO, 80218, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sara Lonardi
- Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | | | - Ling Gao
- Eli Lilly and Company, Bridgewater, NJ, USA
| | - Ling Yang
- Eli Lilly and Company, Bridgewater, NJ, USA
| | | | | | - Josep Tabernero
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
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van Bloemendaal L, Ijzerman RG, Ten Kulve JS, Barkhof F, Diamant M, Veltman DJ, van Duinkerken E. Alterations in white matter volume and integrity in obesity and type 2 diabetes. Metab Brain Dis 2016; 31:621-9. [PMID: 26815786 PMCID: PMC4863900 DOI: 10.1007/s11011-016-9792-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 01/08/2016] [Indexed: 11/28/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is characterized by obesity, hyperglycemia and insulin resistance. Both T2DM and obesity are associated with cerebral complications, including an increased risk of cognitive impairment and dementia, however the underlying mechanisms are largely unknown. In the current study, we aimed to determine the relative contributions of obesity and the presence of T2DM to altered white matter structure. We used diffusion tensor imaging (DTI) and voxel-based morphometry (VBM) to measure white matter integrity and volume in obese T2DM patients without micro- or macrovascular complications, age- gender- and BMI-matched normoglycemic obese subjects and age- and gender-matched normoglycemic lean subjects. We found that obese T2DM patients compared with lean subjects had lower axial diffusivity (in the right corticospinal tract, right inferior fronto-occipital tract, right superior longitudinal fasciculus and right forceps major) and reduced white matter volume (in the right inferior parietal lobe and the left external capsule region). In normoglycemic obese compared with lean subjects axial diffusivity as well as white matter volume tended to be reduced, whereas there were no significant differences between normoglycemic obese subjects and T2DM patients. Decreased white matter integrity and volume were univariately related to higher age, being male, higher BMI, HbA1C and fasting glucose and insulin levels. However, multivariate analyses demonstrated that only BMI was independently related to white matter integrity, and age, gender and BMI to white matter volume loss. Our data indicate that obese T2DM patients have reduced white matter integrity and volume, but that this is largely explained by BMI, rather than T2DM per se.
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Affiliation(s)
- Liselotte van Bloemendaal
- Diabetes Center / Department of Internal Medicine, VU University Medical Center, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Richard G Ijzerman
- Diabetes Center / Department of Internal Medicine, VU University Medical Center, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands
| | - Jennifer S Ten Kulve
- Diabetes Center / Department of Internal Medicine, VU University Medical Center, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, VU University Medical Center, 1007 MB, Amsterdam, The Netherlands
| | - Michaela Diamant
- Diabetes Center / Department of Internal Medicine, VU University Medical Center, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry, VU University Medical Center, 1007 MB, Amsterdam, The Netherlands
| | - Eelco van Duinkerken
- Diabetes Center / Department of Internal Medicine, VU University Medical Center, PO BOX 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Medical Psychology, VU University Medical Center, 1007 MB, Amsterdam, The Netherlands
- Department of Psychology, Pontifícia Universidade Católica (PUC-Rio), Rio de Janeiro, RJ, Brazil
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Matsuba I, Sawa T, Kawata T, Kanamori A, Jiang D, Machimura H, Takeda H, Han JH, Wang K, Tanaka K, Shen L, Ajima M, Kaneshiro M, Kim SW, Umezawa S, Asakura T, Suzuki S, Kim SC. Cross-National Variation in Glycemic Control and Diabetes-Related Distress Among East Asian Patients Using Insulin: Results from the MOSAIc Study. Diabetes Ther 2016; 7:349-60. [PMID: 27255328 PMCID: PMC4900985 DOI: 10.1007/s13300-016-0178-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Guidelines recommend insulin progression for patients with type 2 diabetes (T2D) with inadequate glycemic control. The Multinational Observational Study Assessing Insulin use (MOSAIc [ClinicalTrials.gov identifier, NCT01400971]) study is a 2-year observational study, investigating factors that influence insulin progression in T2D patients. In this first of two reports, we describe baseline clinical and psychosocial characteristics of Chinese, Japanese, and South Korean patients who participated in MOSAIc. Insulin treatment, factors affecting progression, and outcomes will be reported separately. METHODS Patients with T2D using insulin for ≥3 months were eligible. Baseline demographic, clinical, and psychosocial data were collected from patients. Quality of life instruments, including the Diabetes Distress Scale (DDS), were used to assess patient's concerns about disease management, support, and emotional burden. The association between the DDS and the selected covariates was also assessed. RESULTS A total of 373 patients in China, 157 in Japan, and 141 in South Korea were enrolled from July 2011 to July 2013. Mean ± standard deviation duration (years) of T2D differed across countries (China 11.4 ± 7.5; Japan 13.8 ± 8.7; South Korea 15.7 ± 8.8; P < 0.0001). Japanese patients used more noninsulin anti-hyperglycemic agents than did Chinese or South Korean patients (P < 0.0001). Exclusive use of basal insulin was most common in Japan and South Korea compared with China, whereas approximately 66.8% of Chinese patients used mixed insulin. Covariates associated with the DDS were younger age [P = 0.044 (Japan)], higher incidence of monthly hypoglycemia [P = 0.036 [China]; P = 0.021 (South Korea)], and male gender [P = 0.037 (South Korea)]. CONCLUSIONS There were significant differences amongst East Asian patients with T2D treated with insulin, including in quality of life scores. Results from the MOSAIc longitudinal analyses will further investigate trends of insulin intensification and barriers to insulin progression. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Ikuro Matsuba
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan.
| | - Tasuku Sawa
- Department of Internal Medicine, Kawasaki Saiwai Hospital, Kanagawa, Japan
| | - Takehiro Kawata
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Akira Kanamori
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | | | - Hideo Machimura
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Hiroshi Takeda
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | | | - Ke Wang
- Eli Lilly Suzhou Pharmaceutical Company, Shanghai, China
| | - Keiji Tanaka
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Li Shen
- Eli Lilly Suzhou Pharmaceutical Company, Shanghai, China
| | - Miho Ajima
- Department of Diabetology, Kawasaki Saiwai Clinic, Kanagawa, Japan
| | - Mizuki Kaneshiro
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Sang-Wook Kim
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Shinichi Umezawa
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Taro Asakura
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | | | - Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Senay A, Delisle J, Raynauld JP, Morin SN, Fernandes JC. Agreement between physicians' and nurses' clinical decisions for the management of the fracture liaison service (4iFLS): the Lucky Bone™ program. Osteoporos Int 2016; 27:1569-1576. [PMID: 26602915 PMCID: PMC4791513 DOI: 10.1007/s00198-015-3413-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/06/2015] [Indexed: 11/26/2022]
Abstract
UNLABELLED We determined if nurses can manage osteoporotic fractures in a fracture liaison service by asking a rheumatologist and an internist to assess their clinical decisions. Experts agreed on more than 94 % of all nurses' actions for 525 fragility fracture patients, showing that their management is efficient and safe. INTRODUCTION A major care gap exists in the investigation of bone fragility and initiation of treatment for individuals who have sustained a fragility fracture. The implementation of a fracture liaison service (FLS) managed by nurses could be the key in resolving this problem. The aim of this project was to obtain agreement between physicians' and nurses' clinical decisions and evaluate if the algorithm of care is efficient and reliable for the management of a FLS. METHODS Clinical decisions of nurses for 525 subjects in a fracture liaison service between 2010 and 2013 were assessed by two independent physicians with expertise in osteoporosis treatment. RESULTS Nurses succeeded in identifying all patients at risk and needed to refer 27 % of patients to an MD. Thereby, they managed autonomously 73 % of fragility fracture patients. No needless referrals were made according to assessing physicians. Agreement between each evaluator and nurses was of >97 %. Physicians' decisions were the same in >96 %, and Gwet AC11 coefficient was of >0.960 (almost perfect level of agreement). All major comorbidities were adequately managed. CONCLUSIONS High agreement between nurses' and physicians' clinical decisions indicate that the independent management by nurses of a fracture liaison service is safe and should strongly be recommended in the care of patients with a fragility fracture. This kind of intervention could help resolve the existing care gap in bone fragility care as well as the societal economic burden associated with prevention and treatment of fragility fractures.
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Affiliation(s)
- A Senay
- Université de Montréal, 2900 boul Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.
- Orthopaedic Department, Hôpital du Sacré-Coeur de Montréal, 5400 boul Gouin Ouest, Montreal, QC, H4J 1C5, Canada.
- Orthopaedic Department, Hôpital Jean-Talon, 1385 rue Jean-Talon Est, Montreal, QC, H2E 1S6, Canada.
| | - J Delisle
- Orthopaedic Department, Hôpital du Sacré-Coeur de Montréal, 5400 boul Gouin Ouest, Montreal, QC, H4J 1C5, Canada
- Orthopaedic Department, Hôpital Jean-Talon, 1385 rue Jean-Talon Est, Montreal, QC, H2E 1S6, Canada
| | - J P Raynauld
- Hôpital Notre-Dame of the Centre Hospitalier de l'Université de Montréal, 1560 rue Sherbrooke Est, Montreal, QC, H2L 4M1, Canada
- Institut de Rhumatologie de Montréal, 1551 rue Ontario Est, Montreal, QC, H2L 1S6, Canada
| | - S N Morin
- Department of Medicine, Montreal General Hospital, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - J C Fernandes
- Université de Montréal, 2900 boul Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
- Orthopaedic Department, Hôpital du Sacré-Coeur de Montréal, 5400 boul Gouin Ouest, Montreal, QC, H4J 1C5, Canada
- Orthopaedic Department, Hôpital Jean-Talon, 1385 rue Jean-Talon Est, Montreal, QC, H2E 1S6, Canada
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Nixon A, Doll H, Kerr C, Burge R, Naegeli AN. Interpreting change from patient reported outcome (PRO) endpoints: patient global ratings of concept versus patient global ratings of change, a case study among osteoporosis patients. Health Qual Life Outcomes 2016; 14:25. [PMID: 26896284 PMCID: PMC4759933 DOI: 10.1186/s12955-016-0427-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 05/26/2015] [Accepted: 02/12/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Regulatory guidance recommends anchor-based methods for interpretation of treatment effects measured by PRO endpoints. Methodological pros and cons of patient global ratings of change vs. patient global ratings of concept have been discussed but empirical evidence in support of either approach is lacking. This study evaluated the performance of patient global ratings of change and patient global ratings of concept for interpreting patient stability and patient improvement. METHODS Patient global ratings of change and patient global ratings of concept were included in a psychometric validation study of an osteoporosis-targeted PRO instrument (the OPAQ-PF) to assess its ability to detect change and to derive responder definitions. 144 female osteoporosis patients with (n = 37) or without (n = 107) a recent (within 6 weeks) fragility fracture completed the OPAQ-PF and global items at baseline, 2 weeks (no recent fracture), and 12 weeks (recent fracture) post-baseline. RESULTS Results differed between the two methods. Recent fracture patients reported more improvement while patients without recent fracture reported more stability on ratings of change than ratings of concept. However, correlations with OPAQ-PF score change were stronger for ratings of concept than ratings of change (both groups). Effect sizes for OPAQ-PF score change increased consistently with level of change in ratings of concept but inconsistently with ratings of change, with the mean AUC for prediction of a one-point change being 0.72 vs. 0.56. CONCLUSIONS This study provides initial empirical support for methodological and regulatory recommendations to use patient global ratings of concept rather than ratings of change when interpreting change captured by PRO instruments in studies evaluating treatment effects. These findings warrant being confirmed in a purpose-designed larger scale analysis.
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Affiliation(s)
| | - Helen Doll
- ICON Patient Reported Outcomes, Oxford, UK
| | - Cicely Kerr
- Formerly ICON Patient Reported Outcomes, Oxford, UK
| | - Russel Burge
- Eli Lilly and Company LCC, DC, 1730, 46285, Indianapolis, IN, USA
| | - April N Naegeli
- Eli Lilly and Company LCC, DC, 1730, 46285, Indianapolis, IN, USA.
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