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De Santis F, Gubbiotti S. On the distribution of the power function for the scale parameter of exponential families. Stat Med 2024; 43:1973-1992. [PMID: 38634314 DOI: 10.1002/sim.10043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 01/17/2024] [Accepted: 02/09/2024] [Indexed: 04/19/2024]
Abstract
The expected value of the standard power function of a test, computed with respect to a design prior distribution, is often used to evaluate the probability of success of an experiment. However, looking only at the expected value might be reductive. Instead, the whole probability distribution of the power function induced by the design prior can be exploited. In this article we consider one-sided testing for the scale parameter of exponential families and we derive general unifying expressions for cumulative distribution and density functions of the random power. Sample size determination criteria based on alternative summaries of these functions are discussed. The study sheds light on the relevance of the choice of the design prior in order to construct a successful experiment.
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Affiliation(s)
- Fulvio De Santis
- Dipartimento di Scienze Statistiche, Sapienza University of Rome, Rome, Italy
| | - Stefania Gubbiotti
- Dipartimento di Scienze Statistiche, Sapienza University of Rome, Rome, Italy
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2
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Jones DR, Bueno R, Harpole DH, Vaporciyan AA. Thoracic Surgical Oncology Group: An American Association for Thoracic Surgery Clinical Trials Initiative. J Thorac Cardiovasc Surg 2024; 167:1584-1588. [PMID: 38253173 DOI: 10.1016/j.jtcvs.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024]
Affiliation(s)
- David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Raphael Bueno
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
| | - David H Harpole
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Ara A Vaporciyan
- Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
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3
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Wootton SH, Rysavy M, Davis P, Thio M, Romero-Lopez M, Holzapfel LF, Thrasher T, Wade JD, Owen L. Practical approaches for supporting informed consent in neonatal clinical trials. Acta Paediatr 2024; 113:923-930. [PMID: 38389165 PMCID: PMC11006570 DOI: 10.1111/apa.17165] [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: 12/08/2023] [Revised: 01/23/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
The survival and health of preterm and critically ill infants have markedly improved over the past 50 years, supported by well-conducted neonatal research. However, newborn research is difficult to undertake for many reasons, and obtaining informed consent for research in this population presents several unique ethical and logistical challenges. In this article, we explore methods to facilitate the consent process, including the role of checklists to support meaningful informed consent for neonatal clinical trials. CONCLUSION: The authors provide practical guidance on the design and implementation of an effective consent checklist tailored for use in neonatal clinical research.
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Affiliation(s)
- Susan H. Wootton
- Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
- Institute for Clinical Research and Learning Health Care, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
- Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Matthew Rysavy
- Institute for Clinical Research and Learning Health Care, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
- Children's Memorial Hermann Hospital, Houston, Texas, USA
- Division of Neonatology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Peter Davis
- Newborn Research, Neonatal Services, Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Marta Thio
- Newborn Research, Neonatal Services, Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Gandel Simulation Service, Royal Women's Hospital, Melbourne, Australia
| | - Mar Romero-Lopez
- Institute for Clinical Research and Learning Health Care, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
- Children's Memorial Hermann Hospital, Houston, Texas, USA
- Division of Neonatology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Lindsay F. Holzapfel
- Children's Memorial Hermann Hospital, Houston, Texas, USA
- Division of Neonatology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Tamara Thrasher
- Children's Memorial Hermann Hospital, Houston, Texas, USA
- March of Dimes NICU Family Support Program, Houston, Texas, USA
| | - Jaleesa D. Wade
- Division of Neonatology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Louise Owen
- Newborn Research, Neonatal Services, Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
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4
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Palermo TM, Li R, Birnie KA, Crombez G, Eccleston C, Kashikar-Zuck S, Stone AL, Walco GA. Updated recommendations on measures for clinical trials in pediatric chronic pain: a multiphase approach from the Core Outcomes in Pediatric Persistent Pain (Core-OPPP) Workgroup. Pain 2024; 165:1086-1100. [PMID: 38112633 PMCID: PMC11017748 DOI: 10.1097/j.pain.0000000000003105] [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: 06/07/2023] [Revised: 08/09/2023] [Accepted: 08/31/2023] [Indexed: 12/21/2023]
Abstract
ABSTRACT Many gaps remain in finding effective, safe, and equitable treatments for children and adolescents with chronic pain and in accessing treatments in different settings. A major goal of the field is to improve assessment of pain and related experience. Valid and reliable patient-reported outcome measures are critical for advancing knowledge of clinical interventions for pediatric chronic pain. Building on the work of the Ped-IMMPACT group, we previously updated a core outcome set (COS) for pediatric chronic pain clinical trials using stakeholder feedback from providers, youth, and parents. The new COS includes 3 mandatory domains: pain severity, pain-related interference with daily living, and adverse events and 4 optional domains: overall well-being, emotional functioning, physical functioning, and sleep quality. The aim of this study was to use a multiphased approach to recommend specific measures for each of the 7 domains identified in our new COS for pediatric chronic pain. We synthesized evidence through conducting the following: (1) a Delphi study of experts to identify candidate measures for the new COS domains, (2) a review phase to gather evidence for measurement properties for candidate measures, and (3) an expert consensus conference to reach agreement on measurement recommendations. Final recommendations included 9 patient-reported measures. Important contextual considerations are discussed, and guidance is provided regarding strengths and limitations of the recommendations. Implementation of these recommendations may be enhanced by widespread dissemination and ease of access to measurement tools.
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Affiliation(s)
- Tonya M. Palermo
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine Seattle, WA, United States
| | - Rui Li
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Kathryn A. Birnie
- Department of Anesthesiology, Perioperative, and Pain Medicine, University of Calgary Calgary, AB, Canada
| | - Geert Crombez
- Department of Experimental Clinical Psychology and Health Psychology, Ghent University, Ghent, Belgium
| | | | - Susmita Kashikar-Zuck
- University of Cincinnati, Department of Pediatrics, Cincinnati, OH, United States
- Cincinnati Children's Hospital Medical Center Cincinnati, OH, United States
| | - Amanda L. Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Gary A. Walco
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine Seattle, WA, United States
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5
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Lupo PJ, Magyar CL. The evidence is mounting: Insurance coverage disruptions lead to worse outcomes among children diagnosed with cancer. Pediatr Blood Cancer 2024; 71:e30924. [PMID: 38379182 PMCID: PMC10959675 DOI: 10.1002/pbc.30924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Philip J. Lupo
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Christina L. Magyar
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
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6
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Ruiz J, Kelly RK, Aplenc R, Laetsch TW, Seif AE. Absolute neutrophil count clinical trial eligibility criteria for pediatric oncology phase I and phase I/II trials by sponsorship. Pediatr Blood Cancer 2024; 71:e30925. [PMID: 38409529 DOI: 10.1002/pbc.30925] [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: 11/13/2023] [Revised: 02/03/2024] [Accepted: 02/09/2024] [Indexed: 02/28/2024]
Abstract
Normal absolute neutrophil count (ANC) variations, as seen with Duffy-null associated neutrophil count (DANC), are not accounted for in trial eligibility, which may contribute to racial enrollment disparities. We describe ANC eligibility for pediatric oncology phase I/II clinical trials according to primary sponsorship from 2010 to 2023 using ClinicalTrials.gov. Out of 438 trials, 20% were industry-sponsored. Total 17% of trials required ANC ≥1500 cells/μL for enrollment; however, industry-sponsored trials were significantly more likely to require ANC ≥1500 cells/μL than non-industry-sponsored trials (odds ratio 2.53, 95% confidence interval: 1.39-4.62; p < .001). These data suggest laboratory exclusion criteria are one possible mechanism for pediatric clinical trial enrollment disparities.
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Affiliation(s)
- Jenny Ruiz
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rebecca K Kelly
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Richard Aplenc
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Theodore W Laetsch
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alix E Seif
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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7
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Wu AJ, Huggins M, Lin HTG, Caballero-Gonzalez A, Dalvie N, Battista ED, Taveras EM, Fiechtner L. Satisfaction with a meal kit delivery program and feasibility of a phase I trial in the intervening in food insecurity to reduce and mitigate (InFoRM) childhood obesity study. Pediatr Obes 2024; 19:e13111. [PMID: 38439559 PMCID: PMC11006563 DOI: 10.1111/ijpo.13111] [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: 11/02/2023] [Revised: 01/25/2024] [Accepted: 02/19/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Food and nutrition security interventions have been demonstrated to optimize health, prevent and treat chronic diseases among adult populations. Despite the increasing prevalence and intersection of food insecurity and childhood obesity in the United States, there are few food and nutrition security interventions targeted to children and families. OBJECTIVES The primary purpose of this phase I randomized, crossover trial was to assess the safety, acceptability and satisfaction of a meal kit delivery program among children with obesity living in households with food insecurity. Secondarily, we assessed the feasibility of our study design, recruitment and retention to inform future larger scale trials. METHODS We delivered 6 weeks of healthy meal kits, which included fresh pre-portioned ingredients and simple picture-based recipes (two recipes/week) in English or Spanish to prepare one-pot, under 30-min meals (after preparation ~ 10 servings/week). RESULTS Caregivers received and prepared the meal kits and reported overall satisfaction with the meal kit delivery program. CONCLUSION A meal kit delivery intervention for children with obesity and food insecurity is acceptable and a phase I randomized, crossover trial is feasible.
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Affiliation(s)
- Allison J Wu
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
- Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Marissa Huggins
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Arlette Caballero-Gonzalez
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Nisha Dalvie
- Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Elsie M Taveras
- Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | - Lauren Fiechtner
- Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
- Health and Research, The Greater Boston Food Bank, Boston, Massachusetts, USA
- Division of Gastroenterology and Nutrition, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
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8
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Haroutounian S, Holzer KJ, Kerns RD, Veasley C, Dworkin RH, Turk DC, Carman KL, Chambers CT, Cowan P, Edwards RR, Eisenach JC, Farrar JT, Ferguson M, Forsythe LP, Freeman R, Gewandter JS, Gilron I, Goertz C, Grol-Prokopczyk H, Iyengar S, Jordan I, Kamp C, Kleykamp BA, Knowles RL, Langford DJ, Mackey S, Malamut R, Markman J, Martin KR, McNicol E, Patel KV, Rice AS, Rowbotham M, Sandbrink F, Simon LS, Steiner DJ, Vollert J. Patient engagement in designing, conducting, and disseminating clinical pain research: IMMPACT recommended considerations. Pain 2024; 165:1013-1028. [PMID: 38198239 PMCID: PMC11017749 DOI: 10.1097/j.pain.0000000000003121] [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: 03/27/2023] [Revised: 08/31/2023] [Accepted: 09/08/2023] [Indexed: 01/12/2024]
Abstract
ABSTRACT In the traditional clinical research model, patients are typically involved only as participants. However, there has been a shift in recent years highlighting the value and contributions that patients bring as members of the research team, across the clinical research lifecycle. It is becoming increasingly evident that to develop research that is both meaningful to people who have the targeted condition and is feasible, there are important benefits of involving patients in the planning, conduct, and dissemination of research from its earliest stages. In fact, research funders and regulatory agencies are now explicitly encouraging, and sometimes requiring, that patients are engaged as partners in research. Although this approach has become commonplace in some fields of clinical research, it remains the exception in clinical pain research. As such, the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials convened a meeting with patient partners and international representatives from academia, patient advocacy groups, government regulatory agencies, research funding organizations, academic journals, and the biopharmaceutical industry to develop consensus recommendations for advancing patient engagement in all stages of clinical pain research in an effective and purposeful manner. This article summarizes the results of this meeting and offers considerations for meaningful and authentic engagement of patient partners in clinical pain research, including recommendations for representation, timing, continuous engagement, measurement, reporting, and research dissemination.
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Affiliation(s)
- Simon Haroutounian
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Katherine J. Holzer
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Robert D. Kerns
- Departments of Psychiatry, Neurology, and Psychology, Yale University, New Haven, CT, United States
| | - Christin Veasley
- Chronic Pain Research Alliance, North Kingstown, RI, United States
| | - Robert H. Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Dennis C. Turk
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States
| | - Kristin L. Carman
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, United States
| | - Christine T. Chambers
- Departments of Psychology & Neuroscience and Pediatrics, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Penney Cowan
- American Chronic Pain Association, Rocklin, CA, United States
| | - Robert R. Edwards
- Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, United States
| | - James C. Eisenach
- Departments of Anesthesiology, Physiology and Pharmacology, Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - John T. Farrar
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - McKenzie Ferguson
- Southern Illinois University Edwardsville, School of Pharmacy, Edwardsville, IL, United States
| | - Laura P. Forsythe
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, United States
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Jennifer S. Gewandter
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Ian Gilron
- Departments of Anesthesiology & Perioperative Medicine and Biomedical & Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Christine Goertz
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
| | | | - Smriti Iyengar
- Division of Translational Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Isabel Jordan
- Departments of Psychology & Neuroscience and Pediatrics, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Cornelia Kamp
- Center for Health and Technology/Clinical Materials Services Unit, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Bethea A. Kleykamp
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Rachel L. Knowles
- Medical Research Council (part of UK Research and Innovation), London, United Kingdom
| | - Dale J. Langford
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, United States
| | - Sean Mackey
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical Center, Stanford, CA, United States
| | | | - John Markman
- Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Kathryn R. Martin
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Ewan McNicol
- Massachusetts College of Pharmacy and Health Sciences, Boston, MA, United States
| | - Kushang V. Patel
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States
| | - Andrew S.C. Rice
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Michael Rowbotham
- Departments of Anesthesia and Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Friedhelm Sandbrink
- National Pain Management, Opioid Safety, and Prescription Drug Monitoring Program, Specialty Care Program Office, Veterans Health Administration, Washington, DC, United States
| | | | - Deborah J. Steiner
- Global Pain, Pain & Neurodegeneration, Eli Lilly and Company, Indianapolis, IN, United States
| | - Jan Vollert
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster, Germany
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Ruprecht Karls University, Heidelberg, Germany
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9
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Payne RD, Ray P, Thomann MA. Bayesian model averaging of longitudinal dose-response models. J Biopharm Stat 2024; 34:349-365. [PMID: 38105583 DOI: 10.1080/10543406.2023.2292214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/02/2023] [Indexed: 12/19/2023]
Abstract
Selecting a safe and clinically beneficial dose can be difficult in drug development. Dose justification often relies on dose-response modeling where parametric assumptions are made in advance which may not adequately fit the data. This is especially problematic in longitudinal dose-response models, where additional parametric assumptions must be made. This paper proposes a class of longitudinal dose-response models to be used in the Bayesian model averaging paradigm which improve trial operating characteristics while maintaining flexibility a priori. A new longitudinal model for non-monotonic longitudinal profiles is proposed. The benefits and trade-offs of the proposed approach are demonstrated through a case study and simulation.
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Affiliation(s)
- Richard D Payne
- Global Statistical Sciences, Eli Lilly & Company, Indianapolis, IN, USA
| | - Pallavi Ray
- Global Statistical Sciences, Eli Lilly & Company, Indianapolis, IN, USA
| | - Mitchell A Thomann
- Department of Biostatistics and Data Science, Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT, USA
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10
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Tardelli VS. Commentary on Amin-Esmaeili et al.: Non-abstinence outcomes in stimulant clinical trials-Why deny improvement? Addiction 2024; 119:844-845. [PMID: 38476049 DOI: 10.1111/add.16481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Vítor S Tardelli
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
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11
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Hall A, Barbera M, Lehtisalo J, Antikainen R, Huque H, Laatikainen T, Ngandu T, Soininen H, Stephen R, Strandberg T, Kivipelto M, Anstey KJ, Solomon A. The Australian National University Alzheimer's Disease Risk Index (ANU-ADRI) score as a predictor for cognitive decline and potential surrogate outcome in the FINGER lifestyle randomized controlled trial. Eur J Neurol 2024; 31:e16238. [PMID: 38323508 DOI: 10.1111/ene.16238] [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: 11/07/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND AND PURPOSE The complex aetiology of Alzheimer's disease suggests prevention potential. Risk scores have potential as risk stratification tools and surrogate outcomes in multimodal interventions targeting specific at-risk populations. The Australian National University Alzheimer's Disease Risk Index (ANU-ADRI) was tested in relation to cognition and its suitability as a surrogate outcome in a multidomain lifestyle randomized controlled trial, in older adults at risk of dementia. METHODS In this post hoc analysis of the Finnish Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), ANU-ADRI was calculated at baseline, 12, and 24 months (n = 1174). The association between ANU-ADRI and cognition (at baseline and over time), the intervention effect on changes in ANU-ADRI, and the potential impact of baseline ANU-ADRI on the intervention effect on changes in cognition were assessed using linear mixed models with maximum likelihood estimation. RESULTS A higher ANU-ADRI was significantly related to worse cognition, at baseline (e.g., estimate for global cognition [95% confidence interval] was -0.028 [-0.032 to -0.025]) and over the 2-year study (e.g., estimate for 2-year changes in ANU-ADRI and per-year changes in global cognition [95% confidence interval] was -0.068 [-0.026 to -0.108]). No significant beneficial intervention effect was reported for ANU-ADRI, and baseline ANU-ADRI did not significantly affect the response to the intervention on changes in cognition. CONCLUSIONS The ANU-ADRI was effective for the risk prediction of cognitive decline. Risk scores may be crucial for the success of novel dementia prevention strategies, but their algorithm, the target population, and the intervention design should be carefully considered when choosing the appropriate tool for each context.
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Affiliation(s)
- Anette Hall
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Mariagnese Barbera
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | - Jenni Lehtisalo
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Riitta Antikainen
- Center for Life Course Health Research/Geriatrics, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Hamidul Huque
- School of Psychology, University of New South Wales, Sydney, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Tiina Laatikainen
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Tiia Ngandu
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hilkka Soininen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Neurocenter Finland, Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Ruth Stephen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Timo Strandberg
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Theme Inflammation and Aging, Karolinska university hospital, Stockholm, Sweden
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Sydney, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Alina Solomon
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
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12
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Serpa Neto A, Bellomo R. Clinical trials and clinical trials networks. Respirology 2024; 29:369-371. [PMID: 38499335 DOI: 10.1111/resp.14704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Ary Serpa Neto
- Austin Health, Melbourne, Victoria, Australia
- Australian and Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rinaldo Bellomo
- Austin Health, Melbourne, Victoria, Australia
- Australian and Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, Melbourne University, Melbourne, Victoria, Australia
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
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13
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Cao W, Zhu H, Wang L, Zhang L, Yu J. Doubly adaptive biased coin design to improve Bayesian clinical trials with time-to-event endpoints. Stat Med 2024; 43:1743-1758. [PMID: 38387866 DOI: 10.1002/sim.10047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
Clinical trialists often face the challenge of balancing scientific questions with other design features, such as improving efficiency, minimizing exposure to inferior treatments, and simultaneously comparing multiple treatments. While Bayesian response adaptive randomization (RAR) is a popular and effective method for achieving these objectives, it is known to have large variability and a lack of explicit theoretical results, making its use in clinical trials a subject of concern. It is desirable to propose a design that targets the same allocation proportion as Bayesian RAR and achieves the above objectives but addresses the concerns over Bayesian RAR. We propose the frequentist doubly adaptive biased coin designs (DBCD) targeting ethical allocation proportions from the Bayesian framework to satisfy different objectives in clinical trials with time-to-event endpoints. We derive the theoretical properties of the proposed adaptive randomization design and show through comprehensive numerical simulations that it can achieve ethical objectives without sacrificing efficiency. Our combined theoretical and numerical results offer a strong foundation for the practical use of RAR in real clinical trials.
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Affiliation(s)
- Wenhao Cao
- Division of Biostatistics and Health Data Science, University of Minnesota, Minneapolis, Minnesota, USA
| | - Hongjian Zhu
- Statistical Innovation Group, AbbVie Inc., Virtual Office, Sugar Land, Texas, USA
| | - Li Wang
- Statistical Innovation Group, AbbVie Inc., North Chicago, Illinois, USA
| | - Lixin Zhang
- Center for Data Science and School of Mathematical Sciences, Zhejiang University, Hangzhou, China
| | - Jun Yu
- Medical Affairs and Health Technology Assessment Statistics, AbbVie Inc., Virtual Office, Sugar Land, Texas, USA
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14
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Verstockt B, Pivorunas V, Al Mahi N, Smaoui N, Guay H, Kennedy NA, Goodhand JR, Lin S, Bai BYH, Hanauer SB, Ferrante M, Panés J, Vermeire S. Baseline TREM-1 Whole Blood Gene Expression Does Not Predict Response to Adalimumab Treatment in Patients with Ulcerative Colitis or Crohn's Disease in the SERENE Studies. J Crohns Colitis 2024; 18:493-505. [PMID: 37801628 DOI: 10.1093/ecco-jcc/jjad170] [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: 03/31/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND AND AIMS This study assessed whether baseline triggering receptor expressed on myeloid cells [TREM-1] whole blood gene expression predicts response to anti-tumour necrosis factor [anti-TNF] therapy in patients with ulcerative colitis [UC] or Crohn's disease [CD]. METHODS TREM-1 whole blood gene expression was analysed by RNA sequencing in patients with moderately to severely active UC or CD treated with adalimumab in the Phase 3 SERENE-UC and SERENE-CD clinical trials. The predictive value of baseline TREM-1 expression was evaluated and compared according to endoscopic and clinical response vs non-response, and remission vs non-remission, at Weeks 8 and 52 [SERENE-UC], and Weeks 12 and 56 [SERENE-CD]. RESULTS TREM-1 expression was analysed in 95 and 106 patients with UC and CD, respectively, receiving standard-dose adalimumab induction treatment. In SERENE-UC, baseline TREM-1 expression was not predictive of endoscopic response [p = 0.48], endoscopic remission [p = 0.53], clinical response [p = 0.58], or clinical remission [p = 0.79] at Week 8, or clinical response [p = 0.60] at Week 52. However, an association was observed with endoscopic response [p = 0.01], endoscopic remission [p = 0.048], and clinical remission [p = 0.04997] at Week 52. For SERENE-CD, baseline TREM-1 expression was not predictive of endoscopic response [p = 0.56], endoscopic remission [p = 0.33], clinical response [p = 0.07], or clinical remission [p = 0.65] at Week 12, or endoscopic response [p = 0.61], endoscopic remission [p = 0.51], clinical response [p = 0.62], or clinical remission [p = 0.97] at Week 56. CONCLUSIONS Baseline TREM-1 gene expression did not uniformly predict adalimumab response in SERENE clinical trials. Further research is needed to identify potential blood-based biomarkers predictive of response to anti-TNF therapy in patients with inflammatory bowel disease. CLINICALTRIALS.GOV IDENTIFIERS NCT02065622; NCT02065570.
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Affiliation(s)
- Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Valerie Pivorunas
- Precision Medicine Immunology, AbbVie Bioresearch Centre, Worcester, MA, USA
| | - Naim Al Mahi
- Genomic Research Center, AbbVie, North Chicago, IL, USA
| | - Nizar Smaoui
- Genomic Research Center, AbbVie, North Chicago, IL, USA
| | - Heath Guay
- Precision Medicine Immunology, AbbVie Bioresearch Centre, Worcester, MA, USA
| | - Nicholas A Kennedy
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - James R Goodhand
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Simeng Lin
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Benjamin Y H Bai
- Genomics of Inflammation and Immunity Group, Wellcome Sanger Institute, Hinxton, UK
| | - Stephen B Hanauer
- Department of Medicine, Northwestern University Feinberg School of Medicine, Evanston, IL, USA
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Julian Panés
- Hospital Clinic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Catalonia, Spain
| | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
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15
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Mogensen N, Kreicbergs U, Albertsen BK, Lähteenmäki PM, Heyman M, Harila A. Quality of life in children and adolescents after treatment for acute lymphoblastic leukemia according to the NOPHO ALL2008 protocol. Pediatr Blood Cancer 2024:e31018. [PMID: 38644601 DOI: 10.1002/pbc.31018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/27/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND The improved outcome of childhood acute lymphoblastic leukemia (ALL) over the last decades has increased the importance of assessing late effects and health-related quality of life (HRQoL), particularly when evaluating and comparing outcomes in clinical trials. This study aimed to assess HRQoL in children treated for ALL according to the NOPHO ALL2008 protocol. PROCEDURE Children, aged 1 to less than 18 years at diagnosis, alive in first remission, and their parents, were asked to complete PedsQL 4.0 Generic Core Scales (self- and proxy-report) at ≥6 months after end of therapy. Data on socioeconomic factors and parent-reported toxicity were collected through a study-specific questionnaire, and the NOPHO ALL2008 database was used to identify eligible families and add additional disease- and treatment-related data. HRQoL data were collected during 2013-2019 in Sweden, Finland, and Denmark. RESULTS A total of 299 children were included. The older children (8 years and older) reported similar HRQoL scores compared to Finnish reference data, except lower scores for School Functioning in high-risk patients. Scores from the parent-proxy and self-reports from 5-7-year olds were notably lower than reference. Parent-reported toxicity was associated with lower total and physical HRQoL scores in adjusted models for younger as well as older children in the self-report and parent-proxy versions, and also with lower psychosocial score in the parent-proxy. CONCLUSIONS Self-reported HRQoL was similar to reference population. The most important determinant for HRQoL after end of ALL treatment was parent-reported toxicity during treatment. Thus, minimizing complications is an obvious focus for future treatment protocols.
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Affiliation(s)
- Nina Mogensen
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatric Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Institute of Child Health, University College London, London, England
| | - Birgitte Klug Albertsen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Päivi M Lähteenmäki
- Turku University Hospital, University of Turku, and FICAN-West, Turku, Finland
- Swedish Childhood Cancer Registry, Karolinska Institutet, Stockholm, Sweden
| | - Mats Heyman
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatric Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Arja Harila
- Department of Women's and Children's Health, Uppsala University and Pediatric Oncology, Uppsala University Hospital, Uppsala, Sweden
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16
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Shi M, Wang J, Huang H, Liu D, Cheng H, Wang X, Chen W, Yan Z, Sang W, Qi K, Li D, Zhu F, Li Z, Qiao J, Wu Q, Zeng L, Fei X, Gu W, Miao Y, Xu K, Zheng J, Cao J. Bispecific CAR T cell therapy targeting BCMA and CD19 in relapsed/refractory multiple myeloma: a phase I/II trial. Nat Commun 2024; 15:3371. [PMID: 38643278 PMCID: PMC11032309 DOI: 10.1038/s41467-024-47801-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024] Open
Abstract
Despite the high therapeutic response achieved with B-cell maturation antigen (BCMA)-specific chimeric antigen receptor (CAR) T-cell therapy in relapsed and refractory multiple myeloma (R/R MM), primary resistance and relapse exist with single-target immunotherapy. Here, we design bispecific BC19 CAR T cells targeting BCMA/CD19 and evaluate antimyeloma activity in vitro and in vivo. Preclinical results indicate that BC19 CAR specifically recognize target antigens, and BC19 CAR T cells mediate selective killing of BCMA or CD19-positive cancer cells. BC19 CAR T cells also exhibit potent antigen-specific anti-tumor activity in xenograft mouse models. We conduct an open-label, single-arm, phase I/II study of BC19 CAR T cells in 50 patients with R/R MM (ChiCTR2000033567). The primary endpoint was safety. BC19 CAR T cells are well tolerated with grade 3 or higher cytokine release syndrome in 8% of patients and grade 1 neurotoxic events in 4% of patients, which meet the pre-specified primary endpoint. Secondary endpoints include overall response rate (92%), median progression-free survival (19.7 months), median overall survival (19.7 months) and median duration of response (not reached). Our study demonstrates that bispecific BC19 CAR T cells are feasible, safe and effective in treating patients with R/R MM.
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Affiliation(s)
- Ming Shi
- Cancer Institute, Xuzhou Medical University, Xuzhou, 221002, China
| | - Jiaojiao Wang
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Hongming Huang
- Department of Hematology, The Affiliated Hospital of Nantong University, Nantong, 226000, China
| | - Dan Liu
- Cancer Institute, Xuzhou Medical University, Xuzhou, 221002, China
- Jiangsu Bone Marrow Stem Cell Institute, Xuzhou, 221002, China
- Center of Clinical Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
- Jiangsu Center for the Collaboration and Innovation of Cancer Biotherapy, Xuzhou Medical University, Xuzhou, 221002, China
| | - Hai Cheng
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Xu Wang
- Cancer Institute, Xuzhou Medical University, Xuzhou, 221002, China
- Center of Clinical Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
- Jiangsu Center for the Collaboration and Innovation of Cancer Biotherapy, Xuzhou Medical University, Xuzhou, 221002, China
| | - Wei Chen
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Zhiling Yan
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Wei Sang
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Kunming Qi
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Depeng Li
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Feng Zhu
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Zhenyu Li
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Jianlin Qiao
- Jiangsu Bone Marrow Stem Cell Institute, Xuzhou, 221002, China
| | - Qingyun Wu
- Jiangsu Bone Marrow Stem Cell Institute, Xuzhou, 221002, China
| | - Lingyu Zeng
- Jiangsu Bone Marrow Stem Cell Institute, Xuzhou, 221002, China
| | - Xiaoming Fei
- Department of Hematology, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212000, China
| | - Weiying Gu
- Department of Hematology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, 213000, China
| | - Yuqing Miao
- Department of Hematology, Yancheng No. People's Hospital, Yancheng, 224006, China
| | - Kailin Xu
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.
| | - Junnian Zheng
- Center of Clinical Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.
- Jiangsu Center for the Collaboration and Innovation of Cancer Biotherapy, Xuzhou Medical University, Xuzhou, 221002, China.
| | - Jiang Cao
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.
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Jeka S, Dokoupilová E, Kivitz A, Żuchowski P, Vogg B, Krivtsova N, Sekhar S, Banerjee S, Schwebig A, Poetzl J, Body JJ, Eastell R. Equivalence trial of proposed denosumab biosimilar GP2411 and reference denosumab in postmenopausal osteoporosis: the ROSALIA study. J Bone Miner Res 2024; 39:202-210. [PMID: 38477751 DOI: 10.1093/jbmr/zjae016] [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: 11/06/2023] [Revised: 12/29/2023] [Accepted: 01/29/2024] [Indexed: 03/14/2024]
Abstract
Denosumab is a monoclonal antibody used to reduce risk of fractures in osteoporosis. ROSALIA was a multicenter, double-blind, randomized, integrated phase I/phase III study comparing the efficacy, pharmacokinetics (PK), pharmacodynamics (PD), immunogenicity, and safety of proposed biosimilar denosumab GP2411 with reference denosumab (REF-DMAb) (Prolia®; Amgen). Postmenopausal women with osteoporosis were randomized 1:1 to 2 60-mg doses of GP2411 or REF-DMAb, one at study start and one at week 26. At week 52, the REF-DMAb group was re-randomized 1:1 to a third dose of REF-DMAb or switch to GP2411. The primary efficacy endpoint was percentage change from baseline (%CfB) in LS-BMD at week 52. Secondary efficacy endpoints were %CfB in LS-BMD, FN-BMD, and TH-BMD at weeks 26 and 78 (and week 52 for FN-BMD and TH-BMD). Primary PK and PD endpoints were the area under the serum concentration-time curve extrapolated to infinity and maximum drug serum concentration at week 26, and the area under the effect-time curve of the %CfB in serum CTX at week 26. Secondary PK and PD endpoints included drug serum concentrations and %CfB in serum CTX and P1NP during the study period. Similar efficacy was demonstrated at week 52, with 95% CIs of the difference in %CfB in LS-BMD between treatment groups fully contained within prespecified equivalence margins. Similarity in PK and PD was demonstrated at week 26. Immunogenicity was similar between groups and was not impacted by treatment switch. The rate of new vertebral fractures was comparable. Treatment-emergent adverse events were comparable between groups (63.6% [GP2411/GP2411]; 76.0% [REF-DMAb/REF-DMAb]; 76.6% [REF-DMAb/GP2411]). In conclusion, ROSALIA showed similar efficacy, PK and PD, and comparable safety and immunogenicity of GP2411 to REF-DMAb in postmenopausal osteoporosis.
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Affiliation(s)
- Sławomir Jeka
- Clinic and Department of Rheumatology and Systemic Diseases of Connective Tissue, University Hospital No. 2. Bydgoszcz, CM UMK, 85-168 Bydgoszcz, KP, Poland
| | - Eva Dokoupilová
- Medical Plus, s.r.o., 68601 Uherske Hradiste, ZL, Czech Republic
- Masaryk University, Faculty of Pharmacy, Department of Pharmaceutical Technology, 612 00 Brno, JM, Czech Republic
| | - Alan Kivitz
- Altoona Center for Clinical Research, Duncansville, PA 16635, United States
| | - Paweł Żuchowski
- Clinic and Department of Rheumatology and Systemic Diseases of Connective Tissue, University Hospital No. 2. Bydgoszcz, CM UMK, 85-168 Bydgoszcz, KP, Poland
| | - Barbara Vogg
- Clinical Development Biopharmaceuticals, Hexal AG, 83607 Holzkirchen, BY, Germany
| | - Natalia Krivtsova
- Clinical Development Biopharmaceuticals, Hexal AG, 83607 Holzkirchen, BY, Germany
| | - Susmit Sekhar
- Clinical Development Biopharmaceuticals, Hexal AG, 83607 Holzkirchen, BY, Germany
| | - Samik Banerjee
- Clinical Development Biopharmaceuticals, Hexal AG, 83607 Holzkirchen, BY, Germany
| | - Arnd Schwebig
- Clinical Development Biopharmaceuticals, Hexal AG, 83607 Holzkirchen, BY, Germany
| | - Johann Poetzl
- Clinical Development Biopharmaceuticals, Hexal AG, 83607 Holzkirchen, BY, Germany
| | - Jean-Jacques Body
- Department of Medicine, University Hospital Brugmann, Université Libre de Bruxelles (ULB), 1020 Brussels, BE, Belgium
| | - Richard Eastell
- Division of Clinical Medicine, University of Sheffield, Sheffield S10 2TN, SYK, United Kingdom
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18
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Phelps EE, Tutton E, Costa ML, Achten J, Gibson P, Perry DC. A qualitative study of clinicians' experience of a clinical trial for displaced distal radius fractures. Bone Jt Open 2024; 5:324-334. [PMID: 38636944 PMCID: PMC11026126 DOI: 10.1302/2633-1462.54.bjo-2023-0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
Aims The aim of this study was to explore clinicians' experience of a paediatric randomized controlled trial (RCT) comparing surgical reduction with non-surgical casting for displaced distal radius fractures. Methods Overall, 22 staff from 15 hospitals who participated in the RCT took part in an interview. Interviews were informed by phenomenology and analyzed using thematic analysis. Results Analysis of the findings identified the overarching theme of "overcoming obstacles", which described the challenge of alleviating staff concerns about the use of non-surgical casting and recruiting families where there was treatment uncertainty. In order to embed and recruit to the Children's Radius Acute Fracture Fixation Trial (CRAFFT), staff needed to fit the study within clinical practice, work together, negotiate treatment decisions, and support families. Conclusion Recruiting families to this RCT was challenging because staff were uncertain about longer-term patient outcomes, and the difficulties were exacerbated by interdisciplinary tensions. Strong family and clinician beliefs, coupled with the complex nature of emergency departments and patient pathways that differed site-by-site, served as barriers to recruitment. Cementing a strong research culture, and exploring families' treatment preferences, helped to overcome recruitment obstacles.
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Affiliation(s)
- Emma E. Phelps
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Elizabeth Tutton
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, John Radclife Hospital, Oxford, UK
| | - Matthew L. Costa
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Juul Achten
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Phoebe Gibson
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Daniel C. Perry
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
- Department of Child Health, University of Liverpool, Alder Hey Hospital, Liverpool, UK
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19
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Berns A. Academia and society should join forces to make anti-cancer treatments more affordable. Mol Oncol 2024. [PMID: 38634213 DOI: 10.1002/1878-0261.13651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/26/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
Discovery research is the starting point for the development of more effective anti-cancer treatments. It requires an interdisciplinary research environment with first-class infrastructural support in which curiosity-driven research can lead to new concepts for treating cancer. Translating such research findings to clinical practice requires complementary skills and infrastructures, including high-quality clinical facilities, access to patient cohorts and participation of pharma. This complex ecosystem has yielded many new but also "me too" treatment regimens, especially in immuno-oncology resulting in an extremely high pricing of anti-cancer agents. The costs of antibodies, vaccines, and cell therapies charged by pharma stand out although the concepts and methodologies have been largely developed in academia, financed from public funds. Comprehensive Cancer Centres (CCCs) covering a coherent stretch of the cancer research continuum are well-positioned to make these personalized treatments more affordable, but this will require restructuring of the way the translational cancer research continuum is funded.
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Affiliation(s)
- Anton Berns
- Division of Molecular Genetics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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20
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Akkewar AS, Mishra KA, Kamble MG, Kumar S, Dey J, Sethi KK. A mechanistic review on growing multiple therapeutic applications of lutein and its global market research. Phytother Res 2024. [PMID: 38634408 DOI: 10.1002/ptr.8197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/22/2024] [Accepted: 03/13/2024] [Indexed: 04/19/2024]
Abstract
Lutein is a naturally occurring carotenoid synthesized by plants and algae that has a beneficial effect on several biological processes and associated ailments. Its immediate application is in ophthalmology, where it significantly lowers the incidences of age-related macular degeneration (AMD). It also has anti-inflammatory action, treatment of diabetic retinopathy, and cataracts, and enhancement of visual contrast. To critically assess lutein biosynthesis, therapeutic applicability, and market research literature. We have discussed its theoretical frameworks, experimental evidence, limitations, as well as clinical trial results, and future research prospects. The literature for this review article was mined and compiled by collecting and analyzing articles from several databases, including ScienceDirect, Google Scholar, PubMed, Wiley Online Library, Patentscope, and ClinicalTrials.gov published until March 30, 2022. Patent publications were identified using the search terms like IC:(C07C67/56) AND EN_AB:(lutein) OR EN_TI:(lutein) OR EN_AB:(extraction) OR EN_TI:(process). According to the literature, lutein is an essential nutrient given that it cannot be synthesized in the human body and acts as an antioxidant, affecting AMD, diabetic retinopathy, Rheumatic diseases, inflammation, and cancer. Due to inadequate production and laborious extraction, lutein is expensive despite its high demand and applicability. Market research predicts a 6.3% compound annual growth rate for lutein by 2032. Optimizing lutein extraction for high yield and purity is necessary. Lutein has proven applicability in various ailments as well as cosmetics that can be developed as a candidate drug for various diseases discussed in the review.
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Affiliation(s)
- Ashish Sunil Akkewar
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research, Guwahati, Guwahati, India
| | - Km Abha Mishra
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research, Guwahati, Guwahati, India
| | - Mahesh Gopichand Kamble
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research, Guwahati, Guwahati, India
| | - Sanjay Kumar
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research, Guwahati, Guwahati, India
| | - Juhi Dey
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research, Guwahati, Guwahati, India
| | - Kalyan Kumar Sethi
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research, Guwahati, Guwahati, India
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Saini AK, Anil N, Vijay AN, Mangla B, Javed S, Kumar P, Ahsan W. Recent Advances in the Treatment Strategies of Friedreich's Ataxia: A Review of Potential Drug Candidates and their Underlying Mechanisms. Curr Pharm Des 2024; 30:CPD-EPUB-139825. [PMID: 38638052 DOI: 10.2174/0113816128288707240404051856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Friedreich's ataxia (FRDA) is a rare hereditary neurodegenerative disorder characterized by progressive ataxia, cardiomyopathy, and diabetes. The disease is caused by a deficiency of frataxin, a mitochondrial protein involved in iron-sulfur cluster synthesis and iron metabolism. OBJECTIVE This review aims to summarize recent advances in the development of treatment strategies for FRDA, with a focus on potential drug candidates and their mechanisms of action. METHODS A comprehensive literature search was conducted using various authentic scientific databases to identify studies published in the last decade that investigated potential treatment strategies for FRDA. The search terms used included "Friedreich's ataxia," "treatment," "drug candidates," and "mechanisms of action." RESULTS To date, only one drug got approval from US-FDA in the year 2023; however, significant developments were achieved in FRDA-related research focusing on diverse therapeutic interventions that could potentially alleviate the symptoms of this disease. Several promising drug candidates have been identified for the treatment of FRDA, which target various aspects of frataxin deficiency and aim to restore frataxin levels, reduce oxidative stress, and improve mitochondrial function. Clinical trials have shown varying degrees of success, with some drugs demonstrating significant improvements in neurological function and quality of life in FRDA patients. CONCLUSION While there has been significant progress in the development of treatment strategies for FRDA, further research is needed to optimize these approaches and identify the most effective and safe treatment options for patients. The integration of multiple therapeutic strategies may be necessary to achieve the best outcomes in FRDA management.
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Affiliation(s)
- Aman Kumar Saini
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, New Delhi 110017, India
| | - Neha Anil
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, New Delhi 110017, India
| | - Ardra N Vijay
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, New Delhi 110017, India
| | - Bharti Mangla
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, New Delhi 110017, India
| | - Shamama Javed
- Department of Pharmaceutics, College of Pharmacy, Jazan University, P. Box No. 114, Jazan, Saudi Arabia
| | - Pankaj Kumar
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, New Delhi 110017, India
| | - Waquar Ahsan
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jazan University, P. Box No. 114, Jazan, Saudi Arabia
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22
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Aziz YN, Sucharew H, Reeves MJ, Broderick JP. Factors Associated With Premature Termination of Hyperacute Stroke Trials: A Review. J Am Heart Assoc 2024; 13:e034115. [PMID: 38606770 DOI: 10.1161/jaha.124.034115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND We performed a review of acute stroke trials to determine features associated with premature termination of trial enrollment, defined by the authors as not meeting preplanned sample size. METHODS AND RESULTS MEDLINE was searched for randomized clinical stroke trials published in 9 major clinical journals between 2013 and 2022. We included randomized clinical trials that were phase 2 or 3 with a preplanned sample size ≥100 and a time-to-treatment within 24 hours of onset for transient ischemic attack, ischemic stroke, or intracerebral hemorrhage. Data were abstracted on trial features including trial design, inclusion criteria, imaging, location and number of sites, masking, treatment complexity, control group (standard therapy, placebo), industry involvement, and preplanned stopping rules (futility and efficacy). Least absolute shrinkage and selection operator regression was used to select the most important factors associated with premature termination; then, a multivariable logistic regression was fit including only the least absolute shrinkage and selection operator selected variables. Of 1475 studies assessed, 98 trials met eligibility criteria. Forty-five (46%) trials were prematurely terminated, of which 27% were stopped for benefit/efficacy, 20% for lack of money/slow enrollment, 18% for futility, 16% for newly available evidence, 17% for other reasons, and 4% due to harm. Complex trials (adjusted odds ratio [aOR], 2.76 [95% CI, 1.13-7.49]), presence of a futility rule (aOR, 4.43 [95% CI, 1.62-17.91]), and exclusion of prestroke dependency (none/slight disability only; aOR, 2.19 [95% CI, 0.84-6.72] versus dependency allowed) were identified as the strongest predictors. CONCLUSIONS Nearly half of acute stroke trials were terminated prematurely. Broadening inclusion criteria and simplifying trial design may decrease the likelihood of unplanned termination, whereas planned futility analyses may appropriately terminate trials early, saving money and resources.
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Affiliation(s)
- Yasmin N Aziz
- Department of Neurology and Rehabilitation Medicine University of Cincinnati Cincinnati OH USA
| | - Heidi Sucharew
- Department of Emergency Medicine University of Cincinnati Cincinnati OH USA
| | - Mathew J Reeves
- Department of Epidemiology and Biostatistics Michigan State University East Lansing MI USA
| | - Joseph P Broderick
- Department of Neurology and Rehabilitation Medicine University of Cincinnati Cincinnati OH USA
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23
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Rabbia M, Ormazabal MG, Staunton H, Veenstra K, Eggenspieler D, Annoussamy M, Servais L, Strijbos P. Stride Velocity 95th Centile Detects Decline in Ambulatory Function Over Shorter Intervals than the 6-Minute Walk Test or North Star Ambulatory Assessment in Duchenne Muscular Dystrophy. J Neuromuscul Dis 2024:JND230188. [PMID: 38640165 DOI: 10.3233/jnd-230188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Background Stride Velocity 95th Centile (SV95C) is the first wearable device-derived clinical outcome assessment (COA) to receive European Medicines Agency (EMA) qualification as a primary endpoint in patients aged ≥4 years. Objective To compare SV95C-in its first-ever clinical trial application as a secondary endpoint-with established motor function COAs used in the trial (Four-Stair Climb [4SC] velocity, North Star Ambulatory Assessment [NSAA], and Six-Minute Walk Distance [6MWD]). Methods SV95C was a secondary endpoint in a subset (n = 47) of participants in the SPITFIRE/WN40227 trial of taldefgrobep alfa, which was discontinued due to lack of clinical benefit. Participants in the ≤48-week SV95C sub-study were 6-11 years old and received corticosteroids for ≥6 months pre-treatment. Pearson correlations were used to compare SV95C with the other COAs. Responsiveness and changes over time were respectively assessed via standardized response means (SRMs) based on absolute changes and mixed models for repeated measures. Results SV95C change at Week 24 was -0.07 m/s, with limited variability (standard deviation: 0.16, n = 27). The SRM for SV95C indicated moderate responsiveness to clinical change at the earliest timepoint (Week 12, n = 46), while those of the other COAs did not indicate moderate responsiveness until Week 36 (6MWD, n = 33) or Week 48 (4SC velocity, n = 20; NSAA total score, n = 20). Baseline correlations between SV95C and other COAs were strong (r = 0.611-0.695). Correlations between SV95C change from baseline to Week 48 and changes in other COAs were moderate to strong (r = 0.443-0.678).∥. Conclusions Overall, SV95C demonstrated sensitivity to ambulatory decline over short intervals, low variability, and correlation with established COAs. Although the negative trial precluded demonstration of SV95C's sensitivity to drug effect, these findings support the continued use of SV95C in DMD clinical trials.
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Affiliation(s)
| | | | - Hannah Staunton
- Roche Products Ltd, Hexagon Place, Shire Park, 6 Falcon Way, Welwyn Garden City, UK
| | - Klaas Veenstra
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Basel, Switzerland
| | | | | | - Laurent Servais
- MDUK Oxford Neuromuscular Centre and NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Department of Pediatrics, Division of Child Neurology, Centre de Référence des Maladies Neuromusculaires, University Hospital Liège and University of Liège, Avenue de l'Hôpital 1, Liege, Belgium
| | - Paul Strijbos
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Basel, Switzerland
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24
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Warren JL, Wang Q, Ciarleglio MM. A scaled kernel density estimation prior for dynamic borrowing of historical information with application to clinical trial design. Stat Med 2024; 43:1615-1626. [PMID: 38345148 DOI: 10.1002/sim.10032] [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: 07/21/2023] [Revised: 11/07/2023] [Accepted: 01/23/2024] [Indexed: 03/16/2024]
Abstract
Incorporating historical data into a current data analysis can improve estimation of parameters shared across both datasets and increase the power to detect associations of interest while reducing the time and cost of new data collection. Several methods for prior distribution elicitation have been introduced to allow for the data-driven borrowing of historical information within a Bayesian analysis of the current data. We propose scaled Gaussian kernel density estimation (SGKDE) prior distributions as potentially more flexible alternatives. SGKDE priors directly use posterior samples collected from a historical data analysis to approximate probability density functions, whose variances depend on the degree of similarity between the historical and current datasets, which are used as prior distributions in the current data analysis. We compare the performances of the SGKDE priors with some existing approaches using a simulation study. Data from a recently completed phase III clinical trial of a maternal vaccine for respiratory syncytial virus are used to further explore the properties of SGKDE priors when designing a new clinical trial while incorporating historical data. Overall, both studies suggest that the new approach results in improved parameter estimation and power in the current data analysis compared to the considered existing methods.
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Affiliation(s)
- Joshua L Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Qi Wang
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Maria M Ciarleglio
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
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25
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Wohl DA, Koethe JR, Sax PE, McComsey GA, Kuritzkes DR, Moyle G, Kaplan L, van Wyk J, Campo RE, Cohen C. Antiretrovirals and Weight Change: Weighing the Evidence. Clin Infect Dis 2024:ciae191. [PMID: 38606799 DOI: 10.1093/cid/ciae191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 02/27/2024] [Accepted: 04/04/2024] [Indexed: 04/13/2024] Open
Abstract
Body weight is influenced by an interplay of individual and environmental factors. In people with HIV (PWH), weight is also influenced by disease status with loss accompanying disease progression that is reversed with effective antiretroviral therapy (ART). Weight changes in comparative ART trials differ by regimen, with greater gains observed with the integrase strand transfer inhibitors (INSTIs) dolutegravir and bictegravir, particularly when co-administered with tenofovir alafenamide fumarate (TAF), compared to regimens that include agents such as tenofovir disoproxil fumarate (TDF) that attenuate weight gain. We review weight changes in major randomized trials of pre-exposure prophylaxis (PrEP) and initial and switch HIV therapy, highlighting the challenges to assessing the role of ART in weight change. This examination forms the basis for a model that questions assumptions regarding an association between INSTI and TAF and excessive weight gain and calls for more careful consideration of these data when making HIV treatment decisions.
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Affiliation(s)
| | - John R Koethe
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paul E Sax
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Daniel R Kuritzkes
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Graeme Moyle
- Chelsea and Westminster NHS Foundation Trust, London SW10 9NH, UK
| | - Lee Kaplan
- Harvard Medical School, Boston, Massachusetts, USA
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26
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Schwartz JB. Current status of inclusion of older groups in evaluations of new medications: Gaps and implementation needs to fill them. J Am Geriatr Soc 2024. [PMID: 38600697 DOI: 10.1111/jgs.18912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/16/2024] [Indexed: 04/12/2024]
Abstract
Under-representation of subgroups of the population in clinical trials has been and continues to be a problem despite goals of academia, industry, and government. Older adults are among the groups that are under-represented in trials of medications that they are likely to receive once marketing approval has been received. Recent legislation that mandates that clinical trial participants be representative of patient population has been passed and creates hope that greater numbers of older adults will be enrolled in clinical trials and that they will be representative of "typical" geriatric patients. However, there is the need for collection of current data on disease prevalences with granularity as to age, gender, and race as well as geriatric co-morbidities to assess the representativeness of clinical trial participants relative to patient populations. Consensus on definitions and collection of data relevant to geriatric patient populations are needed to evaluate effects of comorbidities, frailty, cognitive and physical function. There will also be a need for expansion of the geriatric research workforce, facilities for research both in academic centers but also in the community and long-term care facilities, and for engagement with and involvement of communities that have been traditionally under-represented to conduct clinical trials that enroll truly representative patient populations.
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Affiliation(s)
- Janice B Schwartz
- Department of Medicine, Divisions of Geriatrics and Clinical Pharmacology, University of California, San Francisco, San Francisco, California, USA
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27
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Li KD, Venishetty N, Fernandez AM, Hakam N, Ghaffar U, Gupta S, Patel HV, Breyer BN. Fragility of overactive bladder medication clinical trials: A systematic review. Neurourol Urodyn 2024. [PMID: 38594889 DOI: 10.1002/nau.25468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/01/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE Overactive bladder (OAB) syndrome significantly impairs quality of life, often necessitating pharmacological interventions with associated risks. The fragility of OAB trial outcomes, as measured by the fragility index (FI: smallest number of event changes to reverse statistical significance) and quotient (FQ: FI divided by total sample size expressed as a percentage), is critical yet unstudied. MATERIALS AND METHODS We conducted a systematic search for randomized controlled trials on OAB medications published between January 2000 and August 2023. Inclusion criteria were trials with two parallel arms reporting binary outcomes related to OAB medications. We extracted trial details, outcomes, and statistical tests employed. We calculated FI and FQ, analyzing associations with trial characteristics through linear regression. RESULTS We included 57 trials with a median sample size of 211 participants and a 12% median lost to follow-up. Most studies investigated anticholinergics (37/57, 65%). The median FI/FQ was 5/3.5%. Larger trials were less fragile (median FI 8; FQ 1.0%) compared to medium (FI: 4; FQ 2.5%) and small trials (FI: 4; FQ 8.3%). Double-blinded studies exhibited higher FQs (median 2.9%) than unblinded trials (6.7%). Primary and secondary outcomes had higher FIs (median 5 and 6, respectively) than adverse events (FI: 4). Each increase in 10 participants was associated with a +0.19 increase in FI (p < 0.001). CONCLUSIONS A change in outcome for a median of five participants, or 3.5% of the total sample size, could reverse the direction of statistical significance in OAB trials. Studies with larger sample sizes and efficacy outcomes from blinded trials were less fragile.
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Affiliation(s)
- Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Nikit Venishetty
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Adrian M Fernandez
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Umar Ghaffar
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Shiv Gupta
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Hiren V Patel
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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28
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Callegaro A, Luo Y, Karkada N, Zahaf T. Dynamic borrowing of historical controls adjusting for covariates in vaccine efficacy clinical trials. Pharm Stat 2024. [PMID: 38591424 DOI: 10.1002/pst.2384] [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: 08/23/2023] [Revised: 12/22/2023] [Accepted: 03/07/2024] [Indexed: 04/10/2024]
Abstract
Traditional vaccine efficacy trials usually use fixed designs and often require large sample sizes. Recruiting a large number of subjects can make the trial expensive, long, and difficult to conduct. A possible approach to reduce the sample size and speed up the development is to use historical controls. In this paper, we extend the robust mixture prior (RMP) approach (a well established approach for Bayesian dynamic borrowing of historical controls) to adjust for covariates. The adjustment is done using classical methods from causal inference: inverse probability of treatment weighting, G-computation and double-robust estimation. We evaluate these covariate-adjusted RMP approaches using a comprehensive simulation study and demonstrate their use by performing a retrospective analysis of a prophylactic human papillomavirus vaccine efficacy trial. Adjusting for covariates reduces the drift between current and historical controls, with a beneficial effect on bias, control of type I error and power.
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Affiliation(s)
| | - Yongyi Luo
- Institute of Mathematics, Swiss Federal Institute of Technology Lausanne (EPFL), Lausanne, Switzerland
| | | | - Toufik Zahaf
- Department of Biostatistics, GSK, Rixensart, Belgium
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29
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Neri B, Mancone R, Fiorillo M, Schiavone SC, De Cristofaro E, Migliozzi S, Biancone L. Comprehensive overview of novel chemical drugs for ulcerative colitis: focusing on phase 3 and beyond. Expert Opin Pharmacother 2024:1-15. [PMID: 38591242 DOI: 10.1080/14656566.2024.2339926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/03/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Despite the growing number of highly efficacious biologics and chemical drugs for ulcerative colitis (UC), steroid-free disease control is still difficult to achieve in subgroups of patients due to refractoriness, adverse events, primary or secondary failure. New treatments are therefore still required in order to optimize clinical management of patients with UC. AREAS COVERED The efficacy and safety of both currently available and newly developed small molecules have been summarized. The PubMed database and clinicaltrials.gov were considered in order to search for phase 2b and 3 trials on new chemical drugs for UC. The study drugs reviewed included Janus kinases (JAK) and sphingosine-1-phosphate receptor (S1Pr) inhibitors, α4 integrin antagonist, and micro-RNA-124 upregulators. EXPERT OPINION Rapidity of onset, low immunogenicity, and safety are the main characteristics of small molecules currently available or under evaluation for treatment patients with UC. Among the currently available chemical drugs, the selective JAK and the S1Pr inhibitors are characterized by a good safety profile combined with the ability to induce clinical remission in UC. A relatively low frequency of endoscopic improvement and healing currently appears associated with their use, being higher in UC patients treated with S1Pr inhibitor Etrasimod. Overall, additional new safe and effective drugs are still required in order to optimize disease control in a larger majority of UC patients.
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Affiliation(s)
- Benedetto Neri
- Department of Systems Medicine, Gastroenterological Unit, University "Tor Vergata" of Rome, Rome, Italy
| | - Roberto Mancone
- Department of Systems Medicine, Gastroenterological Unit, University "Tor Vergata" of Rome, Rome, Italy
| | - Mariasofia Fiorillo
- Department of Systems Medicine, Gastroenterological Unit, University "Tor Vergata" of Rome, Rome, Italy
| | - Sara Concetta Schiavone
- Department of Systems Medicine, Gastroenterological Unit, University "Tor Vergata" of Rome, Rome, Italy
| | - Elena De Cristofaro
- Department of Systems Medicine, Gastroenterological Unit, University "Tor Vergata" of Rome, Rome, Italy
| | - Stefano Migliozzi
- Department of Systems Medicine, Gastroenterological Unit, University "Tor Vergata" of Rome, Rome, Italy
| | - Livia Biancone
- Department of Systems Medicine, Gastroenterological Unit, University "Tor Vergata" of Rome, Rome, Italy
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30
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Obi M, Adams A, Vandenbossche A, Otero Pineiro A, Lightner AL. Patient engagement and satisfaction with early phase cell therapy clinical trials at a tertiary inflammatory bowel disease center. Stem Cell Reports 2024; 19:435-442. [PMID: 38552633 DOI: 10.1016/j.stemcr.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 04/12/2024] Open
Abstract
Several clinical trials are underway investigating cell and gene therapy, and while these trials are meant to significantly impact patient care, they rely on patient engagement and participation. Unfortunately, clinical trials generally require extensive commitment by subjects. While several studies are using validated surveys to measure patient-reported outcomes, there is a lack of characterization of the patient experience as a subject in these trials. As such, we surveyed mesenchymal stromal cell (MSC) trial participants to understand their perspective. We found that there exists a reliance on one's gastroenterologist and colorectal surgeons for trial introduction and that time and cost were the main barriers to participation. Overall, participants demonstrated high satisfaction with MSC trial participation, but future protocols could incorporate increased use of virtual appointments to optimize patient experience.
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Affiliation(s)
- Megan Obi
- Department of General Surgery, Digestive Disease Surgical Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Ashley Adams
- Division of General Surgery, Scripps Clinic Medical Group, Scripps Health, La Jolla, CA 92037, USA
| | - Alexandria Vandenbossche
- Division of General Surgery, Scripps Clinic Medical Group, Scripps Health, La Jolla, CA 92037, USA
| | - Ana Otero Pineiro
- Department of Gastrointestinal Surgery, Hospital Clinic, Barcelona, Spain
| | - Amy L Lightner
- Division of General Surgery, Scripps Clinic Medical Group, Scripps Health, La Jolla, CA 92037, USA.
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31
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Majchrzak-Celińska A, Studzińska-Sroka E. New Avenues and Major Achievements in Phytocompounds Research for Glioblastoma Therapy. Molecules 2024; 29:1682. [PMID: 38611962 PMCID: PMC11013944 DOI: 10.3390/molecules29071682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/22/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
Phytocompounds have been evaluated for their anti-glioblastoma actions for decades, with promising results from preclinical studies but only limited translation into clinics. Indeed, by targeting multiple signaling pathways deregulated in cancer, they often show high efficacy in the in vitro studies, but their poor bioavailability, low tumor accumulation, and rapid clearance compromise their efficacy in vivo. Here, we present the new avenues in phytocompound research for the improvement of glioblastoma therapy, including the ways to enhance the response to temozolomide using phytochemicals, the current focus on phytocompound-based immunotherapy, or the use of phytocompounds as photosensitizers in photodynamic therapy. Moreover, we present new, intensively evaluated approaches, such as chemical modifications of phytochemicals or encapsulation into numerous types of nanoformulations, to improve their bioavailability and delivery to the brain. Finally, we present the clinical trials evaluating the role of phytocompounds or phytocompound-derived drugs in glioblastoma therapy and the less studied phytocompounds or plant extracts that have only recently been found to possess promising anti-glioblastoma properties. Overall, recent advancements in phytocompound research are encouraging; however, only with more 3D glioblastoma models, in vivo studies, and clinical trials it is possible to upgrade the role of phytocompounds in glioblastoma treatment to a satisfactory level.
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Affiliation(s)
- Aleksandra Majchrzak-Celińska
- Department of Pharmaceutical Biochemistry, Poznan University of Medical Sciences, Rokietnicka 3 Str., 60-806 Poznan, Poland
| | - Elżbieta Studzińska-Sroka
- Department of Pharmacognosy and Biomaterials, Poznan University of Medical Sciences, Rokietnicka 3 Str., 60-806 Poznan, Poland;
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32
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Doherty T, Kroon M, Pereira-Kotze C. Valuing Academic Freedom and Advocacy. J Empir Res Hum Res Ethics 2024:15562646241246369. [PMID: 38584389 DOI: 10.1177/15562646241246369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
This is a correspondence letter in response to an article published in the journal: Flaherman VJ, Nankabirwa V, Ginsburg AS. Promoting Transparent and Equitable Discussion of Controversial Research. Journal of Empirical Research on Human Research Ethics 2023; 18(4): 248-9.
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Affiliation(s)
- Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Max Kroon
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Neonatal Service, Mowbray Maternity Hospital, Mowbray, South Africa
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33
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Barrientos-Toro EN, Ding Q, Raso MG. Translational Aspects in Metaplastic Breast Carcinoma. Cancers (Basel) 2024; 16:1433. [PMID: 38611109 PMCID: PMC11011105 DOI: 10.3390/cancers16071433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Breast cancer is the most common cancer among women. Metaplastic breast carcinoma (MpBC) is a rare, heterogeneous group of invasive breast carcinomas, which are classified as predominantly triple-negative breast carcinomas (TNBCs; HR-negative/HER2-negative). Histologically, MpBC is classified into six subtypes. Two of these are considered low-grade and the others are high-grade. MpBCs seem to be more aggressive, less responsive to neoadjuvant chemotherapy, and have higher rates of chemoresistance than other TNBCs. MpBCs have a lower survival rate than expected for TNBCs. MpBC treatment represents a challenge, leading to a thorough exploration of the tumor immune microenvironment, which has recently opened the possibility of new therapeutic strategies. The epithelial-mesenchymal transition in MpBC is characterized by the loss of intercellular adhesion, downregulation of epithelial markers, underexpression of genes with biological epithelial functions, upregulation of mesenchymal markers, overexpression of genes with biological mesenchymal functions, acquisition of fibroblast-like (spindle) morphology, cytoskeleton reorganization, increased motility, invasiveness, and metastatic capabilities. This article reviews and summarizes the current knowledge and translational aspects of MpBC.
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Affiliation(s)
- Elizve Nairoby Barrientos-Toro
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Qingqing Ding
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Maria Gabriela Raso
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
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Oshima K, Tsushima T, Ito Y, Kato K. Recent progress in chemoradiotherapy for oesophageal squamous cell carcinoma. Jpn J Clin Oncol 2024; 54:395-402. [PMID: 38342589 PMCID: PMC10999767 DOI: 10.1093/jjco/hyae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/11/2024] [Indexed: 02/13/2024] Open
Abstract
Oesophageal squamous cell carcinoma is a common malignancy worldwide. Definitive chemoradiotherapy is the standard treatment for patients with resectable stage oesophageal squamous cell carcinoma who cannot undergo surgery, as well as those with locally advanced unresectable oesophageal squamous cell carcinoma. However, it has several disadvantages such as poor survival, radiation-related toxicities and severe and lethal complications related to salvage treatment for residual or recurrent disease. Numerous clinical trials on chemoradiotherapy have been conducted to confirm the optimal combination of irradiation and chemotherapy. For advanced disease, multimodal treatment strategies including salvage surgery are essential. Palliative chemoradiotherapy is also crucial for dysphagia in locally advanced oesophageal squamous cell carcinoma with or without metastatic lesions. Recently, the synergistic mechanism of radiotherapy combined with immunotherapy has been reported. Early phase clinical trials suggest that a combination of immunotherapy and chemoradiotherapy can improve clinical outcomes with manageable side effects, but further investigations are needed. Here, we reviewed the existing clinical data and current development of chemoradiotherapy combined with immunotherapy in patients with oesophageal squamous cell carcinoma.
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Affiliation(s)
- Kotoe Oshima
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Takahiro Tsushima
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Yoshinori Ito
- Department of Radiation Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Ken Kato
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
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Galal MA, Al-Rimawi M, Hajeer A, Dahman H, Alouch S, Aljada A. Metformin: A Dual-Role Player in Cancer Treatment and Prevention. Int J Mol Sci 2024; 25:4083. [PMID: 38612893 PMCID: PMC11012626 DOI: 10.3390/ijms25074083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/30/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Cancer continues to pose a significant global health challenge, as evidenced by the increasing incidence rates and high mortality rates, despite the advancements made in chemotherapy. The emergence of chemoresistance further complicates the effectiveness of treatment. However, there is growing interest in the potential of metformin, a commonly prescribed drug for type 2 diabetes mellitus (T2DM), as an adjuvant chemotherapy agent in cancer treatment. Although the precise mechanism of action of metformin in cancer therapy is not fully understood, it has been found to have pleiotropic effects, including the modulation of metabolic pathways, reduction in inflammation, and the regulation of cellular proliferation. This comprehensive review examines the anticancer properties of metformin, drawing insights from various studies conducted in vitro and in vivo, as well as from clinical trials and observational research. This review discusses the mechanisms of action involving both insulin-dependent and independent pathways, shedding light on the potential of metformin as a therapeutic agent for different types of cancer. Despite promising findings, there are challenges that need to be addressed, such as conflicting outcomes in clinical trials, considerations regarding dosing, and the development of resistance. These challenges highlight the importance of further research to fully harness the therapeutic potential of metformin in cancer treatment. The aims of this review are to provide a contemporary understanding of the role of metformin in cancer therapy and identify areas for future exploration in the pursuit of effective anticancer strategies.
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Affiliation(s)
- Mariam Ahmed Galal
- Department of Biochemistry and Molecular Medicine, College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh 11533, Saudi Arabia; (M.A.G.); (M.A.-R.); (H.D.); (S.A.)
- Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
| | - Mohammed Al-Rimawi
- Department of Biochemistry and Molecular Medicine, College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh 11533, Saudi Arabia; (M.A.G.); (M.A.-R.); (H.D.); (S.A.)
| | | | - Huda Dahman
- Department of Biochemistry and Molecular Medicine, College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh 11533, Saudi Arabia; (M.A.G.); (M.A.-R.); (H.D.); (S.A.)
| | - Samhar Alouch
- Department of Biochemistry and Molecular Medicine, College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh 11533, Saudi Arabia; (M.A.G.); (M.A.-R.); (H.D.); (S.A.)
| | - Ahmad Aljada
- Department of Biochemistry and Molecular Medicine, College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh 11533, Saudi Arabia; (M.A.G.); (M.A.-R.); (H.D.); (S.A.)
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Budhu JA, Chukwueke UN, Jackson S, Lee EQ, McFaline-Figueroa JR, Willmarth N, Dalmage M, Kawachi I, Arons D, Chang SM, Galanis E, Hervey-Jumper SL, Wen PY, Porter AB. Defining interventions and metrics to improve diversity in CNS clinical trial participation: A SNO and RANO effort. Neuro Oncol 2024; 26:596-608. [PMID: 38071654 PMCID: PMC10995510 DOI: 10.1093/neuonc/noad242] [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] [Indexed: 04/06/2024] Open
Abstract
Despite major strides in cancer research and therapy, these advances have not been equitable across race and ethnicity. Historically marginalized groups (HMG) are more likely to have inadequate preventive screening, increased delays in diagnosis, and poor representation in clinical trials. Notably, Black, Hispanic, and Indigenous people represent 30% of the population but only 9% of oncology clinical trial participants. As a result, HMGs lack equitable access to novel therapies, contradicting the principle of distributive justice, as enshrined in the Belmont report, which demands the equitable selection of subjects in research involving human subjects. The lack of clinical trial diversity also leads to low generalizability and potentially harmful medical practices. Specifically, patients with brain cancer face unique barriers to clinical trial enrollment and completion due to disease-specific neurologic and treatment-induced conditions. Collectively, the intersection of these disease-specific conditions with social determinants of health fosters a lack of diversity in clinical trials. To ameliorate this disparity in neuro-oncology clinical trial participation, we present interventions focused on improving engagement of HMGs. Proposals range from inclusive trial design, decreasing barriers to care, expanding trial eligibility, access to tumor profiling for personalized medical trials, setting reasonable metrics and goals for accrual, working with patient community stakeholders, diversifying the neuro-oncology workforce, and development of tools to overcome biases with options to incentivize equity. The diversification of participation amongst neuro-oncology clinical trials is imperative. Equitable access and inclusion of HMG patients with brain tumors will not only enhance research discoveries but will also improve patient care.
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Affiliation(s)
- Joshua A Budhu
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Neurology, Weill Cornell Medicine, Joan & Sanford I. Weill Medical College of Cornell University, New York, New York, USA
| | - Ugonma N Chukwueke
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sadhana Jackson
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Eudocia Q Lee
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - J Ricardo McFaline-Figueroa
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mahalia Dalmage
- Division of Biological Sciences, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - David Arons
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - Susan M Chang
- Division of Neuro-Oncology, University of California San Francisco and Weill Institute for Neurosciences, San Francisco, California, USA
| | | | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of California San Francisco and Weill Institute for Neurosciences, San Francisco, California, USA
| | - Patrick Y Wen
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alyx B Porter
- Department of Neurology, Mayo Clinic Cancer Center, Phoenix, Arizona, USA
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Marks J, Sridhar A, Ai A, Kiel L, Kaufman R, Abioye O, Mantz C, Florez N. Precision Immuno-Oncology in NSCLC through Gender Equity Lenses. Cancers (Basel) 2024; 16:1413. [PMID: 38611091 PMCID: PMC11010825 DOI: 10.3390/cancers16071413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Precision immuno-oncology involves the development of personalized cancer treatments that are influenced by the unique nature of an individual's DNA, immune cells, and their tumor's molecular characterization. Biological sex influences immunity; females typically mount stronger innate and adaptive immune responses than males. Though more research is warranted, we continue to observe an enhanced benefit for females with lung cancer when treated with combination chemoimmunotherapy in contrast to the preferred approach of utilizing immunotherapy alone in men. Despite the observed sex differences in response to treatments, women remain underrepresented in oncology clinical trials, largely as a result of gender-biased misconceptions. Such exclusion has resulted in the development of less efficacious treatment guidelines and clinical recommendations and has created a knowledge gap in regard to immunotherapy-related survivorship issues such as fertility. To develop a more precise approach to care and overcome the exclusion of women from clinical trials, flexible trial schedules, multilingual communication strategies, financial, and transportation assistance for participants should be adopted. The impact of intersectionality and other determinants of health that affect the diagnosis, treatment, and outcomes in women must also be considered in order to develop a comprehensive understanding of the unique impact of immunotherapy in all women with lung cancer.
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Affiliation(s)
- Jennifer Marks
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA;
| | | | - Angela Ai
- Olive View-UCLA Medical Center, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Lauren Kiel
- Dana-Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (R.K.); (O.A.); (C.M.)
| | - Rebekah Kaufman
- Dana-Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (R.K.); (O.A.); (C.M.)
| | - Oyepeju Abioye
- Dana-Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (R.K.); (O.A.); (C.M.)
| | - Courtney Mantz
- Dana-Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (R.K.); (O.A.); (C.M.)
| | - Narjust Florez
- Dana-Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (R.K.); (O.A.); (C.M.)
- Harvard Medical School, Boston, MA 02115, USA
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Sathian B, van Teijlingen E, Simkhada P, Kabir R, Al Hamad H. Editorial: Evidence-based approaches in aging and public health. Front Public Health 2024; 12:1391432. [PMID: 38638469 PMCID: PMC11025452 DOI: 10.3389/fpubh.2024.1391432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024] Open
Affiliation(s)
- Brijesh Sathian
- Geriatrics and Long Term Care Department, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Edwin van Teijlingen
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Padam Simkhada
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Russell Kabir
- School of Allied Health, Anglia Ruskin University, Essex, United Kingdom
| | - Hanadi Al Hamad
- Geriatrics and Long Term Care Department, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
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Rook GAW. Evolution and the critical role of the microbiota in the reduced mental and physical health associated with low socioeconomic status (SES). Neurosci Biobehav Rev 2024; 161:105653. [PMID: 38582194 DOI: 10.1016/j.neubiorev.2024.105653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/03/2024] [Indexed: 04/08/2024]
Abstract
The evolution of the gut-microbiota-brain axis in animals reveals that microbial inputs influence metabolism, the regulation of inflammation and the development of organs, including the brain. Inflammatory, neurodegenerative and psychiatric disorders are more prevalent in people of low socioeconomic status (SES). Many aspects of low SES reduce exposure to the microbial inputs on which we are in a state of evolved dependence, whereas the lifestyle of wealthy citizens maintains these exposures. This partially explains the health deficit of low SES, so focussing on our evolutionary history and on environmental and lifestyle factors that distort microbial exposures might help to mitigate that deficit. But the human microbiota is complex and we have poor understanding of its functions at the microbial and mechanistic levels, and in the brain. Perhaps its composition is more flexible than the microbiota of animals that have restricted habitats and less diverse diets? These uncertainties are discussed in relation to the encouraging but frustrating results of attempts to treat psychiatric disorders by modulating the microbiota.
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Affiliation(s)
- Graham A W Rook
- Centre for Clinical Microbiology, Department of infection, UCL (University College London), London, UK.
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Huang H, Jia S, Wang X, Miao H, Fang H, He H, Wu D, Tang Y, Li N. Quantitative evaluation of the impact of relaxing eligibility criteria on the risk-benefit profile of drugs for lung cancer based on real-world data. Thorac Cancer 2024. [PMID: 38576119 DOI: 10.1111/1759-7714.15269] [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: 02/04/2024] [Accepted: 02/12/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Restrictive eligibility criteria in cancer drug trials result in low enrollment rates and limited population diversity. Relaxed eligibility criteria (REC) based on solid evidence is becoming necessary for stakeholders worldwide. However, the absence of high-quality, favorable evidence remains a major challenge. This study presents a protocol to quantitatively evaluate the impact of relaxing eligibility criteria in common non-small cell lung cancer (NSCLC) protocols in China, on the risk-benefit profile. This involves a detailed explanation of the rationale, framework, and design of REC. METHODS To evaluate our REC in NSCLC drug trials, we will first construct a structured, cross-dimensional real-world NSCLC database using deep learning methods. We will then establish randomized virtual cohorts and perform benefit-risk assessment using Monte Carlo simulation and propensity matching. Shapley value will be utilized to quantitatively measure the effect of the change of each eligibility criterion on patient volume, clinical efficacy and safety. DISCUSSION This study is one of the few that focuses on the problem of overly stringent eligibility criteria cancer drug clinical trials, providing quantitative evaluation of the effect of relaxing each NSCLC eligibility criterion. This study will not only provide scientific evidence for the rational design of population inclusion in lung cancer clinical trials, but also establish a data governance system, as well as a REC evaluation framework that can be generalized to other cancer studies.
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Affiliation(s)
- Huiyao Huang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuopeng Jia
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Wang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huilei Miao
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Fang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hanqing He
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dawei Wu
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Tang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Themistocleous S, Argyropoulos CD, Vogazianos P, Shiamakkides G, Noula E, Nearchou A, Yiallouris A, Filippou C, Stewart FA, Koniordou M, Kopsidas I, Askling HH, Vene S, Gagneux-Brunon A, Prellezo JB, Álvarez-Barco E, Salmanton-García J, Leckler J, Macken AJ, Davis RJ, Azzini AM, Armeftis C, Hellemans M, Di Marzo R, Luis C, Olesen OF, Valdenmaiier O, Jakobsen SF, Nauclér P, Launay O, Mallon P, Ochando J, van Damme P, Tacconelli E, Zaoutis T, Cornely OA, Pana ZD. Perspectives of European Patient Advocacy Groups on Volunteer Registries and Vaccine Trials: VACCELERATE Survey Study. JMIR Public Health Surveill 2024; 10:e47241. [PMID: 38573762 PMCID: PMC10996911 DOI: 10.2196/47241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/31/2023] [Accepted: 01/20/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND The VACCELERATE Pan-European Scientific network aims to strengthen the foundation of vaccine trial research across Europe by following the principles of equity, inclusion, and diversity. The VACCELERATE Volunteer Registry network provides access to vaccine trial sites across the European region and supports a sustainable volunteer platform for identifying potential participants for forthcoming vaccine clinical research. OBJECTIVE The aim of this study was to approach members of patient advocacy groups (PAGs) across Europe to assess their willingness to register for the VACCELERATE Volunteer Registry and their perspectives related to participating in vaccine trials. METHODS In an effort to understand how to increase recruitment for the VACCELERATE Volunteer Registry, a standardized survey was developed in English and translated into 8 different languages (Dutch, English, French, German, Greek, Italian, Spanish, and Swedish) by the respective National Coordinator team. The online, anonymous survey was circulated, from March 2022 to May 2022, to PAGs across 10 European countries (Belgium, Cyprus, Denmark, France, Germany, Greece, Ireland, Italy, Spain, and Sweden) to share with their members. The questionnaire constituted of multiple choice and open-ended questions evaluating information regarding participants' perceptions on participating in vaccine trials and their willingness to become involved in the VACCELERATE Volunteer Registry. RESULTS In total, 520 responses were collected and analyzed. The PAG members reported that the principal criteria influencing their decision to participate in clinical trials overall are (1) the risks involved, (2) the benefits that will be gained from their potential participation, and (3) the quality and quantity of information provided regarding the trial. The survey revealed that, out of the 520 respondents, 133 individuals across all age groups were "positive" toward registering in the VACCELERATE Volunteer Registry, with an additional 47 individuals reporting being "very positive." Respondents from Northern European countries were 1.725 (95% CI 1.206-2.468) times more likely to be willing to participate in the VACCELERATE Volunteer Registry than respondents from Southern European countries. CONCLUSIONS Factors discouraging participants from joining vaccine trial registries or clinical trials primarily include concerns of the safety of novel vaccines and a lack of trust in those involved in vaccine development. These outcomes aid in identifying issues and setbacks in present registries, providing the VACCELERATE network with feedback on how to potentially increase participation and enrollment in trials across Europe. Development of European health communication strategies among diverse public communities, especially via PAGs, is the key for increasing patients' willingness to participate in clinical studies.
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Affiliation(s)
| | | | - Paris Vogazianos
- Department of Behavioural and Social Sciences, School of Humanities, Social and Education Sciences, European University Cyprus, Nicosia, Cyprus
| | | | - Evgenia Noula
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Andria Nearchou
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | | | | | - Fiona A Stewart
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Markela Koniordou
- Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | - Ioannis Kopsidas
- Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | - Helena H Askling
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sirkka Vene
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Amandine Gagneux-Brunon
- Centre d'investigation clinique-INSERM 1408, University Hospital of Saint-Etienne, Saint-Etienne, France
- Groupe Immunité Muqueuse et Agents Pathogènes (GIMAP), EA3064 - Medical School of Saint-Etienne, University of Lyon, Saint-Etienne, France
| | - Jana Baranda Prellezo
- Microbiology Section, Department of Pharmaceutical Sciences and of Health, Faculty of Pharmacy, Universidad San Pablo-Centro de Estudios Universitarios (CEU), Madrid, Spain
| | - Elena Álvarez-Barco
- Centre for Experimental Pathogen Host Research, University College Dublin School of Medicine, National University of Ireland, Dublin, Ireland
| | - Jon Salmanton-García
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Janina Leckler
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Alan J Macken
- Centre for Experimental Pathogen Host Research, University College Dublin School of Medicine, National University of Ireland, Dublin, Ireland
| | - Ruth Joanna Davis
- Department of Diagnostic and Public Health, Infectious Diseases, University of Verona, Verona, Italy
| | - Anna Maria Azzini
- Department of Diagnostic and Public Health, Infectious Diseases, University of Verona, Verona, Italy
| | - Charis Armeftis
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Margot Hellemans
- Vaccine & Infectious Disease Institute - VAXINFECTIO, Centre of Evaluation of Vaccination,, Faculty of Medicine and Health Science, Universiteit Antwerpen, Antwerp, Belgium
| | | | - Catarina Luis
- European Vaccine Initiative (EVI), Heidelberg, Germany
| | - Ole F Olesen
- European Vaccine Initiative (EVI), Heidelberg, Germany
| | - Olena Valdenmaiier
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Stine Finne Jakobsen
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Pontus Nauclér
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Odile Launay
- Inserm CIC 1417, I-REIVAC, University Hospital of Cochin-Broca-Hôtel-Dieu, University of Paris-Descartes, Paris, France
| | - Patrick Mallon
- Centre for Experimental Pathogen Host Research, University College Dublin School of Medicine, National University of Ireland, Dublin, Ireland
| | - Jordi Ochando
- Microbiology Section, Department of Pharmaceutical Sciences and of Health, Faculty of Pharmacy, Universidad San Pablo-Centro de Estudios Universitarios (CEU), Madrid, Spain
| | - Pierre van Damme
- Vaccine & Infectious Disease Institute - VAXINFECTIO, Centre of Evaluation of Vaccination,, Faculty of Medicine and Health Science, Universiteit Antwerpen, Antwerp, Belgium
| | - Evelina Tacconelli
- Department of Diagnostic and Public Health, Infectious Diseases, University of Verona, Verona, Italy
| | - Theoklis Zaoutis
- Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | - Oliver A Cornely
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Faculty of Medicine, and University Hospital Cologne, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
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Milrod CJ, Kim KW, Raker C, Ollila TA, Olszewski AJ, Pelcovits A. Progression-free survival is a weakly predictive surrogate end-point for overall survival in follicular lymphoma: A systematic review and meta-analysis. Br J Haematol 2024. [PMID: 38571449 DOI: 10.1111/bjh.19449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
Although progression-free survival (PFS) is a commonly used surrogate end-point for clinical trials of follicular lymphoma (FL), no analyses have evaluated the strength of surrogacy for PFS with overall survival (OS). A systematic review was performed and 20 studies (total participants, 10 724) met final inclusion criteria. PFS was weakly associated with OS (correlation coefficient; 0.383, p < 0.001). The coefficient of determination was 0.15 (95% CI: 0.002-0.35) suggesting 15% of OS variance could be explained by changes in PFS. This challenges the role for PFS as a surrogate end-point for clinical trials and drug approvals.
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Affiliation(s)
- Charles J Milrod
- Department of Hematology/Oncology, Brown University, Providence, Rhode Island, USA
| | - Kang Woo Kim
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Christina Raker
- Lifespan Biostatistics, Epidemiology, Research Design, and Informatics, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Thomas A Ollila
- Department of Hematology/Oncology, Brown University, Providence, Rhode Island, USA
| | - Adam J Olszewski
- Department of Hematology/Oncology, Brown University, Providence, Rhode Island, USA
| | - Ari Pelcovits
- Department of Hematology/Oncology, Brown University, Providence, Rhode Island, USA
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Stahl F, Evert BO, Han X, Breuer P, Wüllner U. Spinocerebellar Ataxia Type 3 Pathophysiology-Implications for Translational Research and Clinical Studies. Int J Mol Sci 2024; 25:3984. [PMID: 38612794 PMCID: PMC11012515 DOI: 10.3390/ijms25073984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
The spinocerebellar ataxias (SCA) comprise a group of inherited neurodegenerative diseases. Machado-Joseph Disease (MJD) or spinocerebellar ataxia 3 (SCA3) is the most common autosomal dominant form, caused by the expansion of CAG repeats within the ataxin-3 (ATXN3) gene. This mutation results in the expression of an abnormal protein containing long polyglutamine (polyQ) stretches that confers a toxic gain of function and leads to misfolding and aggregation of ATXN3 in neurons. As a result of the neurodegenerative process, SCA3 patients are severely disabled and die prematurely. Several screening approaches, e.g., druggable genome-wide and drug library screenings have been performed, focussing on the reduction in stably overexpressed ATXN3(polyQ) protein and improvement in the resultant toxicity. Transgenic overexpression models of toxic ATXN3, however, missed potential modulators of endogenous ATXN3 regulation. In another approach to identify modifiers of endogenous ATXN3 expression using a CRISPR/Cas9-modified SK-N-SH wild-type cell line with a GFP-T2A-luciferase (LUC) cassette under the control of the endogenous ATXN3 promotor, four statins were identified as potential activators of expression. We here provide an overview of the high throughput screening approaches yet performed to find compounds or genomic modifiers of ATXN3(polyQ) toxicity in different SCA3 model organisms and cell lines to ameliorate and halt SCA3 progression in patients. Furthermore, the putative role of cholesterol in neurodegenerative diseases (NDDs) in general and SCA3 in particular is discussed.
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Affiliation(s)
- Fabian Stahl
- German Centre for Neurodegenerative Disease (DZNE), 53127 Bonn, Germany;
| | - Bernd O. Evert
- Departments of Neurology and Neurodegenerative Diseases, University of Bonn, 53127 Bonn, Germany; (B.O.E.); (X.H.); (P.B.)
| | - Xinyu Han
- Departments of Neurology and Neurodegenerative Diseases, University of Bonn, 53127 Bonn, Germany; (B.O.E.); (X.H.); (P.B.)
| | - Peter Breuer
- Departments of Neurology and Neurodegenerative Diseases, University of Bonn, 53127 Bonn, Germany; (B.O.E.); (X.H.); (P.B.)
| | - Ullrich Wüllner
- German Centre for Neurodegenerative Disease (DZNE), 53127 Bonn, Germany;
- Departments of Neurology and Neurodegenerative Diseases, University of Bonn, 53127 Bonn, Germany; (B.O.E.); (X.H.); (P.B.)
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Gouda P, Rathwell S, Colin-Ramirez E, Felker GM, Ross H, Escobedo J, Macdonald P, Troughton RW, O'Connor CM, Ezekowitz JA. Utilizing Quality of Life Adjusted Days Alive and Out of Hospital in Heart Failure Clinical Trials. Circ Cardiovasc Qual Outcomes 2024:e010560. [PMID: 38567506 DOI: 10.1161/circoutcomes.123.010560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/15/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND In heart failure (HF) trials, there has been an emphasis on utilizing more patient-centered outcomes, including quality of life (QoL) and days alive and out of hospital. We aimed to explore the impact of QoL adjusted days alive and out of hospital as an outcome in 2 HF clinical trials. METHODS Using data from 2 trials in HF (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure [GUIDE-IT] and Study of Dietary Intervention under 100 mmol in Heart Failure [SODIUM-HF]), we determined treatment differences using percentage days alive and out of hospital (%DAOH) adjusted for QoL at 18 months as the primary outcome. For each participant, %DAOH was calculated as a ratio between days alive and out of hospital/total follow-up. Using a regression model, %DAOH was subsequently adjusted for QoL measured by the Kansas City Cardiomyopathy Questionnaire Overall Summary Score. RESULTS In the GUIDE-IT trial, 847 participants had a median baseline Kansas City Cardiomyopathy Questionnaire Overall Summary Score of 59.0 (interquartile range, 40.8-74.3), which did not change over 18 months. %DAOH was 90.76%±22.09% in the biomarker-guided arm and 88.56%±25.27% in the usual care arm. No significant difference in QoL adjusted %DAOH was observed (1.09% [95% CI, -1.57% to 3.97%]). In the SODIUM-HF trial, 796 participants had a median baseline Kansas City Cardiomyopathy Questionnaire Overall Summary Score of 69.8 (interquartile range, 49.3-84.3), which did not change over 18 months. %DAOH was 95.69%±16.31% in the low-sodium arm and 95.95%±14.76% in the usual care arm. No significant difference was observed (1.91% [95% CI, -0.85% to 4.77%]). CONCLUSIONS In 2 large HF clinical trials, adjusting %DAOH for QoL was feasible and may provide complementary information on treatment effects in clinical trials.
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Affiliation(s)
- Pishoy Gouda
- University of Alberta, Edmonton, Canada (P.G., J.A.E.)
| | - Sarah Rathwell
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (S.R., J.A.E.)
| | - Eloisa Colin-Ramirez
- Universidad Anáhuac México, Huixquilucan, Estado de México, Naucalpan, Mexico (E.C.-R.)
| | | | | | - Jorge Escobedo
- Instituto Mexicano del Seguro Social, Mexico City, Mexico (J.E.)
| | - Peter Macdonald
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.)
| | - Richard W Troughton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (R.W.T.)
| | - Christopher M O'Connor
- Duke Clinical Research Institute, Durham, NC (G.M.F., C.M.O.)
- Inova Heart and Vascular Center, Falls Church, VA (C.M.O.)
| | - Justin A Ezekowitz
- University of Alberta, Edmonton, Canada (P.G., J.A.E.)
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (S.R., J.A.E.)
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Li J, An J, Huang M, Zhou M, Montez-Rath ME, Niu F, Sim JJ, Pao AC, Charu V, Odden MC, Kurella Tamura M. Representation of Real-World Adults With Chronic Kidney Disease in Clinical Trials Supporting Blood Pressure Treatment Targets. J Am Heart Assoc 2024; 13:e031742. [PMID: 38533947 DOI: 10.1161/jaha.123.031742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/13/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Little is known about how well trial participants with chronic kidney disease (CKD) represent real-world adults with CKD. We assessed the population representativeness of clinical trials supporting the 2021 Kidney Disease: Improving Global Outcomes blood pressure (BP) guidelines in real-world adults with CKD. METHODS AND RESULTS Using a cross-sectional analysis, we identified patients with CKD who met the guideline definition of hypertension based on use of antihypertensive medications or sustained systolic BP ≥120 mm Hg in 2019 in the Veterans Affairs and Kaiser Permanente of Southern California. We applied the eligibility criteria from 3 BP target trials, SPRINT (Systolic Pressure Intervention Trial), ACCORD (Action to Control Cardiovascular Risk in Diabetes), and AASK (African American Study of Kidney Disease), to estimate the proportion of adults with a systolic BP above the guideline-recommended target and the proportion who met eligibility criteria for ≥1 trial. We identified 503 480 adults in the Veterans Affairs and 73 412 adults in Kaiser Permanente of Southern California with CKD and hypertension in 2019. We estimated 79.7% in the Veterans Affairs and 87.3% in the Kaiser Permanente of Southern California populations had a systolic BP ≥120 mm Hg; only 23.8% [23.7%-24.0%] in the Veterans Affairs and 20.8% [20.5%-21.1%] in Kaiser Permanente of Southern California were trial-eligible. Among trial-ineligible patients, >50% met >1 exclusion criteria. CONCLUSIONS Major BP target trials were representative of fewer than 1 in 4 real-world adults with CKD and hypertension. A large proportion of adults who are at risk for cardiovascular morbidity from hypertension and susceptible to adverse treatment effects lack relevant treatment information.
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Affiliation(s)
- June Li
- Department of Epidemiology and Population Health Stanford University School of Medicine Stanford CA USA
- Geriatric Research and Education Clinical Center VA Palo Alto Health Care Systems Palo Alto CA USA
| | - Jaejin An
- Research and Evaluation Kaiser Permanente Southern California Pasadena CA USA
- Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena CA USA
| | - Mengjiao Huang
- Geriatric Research and Education Clinical Center VA Palo Alto Health Care Systems Palo Alto CA USA
| | - Mengnan Zhou
- Research and Evaluation Kaiser Permanente Southern California Pasadena CA USA
| | - Maria E Montez-Rath
- Division of Nephrology, Department of Medicine Stanford University School of Medicine Stanford CA USA
| | - Fang Niu
- Kaiser Permanente National Pharmacy Downey CA USA
| | - John J Sim
- Research and Evaluation Kaiser Permanente Southern California Pasadena CA USA
- Division of Nephrology and Hypertension Kaiser Permanente Los Angeles Medical Center Los Angeles CA USA
| | - Alan C Pao
- Division of Nephrology, Department of Medicine Stanford University School of Medicine Stanford CA USA
- VA Palo Alto Health Care Systems Palo Alto CA USA
| | - Vivek Charu
- Quantitative Sciences Unit, Department of Medicine Stanford University School of Medicine Stanford CA USA
- Department of Pathology Stanford University School of Medicine Stanford CA USA
| | - Michelle C Odden
- Department of Epidemiology and Population Health Stanford University School of Medicine Stanford CA USA
- Geriatric Research and Education Clinical Center VA Palo Alto Health Care Systems Palo Alto CA USA
| | - Manjula Kurella Tamura
- Geriatric Research and Education Clinical Center VA Palo Alto Health Care Systems Palo Alto CA USA
- Division of Nephrology, Department of Medicine Stanford University School of Medicine Stanford CA USA
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Rucker JJ. Evidence versus expectancy: the development of psilocybin therapy. BJPsych Bull 2024; 48:110-117. [PMID: 37246405 PMCID: PMC10985726 DOI: 10.1192/bjb.2023.28] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/07/2023] [Accepted: 04/02/2023] [Indexed: 05/30/2023] Open
Abstract
SUMMARY Although the development of psilocybin therapy has come as a surprise to many, modern research with the drug has been ongoing for 25 years. Psilocybin therapy is composed of psilocybin dosing sessions embedded within a wider process of psychoeducation, psychological support and integration. Early phase clinical trial evidence is promising, particularly for treatment-resistant depression. However, masking probably fails and expectancy effects may be a part of the mechanism of change. Disambiguating between drug and expectancy effects is a necessary part of the development process, yet this is difficult if masking fails. Hitherto, masking and expectancy have not been routinely measured in psilocybin or other medication trials. Doing so represents an opportunity for research and may influence psychiatry more widely. In this opinion piece I summarise the clinical development process of psilocybin therapy thus far, discussing the hope, the hype, the challenges and the opportunities along the way.
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Affiliation(s)
- James J. Rucker
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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47
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Terman SW, Kirkpatrick L, Kerr WT, Akiyama LF, Baajour W, Atilgan D, Dorotan MKC, Choi HW, French JA. Challenges and directions in epilepsy diagnostics and therapeutics: Proceedings of the 17th Epilepsy Therapies and Diagnostics Development conference. Epilepsia 2024; 65:846-860. [PMID: 38135921 PMCID: PMC11018495 DOI: 10.1111/epi.17875] [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: 11/10/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/24/2023]
Abstract
Substantial efforts are underway toward optimizing the diagnosis, monitoring, and treatment of seizures and epilepsy. We describe preclinical programs in place for screening investigational therapeutic candidates in animal models, with particular attention to identifying and eliminating drugs that might paradoxically aggravate seizure burden. After preclinical development, we discuss challenges and solutions in the design and regulatory logistics of clinical trial execution, and efforts to develop disease biomarkers and interventions that may be not only seizure-suppressing, but also disease-modifying. As disease-modifying treatments are designed, there is clear recognition that, although seizures represent one critical therapeutic target, targeting nonseizure outcomes like cognitive development or functional outcomes requires changes to traditional designs. This reflects our increasing understanding that epilepsy is a disease with profound impact on quality of life for the patient and caregivers due to both seizures themselves and other nonseizure factors. This review examines selected key challenges and future directions in epilepsy diagnostics and therapeutics, from drug discovery to translational application.
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Affiliation(s)
- Samuel W Terman
- University of Michigan Department of Neurology, Ann Arbor, MI 48109, USA
| | - Laura Kirkpatrick
- University of Pittsburgh Department of Neurology, Pittsburgh, PA 15213, USA
- University of Pittsburgh Department of Pediatrics, Pittsburgh, PA 15213, USA
| | - Wesley T Kerr
- University of Michigan Department of Neurology, Ann Arbor, MI 48109, USA
- University of Pittsburgh Department of Neurology, Pittsburgh, PA 15213, USA
- University of Pittsburgh Department of Biomedical Informatics, Pittsburgh, PA 15213, USA
| | - Lisa F Akiyama
- University of Washington Department of Neurology, Seattle, WA 98105, USA
| | - Wadih Baajour
- University of Texas Health Science Center at Houston, Department of Neurology, Houston, TX 77030, USA
| | - Deniz Atilgan
- University of Texas Health Science Center at Houston, Department of Neurology, Houston, TX 77030, USA
| | | | - Hyoung Won Choi
- Emory University Department of Pediatrics, Division of Neurology, Atlanta, GA 30322
| | - Jacqueline A French
- NYU Grossman School of Medicine and NYU Langone Health, New York, NY 10016, USA
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Williams CP, Deng L, Caston NE, Gallagher K, Angove R, Pisu M, Azuero A, Arend R, Rocque GB. Understanding the financial cost of cancer clinical trial participation. Cancer Med 2024; 13:e7185. [PMID: 38629264 PMCID: PMC11022148 DOI: 10.1002/cam4.7185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/14/2024] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Though financial hardship is a well-documented adverse effect of standard-of-care cancer treatment, little is known about out-of-pocket costs and their impact on patients participating in cancer clinical trials. This study explored the financial effects of cancer clinical trial participation. METHODS This cross-sectional analysis used survey data collected in December 2022 and May 2023 from individuals with cancer previously served by Patient Advocate Foundation, a nonprofit organization providing social needs navigation and financial assistance to US adults with a chronic illness. Surveys included questions on cancer clinical trial participation, trial-related financial hardship, and sociodemographic data. Descriptive and bivariate analyses were conducted using Cramer's V to estimate the in-sample magnitude of association. Associations between trial-related financial hardship and sociodemographics were estimated using adjusted relative risks (aRR) and corresponding 95% confidence intervals (CI) from modified Poisson regression models with robust standard errors. RESULTS Of 650 survey respondents, 18% (N = 118) reported ever participating in a cancer clinical trial. Of those, 47% (n = 55) reported financial hardship as a result of their trial participation. Respondents reporting trial-related financial hardship were more often unemployed or disabled (58% vs. 43%; V = 0.15), Medicare enrolled (53% vs. 40%; V = 0.15), and traveled >1 h to their cancer provider (45% vs. 17%; V = 0.33) compared to respondents reporting no hardship. Respondents who experienced trial-related financial hardship most often reported expenses from travel (reported by 71% of respondents), medical bills (58%), dining out (40%), or housing needs (40%). Modeling results indicated that respondents traveling >1 h vs. ≤30 min to their cancer provider had a 2.2× higher risk of financial hardship, even after adjusting for respondent race, income, employment, and insurance status (aRR = 2.2, 95% CI 1.3-3.8). Most respondents (53%) reported needing $200-$1000 per month to compensate for trial-related expenses. Over half (51%) of respondents reported less willingness to participate in future clinical trials due to incurred financial hardship. Notably, of patients who did not participate in a cancer clinical trial (n = 532), 13% declined participation due to cost. CONCLUSION Cancer clinical trial-related financial hardship, most often stemming from travel expenses, affected almost half of trial-enrolled patients. Interventions are needed to reduce adverse financial participation effects and potentially improve cancer clinical trial participation.
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Affiliation(s)
| | - Luqin Deng
- University of Alabama at BirminghamBirminghamAlabamaUSA
| | | | | | | | - Maria Pisu
- University of Alabama at BirminghamBirminghamAlabamaUSA
| | - Andres Azuero
- University of Alabama at BirminghamBirminghamAlabamaUSA
| | - Rebecca Arend
- University of Alabama at BirminghamBirminghamAlabamaUSA
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Ritchie M, Salazar CR, Gillen DL, Grill JD. Post-disclosure distress among racial and ethnic groups in a preclinical AD trial. Alzheimers Dement 2024; 20:2508-2515. [PMID: 38329007 PMCID: PMC11032552 DOI: 10.1002/alz.13726] [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: 09/01/2023] [Revised: 12/13/2023] [Accepted: 01/06/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Trialists need a thorough understanding of whether reactions to Alzheimer's disease (AD) biomarker information differ among racial and ethnic groups in preclinical AD trials. METHODS We used data from the Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease Study to analyze cognitively unimpaired participants' responses on the Impact of Event Scale (IES) 24 to 72 hours after amyloid disclosure. We fit a linear regression model to test whether mean IES scores differed among participants from specific racial and ethnic groups. We considered potential effect modification by amyloid status. RESULTS Reactions to disclosure did not significantly differ among participant groups based on self-reported race and ethnicity. Although the results were not significant when stratified by amyloid status, all racial and ethnic groups except for participants self-reporting Hispanic/Latino ethnicity were observed to have higher mean IES in the elevated amyloid group. DISCUSSION These results support continued use of current disclosure methods in preclinical AD trials.
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Affiliation(s)
- Marina Ritchie
- UC Irvine Institute for Memory Impairments and Neurological DisordersUniversity of California, IrvineIrvineCaliforniaUSA
- Department of Neurobiology and BehaviorUniversity of California, IrvineIrvineCaliforniaUSA
| | - Christian R. Salazar
- UC Irvine Institute for Memory Impairments and Neurological DisordersUniversity of California, IrvineIrvineCaliforniaUSA
| | - Daniel L. Gillen
- UC Irvine Institute for Memory Impairments and Neurological DisordersUniversity of California, IrvineIrvineCaliforniaUSA
- Department of StatisticsUniversity of California, IrvineIrvineCaliforniaUSA
| | - Joshua D. Grill
- UC Irvine Institute for Memory Impairments and Neurological DisordersUniversity of California, IrvineIrvineCaliforniaUSA
- Department of Neurobiology and BehaviorUniversity of California, IrvineIrvineCaliforniaUSA
- Department of Psychiatry and Human BehaviorUniversity of California, IrvineIrvineCaliforniaUSA
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50
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Daly T, Herrup K, Espay AJ. An Ethical Argument for Ending Human Trials of Amyloid-Lowering Therapies in Alzheimer's Disease. AJOB Neurosci 2024; 15:80-81. [PMID: 36197130 DOI: 10.1080/21507740.2022.2129858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
Given the past two decades of over 40 failed trials of amyloid-lowering therapies in Alzheimer's Disease (AD), many of which succeeded in lowering amyloid as designed, we present an ethical argument for emptying the drug pipeline of tests of amyloid-lowering agents so as to end the historical dominance of the amyloid-reducing therapeutic approach in AD.
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