1
|
Lluch-Galcerá JJ, Carrascosa JM, González-Quesada A, Rivera-Díaz R, Sahuquillo-Torralba A, Llamas-Velasco M, Gómez-García FJ, Herrera-Acosta E, de la Cueva P, Baniandrés-Rodríguez O, Lopez-Estebaranz JL, Belinchón I, Ferrán M, Mateu A, Rodríguez L, Riera-Monroig J, Abalde-Pintos MT, Carretero G, García-Donoso C, Pujol-Marco C, Del Alcázar E, Santamaría-Domínguez C, Suárez-Pérez JA, Nieto-Benito LM, Ruiz-Genao DP, Salgado-Boquete L, Descalzo MÁ, García-Doval I. Safety of biologic therapy in combination with methotrexate in moderate to severe psoriasis: a cohort study from the BIOBADADERM registry. Br J Dermatol 2024; 190:355-363. [PMID: 37846976 DOI: 10.1093/bjd/ljad382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 05/24/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Safety is an important consideration in decisions on treatment for patients with moderate-to-severe psoriasis and the study of drug safety is the main purpose of the BIOBADADERM registry. The combination of a biologic agent and a conventional systemic drug [generally methotrexate (MTX)] is a common treatment in clinical practice. However, there is a paucity of evidence from real-world practice on the safety of such combination regimens in the treatment of psoriasis. OBJECTIVES The primary objective of this study was to ascertain whether the use of regimens combining biologic drugs with MTX in the management of moderate-to-severe psoriasis increases the risk of adverse events (AEs) or serious AEs (SAEs). We compared monotherapy using tumour necrosis factor (TNF), interleukin (IL)-17 and IL-23 inhibitors with the use of the same drugs in combination with MTX. METHODS Using data from the BIOBADADERM registry, we compared biologic monotherapies with therapies that were combined with MTX. We estimated adjusted incidence rate ratios (aIRR) using a random effects Poisson regression with 95% confidence intervals for all AEs, SAEs, infections and serious infections and other AEs by system organ class. RESULTS We analysed data from 2829 patients and 5441 treatment cycles, a total of 12 853 patient-years. The combination of a biologic with MTX was not associated with statistically significant increases in overall risk of AEs or SAEs in any treatment group. No increase in the total number of infections or serious infections in patients receiving combined therapy was observed for any group. However, treatment with a TNF inhibitor combined with MTX was associated with an increase in the incidence of gastrointestinal AEs (aIRR 2.50, 95% CI 1.57-3.98; P < 0.002). CONCLUSIONS The risk of AEs and SAEs was not significantly increased in patients with moderate-to-severe psoriasis receiving different classes of biologic drugs combined with MTX compared with those on biologic monotherapy.
Collapse
Affiliation(s)
- Juan José Lluch-Galcerá
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, IGTP. Badalona, Barcelona, Spain
- Departament de Medicina, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Jose Manuel Carrascosa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, IGTP. Badalona, Barcelona, Spain
- Departament de Medicina, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Alicia González-Quesada
- Department of Dermatology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Islas Canarias, Spain
| | - Raquel Rivera-Díaz
- Department of Dermatology, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | | | - Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa (IIS-LP), Madrid,Spain
| | | | | | - Pablo de la Cueva
- Department of Dermatology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | | | - Isabel Belinchón
- Department of Dermatology, Hospital General Universitario de Alicante-ISABIAL-UMH, Alicante, Spain
| | - Marta Ferrán
- Department of Dermatology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Almudena Mateu
- Department of Dermatology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Lourdes Rodríguez
- Department of Dermatology, Hospital Virgen del Rocío, Seville, Spain
| | - Josep Riera-Monroig
- Department of Dermatology, Hospital Clinic de Barcelona, UB, Barcelona, Spain
| | - M Teresa Abalde-Pintos
- Department of Dermatology, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Gregorio Carretero
- Department of Dermatology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Islas Canarias, Spain
| | - Carmen García-Donoso
- Department of Dermatology, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Conrad Pujol-Marco
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia,Spain
| | - Elena Del Alcázar
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, IGTP. Badalona, Barcelona, Spain
- Departament de Medicina, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Cristina Santamaría-Domínguez
- Department of Dermatology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa (IIS-LP), Madrid,Spain
| | | | - Lula María Nieto-Benito
- Department of Dermatology, CEIMI, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Laura Salgado-Boquete
- Department of Dermatology, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | - Ignacio García-Doval
- Research Unit, Spanish Academy of Dermatology and Venereology, Madrid, Spain
- Department of Dermatology, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| |
Collapse
|
2
|
Joven B, Hernández Sánchez R, Pérez-Pampín E, Aragón Díez Á, Almodóvar R, Martínez-Ferrer Á, Belzunegui J, Rubio E, Díaz-Cerezo S, Moyano S, Gómez-Barrera M, Yébenes M, Núñez M. Persistence and Use of Ixekizumab in Patients with Psoriatic Arthritis in Real-World Practice in Spain. The PRO-STIP Study. Rheumatol Ther 2023; 10:1319-1333. [PMID: 37481752 PMCID: PMC10468471 DOI: 10.1007/s40744-023-00584-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/30/2023] [Indexed: 07/25/2023] Open
Abstract
INTRODUCTION Ixekizumab (IXE) is an IgG4-type monoclonal antibody targeting IL-17A indicated alone or in combination with methotrexate, for the treatment of active psoriatic arthritis (PsA) in adult patients with insufficient response or with intolerance to one or more disease-modifying anti-rheumatic drug (DMARD) therapy. The PRO-STIP study aimed to describe persistence, patient characteristics, treatment patterns, and effectiveness in patients with PsA receiving IXE in a real-world clinical setting in Spain. METHODS This was an observational, multicentric, retrospective, longitudinal study in adult PsA patients who started IXE between January 2019 and December 2020, with at least 24 weeks of follow-up. A descriptive analysis of patient characteristics and treatment patterns was performed. The primary objective, treatment persistence, was estimated by Kaplan-Meier survival curve. Effectiveness was evaluated by Disease Activity in Psoriatic Arthritis (DAPSA) scores at baseline and at 12 and 24 weeks. RESULTS Eighty-nine patients met the selection criteria (55.1% women and mean age 51.5 years). The median time from PsA diagnosis to starting IXE was 7.7 years (IQR 3.4-14.6). Prior to IXE, 95.5% patients had been treated with at least one biologic or targeted synthetic DMARD (b/tsDMARD). The observed persistence rates were 95.5%, 84.3% and 68.5% at 24, 48, and 104 weeks, respectively. The median persistence was not reached in the study period (mean persistence, 86.9 [95% CI 80.6-93.2] weeks). Twenty-eight (31.5%) patients discontinued IXE, 19 patients (21.3%) due to loss of effectiveness and two patients (2.2%) due to adverse events. In patients receiving treatment and with available effectiveness assessment (n = 24), DAPSA decreased significantly from baseline 23.7 (95% CI 19.5-27.9) to 14.8 (95% CI 10.5-19.2) at 12 weeks (p = 0.005) and 14.3 (95% CI 11.1-17.4) at 24 weeks (p = 0.004). CONCLUSIONS PsA patients treated with IXE in a real-world setting show high treatment persistence through 104 weeks and improvements in disease activity after treatment initiation. This suggests that IXE could be an effective treatment for patients with PsA. RETROSPECTIVELY REGISTERED Date of registration: 25th May 2021.
Collapse
Affiliation(s)
- Beatriz Joven
- Hospital Universitario, 12 de Octubre, Madrid, Spain
| | | | - Eva Pérez-Pampín
- Hospital Clínico Universitario Santiago, Santiago de Compostela, Spain
| | | | | | | | | | - Esteban Rubio
- Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | - Manuel Gómez-Barrera
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, Spain
| | - María Yébenes
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, Spain
| | | |
Collapse
|
3
|
Meissner Y, Schäfer M, Albrecht K, Kekow J, Zinke S, Tony HP, Strangfeld A. Risk of major adverse cardiovascular events in patients with rheumatoid arthritis treated with conventional synthetic, biologic and targeted synthetic disease-modifying antirheumatic drugs: observational data from the German RABBIT register. RMD Open 2023; 9:e003489. [PMID: 37880180 PMCID: PMC10603345 DOI: 10.1136/rmdopen-2023-003489] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/02/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE To estimate the effects of Janus kinase inhibitors (JAKi), tumour necrosis factor inhibitors (TNFi), other biologic(b) or conventional synthetic(cs) disease-modifying antirheumatic drugs (DMARDs) on the risk of major adverse cardiovascular events (MACE) in patients with rheumatoid arthritis (RA). METHODS Cohort study analysing episodes of DMARD-treatment initiated between January 2017 and April 2022 in the biologics register Rheumatoid Arthritis: Observation of Biologic Therapy. Incidence rates (IRs) per 100 patient-years with 95% CIs were calculated for overall patients and those with cardiovascular risk (age ≥50 years and ≥1 cardiovascular risk factor). MACE risk was estimated as HRs by inverse probability of treatment weight-adjusted Andersen-Gill models. RESULTS A total of 154 MACE occurred among 14 203 treatment episodes (21 218 patient-years). IRs were 0.68 (0.47; 0.95), 0.62 (0.45; 0.83), 0.76 (0.53; 1.06) and 0.95 (0.68; 1.29) for JAKi, TNFi, bDMARDs and csDMARDs, respectively. IRs were higher in cardiovascular risk patients. Adjusted HRs (95% CI) comparing JAKi, bDMARDs and csDMARDs with TNFi were 0.89 (0.52 to 1.52), 0.76 (0.45; to1.27) and 1.36 (0.85 to 2.19) in overall, and 0.74 (0.41 to 1.31), 0.75 (0.45 to 1.27) and 1.21 (0.74 to 1.98) in cardiovascular risk patients. HRs were not increased in patients ≥65 years, with cardiovascular history or smokers, and also not when using csDMARD as reference instead of TNFi. IRs for baricitinib, tofacitinib and upadacitinib were 0.49 (0.25 to 0.85), 0.98 (0.58 to 1.55) and 0.53 (0.15 to 1.36), respectively. CONCLUSION In this German observational cohort study, MACE did not occur more frequently with JAKi compared with other DMARDs. However, individual JAKis showed different unadjusted IRs.
Collapse
Affiliation(s)
- Yvette Meissner
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Martin Schäfer
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Katinka Albrecht
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Joern Kekow
- Clinic of Rheumatology & Orthopaedics, Otto-von-Guericke University Magdeburg, Vogelsang-Gommern, Germany
| | | | - Hans-Peter Tony
- Department of Internal Medicine 2, University of Wuerzburg, Wuerzburg, Germany
| | - Anja Strangfeld
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| |
Collapse
|
4
|
Barreiro-de Acosta M, Molero A, Artime E, Díaz-Cerezo S, Lizán L, de Paz HD, Martín-Arranz MD. Epidemiological, Clinical, Patient-Reported and Economic Burden of Inflammatory Bowel Disease (Ulcerative colitis and Crohn's disease) in Spain: A Systematic Review. Adv Ther 2023; 40:1975-2014. [PMID: 36928496 PMCID: PMC10129998 DOI: 10.1007/s12325-023-02473-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 11/28/2022] [Accepted: 02/16/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION This study describes the epidemiological, clinical, patient-reported and economic burden of inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), in Spain. METHODS A systematic review was performed of observational studies reporting the epidemiological, clinical, patient-reported and economic burden of IBD in the Spanish population, from 2011 to 2021. Original articles and conference abstracts published in English or Spanish were eligible. RESULTS A total of 45 publications were included in the review. The incidence of IBD in adults ranged from 9.6 to 44.3 per 100,000 inhabitants (4.6 to 18.5 for CD and 3.4 to 26.5 for UC). The incidence increased between 1.5- and twofold from 2000 to 2016 (regionally). Up to 6.0% (CD) and 3.0% (UC) IBD-associated mortality was reported. Disease onset predominantly occurs between 30 and 40 years (more delayed for UC than CD). Most frequently reported gastrointestinal manifestations are rectal bleeding in UC and weight loss in CD. Extraintestinal manifestations (EIM) have been described in up to 47.4% of patients with CD and 48.1% of patients with UC. Psychiatric comorbidities were frequently reported in both CD and UC (depression up to 20% and anxiety up to 11%). Reduced health-related quality of life (HRQoL) compared to the general population was reported. Significant symptomatology was associated with high levels of anxiety, depression, stress and lower HRQoL. Main healthcare resources reported were emergency department visits (24.0%), hospitalization (14.7%), surgery (up to 11%) and use of biologics (up to 60%), especially in CD. Direct and indirect annual costs per patient with UC were €1754.1 and €399.3, respectively. CONCLUSION Patients with CD and UC present a high disease burden which negatively impacts their HRQoL, leading to elevated use of resources.
Collapse
Affiliation(s)
- Manuel Barreiro-de Acosta
- Gastroenterology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago, Spain
| | | | | | | | - Luis Lizán
- Health Outcomes Research Department, Outcomes'10, S.L., Castellón de la Plana, Spain
- Department of Medicine, Jaume I University, Castellón de la Plana, Spain
| | - Héctor David de Paz
- Health Outcomes Research Department, Outcomes'10, S.L., Castellón de la Plana, Spain
| | - María Dolores Martín-Arranz
- Department of Gastroenterology of La Paz University Hospital, School of Medicine, Hospital La Paz Institute for Health Research, La Paz Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
5
|
Mikolajczyk AE, Cohen NA, Watson S, Ackerman M, Goeppinger SR, Hart J, Turner JR, Rubin DT. Assessment of the Degree of Variation of Histologic Inflammation in Ulcerative Colitis. Inflamm Bowel Dis 2023; 29:222-227. [PMID: 35436339 PMCID: PMC10686247 DOI: 10.1093/ibd/izac070] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Treatment of ulcerative colitis (UC) now includes mucosal healing. Adoption of histologic end points is hindered by a lack of evidence guiding optimal sampling, interpretation, and reproducibility of results. METHODS We analyzed biopsy fragments from colonoscopies in 92 patients with UC. Fragments were scored using 6-point histologic inflammatory activity (HIA) scale. Variability was determined using ordinal representations of HIA scores. The most frequently observed score and percentage of biopsy fragments with that score were determined for each biopsy, each segment, and across all 3 segments for each colonoscopy. Mean percentages and 95% confidence intervals (CIs) were calculated. RESULTS We reviewed 1802 biopsy fragments. The mean percentages of intrasegment biopsy fragments with the same HIA score were 85.5% (95% CI, 80.9% to 92.9%), 79.6% (95% CI, 76.0% to 87.3%), and 82.7% (95% CI, 79.1% to 90.0%) for the rectum, left colon, and right colon, respectively. The mean percentage of intersegment biopsy fragments with the same HIA score was 70.2% (95% CI, 65.7% to 82.5%). The mean percentages of intrabiopsy fragments with the same HIA score were 83.3% (95% CI, 77.6% to 93.5%), 83.6% (95% CI, 80.1% to 89.7%), and 90.2% (95% CI, 87.6% to 94.7%) for the rectum, left colon, and right colon, respectively. All 3 analyses revealed increased variation when a greater degree of histologic inflammation was present in the biopsies (mean HIA score ≥2). CONCLUSIONS We found minimal variability between degree of inflammation among biopsy fragments within and among different colorectal segments in UC, suggesting that even a single biopsy would adequately reflect the inflammation of the entire colorectum. These findings have significant implications for the use of histology as a clinical target and trial end point in UC.
Collapse
Affiliation(s)
- Adam E Mikolajczyk
- University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL, United States
| | - Nathaniel A Cohen
- University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL, United States
| | - Sydeaka Watson
- University of Chicago Medicine, Department of Health Studies, Chicago, IL, United States
| | - Max Ackerman
- University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL, United States
| | - Sarah R Goeppinger
- University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL, United States
| | - John Hart
- University of Chicago Medicine, Department of Pathology, Chicago, IL, United States
| | - Jerrold R Turner
- Brigham and Women’s Hospital, Department of Pathology, Chicago, IL, United States
| | - David T Rubin
- University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL, United States
| |
Collapse
|
6
|
Pfäffle R, Knüpfer M, Göbert M, Vogel M, Gausche R, Beger C, Keller E, Körner A, Thome U, Kiess W. Growth Patterns of Children With Short Stature in Adulthood According to Auxological Status and Maturity at Birth. J Clin Endocrinol Metab 2022; 107:3320-3327. [PMID: 36099499 DOI: 10.1210/clinem/dgac510] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Prematurity carries a risk for impaired postnatal growth and long-term growth restriction. Especially children born SGA seem vulnerable for poor growth, as a persistent short stature can be observed in app 10-15% of these children. OBJECTIVE In this study we aimed to recognize differences in growth patterns of children according to sex, maturity, and auxological status at birth facilitating earlier identification of small-for-gestational-age (SGA) children with adult short stature. METHODS The growth data of 44 791 infants born between January 1, 1980, and December 30, 2012, among 2 pediatric cohorts with follow-up through December 31, 2020, were analyzed. A total of 5698 children with birth data had measurements at near final height (nfh) and at least 2 further points. RESULTS Preterm children (gestational age < 37 weeks) had a significantly lower mean nfh SDS than term children (preterm, -0.61; term, -0.18) and a higher likelihood of nfh < third percentile (preterm, 20.5%; term, 12.2%). SGA born children also had a lower mean nfh SD score (SDS) than children born appropriate for gestational age (AGA) (SGA, -1.06; AGA, -0.15) and a higher likelihood of nfh < third percentile (SGA, 28.2%; AGA 10.1%). Of 1204 SGA children, 672 (56%) showed successful catch-up growth (CUG) to nfh greater than or equal to the 10th percentile (SGA-CU), and 532 children (44%) did not (SGA-S). The difference in their mean nfh SDS (SGA-CU, -0.12; SGA-S -2.26) can only partly be explained by the differences in mean mid-parental height SDS (SGA-CU, -0.3; SGA-S, -1.19). During the first year, SGA-CU showed higher CUG (SGA-CU, +1.2 SDS; SGA-S, +0.45 SDS), which helps to discriminate between groups earlier. CONCLUSION Final growth outcome was influenced by prematurity and auxological status at birth, but not by sex. Height/length SDS increments during year 1 are instrumental to discern SGA children with later normal or short stature. While observing CUG until year 2 and 3 can add specificity, discrimination thereafter becomes difficult.
Collapse
Affiliation(s)
- Roland Pfäffle
- Hospital for Children and Adolescents, University of Leipzig, 04103 Leipzig, Germany
- CrescNet Database, University of Leipzig, 04103 Leipzig, Germany
| | - Matthias Knüpfer
- Hospital for Children and Adolescents, University of Leipzig, 04103 Leipzig, Germany
- Department of Neonatology, Hospital for Children and Adolescents, University of Leipzig, 04103 Leipzig, Germany
| | - Melanie Göbert
- Hospital for Children and Adolescents, University of Leipzig, 04103 Leipzig, Germany
| | - Mandy Vogel
- LIFE-Child-Leipzig Research Center for Civilization Diseases, University of Leipzig, 04103 Leipzig, Germany
- Centre of Pediatric Research (CPL), University of Leipzig, 04103 Leipzig, Germany
| | - Ruth Gausche
- CrescNet Database, University of Leipzig, 04103 Leipzig, Germany
| | - Christoph Beger
- CrescNet Database, University of Leipzig, 04103 Leipzig, Germany
| | - Eberhard Keller
- CrescNet Database, University of Leipzig, 04103 Leipzig, Germany
| | - Antje Körner
- Hospital for Children and Adolescents, University of Leipzig, 04103 Leipzig, Germany
- LIFE-Child-Leipzig Research Center for Civilization Diseases, University of Leipzig, 04103 Leipzig, Germany
- Centre of Pediatric Research (CPL), University of Leipzig, 04103 Leipzig, Germany
| | - Ulrich Thome
- Hospital for Children and Adolescents, University of Leipzig, 04103 Leipzig, Germany
- Department of Neonatology, Hospital for Children and Adolescents, University of Leipzig, 04103 Leipzig, Germany
- Centre of Pediatric Research (CPL), University of Leipzig, 04103 Leipzig, Germany
| | - Wieland Kiess
- Hospital for Children and Adolescents, University of Leipzig, 04103 Leipzig, Germany
- LIFE-Child-Leipzig Research Center for Civilization Diseases, University of Leipzig, 04103 Leipzig, Germany
- Centre of Pediatric Research (CPL), University of Leipzig, 04103 Leipzig, Germany
| |
Collapse
|
7
|
Oya M, Kaneko S, Imai T, Tsujino T, Sunaya T, Okayama Y. Effectiveness and safety of sorafenib for renal cell, hepatocellular and thyroid carcinoma: pooled analysis in patients with renal impairment. Cancer Chemother Pharmacol 2022; 89:761-772. [PMID: 35445315 PMCID: PMC9135823 DOI: 10.1007/s00280-022-04428-0] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/25/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Sorafenib is an oral multikinase inhibitor with regulatory approval in advanced renal cell carcinoma (RCC), hepatocellular carcinoma (HCC) and refractory differentiated thyroid carcinoma (DTC). Vascular endothelial growth factor receptor (VEGFR) inhibitors like sorafenib may cause proteinuria. This study aimed to analyze the effectiveness and safety of sorafenib in RCC, HCC and DTC patients with chronic kidney disease (CKD). METHODS This retrospective study analyzed integrated data from prospective post-marketing surveillance studies for advanced RCC, HCC and DTC. Background factors considered to affect patients' prognosis were balanced by propensity score matching using eGFR cut-off values of 60 mL/min/1.73 m2. RESULTS In the combined matched population (N = 2430), sorafenib was equally effective in patients with lower and higher eGFR values. Sorafenib had an overall response rate (ORR: complete + partial responses) of 18.9% and a disease control rate (DCR: complete + partial responses + stable disease) of 67.0%. There were no significant differences between lower and higher eGFR groups for response rates. Renal function was maintained throughout the 12-month study period in the combined population and in each indication. Adverse events (AEs) and serious AEs were reported in 91.6% and 58.2% of propensity score-matched patients, and with no significant differences between lower and higher eGFR groups. CONCLUSION The effectiveness and safety of sorafenib were similar in patients with eGFR < 60 and ≥ 60 mL/min/1.73 m2 during the 12-month observation period, and without impairing renal function.
Collapse
Affiliation(s)
- Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Shuichi Kaneko
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Tsuneo Imai
- National Hospital Organization, Higashi Nagoya National Hospital, Nagoya, Japan
| | - Toshiaki Tsujino
- Medical Affairs and Pharmacovigilance, Bayer Yakuhin, Ltd., 2-4-9 Umeda, Kita-ku, Osaka, 530-0001, Japan
| | | | - Yutaka Okayama
- Medical Affairs and Pharmacovigilance, Bayer Yakuhin, Ltd., 2-4-9 Umeda, Kita-ku, Osaka, 530-0001, Japan.
| |
Collapse
|
8
|
Bridger C, Prabhala T, Dawson R, Khazen O, MacDonell J, DiMarzio M, Staudt MD, De EJB, Argoff C, Pilitsis JG. Neuromodulation for Chronic Pelvic Pain: A Single-Institution Experience With a Collaborative Team. Neurosurgery 2021; 88:819-827. [PMID: 33372201 PMCID: PMC7956019 DOI: 10.1093/neuros/nyaa537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/10/2020] [Accepted: 10/10/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Secondary to the complex care, involved specialty providers, and various etiologies, chronic pelvic pain patients do not receive holistic care. OBJECTIVE To compare our general and neuromodulation cohorts based on referrals, diagnosis, and therapy and describe our neuromodulation patients. METHODS A multidisciplinary team was established at our center. The intake coordinator assessed demographics and facilitated care of enrolled patients. Outcomes were compared using minimal clinical important difference of current Numerical Rating Scale (NRS) between patients with neuropathic pain who received neuromodulation and those who did not. The neuromodulation cohort completed outcome metrics at baseline and recent follow-up, including NRS score (best, worst, and current), Oswestry Disability Index (ODI), Beck Depression Inventory, and Pain Catastrophizing Scale. RESULTS Over 7 yr, 233 patients were referred to our consortium and 153 were enrolled. A total of 55 patients had neuropathic pain and 44 of those were managed medically. Eleven underwent neuromodulation. A total of 45.5% patients of the neuromodulation cohort were classified as responders by minimal clinically important difference compared to 26.6% responders in the control cohort at most recent follow-up (median 25 and 33 mo, respectively). Outcome measures revealed improvement in NRS at worst (P = .007) and best (P = .025), ODI (P = .014), and Pain Catastrophizing Scale Rumination (P = .043). CONCLUSION Eleven percent of patients were offered neuromodulation. There were more responders in the neuromodulation cohort than the conservatively managed neuropathic pain cohort. Neuromodulation patients showed significant improvement at 29 mo in NRS best and worst pain, disability, and rumination. We share our algorithm for patient management.
Collapse
Affiliation(s)
- Cheyanne Bridger
- Department of Neurosurgery, Albany Medical College, Albany, New York
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Tarun Prabhala
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Rachael Dawson
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Olga Khazen
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Jacquelyn MacDonell
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Marisa DiMarzio
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Michael D Staudt
- Department of Neurosurgery, Albany Medical College, Albany, New York
| | - Elise J B De
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Charles Argoff
- Department of Neurology, Albany Medical College, Albany, New York
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical College, Albany, New York
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| |
Collapse
|
9
|
Sacristán JA, Dilla T, Díaz-Cerezo S, Gabás-Rivera C, Aceituno S, Lizán L. Patient-physician discrepancy in the perception of immune-mediated inflammatory diseases: rheumatoid arthritis, psoriatic arthritis and psoriasis. A qualitative systematic review of the literature. PLoS One 2020; 15:e0234705. [PMID: 32555708 PMCID: PMC7299355 DOI: 10.1371/journal.pone.0234705] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 06/02/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction Recommendations on chronic diseases management emphasise the need to consider patient perspectives and shared decision-making. Discrepancies between patients and physicians’ perspectives on treatment objectives, disease activity, preferences and treatment have been described for immune-mediate inflammatory diseases. These differences could result on patient dissatisfaction and negatively affect outcomes. Objective To describe the degree of patient-physician discrepancy in three chronic immune-mediated inflammatory diseases (rheumatoid arthritis [RA], psoriatic arthritis [PsA] and psoriasis [Ps]), identifying the main areas of discrepancy and possible predictor factors. Methods Qualitative systematic review of the available literature on patient and physician discrepancies in the management of RA, PsA and Ps. The search was performed in international (Medline/PubMed, Cochrane Library, ISI-WOK) and Spanish electronic databases (MEDES, IBECS), including papers published from April 1, 2008 to April 1, 2018, in English or Spanish, and conducted in European or North American populations. Study quality was assessed by the Oxford Centre for Evidence-Based Medicine criteria. Results A total of 21 studies were included (13 RA; 3 PsA; 4 Ps; 1 RA, Ps, and Axial Spondyloarthritis). A significant and heterogeneous degree of discrepancy between patients and physicians was found, regarding disease activity, treatment, clinical expectations, remission concept, and patient-physician relationship. In RA and PsA, studies were mainly focused on the evaluation of disease activity, which is perceived as higher from the patient’s than the physician’s perspective, with the discrepancy determined by factors such as patient’s perception of pain and fatigue. In Ps, studies were focused on treatment satisfaction and patient-physician relationship, showing a lower degree of discrepancy in the satisfaction regarding these aspects. Conclusions There is a significant degree of patient-physician discrepancy regarding the management of RA, PA, and Ps, what can have a major impact on shared decision-making. Future research may help to show whether interventions considering discrepancy improve shared decision-making.
Collapse
Affiliation(s)
| | - Tatiana Dilla
- Global Patient Outcomes and Real World Evidence, Lilly International, Madrid, Spain
| | | | | | | | - Luis Lizán
- Outcomes’10, Castellón de la plana, Spain
- Department of Medicine, Jaume I University, Castellón de la plana, Spain
- * E-mail:
| |
Collapse
|
10
|
Buechel M, Herzog TJ, Westin SN, Coleman RL, Monk BJ, Moore KN. Treatment of patients with recurrent epithelial ovarian cancer for whom platinum is still an option. Ann Oncol 2019; 30:721-732. [PMID: 30887020 PMCID: PMC8887593 DOI: 10.1093/annonc/mdz104] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Ovarian cancer remains the most deadly gynecologic cancer with the majority of patients relapsing within 3 years of diagnosis. Traditional treatment paradigms linked to platinum sensitivity or resistance are currently being questioned in the setting of new diagnostic methods and treatment options. DESIGN Authors carried out review of the literature on key topics in treatment of recurrent epithelial ovarian cancer (EOC) when platinum is still an option; including secondary surgical cytoreduction, chemotherapy, novel treatment options, and maintenance therapy. A treatment algorithm is proposed. RESULTS Molecular characterization of EOC is critical to help guide treatment decisions. The role of secondary cytoreductive surgery is currently being evaluated with results from Gynecologic Oncology Group (GOG) 213 and anticipated results from DESKTOP III clinical trials. Chemotherapy backbone has remained relatively unchanged but utilizing non-platinum-based regimens is under investigation. In addition, maintenance therapy with anti-angiogenic therapy and Poly (ADP-ribose) Polymerase (PARP) inhibitors has emerged as the standard of care. Novel combinations, including immunotherapy and anti-angiogenesis agents, may further change the current landscape. CONCLUSIONS The treatment of recurrent EOC is rapidly changing. Clinical trial design will need to continue to evolve as many novel therapies move to the upfront setting. Ultimately, the treatment of patients with recurrent EOC must incorporate individual patient and tumor factors.
Collapse
Affiliation(s)
- M Buechel
- Section of Gynecologic Oncology, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City.
| | - T J Herzog
- Division of Gynecologic Oncology, University of Cincinnati Cancer Institute, University of Cincinnati, Cincinnati
| | - S N Westin
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - R L Coleman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - B J Monk
- Division of Gynecologic Oncology, Arizona Oncology, Phoenix, USA
| | - K N Moore
- Section of Gynecologic Oncology, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City
| |
Collapse
|
11
|
De Ruysscher D, Lueza B, Le Péchoux C, Johnson DH, O'Brien M, Murray N, Spiro S, Wang X, Takada M, Lebeau B, Blackstock W, Skarlos D, Baas P, Choy H, Price A, Seymour L, Arriagada R, Pignon JP. Impact of thoracic radiotherapy timing in limited-stage small-cell lung cancer: usefulness of the individual patient data meta-analysis. Ann Oncol 2016; 27:1818-28. [PMID: 27436850 PMCID: PMC5035783 DOI: 10.1093/annonc/mdw263] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [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: 01/27/2016] [Revised: 06/24/2016] [Accepted: 06/28/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chemotherapy (CT) combined with radiotherapy is the standard treatment of 'limited-stage' small-cell lung cancer. However, controversy persists over the optimal timing of thoracic radiotherapy and CT. MATERIALS AND METHODS We carried out a meta-analysis of individual patient data in randomized trials comparing earlier versus later radiotherapy, or shorter versus longer radiotherapy duration, as defined in each trial. We combined the results from trials using the stratified log-rank test to calculate pooled hazard ratios (HRs). The primary outcome was overall survival. RESULTS Twelve trials with 2668 patients were eligible. Data from nine trials comprising 2305 patients were available for analysis. The median follow-up was 10 years. When all trials were analysed together, 'earlier or shorter' versus 'later or longer' thoracic radiotherapy did not affect overall survival. However, the HR for overall survival was significantly in favour of 'earlier or shorter' radiotherapy among trials with a similar proportion of patients who were compliant with CT (defined as having received 100% or more of the planned CT cycles) in both arms (HR 0.79, 95% CI 0.69-0.91), and in favour of 'later or longer' radiotherapy among trials with different rates of CT compliance (HR 1.19, 1.05-1.34, interaction test, P < 0.0001). The absolute gain between 'earlier or shorter' versus 'later or longer' thoracic radiotherapy in 5-year overall survival for similar and for different CT compliance trials was 7.7% (95% CI 2.6-12.8%) and -2.2% (-5.8% to 1.4%), respectively. However, 'earlier or shorter' thoracic radiotherapy was associated with a higher incidence of severe acute oesophagitis than 'later or longer' radiotherapy. CONCLUSION 'Earlier or shorter' delivery of thoracic radiotherapy with planned CT significantly improves 5-year overall survival at the expense of more acute toxicity, especially oesophagitis.
Collapse
Affiliation(s)
- D De Ruysscher
- Department of Radiation Oncology (MAASTRO Clinic), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands Department of Oncology, Experimental Radiation Oncology, KU Leuven, Leuven, Belgium
| | - B Lueza
- Department of Biostatistics and Epidemiology and "Ligue Nationale Contre le Cancer" meta-analysis platform, Gustave Roussy, Villejuif, France CESP, INSERM U1018, Université Paris-Sud, Université Paris-Saclay, Villejuif
| | - C Le Péchoux
- Department of Oncology and radiation therapy, Gustave Roussy, Villejuif Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - D H Johnson
- UT Southwestern University School of Medicine, Dallas, USA
| | - M O'Brien
- EORTC Data Center, Brussels, Belgium
| | - N Murray
- British Columbia Cancer Agency, Vancouver, Canada
| | - S Spiro
- University College London Hospitals, London, UK
| | - X Wang
- Alliance Data and Statistical Center, Duke University, Durham, USA
| | - M Takada
- Osaka Prefectural Habikino Hospital, Osaka, Japan
| | - B Lebeau
- Hôpital St Antoine, Paris, France
| | - W Blackstock
- Wake Forest University School of Medicine, Winston-Salem, USA
| | - D Skarlos
- Second Department of Medical Oncology, Metropolitan Hospital N. Faliro, Athens, Greece
| | - P Baas
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H Choy
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, USA
| | - A Price
- NHS Lothian and University of Edinburgh, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - L Seymour
- NCIC Clinical Trials Group and Queen's University, Kingston, Canada
| | - R Arriagada
- Gustave Roussy, Villejuif, France Karolinska Institutet, Stockholm, Sweden
| | - J-P Pignon
- Department of Biostatistics and Epidemiology and "Ligue Nationale Contre le Cancer" meta-analysis platform, Gustave Roussy, Villejuif, France CESP, INSERM U1018, Université Paris-Sud, Université Paris-Saclay, Villejuif
| |
Collapse
|